Recognising the Subtle Shifts: Early Behavioral Symptoms
While memory loss is a well-known symptom of dementia, the earliest warning signs are often subtle, and they can be behavioral or emotional, rather than strictly cognitive. These changes are not simply a result of aging but are caused by progressive damage to the brain's nerve cells. The exact manifestation can vary depending on the type of dementia, but several common themes emerge. Family and friends are often the first to notice these deviations from a person's usual character.
Emotional and Personality Changes
Damage to the brain's frontal and temporal lobes can significantly alter mood and personality. A person who was once outgoing and vibrant may become withdrawn, while someone who was always patient might become easily frustrated.
Common emotional and personality changes include:
- Apathy and listlessness: A distinct lack of interest or enthusiasm for activities and hobbies that were once enjoyed is a hallmark of early dementia, often affecting up to 40% of people with Alzheimer's. It's crucial to distinguish this from depression, though the two can co-occur.
- Increased anxiety and depression: Many people in the early stages feel confused and anxious about their declining abilities, leading to heightened stress responses. New-onset depression in later life can also be a risk factor.
- Irritability and aggression: A person may become more easily agitated or angry, especially when faced with frustration from not being able to communicate or complete a task.
- Loss of inhibition: Certain types of dementia, like frontotemporal dementia (FTD), can cause a person to lose their filter, making inappropriate jokes or comments.
Changes in Social Interaction and Communication
As cognitive function declines, so do the abilities required for smooth social interactions. The difficulty is not just in remembering a conversation, but in following its flow and finding the right words to contribute.
- Social withdrawal: The person may retreat from hobbies, social gatherings, or work activities, not because they are lonely, but because they can no longer keep up with conversations or feel uncomfortable about their cognitive struggles.
- Communication problems: This involves struggling to find the right words, repeating stories, or stopping mid-sentence with no idea how to continue. This can cause frustration for both the person and those around them.
- Suspiciousness or paranoia: Some individuals may start to accuse others of stealing things they have simply misplaced, which can be distressing for family members.
Impact on Daily Habits and Functioning
Executive functions, such as planning, problem-solving, and decision-making, are essential for managing daily life. Impairment in these areas can lead to noticeable changes in a person's habits and judgment.
- Decreased or poor judgment: This can manifest in poor financial decisions, neglecting personal hygiene, or dressing inappropriately for the weather.
- Difficulty completing familiar tasks: What was once a routine activity, like following a recipe, managing bills, or driving to a familiar location, may become challenging or overwhelming.
- Misplacing items: A person might place objects in unusual places and then be unable to retrace their steps to find them.
Early Dementia vs. Normal Aging: A Comparison
It is important to differentiate these behavioral changes from typical age-related shifts. While normal aging can bring some forgetfulness, early dementia involves a persistent and disruptive decline in function.
| Sign of Early Dementia | Typical Age-Related Change |
|---|---|
| Making poor judgments and decisions frequently. | Making a bad decision once in a while. |
| Significant difficulty managing a monthly budget. | Missing a monthly payment on occasion. |
| Losing track of the date, season, and time of year. | Forgetting which day it is but remembering it later. |
| Trouble holding a conversation or repeating oneself. | Sometimes having trouble finding the right word. |
| Misplacing things and being unable to retrace steps to find them. | Misplacing things from time to time and retracing steps to find them. |
Understanding and Responding to Behavioral Changes
Behavior is often a form of communication when the person with dementia can no longer articulate their needs. Responding with patience and empathy is crucial. Instead of arguing, validate their feelings and try to identify the cause of the behavior, which could be confusion, pain, or an overstimulating environment.
- Establish a consistent routine: Predictability provides comfort and a sense of security, reducing anxiety.
- Simplify the environment: Reduce clutter, noise, and potential triggers. This can prevent disorientation and agitation.
- Use distraction and redirection: When a challenging behavior occurs, try to gently shift their focus to another activity. If they are fixated on going “home,” look at family photo albums or reminisce about their home life.
- Empathise and reassure: Respond to the emotion behind the behavior. If they are afraid, reassure them that they are safe and that you will help them.
Conclusion
The early behavioral changes associated with dementia are a critical aspect of the disease and can occur even before memory loss becomes prominent. Symptoms like apathy, personality shifts, social withdrawal, and poor judgment should not be dismissed as normal aging. Early recognition and a proper diagnosis can help families prepare for the future, access resources, and implement strategies to manage these changes effectively. By understanding that these behaviors are caused by brain changes and not intentional actions, caregivers can respond with patience and empathy, improving the quality of life for everyone involved. For more information and support, the Alzheimer's Association offers a 24/7 helpline and extensive resources for caregivers.
