Have you been worried about an older person’s memory or thinking skills? If so, you’ve probably found yourself wondering if this could be Alzheimer’s, or another dementia.
What to do next? If you look online or ask people, the advice is generally this: tell the doctor.
This advice isn’t wrong, but it’s incomplete. Yes, you should tell the doctor. But you’ll dramatically improve your chances of getting to the bottom of things if you come to the doctor with useful information on what you’ve observed.
In fact, research has found that interviewing family members about the presence or absence of eight particular behaviors can be just as effective, when it comes to detecting possible Alzheimer’s, as certain office-based cognitive tests.
I cover these eight behaviors (plus paranoia, false accusations, and many more that I usually check for) in the video below.
8 Alzheimer’s Behaviors to Track
For each of these behaviors, try to make note of the following:
- Whether there’s been a decline or change compared to the way your parent used to be
- Whether this seems to be due to memory and thinking, versus physical limitations such as pain, shortness of breath or physical disabilities
- When you – or another person – first noticed problems, and what you observed
- What kinds of problems you see your parent having now
If you don’t notice a problem in any of the following eight areas, make a note of this. (E.g., “No such problem noted.”) That way you’ll know you didn’t just forget to consider that behavior.
Have you noticed:
- Signs of poor judgment? This means behaviors or situations that suggest bad decisions. Examples include worrisome spending, or not noticing a safety issue others are concerned about.
- Reduced Interest in Leisure Activities? This means being less interested and involved in one’s usual favorite hobbies and activities. You should especially pay attention if there isn’t a physical health issue interfering with doing the activity.
- Repeating Oneself? Has your parent started repeating questions or stories more than he used to?
- Difficulty Learning to Use Something New? Common examples include having trouble with a new kitchen appliance or gadget. This can be a tricky one to decide on, given that gadgets become more complicated every year. But if you’ve noticed anything, jot it down.
- Forgetting the Year or Month? Especially once one stops working, it can be easy to lose track of the date or day of the week. But if you notice your parent forgetting the year or month, make a note of this.
- Difficulty Managing Money and Finances? Common examples include having trouble paying bills on time, struggling to balance the checkbook, or otherwise having more difficulty than one used to have managing finances.
- Problems with Appointments and Commitments? If you’ve noticed that your parent is having more trouble keeping track of appointments and plans, make note of this.
- Daily Struggles with Memory or Thinking? It’s normal for older adults to take a little longer to remember things, since many brain functions do slow a bit with aging. But it seems that your parent often can’t remember things that happened, or otherwise seems to be more confused with thinking, make note of this.
For more on diagnosing Alzheimer’s and other dementias
If you’re worried that your older relative might have dementia, I recommend you learn more here:
How We Diagnose Dementia: The Practical Basics to Know
My book, “When Your Aging Parent Needs Help“, also comes with worksheets to help you check for signs of dementia, a handy checklist of what information to bring to the doctors, and more.
Remember, being proactive usually leads to better results and less stress overall!
I particularly like this approach because it emphasizes empowering the caregiver or family member. Arriving at your doctor’s office with specific information and helpful hypothesis is a great approach. Thanks!
My mil I believe has Altzheimers Disease and LBD set in. The other relatives who sponsored her here from another country, dismiss the possibility of any type of neurological disorder. When she is checked out, it will be for medical assessment not mental assessment. All of the Medical tests come out normal, so they She is fine. They won’t do a mental assessment. This is wrong. I have no control over her mental needs. If I ask for help they either ignore me or yell at me saying I am complaining. Her ins would cover the proper mental treatment that could effect her medically in the future. They are doing what they think is right to do. I see no love, compassion or proper conduct. I will never forgive them. Me Nd my husband are left to “Carry The Burden.” Absence Without Heart!?
Hm, well if she is having memory or thinking problems, she should have an assessment that checks for medical causes but also documents her cognitive state and addresses any abnormalities.
If you are not in charge of what happens with her evaluation, that can be very frustrating, especially if you are being asked to take care of her.
