The Early Signs of Dementia

Dementia is usually gradual and progressive, causing problems with executive function, which can include memory and self-care skills. Some early signs of dementia include cognitive symptoms and changes in behavior, mood, and personality.

There are many different neurological disorders that cause dementia. The most common and well recognized is Alzheimer’s disease.

This article describes the symptoms, diagnosis, causes, treatment, and prevention of dementia. 

Dementia Symptoms

The symptoms of dementia can be subtle at first. Over time, the effects can advance to such a degree that many people who have dementia may not be able to independently take care of themselves. 

Early Signs

Early signs of dementia can include cognitive symptoms, mood changes, behavioral changes, and personality changes. 

Some early signs of dementia include: 

• Forgetting where you put things 
• Being irritable, anxious, or sad 
• Becoming withdrawn 
• Absentmindedness 
• Forgetting recent events 

For many people, these are normal personality traits and are not signs of dementia. They can also be caused by being busy, distracted, lack of sleep, or having another illness. These signs may be indications of early dementia if they are out of character, persistent, and getting worse. 

Cognitive Symptoms

Cognitive skills are thinking skills, and include things like memory, planning, and organization, A decline in cognitive skills, the main effect of dementia, can make it hard to function normally. 

As dementia advances, common cognitive symptoms people may experience include:

• Excessive sleeping or erratic sleeping habits 
• Having difficulty with simple calculations 
• Getting lost 
• Confusion 
• Confabulation, which is having false memories or saying false things to fill in for missing memory 
• Loss of appetite or increased appetite 
• Incontinence 
• Not recognizing close friends, family members, or longtime coworkers 

Sometimes people who have dementia may notice these problems, and this can be frustrating or embarrassing. Often, as dementia progresses, people no longer notice their own cognitive deficits. 

Psychological Symptoms

There are many behavioral and emotional issues that can occur with dementia. These problems are not related to a person’s baseline personality, and people who have dementia can begin to act very differently than they ever acted before.

Psychological, psychiatric, and behavioral symptoms of dementia include:

• Depression 
• Anxiety 
• Agitation 
• Combativeness 
• Paranoia 
• Lack of inhibition 
• Stealing, sneaking, or lying
• Childlike self-centeredness, a lack of consideration for others
• Inappropriate behavior, such as undressing in public
• Crying or laughing uncontrollably, especially with pseudobulbar palsy (a neurological disorder that also causes loss of control of facial expressions)
• Hallucinations or psychosis, especially with Lewy body dementia or Huntington’s disease

These symptoms can fluctuate and may temporarily worsen during illnesses or infections or when adjusting to a new medication.

Diagnosis

The diagnosis of dementia is based on the clinical history and medical examination. Often, other causes of the symptoms need to be ruled out, especially if the symptoms began and progressed abruptly or unexpectedly.

A physical examination, including a neurological examination, can help identify signs of other potential causes, such as an infection, stroke (a blockage of blood flow or bleeding in the brain), or a brain tumor.

If needed, blood tests, brain imaging tests, genetic tests, or other specific testing can be done to identify medical conditions that could be causing the signs and symptoms.

Dementia screening tests and cognitive tests can help with diagnosis and with tracking changes over time. 

Common tests used in the evaluation of dementia include: 

• Mini mental status examination 
• General Practitioner Assessment of Cognition (GPCOG)
• The Montreal Cognitive Assessment (MoCA)
• The Saint Louis University Mental Status Examination (SLUMS)
• Clock drawing test

These tests examine certain executive functions. They are scored and compared to standard scores to help determine whether there is an objectively measurable problem.

Cognitive tests and screenings are not used alone to diagnose any type of dementia. They are tools that are used along with a symptom history, clinical examination, and overall picture of what’s been happening.  

Causes

Dementia is caused by degeneration or damage to areas of the brain that are involved with memory, thinking, planning, and other executive functions.

Sometimes, as with Alzheimer’s disease, there is a concentration of degeneration in specific areas of the brain, such as the hippocampus.

Additionally, any condition that causes large areas of brain damage, such as multiple strokes, can also cause dementia due to extensive interruption of brain communication between different regions. Some types of dementia are also characterized by protein buildup in the brain, specifically Lewy bodies and tau proteins. 

Some of the conditions that cause dementia include:

• Alzheimer’s disease: A common type of dementia that results in memory loss and depression, Alzheimer's disease often causes affected people to be suspicious of others.
• Vascular dementia: Small or large strokes can cause damage throughout the brain, leading to a deterioration of thinking and memory.
• Frontotemporal dementia: This disease causes loss of brain tissue in the frontal and temporal lobes of the brain, with resulting behavioral changes and memory loss.
• Pick's disease: A rapidly worsening dementia, Pick's disease causes personality changes and inability to care for oneself.
• Lewy body dementia: This type of dementia causes memory problems and movement impairment, including tremors and stiffness.
• Multisystem atrophy: This rare disease causes dementia and movement problems due to degeneration of the brain stem, cerebellum, and other areas of the brain.
• Parkinson’s dementia: Parkinson's disease may cause dementia, usually in late stages.
• Pseudobulbar palsy: This condition causes emotional instability, movement problems, and a decline in memory and thinking abilities.
• Huntington's disease: This hereditary disease causes loss of motor control, spasms, and symptoms of psychosis.
• Creutzfeldt-Jakob disease: This rare condition caused by brain damage results in personality changes, dementia, and loss of coordination.

Sometimes dementia can have mixed causes, or the specific disorder might not be defined. 

Down syndrome and cerebral palsy are conditions present at birth that are associated with a higher than usual risk of Alzheimer’s disease and other types of dementia. 

Treatment

Medication and cognitive therapy are the cornerstones of dementia treatment. There is no known cure for any type of dementia. Namenda (memantine), Aricept (donepezil), Razadyne (galantamine), and Exelon (rivastigmine) are medications approved to treat certain types and stages of dementia. They may slow disease progression for some people.

Cognitive training can be started at the early stages of dementia when a person is still able and willing to participate. This type of therapy may include activities to maintain organizational and memory skills.

Symptomatic Treatment

Management of the effects of dementia can be beneficial. For example, many people who have dementia lose interest in eating. Nutritional supplementation with high-calorie drinkable supplements can be helpful, and in some situations, a feeding tube may be necessary.

Other important interventions can include the prevention and treatment of bedsores, muscle contractures, and infections.

Prevention

You can reduce the risk and impact of some types of dementia. Vascular dementia can be disabling on its own, and it can contribute to the effects of other types of dementia.

Getting treatment for the health problems that contribute to vascular dementia, like unhealthy cholesterol levels and hypertension, can have a substantial effect on lowering the risk.

Additionally, lifestyle habits like getting regular exercise, avoiding smoking, limiting alcohol, and staying physically and mentally active are associated with a lower risk of vascular dementia, Alzheimer’s disease, and other types of dementia.

Summary 

Dementia is a progressive decline in cognitive functions, and there are many causes. Dementia is more common with advancing age. While there is no cure for dementia, there are some medical treatments that may slow disease progression and help reduce the symptoms.

People who develop dementia might be aware of the problem at first but will not be concerned about the effects as the disease progresses and will need caregiver support.  

A Word From Verywell 

Dementia changes a person’s behavior and personality. It can be painful for loved ones to watch, and the practical day-to-day challenges can be overwhelming. Be sure to get the support and assistance you need for anyone in your life who is coping with dementia.