Symptoms of Dementia

Dementia is not a single disease. It's the name for a group of symptoms caused by damage to the brain from different diseases, the most common being Alzheimer's disease. Which symptoms someone has depends largely on which parts of the brain are affected, so dementia can look quite different from one person to the next.

This guide covers the main symptoms, how they tend to change over time, how they differ between types of dementia, and when to get help.

In short: Common early symptoms include memory loss, difficulty concentrating, struggling with familiar tasks, trouble following conversations or finding words, confusion about time and place, and mood changes. Symptoms usually start mildly and get worse over time. Dementia is not a normal part of aging, so if you're worried, talk to a doctor.

The main types of symptoms

Most dementia symptoms fall into a few broad areas. A person won't necessarily have all of them, especially early on.

Memory

Memory problems are the best-known first sign of dementia, particularly in Alzheimer's disease. Typical examples are:

• forgetting things that happened recently, while older memories stay clearer
• asking the same question several times
• misplacing everyday objects
• forgetting names, appointments or recent conversations

Thinking, concentration and planning

People may find it harder to:

• concentrate or follow a series of steps, such as a recipe
• plan and organize, or make decisions
• solve problems, such as handling money, paying bills or counting change at the store

Language and communication

Common changes include struggling to find the right word, losing track of a conversation, or finding it hard to follow what others are saying.

Orientation

The person may lose track of the time, day or date, or become confused about where they are, even in a familiar place.

Visual perception

Some people have trouble judging distances (for example on stairs), telling colors or contrast apart, misidentify objects, or misinterpret reflections and patterns. These problems can make driving unsafe. They are more prominent in some types of dementia than others.

Mood, emotions and behavior

Dementia often affects how a person feels and behaves, not just how they think. People may become anxious, irritable, depressed, frightened, suspicious or withdrawn, and may lose interest in hobbies or people. A person may also lack insight, which means they don't recognize the changes in themselves.

Early symptoms

In the early stage, symptoms are often mild and easy to put down to stress, tiredness or getting older. Common early symptoms include:

• memory loss
• difficulty concentrating
• finding it hard to carry out familiar daily tasks
• struggling to follow a conversation or find the right word
• being confused about time and place
• mood changes

Behavior changes are not usually the first sign, except in frontotemporal dementia. Noticeable physical changes early on are mainly seen in dementia with Lewy bodies.

When symptoms are mild and don't yet affect everyday life much, a doctor may describe them as mild cognitive impairment (MCI). MCI is not dementia. Some people with MCI go on to develop dementia, while others don't. See what is mild cognitive impairment?

For a closer look at the first signs, see subtle early symptoms of dementia and early-stage dementia.

How symptoms change over time

Most types of dementia are progressive: symptoms start mildly and get worse over time. How quickly this happens varies a great deal between people. Dementia is often described in three broad stages.

Middle stage

In the middle stage, symptoms become more noticeable and the person needs more help with daily life, such as reminders to eat, help with bathing and dressing, and support with appointments and money. Memory and confusion get worse.

This is also the stage when changes in behavior usually start. Alzheimer's Society describes changes such as:

• agitation, or verbal or physical aggression
• walking about repeatedly or restlessly
• disturbed sleep, such as sleeping more in the day and being awake at night
• delusions (strongly believing something that isn't true), sometimes with paranoia

Some people become more confused or distressed in the late afternoon and evening, often called sundowning. The middle stage is often the longest. See what happens in the middle stage of dementia.

Later stage

In the later stage, symptoms affect almost every part of a person's life. Later-stage symptoms commonly include:

• Memory problems. The person may not recognize close family or friends, or know where they are.
• Communication problems. Some people eventually lose the ability to speak. Nonverbal communication, such as touch and facial expression, becomes more important.
• Mobility problems. Many people become less able to move around, and some need a wheelchair or are confined to bed.
• Behavioral and psychological symptoms. These can include agitation, depression, anxiety, wandering, aggression and sometimes hallucinations.
• Incontinence. Bladder incontinence is common, and some people also lose bowel control.
• Eating and swallowing. Loss of appetite, weight loss and swallowing difficulties are common. Swallowing problems can lead to choking and chest infections such as pneumonia.

See end-stage dementia for what to expect and how to help.

Symptoms by type of dementia

Different diseases affect different parts of the brain, so the early symptoms in particular can vary. Later on, the types tend to look more alike.