You could consider looking for a therapist or professional, to help you discuss this issue within the family, or at least to help you set some limits on how you will be helping. Geriatric care managers are professionals that have experience with memory issues, they can’t do the complete evaluation or diagnosis on their own, but they would at least be well positioned to back up your concerns (or to reassure you). Good luck!
Alzheimers and dementia run rampant in my family. I feel like I’m in a catch-22 situation. I’m 55. Male. I was diagnosed with bipolar II a couple of years ago after decades of depression and severe chronic insomnia. Drugs used to treat both are often associated with decreased cognitive function and memory loss. Depression and insomnia wreak havoc on the brain by themselves. So this seems like a “choose your poison” type of scenario. Do you have any advice?
Thank you
The connection between use of medications and Alzheimer’s or other causes of cognitive impairment has been studied extensively, but we still don’t have a clear picture. It seems that the effects of medications like antihistamines, benzodiazepines and anticholinergics on cognition are real, but probably mostly short term and reversible.
Depression seems to be associated with the development of dementia, especially if the depression is recurrent, or comes on in later life. There isn’t good evidence that this is a causal relationship, and in fact late life depression could be the earliest symptom of dementia, rather than a cause of dementia.
My advice to a middle-aged person with a mood disorder who’s concerned about dementia risk, is to strive for an active lifestyle, avoid smoking and excessive alcohol use, eat a healthy, Mediterranean style diet and manage mood symptoms as well as possible. This may include taking antidepressant mediations for many people, which is preferable to having poorly managed mental health issues that get in the way of healthy habits.
I live with a 75 year old man I am 62 .and the day to day situations are beyond ridiculous, hes paranoid verbally abusive,rude ,expects me to do everything for him but treats me bad ,I am spent and will probably leave to get my own place in June, he has two sisters who do nothing for him but steal his money,
I’m sorry to hear about your partner. If you think he is living with dementia, an evaluation by a medical professional might be helpful. Check out this article about getting a dementia diagnosis.
You might also be interested in this one about capacity if you think huis sisters are taking advantage of him financially. or this video about elder abuse.
Remember to have a plan for your own safety in this situation. Thanks for reading the article and stay safe.
Hello. Our brother lives in another state. He lives alone. We have noticed during the past several years that his cognitive abilities are declining. Could you give us some guidance as to how we should approach the situation? He is a proud person who wouldn’t be open to us scheduling a cognitive assessment. He is also a hoarder and values items that have not real value. We are at a loss.
~ His brothers and sisters
It’s never easy to bring up the issue of changes in memory with a family member. This article might be helpful to learn more about how a dementia diagnosis is made.
If your brother has a family doctor or other primary care provider, it might be a good idea to share your concerns with him or her. The doctor might not be able to share info with you, without your brother’s permission, but you can share letters or documents with them, without violating privacy legislation. You can let the provider know about the hoarding as well, although this is often a longstanding pattern and can be along and painstaking process to deal with.
You might also want to check out Dr. Kernisan’s new book: “When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, & More” . The communications strategies and steps to take to figuring out the best way to help a family member could be applied to a sibling or a parent.
You can pre-order the book here:
https://www.amazon.com/Aging-Parent-Needs-Step-Step/dp/173615320X/ref=sr_1_fkmr0_1?dchild=1&keywords=dr+leslie+kernisan&qid=1611329842&sr=8-1-fkmr0
My sister is demonstrating all the eight signs of Alzheimer’s listed above. I have tried to discuss my concerns with her however when I do, she becomes extremely defensive and refuses to discuss any possibility of a problem with her memory. I am at a loss for what to do for her. Her primary care physician told her she felt she was paranoid and she refused to see her anymore. She lives alone and I am extremely concerned about discissions she makes concerning her finances. What should I do??
What a stressful situation you’re in. It’s too bad that she’s fired her family MD, as that’s often a great route to go to express your concerns.
In some regions, you can call Adult Protective Services and ask for a worker to be assigned to your sister’s case. Unless there’s serious self-neglect though, they may not be able to do very much.
