Most of us are aware of the more usual signs of dementia – namely, memory loss, confusion, disorientation – but what about the less obvious symptoms? Researchers from the University of Michigan studied 300 people over 65 who scored low on cognitive tests – a red flag for dementia – and over eight in 10 participants claimed that they had never been told they had the disease and were unaware of the symptoms. Last year, NHS figures showed that up to 100,000 people in England may be living with undiagnosed forms of dementia that present with symptoms such as depression and hallucinations, according to government figures.
It’s true that dementia can be difficult to diagnose, especially if symptoms are mild. In fact, there are more than 200 types of dementia and, according to Dementia UK, there are estimated to be 70,800 people living with young-onset dementia (under the age of 65).
A diagnosis can be overwhelming – but spotting symptoms quickly can help with treatment and care. So what are some of the hidden signs that you might see in someone with early-stage dementia?
Suddenly forgetting birthdays and anniversaries
We’re all guilty of missing the occasional celebratory event; it’s nothing to worry about. But when it starts to become more regular, it may be worth getting checked out.
“Mild problems with short-term memory and recall of recent events are a common sign of the early stages of most forms of dementia,” says Caroline Scates, deputy director of Admiral Nurse Development at Dementia UK. “Yet memories of childhood and early life remain very clear, which can lead people to think that the person is fine. It tends to be family and friends – who spend a lot of time with the person – who pick up on signs that they’re forgetting things that happened recently or they’re repeating themselves or asking the same questions again and again.”
Change in behaviour at dusk
Some people who have dementia experience a growing sense of agitation or anxiety as day turns into night. This may be because hunger, thirst and physical pain can be worse at this time of day.
“It’s known as ‘sundowning’ and often makes anyone with dementia feel very strongly that they’re in the wrong place,” says Caroline. “There might be a strong feeling that they need to go home, or that they need to pick the children up from school, even if they’re now adults. There could be shouting, arguing, pacing or confusion.”
Seeing or hearing something that isn’t there
For many people with dementia, the brain misinterprets information, which can cause changes in perception where they experience things differently from other people.
“Some people with dementia experience something that’s not really happening, such as hearing voices (auditory hallucinations) or seeing things that aren’t there (visual hallucinations),” says Caroline. “Visual hallucinations are more common in people with Lewy body dementia – a progressive, complex and challenging condition that’s thought to account for 10-15% of all those with dementia.”
Feeling more anxious or frightened
Dementia causes changes to behaviour and personality. These changes are especially common if there’s damage to the frontal and temporal lobes of the brain – for example, in frontotemporal dementia.
Caroline adds: “Someone living with early dementia may become irritable or anxious over things that never used to bother them. They may start being secretive, irrational or make some out-of-character decisions. Sometimes they can be withdrawn or suspicious of others, or become moody and depressed.”
Avoiding talking to people – even on the phone
Known as aphasia, difficulties with language or speech can occur in all forms of dementia; signs include struggling to find a word or get to the point of a story, or possibly slurred speech. This can lead to an avoidance of communication – so speaking, reading and writing less, says Caroline. Handwriting might also change, becoming more difficult to decipher.
Struggling to stay focused
Over time, dementia will cause a general decline in social and life skills, and this can include struggling to maintain focus on single tasks.
“Perhaps there may be a struggle to complete tasks or meet deadlines and work, and there could be problems with literacy, numeracy and other basic skills,” says Caroline. “An ability to plan ahead might be affected, and driving skills could deteriorate.”
Trouble managing money
People with Alzheimer’s disease and related dementias may start having trouble managing their finances several years before their diagnosis, according to one large-scale study from 2021.
Scientists at Johns Hopkins University analysed information from 1999 to 2018 on more than 81,000 people over 65, about a third of whom were diagnosed with dementia within this period.
The study found that people who had dementia had more missed credit card payments as early as six years before their diagnosis, and were more likely to have lower than average credit scores two and a half years before their diagnosis.
For more information and support, contact dementiauk.org.