Alzheimer's disease

The most common cause of dementia. Early symptoms usually center on memory: forgetting recent events, names and faces, asking the same questions repeatedly, difficulty with planning and organizing, getting confused in unfamiliar places, problems finding words, and difficulty with numbers or money. People may also become withdrawn or anxious. See stages of Alzheimer's disease and is it Alzheimer's or dementia?

Vascular dementia

The second most common cause, linked to reduced blood flow to the brain. Memory loss may be less obvious early on. Symptoms can include problems with attention, planning and reasoning, slowed thinking, walking difficulties, and mood changes such as depression. Some people have stroke-like symptoms such as weakness or paralysis on one side of the body. Symptoms can come on suddenly and get worse quickly, or develop gradually. See stages of vascular dementia.

New stroke symptoms are an emergency. If someone suddenly has a drooping face, weakness in an arm, or slurred speech, call 911 right away (999 in the UK). Don't drive them to the hospital yourself.

Dementia with Lewy bodies

Shares many symptoms with Alzheimer's disease, but people may also have:

• alertness and confusion that vary a lot, even within a day
• visual hallucinations (seeing things that aren't there)
• slow movement and stiffness, similar to Parkinson's disease
• repeated falls and fainting
• disturbed sleep, including acting out dreams

See stages of Lewy body dementia and Parkinson's disease dementia.

Frontotemporal dementia

More often starts at a younger age than other types, usually between 45 and 65. Early symptoms are often changes in personality and behavior rather than memory, such as:

• seeming less sensitive to other people's feelings
• behaving in socially inappropriate ways, or becoming withdrawn and losing motivation
• obsessive behaviors, such as fixating on particular foods, overeating or drinking too much
• language problems, such as difficulty finding or understanding words

See 7 stages of frontotemporal dementia, behavioral variant FTD and primary progressive aphasia.

Other types

Some people have more than one type, most often Alzheimer's disease with vascular dementia (mixed dementia). Heavy drinking over many years can also cause alcohol-related dementia. When symptoms begin before 65, it's called young-onset or early-onset dementia: see signs and symptoms of early onset dementia.

Other conditions that can cause similar symptoms

Not every memory or thinking problem is dementia. Similar symptoms can be caused by:

• depression, anxiety or stress
• delirium (sudden confusion), often caused by an infection or other illness
• thyroid, kidney or liver problems
• low vitamin B12 or other vitamin deficiencies
• side effects of some medicines, or interactions between several medicines

Some of these can be treated, which is one reason it's worth getting symptoms checked rather than assuming they're dementia.

When to see a doctor

If you're worried about your own memory, or about someone close to you, make an appointment with a primary care provider (a family doctor or internist) sooner rather than later. Dementia is not a normal part of aging.

Get help right away if symptoms come on suddenly. Call 911 for stroke signs such as sudden confusion, trouble speaking, or numbness or weakness on one side of the body. Sudden confusion without stroke signs can be delirium, which also needs same-day care, for example at the ER.

At the appointment, the doctor will usually:

• ask about symptoms and how they affect everyday tasks like personal care, shopping and paying bills
• do a physical examination, and may order blood and urine tests to rule out other causes
• ask the person to do a short memory or thinking test

If the person has Medicare: the yearly Annual Wellness Visit includes a cognitive assessment to look for signs of dementia, including Alzheimer's disease. It isn't a routine physical exam, and it costs nothing if the provider accepts Medicare assignment. If the provider suspects a problem, Medicare also covers a separate, more thorough cognitive assessment visit.

If possible, someone who knows the person well should go with them. They can describe the changes they've noticed and help remember what was said. If other causes are ruled out, the primary care provider may refer the person to a specialist for a fuller assessment, such as a neurologist, a geriatrician or a geriatric psychiatrist, or to a memory or dementia clinic, often based at a university medical center.

In the UK: start with a GP, who can refer the person to an NHS memory clinic for assessment.

If you're worried about someone who doesn't want to see a doctor, it can help to suggest a general checkup, or to frame it as ruling out other causes. You can also share your concerns with their doctor, although the doctor may not be able to share information with you without the person's permission.

Living with the symptoms

Symptoms of dementia can't currently be reversed, but there is a lot that can help people live well, including medicines for some types, practical support, and understanding what's behind changes in mood and behavior. Knowing the symptoms early gives people time to get a diagnosis, access support and plan ahead while they can still take part in decisions.