Dr. Kernisan’s new book is for children who are helping aging parents, but many of the issues the book covers could be applied to helping other family members too. The book provides advice on how to communicate with someone who’s living with dementia and resisting help.
Why cant I stop obsessing that I have dementia? The MOCA came back at 22. I should be fine. Right? So why am I so afraid? Most days I can function pretty well even though I had to give up practicing law. . What if it’s just the insomnia and anxiety? I can’t put my finger on anything really wrong. A little memory problem. Uncharacteristic bursts of anger. Can’t keep track of my bills and my money anymore A few other things. But a lot of little quirks don’t necessarily add to to anything right? My daughter won’t talk about it. She says wait till after the neuropsych test. That’s 3 months away. How can I wait!!! Is there anything I can read or do to rule out this supposed thing so I know one way or the other ? I just want to know
It’s really difficult to wait for test results, especially for weeks or months. I see a lot of people in my practice who have major anxiety about their cognitive performance, and the irony is that that anxiety can worsen cognitive performance! So it can be a bit of a vicious cycle.
The diagnosis of dementia is based on memory testing but also on the history of the changes that are being observed, and sometimes a brain scan can help, but usually mainly to rule out other conditions.
The truth is that without a brain biopsy (that we don’t do routinely), you may never know for 100% certain if you do or don’t have dementia, until enough time passes to see how things change, whether they improve or worsen. In the meantime, maintaining healthy habits for your brain is the best way to relieve stress and prevent vascular events that can increase the risk of dementia or worsen its course.
I hope that helps to reassure you and I hope you get good news!
My Father died 3 months ago, yesterday, after having been in the hospital for over a month.
Two weeks later I had to put my horse down – I was there when she was born 27 years ago.
In the next month or so I realized my mother had beginning dementia. My father had been doing EVERYTHING for the past several years – shopping, cooking, paying the bills, etc. My 84 year old mother lost her drivers license a couple of years ago, having totaled 2 cars. They paid a lawyer $4500 to help her get her license back – she should not have been driving, but, my father said he would never hear the end of it if they didn’t try. She proceeded to badly fail the driving test 2 times and was told in writing that she would not be tested again. She blames the test giver and insists she’s going to get a license again… Her memory is poor, yet she insists it’s perfect. Three credit cards have gone to collection, but, she insists she can pay the bills. The only reason the water and gas are still on is because of COVID-19. I am an only child, I have no POA, and she fights me on everything…
Help!?!
My father was also 84 – on one of his good days in the hospital, he told me I be sorry if he died.
Now I know why…
It sounds like you have a lot on your plate right now and I’m so sorry for your losses.
An older parent’s driving is a tough issue for many families. Dr. K has a new book ““When Your Aging Parent Starts Needing Help: a geriatrician’s step by step guide to memory loss, resistance , safety worries and more” which is an excellent resource for someone in your position. You can find out more about it here.
There are no quick fixes when an aging parent shows signs of poor decision making, and it takes careful assessment and information gathering to know the best way to start. A Geriatrician or primary care provider would be a great ally in the process, if your mom would agree to go. Sometimes focusing on a physical rather than a cognitive issue is a more successful strategy. I made a video about the driving issue, which you can watch on my YouTube channel, here: https://youtu.be/VX4AiEQG9UY
Hope these resources help!
My 89 year old mother has been taking toprol xl sustained release tablet 50 mg two times a day, at least since 2018. She has been experiencing short-term memory loss for a few years now. Her new doctor (the other retired) reduced the dosage to once daily. Can this medication cause short-term memory issues? If so, would reducing the dosage help her memory (if this was the cause)?
It’s a great idea to review medications in an older adult with memory changes, as there are some drugs that can make cognitive performance worse.
