Is it dementia or normal aging?

Q: My mother is 77 years old. Lately, she has been very forgetful. Initially, we thought that is was just age-related, but two weeks ago she went to visit a friend of hers and couldn’t find her way home. The other day, I found a box of unused high blood pressure medication in her room – she had forgotten to take them for over a month (despite regularly taking them for over 10 years).

Everyone around her feels that she is just getting on with age and that ‘these things happen’ when you reach a certain age. I am, however, very worried. My mother is very independent and active and insists on living alone.

She cooks for herself, takes care of a couple of livestock and even tends to a small garden. I feel that she should no longer live alone because her forgetful nature may put her in harm’s way (for example, she could forget to put off the stove and burn the house down). Could this forgetfulness be a sign of dementia or is it just normal ageing?

--------------

You are quite right to be worried about your mother. The incidents you describe are not normal age-related memory loss episodes. They are red flags pointing towards the development of dementia.

Here is a quick comparison between normal age-related changes and dementia.

Disrupts life

Normal ageing: It is normal to forget things from time to time. Your life, however, is not disrupted by the memory loss. For example, you may forget where you put your spectacles case.

Dementia: Memory loss is so profound that you may even forget how to perform activities that you were previously well accustomed to. For example, you may forget how to drive, or how to use the microwave/cooker or get back home after going for a walk.

Forgetting names

Normal ageing: You may not remember the name of people you were recently introduced to or people you do not regularly see.

Dementia: Forgetting the names of your children or people you interact with daily.

Misplaced items

Normal ageing: You misplace an item, but can slowly retrace your steps until you find it.

Dementia: You do not have the ability to retrace your steps to locate a misplaced object. You sometimes place objects in odd places. For example, you may put the house keys inside the fridge. You are constantly accusing people around you of stealing objects only for them to be found in odd places around your home.

Which day is it?

Normal ageing: Occasionally, the elderly can forget which day (or date) it is, but with a little self-prodding, most of them can figure it out.
Dementia: Lose track of days and even months. Even after being reminded, they often shortly forget.

Drug mishaps

Normal ageing: Forgetting to take a single dose (either because it is not your regular medication or you broke your usual daily routine).
Dementia: Not being aware that you are supposed to take medication at all.

Repeating stories

Normal ageing: It is not unusual to have an elderly person repeat something they had said earlier. They may even have a favourite story which they tell each time there is a family gathering. Often, if you let them know that they had told you the same thing before, they will acknowledge it and not repeat themselves again.

Dementia: You repeat statements (or even actions, like greeting someone) multiple times within a short period of time. Even after it is pointed out to you that you had said something earlier, your brain does not acknowledge it.

Changes in mood

Normal ageing: Occasional episodes of anxiety, anger or low spirits. Often, this can be explained by the circumstances which the person was going through at the time.

Dementia: Unexplained episodes of depression, anxiety, fear and social withdrawal. There may even be irritability, loss of inhibition and violence. Occasionally, there may be delusions.

Poor hygiene

Normal ageing: May occasionally wear a shirt with a missing button or put on a petticoat that is longer than the dress.

Dementia: No longer able to care for their personal hygiene. May not even be aware that they need to take a bath or change their clothes.

Evaluation by physician

There are several causes of dementia and it is important that your mother is fully evaluated by a qualified physician. He or she will be able to determine if there is another health condition that may have led to your mother’s mental decline.

Not all dementia is Alzheimer’s disease

Most people assume that dementia in an elderly person is always due to Alzheimer’s disease. This is, however, not true. Dementia can be due to several causes. These include:

• Vascular dementia: this usually occurs after multiple strokes and is due to compromised blood supply to the brain. Vascular dementia is more common amongst diabetics and people with high blood pressure.

• Infection: Diseases such as syphilis and HIV may affect the brain and cause dementia.

• Neurological disorders such as Parkinson’s and Lewy body disease (not everyone with Parkinson’s, however, gets dementia)

• Alcoholism: Nerve tissue is often destroyed by alcohol abuse. This is often related to Vitamin B deficiency.

• Brain trauma: Injury to the brain after an accident or fall can result in severe damage (symptoms of dementia can develop several weeks after the injury).

For this reason, any elderly person presenting with features of dementia must be fully assessed by their doctor.