Dementia Is More Than "Being Forgetful"
Getting older comes with many changes, including occasional memory lapses. But there is a clear difference between age-related cognitive changes and dementia. Roughly 7 million people in America have dementia, and that number is expected to double by 2060. Experts say cognitive impairment becomes more severe when it starts to impair daily function.
Dr. Stephanie Nothelle, a geriatrician and associate professor at Johns Hopkins School of Medicine, says the "magic line" that transitions someone from mild cognitive impairment to dementia is when a cognitive impairment impairs function — for example, no longer being able to drive, getting lost on a familiar route, or suddenly being unable to do taxes after decades of doing them.
Dementia is an umbrella term describing multiple forms of cognitive impairment, including Alzheimer's disease (the most common form), vascular dementia and Parkinson's. While cognitive impairment is a common thread, there are also physical symptoms associated with dementia. Here are six to watch for.
1. Trouble Walking and Balancing
Nothelle says many physical manifestations happen later in the course of dementia, but the ability to walk and maintain balance is an earlier issue that worsens throughout the disease.
"The ability to maintain your balance and walk smoothly requires a lot of brain power because you have to process a lot of different inputs," Nothelle said. You process sensations from your feet and what your eyes see, and you must react quickly. "It's a very cognitive task to be able to walk."
Because of this, trouble walking, trouble balancing and falling frequently can be signs of dementia — though these issues can also be due to arthritis or even clumsiness.
2. Posture Changes and Feet Shuffling
The second-most-common form of dementia is Lewy body dementia, which includes Parkinson's disease. Dr. Jori Fleisher, an associate professor of neurological sciences at Rush University in Chicago, says you may notice posture changes, feet shuffling or slower walking than before.
While it's easy to chalk these up to getting older, not paying attention or arthritis, "if we're seeing a pattern of that, we want to pay attention to it," she added.
3. Changes in Sense of Taste and Smell
Changes in taste or smell can be attributed to many issues, such as COVID-19 or sinus problems. But outside of known factors, unexplained changes can also be related to dementia.
"Sometimes the person doesn't notice it themselves, but their loved one is going, 'Hey, something on the stove was burning and you didn't smell that,'" Fleisher explained. This symptom should prompt a doctor's visit. While not a sign of all forms of dementia, it is associated with Lewy body dementia.
4. Problems Swallowing
People with dementia may experience trouble swallowing food and drinks. "People will be eating or drinking, and things will have a tendency to accidentally 'go down the wrong pipe,'" Nothelle said. Food or fluid entering the windpipe and lungs doesn't belong there. Saliva helps us swallow, and our mouths are full of bacteria — some good, some not — and if bad bacteria end up in the lungs with food, it can set up an infection.
"We call that aspiration pneumonia, and that's why pneumonia is relatively common in the later part of dementia," Nothelle explained.
5. Bladder Control Issues
"Incontinence, unfortunately, can be a symptom of dementia," Nothelle said. Bladder control requires many nerves, "and those nerves degenerate as dementia progresses." Similarly, Fleisher notes that new constipation later in life can be a sign of Parkinson's and related conditions, often preceding other symptoms by years.
6. Sleep Changes
According to Fleisher, sleep changes are also important to watch for. The person may not notice, but if you live with someone and find they're moving around a lot at night, punching, shouting or talking in their sleep, let their health care team know.
"That may be something called REM behavior disorder, which often can come years before a person has Parkinson's or Lewy body dementia," she added.
An Early Diagnosis Can Be a Powerful Way to Prepare
It can be hard to admit to health problems or changes, especially when it comes to cognition — but it's important. Fleisher says we are living in a time of innovation for dementia treatments, with lots of research underway. Doctors can check biomarkers in blood or spinal fluid to determine what kind of dementia someone has and make treatment decisions based on that.
Both experts say it's best to start treatments or interventions early. Treatments aren't a cure but can help with disease management. An early diagnosis can also help families and individuals prepare — including planning and having a say in your future care, where you'll live or financial choices.
That makes it important to pay attention to any signs of dementia in yourself or a loved one and reach out to a doctor if you notice concerning changes. For daily health management, you can use the Xiaoshu Health App to sync Apple Health data — such as sleep, walking stability and activity levels — to help you and your family spot changes earlier and provide useful reference for medical visits.