Alan Baker of Spokane, Washington, began to have serious problems with memory, confusion and movement when he was about 72 years old. When his wife, Mary, began to observe his decline and difficulty handling everyday tasks, a five-year journey of misdiagnosis began.
In the first six months, he made 18 hospital visits. First, he was diagnosed with a vitamin B12 deficiency, but B12 shots didn’t help. Next, he was told he’d had a stroke and, with treatment, his condition improved slightly before relapsing again.
Several doctors insisted he had dementia and advised a nursing home. But Mary didn’t think so, and she persevered in a search for answers.
After a seemingly unending series of doctor and hospital visits, a doctor in Spokane, Washington, diagnosed Alan with normal pressure hydrocephalus (NPH), a brain disorder that occurs when excess cerebrospinal fluid accumulates in the brain’s ventricles, causing problems with walking and cognition that could easily be mistaken for dementia.
After confirming the diagnosis with an NPH specialist, a neurosurgeon placed a shunt in Alan’s brain for three days to begin the process of draining excess fluid. Gradually, Alan’s cognitive skills began to improve, and he was able to talk, feed himself, dress himself and move again. Eventually, a permanent shunt was implanted in his brain.
Today, at the age of 82, Alan Baker has most of his faculties back. He’s traveling yearly to his winter home, working in the yard and making coffee and breakfast every morning. Walking and exercise are again part of his daily routine, and he has even recently renewed his driver’s license.
“Many health conditions can be confused with dementia, so if you find yourself or a loved one suddenly experiencing cognitive changes, immediately seek medical attention and a thorough evaluation instead of falling into a trap of thinking you have dementia,” says Dr. Vanessa Rodriguez, an associate professor of geriatrics and palliative medicine at Mount Sinai Hospital in New York.
Dementia or False Alarm?
These are some of the common health conditions that can mimic dementia:
1. Delirium
Delirium causes people to act out of character and can easily resemble symptoms of dementia.
Unlike dementia, which is a neurodegenerative disease that evolves over months and years with progressive loss or damage to the nerve cells in the brain, delirium is a mental state in which you can quickly – within hours or days – become confused, disoriented and unable to think clearly.
A person of any age can experience delirium, but it occurs most often in older adults.
Causes of delirium include:
Infections
Fever
Pain
Electrolyte imbalances caused by dehydration
Thyroid dysfunction
Surgery and hospitalization
Metabolic disorders
Organ failure
Drug or alcohol withdrawal
Low sodium or sugar levels in the blood
Poor nutrition
Physical injury
Low levels of blood oxygen
Common symptoms of delirium include:
Agitation
Stress
Drowsiness
Social withdrawal
Reduced situational awareness
Difficulty performing everyday tasks, including eating and walking
Language difficulties, including following conversations and speaking clearly
Hallucinations
Mood swings
If the underlying conditions causing delirium are treated properly, it’s usually reversible.
2. Depression
Depression is a serious mood disorder that causes persistent feelings of sadness and changes how you think, act, sleep and eat. Left untreated, it can cause confusion, forgetfulness and significant cognitive decline. It can also cause you to lose interest in everything going on around you.
Many aspects of depression – withdrawal, apathy and not being quick and nimble – look like dementia, particularly in older adults, explains Dr. David Reuben, chief of the division of geriatrics at UCLA.
While people with dementia are usually disoriented, people with depression can have trouble concentrating, but are not disoriented, and are more likely than those with dementia to notice their own memory problems. Writing, speaking and motor skills tend not to be impaired by depression.
Unlike dementia, mood, concentration and intellectual function can improve when depression is properly treated with medications and therapy.
3. Adverse Side Effects From Medication Interactions
Certain medications can affect older adults and cause cognitive side effects that can be mistaken for dementia. Common reactions to specific drugs or to multi-drug interactions can cause confusion, memory lapses and difficulty concentrating.
