Dementia’s devastation may slip under our notice unless we recognize its many manifestations in behavior, speech, and mood.

The neatly dressed, immaculately groomed, and coiffed woman sat before me with a pleasant smile. She wore stylish, designer eyeglasses and looked at me like I were someone she recognized, but we had never met. For a moment, she hesitated, took off her glasses, and put them down on the table between us.

Now the challenge was to determine the level of her dementia, how it was affecting her lifestyle, and whether or not there might be some hope in a new medication that had just been released for clinical trials. Part of the protocol required that she read something, and other parts that she perform an action, or recall items shown to her, and she would need her glasses for these tests.

When asked to replace her glasses, she looked at them as strange objects and had no idea what to do with them. Turning the glasses over and examining them, she still didn’t understand what they were meant to do.

Her daughter, who accompanied her for the evaluation, was almost in tears as she told me, “It has become even worse when we sit down for dinner because she doesn’t know what is food and what utensils are. She often tries to eat her fork, and we have to stop her.”

The woman was in her early 70s and previously had a successful clothing design business. But there had been noticeable slips in her behavior and even her ability to keep her company's accounts correct. A math whiz, she kept blaming it on the sunlight coming in through the windows in her office.

She no longer went to the office after daily arguments, and her suspicion regarding her staff disrupted her business. Previously, she enjoyed good interactions with everyone in the office. Most had worked with her for decades and were shocked at her behavior.

The Thief We Fail to Acknowledge

Dementia prevalence increases in direct correlation with age; it reaches 1% in the 60–64 age group and 24–33 % in the 85+ age group. The term “dementia with late onset” refers to the disorder’s emergence after the age of 65, whereas “early-onset dementia” describes its incidence before that age. The signs may be subtle and even experienced clinicians may miss the probable diagnosis of dementia.

Roughly half of the 600 older persons whose brain scans and health indicators were investigated went on to acquire cognitive impairment. In addition to signs of brain aging, they found that the genotype, specific cognitive test scores, hearing loss, memory problems reported by the individual themselves, and symptoms of depression were associated with future cognitive impairment in older persons who were otherwise neurologically healthy.

According to a recent study, people with dementia start losing weight at least ten years before their symptoms appear, and this process speeds up in the two to four years leading up to the diagnosis. Dementia progression may be accelerated by hormonal and metabolic changes associated with weight reduction.

I can remember a neighbor who lived alone, was in her 80s, and went out several times a week to volunteer with, as she said," the elderly at the local hospital." No, she never saw herself as elderly or incapable of caring for all of her needs.

But one day, she mentioned to me that she had an evil twin coming into her home and hiding things on her. "I know she's hiding things," she said, "because I find them in places I would never have put them." It was at this point that she stopped preparing food for herself, and I had to arrange for a local senior-support organization to deliver meals to her. But things got worse and she was becoming more mentally unstable until she was evaluated by a healthcare professional from that local hospital.

Once the evaluation was completed and she went to meet a team that worked on a dementia-related unit at the hospital where she had volunteered, she related the story of the evil twin. The decision was made that she could be admitted, and they would care for her.

Within months of arriving on the unit, she was discovered to have advanced cancer, had three surgeries, and died. We will never know if her dementia was related, somehow, to her cancer or the use of pain medication for it.

What Do We Look for?

Some of the subtle and not so subtle changes that should be noted in potential neurocognitive changes:

1. Losing track of newly acquired knowledge. Another symptom is an increase in the frequency with which you need to use memory aides, as well as a tendency to forget crucial dates or events.
2. Difficulty maintaining track of regular expenses or following a tried-and-true recipe.
3. Navigating to a known place, problems with a shopping list, or recalling the rules of a beloved game.
4. Sometimes they need assistance with the microwave’s settings or record a TV program.
5. Perplexed by events that do not unfold in real time. They could become disoriented and lose track of their way at times.
6. Has problems maintaining balance or reading. They might also have trouble seeing colors or gauging contrast, which could make them a dangerous driver.
7. Difficulty keeping up with or contributing to a discussion. They might repeat themselves or freeze up in the midst of a sentence, leaving you to figure out what to say next. They might not know how to spell certain words, have problems identifying commonplace objects, or even call something the wrong name (such a “watch” being called a “hand-clock”). One thing to remember is that sometimes there are regional names for certain things such as a door knocker may be called something else.
8. Possibly misplace items and not be able to trace their path back to them. As the illness advances, he or she may begin to falsely accuse others of stealing.
9. Perhaps they are careless with their money or do not keep themselves clean. Lack of care for personal cleanliness can also be caused by depression.
10. Do not participate in extracurricular activities, hobbies, or social gatherings. If they have a favorite team or pastime, they could struggle to keep up. And feelings of bewilderment, suspicion, depression, anxiety, or terror may set in. Whether they are at home, with friends, or somewhere else, they could quickly become agitated.

Although there are numerous changes that we may notice, there are a number of other reasons that some of these changes may be due to something else. We know that medication as well as a loss of active involvement in work or some other activity may be the reason for changes in behavior.

Remember, don't jump to a conclusion that the person is suffering from a cognitive impairment. Go slow, consider everything, and have an evaluation by a healthcare professional.