Confusion and Forgetfulness: The Right Diagnosis Is Important

Carolyn was worried about her 82-year-old mother. Mom, always so active and independent, had stopped going outside. Her condo was untidy, and there was little nourishing food in the kitchen. Mom seemed forgetful and her speech was slurred. Carolyn insisted that Mom go to the doctor to discuss the possibility of Alzheimer’s disease.

The doctor quickly discovered the real problem: Mom was experiencing negative side effects from a combination of medications she was taking for arthritis pain and insomnia. The doctor adjusted her medications, and Mom experienced almost immediate improvement.

As we grow older, memory loss and cognitive impairment become more common—not only as a result of Alzheimer’s, but also due to diseases such as Lewy body dementia, Parkinson’s disease, vascular dementia, and multi-infarct dementia from a stroke or series of strokes. Early diagnosis of these conditions is important so that the appropriate treatment and care can be started.

Patients and families should also remember that a complete medical evaluation may uncover a treatable, even curable, underlying cause for the patient’s symptoms. So it is important not to assume that confusion, memory loss and other personality changes inevitably signal dementia. Treatable causes may include:

Drug side effects and interactions—A medication regimen may begin simply with treatment for high blood pressure. Then another drug is added for another reason, and soon the pill reminder box is full. A number of drugs can cause confusion, alone or in combination with other drugs. Some of these include heart medications, steroids, narcotics, drugs to treat incontinence, sleep medications and antihistamines. Bring a list of all medications, including herbal preparations and supplements, to physician appointments.

Depression—Depression and dementia share many symptoms, such as forgetfulness and the inability to focus. Often, symptoms are much improved with counseling, medication and lifestyle changes.

Thyroid disease—When the thyroid gland produces too little or too much thyroid hormone, memory loss and confusion may result. A simple blood test can reveal a thyroid disorder. Most types of thyroid disease are easily treatable.

Vitamin deficiency—Sometimes elderly people have problems absorbing Vitamin B3, B12 or other vitamins from food. If the deficiency goes untreated, the resulting anemia can lead to symptoms of mental confusion, uncertainty and slowness.

Dehydration—As we grow older, the mechanism in our brain that tells us we are thirsty sends out a weaker signal, so seniors may drink less water than is needed for good health. Some heart patients may be on a restricted fluid regimen. Still other seniors try to limit fluid intake because of fear of incontinence. Dehydration symptoms, including disorientation and lethargy, can be similar to those of dementia.

Alcohol abuse—Some of the symptoms associated with alcoholism are very similar to those of dementia. Chronic alcohol abuse can cause permanent brain damage, including memory loss and confusion. But if the person gets his or her drinking under control, there is a good chance of improvement.

Head injury—Sometimes a seemingly minor fall or other injury results in a hematoma (blood clot) in the brain. This possibility increases as we grow older. These clots can prevent the brain from functioning normally, and can cause dementia-like symptoms. (Reminder: if a brain injury is suspected, call the doctor right away.)

Cognitive impairment is not a “natural part of growing older.” Geriatricians now recognize that dementia is part of a disease process. If a senior does have Alzheimer’s disease, it’s important to seek the best care to improve quality of life. But remember: the first step is to rule out other, treatable conditions.