When we think of the phrase “cognitive decline,” the most common symptom that comes to mind is memory loss. In popular culture, the “senior moment” has become a cliché, with many older people wondering whether those episodes of minor forgetfulness are in fact the early warning signs of something more worrisome. (We wrote about the topic of normal brain aging just a few weeks back here on the Blog.)
However, memory loss isn’t the only signal that you or someone you love might be experiencing cognitive decline. We just came across this article in the New York Times in which personal health reporter Dana Smith lists several other concerning signs that may merit further medical scrutiny. If these warning signs are starting to occur more frequently in the behavior of someone you love, it could be time for further cognitive assessment.
Let’s take a look at Smith’s findings. (Please note that a subscription may be required to access the New York Times article, but we’ve done our best to include the gist of the article here.)
Forgetfulness Not Always the Primary Symptom of Dementia
Smith begins, “Memory loss is the most well-known symptom of dementia, particularly Alzheimer’s disease. But experts say there are other warning signs that can signal early brain changes — ones that are especially important for types of dementia where forgetfulness is not the primary symptom.”
Experts are quick to add that these issues aren’t exclusive to dementia, but could be attributed to other health-related changes or even an “off” day. Still, they are worth paying attention to, especially if they become a pattern or appear in combination.
Let’s look closer.
Dementia Can Bring On Financial Problems
Early signs of dementia can be found in money problems or declining credit scores, years before memory loss or other more obvious symptoms emerge in a person. “They might forget to pay their bills, for instance, or no longer be able to stick to a budget,” Smith writes.
Dr. Winston Chiong, a professor of neurology at the University of California, San Francisco, explains, “One of the reasons why financial mismanagement can be a sensitive indicator is just because it’s so complicated.” He adds that financial literacy involves the interplay of multiple brain regions, which is why finances can be one of the first areas where “cracks in someone’s cognition” start to appear.
Financial Behavior Linked to Specific Type of Dementia
This difficulty with finances might be a particular indicator for a certain relatively rare type of dementia, called frontotemporal dementia. In this version of the disease, judgment is affected very early on. Smith writes, “Some people with this condition might make big, impulsive purchases. Others might trust people they would not normally, increasing their risk of being scammed.”
Dr. Chiong adds, “People with frontotemporal dementia are less sensitive to potential negative consequences.” This might lead them to have increased “susceptibility to different kinds of manipulation,” or they may be “more likely to be wasteful with money or careless with money.”
For more on frontotemporal dementia and the sad story of actor Bruce Willis, check out this Blog article from early 2023.
Dementia Can Trigger Sleep Disruption
Normal aging does have an effect on sleep, and sleep disorders can become more common as people get older. Smith writes that “older adults tend to sleep more lightly and go to bed and wake up a little earlier than they used to — that is completely normal. But if there are dramatic changes in someone’s sleep habits, where they are starting their morning at 3 a.m. or are unable to stay awake during the day, it can be a sign of dementia.”
Joe Winer, an instructor of neurology and neurological sciences at Stanford University, explains, “Some of the brain regions, like in the brainstem, that are really important for regulating sleep and wake cycles are the first that are affected by Alzheimer’s disease. So years before someone has any signs of memory symptoms,” they might experience changes in their sleep patterns.
Some Conditions Cause Unusual Dream Behavior
Smith writes, “One change that can occur specifically with dementia with Lewy bodies — another type of progressive brain disorder — is that a person might begin acting out their dreams. This is also true for Parkinson’s disease, which is related to dementia with Lewy bodies.”
Normally, our muscles become paralyzed while we’re in REM sleep, and this is when we usually have the most vivid dreams. But in these two neurodegenerative disorders, toxic proteins attack the cells in the brainstem that control that paralysis.
According to Dr. Ronald Postuma, a professor of neurology and neurosurgery at McGill University, this condition—called REM sleep behavior disorder–is not just normal sleep walking or sleep talking. Instead, at his clinic, patients typically come to see him after their “bed partner has told them that they were hitting them, screaming, yelling during their dreams.”
Dementia Can Cause Personality Changes
“In a study published last year, researchers found that people with dementia experienced slight drops in extroversion, agreeableness and conscientiousness before they showed any signs of cognitive impairment,” Smith writes.
Angelina Sutin, a professor of behavioral sciences and social medicine at Florida State University, led the study. She says that these personality changes accelerated as more dementia symptoms emerged.
The research was conducted using a standardized personality test, but there are some everyday examples of behavior that you can look out for. Dr. Sutin explains that a decrease in extroversion might look like a person becoming more withdrawn, or narrowing their social circle. It might be easier to notice that someone is “not going out as frequently anymore than to recognize how much their memory has declined,” she says.
Changes Can Appear Suddenly or Gradually
In some types of dementia, certain personality changes might happen quite suddenly as a result of damage occurring in the brain. This is common in frontotemporal dementia, for example, where “a decline in agreeableness, where the person becomes less trusting and friendly, is linked to decreased brain volume in the frontal cortex — a key component of the condition,” Smith writes.
But at other times and in other types of dementia, the changes might arise gradually. “For example, a person with Alzheimer’s disease might appear to be less conscientious, becoming increasingly disorganized or having difficulty completing work or household tasks as their memory declines,” Smith explains.
Dementia Can Lead to Difficulties With Driving
Next to dealing with finances, driving is one of the most complex cognitive behaviors that people engage with daily. Dr. Ganesh Babulal, an associate professor of neurology at Washington University in St. Louis, demonstrated in his research that problems behind the wheel can show up years before they do elsewhere.
Driving “is this ultimate blend of the cognitive system,” says Dr. Babulal. “And if there’s one thing that’s out of whack, that unfortunately will compromise and shift the driver from being in control to being at a risk for a crash or a collision.”
Impairment can appear as scratches on a car, getting into fender benders or near misses, or even running stop signs or stoplights. Braking or accelerating suddenly or taking turns too fast could also be warning signs. Dr. Babulal adds that the result could be drivers choosing not to drive as much, especially at night, in bad weather, or during peak traffic. They may even feel reluctant to drive with passengers in the car, especially grandchildren.
Other physical issues typical of old age can curtail driving, like vision problems, neuropathy, or the side effects of certain medications. But, Smith says, if you notice troubling changes in someone’s ability to drive, it might be worth having the “car key conversation.”
Dementia Can Rob People of Their Sense of Smell
Smith concludes her article with one of the more unusual signs of dementia: the loss of a reliable sense of smell.
“Parts of the brain that control smell, known as the olfactory system, are among some of the first areas damaged in Alzheimer’s disease and dementia with Lewy bodies; this is also the case for Parkinson’s disease,” she writes. “Many people with these conditions begin to lose their sense of smell years, or even decades, before other symptoms appear.”
It’s worth noting that different types of brain diseases seem to affect people’s sense of smell in different ways. Smith tells us that Alzheimer’s for example, seems to make people misidentify smells instead of getting rid of odors altogether. Dr. Postuma says of his Alzheimer’s patients, “They go, ‘What a lovely smell. It smells so sweet. It must be gasoline.’” While in contrast, he adds, those with Parkinson’s and dementia with Lewy bodies are often “skeptical that I am even giving them a smell at all.”
Hearing and vision loss can be risk factors for dementia but are not thought to be caused by the disease itself. On the other hand, loss of smell appears to be one of the earliest warning signs of neurodegeneration, and part of the vital tapestry of catching signs of dementia as early as possible.
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(originally reported at www.nytimes.com)