It happens to all of us; we can't remember somebody's name or we forget where we left our car keys. Those who think they are becoming increasingly forgetful sometimes fear the worst… am I becoming demented? Biomedical scientist Liesbeth Aerts explains when forgetfulness is innocent and when it becomes worrying: "The first symptoms are often very subtle and different for everyone."

Early signs of dementia manifest differently in everyone: you can pay attention to these 10 things

Anybody who gets a day older can confirm that not everything goes as smoothly as it did when they were eighteen. Physical activities become a bit slower to complete, you get tired a bit faster, and there is a little more mental wear and tear along the way. This is a normal part of getting older, according to various international Alzheimer's and dementia organisations. What is the difference when it comes to dementia? In other words, when is being forgetful no longer innocent?

Problems in daily life

Dementia is not a normal ageing phenomenon, but the expression of a disease. The diagnosis is made when a doctor or specialist identifies a decline in mental abilities. The decline is such that the person has difficulty with daily activities, such as getting dressed or groomed independently, cooking food, or going to the store. You cannot prevent dementia, but you can partly limit your risk by living a healthy life. According to Dementia New Zealand around 70,000 people have dementia in this country.

Researchers have known for years that long before the first symptoms of dementia appear, damage can already be found in the brain tissue of (future) patients. The underlying disease is therefore often already present before there is a problem. In addition, the first symptoms are often so subtle that it takes a long time to realise that there may be more to it. Often years pass before someone is finally diagnosed with dementia.

Sometimes memory and cognitive tests show that there is indeed a decline in mental capacity that cannot be fully attributed to the normal ageing process. However these problems are often so mild that the person in question experiences few problems in practice. Doctors then speak of mild cognitive impairment. Although this is often seen as the pre-stage of dementia, it is certainly not the case that everyone with mild cognitive impairment will actually develop dementia.

Ten signs there's more to it

There are different types of dementia, each with typical and atypical symptoms. In addition, each individual has his or her own unique experience. There is no general definition of what the first stage of dementia looks like, but the following ten symptoms are the most common.

1. Severe memory problems

Quite normal
Not being able to think of a name occasionally or forgetting when an appointment was, such things are quite normal... especially if you can remember it a few hours later.

Suspicious
One of the typical early symptoms of Alzheimer's disease is forgetting new information. People with dementia can no longer do without a calendar or other aid to remember appointments or dates because they simply can no longer store that new information in their memory. Other omens include forgetting important dates or events and asking the same question over and over again.

2. Difficulty planning and problem solving

Quite normal
If you occasionally make a calculation error or overlook an invoice, you don't have to worry immediately. It is also not abnormal that you find it more difficult to do many things at the same time as you get older.

Suspicious
Executing complex plans, for example, with many calculations is difficult and requires much more concentration than before. Typical examples are getting stuck or making mistakes when cooking or baking a recipe that you have made (successfully) often in the past. It is also suspicious if you can no longer keep track of your finances and bills when you used to be able to do so without any problems.

3. Difficulties with familiar tasks

Quite normal
Needing help with technology or figuring out how to operate another new household appliance: these are no reason to panic.

Suspicious
If someone has trouble compiling a shopping list or forgets the rules of his or her favourite game, this could be an indication that problems are starting. Forgetting the way to a place where you have been for years is also not normal.

4. Being disoriented

Quite normal
Forgetting what day of the week it is. This happens to everyone sometimes.

Suspicious
People with dementia can sometimes become disoriented in time and space. For example, he or she no longer knows what season it is or whether something happened yesterday or last week. Forgetting where one is and/or how one got there can also be an early sign of dementia.

5. Misinterpreting visual information

Quite normal
Cataracts can be the cause of blurred vision in older people, but that has nothing to do with dementia.

Suspicious
Sometimes early dementia can manifest itself in problems with vision. This concerns difficulty in estimating distance, colour or contrast and can make it difficult to read, and especially to drive.

6. Language problems

Quite normal
Don't worry if you can't find the right word for a while, but find it later.

Suspicious
Those who are or become demented may experience problems following a (one-on-one) conversation or starting a conversation. He or she repeats himself or herself within the same conversation or abruptly stops talking. It is also possible that someone with (early) dementia cannot find the right word for normal things. Instead, he or she will use a wrong word or description, for example, "hand-clock" instead of watch.

7. Losing things and not being able to find them again

Quite normal
Losing your key or wallet, but being able to think in your mind where the item might be, is quite normal.

Suspicious
People with dementia sometimes put objects in an unusual place, for example, keys in the refrigerator. Moreover, when they lose something, they are no longer able to trace where they have been or where they last saw something in order to find it again. That is why it sometimes happens that people with dementia (often in a more advanced stage) start accusing others of stealing.

8. Poor estimation or judgement

Quite normal
We all make bad decisions from time to time, such as delaying a doctor's visit when we're not feeling well or not changing the oil in our car on time. In this case, it's more about procrastination than misjudgement of the situation.

Suspicious
A sign of dementia can be that someone is less able to assess the risks or consequences of his or her actions. This manifests itself in the handling of money, for example, in spending excessively. In the area of ​​personal care, it happens that people with dementia wear too many warm clothes on a hot day, or no longer comb their hair, et cetera.

9. Taking less initiative

Quite normal
It is not unusual that those who get older also get tired faster and sometimes just don't feel like social obligations.

Suspicious
Difficulty remembering or following a conversation can make someone with early dementia more withdrawn. They may lose interest in their previous hobbies or passions. For example, it becomes too difficult to keep following the score in their favourite rugby match.

10. Mood and personality changes

Quite normal
Being in a bad mood from time to time when something goes wrong or sticking to your own routine and way of doing things is nothing to worry about.

Suspicious
When someone feels confused, depressed, anxious or restless for no apparent reason, this could be a sign of an underlying problem.

What should you do?

When you notice one or more signs of dementia in yourself or someone close to you, it can be very confrontational. People who work in local and international dementia organisations also realise this. It sometimes seems easier to dismiss concerns than to talk about them, especially if you're worried about someone else. You may be afraid of making him or her worried or angry. Nevertheless, it is important to discuss your concerns with the doctor, so that he or she can investigate the cause of the problems and possibly propose appropriate help.

Acknowledgement
The original of this article was written by Liesbeth Aerts and published on the 3rd of August in “Algemeen Dagblad”, a Dutch newspaper. It was translated with the support of Google Translate, after which small changes were made by Home4All staff to make it relevant for a New Zealand audience.