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Confusion and Forgetfulness: The Right Diagnosis is Important

Man in hospital bedRalph had hip replacement surgery at the local community hospital. Though he was in good general health and normally had his "wits about him," he emerged from the surgery confused. He didn't recognize his wife Betsy and thought he was at home, not at the hospital. Betsy worried that he had developed dementia. But by morning, Ralph was recovering his orientation.

As it turns out, delirium after surgery is common in elderly people and is just one of many conditions that mimic Alzheimer's disease or other dementia. Delirium is normally temporary and reverses itself in a short time. But a number of other diseases and causes may convince family members that their loved one is "becoming senile"—even though a treatable condition is actually causing the symptoms.

Because there are so many possible reasons for dementia-like symptoms, it's important for a physician to perform a thorough medical workup to eliminate other causes before making a diagnosis of Alzheimer's or other dementia. Unfortunately, as we grow older, conditions that cause cognitive impairment become more common—not only Alzheimer's, but also such diseases as Lewy body dementia, Parkinson's disease, vascular dementia or multi-infarct dementia from a stroke or series of strokes. Early diagnosis is important so that the appropriate treatment and care can be started.

But sometimes, underlying causes of symptoms that mimic Alzheimer's disease can be reversed or even cured completely. This is why it is important not to assume that confusion, memory loss and other personality changes inevitably signal dementia. Treatable causes 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 little pill calendar box is full. A number of drugs can cause confusion, alone or in combination with others. Some of these include heart medications, steroids, narcotics, drugs to treat incontinence—even antihistamines. Be sure to 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. And sometimes depression accompanies dementia. The healthcare provider can determine whether depression is Alzheimer's-related or a stand-alone, treatable condition. 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 can result. A simple blood test can reveal a thyroid disorder, and most types of thyroid disease are easily treatable. 

Vitamin deficiency—Sometimes elderly people have problems absorbing Vitamin B3, B12 or other B vitamins from food. If this 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. Others may be on a restricted fluid regimen for heart disease. Still others try to limit fluid intake because of fear of incontinence. Dehydration symptoms, including disorientation and lethargy, can be similar to dementia.

Alcohol abuse—Some of the symptoms associated with alcoholism are very similar to those of dementia. Brain damage from chronic alcohol abuse can cause permanent cognitive losses, 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. Hematomas can cause dementia-like symptoms. If a hematoma is serious enough, it can even lead to death.

Cognitive impairment is not a "natural part of growing older." Geriatricians now recognize that dementia is part of a disease process. Care for Alzheimer's and other dementias are improving all the time. But remember: the first step is to rule out other, treatable conditions.

Click here to learn how home care can help family caregivers help those with Alzheimer's disease.

For More Information

For more information about early diagnosis of Alzheimer's disease, see "Promising Research for Earlier Diagnosis of Alzheimer's Disease" in the June 2009 issue of Caring Right at Home.

Learn more about Alzheimer's disease, Lewy body dementia, Parkinson's-related dementia, vascular dementia and other related conditions from the National Institute on Aging's Alzheimer's Disease Education and Referral (ADEAR) Center.   

The Alzheimer's Association offers information about the diagnosis of Alzheimer's and related dementias, including information about ruling out treatable conditions.


Right at Home is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned, franchised providers of in-home care and assistance services.


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New Study Shows What Americans Don't Know About Long-Term Care
Holiday Visits May Be the Time to Discuss Home Care
Ho Ho Hungry! Are Your Eyes Bigger Than Your Stomach?
Confusion and Forgetfulness: The Right Diagnosis is Important
Coping with Medical Challenges During the Holidays

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