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Running red lights. Falling for scams. Shutting out friends.
Memory loss is the most well-known symptom of dementia, particularly Alzheimer’s disease. But experts say there are other warning signs that can signal early brain changes — ones that are especially important for types of dementia where forgetfulness is not the primary symptom.
Just like occasional lapses in memory, these issues can also be attributed to other age- or health-related changes (or just a bad day), so experts emphasized that they aren’t necessarily red flags for dementia in isolation. But, especially in combination, they might be a sign that it’s time to see a doctor.
1. Financial Problems
People with dementia can experience money problems or declining credit scores years before memory loss, or other cognitive symptoms, emerge. They might forget to pay their bills, for instance, or no longer be able to stick to a budget.
“One of the reasons why financial mismanagement can be a sensitive indicator is just because it’s so complicated,” involving the interplay of multiple brain regions, said Dr. Winston Chiong, a professor of neurology at the University of California, San Francisco. Consequently, finances can be one of the first areas where cracks in someone’s cognition start to appear.
Poor financial decision-making is especially a concern for those with frontotemporal dementia, a relatively rare form of dementia where judgment is affected very early on in the disease. Some people with this condition might make big, impulsive purchases. Others might trust people they would not normally, increasing their risk of being scammed.
“People with frontotemporal dementia are less sensitive to potential negative consequences,” Dr. Chiong said. Because of this, they may have increased “susceptibility to different kinds of manipulation,” or they may be “more likely to be wasteful with money or careless with money.”
2. Sleep Issues
Sleep disorders can become more common as people age, and older adults tend to sleep more lightly and go to bed and wake up a little earlier than they used to — that is completely normal. But if there are dramatic changes in someone’s sleep habits, where they are starting their morning at 3 a.m. or are unable to stay awake during the day, it can be a sign of dementia.
“Some of the brain regions, like in the brainstem, that are really important for regulating sleep and wake cycles are the first that are affected by Alzheimer’s disease,” said Joe Winer, an instructor of neurology and neurological sciences at Stanford University. “So years before someone has any signs of memory symptoms,” they might experience changes in their sleep patterns.
One change that can occur specifically with dementia with Lewy bodies — another type of progressive brain disorder — is that a person might begin acting out their dreams. This is also true for Parkinson’s disease, which is related to dementia with Lewy bodies. Ordinarily, our muscles become paralyzed while we’re in REM sleep, which is when we tend to have the most vivid dreams. But in these two neurodegenerative disorders, toxic proteins attack the cells in the brainstem that control sleep paralysis.
This condition, called REM sleep behavior disorder, is not just normal sleep walking or sleep talking, said Dr. Ronald Postuma, a professor of neurology and neurosurgery at McGill University. At his clinic, patients usually come in after their “bed partner has told them that they were hitting them, screaming, yelling during their dreams.”
3. Personality Changes
In a study published last year, researchers found that people with dementia experienced slight drops in extroversion, agreeableness and conscientiousness before they showed any signs of cognitive impairment. Those personality changes accelerated as more dementia symptoms emerged, said Angelina Sutin, a professor of behavioral sciences and social medicine at Florida State University, who led the study.
While the research was conducted using a standardized personality test, there are a few changes in everyday behavior that you can watch out for. A decrease in extroversion, for example, may look like a person becoming more withdrawn, or a narrowing of their social circle.
It may be easier to tell that someone is “not going out as frequently anymore than to recognize how much their memory has declined,” Dr. Sutin said.
Some of these personality changes might happen spontaneously, as a result of the damage occurring in the brain. With frontotemporal dementia, for instance, a decline in agreeableness, where the person becomes less trusting and friendly, is linked to decreased brain volume in the frontal cortex — a key component of the condition.
Other times, the changes might arise because of the cognitive symptoms. For example, a person with Alzheimer’s disease might appear to be less conscientious, becoming increasingly disorganized or having difficulty completing work or household tasks as their memory declines.
4. Driving Difficulties
Along with handling finances, driving is one of the most complex cognitive behaviors people perform every day. Ganesh Babulal, an associate professor of neurology at Washington University in St. Louis, has demonstrated in his research that problems behind the wheel can manifest years before they do elsewhere.
Driving “is this ultimate blend of the cognitive system,” Dr. Babulal said. “And if there’s one thing that’s out of whack, that unfortunately will compromise and shift the driver from being in control to being at a risk for a crash or a collision.”
Cognitive impairment can show up as scratches on a car, getting into a fender bender (or a near miss) or running stop signs or stoplights. People may also brake or accelerate suddenly or take turns too fast. As a result, Dr. Babulal said that they may stop driving as much — especially at night, in bad weather or during rush hour — or they may feel reluctant to drive with grandchildren or other passengers in the car.
Of course, other physical issues that can occur with old age, like vision problems, neuropathy or medication side effects, can affect people’s driving. But if you notice troubling changes in someone’s ability, it might be worth having the “car key conversation.”
5. Loss of Smell
Parts of the brain that control smell, known as the olfactory system, are among some of the first areas damaged in Alzheimer’s disease and dementia with Lewy bodies; this is also the case for Parkinson’s disease. Many people with these conditions begin to lose their sense of smell years, or even decades, before other symptoms appear.
Unlike hearing and vision loss, which can be risk factors for dementia but are not thought to be caused by the disease itself, loss of smell appears to be one of the earliest manifestations of neurodegeneration.
Different types of brain diseases seem to affect people’s sense of smell in varying ways. For example, people with Alzheimer’s tend to be able to detect an odor, but they may misidentify it. “They go, ‘What a lovely smell. It smells so sweet. It must be gasoline,’” Dr. Postuma said. In contrast, he added, those with Parkinson’s and dementia with Lewy bodies are often “skeptical that I am even giving them a smell at all.”
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