Dementia often develops slowly and the early signs are not always obvious.
Dementia often develops slowly and is not always obvious in the early stages. Symptoms similar to dementia can be seen in other illnesses. Sometimes it can be difficult to tell apart dementia from the usual mild forgetfulness seen in normal ageing.
Memory loss – what is normal?
Most of us forget things every day, like people’s names or where we put our keys, but this is not necessarily a sign of Alzheimer’s disease or another form of dementia. In dementia, memory loss is more serious than forgetting things occasionally.
There are many reasons why people become forgetful. Some medicines and drugs can affect memory, for example. Depression, anxiety, vitamin deficiency and thyroid problems can also cause forgetfulness, so it’s important to get the right diagnosis.
You should see your GP if you or your family and friends are worried about any changes in:
- general mental functioning
- ability to carry out daily tasks
Your GP will be able to either reassure you or, if necessary, refer you to a specialist. Early diagnosis of dementia is important to allow you to get the right help and treatments and to plan for the future.
Everyone with dementia will experience symptoms in their own way. Different diseases that cause dementia can have different early symptoms but many overlap.
Alzheimer’s is probably the best-known cause of dementia, accounting for about two-thirds of cases in the elderly. Alzheimer’s often develops slowly over several years. It is not always obvious to begin with and symptoms can overlap with other illnesses. Sometimes it can be difficult to distinguish Alzheimer’s from mild forgetfulness which can be seen in normal ageing.
Early signs of the disease usually include difficulties forming new memories, but people may also experience language or spatial awareness difficulties.
Typical early symptoms of Alzheimer’s may include:
- Regularly forgetting recent events, names and faces.
- Becoming increasingly repetitive, e.g. repeating questions after a very short interval.
- Regularly misplacing items or putting them in odd places.
- Getting confused about the date or time of day.
- Being unsure of where you are or getting lost, especially in unfamiliar places.
- Having problems finding the right words.
- Having mood or behaviour problems such as loss of interest in daily activity, becoming easily upset or annoyed or losing confidence.
Alzheimer’s gets worse over time, but the speed of change varies from one person to another. As Alzheimer’s progresses:
- People find that their ability to remember, think and make decisions worsens.
- Communication and language become more difficult.
- People may have difficulty recognising household objects or familiar faces.
- Day-to-day tasks become harder, for example using a TV remote control, phone or kitchen appliance. People may also have difficulty locating objects in front of them.
- Changes in sleep patterns often occur.
- Some people become sad, depressed or frustrated about the challenges they face. Anxieties are also common and people may seek extra reassurance or become fearful or suspicious.
- People may experience hallucinations, where they see things or people that aren’t there.
- People may become increasingly unsteady on their feet and are at greater risk of falling.
- People gradually require more help with daily activities like dressing, eating and using the toilet.
After Alzheimer’s, the most common cause of dementia is vascular dementia, Some people have both vascular dementia and Alzheimer’s disease – often called ‘mixed dementia’.
Vascular dementia can have symptoms similar to Alzheimer’s and other forms of dementia. These can include memory loss, disorientation and problems with communication. There can also be more specific symptoms and these may differ depending on the area of the brain that is affected.
These symptoms may include:
- Thinking skills – taking more time to process information and having problems with attention, planning and reasoning
- Personality changes – these may include depression and apathy (becoming less interested in things). People may also become more emotional.
- Movement problems – difficulty walking or changes in the way a person walks.
- Bladder problems – frequent urge to urinate or other bladder symptoms. This can be common in older age, but can be a feature of vascular dementia when seen with other symptoms.
The symptoms of vascular dementia get worse over time. In the later stages the symptoms become more widespread and people need help eating, dressing and using the toilet. Vascular dementia normally progresses over several years. However, the speed of progression can vary over time and from person to person. There may be a sudden or stepwise change after an event such as a stroke.
Dementia with Lewy bodies
Dementia with Lewy bodies can cause common dementia symptoms, including memory loss, spatial awareness problems and a decline in problem solving skills. There are also some more specific symptoms associated with the disease. Some of these symptoms are also seen in Parkinson’s dementia.
These symptoms include:
- Alertness – changes in alertness, attention and confusion, which may be unpredictable and change from hour-to-hour or day-to-day.
- Movement problems – Parkinson’s disease-type symptoms such as slowed movements, muscle stiffness and tremors.
- Visual hallucinations – seeing things that are not really there, e.g. people or animals. These often happen repeatedly and are realistic and well-formed.
- Sleep disturbances – acting out dreams or shouting out while sleeping which can disrupt sleep and potentially cause injury.
- Stability – fainting, unsteadiness and falls.
DLB is a progressive condition which means symptoms get worse over time. As the disease progresses, people will need increasing help with eating, moving, dressing and using the toilet. DLB can progress slowly over several years but the speed of progression and type of symptoms can vary from person to person.
Frontotemporal dementia (FTD)
The early symptoms of FTD vary from person to person and depend on which area of the brain is affected. In behavioural variant frontotemporal dementia, the parts of the frontal lobe that regulate social behaviour may be most affected. In semantic dementia, the parts of the temporal lobe that support understanding of language and factual knowledge are most affected. In progressive non-fluent aphasia, parts of the frontal and temporal lobes that control speech are most affected.
Symptoms may include:
- Personality changes – this may include a change in how people express their feelings towards others or a lack of understanding of other people’s feelings. They may also show a lack of interest or concern, become disinhibited or behave inappropriately.
- Lack of personal awareness – people may fail to maintain their normal level of personal hygiene and grooming.
- Lack of social awareness – this might include making inappropriate jokes or showing a lack of tact.
- Diet – changes in food preference, over-eating or over-drinking.
- Behaviour changes – humour or sexual behaviour may change. People may become more aggressive, develop unusual beliefs, interests or obsessions. Some people become impulsive or easily distracted.
- Decision making – difficulty with simple plans and decisions.
- Awareness – lack of awareness of any changes in their personality or behaviour.
- Language – decline in language abilities. This might include difficulty getting words out or understanding them. People may repeat commonly used words and phrases, or forget the meaning of words.
- Recognition – difficulty recognising people or knowing what objects are for.
- Memory – day-to-day memory may be relatively unaffected in the early stages, but problems with attention and concentration could give the impression of memory problems.
- Movement problems – around one in every eight people with behavioural variant FTD also develops movement problems of motor neurone disease. This can include stiff or twitching muscles, muscle weakness and difficulty swallowing.
Symptoms get worse over time, gradually leading to more widespread problems with day-to-day function. Some people may develop motor problems similar to those seen in Parkinson’s. Over time people with FTD can find it harder to swallow, eat, communicate and move. They will require more support to look after themselves. The speed of change can vary widely, but some people live with the condition for more than 15 years.
You can read more about the different forms of dementia by visiting our ‘Types of dementia’ pages.
This information was updated in January 2018 and is due for review in January 2020. Please contact us if you would like a version with references.