Main image courtesy of Queen’s University.

Physicians stress that dementia is not a normal or expected part of the aging process. However, around 5.6 million people over the age of 65 in the U.S. are dealing with a dementia-related condition. If you’re working with seniors in a long term care nursing facility, chances are you have many residents that have some of the typical symptoms of dementia such as memory loss, difficulty with language, disorientation, etc., or have been officially diagnosed with the condition. 

But how can we be sure that every dementia diagnosis is the right one? Are there other conditions out there that could cause a doctor to give a dementia misdiagnosis? At Mariposa Training, we believe that those caring for the geriatric community should be trained and educated in some of the conditions that are commonly misdiagnosed as dementia. This is why we thought this article would be helpful, as we’re going to discuss:

• What dementia is and what it isn’t
• Common conditions misdiagnosed as dementia 

What is dementia?

Common symptoms of dementia

Dementia is primarily a condition that affects the senior population, who are 65 years or older. That’s not to say that dementia cannot affect those who are younger, because it can, around 200,000 people in the U.S. under the age of 65 are dealing with the early-onset form of the condition. Doctors still do not know what exactly causes dementia and Alzheimer’s, although age, family history, diet, and the environment may play a role. 

Typical symptoms of dementia include:

• Memory loss or confusion
• Trouble speaking or with words
• Difficulty with tasks
• Disorientation
• Change in behavior
• Poor judgment and safety awareness
• Attention seeking or isolationist behavior

These changes are gradual, and take place over months and years. They are not sudden or appear out of nowhere. When someone has dementia, this condition is non-reversible, as it is caused by the degradation of brain cells and the loss of the functional abilities of cells. This leads to the atrophy of the brain, affecting the cells that contain memories. Dementia is not something that causes a person to change overnight, and there are signs the increase in severity over time that may indicate something is going on that warrants a trip to the doctor. 

Many people who are caring for loved ones either informally (a loved one) or formally (a nurse, CNA, etc.) may become concerned when they start to notice a change in behavior of an elderly person. The warning signs of dementia could include:

• Getting lost in familiar places
• Trouble with pills and medication
• Misplacing things
• Difficulty completing everyday tasks
• Mood swings

Although these can be some of the warning signs of dementia, the problem may actually not be a dementia diagnosis. Even professionals can misdiagnose dementia, as the symptoms and signs of the disease can actually be the result of a different problem altogether. There are a variety of other reasons why a senior in your care is exhibiting these kinds of behavior, or acting in a way that is different than you’re used to. 

Common conditions that can lead to a dementia misdiagnosis

These 8 conditions could actually be the cause of cognitive and behavioral problems in elderly adults

While the warning signs and symptoms listed above could very well mean that a senior is starting to show the signs of dementia, that might not always be the case. There are other common reasons behind why an elderly person may start to develop the symptoms we associate with dementia, which can lead to a dementia misdiagnosis. 

Delirium

Delirium is one of the most common causes behind a dementia misdiagnosis. This is due to the fact that this condition presents itself very similarly to chronic, irreversible dementia. It is crucial that those caring for seniors know how to recognize the difference between these two conditions. The symptoms of delirium are very similar to those dementia and can include:

• Changes in behavior
• Confusion
• Feeling disoriented
• Problems with memory
• Difficulty with words

The important thing to remember when trying to differentiate between the two is that delirium is something that occurs in a very short period of time, such as hours, days, or weeks. This is a sudden onset that might appear to caregivers as something that materialized overnight. The causes of delirium can be reversible, unlike dementia. Once the root cause of the problem is discovered and treated, the senior resident will eventually return back to their baseline status.

There are two main causes of delirium relating to environmental and human condition changes.

Environmental

Delirium can develop when there are changes to the environment that a senior is accustomed to living in. This can occur when they are required to change rooms, get a new roommate, there are changes to the routine of family visits or interactions, or they’ve experienced trauma and find themselves in a new place. 

Hospital induced delirium is very common in older adults who are admitted due to a fall or a sudden onset of an illness. They find themselves in a foreign environment with lots of new people who are asking them questions and trying to assist them. The hospital environment is very disruptive to their routine, and typically results in new medication and a new sleep routine—both of which can cause confusion and delirium. There are ways to limit the amount of disruption that elderly patients experience in a hospital setting, and reduce their chances of developing delirium or sundowning syndrome. 

• Keep sleep disturbances to a minimum so their circadian rhythm is correct
• Encourage movement during the day to make a routine
• Avoid overstimulation
• Avoid sedatives and minimize pain

Conditional 

Delirium can also be caused by changes to the bodily condition. It can be the result of an onset of depression, over/under medication, dehydration/lack of nutrition, isolation, or an undiagnosed condition. 

