How can you really know?

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I think the most telling difference was explained to me this way - it's not necessarily forgetting where you've put the recipe for your favourite cookies, it's not being able to follow the steps to make them after you've found it.
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jacobsonbob Jan 2021
...or, as I've read before, forgetting where you put your car keys vs. not remembering the purpose of car keys.
When trying to tell the difference between normal aging and dementia, the early stages can be difficult to pick up on, esp if you don't reside in the same place with the person. Too often with shorter visits and even doc visits, they can pull off enough to appear "normal", or at least normal enough that people miss it or dismiss it as aging.

Repetition, statements or questions, within a very short time period (aka a few minutes) is common (it's what clued me to my mother's dementia.) Repeating old stories is NOT the same. Repeating that story over and over in a matter of minutes IS cause for concern.

Being unable to follow steps to do a task, such as cooking, baking or balancing a check book can be another sign.

Being confused by a remote control or a phone can sometimes be a sign.

The VERY early sign I missed (picked up on it after the fact) was accusing others of taking items, sometimes the most ridiculous mundane things that aren't worth stealing, like tweezers!

But, those early signs can be different for people or can be highly dependent on what the underlying cause of the dementia is. Sometimes it can be behavioral issues, rather than repeating or being unable to follow steps.

As noted, repetition was my first clue (I knew 0 about dementia then.) Having trouble with the checking account happened around the same time (making mistakes, over or underpaying, etc.) Once we took the car away, I had to take her shopping. I would find fresh veggies shriveled up in the fridge and realized she wasn't cooking anything. She would eat frozen dinners, but never bought enough to last until my next trip, so I would have to get her to pick more! She would put supplies away in the spare BR closet, where she always put them, but would forget they were there, didn't look and would ask for more! Despite having freezer bags, plastic wrap, tin foil and plastic containers for freezing things, she was wrapping items in torn up grocery bags! Once she removed the trash bag, she wouldn't get another from the closet, she would put the little grocery bag in it's place! I would put a good handful of bags into the trash can, at the bottom, so she would see them and use them.

A regular doc should be doing cognitive tests at each exam. They're not as extensive, but also not as intensive. The initial one would be for a baseline. Follow on tests can reveal if there has been degradation. Back when mom really needed this done, they hadn't started it. The agency I was hiring to bring in aides, 1hr/day, sent a nurse to mom's condo to test her. It was a better test, and is covered by Medicare. Even better, it was at home, at her kitchen table, with 2 of us there as well, so it was less "threatening" and/or more comfortable for her to do it this way. The nurse was also able to provide suggestions, such as using a timed/locked med dispenser.

For family, you have to be in touch often enough to note changes. In our case, it was mostly through phone calls, as I was still working then. In person is even better, esp if the visit can be extended or you stay with the person for a few days, to get a better idea of what's going on, or not.

One final note: with or without dementia, do be aware that UTIs (or ANY infection) can cause dementia-like symptoms in elders! The tell-tale pain doesn't always present itself with them. In cases of sudden changes, do test for UTIs and have blood work done too (elevated WBC could indicate an infection elsewhere.) IF infection is found, often once it is treated, all the dementia-like symptoms go away.

Also, drinking too many fluids or not enough can also bring on some cognitive confusion, as the electrolytes get out of whack. For many, it's not having enough fluids, but my mother was drinking too many fluids, and washed out her system! This happened before the dementia. An overnight stay with IV fluids (mainly potassium) brought grumpy mom back!

Happy observing!!
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DLM103 Jan 2021
Thanks for the post. My loved one is confusing her cellphone with her TV remote. She thinks she can control the TV with it. I try to remind her that she has a separate remote control for the TV. This seems to get her upset with me. She replies I am not losing it. Stop making it seem like I am. Some days she is fine when I talk with her and other she seems off. I had her doctor test for a UTI. Mom called yelling what did you say to doctor - I just had to do a urine test. I told mom that since she had a back ache, I thought she should be tested for a UTI. She said she knew why she had a back ache, she slept wrong. The test didn't detect a UTI. I need to take her to her doctor tomorrow. I want to mention this situation to the doctor without mom knowing. Any suggestions? Another factor involved is that she moved into Assisted Living about 6 months ago during COVID, she hates it and blames me for it. She hates the food, says it's too salty. She says she's not eating but who knows. I suggested she tell the doctor about the food and maybe doctor can inform AL that she needs low salt options. I am carrying the guilt of putting her in AL. I couldn't take care of her by myself anymore. She wasn't really cooking anymore just like a can of beans, eggs, etc. and would only really eat when I would bring her food. She is a big chocolate eater and was hooked on eating muffins for breakfast- which I know was because it was easy to eat. I discussed AL with her and asked what her top 3 places would be to look at. I researched her top choice and took her there to see. She liked it. I gave her all the info to read and told her to look it over since it was a big thing to think about. Now I wonder if she even looked at it. She never said she didn't want to go to AL so now she is in AL. I was hoping AL would give her a chance to socialize and play bingo like she liked before but she says the AL plays bingo the way little kids play it, not like the bingo cards she likes. Needless to say, she doesn't seem to participate in much but due to COVID she is afraid to get sick too. She does walk the hallways at times but limited mobility was one of the reasons I couldn't take care of her anymore. She can only walk so much and she had fallen several times. Since being in AL, they have been quarantined to their rooms with meals delivered to them for a lot of the time she has been there. When they had 30 min indoor/outdoor visits and use of the dining room she seemed to be doing better. Hopefully AL will be able to do visits again soon. Any suggestions would be appreciated.
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It depends on the type of dementia. Lewy Body dementia is associated with Parkinson's disease. So that one starts with Parkinson's disease symptoms: stiffness, shuffling, tremor in the hands, and the dementia is a latter symptom. With vascular dementia, a stroke is the causative factor. Whatever portion of brain is affected determines the problems, but the onset is more sudden and it doesn't really change with time. If you notice sudden odd behavior, get your loved one to the ER since "clot type" strokes can be reversed with prompt treatment. The most common type of dementia (75-80%) is Alzheimer's disease. This one has a more subtle onset and the first noticeable symptoms problems with judgment (handling money, following multi-step procedures, difficulty following a conversation... there are some medications that can help in the early stages. The forgetfulness associated with Alzheimer's is the difficulty retaining/accessing current information. Slowly, the more distant memories are lost along with abilities associated with them.

