10 Early Warning Signs of Dementia & How to Spot Them

The term “dementia” is a very broad one and, as you’ll see, there are many different kinds of dementia.  Dementia tends to start after the age of 65 years but can develop earlier than that in some cases.

Regardless of the type of dementia you have, there are several features that are similar across all of the different types and there are specific early warning signs that help to determine if you have early dementia versus simply having some of the normal signs of the aging process.

Dementia affects three major areas of the sufferer’s life.  The first is language, with difficulties in finding words, expressing thoughts, and understanding new things.  The second is memory, with difficulty remembering simple things, such as where an object is located, the names of people you know, and basic facts about your past life. The third is decision-making, meaning that judgment and personality can be so impaired that decisions about how to do a complex task or even what to do next become difficult. Ultimately, these things ultimately block the ability to perform the basic activities of daily living.

Many older people wonder if what they’re experiencing as they age is normal or if it represents a sign of dementia and this can be worrying or frightening.  Fortunately, just because you forgot a phone number or forgot where you left your keys, it doesn’t mean you have dementia.  In fact, there are 10 major early warning signs of dementia that can help you decide if you or a loved one might be suffering from some type of dementia.

Here are the 10 signs you need to think about before you begin to worry about having one of these worrisome diseases. We will also talk about how the normal aging process differs from dementia:

1. Memory loss

Memory loss can be one of the first signs of dementia and can be the most frustrating for some. The memory loss seen most commonly is of those things that have been recently learned. This means not remembering the names of people you meet, not being able to memorize phone numbers, and forgetting where you leave things. You may forget an appointment to visit the doctor or even the birthdates of your grandchildren.  You may find yourself writing down more things you would otherwise be able to memorize or rely on others to remember things for you.

The memories you have of your past life tends to be preserved in early dementia so you will remember your childhood memories without difficulty. You will also remember the names and faces of people you love and care about. You will not have too much difficulty finding your way around familiar places under familiar circumstances unless the dementia is more advanced.

The type of memory changes you can expect with aging will be different if you do not have dementia.  Everyone forgets where they left their cell phone or keys and everyone forgets people’s names and certain appointments.  When it comes to forgetting appointments, if this is just a part of the aging process, you will remember later that you forgot the time or will remember that you forgot something you should not have forgotten.

2. Problem-solving and planning difficulties

Another early sign of dementia is difficulty in following a prescribed plan. If you cook, you might find yourself hopelessly mired in the recipe, forgetting ingredients or forgetting where you were in the making of the recipe.  Tasks that have more than a few steps will be harder to accomplish and you will have more difficulty planning which things you need to do in the task and even where to start solving a complex problem.

Driving may be difficult because you will have difficulty planning how to get from point A to point B. Paying bills can be hard because it can involve balancing a checkbook or planning what to pay and when. Concentrating on a challenging task can be even more difficult than it used to be.

This isn’t to say that some of the problems in planning cannot be a common part of the aging process. For example, everyone makes mistakes balancing their checkbook and anyone can forget an ingredient in a recipe. It’s when this becomes a recurrent thing interfering with your life that you should be more concerned.

3. Difficulty with task completion

Individuals with dementia will have a more difficult time getting everyday tasks completed. With dementia, you will be much slower in completing tasks and may drop them altogether. Things, like remembering the rules to a game you know how to play under normal circumstances or starting a project only to drop it halfway through, are more common occurrences in people who have dementia. Even driving to places you know how to get to under typical circumstances becomes a challenge because you might forget where you are on the road, even if you’ve done it many times before.

So, how does this differ from the normal aging process? People of any age might forget how to set the clock in their car when they only do it twice a year and may forget how to operate a complex piece of machinery.  Tasks that are particularly complex are easier to abandon so just because you decide to give up, it doesn’t mean you have dementia. In addition, everyone can get lost in their thoughts and miss a turn on the highway, even if the route is otherwise familiar.

4. Confusing the place and time

People who have dementia will gradually lose their sense of time. Dates become meaningless and they can even forget what season or month it is.  Because there is a loss of sense of time, there is more of an emphasis on the here and now and less of an emphasis on future planning.

This can extend to becoming lost and forgetting where they are, especially if they are in a place that is not familiar to them.  If you go to a relative’s or friend’s house and find yourself confused about where you are, how you got there, or how long you’ve been there, this could be an early warning sign of dementia. 

A person who is just dealing with the signs of aging can also get confused by what day of the week it is and what they have to do on any given day. This is normal and it usually involves being able to recognize that they have forgotten what day it is and figuring out what day it really is. There is not a true loss of the sense of time—just a matter of being occasionally forgetful and distracted enough to forget the time.

