Is it Alzheimer's?
Everyone struggles to come up with a name once in a while. But how can you tell if it's more serious?
"One symptom alone does not necessarily indicate that a person has Alzheimer's or dementia," says Raj C. Shah, MD, of the Rush Memory Clinic at Rush University Medical Center, in Chicago. (Dementia is chronic loss of cognition, usually affecting memory, and Alzheimer's causes about 60% to 80% of dementia cases.)
Serious memory loss and confusion are not a normal part of aging. But forgetfulness caused by stress, anxiety, or depression can be mistaken for dementia, especially in someone who is older.
"We all forget the exact details of a conversation or what someone told us to do, but a person with Alzheimer's will forget what just happened, what someone just said, or what he or she just said and therefore repeat things over and over again," says Lisa P. Gwyther, co-author of The Alzheimer's Action Plan: A Family Guide.
Memory loss isn't consistent, and people with Alzheimer's disease may forget the dog's name one day and remember it the next. "Nothing is certain or predictable with most dementias except they do progress," says Gwyther.
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A person with Alzheimer's disease will begin to make decisions that seem silly, irresponsible, or even inappropriate and are a marked departure from past behavior, such as dressing improperly for the weather or no longer being able to assess for themselves what is safe.
"The earliest changes in judgment usually involve money. So people who were normally very cautious with their finances will start spending in unusual ways, like giving money to unworthy strangers like telemarketers, or withholding money they should pay, because they incorrectly believe their utility company is suddenly untrustworthy," says Gwyther.
People with Alzheimer's have difficulty with abstract thinking as the disease progresses, making numbers and money particularly troublesome.
While missing an occasional monthly payment isn't something to worry about (at least in terms of the brain's health), if your loved one suddenly has difficulty handling money, paying bills, managing a budget, or even understanding what numbers represent, it could be a sign of dementia.
Difficulty with familiar tasks
A person suffering from dementia often takes longer to complete, and may have trouble finishing, everyday tasks that he or she has done hundreds of times before.
For instance, a former whiz in the kitchen may have a problem making his or her signature dish or even remembering how to boil water.
Common activities like remembering how to get to a familiar location, play a favorite game, or manage a budget may also prove difficult.
Trouble planning or problem-solving
As dementia progresses, your loved ones may have trouble concentrating and find that fairly basic activities take them longer to do than before.
In particular, they may struggle to develop and follow a plan, like creating and using a grocery list, following a recipe, or keeping track of monthly bills.
This difficulty is far more pronounced than making the occasional error when balancing a checkbook or forgetting an item on your grocery list.
Finding car keys in the freezer, the remote in a sock drawer, or routinely discovering other "missing" items in strange spots is usually a strong indicator that your family member may be suffering from dementia.
Although we tend to associate forgetfulness with the natural aging process, people with Alzheimer's don't just occasionally forget where they left their car keys or reading glasses; they leave them in unusual places and are later unable to retrace their steps to find them.
Often they'll also become suspicious and accuse someone else of hiding or stealing their belongings.
Confusion with time or place
Disorientation as to time and place, such as forgetting where you live, getting easily lost, and losing track of dates, seasons, and the passage of time is a common experience for individuals with Alzheimer's disease.
"The real issue with Alzheimer's is perception of time," explains Gwyther. "Five minutes can seem like five hours for someone with Alzheimer's disease, so a husband may think his wife has been gone for hours or even weeks, even if it's just been a few minutes, or he might tell his grandchild that he hasn't seen him in five years, even though he just saw them yesterday."
As dementia progresses, a person's language and communication skills diminish. He or she may stop mid-conversation and not know how to continue.
Vocabulary can be especially troublesome. A person may struggle to find the right word; call things by the wrong names (e.g., a car a TV); substitute unusual or incorrect words for familiar words and names (e.g., calling one's husband "him" or "that guy"); invent new words; or use familiar words over and over again.
With time, people may rely on gestures instead of speaking, revert back to speaking in a native language, or just speak less in general.
Unfortunately, about 60% of people with dementia have a tendency to walk off, wander aimlessly, and become lost, often repeatedly.