Metoprolol (aka toprol) is a beta blocker, usually used for management of high blood pressure or some types of heart disease. Metoprolol can cross the blood-brain barrier and act on the central nervous system, but this doesn’t seem to have a significant short-term effect on brain symptoms, like mood. I found this article that looked at scientific studies of beta blockers and mood, and found no association: https://pubmed.ncbi.nlm.nih.gov/21192142/
In general, treating heart disease and hypertension is beneficial for older adults, and may reduce long-term dementia risk. If you notice your mother’s memory improving on the lower dose of metoprolol, that’s great. You might be interested in Dr. K’s article about how we diagnose dementia if you’re wondering about other causes of memory change, which you can read here: https://betterhealthwhileaging.net/how-to-diagnose-dementia-the-basics/
Hello, I am wondering if you can give me some advice. My dear friend who lives almost 100 miles away and I recently took a trip to Phoenix for a weekend. I just turned 70 and she is almost 69. The last few times I have seen her over the years and during our phone conversations I hear how she has had several falls, she has trouble remembering stuff, more so than usual. She is aware she has a problem with her memory, and often states “I just think too fast”, to explain when things go wrong or when she makes mistakes. During our trip, she seemed to me like she is suffering from and developing dementia and I fear it will only continue to get worse over time. I am afraid to say anything to her, but wish she would get a medical assessment of her physical and cognitive mental health. What do you suggest I can do to help her? I do not think I should say anything to her husband or son without her present, and she will probably get extremely offended. It could ruin our friendship.
Thank you for your time. I enjoyed your article, I was not aware of Hospital Delirium. Good to know. I am a CNA and CHHA working in both facilities and private homes for the elderly, Only now I have to admit I am an elderly old gal myself.
Thanks for your important work as a CNA and CNHA! You make a difference in so many lives.
It must be hard to see the changes in your friend and I can understand struggling with how to bring it up. I think if you’re coming from a caring perspective, it’s OK to talk to her family members. They may be noticing changes too.
The other thing is that if your friend IS getting dementia, she may not have insight into how her memory and thinking is changing and affecting her life. Those changes in insight are very common, especially in Alzheimer’s. So, waiting for her to realize when it’s time to get help might not work.
It might be effective to encourage her by normalizing memory concerns with aging. Let her know that you notice changes in yourself (there is a normal change in memory with age, usually mild and doesn’t affect day to day function), and it’s good to see the doctor to make sure there isn’t another issue that’s causing a problem (like a thyroid condition, medication side effect, etc.).
Your friend is so lucky to have you in her life and you’re right to want to preserve the relationship as best you can. If she is developing dementia, she’ll need your support.
Thanks for your kind words and I’m glad you enjoyed the article!
My mother has been given a “differential diagnosis” of Alz disease/dementia vs. Vascular dementia, Frontoparietal Lobe Dysfunction, Cogwheel Rigidity, Sundowning with Paranoid Delusions, Visual Hallucinations… All pending further testing, by a Neuro who literally left town the week after he saw her. Her VERY OLD doctor primary care Dr. won’t send her for further tests as he “saw no evidence of significant decline”. She passed the MMSE test and he refused to listen to the things she does. She has finally agreed to let my sister help with her bills, but her functions for everyday living are rapidly declining. She lives alone and barely remembers how to used the stove and microwave, yet still has a Driver’s License. She talks about “laying there dying because no one will help her” but they seem to thinks she is functioning normally. I have demanded another referral to see a new Neurologist, and I hope she will go without kicking and screaming. Mood swings are angry, confused, distrustful, and depressed. Why won’t doctors listen to you about what you are seeing? I want her to live somewhere with social interaction (Assisted Living), not the current self imposed isolation she begs to leave, but no one hears us….
It sounds like a very frustrating scenario, and I can understand not feeling heard. Unfortunately, this story is not uncommon, and it’s often a long journey to diagnosis and a change in living situation.
It may be possible to move forward with a move to Assisted Living even without a formal diagnosis, just based on the functional level you describe.
I would highly recommend checking out Dr. K’s new book called: “When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more”. This is a practical guide to how to start helping an aging parent, even when you don’t know where to start. You can learn more here. The book can help you to set small goals and make progress towards helping your mom. You can find more info here: https://betterhealthwhileaging.net/education-and-support/when-your-aging-parent-needs-help/