5. Difficulty with spatial relationships

 This involves difficulty understanding the relationship between two things seen visually. One of the tests for early dementia is to ask the person to draw a clockface. This sounds simple but is hard to do for the person with dementia. When you have problems with spatial relationships, it can be harder to read and harder to drive because judging distances and contrasts between colors is more difficult to do.

Some spatial relationship changes are normal and are a part of the aging process. If you have cataracts, for example, you might have difficulty reading in low light, have problems with glare when driving at night, and will have more trouble with telling the difference between colors that are similar to one another. This does not represent dementia and is only a vision problem.

 

6. Difficulty with speech and writing

 People who have dementia have difficulty expressing themselves when writing and speaking. They may have problems carrying on a normal conversation and may forget what they were saying in the middle of a sentence. Because of this, they don’t engage in conversation as much as they used to. Word-finding difficulties become more common so they shy away from saying as much as they would like. Naming simple objects becomes harder so they often call things by the wrong name. 

On the other hand, everyone—even young people—sometimes have difficulty finding the right word to say.  Usually this is occasional and doesn’t interrupt the flow of conversation. Writing is not typically impaired as one gets older, except that your handwriting can get worse. You will usually be able to express yourself in writing, especially when you have the time to think of the right word to say.

7. Losing the ability to trace one’s steps

This is part of the problem the dementia patient has with losing things. Not only can they not remember where they placed something, but they have also lost the ability to remember where they’ve recently been so they cannot retrace their steps so as to recover what has been lost. This can lead to confusion and to the mistaken belief that someone has taken their belongings.

If you are simply dealing with aging—and even if you’re not getting old—losing things is a normal part of life. Usually though, you can remember where you’ve been recently and can retrace your steps in order to find a lost object.  Again, it is a matter of not losing track of the passage of time so you can remember what you’ve recently been doing.

8. Problems with poor judgment

Because the person with dementia does not think ahead about the implications of doing something, they are particularly prone to doing things they would otherwise have thought twice about. They may be more impulsive and might give away large sums of money to a stranger or may make other bad decisions because they do not think about what will happen in the future regarding their decision and they cannot identify when an idea is a bad one.

If you are having normal signs of aging, you may make a bad decision every once in a while, especially when pressured by another person who doesn’t have your best interests at heart. You will generally later recognize that the decision was a bad one and will see the error you made. It is not a pattern of behavior that affects large portions of your life.

9. Social or interpersonal withdrawal

 The person with dementia tends to withdraw from many types of social interaction, even in the early stages of their disease. They may feel overwhelmed by larger social situations, such as parties or family gatherings, and may not want to talk socially with others on an interpersonal level. They may seem withdrawn and can start losing interest in favorite activities and hobbies.

Things that used to interest them no longer seem interesting and lively discussions with others become a thing of the past. Some of this might be due to the normal social withdrawal that happens when the person with dementia no longer gets anything from social interactions and feels embarrassed by their inability to be easily conversant with others.

If you are getting older and dealing with the normal aging process, on the other hand, you can simply be tired of certain social situations and large gatherings. Work and even leisure activities can become wearisome so you might not want to engage in them to the degree that you used to. This is not evidence of dementia.

10. Personality changes and mood disturbances

 Dementia doesn’t just affect the person’s thinking; it affects their personality and mood as well. Some types of dementia have mood changes as more obvious early signs of the disease process. The person with dementia may appear more depressed than is normal for them and the memory problems can lead to a sense of increased suspicion of others. The combination of poor memory and confusion can lead to being more upset over little things that can otherwise be explained.

The person who is simply dealing with aging may have periods of depression or depressed mood that comes from normal grieving and the changes that come with being older. In addition, the older person might be relatively set in their ways so that deviations from regular daily activities become more irritating. Again, these types of things do not represent evidence of dementia.

What is the Difference between Alzheimer’s Disease and Dementia?

When people think of dementia, many think of Alzheimer’s disease and think that these are one and the same. The truth is that Alzheimer’s disease or “Alzheimer’s dementia” is the most common type of dementia in the United States. It is not, however, the only kind of dementia and is not even the most common type of dementia in some parts of the world. There are many other kinds of dementia a person can have.

Alzheimer’s disease represents more than 60 percent of all dementia cases in the US.  It often starts with simple memory loss and personality changes; it gradually progresses over a period of several years so that the person with Alzheimer’s disease loses the ability to care for themselves and the ability to remember people (even those close to them).

