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Visions Journal

Is This Supposed to Happen?

Distinguishing Signs of Dementia from the Normal Cognitive Changes of Aging

Holly Tuokko, PhD

Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, p. 13

Recalling names, finding keys or glasses, and remembering just what it was you wanted in the basement once you are down there, are the types of memory problems reported with increasing frequency by people as they move into older adulthood. Are these changes that are to be expected with increasing age as a matter of course, or are they the subtle, early signs of a cognitive disorder, like Alzheimer’s disease?

Over the past 20 years, a substantial amount of research has been conducted to address this question and it has been demonstrated that some modest degree of cognitive change is to be expected with increasing age. Most notably, these changes have been observed on some types of memory tasks, like finding words and names quickly. At the same time, some changes in cognition are important indicators of a variety of disorders affecting older adults. For this reason, it is important that changes in cognition that are occurring with increasing frequency, or come on suddenly, are not dismissed too casually or overlooked.

What then are the early cognitive features that distinguish between those persons who will decline to dementia over time and those who will not? Although research has been active in this area for over 30 years, to date it has not been possible to make precise predictions of this kind. That is, no one test or type of impairment has been identified as always predictive of decline. However, a few valuable lessons have been learned that can be used as signposts to guide us.

First, it is clear from the research literature that not all people who report or show some signs of cognitive impairment will progress to dementia. There is great variability between studies in the estimates of what proportion of people will develop dementia. Even so, it is typically the presence of memory impairment — the kind that’s both observed as increasing by family or close friends and evident on specialized memory tests — that is related to future decline.

Second, changes in how a person behaves may also indicate early signs of a problem. For example, dramatic changes in how a person acts, such as extreme suspiciousness, withdrawal, or inactivity, may require prompt attention. Similarly, if people begin to have difficulty performing familiar tasks they have done for years, like preparing a meal or balancing a chequebook, this too may warrant further investigation.

Third, cognitive changes may be indicative of a wide variety of conditions seen in older adults, not just dementia. Some of these other conditions may require prompt medical attention, if permanent problems are to be avoided. For example, any abrupt change in cognitive functioning (e.g., confusion or disorientation) or sudden onset of unusual behaviour is often indicative of an underlying physical problem that, without prompt treatment, can result in death. Similarly, low motivation and poor attention associated with depressive syndromes in older adults may affect cognitive abilities. Treatment of depression, with medications or through individual or group counselling, may elevate the person’s overall level of functioning through improvement in mood, energy level, and/or sleep quality.

In conclusion, some changes in cognitive functioning (e.g., recalling names quickly) in older adults are common, age-consistent, and are not cause for alarm. Others may be first indicators of an underlying problem. A variety of underlying problems may present with cognitive changes. Any abrupt or sudden changes in cognitive functioning are cause for concern and require prompt medical attention. Changes in cognition that seem to increase gradually over time require further evaluation, particularly when accompanied by changes in behaviour (e.g., withdrawal, suspiciousness, inactivity). A high degree of vigilance is required for the early detection of treatable emerging conditions, but this must be balanced with the understanding that some modest changes in cognition are to be expected with advanced age, and not all persons with mild cognitive problems show deterioration over time.

About the author
Holly is the Associate Director of the Centre on Aging at the University of Victoria, where she is also an Associate Professor in the Department of Psychology

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