“Hey, where are my keys? I’ve looked EVERYWHERE!”
“Oh, no…is this Alzheimer’s??”
Sound familiar?
Increased awareness of Alzheimer’s and other degenerative dementias means Baby Boomers (and the generations that follow) are acutely cognizant of the havoc it can wreak on a life. Some of us become hyperaware of the slightest changes we perceive, worried that any mental lapse is a sign of impending dementia.
Others, knowing that some change in cognition is normal with advancing age, mistakenly write off real symptoms as “just getting old.”
So, how can you tell the difference between normal aging and early signs of dementia?
Well, I’m going to first state that you should talk to your doctor if you’re experiencing changes in your abilities and suspect a problem. But to help inform us I’ve gathered some resources that discuss the distinction between “normal aging” and early signs of dementia.
Dementia is hard to diagnose
First of all, it’s worth again mentioning that there’s no 100% accurate way to diagnose degenerative dementias (like Alzheimer’s disease and dementia with Lewy bodies). No existing blood test or brain scan can tell you, “yes, this is going to become Alzheimer’s.”
So diagnoses are made by looking at an aggregate of a person’s personality, habits, abilities, genetics, past experiences, etc. By comparing the “before” and the “after,” doctors discern the patterns that point to the most likely cause.
Diagnosis is further complicated because many symptoms of degenerative dementia are just extreme versions of regular changes that accompany aging. In addition, often people in early stages of dementia experience moments of lucidity and symptoms that seem to wax and wane.
Caregiver.org asks, “Does any loss of memory signify dementia? Isn’t memory loss a normal part of aging?”
They answer, “We often hear that because someone is old, memory problems are ‘just natural’ and are to be expected. But we know that serious memory loss is not a normal part of aging, and should not be ignored.”
Progressive dementia vs normal aging
In USA TODAY’s 2007 article, “Is it aging or Alzheimer’s?” author Kathleen Fackelmann relates: “Starting at age 50, most people develop some signs of a brain that’s slowing down, says memory expert Gary Small of UCLA. ‘The brain ages just like the rest of the body.’ In most cases, the occasional memory lapse is nothing to worry about, Small says.”
Speaking at Harvard University’s Dialogues on the Brain (October 27, 1994 and June 5, 1995): Memory Loss, Aging, and Alzheimer’s Disease , Dr. Marilyn Albert, now a professor of Neurology at Johns Hopkins and Director of the Division of Cognitive Neuroscience, stated the following:
“What is very clear is that the memory changes in normal aging are very different from those in Alzheimer’s disease, even early in its course. A person with early Alzheimer’s disease will not only have trouble learning something new, but, even if they manage to learn it, they will forget it much more rapidly than a normal older person.
…
That’s why, for example, someone with early Alzheimer’s disease will almost never be able to learn how to use a new piece of equipment around the house, such as a new microwave oven, or a new CD player, because the information is lost so rapidly. And one finds that these problems become gradually worse, so that they interfere more and more with a patient’s daily life.”
Finally, iCareVillage.com states that if one is “experiencing signs of dementia that are severe enough to interfere with everyday life, social activities or a job, it is time to see a qualified doctor and ask for a thorough assessment.”
Examples
Here are some examples of situations examining both normal reactions and dementia-influenced ones. The following list combines information merged from 2 sources:
from iCareVillage.com’s 2010 article, “Difference between Normal Forgetfulness and Dementia” (by Laurie White, MSW): “The 10 Warning Signs of Alzheimer’s Disease.” (White notes that her list is used with permission from the Alzheimer’s Association, with examples adapted by iCareVillage.com)
from the Alzheimer’s Association‘s updated 2011 brochure “is it alzheimer’s or just signs of aging? Warning signs you should know,” in the section “10 Signs of Alzheimer’s/dementia.”
1. Memory loss that disrupts daily life
One of the most common signs of dementia, especially in the early stages, is forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.
What’s a typical age-related change?
