Is It Dementia? Maybe or Maybe Not
Other conditions come with similar symptoms, experts say
Most people recognize memory problems as a hallmark of Alzheimer’s disease and other types of dementia. As soon as we, or a loved one, begin to exhibit an inability to remember words, names or what took place moments earlier, we worry: Is it dementia? Are these dementia symptoms?
Other signs, including behavioral changes and general apathy, also may indicate the early stages of a degenerative brain disease.
Or they may be pointing to something completely different.
Dementia is a fairly broad term, said Joel Kramer, a professor and director of the Memory and Aging Center Neuropsychology program at the University of California, San Francisco. "Dementia just really means someone has cognitive or behavioral problems to the point where it significantly interferes with their ability to take care of themselves and engage in their typical day-to-day activities," he said.
There are dozens of things that can cause dementia or dementia-like symptoms, Kramer said. One category involves neurodegenerative diseases such as Alzheimer’s, frontotemporal dementia, Parkinson’s and Huntington’s disease. Those are the kinds of things we tend to think of first.
“These are very specific brain diseases,” Kramer said. “They have an insidious onset, gradual progression, and at this point we don't have any cures.”
Certain medications can help with symptoms, but each disease will continue to get worse with time, he said.
The other major category is non-neurodegenerative causes of dementia. Some of those are treatable and reversible. Others may be treatable but the underlying cause will persist.
Examples of these, according to Kramer, are:
- Cerebrovascular disease A series of small strokes, or one or more larger ones, can cause dementia symptoms. This so-called vascular dementia is probably the most common cause of dementia in people over 60 who don’t have a neurodegenerative disease, Kramer said. With small strokes, most people will not even be aware they had them. “If you take 100 people in their 70s who will deny they've ever had a stroke and you do MRI scans, you'll probably find 20 people who have evidence for a small stroke or vascular injury to the [brain],” he said.
- Autoimmune disorders Examples of these disorders, which can cause dementia symptoms, include Hashimoto’s thyroiditis and herpes encephalitis, Kramer said. They can come on suddenly; the body mounts an autoimmune response to a particular protein. A small tumor can also spur an autoimmune response, he said. “If your doctor's not aware of these conditions, they might be missed.”
- Tertiary (late stage) syphilis When syphilis progresses to this stage without treatment, it can cause dementia. But with antibiotics, the underlying infection can usually be cured.
- Medications Certain types of drugs can cause dementia-like symptoms, particularly in older adults. Medications called anticholinergics block acetylcholine, a key neurotransmitter. This leads to lower brain function, which people often experience as sedation. The drugs include things that we might normally not think twice about taking. They include sedating antihistamines (such as Benadryl), motion sickness drugs (such as Antivert), pain relievers with sleep aids (such as Tylenol PM) and muscle relaxants (such as Flexeril). The danger of these drugs in older adults grows when multiple physicians prescribe medications that don’t mix or whose effects compound each other.
- Nutritional deficiencies A lack of certain vitamins, such as vitamin D, may lead to dementia. One large 2014 study showed people with very low levels of vitamin D were more than twice as likely to develop Alzheimer's or other types of dementia than those with normal levels, according to the Mayo Clinic. But more study is needed to prove a cause-and-effect relationship, Mayo said. A lack of vitamins B-6 and B-12 and dehydration can also cause dementia-like symptoms, Mayo said. So can a lack of thiamine (vitamin B-1), which is common among people with chronic alcoholism.
- Metabolic and endrocrine problems These include low blood sugar, thyroid problems and having too much or too little sodium or calcium in the body, the Mayo Clinic said. Liver and kidney dysfunction can result in dangerous levels of toxins in the blood, which can also cause dementia-like symptoms, Kramer said. These conditions are often treatable and reversible, he said.
- Lyme disease If left untreated, Lyme disease, caused by the bite of an infected deer tick, can cause memory loss, according to the U.S. Centers for Disease Control.
- Emotional problems Depression is sometimes diagnosed as dementia, particularly when frontotemporal dementia (FTD) is suspected. Caregivers often report apathy as the first symptom in people with FTD. That’s a common marker of depression, too, and doctors may assume that’s what is wrong. Apathy can also be a very early symptom in Alzheimer’s disease, Kramer said.
Testing Is Vital
Since so many other conditions may resemble dementia, it’s important to get a thorough evaluation if you or a loved one is having symptoms, Kramer said. He recommends seeking a doctor with some expertise in dementia.
And if you are fortunate enough to be cognitively healthy, remember that eating a healthy diet and getting regular exercise may help keep your brain in good shape.