A few moments of confusion. A forgotten conversation. A misplaced phone or keyring. Standalone mental lapses aren’t a big deal. But, when they happen often, it’s time to pay attention. The person you love might need help with cognitive decline or dementia.
Mental changes are common, especially as we get older, says Apta Errabelli, MD, an internal and geriatric medicine specialist at The Christ Hospital Physicians-Primary Care. Lapses aren’t always signs of dementia, but it’s important to talk with a doctor if you see them in someone you love or notice them in yourself.
"Cognitive decline, especially dementia, is extremely common with advancing age,” she says. “In adults above age 80, almost one in four people will show signs of cognitive decline or dementia.” Recent estimates show that 1 in 9 people have diagnosed dementia.
The early signs of dementia
Dementia is a specific type of cognitive decline in which at least two brain functions decrease. There are many forms of dementia, but Alzheimer’s disease is the most common one. People with dementia can have problems with memory, attention, executive function, language and the ability to navigate. They may find it harder to complete daily activities or live independently.
If your loved one has always been mentally sharp, it can be a shock when they show signs of mental aging. Not all changes mean they have dementia, though. Some behavioral shifts are normal and should be expected, Dr. Errabelli says.
Normal signs of aging include:
Signs of dementia include:
Asking the same question repeatedly
Depression or change in behavior or personality
Difficulty with organization
Difficulty making financial decisions
Forgetting entire conversations
Frequently losing or misplacing items
Getting lost in familiar places
Language problems (talking less or simpler speech)
Dr. Errabelli says initial changes can be subtle and infrequent, so it’s important to assess your loved one’s behavior over time.
"Pay close attention to how someone speaks and expresses themselves. Observe if their decisions seem logical or reasonable,” she says. “Monitor if the things they are doing make sense or if something seems off about the way they’re using their judgment.”
Diagnosing dementia
No test can say for certain if someone has dementia. Instead, neurologists, geriatricians and primary care providers rely on screenings—like the Montreal Cognitive Assessment (MoCA) test—and in-person conversations, Dr. Errabelli says.
“Classically, when someone has a memory or cognitive complaint, we conduct pencil and paper testing,” she says. “These tests look at different areas of brain function and can tell us whether your loved one’s is normal compared to other people.”
For these tests, your loved one will answer several written questions without any help. The tests take 10 to 20 minutes in the doctor’s office. Screening results don’t provide a diagnosis, but they do give providers a snapshot of what’s going on in the brain at a particular moment. Face-to-face conversations also help determine how well your loved one functions in daily life compared to years past.
Other tools used to diagnose dementia include:
These tests reveal deposits of amyloid and tau, proteins that are linked to Alzheimer’s disease. In fact, research around new blood testing for Alzheimer’s reveals it is 90 percent accurate in detecting Alzheimer’s disease in people who show signs of cognitive decline. However, Dr. Errabelli says these tests aren’t frequently used because they’re newer, expensive and require a specialist.
Inherited dementia is rare, but genetic testing is also available to identify the APOE4 protein associated with its development.
Treating dementia
Reversing dementia isn’t possible. However, providers can prescribe medications like memantine and acetylcholinesterase inhibitors to improve your loved one’s daily functioning. These medications increase various nerve transmitters in the brain to temporarily control dementia symptoms, but they can’t stop long-term decline.
Dr. Errabelli says the Food & Drug Administration recently approved several new monoclonal antibody infusion therapies to treat diseases like Alzheimer’s.
“These medications target proteins that accumulate in the brain of patients with Alzheimer’s disease,” she says. “The data is a little controversial on how effective these infusions are and whether they help improve function. But, according to the research, they seem to clear the protein from the brain.”
Alongside medication, Dr. Errabelli recommends these lifestyle behaviors to strengthen brain functioning:
Drinking plenty of water
Eating a brain-healthy Mediterranean diet
Engaging in stress-free social interaction
Exercising regularly, such as walking 20 minutes a day
Getting enough sleep
Reviewing all medications and supplements with your doctor
Talking about dementia
Starting a conversation with your loved one about their mental changes can be difficult. But Dr. Errabelli recommends speaking up when you notice frequent lapses. Your talk could encourage your loved one to visit the doctor and perhaps get an early diagnosis.
“It’s important to diagnose cognitive changes early because our brain is very dynamic. It can change, grow and improve,” she says. “If you diagnose dementia in the early stages, you still have a lot of brain that may be functioning well. And you can strengthen it.”
Before you talk with your loved one, collect as much information as you can about their mental changes. Then, approach the discussion in a compassionate, non-threatening, non-accusatory way. Your loved one may have already noticed some changes. They could be ready to make an appointment with their primary care provider, who could refer them to a neurologist or geriatrician for specialty care.
If your loved one becomes defensive or denies they’re having problems, take steps to protect them as much as possible.
“Your top priority is putting safeguards around them,” she says. “Be sure there are guardrails in place so they’re taking their medication correctly, that their communications with other people are safeguarded and that their finances are protected.”
Ultimately, she says, maintaining a supportive relationship with your loved one is critical.
“It’s important that you nurture the relationship with your loved one,” she says. “It’s critical that you be there to provide care that’s needed and help them.”