Sometimes forgetting names or appointments, but remembering them later; occasionally forgetting an appointment, a birthday or someone’s name.
What’s NOT Normal
Forgetting things more often and not remembering them later, especially recent events or experiences. Not recognizing a familiar friend or relative.
2. Difficulty performing familiar tasks at home, at work or at leisure
People with dementia often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game.
What’s a typical age-related change?
Forgetting to put an ingredient in a recipe periodically or forgetting to serve the cookies at the end of the meal. Occasionally needing help to use the settings on a microwave or to record a television show.
What’s NOT Normal
Forgetting how to make a favorite long-time recipe or forgetting that you made cookies to serve to guests.
3. Problems with language
People with Alzheimer’s or other dementias may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”).
What’s a typical age-related change?
Sometimes having difficulties coming up with the right word; “it’s on the tip of my tongue.”
What’s NOT Normal
Forgetting simple words and substituting words that make it hard to understand what the person is trying to say “I need to put the things on my hands to keep them warm” (gloves) or substituting occasional for offensive because both words start with “o.” Difficulty having a conversation.
4. Disorientation to place and time
People with dementia can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.
What’s a typical age-related change?
A momentary lapse of memory causing you to forget where you are going or what day of the week it is…but figuring it out later.
What’s NOT Normal
Getting lost driving to where you have worked for 20 years, getting lost walking in your neighborhood. Losing track of the year or season.
5. Poor or decreased judgment
People with Alzheimer’s may experience changes in judgment or decision making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.
What’s a typical age-related change?
Making a bad decision once in a while.
What’s NOT Normal
Poor judgement and decision-making. For example, giving away large sums of money in response to mail solicitations or telemarketers.
6. Problems with abstract thinking; challenges planning or solving problems
Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.
What’s a typical age-related change?
Having trouble balancing your checkbook from time to time or making occasional errors. Occasionally missing a monthly payment.
What’s NOT Normal
Having trouble with numbers and forgetting how they should be used. Inability to manage a budget.
7. Misplacing things
A person with dementia may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.
What’s a typical age-related change?
Misplacing things from time to time, such as a pair of glasses or the remote control. Periodic short lapse of memory: misplacing keys, forgetting a person’s name, forgetting where you parked the car at the mall.
What’s NOT Normal
Putting things in inappropriate places such as the fish in the dishwasher. Losing things and being unable to retrace the steps to help find them.
8. Changes in personality or mood
The mood and personalities of people with dementia can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.
What’s a typical age-related change?
Feeling sad, moody, or irritable from time to time. A person’s personality may gradually change a bit with age.
What’s NOT Normal
A person with Alzheimer’s disease or other dementias can experience abrupt and dramatic changes in personality, act out of character, or become extroverted. Normal aging does not cause rapid, unexplained mood swings—going from being calm to being sad or angry for no apparent reason.
9. Loss of initiative and changes in behavior
A person with dementia may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. In addition, they may develop very specific ways of doing things and become irritable when a routine is disrupted.
What’s a typical age-related change?
Not being up to doing something, going somewhere, or being with friends. It’s normal for older people to sometimes feel weary of work, family and social obligations.
What’s NOT Normal
A person with Alzheimer’s may sit in front of the TV for hours, require more than usual coaching to do usual activities.
10. Trouble understanding visual images and spatial relationships
For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realize they are the person in the mirror.
What’s a typical age-related change?
Vision changes related to cataracts.
What’s NOT Normal
Incorrectly processing the things they see. For example, being scared of a dog in a photo.
Other things might cause symptoms like progressive dementia’s
Vitamin deficiencies (especially B1, B 6, B12), illness, depression, dehydration, medication interactions, and other elements can cause symptoms that look like progressive dementia. But unlike with progressive dementia, these symptoms can be reversed when the underlying cause is addressed.
