Aging comes with many changes, not the least of which is occasional memory loss, which tends to worry many people at this time.
These cognitive changes can be totally normal, so there’s no need to panic if you occasionally forget your sunglasses or the name of your son’s former teacher. But there is a clear difference between age-related cognitive changes and dementia.
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About 7 million people in America suffer from dementia, and that number is expected to double by 2060. Experts say cognitive impairment becomes somewhat more severe over time.
“The magic line that transitions someone from mild cognitive impairment to dementia is when one of their cognitive impairments affects function. To me, that’s one of the key parts of defining when someone has transitioned to dementia,” said Dr. Stephanie Nothelle, a geriatrician and associate professor at the Johns Hopkins School of Medicine in Baltimore.
That could mean you can no longer use a car, get lost while driving a familiar route or not be able to pay your taxes after decades of doing them, she said. If cognitive changes make it difficult to get through a normal day, that’s a red flag, she added.
Dementia is an umbrella term that describes multiple forms of cognitive impairment, including Alzheimer’s disease (the most common form of dementia), vascular dementia and Parkinson’s, according to Nothelle.
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The exact manifestations of the disease depend on the actual diagnosis. And while cognitive impairment is a common thread, there are also some physical symptoms that tend to be associated with dementia. Here they are:
1. Gait and balance problems
“I find that many of the most physical manifestations appear later in the course of dementia,” Nothelle said. But there is one physical problem that occurs earlier and worsens over the course of the disease, she said, and that is “one’s ability to walk and maintain balance.”
“The ability to keep your balance and walk smoothly actually takes a lot of brain power because you have to process a lot of different inputs,” Nothelle noted.
You have to process the sensations in your feet, you have to process what your eye sees in the environment around you and more. “You have to react quickly to these things, so it’s a very cognitive task to be able to walk,” Nothelle said.
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Because of this, walking problems, balance problems and frequent falls are a sign of dementia. (But note that these problems aren’t just a sign of disease; they can be caused by arthritis or even clumsiness.)
2. Postural changes and leg movement
The second most common form of dementia is dementia with Lewy bodies, said Dr. Jori Fleisher, associate professor of neuroscience at Rush University in Chicago. It describes several types of dementia, including Parkinson’s disease.
In this manifestation, you may notice changes in posture, wobbly legs, or someone walking more slowly than before, Fleisher said.
While it’s easy to attribute these problems to aging, inattention or arthritis, “if we see a pattern in that, we want to pay attention,” she added.
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3. Changes in the sense of taste and smell
A change in the sense of taste or smell can be attributed to many problems, such as a COVID-19 infection or a history of sinus problems, but outside of the known factors, unexplained changes in these senses can also be linked to dementia.
“Sometimes the person doesn’t notice it, but the loved one says, ‘Hey, something was burning on the stove and you didn’t smell that,'” Fleisher explained.
This is a symptom that should prompt someone to see a doctor. While it may not be a sign of all forms of dementia, it is associated with dementia with Lewy bodies, according to Fleisher.
4. Problems swallowing
People with dementia may also have trouble swallowing food and drink.
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“People will eat or drink, and things will tend to ‘go by mistake,’ so to speak,” Nothelle said.
In this case, the food is actually going down the wrong pipe, she said. “If you have food or liquid going down into your lungs, it shouldn’t be there,” Nothelle noted.
Saliva helps us swallow food and drink, and “our mouth is full of bacteria,” she said. While some of the bacteria is good, some of it is not so good (hence cavities and gum disease), and if those bad bacteria end up in your lungs with food, it can cause you to get an infection, she explained.
“We call this aspiration pneumonia, and that’s why pneumonia is relatively common in late dementia,” Nothelle explained.
Things like swallowing problems, balance problems, and more can all be ways that dementia manifests itself physically. Westend61 via Getty Images
5. Bladder control problems
“Incontinence, unfortunately, can be a symptom of dementia,” Nothelle said.
A lot of nerves are needed for bladder control, “and those nerves degenerate as dementia progresses,” she said.
Similarly, people may experience new constipation later in life, according to Fleisher.
“This can also be a sign of Parkinson’s disease and related conditions, and often precedes the other symptoms by years,” noted Fleisher.
6. Sleep changes
According to Fleisher, sleep changes are also important to watch.
The person experiencing sleep changes may not notice, but if you live with someone and find they’re moving around a lot at night, punching, yelling or talking in their sleep, it’s important to let your health care team know, Fleisher said.
“This can be something called REM behavior disorder, which can often occur years before a person has Parkinson’s or Lewy body dementia,” she added.
An early diagnosis can be a powerful way to prepare for the future.
Sure, it can be hard to recognize any health problems or changes, especially when it comes to cognition—but it’s important to do so.
We live in a time of innovation when it comes to dementia treatments, Fleisher said.
“There’s a lot of different research going on right now to try to find treatments and pharmaceutical options for people,” Nothelle added.
Doctors can check for biomarkers in blood or cerebrospinal fluid to determine what kind of dementia someone has and make treatment decisions based on that, Fleisher said.
No matter what, it’s best to start treatments or interventions early in the course of the disease, both Nothelle and Fleisher said.
Treatments are not a cure, but they can help manage the disease. Moreover, an early diagnosis can help families (and individuals) best prepare.
“Finding out early can be really helpful for a lot of different reasons, including planning and just having a say in the future,” Nothelle said. If you find out early, you can often still make some decisions, whether it’s your care, where you’ll live or financial choices.
All of this makes it important to pay attention to any signs of dementia (either in yourself or a loved one) and contact a doctor if you notice any changes.
“As scary as we know it is, a diagnosis and knowledge and early detection is power,” Fleisher said.
Whether or not you have any of the above symptoms, there are things you can do to reduce your risk of dementia or slow the progression of the disease. That includes all the things that go into a healthy lifestyle, both experts said.
To reduce your chances of dementia, it’s helpful to eat a nutritious diet (Fleisher recommends the MIND diet), exercise, socialize with loved ones, and manage chronic conditions like diabetes, obesity, and sleep apnea.
Experts predict that 42 percent of Americans over 55 will develop dementia in their lifetime, but there are things you can do to prepare for the disease if you receive a diagnosis and things you can do to reduce your risk.
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