Knowing whether someone has dementia can feel confusing.

How do you tell the difference between normal, and a medical condition?

In this article we’ll talk about the 5 things that can suggest that someone is experiencing dementia, rather than the natural changes of aging.

#1 What’s your story?

Just like with any other medical condition, memory changes have a particular story that go with them.

For example, if you broke your foot it might go like this: “I fell down and now every time I stand it hurts”.

When it comes to memory, we can think of the story as unfolding gradually along a spectrum, which each of the following sections explore.

Normal aging

Normal aging sounds like:

• occasionally pausing to come up with the right word (“tip-of-the-tongue” word finding problems)

• finding it more difficult to multitask

• taking longer to recall information, process new information, or get your thoughts together

Despite these changes, most of your friends and family haven’t found you to be “overly” forgetful (they aren’t worried about it), and when doctors do a memory test with you, your score is normal.

Pre-Dementia

Pre-dementia, known to doctors as “Mild Cognitive Impairment”, or MCI, is when forgetfulness is happening a lot more often.

This can sound like:

• repeating yourself in conversations or asking the same question over and over again

• misplacing items around the house multiple times a week

• forgetting upcoming events or recent events (such as doctor’s appointments)

• needing to write things down, make lists, or set reminders to overcome these memory lapses

People around you are starting to get concerned. When doctors do a memory test with you, your score is lower than it should be.

Dementia

Changes progress to dementia when other people are needing to step in and help with daily tasks.

This might look like:

• someone needing to remind you to take your medications, pay your bills, or figure out your taxes for you

• getting lost while out driving

• forgetting the ingredients when cooking or forgetting to turn off the stove, to the point someone else is having to prepare some of your meals

• not remembering the right foods to buy at the grocery store, even if you bring a list, to the point someone else is doing the grocery shopping for you

When doctors do a memory test with you, your score is, again, lower than it should be.

Dementia itself can be separated into early, moderate, and severe phases, based on how much help you’re needing in your day-to-day life.

• Early dementia: needing help with things like remembering medications, cooking, paying bills, driving, or organizing your taxes.

• Moderate dementia: needing reminders to shower or change your clothes.

• Severe dementia: needing help to take a shower, put on clothes, or use the washroom.

• Last months of dementia: needing help to eat, unable to walk, and limited communication with others.

#2 Memory Testing

Memory testing is necessary for telling normal aging and pre-dementia (MCI) apart.

• Normal aging will have a normal score.

• Pre-dementia will have a score that is lower than it should be for your age and educational background.

Right now, healthcare providers mainly use two different pen-and-paper tests in Canada, called the “MoCA” (pronounced Moh-Kah) or “MMSE” (pronounced as its individual letters, M-M-S-E).

IMPORTANT: getting a low score on it’s own without any reported problems with memory can be normal if you didn’t do a lot of tests growing up (for example if you completed only elementary school).

#3 Daily Life

Needing help in your daily life is what tells pre-dementia (MCI) and dementia apart.

• If you are coping on your own with memory tools (like lists, reminders, etc), this is suggestive of MCI

• If you are needing help from others, this is suggestive of dementia

Doctors will ask you questions about the 7 daily tasks shown in the diagram below, and if you’re needing help because of forgetfulness or some other part of brain activity (like problem-solving, speaking, etc) then this is suggestive of dementia.

IMPORTANT: If you’re needing help because physically you can’t do the tasks (such as being too tired, or having difficulties with balance), then this does not mean you have dementia, simply because you need help.

When you’re needing help with your morning routine - getting out of bed, getting dressed, taking a shower, using the washroom, and walking around - then this suggests you’re in the middle stages of dementia. Again, this should be due to cognitively not being able to figure out the tasks, not because physically you’re too weak, off-balance, or in pain to do them.

#4 Reversible Causes

Whether you have normal aging, mild memory problems, or dementia, it is very important that we spend time looking for and fixing any reversible causes.

You can find detailed guides to all of the following at aldora, but in brief:

A doctor should examine you.

Your doctor should do what’s called a “neurologic physical exam” - testing your strength, your nerves, your balance, coordination, and stiffness. Any changes they see should prompt them to order a CT scan of the brain to see if something else is going on, and possible send you to see a neurologist or geriatrician.

You need some routine Blood Work

Your doctor should order tests for reversible medical conditions that can cause memory problems.

Ask your doctor to check:

1. CBC, electrolytes, creatinine

2. Calcium, albumin

3. TSH, B12

4. HbA1C (for diabetes)

5. Other special tests if you are less than 65 or have an unusual story (ask your doctor)

If any of these tests are very abnormal, your doctor should work with you to bring them back into a normal range.

However, if any of these tests are just slightly abnormal, they probably aren’t the cause of your changes to memory. You can still work with your doctor to bring them back into a normal range for good health, but they aren’t enough to explain your symptoms.

Review your situation for preventable causes:

As we discuss in this article, 45% of dementia is preventable if certain every-day problems are caught early and fixed.

These include things like alcohol use, depression, hearing problems, smoking, diabetes, social isolation, head injuries, high cholesterol, vision problems, etc.

Aldora has guides on each of these topics to show you step-by-step how to fix them.

What about Medications?

You do not need medication for pre-dementia, as of right now in Canada. If you live in the USA, you might be eligible for new medications, although these come with significant risks at the moment.

For those with dementia, there is a medication called donepezil that is commonly used. You can read more here.

We will keep you updated on new medications as they become available when you become a member.

#5 Yearly check-ins with your doctor

How often do you need to see your doctor if you have concerns about your memory?

Normal Aging

Only when you need them.

You only need to see your doctor if you or your family notice new or concerning changes. This could include:

• getting more repetitive in conversations

• misplacing items around the house (multiple times a week)

• forgetting upcoming events or recent events that have just happened

• having to write everything down or else you’ll forget (even simple things, like what someone has just said)

If you are experiencing these symptoms, book an appointment with your healthcare provider to have a memory test done and review Step #4 above.

Make sure you learn the aldora 18 to reduce your chances of developing dementia in the future.

Pre-dementia

Every year.

If you have mild cognitive impairment (MCI), you should see your doctor once a year to repeat testing and review your symptoms.

If your symptoms progress to the point of needing help with daily tasks then you might want to book an earlier appointment to review and ask whether any new medications are now available.

If you are working on fixing preventable causes (such as high blood pressure, diabetes, etc), you might need to see your doctor more often to get these targets under control.

Throughout this time, make sure you are following aldora’s strategies for reversing or slowing down these changes.

Dementia

Every 6-12 months, or more frequently if you need them.

If you have early dementia, you should see your doctor once a year to repeat testing and review your symptoms.

If you have moderate dementia, consider seeing your doctor every six months or less, as there are many changes during this time that you might need help navigating.

If at any time you or your loved one struggles with hallucinations, odd behaviours, wandering away from home, etc, you should see your doctor and likely a specialist, like a geriatrician or geriatric psychiatrist, as soon as you notice these changes. There are medications that can help.

You can also join your local Alzheimers Society FirstLink program for courses, resources, and support with daily activities. You do not need to wait for a physician referral to get their help - sign up today.

In closing…

You now have a roadmap for what to expect when seeing your doctor or nurse practitioner for memory problems.

If you have normal changes, pre-dementia, or early dementia, you can find answers to protecting your mind or reversing changes with aldora.

Disclaimer: The content on Aldora Health is for educational and informational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. For more read our Terms of Use.