Dementia-like symptoms: What else could it be?

Confusion

When someone has difficulty recognising what time of day it is and where they are and becomes over-anxious or agitated, it is often assumed that they are showing the first signs of dementia. If these symptoms of confusion have developed relatively quickly, they may have been caused by a lack of food or dehydration, or by a urinary or chest infection.

It is important that an early diagnosis is made to establish whether the symptoms are caused by a treatable illness. A change in – or a reaction to – medication or taking alcohol in conjunction with medication, can also produce symptoms of confusion.

Care workers should look out for these signs and encourage the person to seek medical advice from their GP to eliminate these possibilities.

Depression

The symptoms of depression are often mistaken for dementia. It is not easy to define the symptoms because many people with dementia develop signs of depression, such as feelings of low self-esteem and confidence, tearfulness and appetite, concentration and memory problems. If depression is diagnosed by a GP, a wide range of treatments are available.

In a video on the NHS Choices website, called Depression – Lawrence’s story, Lawrence, a psychiatric nurse, talks about his experience of living with depression. You can see how some of the things he describes could be mistaken as early signs of dementia. He says:

I worry about how I am perceived by people, because I know I say insensitive and inappropriate things. It’s like my mouth goes or my fingers type before my brain has a chance to engage, and at the time I think it’s okay to say the things I’m saying or typing. Then I beat myself up for ages afterwards, and cry and tell myself I’m a horrible person and worthless.

But I just can’t seem to stop. I also get extremely angry about little things... I can’t bring myself to tell my family or most of my friends and I feel so alone with it. I think this is because I don’t feel it’s an illness, and to tell people would just be like saying “oh by the way, I’m a complete idiot and want you to feel sorry for me”, even though I know that’s silly.

Medical conditions

Thyroid, kidney, liver, heart and lung problems, urinary and chest infections and strokes are among the many medical conditions that can produce dementia-like symptoms. Older people with poor vision can appear to show signs of dementia, including poor spatial awareness (for example they may bump into furniture, or fall over chairs and other objects in their home). They may struggle to read or follow television programmes. A simple eye test – and new glasses – may be all they need to overcome these problems. People with hearing difficulties may appear to show signs of dementia because they have difficulty following conversations. They may become confused and withdrawn. Again, a simple hearing test and hearing aid may resolve these difficulties.

Emotional distress

The death of a spouse, relative or close friend, and worry over retirement and moving home, can create emotional problems that can be easily mistaken for dementia. Bereavement can cause a range of problems, from exhaustion, sleep deprivation, headaches and high blood pressure to irritability, hallucinations and loss of appetite. The support of family and friends is invaluable in helping someone cope with bereavement. Grief counselling – offered by organisations such as Cruse Bereavement Care – can help people deal with a devastating loss in a supported relationship.

If you care for someone who lives alone, you may be the only person they see in a day, week or longer. They may feel isolated or lonely, appear confused and suffer memory lapses – symptoms, perhaps, of their living arrangements. How can you help? By encouraging them to take part in social activities, to join local community groups or to maintain or take up hobbies.

When caring for a person from a different culture or background, care workers should take into account the effect that their beliefs may have on their behaviour and emotional responses and not to confuse them with symptoms of dementia.

Moving home

As people get older, they often move to new accommodation better suited to meet their needs. They may move into a smaller property, sheltered housing or into a care home if they are no longer able to care for themselves at home. The move can create symptoms of physical and emotional stress that can be mistaken for dementia (that is, they become withdrawn, angry, restless, struggle to communicate with others and suffer memory problems).

Where we live gives us our sense of identity. We all have routines and preferences that help shape how we live our lives. Moving house may mean routines have to be changed and this can have an impact on a person’s personality and way of life. Moving to a care home can present many new challenges (from the way someone eats, sleeps and spends their leisure time to sharing a communal lounge or dining room). With the right support and care, most people adjust to their new surroundings without stress taking its toll.

As a care worker, how can you help?

There are many conditions and circumstances where you may see signs and symptoms that may be confused with dementia. As a care worker, it is not your responsibility to try to diagnose the condition. However, as you may be the one person who sees the individual on a regular basis, you are well placed to notice any changes. Encouraging an older person to visit their GP on a regular basis can help them to maintain their general health and wellbeing.

• Further reading Open

  Alzheimer's Society (2012) 'Depression and anxiety'. Factsheet 444. London: Alzheimer's Society.

  Counsel and Care (2010) 'Memory loss, depression, 'confusion' and dementia'. Guide 9. London: Counsel and Care.

• Useful links Open

  Alzheimer’s Society
  The Alzheimer’s Society produces over 80 factsheets on all sorts of topics related to dementia, including many that relate to early signs and diagnosis, including Risk factors for dementia (450), Assessment and diagnosis (426), After a diagnosis (471), and The progression of Alzheimer’s disease and other dementias (458).

  healthtalk
  The healthtalk website contains stories from 31 carers of people with dementia, some presented in videos, some in audio recordings. The stories cover a wide range of areas, including recognising the early signs of dementia and getting the diagnosis.

  NHS Choices
  NHS Choices describes itself as the ‘online front door to the NHS’. It is the UK’s biggest health website and includes an A–Z of health conditions, including dementia, as well as explaining about treatments and how the health system works. The Dementia Guide on this site includes a section on Getting a dementia diagnosis, Benefits of early dementia diagnosis, and What to do if you’ve just been diagnosed with dementia.

  Unlocking diagnosis: The key to improving the lives of people with dementia.
  This All-Party Parliamentary Group of Dementia publication reports on the APPG’s 2012 inquiry into differing diagnosis rates – and the barriers for lifting these – around the UK.

  World Alzheimer Report 2011: The benefits of early diagnosis and intervention
  The Alzheimer’s Disease International 2011 report investigated the benefits and disadvantages of early diagnosis and intervention for people with dementia, the implications of early diagnosis for health and social care costs, and best practice in early intervention around the world.

• Related pages from this section Open

  • Early signs and diagnosis of dementia
    • Early signs of dementia
    • Dementia risk factors
    • What else could it be?
    • Causes of dementia (video)
    • Why early diagnosis is important
    • Early diagnosis and drug treatment (video)
    • Getting a diagnosis
    • Diagnosis when someone has sensory loss