The occasional lapse is remembering a name, where an item is placed... may be more a symptom of stress or a need ways to keep track of information. We must remember that our current lives are bombarded with information and that can be very stressful.
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cwillie Jan 2021
Strokes aren't the only cause of vascular dementia, anything that impairs vascular health can cause cumulative microscopic damage - My mom never had a stroke, but she did have several TIAs and had been living with cardiovascular disease for 30 years. I personally believe that research will discover that this kind of dementia is much more prevalent than we know.
You know by getting your loved one or yourself tested for cognitive impairment. If you can't find your keys, that's forgetfulness. If you find them in the freezer a few days later, that may be a sign of dementia.
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Isthisrealyreal Jan 2021
Stress can cause situations like putting your keys in the freezer or the milk in the cupboard.
You may not be able to tell normal aging from dementia, but you can suspect dementia. A simple example would be if you walk into a room and not know why you're there but after leaving, recall why you went there, that's more normal aging. If you don't recall even being in the room, that takes further screening. Dementia is not normal aging. But dementia is more than short term memory loss, it's a complex set of symptoms that should be evaluated by a PCP.

If you're asking because you are a caregiver of someone suspected of having dementia symptoms, make an appt with the persons PCP and educate yourself about the symptoms and causes of dementia.
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disgustedtoo Jan 2021
"...if you walk into a room and not know why you're there but after leaving, recall why you went there, that's more normal aging."

This has happened to me so many times, I started calling it the threshold syndrome. Turns out it really IS a thing! (there are other postings about this as well) They've done studies, and it is REAL.

Sometimes I've been able to thwart the memory lapse by repeating, either in my mind or out loud, what it is I'm going there to do (often it requires passing through several thresholds, as in the testing they did, so the repeating helps!)
Mostly it is a matter of education to guess which is occurring. There is an enormous amount of literature right here if you access CareTopics from the blue timeline above. Also google Dementia associated with Aging.
In the final analysis an evaluation of testing from a qualified Neuro-psyc specialist is the easiest and most certain way to get an accurate diagnosis.
If you ask specific questions here about what you're seeing we can help some, but there is no substitute for diagnosis by MD.
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Watching both my mother and my MIL in various stages of mental aging--it has been an interesting ride.

Neither has 'all their marbles' to be kind of crude--and each has days when they are much better than others. Do we try to chase down and exact dx? Not at this point. No need. Neither drives or even leaves the house, ever. Their homes are as 'safe' as we can make them and they can make their own decisions. They may be weird or not what we'd choose, but they aren't bad, necessarily.

My opinion since I see neither of them often, I really do notice the slow slide into dementia of some kind. Neither one has good long term memory and short term memory can also be sketchy. Stories get mixed up, events are comingled and re-told and you really cannot trust their statements.

My SIL SWEARS her mom is 'fine' but no 'fine' person screams and swears non stop until the person they're angry with leaves the room. She had a half-hearted dementia test last year when she was in rehab for a fall and they just said for a 90 yo woman, she was OK. Against DH's opinion, she did return home after a 12 week rehab stay. He wanted her in a home for her own safety, she fought him tooth and nail and he gave up.

My mom just lives in her own little hoarded out apartment and really doesn't move 1/2 mile in a day. She watches TV all day and can take care of herself, to an extent. If I had any say ( and I do not) I would want her to have 3xs a week in home aides to help her bathe, clean her place and keep her company. She has declined all of that.

Perhaps at some time we'll pursue dementia testing--but not right now. We're just trying to ride out the pandemic. It really won't make a difference to either of their lives.

That's just MY 'moms'--your LO's can be totally different.
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Davenport Jan 2021
Midkid, my experience mirrors your description. (My two sisters--one who lived far away, the other closer but was working 12 hours a day & had 2 children in Jr. High/High School; While I was living with & making my mom's living in her home possible, both sisters insisted mom was FINE and doing GREAT--based on the occasional special-occasion visit).

Unless one lives full-time with the loved one, others just simply do NOT have standing to make such judgments.

In my case, both sisters accused me of overreacting, being hysterical, and not having the 'constitution' to handle living with our mom [I was the 'high strung' sister.] This throughout me having to take her keys away, a half dozen falls/broken bones/ambulance rides 24/7, and recoveries from multiple orthopedic surgeries. They fought me at every step. As we know on this forum, an all-too-common scenario.

Love and strength to ALL of you.
Report has some very good examples...

These articles are what helped me to suspect dementia In my father. At first he would forget words, and I didn’t really know what was going on. Then he started to forget recent conversations, then he started to get more and more confused. I said this can’t be normal aging. Thankfully we finally got him to see a neurologist and he was diagnosed with vascular dementia. Hope this helps
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My sister(81) has dementia and lives in a nearby Care Home/6 beds. She was a lovely, creative artist most of her life. I judge the level/decline of her dementia by the quality of her art work. She is now @ toddler level...with scribbles back and forth on the pages of her Adult Coloring books.
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Imho, a neurologist can provide an M.R.I. of brain functionality, which is typically the gold standard to detect for dementia. Prayers sent.
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