This can manifest as a change in the person’s behavior, the inability to see things correctly (such as hallucinations), lethargy, or uncontrollable emotions such as aggression, irritability, or fear. 

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Once the real cause of the problem is addressed in both types of situations, the delirium should subside and the senior resident should return to their normal base line. It is essential to find out the real cause of the sudden behavior change in delirium, as the longer the elderly resident has it, the more damage it may inflict.

Medication

Changing medication is another common trigger of dementia-like symptoms. Every person reacts to medication differently, and when older adults are taking more than one kind of medication, there is always the chance of negative drug interaction or side effects. This is especially common if the person has recently just started taking a new medication. If they’re experiencing confusion or fogginess, one of the first questions that staff or other caregivers should ask is if new medication has been added to their daily intake. 

Over the counter drugs may also interact with medication in a way that can cause cognitive impairment, so this should also be taken into consideration. It’s important to point out that even medication that the senior resident has taken for years can still cause symptoms that resemble dementia. This is due to the fact that as the person continues to age, their kidneys and liver become less effective at filtering the medication from the body, which can cause a negative buildup and lead to cognitive issues.

Infection

Urinary and respiratory infections are common infections that can also cause an elderly resident to experience delirium, which as we know, can have similar symptoms to dementia. Infections cause the white blood cells of the body to rush to a certain site to try and get the body back to homeostasis. This can cause older residents to feel confused or drowsy instead of the more common symptom of an infection, which is a fever. Many senior residents manifest different symptoms from that of younger people when it comes to infections, which is why the confusion it creates often gets misdiagnosed. 

In the case of urinary tract infection, a resident may not even experience the traditional symptoms such as burning while urinating, or having the sudden urge to relieve themselves. Instead, they may feel irritated or have trouble remembering things. The same is true for a respiratory infection, which instead of a fever, senior residents appear confused or lethargic.

Sleep issues

Everyone, no matter their age, needs a good night's sleep. Sleep is an essential part of living a healthy life, and although we need less of it as we age, it’s still crucial to maintain proper cognitive function. If a senior is not getting the right amount of sleep, or they are having sleep disturbances, this could contribute to delirium symptoms. When sleep is disrupted, our circadian rhythm is interrupted, which may cause wakefulness at night.

If this is the case, it can lead to sundowner syndrome, which is typically defined as a set of behaviors that are the result of environmental or bodily changes. A resident with sundowner syndrome will become confused as the afternoon turns to evening, and the light starts to disappear. Their agitation or confusion could be the result of restless sleep. It is helpful to keep it dark at night and bright during the day, in order to keep their biological clock correct. 

Movement during the day is also essential to ensure sleep at night. Residents should move around and stay active as much as they are able to. Daytime naps should be limited (or eliminated), as this could also be contributing to sleep issues or insomnia. 

Dehydration

When a senior resident is dehydrated, it can cause them to exhibit symptoms of dementia such as memory loss, confusion, and irritability. The need to satiate their thirst decreases as senior residents age, which is a large reason why many find themselves dehydrated. Dehydration is more common in the elderly because the body’s ability to retain water decreases with age. If a resident is on medication that has diuretic or laxative side effects, it is even more likely they will experience dehydration.

In addition to dehydration, not getting the right nutrients at meal times can also cause elderly residents to start to show signs of delirium. Like the thirst mechanism, this is the result of the decrease in appetite that is common with age.

Depression

The symptoms of depression manifest differently in every individual, but what could actually be a mental illness could be misdiagnosed as dementia. Depressive symptoms in senior residents can include low self-esteem, tearfulness, loss of appetite, and concentration problems. If staff aren’t aware of their mental health history, or there has never been an episode of depression, it may cause doctors to misdiagnose this as dementia. 

Emotional distress

If a senior resident is dealing with grief or bereavement over the loss of a loved one, they can manifest symptoms similar to that of dementia. When someone is in emotional distress, they may have trouble sleeping, experience loss of appetite, have blood pressure issues, be irritated or agitated, or even experience hallucinations. These symptoms, while similar to those seen in dementia patients, are really the result of something else that’s happening in their life.

Normal pressure hydrocephalus 

Normal pressure hydrocephalus is a treatable condition that occurs when fluid accumulates in the brain, which can cause cognitive problems. This is diagnosed through brain imaging and can be treated by inserting a shunt to drain the fluid. After the fluid is drained, the person should improve and return to their normal baseline.

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Commonly known dementia symptoms such as memory loss, confusion, difficulty with words, behavior changes, and disorientation can lead doctors to misdiagnose the disease. This is why it’s essential to have the right training, so caregivers of the elderly can look for and find the real cause of why these symptoms are manifesting and give the resident the relief they need.

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