They lose the nuances and vibrance in their personality. It is caused by damage to the “communicating abilities” between brain cells and ultimately leads to permanent injury and death to the cells of the brain.  Because brain cells do not regenerate, this is an irreversible and inevitably fatal disease.

The second most commonly seen type of dementia (and the most common type of dementia in parts of Asia) is vascular dementia.  This involves damage to the blood flow that normally nourishes brain cells.  Many people refer to this type of dementia as resulting from “mini-strokes”. The end result is a stepwise loss of brain function when each of these small strokes occurs, damaging smaller areas of the brain at a time.

The symptoms can otherwise be similar to Alzheimer’s disease, with prominent symptoms of confusion and lack of memory.  Concentration becomes difficult and there can be physical impairment as well, because the parts of the brain responsible for movement and other crucial functions are also affected.

There is a type of dementia called Lewy body dementia, which is caused by deposits of protein called “Lewy bodies” that build up within nervous system tissue. This results in a disruption in the chemical messaging system of the brain, leading to loss of memory, confusion, and disorientation. Lewy body dementia accounts for 20 to 25 percent of all dementia cases.

A common feature with this type of dementia is insomnia and daytime sleepiness, as well as visual hallucinations and disorientation.  Because some people with Alzheimer’s disease and some with Parkinson’s disease also have Lewy bodies in their brain, these diseases are often confused with one another and can coexist.

Individuals who have Parkinson’s disease normally have problems walking and commonly have a tremor. Later on in the disease process, however, they can develop dementia. Typical signs that dementia has set in as part of Parkinson’s disease include judgment difficulties and problems with reasoning. Visual hallucinations can be seen in this type of dementia, which can be both terrifying and confusing. Speech becomes more challenging and the other common signs of dementia, such as irritability, suspicion, and depression are seen as well.

Frontotemporal dementia or “Pick’s disease” is a type of dementia that affects the part of the brain that controls behavior and language abilities. It is seen in older individuals but can affect people who are as young as aged 45 years. One of the key features of this disorder is the loss of inhibition and a lack of motivation.  Personality changes are common as are language difficulties, leading to an inability to remember what certain words actually mean.

Creutzfeldt-Jakob disease or CJD is relatively rare but receives a great deal of attention because it is so rapidly progressive.  It is believed to be caused by a type of infectious agent that infects primarily the brain. Many of the symptoms are the same as other types of dementia; however, there are also physical symptoms, such as muscle stiffness and twitching. This type of dementia is so serious because most people who have the disease die within a year after it first presents itself.

Wernicke-Korsakoff disease or “Wernicke’s encephalopathy” is one of the few reversible types of dementia.  It is primarily caused by vitamin B1 or thiamine deficiency. It is more commonly seen in people who are alcoholics, in part because they do not eat a healthy diet.

Common early findings are double vision and poor coordination of the muscles. When it leads to dementia, things like memory, the acquisition of new skills, and information processing can be impaired. Confabulation or “making things up” is a typical feature of this disease as the person will have memory lapses that they try to make up for.

Normal pressure hydrocephalus is another potentially reversible type of dementia.  People with this disease have a buildup of fluid in the internal chambers of the brain that are supposed to cushion both the brain and the spinal cord.  The fluid collects and pushes on the normal brain structures, leading to brain injury and possible brain cell death.

The causes of this problem are several and include having had a fall, bleeding in the brain, a previous brain infection, brain tumors, or prior brain surgery. Besides the typical memory and behavior symptoms seen in other types of dementia, people with normal pressure hydrocephalus will have balance difficulties, a history of falling, and both bowel and bladder control problems.

Huntington’s disease is a genetic type of dementia that can occur in people as young as their teens, although it most commonly develops around 35 to 45 years of age. It used to be called “Huntington’s chorea” because it involves movement disturbances that doctors call “chorea”. People with this disease begin with tremor and walking problems that progress to having difficulty speaking and thinking problems, which are more typical signs and symptoms of dementia.

As many as 45 percent of individuals who have dementia will have a combination of problems in the brain that are causing their memory and thought problems.  These people have what can only be called “mixed dementia”.  It makes sense that this type of dementia is common because older individuals who have vascular dementia because of circulation difficulties will also have a risk of developing Alzheimer’s disease and vice versa. The features of memory loss, behavior difficulties, mood changes, and physical symptoms common to all types of dementia can be seen in mixed dementia.

How Early Can Dementia Start?

