Distinguish Real Signs and Symptoms of Dementia from Depression or Normal Aging

Man is a pattern-seeking creature. It’s built into humanity, a function of evolution. We form shapes out of randomness and make faces from shadows and mountains on a cold and distant moon. Evolutionary psychologists think our capacity—some would say need—to do so springs from having to spot the movement of predators or prey on a savannah teeming with chaotic nature. It helps us spot danger. It might be the reason why, when talking to an aging loved one, we are sure we see dementia in every forgotten name or misplaced memory.

That’s a normal part of helping a loved one as they get older. Mental illnesses are very real and losing someone you love inside their own mind is one of the greatest fears we face, which makes us hyper-alert for any signs. While on the whole this is good, we also need to know how to distinguish signs and symptoms of dementia from normal symptoms of aging, and especially from depression. Depression is an altogether different condition, and needs to be taken seriously and treated. Consigning everything to a stereotypical senility  is medically incorrect, and isn’t the best way to help someone you love, which is why knowing the signs is so important.

Understanding The Types and Signs of Dementia

Although in popular language saying “she might have dementia” is broadly accepted, it is an inaccurate phrasing. Dementia isn’t a specific disease, but an umbrella term for many different types of declines in mental ability. The most common of these is Alzheimer’s, which accounts for anywhere between 60-80% of dementia cases. Other types include vascular dementia (most commonly found after a stroke), frontotemporal dementia, Huntington’s Disease, or Dementia with Lewy Bodies (also known as Lewy Body Dementia, a disorder made widely known after the tragic suicide of Robin Williams).
All of these illnesses have specific, but often overlapping symptoms. Some of the early warning signs can include:

• Repetitive questioning
• Short-term memory changes
• Verbal aphasia (not being able to find the right word; struggling with language)
• General apathy or listlessness
• Sudden and unpredictable mood changes
• Difficulty following the conversation or understanding what is happening (like being unable to follow the plot in a movie, only in real life)
• Difficulty doing normal tasks
• Getting lost in normal places

There are of course more signs, and some that are more prominent and idiosyncratic, such as hallucinations with Lewy Body Syndrome, or having severe memory loss, but being otherwise unimpaired and fully-functioning, as in Wernicke-Korsakoff Syndrome. But those are more overt disorders. The problem is knowing when subtle signs mean something severe.

Understanding Normal Aging Slowdowns

It isn’t actually unusual to have more trouble remembering things when you are older, especially things that happened a long time ago. Think about when you are 30 or 40: faces of schoolmates fade into a greyish blur and you don’t remember every teacher’s name you’ve ever had. The brain is a magnificent and willful computer; it sorts what it feels are needed memories and locks others away so that we can function. As you get older, there are more and more memories that need to be sorted. That’s why when an aging loved one is telling a story from a long time ago (or maybe not that long ago) details get lost, and they start and stop again. “Was that Mike—no, it was Larry!” It’s easy when that happens to think, “Dad is losing it.” But that’s normal. The brain is a physical part of our body, and just as a 70-year-old can’t jump as high as when he was younger, mental facilities become slightly more rigid as well.
Clinically, signs of dementia come from having “multiple cognitive deficits,” with short-term memory being an early sign. Dementia isn’t just forgetting things; it is the growing inability to live independently. Think of it like this: when you lose the plot in the movie, you might forget why the lead character suddenly has an Australian accent and is going undercover in the Sydney Mafia. In real life, an aging loved one might forget the part where they set the alarm, pay bills, or even eat. It isn’t being scatterbrained; it is being unable to take care of yourself. Those are the signs loved ones should be looking for.

Signs of Dementia vs. Depression

This is a far more serious issue and one that is often overlooked in our understandable rush to see any signs of creeping mental illness. Senior depression is a devastating condition, brought on by a confluence of events, including feeling helpless, losing friends, isolation, and the fear of dying. It is too often marked by an inability and reluctance to talk about it, which makes it doubly difficult for loved ones to understand what is going on.
One of the problems is that many symptoms tend to overlap with dementia. Apathy, mood changes, confusion, loss of appetite, difficulty doing simple tasks, sudden crying, an inability to take care of oneself, and other signs can often be interpreted as dementia. But depression is an altogether different condition, and one that very seriously needs to be treated.
The first step is knowing what you are dealing with. While it may be hard to get someone struggling with depression to perform a memory assessment test, it might be vital to understanding their condition. If depression is diagnosed, outpatient psychotherapy may be the best way to go. Getting help may be the best way to allow our aging loved ones to enjoy their later years and to see them as a vital and exciting part of life, to try new things and to embrace the possibilities. Thinking “mom is getting senile” when mom is really crying desperately for help is a compounding tragedy that can echo for years.
Other than looking for patterns, one thing humans are very good at is making little jokes to stave off being sad or scared. We say “the old gal is losing it” and laugh a little bit so that we don’t have to think of what it really means. But dementia and depression are serious issues, and they can both, to varying extents, be treated or slowed down if caught early enough. So while it is important not to overreact, it is also important to see the man in the moon for what he really is.
When families, caregivers, and older adults are concerned about memory loss, dementia, and other aspects of aging, The Institute on Aging is ready to offer support and guidance. Please contact us today to learn about our programs and resources.