Pseudo Dementia

In working with seniors, one common error is the rush to assume that because someone has reached a certain age, any negative changes in thinking or behavior must be due to the onset of dementia.

Promoted by age related stereotypes, many suspect dementia as the probable cause of symptoms that for non-seniors would be quickly attributed to other logical sources.

Pseudo Dementia describes any decline in thinking or behavior, where it is falsely presumed that the sources of those symptoms are the onset of dementia.

There are a number of common factors with the potential to cause or intensify symptoms similar to those of dementia. Caregivers need to be aware of these factors, and reassess for their impact as necessary.

Sensory Deficits

The progressive loss of one’s hearing or eyesight can be significant in its potential to affect the character and behavior of any individual. We process information only after we have received it through our senses. A person’s confusion or delayed reaction time may not be due to a declining ability to think, but rather that incoming sensory stimuli has become inaccurate or insufficient.

Many seniors are self conscious about hearing loss and do not wish to expose this deficit, especially when meeting someone unfamiliar. Responses to questions that seem inappropriate or out of context may be due to their thinking you said something quite different than what was actually asked.

Side Effects of Medications

Many widely prescribed medications have possible and probable side effects. For those taking several medications these effects may become more pronounced. Tiredness, disorientation, inability to concentrate, agitation and appetite disturbances are just a few of the side effects that may be mistaken for dementia.

Additionally, those still administering their own medications may be doing so improperly, and under or over-dosing may cause mood swings or other variables in behavior.

Alcohol

Seniors who have enjoyed having a drink in the afternoon and have been doing so with no problem for the past 40 years may be affected differently now that they are a little older.

When alcohol is consumed along with other medications typically prescribed to seniors, dementia-like side effects may be the result.

Additionally, the metabolism of an older person is generally slower than that of a younger person. The same size drink formerly tolerated will stay in a senior’s system longer and with greater intoxicating effect.

Just as with a person of any age, drinking to compensate for anxiety or depression can become problematic for seniors. A person’s past behavior needs to be considered before making any assessment of current symptoms.

Depression

A frequent cause of emotional, cognitive and behavioral changes is the onset or flare up of depression. Moving from one’s home of many years, the death of a spouse or the anniversary of any such loss, declining health and loneliness are just some of the triggers for depression, generally resulting in sadness, apathy, social withdrawal and disturbances of concentration.

As with alcoholism, each person’s history must be considered for any comparative baseline to be made.

Nutritional Deficits

Many cognitive and behavioral symptoms can be traced back to food, water and nutritional deficiencies.

For seniors challenged with sensory and physical limitations, it may be difficult to go grocery shopping on a regular basis. Additionally, the loss of teeth can interfere with eating habits and lead to a decrease in the intake of solid foods.

It is generally overlooked that some medications alter the sense of taste, making it difficult to enjoy food. Also, those who cannot taste properly may be at risk for consuming spoiled food. This may be especially true for survivors of the great depression who, in their reluctance to waste, tend to save food past its point of freshness.

For all of us, good food is an important part of enjoying life. If one no longer gets pleasure from the taste of food they will naturally eat less of it. This can have a depressing emotional impact as well, which may further effect eating habits.

Dehydration is a major issue for seniors. Adequate fluid intake is necessary for proper functioning of the brain. Also essential for proper digestion, inadequate fluid intake reduces the body’s ability to flush out toxins and other waste products.

Environmental Factors

If a senior has recently moved in to a new residence or facility, a decline in cognitive functioning may be due to unseen environmental factors.

Mold, dust, cleaning solutions, disinfectants, dry cleaning chemicals, and airborne contaminants within forced air ventilation systems may trigger the onset of undiagnosed allergies.

Sudden dietary changes to commercially prepared foods containing artificial sweeteners and preservatives may cause adverse effects on thinking and judgment.

Seniors residing in low income or improperly maintained homes may be at risk of ingesting lead particles from paint, airborne asbestos from pipes and insulation, or carbon monoxide poisoning from an improperly vented furnace.

General Medical Disorders

Seniors having difficulty breathing may experience insufficient oxygen transfer to the bloodstream, necessary for proper brain functioning. COPD (Chronic Obstructive Pulmonary Disease) and asthma are two examples that in their acute phase could temporarily contribute to impaired thinking and judgment.

Other familiar ailments having the potential to effect thinking and behavior are mini-strokes (Transient Ischemic Attacks), Parkinson’s disease, and disorders of the thyroid. Lingering infections such as an undiagnosed UTI (urinary tract infection) may also initiate or worsen the presence of dementia like symptoms.

Sexually Transmitted Diseases

Senior adults do not fit the conventional typecast of those who carry and transmit STD’s (sexually transmitted diseases). Despite this, an increasing number of seniors are being diagnosed with HIV and other viral infections such as Herpes. But because of assumptions based on such stereotypes, any decline in mental functioning due to this category of illness is often the last to be ruled out.

Further Considerations

To most accurately distinguish between Dementia and Pseudo Dementia consult a geriatric physician or neurologist who can provide a thorough workup and plan of action.

Speaking to family members will give caregivers insight about their loved one’s personality traits and prior levels of functioning. Understanding a person’s likes, dislikes and manner of coping often goes a long way towards determining what behavior is normal or out of character.

Most importantly caregivers must be compassionate and patient. As a normal response to aging, thoughts and movements occur more slowly, and this natural process should not be hastily judged as the inevitable onset of dementia.