Dementia - early signs

The early signs of dementia are very subtle and vague, and may not be immediately obvious. Early symptoms also depend on the type of dementia and vary a great deal from person to person.

Early symptoms of dementia

Although the early signs vary, common early symptoms of dementia include:

• memory problems, particularly remembering recent events
• increasing confusion
• reduced concentration
• personality or behaviour changes
• apathy and withdrawal or depression
• loss of ability to do everyday tasks.

Sometimes, people fail to recognise that these symptoms indicate that something is wrong. They may mistakenly assume that such behaviour is a normal part of the ageing process. Symptoms may also develop gradually and go unnoticed for a long time. Also, some people may refuse to act, even when they know something is wrong.

Ten warning signs of dementia

Go through the following checklist of the common symptoms of dementia. If the person affected has several of these signs, consult a doctor for a complete assessment.

Dementia and memory loss

It’s normal to occasionally forget appointments and remember them later. A person with dementia may forget things more often or not remember them at all.

Dementia and difficulty with tasks

People can get distracted and they may forget to serve part of a meal. A person with dementia may have trouble with all the steps involved in preparing a meal.

Dementia and disorientation

A person with dementia may have difficulty finding their way to a familiar place or feel confused about where they are, or think they are back in some past time of their life.

Dementia and language problems

Everyone has trouble finding the right word sometimes, but a person with dementia may forget simple words or substitute inappropriate words, making sentences difficult to understand. They may also have trouble understanding others.

Dementia and changes in abstract thinking

Managing finances can be difficult for anyone, but a person with dementia may have trouble knowing what the numbers mean or what to do with them.

Dementia and poor judgement

Many activities require good judgement. When this ability is affected by dementia, the person may have difficulty making appropriate decisions, such as what to wear in cold weather.

Dementia and poor spatial skills

A person with dementia may have difficulty judging distance or direction when driving a car.

Dementia and misplacing things

Anyone can temporarily misplace a wallet or keys. A person with dementia may not know what the keys are for.

Dementia and mood, personality or behaviour changes

Everyone becomes sad or moody from time to time. Someone with dementia can have rapid mood swings, for no apparent reason. They can become confused, suspicious or withdrawn. Some can become disinhibited or more outgoing.

Dementia and loss of initiative

It is normal to tire of some activities. Dementia may cause a person to lose interest in previously enjoyed activities or require cues prompting them to become involved.

Conditions with symptoms similar to dementia

Remember that many conditions have symptoms similar to dementia, so it is important not to assume that someone has dementia just because some of the above symptoms are present. Strokes, depression, excessive long-term alcohol consumption, infections, hormonal disorders, nutritional deficiencies and brain tumours can all cause dementia-like symptoms. Many of these conditions can be treated.

Diagnosis of dementia

The best place to start the diagnostic process is talking with the person’s local doctor or a Cognitive Dementia and Memory Service (CDAMS) clinic about getting a diagnosis is critical at an early stage. Only a doctor can diagnose dementia. A correct diagnosis of dementia at an early stage is important for early treatment, support and planning for the future.
A complete medical assessment may identify a treatable condition and make sure that it is treated correctly, or it may confirm the presence of dementia and whether it is Alzheimer’s disease or another type of dementia. Six types of assessment can help to confirm or exclude a diagnosis of dementia.

Medical history

The doctor will ask about past and current medical problems, family medical history, any medications being taken and the problems with memory, thinking or behaviour that are causing concern. The doctor may also wish to speak to a close family member who can help provide all the necessary information.

Physical examination

To help rule out other conditions, a physical examination may include tests of the senses, movement, and heart and lung function.

Laboratory tests

These will include a variety of blood and urine tests to identify any possible illness that could be responsible for the symptoms. In some cases, a small sample of spinal fluid may be collected for testing.

Cognitive testing

A variety of tests are used to assess thinking abilities, including memory, language, attention and problem-solving. This can help identify specific problem areas, which in turn helps identify the underlying cause or the type of dementia.

Brain imaging

There are certain scans that look at the structure of the brain and are used to rule out brain tumours or blood clots in the brain as the reason for symptoms.
Some scans can also detect patterns of brain tissue loss that can differentiate between different types of dementia. Other types of scans look at how active certain parts of the brain are and can also help determine the type of dementia.

Psychiatric assessment

Psychiatric assessment helps to identify treatable disorders, such as depression and to manage any psychiatric symptoms, such as anxiety or delusions that may occur along with dementia.

Talking with a doctor

After considering the person’s symptoms and ordering screening tests, the doctor may offer a preliminary diagnosis or refer the person to a Cognitive Dementia and Memory Service (CDAMS) clinic, neurologist, geriatrician or psychiatrist.

Some people may be resistant to the idea of visiting a doctor. In some cases, people do not realise, or else they deny, that there is anything wrong with them. This can be due to the brain changes of dementia that interfere with the ability to recognise or appreciate the changes occurring. Others have an insight of the changes, but may be afraid of having their fears confirmed.

One of the most effective ways to overcome this problem is to find another reason for a visit to the doctor. Perhaps suggest a check-up for a symptom that the person is willing to acknowledge, such as blood pressure, or suggest a review of a long-term condition or medication.

Another way is to suggest that it is time for both of you to have a physical check-up. Any expressed anxiety by the person is an excellent opportunity to suggest a visit to the doctor. Be sure to provide a lot of reassurance. A calm, caring attitude at this time can help overcome the person's very real worries and fears.

Sometimes, your friend or family member may refuse to visit the doctor to ask about their symptoms. You can take a number of actions to get support including:

• talking with other carers who may have had to deal with similar situations
• contacting your local Aged Care Assessment Team (ACAT)
• calling the National Dementia Helpline.

Where to get help

• Your GP (doctor)
• Your local council
• Your local community health centre
• National Dementia Helpline, Dementia Australia Tel. 1800 100 500
• Aged Care Assessment Services
• My aged care Tel. 1800 200 422
• Cognitive Dementia and Memory Service (CDAMS) clinics
• Carers Victoria Tel. 1800 514 845
• Carer Gateway Tel. 1800 422 737
• Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers