Is it Alzheimer’s?

As much as 20% of Alzheimer's patients experience sundowning at some point, and it's a common reason that family members decide to put their loved one in a nursing home.Everyone struggles to come up with a name once in a while. But how can you tell if it's more serious?

"One symptom alone does not necessarily indicate that a person has Alzheimer's or dementia," says Raj C. Shah, MD, of the Rush Memory Clinic at Rush University Medical Center, in Chicago. (Dementia is chronic loss of cognition, usually affecting memory, and Alzheimer’s causes 50% to 80% of dementia cases.)

There are many other causes of memory loss, including vitamin B12 deficiency, and brain, thyroid, kidney, or liver disorders. However, having several other symptoms could be a sign of Alzheimer's disease (AD). Recognising the signs of dementia can help lead to a quicker diagnosis.

Difficulty dressing

Dressing is difficult for dementia patients, who sometimes feel overwhelmed by the choices or may not remember even how to dress, tie a shoe lace, or buckle a belt.

They may wear the same thing over and over again, forgetting that they wore the same outfit the day before. And as previously mentioned, buttoning and unbuttoning clothes can become more difficult in the mid-to-late stages of AD due to a decline in motor skills.

Verbal and physical aggression

As the dementia worsens over time, it is not unusual for someone to become physically or verbally aggressive.

Verbal outbursts, including cursing, arguing, name calling, shouting, and threatening, are common, and some patients will even get physical, hitting and pushing caregivers, for example.

These aggressive acts often seem to come out of nowhere, but there's usually a reason behind the behaviour that may not be readily apparent to family members or caregivers, such as physical discomfort, inability to communicate properly, or frustration at a situation.

Trouble sleeping

Certain symptoms, like restlessness, anxiety, agitation, disorientation, and confusion, tend to get worse as the day goes on and even continue through the night, often resulting in difficulty sleeping and wandering.

Experts call this phenomenon "sundowning," and it can be due to exhaustion, changes in the person's biological clock, the inability to separate dreams from reality, and a decreased need for sleep that can occur with age.

Memory loss

Serious memory loss and confusion are not a normal part of aging. But forgetfulness caused by stress, anxiety, or depression can be mistaken for dementia, especially in someone who is older.

"We all forget the exact details of a conversation or what someone told us to do, but a person with AD will forget what just happened, what someone just said, or what he or she just said and therefore repeat things over and over again," says Lisa P. Gwyther, co-author of The Alzheimer's Action Plan: A Family Guide.

Difficulty with familiar tasks

A person suffering from dementia often takes longer to complete, and may have trouble finishing, everyday tasks that he or she has done hundreds of times before. For instance, a former whiz in the kitchen may have a problem making his or her signature dish or even remembering how to boil water. Common activities like remembering how to get to a familiar location, play a favourite game, or manage a budget may also prove difficult.

Misplacing things

Finding car keys in the freezer, the remote in a sock drawer, or routinely discovering other "missing" items in strange spots is usually a strong indicator that your family member may be suffering from dementia.

Although we tend to associate forgetfulness with the natural aging process, people with AD don't just occasionally forget where they left their car keys or reading glasses; they leave them in unusual places and are later unable to retrace their steps to find them.

Often they'll also become suspicious and accuse someone else of hiding or stealing their belongings.

Confusion with time or place

Disorientation as to time and place, such as forgetting where you live, getting easily lost, and losing track of dates, seasons, and the passage of time is a common experience for individuals with AD.

"The real issue with AD is perception of time," explains Gwyther. "Five minutes can seem like five hours for someone with AD, so a husband may think his wife has been gone for hours or even weeks, even if it's just been a few minutes, or he might tell his grandchild that he hasn't seen him in five years, even though he just saw them yesterday."

Wandering

Unfortunately, about 60% of people with dementia have a tendency to walk off, wander aimlessly, and become lost, often repeatedly. Restlessness, fear, confusion related to time, the inability to recognise familiar people, places, and objects, as well as stress can all cause wandering.

In some cases, the person might leave the house in the middle of the night to fulfil a physical need, such as finding a toilet or food, or he may be attempting to "go home" because he doesn't realise he is home or he believes it's 20 years earlier and he needs to go to a former job.

Don't recognise family and friends

As AD progresses, your loved one may not always recognise you or other family members and friends, which can be heart-breaking.

"Recognition does come and go for a while," says Gwyther. "In general, people forget what they just learned or whom they just met, then friends, and family last. But sometimes it's hard to explain why someone remembers one child's name and not another. Well-practised memories and stories last longer than newer ones, but in the very late stages, people may only remember their parents."

Forgetting meals

People with dementia can literally forget to eat and drink, especially because many AD patients experience decreased appetite and interest in food.

On the other hand, others forget that they've already eaten and, as a result, eat lunch or dinner multiple times a day. Oddly enough, it's not unusual for a person with AD to develop new favorite foods and suddenly dislike foods he or she previously loved.

Additionally, the person may lose the ability to tell if a food or beverage is too hot to eat or drink, forget to chew slowly and swallow, or not remember how to use eating utensils and revert to eating with their fingers.

Inappropriate behavior

In the mid and especially late stages of Alzheimer's, a person may begin to lose control of his or her impulses and act out in inappropriate or uncharacteristic ways.

"They may say tactless things, like 'Gosh, you got fat,' that they would have never said before," says Gwyther.

Additionally, people with AD may forget that they are married and begin to flirt and make inappropriate sexual advances, or they might start taking their clothes off at inappropriate times or in unusual settings.

Shoplifting is not uncommon among adults with AD, who don't understand or remember that they must pay for items in stores.

Verbal and physical aggression

As the dementia worsens over time, it is not unusual for someone to become physically or verbally aggressive.

Verbal outbursts, including cursing, arguing, name calling, shouting, and threatening, are common, and some patients will even get physical, hitting and pushing caregivers, for example.

These aggressive acts often seem to come out of nowhere, but there's usually a reason behind the behaviour that may not be readily apparent to family members or caregivers, such as physical discomfort, inability to communicate properly, or frustration at a situation.

Getting diagnosed

Even if someone has Alzheimer's, it doesn't mean his or her life is over; a person with AD can live a meaningful and productive life for many years, but it's important to get a proper diagnosis.

People often wait too long to seek help, says Dr. Shah. 

"Most diagnoses are still made in the moderate stage, after most individuals have been experiencing symptoms for years already," says Dr. Shah. "It doesn't help the person or family to wait until symptoms become so obvious that the diagnosis can be easily made. It is better to seek an evaluation earlier to help maintain quality of life and to prevent social or medical crises due to memory loss."