Restlessness, fear, confusion related to time, the inability to recognize familiar people, places, and objects, as well as stress can all cause wandering.
In some cases, the person might leave the house in the middle of the night to fulfill a physical need, such as finding a toilet or food, or he may be attempting to "go home" because he doesn't realize he is home or he believes it's 20 years earlier and he needs to go to a former job.
Repetitive speech or actions
The frequent repetition of words, statements, questions, or activities is a hallmark of dementia and Alzheimer's.
Sometimes this repetitive behavior is triggered by anxiety, boredom, or fear of the environment or to achieve comfort, security, or familiarity.
Trouble with visual or spatial relationships
One symptom of dementia is vision problems that are different from typical age-related problems such as cataracts.
People with Alzheimer's tend to have difficulty reading, judging distances, and determining color or contrast as time goes on.
In terms of perception, they may look in a mirror and think someone else is in the room instead of realizing they are looking at a reflection.
Dementia can also cause changes in visual and spatial abilities. They can find it tough to distinguish food from the plate it's on, for instance.
Seemingly purposeless activity
If your relative begins to routinely engage in seemingly pointless endeavors, like opening and closing a drawer, packing and unpacking clothing, pacing, or repeating demands or questions, it may be a sign of Alzheimer's disease.
Although from the outside it might seem like these behaviors are futile or even crazy, experts say they usually fulfill a need for the person, such as the need to feel productive or busy.
Alzheimer's can be a lonely and isolating disease that can result in a general lack of interest in surrounding activities or withdrawal from family and friends. People with dementia or Alzheimer's disease may start to remove themselves from hobbies, social activities, work projects, or sports they previously loved, perhaps because they forget how to perform their favorite pastime, like knitting or playing the piano.
It's also likely that because of all the changes they have experienced, they may feel embarrassed or ashamed and therefore avoid social situations and friends entirely.
Loss of initiative and motivation
If apathy, loss of interest in social activities and hobbies, and social withdrawal occur in the early or mid-stage of Alzheimer's, they may be due to depression.
About 40% of people with Alzheimer's disease also have depression. Unfortunately, identifying depression can be difficult, and the cognitive impairment makes it difficult for the person to articulate his or her feelings.
If a family member sleeps all the time or watches TV all day and refuses to do any other activities, she may have depression as well, and you should talk to her doctor.
Don't recognize family and friends
As Alzheimer's progresses, your loved one may not always recognize you or other family members and friends, which can be heart-breaking.
"Recognition does come and go for a while," says Gwyther. "In general, people forget what they just learned or whom they just met, then friends, and family last. But sometimes it's hard to explain why someone remembers one child's name and not another. Well-practiced memories and stories last longer than newer ones, but in the very late stages, people may only remember their parents."
Loss of motor skills and sense of touch
Dementia affects fine motor skills, interfering with one's ability to button or unbutton clothes or use utensils, like forks and knives.
But motor problems, like weakness or trembling hands, or sensory symptoms, like numbness or loss of sensation, may also be a sign of a different type of disease such as Parkinson's, so it's important to discuss your parent's or relative's specific symptoms with a doctor.
Dressing is difficult for dementia patients, who sometimes feel overwhelmed by the choices or may not remember even how to dress, tie a shoe lace, or buckle a belt.
They may wear the same thing over and over again, forgetting that they wore the same outfit the day before. And as previously mentioned, buttoning and unbuttoning clothes can become more difficult in the mid-to-late stages of Alzheimer's disease due to a decline in motor skills.
Disregard for grooming and hygiene
As the illness progresses, individuals with Alzheimer's disease often forget to brush their teeth, bathe regularly, change their clothes, and even use the toilet.
They may not remember why they even need to bathe or brush their teeth.
Likewise, they may forget how to comb their hair, clip their fingernails, shave, or use a toothbrush or comb.
People with dementia can literally forget to eat and drink, especially because many Alzheimer's patients experience decreased appetite and interest in food.
