Dementia does more than rob people of their memories — research continues to show that this complicated condition is marked by a number of symptoms, especially at the onset. But they’re not always easy to recognize. From failing to pick up on sarcasm to losing a sense of social norms, some of dementia’s early warning signs are subtle.
How can you know if you or a loved one is showing signs of Alzheimer’s disease or another form of dementia?
Any change that is different from a person’s usual behavior or abilities could 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.
Take a look at some of the earliest signs of dementia — you may be surprised.
If you or a loved one are experiencing any of these signs or symptoms, it’s worth checking in with your doctor. However, 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.
1. Failing to Pick Up on Sarcasm and Spot a Liar
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 sign of dementia that Rankin noticed? People with FTD couldn't tell when someone was lying, although people with Alzheimer's disease could tell. "FTD patients don't have that sense anymore that things that people do could turn out badly," she says.
2. Falling More Frequently Than You Used To
Constantly tripping over your own two feet? Everyone falls now and again, but frequent falling could be an early signal of Alzheimer’s disease, according to research. A study published in October 2021 in the journal Frontiers in Neuroscience found that older adults who later develop Alzheimer’s disease are at higher risk for falls and other accidents in the years prior to their diagnosis than those who don't have Alzheimer’s.
“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 also be a symptom of other brain disorders, including progressive supranuclear palsy.
3. Disregarding the Law and Other Social Norms
Some people with dementia lose their sense of social norms. Shoplifting, breaking into someone’s house, inappropriate interpersonal behaviors such as sexual comments or actions, and even criminal behavior, according to a review published in October 2020 in the journal Cortex, all make the list of surprising dementia symptoms.
This could lead to trouble with the law, too: 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 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.”
4. Staring With ‘Reduced Gaze’ and Trouble Reading
“Reduced gaze” is the clinical term for the 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.
5. Eating Nonfood Objects and Rancid Foods
One surprising early sign of dementia is eating nonfood objects or foods that are rancid or spoiled. This is partly because the person forgets what to do with the things in front of them. For example, people with dementia might try to eat a flower from a vase on a restaurant table because they “know they are there to eat but don’t know what the flower is doing there,” says Rankin.
Unlike some other Alzheimer’s symptoms or dementia symptoms, this one has few other likely explanations.
6. Not Understanding 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 losing knowledge of objects — not just what they are called but also what they’re used for — is an early dementia symptom. Oddly enough, people who are losing this knowledge can be very competent in other areas of their lives.
7. 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 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.
8. 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. But while these habits are within the normal realm, extreme hoarding or detailed rituals or compulsions, such as buying a crossword puzzle book every time they go to the store even if they have hundreds of them, can be dementia symptoms.
9. Having a Hard Time Managing Money
One of the classic early signs of Alzheimer’s disease is an increasing difficulty with money management. This might start off as having 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.
10. Difficulty Forming the Words to Speak
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. 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 actually forming the words to speak.
Additional reporting by Brian P. Dunleavy.