While side effects to drugs can happen at any age, it’s a more common problem in older people. An older body processes medications differently than a young one, making adverse reactions more prevalent. Due to an increase of fat storage in older people and a decrease in renal function, the length of time medications live in an older body can be seriously increased.
Prescribed medications that can cause side effects easily mistaken for dementia include:
Acetylcholine blockers. These drugs block the action of acetylcholine, a type of neurotransmitter. Blocking this neurotransmitter inhibits involuntary muscle movements and various body functions. They’re prescribed to treat irritable bowel syndrome, insomnia, bladder control problems, depression, heart disease, Parkinson’s disease, vertigo and other conditions.
Benzodiazepines. These medications – including Valium, Xanax, Halcion, Ativan and Klonopin – are used to treat anxiety and insomnia and have a sedative effect that can cause cognitive problems.
Corticosteroids. Corticosteroids – including cortisone and prednisone – are a kind of inflammatory drug used to treat diseases like rheumatoid arthritis, lupus and vasculitis (inflammation of the blood vessels) and can cause symptoms that could be confused with dementia.
Chemotherapy medications. “Chemo brain” is a condition caused by chemotherapy drugs that can affect memory, focus, attention and other mental processes.
However, prescription medications are not the only drugs that can cause dementia-like symptoms. Common over-the counter medicines – like antihistamines (Benadryl) and sleep aids (Tylenol PM, Aleve PM and Nytol) – can also cause confusion. Don’t assume medications are safe simply because they don’t require a prescription.
If you or a loved one is experiencing changes in memory or thinking, your medical provider should review a list of all the medications you’re taking to look for and stop any that may be causing confusion.
“Sometimes, the effect on the brain happens right after taking a new medication, but other times it takes months or years before a drug begins affecting your brain,” says Dr. Milta Oyola Little, a geriatric medicine specialist at Duke Health.
4. Dehydration
Dehydration occurs when you lose more fluid than you take in and the body doesn’t have enough water and other fluids to carry out its normal functions. When water levels are too low, brain cell functioning is compromised, causing some of the following symptoms that can be confused with dementia:
Delirium
Weakness
Confusion
Difficulty focusing
Trouble concentrating
Slow reaction times
Inability to think clearly
Lethargy
Exhaustion
The brain is made up of 80% water, and when it doesn’t get enough, brain tissue shrinks in size. It only takes a 2% decrease in brain hydration to cause short term memory loss.
Many older adults don’t drink enough water and, therefore, are at a higher risk than others of becoming dehydrated. As you age, your body can’t retain water as efficiently as it once did.
Kidneys may not be functioning as well as when you were younger, leading to fluid imbalances, and many prescribed medications have diuretic effects that can cause the body to lose water.
With proper hydration, cognitive problems caused by dehydration will go away, whereas cognitive dementia symptoms do not.
5. Vitamin B12 Deficiency
Vitamin B12 is an essential nutrient that helps your body keep your nerve cells and blood cells healthy. Because your body doesn’t produce this vitamin on its own, you need to get it from foods high in vitamin B12, such as meat, poultry, dairy, eggs and fortified foods (like cereals, bread and nutritional yeast).
If you don’t get enough vitamin B12, you may experience dementia-like problems, including:
Memory loss
Agitation
Depression
Delusion
Paranoia
As you age, the body’s ability to absorb vitamin B12 can decline, making older people at higher risk.
Unlike dementia, though, a B12 deficiency can be reversed with weekly shots of vitamin B12 or vitamin B12 supplements.
6. Thyroid Imbalances
The thyroid is an endocrine gland at the front of the neck that makes and releases certain hormones. Its job is to control the speed of metabolism, which is the process by which the body transforms the food you consume into energy. Every cell in the body needs energy to function, including the brain.
