Early Signs of Dementia and Alzheimer's: When to See a Neurologist

Almost everyone forgets a name or misplaces their keys from time to time, and these lapses become more common with age. But when memory and thinking problems start to interfere with daily life, they may be early signs of dementia. Knowing the difference, and seeking an evaluation early, can make a meaningful difference for patients and their families.

What Is Dementia?

Dementia is not a single disease. It is a general term for a decline in memory, thinking, language, judgment or behavior that is severe enough to affect a person's independence in everyday activities. Several different conditions can cause it:

• Alzheimer's disease, the most common cause, typically begins with difficulty remembering recent events and new information.
• Vascular dementia results from strokes or reduced blood flow to the brain and often affects speed of thinking and planning.
• Lewy body dementia may cause fluctuating alertness, visual hallucinations, sleep disturbances and Parkinson-like movement changes.
• Frontotemporal dementia often starts earlier in life and first changes personality, behavior or language.

Many people have more than one process at once, especially Alzheimer's changes combined with vascular disease.

Normal Aging or Early Dementia?

Some changes are typical with age: thinking a bit more slowly, occasionally forgetting a name but remembering it later, or walking into a room and forgetting why. The difference with dementia is that problems are persistent, progressive and disruptive.

• Typical aging: occasionally missing a payment. Possible dementia: no longer able to manage monthly bills.
• Typical aging: forgetting which word to use. Possible dementia: trouble following or joining a conversation.
• Typical aging: misplacing things and retracing steps to find them. Possible dementia: putting things in unusual places and being unable to find them.
• Typical aging: forgetting the day of the week and remembering later. Possible dementia: losing track of the season or the year.

Early Warning Signs to Watch For

• Memory loss that disrupts daily life, such as asking the same questions repeatedly or relying heavily on notes for things once remembered easily.
• Trouble planning or solving problems, like following a familiar recipe or keeping track of finances.
• Difficulty completing familiar tasks, such as driving to a familiar place or using a remote control.
• Confusion about time or place.
• Trouble with visual and spatial information, including judging distance or reading.
• New problems with words in speaking or writing.
• Poor judgment, such as falling for scams or neglecting hygiene.
• Withdrawal from work, hobbies or social activities.
• Changes in mood or personality, including new anxiety, suspicion or irritability.

Often it is a spouse, adult child or friend who notices these changes first. If family members are concerned, their observations are an important part of the evaluation.

Mild Cognitive Impairment

Between normal aging and dementia lies mild cognitive impairment (MCI). People with MCI have measurable changes in memory or thinking, but they still manage their daily activities independently. MCI does not always progress, and some people stay stable or improve when a contributing cause is treated, but it does increase the risk of developing dementia. Identifying MCI allows closer monitoring and early action.

Treatable Causes of Memory Problems

Not all memory loss is caused by a progressive brain disease. A thorough evaluation looks for conditions that can be treated, including:

• Vitamin B12 deficiency and thyroid disorders.
• Side effects of medications, especially some sleep aids, allergy medicines, bladder medicines, pain medicines and sedatives.
• Depression and anxiety, which can significantly affect concentration and memory.
• Sleep apnea and chronic poor sleep.
• Hearing loss, which strains attention and can mimic memory problems.
• Normal pressure hydrocephalus, a condition that may cause memory changes along with walking difficulty and urinary urgency.
• Excessive alcohol use.

How Dementia Is Evaluated

A neurological evaluation for memory concerns usually includes:

• A detailed history from the patient and someone who knows them well.
• A neurological examination looking for signs of stroke, Parkinsonism or other conditions.
• Cognitive testing to measure memory, attention, language and problem solving. Our office offers NeuroTrax computerized cognitive testing, which measures several domains and can be repeated to track changes over time.
• Blood tests for reversible causes.
• Brain imaging, typically MRI or CT, to look for strokes, shrinkage patterns, tumors or fluid build-up.
• In selected cases, additional biomarker tests, such as specialized PET scans, spinal fluid analysis or newer blood tests that look for Alzheimer's-related proteins.

Preparing for a Memory Evaluation

A little preparation helps the visit go smoothly and makes the results more useful:

• Bring a complete list of medications and supplements, including over-the-counter sleep and allergy products.
• Ask a family member or close friend to come along, or to write down the changes they have noticed and when they began.
• Bring glasses and hearing aids, and get a good night's sleep before any cognitive testing.
• Bring copies of recent blood work and any previous brain imaging reports.

Treatment and Support

While most causes of dementia cannot yet be cured, treatment can help. Medications such as cholinesterase inhibitors and memantine may modestly improve or stabilize symptoms for a period of time in Alzheimer's disease and some other dementias. For people with early Alzheimer's disease confirmed by biomarker testing, newer infusion therapies that target amyloid may slow decline in carefully selected patients, with monitoring for side effects.

Equally important are steps that support brain health and quality of life:

• Controlling blood pressure, diabetes and cholesterol to protect the brain's blood vessels. See our guide to stroke prevention.
• Regular physical exercise, social engagement and mentally stimulating activities.
• Treating hearing loss, depression and sleep problems.
• Planning ahead for safety, driving, finances and legal decisions while the person can take part in those choices.
• Support for caregivers, who carry a heavy load and need help too.

When to Make an Appointment

See a neurologist if memory or thinking changes are new, getting worse or worrying you or your family. A sudden change in thinking, confusion with fever, or confusion together with weakness or trouble speaking needs emergency care.

Memory Evaluation in Westwood, NJ

Dementia is a clinical interest of Dr. David D. Van Slooten and Dr. Lorraine S. Lira. Our practice combines a careful neurological evaluation with in-office computerized cognitive testing to understand what is happening and plan next steps. Learn more about our neurology services or find directions on our contact page.

This article is for general education and does not replace advice from your own physician. If you think you are having a medical emergency, call 911.