Cognitive decline is the health condition seniors generally fear the most. The thought of a gradual slide into dementia terrifies many of us, which is why we tend to overreact at every minor mental slip-up. If I’ve misplaced my glasses, does that mean Alzheimer’s disease is lurking just outside the door?

Fortunately, the answer is no. But there’s another aspect of the fear of dementia that more seniors and families should be aware of: there are several very treatable medical conditions that can mimic the symptoms of cognitive decline. Sometimes even doctors are fooled, which can lead to tragic misdiagnosis.

This week we discovered this thought-provoking article from US News in which reporter Barbara Sadick lists at least eight “dementia mimics.” If you or a loved one starts exhibiting worrisome symptoms of cognitive decline, consider whether or not one of these common conditions might be the culprit. Moreover, when seeking medical treatment, make certain your doctor – hopefully one who specializes in geriatric medicine – is asking the right questions.

Dementia Mimics Cause Loss of Memory and Coordination

Sadick begins her article with the story of Alan Baker, a Spokane, Washington resident who embarked on a five-year-journey of misdiagnosis when his wife, Mary, noticed some signs of cognitive decline in her husband. Alan, then 72, made 18 hospital visits in the first six months. He was diagnosed with a vitamin deficiency, told he’d had a stroke, and eventually doctors insisted that he had dementia.

“But Mary didn’t think so, and she persevered in a search for answers,” Sadick writes.

It was finally a doctor in Spokane—after seemingly unending hospital visits—who diagnosed Alan with normal pressure hydrocephalus (NPH), “a brain disorder that occurs when excess cerebrospinal fluid accumulates in the brain’s ventricles, causing problems with walking and cognition that could easily be mistaken for dementia,” Sadick explains.

She continues, “After confirming the diagnosis with an NPH specialist, a neurosurgeon placed a shunt in Alan’s brain for three days to begin the process of draining excess fluid. Gradually, Alan’s cognitive skills began to improve, and he was able to talk, feed himself, dress himself and move again. Eventually, a permanent shunt was implanted in his brain.”

Alan is now 82, and has most of his faculties restored. He travels with Mary, works in the yard, and makes breakfast daily. He even recently renewed his driver’s license.

“Dementia Mimics” Require a Thorough Medical Evaluation

Dr. Vanessa Rodriguez, an associate professor of geriatrics and palliative medicine at Mount Sinai Hospital, says, “Many health conditions can be confused with dementia, so if you find yourself or a loved one suddenly experiencing cognitive changes, immediately seek medical attention and a thorough evaluation instead of falling into a trap of thinking you have dementia.”

Sadick presents us with the following common health conditions that can be easily mistaken for dementia. We’re calling them “dementia mimics.” Let’s take a closer look.

Dementia Mimic #1: Delirium

According to Sadick, delirium is “a mental state in which you can quickly—within hours or days—become confused, disoriented and unable to think clearly.”

While delirium can cause people to act out of character and resembles dementia, it is not neurodegenerative and does not evolve over months or years, causing damage to the brain the way dementia does. Symptoms include agitation, stress, drowsiness, social withdrawal, reduced situational awareness, difficulty performing everyday tasks, difficulties speaking or following conversations, hallucinations, and mood swings.

Delirium can be common in older adults, though a person of any age can experience it, and it is often caused by infections and fevers, pain or physical injury, electrolyte imbalance and dehydration, thyroid dysfunction, poor nutrition, metabolic disorders, drug withdrawal, and more.

“If the underlying conditions causing delirium are treated properly, it’s usually reversible,” Sadick writes.

Dementia Mimic #2: Depression

Sadick defines depression as “a serious mood disorder that causes persistent feelings of sadness and changes how you think, act, sleep and eat. Left untreated, it can cause confusion, forgetfulness and significant cognitive decline. It can also cause you to lose interest in everything going on around you.”

Dr. David Reuben, chief of the geriatrics division at UCLA, says that many aspects of depression can look like dementia, especially withdrawal, apathy, and not being quite as quick or nimble as usual.

