Dementia does more than rob people of their memories. Research continues to show that dementia — an umbrella term for numerous kinds of cognitive impairments and brain changes — can lead to a wide range of symptoms, especially at the beginning stages. But the signs are not always easy to recognize.

Frontotemporal dementia, for example, can show up with changes in personality, empathy, and language, whereas dementia with Lewy bodies can manifest as overly stoic looks, odd ideas, and even hallucinations.

How can you know if you or a loved one is showing signs of Alzheimer’s disease or another form of dementia?

Any deviation from a person’s usual behavior or abilities might be a cause for concern, says Katherine Rankin, PhD, a neuropsychologist who conducts research at the University of California in San Francisco Memory and Aging Center.

It’s important to note that the behaviors mentioned on this list are not signs of dementia unless they are a change from someone’s previous behavior, according to Dr. Rankin. Speak to a doctor if you’re concerned about one or more of these changes in yourself or a loved one.

1. Moving Less, Being More Sedentary

In a study using data from more than 2,500 adults ages 50 and older, those with worse memory spent less time being physically active more than 17 years later. Participants 50 and older whose memory declined the most over time got 1.6 fewer hours of light activity per week, and those ages 70 and older with worse cognitive health got 2.3 fewer hours of light activity per week.

These findings suggest that a drop in your previous activity level may indicate underlying memory and thinking problems, and that this connection may become more noticeable later in life.

But less movement in and of itself may not directly reflect the development of dementia. Aging and other aging-related conditions may mean that some people naturally move around less than they used to. 

2. Trouble With Driving

3. More Frequent Falls

“People will come into our office concerned because they forgot what was on their grocery list last week, but when their spouse says they’ve fallen four times in the past year, that’s a sign of a problem,” says Rankin.

Frequent falls may be a symptom of numerous brain disorders, including progressive supranuclear palsy.

4. Failure to Pick Up on Sarcasm and Spot Liars

You may or may not appreciate a sarcastic sense of humor, but sarcasm is a part of our culture. ”We see it as a nice way to be critical, and so we use it constantly, even when we are trying to be nice,” says Rankin, whose research found that people with both frontotemporal dementia (FTD) and Alzheimer’s disease tend to have a harder time picking up on sarcasm.

Another unusual feature of dementia that Rankin noticed? People with FTD couldn’t tell when someone was lying, but people with Alzheimer’s disease could. ”FTD patients don’t have that sense anymore that things that people do could turn out badly,” she says.

5. Disregard for the Law and Other Social Norms

This could lead to trouble with the law: Early-onset dementia can hit people as early as their thirties and forties, well before anyone around them would consider their out-of-character behavior to be a sign of dementia.

But, says Rankin, “Obviously, the majority of people engaging in those behaviors don’t have dementia. It’s only when a previously law-abiding citizen starts to steal or do other things that are out of character that it becomes a concern for dementia.”

6. ‘Reduced Gaze’ and Trouble Reading

“Reduced gaze” is the clinical term for a Lewy body dementia symptom that alters people’s ability to move their eyes normally. “We all move our eyes and track with them frequently,” says Rankin. But people showing early signs of dementia look like they’re staring a lot. Rankin adds that they might skip lines when they try to read. This is one of the signs of dementia that the person with dementia might not completely be aware of, although people around them probably will be.

7. Confusion About What Objects Are Used For

Now and again, most people find themselves desperately searching for the right word. In fact, failing to find the word you’re thinking of is surprisingly common and not necessarily a sign of dementia, says Rankin. But a loss of knowledge about objects — not just what they are called but also what they’re used for — can be an early symptom of Alzheimer’s disease. Oddly enough, people who are losing this knowledge can be very competent in other areas of their lives.

8. Inappropriate Behavior and Loss of Empathy

If someone who is usually sweet, considerate, and polite starts to say insulting or inappropriate things — and shows no awareness of their inappropriateness or concern or regret about what they’ve said — they could be exhibiting an early sign of frontotemporal dementia. In the early stages of some types of dementia, symptoms can include losing the ability to read social cues and, therefore, the ability to understand why it’s not acceptable to say hurtful things.

9. An Increase in Compulsive, Ritualistic Behaviors

One sign of dementia that most people don’t expect is the need to complete extreme rituals or compulsive behaviors. “Plenty of people have odd habits and like things done a certain way,” says Rankin. These habits may be within the normal realm, but extreme hoarding or detailed rituals or compulsions, such as when a person buys a crossword puzzle book every time they go to the store even if they have hundreds of them, could be symptoms of frontotemporal dementia.

10. Difficulty Managing Money

One of the classic early signs of Alzheimer’s disease is an increasing difficulty with money management. This might start off as trouble balancing a checkbook or keeping up with expenses or bills, but as the disease progresses, poor financial decisions are often made across the board.

Though many people brush off this symptom as a normal part of aging, they shouldn’t. “We tend to associate aging with losing your mind. That’s not healthy aging — it’s a disease,” emphasizes Rankin.

11. Difficulty Forming Words

When people who used to be fluent and could speak smoothly stop being able to produce language that way, this may be a sign of dementia, says Rankin — specifically, a rare form called primary progressive aphasia. Despite this symptom, patients are often crystal clear in other areas. They can run a business, manage their family, or draw beautifully, but they have increased difficulty speaking.

The Takeaway

• Memory loss isn’t always the first sign of dementia because many brain illnesses do not start in the memory areas of the brain.
• Different types of dementia may first affect visual processing, language, judgment, or facial expressions, while sparing memory early in the disease
• A number of other behavioral changes can be early symptoms, including trouble driving, falling, staring, difficulty forming words, a loss of empathy, reduced activity levels, and failure to pick up on sarcasm.
• If you notice these alterations in yourself or a loved one, check in with your healthcare provider.
  

Additional reporting by Brian P. Dunleavy.