There are two kinds of thyroid dysfunctions – both of which can develop gradually and lead to cognitive problems that can be mistaken for dementia:
Hypothyroidism. Hypothyroidism occurs when the thyroid isn’t producing enough thyroid hormone into the bloodstream, causing your metabolism to slow down. If thyroid levels are extremely low (myxedema), your condition is serious and can cause confusion, forgetfulness, brain fog and other dementia-like symptoms.
Hyperthyroidism. Hyperthyroidism occurs when the thyroid is overactive and releases high levels of thyroid hormone into the bloodstream. It can cause dementia-like symptoms, like problems focusing, attention issues and difficulty concentrating.
In addition, if thyroid hormones are out of balance, it can affect the learning and memory functions of the hippocampus, which is the part of the brain that stores memories and plays a role in spatial processing and navigation.
As a result, older people with thyroid imbalances can be misdiagnosed with dementia.
When an older person appears to have dementia, experts say the thyroid levels should be immediately checked using a blood test. If thyroid levels are low, they can be treated with hormone replacement therapy. If they’re high, anti-thyroid medications can restore hormone levels.
7. Urinary Tract Infection
Urinary tract infections (UTIs) are common urinary health issues caused by bacteria entering the urinary tract.
While typical symptoms include needing to pee often, pain and burning while peeing and pain in the side or lower back, UTIs can often cause cognitive dysfunction symptoms mimicking delirium, which can be mistaken for dementia.
When you have an infection, your immune system kicks into high gear to fight it and releases chemicals that cause inflammation. In older adults, the brain is more affected by inflammation and stress than it is in younger people. The stress hormones the body produces to fight infection are often what shows up as delirium.
Cognitive dysfunction symptoms caused by UTIs, including:
Agitation
Restlessness
Confusion
An inability to perform familiar tasks
Memory loss
Hallucinations
Unlike dementia, which is a long progressive change in cognition, UTI symptoms come on quickly and are often missed in older people because they usually don’t have the typical UTI symptoms of fever and pain.
UTIs are treatable with antibiotics and lots of fluid, rest and a healthy diet.
8. Normal Pressure Hydrocephalus
The brain contains chambers, called ventricles, that contain fluid called cerebrospinal fluid (CSF) that cushions the brain and spinal cord from injury and provides nutrients to the body. Normally, the body makes just enough CSF each day and absorbs the same amount.
However, too much fluid can build up in the ventricles and cause normal pressure hydrocephalus (NPH), a condition in which the brain’s ventricles swell and press against the nearby brain tissue. If the compression on the brain lasts too long, pressure caused by the excess fluid can permanently change or destroy brain tissue.
While NPH is not common and usually affects older adults, symptoms can resemble dementia, particularly Alzheimer’s disease.
NPH symptoms include difficulty walking, confusion, forgetfulness, mood changes, depression and difficulty thinking and having a conversation.
The Hydrocephalus Association estimates that almost 700,000 adults have NPH, but it’s often misdiagnosed as one of the stages of Alzheimer’s disease or Parkinson’s disease. In fact, less than 20% of people with NPH are diagnosed properly.
Unlike dementia, early diagnosis prevents long-term problems and can be treatable and reversible.
Physical exams, CT scans, MRI scans of the brain and a spinal tap to remove samples of CSF can confirm the diagnosis. If NPH is confirmed, a shunt – like the one implanted in Alan Baker’s brain – can be used to prevent fluid from building up.
Bottom Line
Many conditions can imitate symptoms of dementia and lead to a misdiagnosis, which often causes a delay in treatment.
Reuben suggests that doctors need to be better trained in the problems and causes of cognitive abnormalities, especially in older people. To avoid a misdiagnosis, older adults should undergo a cognitive assessment, such as the SAGE test, as part of their annual wellness visit. If there are concerns about cognitive issues or uncertainties about symptoms, it’s important for patients or family members to voice them to their doctor and ask for an evaluation.
“Every case of cognitive decline is not dementia,” says Reuben. “Some can be treated and reversed, and others may just be normal aspects of aging, but we are continually pushing toward early evaluation of dementia-like symptoms.”