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When Is It Time for a Dementia Evaluation?

At least three-fourths of people over age 50 report that their memory is not as good as it was. The reality is that more than 90 percent of those who do complain about memory impairment do not have Alzheimer’s or dementia.

Many memory complaints reflect changes in ability over time, but appear to be relatively minor and due to normal age-related changes in the function of the brain.

So how do you know if your loved one is part of the minority whose changes in memory are more serious and warrant an evaluation by a health professional—and how do you get him or her to go?

Red flags

Momentarily forgetting someone’s name or a specific word is actually normal and does not necessarily worsen with age. The following behaviors, on the other hand, may be signs that something more serious is taking place.

Difficulty with routine tasks. Trouble completing tasks that a person has done many times before, like figuring out a tip at a restaurant, filling out tax forms or managing a checkbook, is a real reason for concern.

Getting lost. Another red flag is when a person becomes lost while walking or driving in a familiar place, even if they say their navigational difficulties were due to inclement weather or having to make a big detour. This too is a potential warning sign of early Alzheimer’s or dementia that needs to be investigated further.

Loss of recent memory. Forgetting what you had for dinner the day before or what movie you watched a few hours earlier is not always a sign of normal brain aging. Other warning signs include forgetting important dates or events or repeatedly asking the same question.

Forgetting simple words. People with Alzheimer’s or dementia may also have difficulty following or joining in a conversation. They may stop in the middle of a sentence and be unable to pick up where they left off. This is different from the occasional difficulty coming up with a name or word.

Poor judgment in financial matters. It’s not uncommon for people with Alzheimer’s or dementia to buy things they don’t need, to give away significant sums of money to telemarketers or unscrupulous salespeople, or to repeatedly make donations in response to mailed or telephoned requests to legitimate organizations.

Mood change. People with Alzheimer’s or dementia may exhibit confusion, suspicion, fear, depression or anxiety, traits that they never had before.

Finally, when a person regularly complains about poor memory and mentions that it is worse than the year before, it should be looked into.

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How to suggest a visit

What can you do to get your loved one who is suspected of having a memory problem to go to the doctor for a proper evaluation?

First, don’t assume that your loved one won’t follow up on the suggested doctor visit. You may be surprised by his or her willingness to go. Still, many people get a common response of, “I don’t think anything is wrong with my memory, and there is no reason to see a doctor.”

If that’s the case, a good retort would be, “Please, do it for me. I would feel a lot better if I knew there was nothing wrong with you.” This way, the burden is taken off the person with the suspect memory and placed on the spouse or concerned family member. Agreeing to see the doctor under this condition is usually acceptable.

Group pressure to get a loved one to submit to a medical evaluation can often work wonders when an individual family member gets turned down. If everyone in the family agrees that faulty memory is an important issue and they then express their desire for a medical checkup for their parent, an agreement to see the doctor is much more likely.

And what if there is still reluctance to seek medical advice? Some people choose to live their lives free of doctors, and that’s everyone’s right. Granted, it’s very hard to sit idly by, watching someone make poor choices, knowing that it could possibly hurt him or her.

Nevertheless, it’s probably a good idea to hold off for a month or two before bringing up the notion of visiting the doctor again. A useful way to reopen the conversation might be by saying “I’m still concerned about your memory. Will you think about seeing the doctor this week?”

A more difficult issue is what to do when the person is clearly in danger. Steps you should consider include mentioning your concerns to the person’s primary care physician, describing your concerns as a medical rather than a memory issue, or, as a last resort, contacting the local public agency charged with evaluating and protecting the at-risk elderly.

Since many older people have regularly scheduled doctor’s appointments due to a variety of other medical issues, there’s nothing wrong with calling ahead and mentioning to the doctor that you have worries about your loved one’s memory and would like this discussed at the next appointment.

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Alternatively, if you typically accompany your spouse or parent on doctor’s visits, you can bring up your concerns at this time.

Bottom-line advice

Don’t jump to conclusions about the nature of the perceived memory problems of your loved one. Many people don’t have severe memory problems indicative of Alzheimer’s, even when they are in their 70s or older.

This is reassuring, as is the fact that there are medications and therapies to assist those who do have Alzheimer’s or dementia.

There are also several causes of memory difficulties that can be reversed. Memory loss may be linked to low thyroid levels, poor nutrition, medication side effects, or depression.

Sometimes, after performing a few tests, a doctor may find that memory issues are directly caused by an adverse reaction to a medication that a patient is taking. Luckily, stopping the medication (if possible), switching drugs, or lowering the dosage can rectify these memory issues.

Also keep in mind that if a loved one does have some form of dementia, many people still enjoy life and do well, even if their memories are no longer perfect.

Read more about the emotional toll of an Alzheimer's diagnosis and tips for avoiding caregiver burnout.

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