On the other hand, others forget that they've already eaten and, as a result, eat lunch or dinner multiple times a day. Oddly enough, it's not unusual for a person with Alzheimer's to develop new favorite foods and suddenly dislike foods he or she previously loved.
Additionally, the person may lose the ability to tell if a food or beverage is too hot to eat or drink, forget to chew slowly and swallow, or not remember how to use eating utensils and revert to eating with their fingers.
In the mid and especially late stages of Alzheimer's, a person may begin to lose control of his or her impulses and act out in inappropriate or uncharacteristic ways.
"They may say tactless things, like 'Gosh, you got fat,' that they would have never said before," says Gwyther.
Additionally, people with Alzheimer's disease may forget that they are married and begin to flirt and make inappropriate sexual advances, or they might start taking their clothes off at inappropriate times or in unusual settings.
Shoplifting is not uncommon among adults with Alzheimer's, who don't understand or remember that they must pay for items in stores.
Delusions and paranoia
Some people may go from seemingly irrational suspicions (say that someone else stole their glasses) to firmly held false beliefs or delusions (say that someone is trying to hurt or kill them).
Additionally, they may begin experiencing hallucinations or seeing, hearing, smelling, or tasting things that aren't there.
A person may see the face of a former friend in a door or hear voices, for instance. According to experts, memory loss and the ensuing confusion associated with Alzheimer's may cause the person to perceive things in new, unusual ways or become suspicious or misinterpret what he or she actually sees and hears.
Verbal and physical aggression
As the dementia worsens over time, it is not unusual for someone to become physically or verbally aggressive.
Verbal outbursts, including cursing, arguing, name calling, shouting, and threatening, are common, and some patients will even get physical, hitting and pushing caregivers, for example.
These aggressive acts often seem to come out of nowhere, but there's usually a reason behind the behavior that may not be readily apparent to family members or caregivers, such as physical discomfort, inability to communicate properly, or frustration at a situation.
Certain symptoms, like restlessness, anxiety, agitation, disorientation, and confusion, tend to get worse as the day goes on and even continue through the night, often resulting in difficulty sleeping and wandering.
Experts call this phenomenon "sundowning," and it can be due to exhaustion, changes in the person's biological clock, the inability to separate dreams from reality, and a decreased need for sleep that can occur with age.
As much as 20% of Alzheimer's patients experience sundowning at some point, and it's a common reason that family members decide to put their loved one in a nursing home.
Clingy or childlike behavior
Experts refer to the tendency for Alzheimer's sufferers to become completely dependent on a certain individual and constantly follow them around as "shadowing."
Shadowing tends to occur at the end of the day or in the evening when the person may begin to feel particularly worn down, confused, and fearful.
"It's often a result of getting scared in a world that is confusing to them, so the patient constantly needs the person they most trust in view," explains Gwyther. "If that person is out of sight, they may not know how long they've been gone or where to find them, so they will follow them around the house and even into the bathroom."
Even if someone has Alzheimer's, it doesn't mean his or her life is over; a person with the disease can live a meaningful and productive life for many years. But to do so, it helps to get treated for the disease as early as possible.
People often wait too long to seek help, says Dr. Shah. "Most diagnoses are still made in the moderate stage, after most individuals have been experiencing symptoms for years already," he says. "It doesn't help the person or family to wait until symptoms become so obvious that the diagnosis can be easily made."
As the disease progresses, people with Alzheimer's can grow increasingly agitated or angry. They may constantly move around and pace, get upset in certain places, or become fixated on specific details. Agitation usually results from fear, confusion, fatigue, and feeling overwhelmed from trying to make sense of a world that no longer makes sense, explains Gwyther.
Certain circumstances can also make the individual more anxious, such as relocating to a nursing home. In addition to agitation, rapid and seemingly unprovoked mood swings are another sign of dementia—going from calm to tearful to angry for no apparent reason.
If you (or your loved one) are showing signs of Alzheimer's or dementia, you should schedule an appointment with your doctor to get a proper diagnosis and start treatment options. "It is better to seek an evaluation earlier to help maintain quality of life and to prevent social or medical crises due to memory loss," says Dr. Shah.
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