Identifying signs of dementia in those you care for

Written on the 4 July 2022 by Dr Kailas Roberts

How can you tell when someone's forgetfulness is more than just the product of getting older? After all, age is associated with "normal" changes when it comes to memory and other thinking skills, and these don't necessarily mean anything serious is going on.  Brain scans go some way to explaining why our brain loses its efficiency even in the absence of disease: the hippocampi, for instance, which are two seahorse-shaped structures critical for encoding new memories, tend to shrink as the years' pass, and there are changes in blood supply that mean our brains are not fed oxygen and fuel as well.

In normal ageing, we expect to see some deterioration in the ability to remember things - especially the specifics - but healthy older adults should be able to remember the broader details of things. As an example, forgetting the names of people they have recently met at a social gathering is not itself a cause for concern, but forgetting that they've even attended the gathering is.

The other thing to consider is the frequency of the problems - is the forgetfulness just occasional or is it all the time? Is it getting a lot worse? In the normal process of ageing, forgetting things should be the exception rather than the rule. If it is happening frequently, it needs further assessment, and if it seems to be getting worse over time, this again suggests the need to seek a medical evaluation.

Normal ageing is also often associated with a slowing of brain processes - meaning that it takes longer to bring information to mind. This might lead to 'tip of the tongue' moments and problems finding the right word. Given time though, the answer usually comes though - unfortunately often only after the relevance of it has passed!

A COMPLETE LACK OF ABILITY TO REMEMBER SOMETHING DESPITE BEING GIVEN CLUES OR REMINDERS CAN BE A RED FLAG THAT SOMETHING IS AMISS.

There are also other changes that shouldn't happen just because of advancing age. We don't expect any major change in the ability to speak or write, or the ability to recognise whether objects are in the environment around you - so-called visuospatial skills - should remain intact. Difficulty handling and using familiar objects may signify a problem.

Although it is not commonly known, dementia may involve thinking skills other than memory, at least initially. This means that even if someone remembers well if there are changes in language, recognition, visuospatial skills or even behaviour, this could still be dementia at play.

Another important thing to recognise is how much effect the changes in memory and thinking have on people day-to-day. Can they generally get by despite being a little forgetful? Maybe they use more lists or rely more on calendars or diaries?

Functional impairment is a key part of dementia, and its absence means we cannot definitively make a diagnosis. When someone stops being able to perform their usual daily activities because of impaired thinking, then that's a reason to become concerned. Often, more complex tasks are compromised first. Things like cooking, which requires planning, timing, and sequencing, maybe the first noticeable issue, as might managing finances.

It is also important to recognise when there might be some other cause of cognitive problems. Individuals can appear very confused and as if they have dementia because of certain medications, for instance. A clue to this is a link in time between starting a new medication and the thinking problems developing. Likewise, physical problems such as thyroid changes and sleep apnoea can cause cognitive impairment. An abrupt change in cognition is not especially suggestive of dementia alone and should result in an assessment by their treating doctor.

*As published in Inside Aging