6 Medical Conditions That Have Dementia-Like Symptoms

Here are some common medical conditions that can be mistaken for dementia.

1. Drug interactions or side effects

If someone complains of memory problems, Hashmi says their first question is always, “Have you recently started a new medication?”

Older adults are more likely than younger people to develop cognitive impairment as a side effect of medication, and drug toxicity is the culprit in as many as 12% of patients who present with suspected dementia , according to the research.

Many types of prescription and over-the-counter medications can affect your cognition, but the most common are those for sleep, urinary incontinence, pain, anxiety, and allergies. Taking too many drugs (called polypharmacy) can also affect your ability to think clearly and remember things, observes Hashmi. Research from the Lown Institute shows that almost half of seniors (42%) take at least five prescription medications.

Even a prescription you’ve been taking for many years can be confusing. The reason why, Hashmi explains, is that your kidneys and liver become less efficient at removing drugs from your body as you age, so a drug can build up in your system over time and cause problems.

2. A respiratory infection (including COVID-19)

Any untreated infection, Hashmi says, can cause delirium — a sudden change in alertness, attention, memory and orientation that can mimic dementia. When you have an infection, your body’s white blood cells rush to the site of infection, causing a chemical change in the brain that makes some seniors feel sleepy, fuzzy, or confused.

Respiratory infections are harder to diagnose in people 65 and older because they’re more likely to not have classic symptoms, such as fever or cough, Hashmi notes. In a study published in Open JAMA Network, for example, 37% of elderly patients with COVID-19 who visited the emergency room with delirium had no symptoms typical of COVID, such as fever or shortness of breath.

Delirium tends to come on suddenly, whereas classic dementia usually progresses slowly, with subtle memory changes that get progressively worse over many years, Hashmi says. “Dementia is almost never sudden onset unless it is caused by a stroke. If you see a sudden change [in mental status], always think of delirium as the root cause. It is perfectly treatable if you hit the trigger or the underlying source of it, which is usually an infection.

Patients have also reported difficulty concentrating, memory loss and attention deficits after recovering from COVID-19 infection. In most patients, these symptoms disappear after a few months.

3. A urinary tract infection

Urinary tract infections are another common cause of delirium and dementia-like symptoms in older adults. In surveys, around 1 in 10 women over 65 and up to 30% of women over 85 reported having had a urinary tract infection in the past year. Men are also more likely to have UTIs as they age.

Like respiratory infections, UTIs manifest differently in people older than 65 than in younger patients, says James M. Ellison, MD, geriatric psychiatrist and chair of memory care and geriatrics. from the Swank Foundation for ChristianaCare, a health care system in Delaware and Maryland. .

In older people, “some of the warning signals that help us make the correct diagnosis are impaired or absent,” says Ellison. “So, for example, an older person with a UTI may experience a change in mental status without fever or burning on urination.”

The good news is that most UTIs and the cognitive issues that accompany them can be diagnosed with a simple urine test and then treated with an antibiotic, Ellison says.

4. Sleep problems or disturbed sleep

Getting a good night’s rest is key to protecting the brain as you age, Ellison says. Sleep gives our brain time to learn, store memories and filter out toxic substances. If your sleep-wake cycle is disrupted or you suffer from insomnia, you may experience dementia-like symptoms such as trouble concentrating, confusion, mental fatigue and irritability.

Studies have shown that insomnia affects 30-48% of older people. If you have trouble closing your eyes, experts recommend limiting or eliminating daytime naps, limiting alcohol and caffeine intake at night, and sticking to a consistent sleep schedule and other good sleep hygiene habits. If these remedies don’t work, cognitive behavioral therapy can help. Ellison cautions against using sleeping pills except in the very short term and under the direction of a doctor.

Some seniors also suffer from sleep apnea, a sleep-related breathing problem that can deprive your brain of the oxygen it needs while you sleep, which can cause long-term damage. Many patients don’t realize they have the disease, Ellison says. Tell your doctor if you have any signs of apnea, such as loud snoring, waking up gasping or choking, uncontrolled high blood pressure, morning headache, or dry mouth on waking.

If you’re diagnosed with sleep apnea, using a continuous positive airway pressure (CPAP) machine while you sleep has been shown to be an effective treatment, Ellison says.

5. Dehydration

Dehydration can also resemble dementia, and it’s common in older patients, Hashmi says. As you get older, your body’s ability to hold water in your blood vessels decreases and your thirst mechanism isn’t as strong, so it’s easy to become dehydrated without realizing it. If you take diuretics or laxatives, they can further contribute to water loss.

If someone you love seems foggy or confused, check to see if their urine is dark yellow or brown, which may indicate a lack of fluids. Another sign of severe dehydration is a white coating on the tongue, Hashmi says. Intravenous fluids can often reverse cognitive problems caused by severe dehydration. “It’s amazing what a liter of intravenous fluid can do,” adds Hashmi.

To prevent dehydration, seniors should aim to drink at least 48 ounces of caffeine-free fluids (six 8-ounce glasses) per day.

6. Normal pressure hydrocephalus

Normal pressure hydrocephalus is a treatable disorder in which cerebrospinal fluid builds up in the brain, disrupting and damaging nearby brain tissue and causing cognitive problems.

A neurologist can diagnose normal pressure hydrocephalus using brain imaging and cerebrospinal fluid tests. It is usually treated by inserting a flexible tube, called a shunt, into the brain to drain fluid.

“We see a few cases every year,” Ellison says. “When we diagnose it, we’re always happy because it’s a treatable disease. …I’ve seen people improve dramatically.

Other disorders with dementia-like symptoms

Many other conditions, in addition to those above, can cause symptoms that mimic dementia or Alzheimer’s disease, including heart, lung, liver or kidney problems, thyroid problems, sodium or vitamin B12, certain cancers, pain, constipation, alcohol consumption and depression.

Many of these conditions are treatable, and cognitive symptoms can be reversed, as long as they’re properly diagnosed, Ellison and Hashmi say. A routine metabolic blood test and urinalysis, along with neuroimaging, will detect many of these disorders.

If the tests return to normal, experts suggest seeking a referral to a geriatrician who specializes in the elderly, who will carry out a full evaluation before accepting a diagnosis of Alzheimer’s disease or dementia.

“It’s very important for clinicians and patients to recognize that dementia is not a normal part of aging,” Ellison says. About 11% of adults 65 and older have Alzheimer’s disease, the most common form of dementia, according to the Alzheimer’s Association. “Everyone deserves a good checkup to identify treatable and reversible conditions,” Ellison adds.

Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation’s leading consumer publications. His work has appeared in Reader’s Digest, Real Simple, Prevention, The Washington Post and The New York Times.

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