All types of dementia tend to be more common in individuals older than 65 years of age with the average age of onset being about 80 years of age. People can, however, develop dementia earlier than that—as young as 40 years of age.  Most people who have early-onset dementia have some type of hereditary reason for having the disease so early in life. Certainly, people who have dementia because of head injuries or infection can be younger than is normally seen in dementia.

If dementia—especially Alzheimer’s dementia—runs in your family from an early age, you need to consider being tested for early-onset Alzheimer’s disease.  Knowing if you have the genetic predisposition for this disease can lead to the treatment of symptoms with medication that can slow the progression of Alzheimer’s disease. In addition, there are many people with reversible dementia seen at an early age so getting a diagnosis, even when you are younger than 65 years of age, doesn’t mean you will have an irreversible progression of dementia symptoms.

How Quickly does Dementia Progress?

The natural course of nearly all types of dementia is that it will worsen over time.  Exactly how fast it worsens depends on the type of dementia a person has.  People with Creutzfeldt-Jakob disease have a rapid progression of their symptoms, with death occurring within a few months to a year after being diagnosed with the disease.  This is perhaps the worst-case scenario when it comes to having dementia.

Older people who have Alzheimer’s disease have a shortened survival rate compared to older people who do not have dementia. The survival rate can be as short as three years or as long as twenty years, depending on the person.  People who get on medication for Alzheimer’s disease early in their disease process will have a longer lifespan and a longer period of time with mild disease than those who do not have the opportunity to take medication.

Even so, there is no medication yet that will actually cure Alzheimer’s dementia. In addition, people who start their dementia healthier from the beginning will have better physical reserves and will live longer than people who are frail when they get the diagnosis.

People who have vascular dementia do not survive as long as people with Alzheimer’s dementia, with a survival rate of between 3 and 5 years.  Part of the problem is that the disease involves the same risk factors as having heart disease so the person with vascular dementia has a greater chance of having a heart attack or possibly a more severe stroke than the average person.

Is Dementia Inherited?

While it is impossible to say that a person will “get” Alzheimer’s disease from their mother or father, there does appear to be a genetic basis for having this disease, particularly in those who start having symptoms in their 40s and 50s.  There are two kinds of genes that seem to be prevalent in people who have Alzheimer’s disease:

• Risk-related genes. These are genes that increase the chance of developing dementia but do not guarantee that the person with the gene will get the disease. There are several of these genes that are directly related to Alzheimer’s disease.  These are the APOE-e4 gene, the APOE-e2 gene, and the APOE-e3 gene. The APOE genes are inherited from either one’s mother or one’s father.  If you get one copy of the APOE-e4 gene (the one most commonly linked to early-onset Alzheimer’s disease) from a parent, you will have an increased risk of having the disease yourself. If you have two copies of this gene, your chances of having Alzheimer’s disease are even greater.  It never represents a certainty, however, that you will get the disease.
• Deterministic genes. These are genes that, if inherited, guarantee that you will get the disease. There are several deterministic genes linked to Alzheimer’s disease but these are fortunately very rare.  Only a few hundred families in the world carry the risk of developing Alzheimer’s disease because of these types of genes.  People in these families have a very high risk of developing Alzheimer’s disease, usually between 45 and 55 years of age.

While the risk of having a genetic form of Alzheimer’s disease is extremely rare, knowledge of these genes has helped pave the way for researchers who are studying the disease and its underlying causes. Each of these genes has been found to be related to one of the steps in the biological development of Alzheimer’s disease.  If you know that Alzheimer’s disease is prevalent in your family, you might be a candidate for one of the ongoing research projects on how the disease develops and how it can be treated.

Besides the APOE-e4 gene, there are three other genes that seem to increase the risk of developing Alzheimer’s disease. These are the APP gene, which stands for “amyloid precursor protein”, first discovered in 1987, the presenilin-1 (PS-1) gene, first identified in 1992, and the presenilin-2 (PS-2) gene, first discovered in 1993. All of these are referred to as genetic mutations because they change the way the gene functions and all can be found in certain types of inherited Alzheimer’s disease.

So, should you be tested for Alzheimer’s disease? There are genetic tests out there, particularly for the APOE-e4 gene, and you can even be tested for the gene in some mass screening tests that are used to test large populations for certain genetic diseases. Testing for the different Alzheimer’s risk-related genes is also available in some kinds of research studies.  Most doctors, however, do not recommend being tested unless the disease is particularly prevalent in your family. The reason behind this is because none of these more common genes is “deterministic” and will not necessarily say for sure that you will develop this type of dementia.