Johns Hopkins Medicine’s article “Dementia” states: “There are other conditions that can cause dementia or dementia-like symptoms including reactions to medications, metabolic problems and endocrine abnormalities, nutritional deficiencies, infections, brain tumors, anoxia or hypoxia, and heart and lung problems. A comprehensive work-up is therefore indicated for all patients who develop symptoms of dementia.”
This is one reason that it’s particularly important to see your doctor if you start experiencing signs of dementia: if your symptoms aren’t caused by dementia then she can identify and treat the source of the problems.
Additional Resources
Memory problems are typically one of the first warning signs of cognitive loss, possibly due to the development of Alzheimer’s disease. Some people with memory problems have a condition called amnestic mild cognitive impairment (MCI). People with this condition have more memory problems than normal for people their age, but their symptoms are not as severe as those seen in people with Alzheimer’s disease. Other recent studies have found links between some movement difficulties and MCI. Researchers also have seen links between MCI and some problems with the sense of smell. The ability of people with MCI to perform normal daily activities is not significantly impaired. However, more older people with MCI, compared with those without MCI, go on to develop Alzheimer’s.
A decline in other aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimer’s disease.
–National Institute of Aging’s Alzheimer’s Disease Fact Sheet
References
“Is it aging or Alzheimer’s?” (Kathleen Fackelmann, 2007)
Dialogues on the Brain (October 27, 1994 and June 5, 1995): Memory Loss, Aging, and Alzheimer’s Disease
Harvard Medical School > The Harvard Mahoney Neuroscience Institute > “On the Brain”
- Dr. Marilyn Albert: Now a Professor of Neurology at Johns Hopkins and Director of the Division of Cognitive Neuroscience, Dr. Albert focuses on the cognitive and brain changes associated with aging and Alzheimer’s disease (AD).
Professor of Neurology
Director, Division of Cognitive Neuroscience
Specialty Areas: Memory Disorders
The Johns Hopkins Hospital
Department of Neurology
Reed Hall East, Room 2227
Baltimore, MD 21287
Johns Hopkins Medicine > Neurology and Neurosurgery > Centers & Clinics > Memory Disorders Center
“Difference between Normal Forgetfulness and Dementia” (by Laurie White, MSW)
“is it alzheimer’s or just signs of aging? Warning signs you should know” (.PDF file)
Home > Neurology and Neurosurgery > Centers & Clinics > Memory Disorders Center > Conditions > Dementia
National Institutes of Health > National Institute on Aging > Alzheimer’s Disease Education and Referral Center > Alzheimer’s Disease Fact Sheet
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This is a very thorough and comprehensive article with great information that will prove valuable to all who read it. When I’m asked the question of dementia vs normal aging, I oftentimes use the following example that seems to make sense to most of those with whom I speak: If you lose your car keys or forget where you put them? Most likely normal aging. When you pick up your car keys and wonder what the heck they are and how they’re used? Time to look into a dementia-related disorder.
Thank you for reading! And I think that your car keys example is an excellent way to explain the difference; thank you for sharing that, too.
Yes. We all struggle with the signs of an aging mind and worry that it might be more than simple aging! A sign can be doing something bizarre (like putting your purse in the oven) or forgetting how to do something that you have done routinely over the years (like write a check). Being observant of someone’s environment and behaviors can give you lots of clues! (Though many are very good at compensating early on…..)
The purse in the oven is always a giveaway!
Seriously, though, I think you offer very good examples. And you’re absolutely right that many people are good at compensating and hiding problems, especially in the early stages.
Compound that with our own natural rhythms (I can’t be the only one who has days when I seem to drop or knock over just about everything! But I have other days where I’m very focused and alert…and drop very few things.) and it can paint a murky picture.
Because of that, I agree that it’s important to observe behavior over a long period of time. Which sounds more formal than it actually is. It’s really just about being aware of what is “normal” for someone, then being able to pick up on changes. That’s a really good insight.
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Thanks – I was fairly sure that I’m just getting old, but now I know for sure! Although I have occasionally been putting inappropriate things in the fridge since I was old enough to walk, I probably do that less now!
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