As the population ages, concerns for dementia are on the rise for a great many people. It can be very difficult to know if dementia is developing in oneself or a loved one, or if cognitive challenges are related simply to the normal aging process. Decline in memory is certainly a classic sign of dementia, but changes in memory can also be normal, beginning as early as the 20s or 30s(1), and certainly before age sixty. Most people with diagnosed Alzheimer’s disease are age 65 and older(2). Aside from memory decline, early warning signs of dementia have been identified, as discussed in a New York Times article from September, 2024, by Dana G. Smith(3). These warning signs signal early brain changes, including those related to dementias in which forgetfulness is not the primary symptom.
Warning Signs of Dementia:
- Financial Problems.
Declining credit scores, forgetting to pay bills, and no longer being able to stick to a budget may be observed. Managing finances is a complicated task, involving multiple brain regions and abilities, so problems with financial management can be among the first signs that cognition is starting to decline. This is especially true as frontotemporal dementia is developing; a rare form of dementia that affects judgment, impulsivity, and the ability to recognize potential negative consequences, leading to increased vulnerability to financial scams and increased carelessness with money. - Sleep Issues.
Older people sleep more lightly, and go to bed and awaken earlier than they used to, which can be normal. Dramatic changes in sleep habits are more concerning, such as starting the day many hours earlier than they used to, or being unable to stay awake during the day. In Dementia of the Alzheimer’s Type, brain regions including the brainstem that are important for regulating sleep and wake cycles are among the first affected by the disease, so sleep changes can occur years before memory symptoms are evident. In Lewy Body dementia, another progressive brain disorder, a person may begin acting out their dreams. This can also occur with Parkinson’s disease, which is related to Lewy Body dementia. In these two disorders, toxic proteins attack the cells in the brainstem that control sleep paralysis, and this results in REM sleep behavior disorder (in which a person may strike out at others, scream, and yell during their dreams). - Personality Changes.
Per a 2023 study, people with dementia tend to become less extroverted, agreeable, and conscientious before they show signs of cognitive impairment(4). These personality changes become more obvious as dementia symptoms emerge. They may withdraw socially, and narrow their social circle. People with frontotemporal dementia may become less trusting and friendly, which has been linked to decreased brain volume in the frontal cortex. They may appear less conscientious, more disorganized, and have difficulty completing tasks, all of which arise when memory declines. - Driving Difficulties.
Driving, like financial management, is a task that requires complex cognitive abilities. Watch for unexplained scratches and dents, braking or accelerating suddenly, taking turns too fast, fender benders, near-misses, and running signs or stoplights. As the ability to drive safely declines, some are reluctant to drive at night, in bad weather or traffic, or with loved ones in the car with them. Discussions about when to stop driving can be extremely difficult, but it is important to raise concerns about driving challenges as soon as they are noticed. A driving evaluation can be an excellent resource, in helping to determine if and how driving remains safe, and so that the evaluator may deliver the bad news when driving is no longer safe. - Loss of Smell.
The olfactory system, the parts of the brain that control smell, are often among the earliest affected areas of the brain when Dementia of the Alzheimer’s Type, dementia with Lewy bodies, and Parkinson’s disease are developing. People who are eventually diagnosed with these conditions may begin to lose their sense of smell many years before their other symptoms appear. People with Dementia of the Alzheimer’s Type may detect an odor, but misidentify it, while those with Parkinson’s and Lewy body dementia may not smell an odor at all.
If you are concerned about warning signs of dementia, and would like have an assessment of your cognitive abilities, please feel free to reach out to me: https://amyblackmonphd.com/contact/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC2683339/#:~:text=most%20abilities%20tend%20to%20peak,%E2%80%9D%20(Schaie%2C%201989) ↩︎
- https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048356 ↩︎
- https://www.nytimes.com/2024/09/26/well/mind/dementia-signs-symptoms.html?smid=nytcore-ios-share&referringSource=articleShare&sgrp=c-cb ↩︎
- https://www.sciencedirect.com/science/article/pii/S1525861023004759 ↩︎