That said, he says that dementia patients are usually disoriented, while those with depression may simply have trouble concentrating. People with depression are more likely than those with dementia to notice their own memory problems, and are less likely to have issues with writing, speaking, and motor skills.

“Unlike dementia, mood, concentration and intellectual function can improve when depression is properly treated with medications and therapy,” Sadick writes.

Dementia Mimic #3: Medication Side Effects

“Certain medications can affect older adults and cause cognitive side effects that can be mistaken for dementia,” Sadick explains. “Common reactions to specific drugs or to multi-drug interactions can cause confusion, memory lapses and difficulty concentrating.”

Older bodies process medications differently than younger ones, which can make adverse reactions more prevalent. “Due to an increase of fat storage in older people and a decrease in renal function, the length of time medications live in an older body can be seriously increased,” Sadick adds.

The following common prescription medications that can cause side effects easily mistaken for dementia:

Acetylcholine blockers: These drugs block acetylcholine, a type of neurotransmitter, in order to inhibit involuntary muscle movements and various body functions. They are prescribed for conditions like insomnia, bladder control problems, depression, heart disease, Parkinson’s disease, and others.

Benzodiazepines: Medications such as Valium, Xanax, Halcion, Ativan and Klonopin are used to treat anxiety and insomnia. They have a sedative effect that can cause cognitive problems.

Corticosteroids: These are a kind of inflammatory drug, like cortisone or prednisone, used to treat diseases like rheumatoid arthritis, lupus, and vasculitis.

Chemotherapy medications: According to Sadick, “Chemo brain” is a condition caused by chemotherapy drugs that can affect memory, focus, attention and other mental processes.

While these more powerful prescription medications are the most likely culprits to result in dementia-like symptoms, over-the-counter drugs can have such side effects, too. Antihistamines, like Benadryl, and sleep aids (Tylenol PM, Aleve PM, and Nytol) can also cause confusion. “Don’t assume medications are safe simply because they don’t require a prescription,” Sadick warns.

If you or a loved one is experiencing changes in memory or cognition, make sure your medical provider reviews the list of all the medications you’re taking and stops any that may cause confusion.

“Sometimes, the effect on the brain happens right after taking a new medication, but other times it takes months or years before a drug begins affecting your brain,” warns Dr. Milta Oyola Little, a geriatric medicine specialist at Duke Health.

Dementia Mimic #4: Dehydration

Sadick defines dehydration as what “occurs when you lose more fluid than you take in and the body doesn’t have enough water and other fluids to carry out its normal functions.”

Low hydration levels compromise brain cell functioning, which can cause delirium, weakness, confusion, difficulty with focus and concentration, slow reaction time, muddled thinking, lethargy, and exhaustion. All of these can be confused with dementia.

Because the brain is made up of 80 percent water, brain tissue shrinks in size when it doesn’t get enough, and it only takes a 2 percent decrease in brain hydration to cause short term memory loss. Older people are at higher risk of dehydration thanks to less efficiency in retaining water as well as lower kidney functioning. Some medications can also cause water loss in the body.

“With proper hydration, cognitive problems caused by dehydration will go away, whereas cognitive dementia symptoms do not,” Sadick writes.

Dementia Mimic #5: Vitamin B12 Deficiency

Sadick explains that vitamin B12 “is an essential nutrient that helps your body keep your nerve cells and blood cells healthy. Because your body doesn’t produce this vitamin on its own, you need to get it from foods high in vitamin B12, such as meat, poultry, dairy, eggs and fortified foods (like cereals, bread and nutritional yeast).”

As we age, our bodies’ ability to absorb this essential vitamin can decline, leaving older people at a higher risk for deficiency. A lack of vitamin B12 can cause some dementia-like problems, including memory loss, agitation, depression, delusion, and paranoia.

“Unlike dementia, though, a B12 deficiency can be reversed with weekly shots of vitamin B12 or vitamin B12 supplements,” Sadick writes.

Dementia Mimic #6: Thyroid Imbalances

“The thyroid is an endocrine gland at the front of the neck that makes and releases certain hormones,” Sadick explains. “Its job is to control the speed of metabolism, which is the process by which the body transforms the food you consume into energy. Every cell in the body needs energy to function, including the brain.”

Two different thyroid dysfunctions can develop gradually and lead to cognitive problems that mimic dementia:

Hypothyroidism is when the thyroid doesn’t produce enough thyroid hormone, which slows your metabolism. Extremely low thyroid levels—called myxedema—can cause confusion, forgetfulness, and brain fog.

Hyperthyroidism is when the thyroid release too much thyroid hormone, which can lead to attention issues, like problems with focus and concentration.

Unbalanced thyroid hormone can affect learning and memory in the hippocampus, the part of the brain that stores memories and plays a role in spatial awareness and navigation. All of this can lead to easy misdiagnosis of dementia in older people suffering from thyroid problems.

“When an older person appears to have dementia, experts say the thyroid levels should be immediately checked using a blood test,” Sadick writes. “If thyroid levels are low, they can be treated with hormone replacement therapy. If they’re high, anti-thyroid medications can restore hormone levels.”

Dementia Mimic #7: Urinary Tract Infection

Sadick defines urinary tract infections (UTIs) as “common urinary health issues caused by bacteria entering the urinary tract.”

Typical symptoms include needing to urinate often, pain and burning while urinating, and pain in the side or lower back. But UTIs can also cause cognitive dysfunction symptoms similar to delirium. Infection in the body triggers the immune system to fight it, releasing chemicals that create inflammation. The brains of older people are more affected by stress and inflammation than those of younger people, and this can look like delirium – and by extension, dementia. 

UTIs can cause agitation, restlessness, confusion, an inability to perform familiar tasks, memory loss, and even hallucinations. But unlike dementia, UTI symptoms come on quickly and are often missed in older people because they don’t show the typical symptoms of fever and pain. That said, Sadick writes, “UTIs are treatable with antibiotics and lots of fluid, rest and a healthy diet.”

Dementia Mimic #8: Normal Pressure Hydrocephalus

Finally, Sadick returns us to the diagnosis that ultimately solved the mystery for Alan Baker of Spokane: normal pressure hydrocephalus, or NPH.  

Sadick explains that the brain is made up of chambers, called ventricles, which contain a fluid called cerebrospinal fluid (CSF). This cushions the brain and spinal cord from injury and provides nutrients to the body. While the body usually makes just enough CSF every day and absorbs it, too much fluid can build up in the ventricles. This is called normal pressure hydrocephalus and results the ventricles swelling and pressing against the nearby brain tissue, potentially resulting in changes to and even damage to the brain itself.  

This relatively uncommon condition usually affects older adults, and symptoms can resemble Alzheimer’s disease: difficulty walking, confusion, forgetfulness, mood changes, depression, and difficulty with thinking and conversing.

“The Hydrocephalus Association estimates that almost 700,000 adults have NPH, but it’s often misdiagnosed as one of the stages of Alzheimer’s disease or Parkinson’s disease. In fact, less than 20 percent of people with NPH are diagnosed properly,” Sadick writes.

But unlike dementia, early diagnosis of NPH prevents long-term problems and can even be treatable and reversible with physical exams, scans, and a shunt used to prevent fluid from building up.

The Bottom Line: Beware of Hasty Misdiagnosis

Sadick concludes with the warning: at the first sign of dementia-like symptoms, don’t delay in seeking diagnosis, and make sure you’re armed with the right questions.

Dr. Reuben of UCLA says that doctors need to be better trained to understand the wide array of problems that can cause cognitive abnormalities in older people. “Every case of cognitive decline is not dementia,” he says. “Some can be treated and reversed, and others may just be normal aspects of aging, but we are continually pushing toward early evaluation of dementia-like symptoms.”

Sadick adds, “To avoid a misdiagnosis, older adults should undergo a cognitive assessment, such as the SAGE test, as part of their annual wellness visit. If there are concerns about cognitive issues or uncertainties about symptoms, it’s important for patients or family members to voice them to their doctor and ask for an evaluation.”

(originally reported at https://health.usnews.com)