Noticing the Early Whispers of Change

By: Dr. Keith Darrow, PhD, CCC-A

Signs of Early Brain Changes: Catch Those Sneaky Signals Before They Catch you!

As I venture through my quest to save as many people as I can from the devastating impacts of dementia and Alzheimer’s disease, something occurred to me recently. Memory loss is an obvious (and the most recognized) symptom of dementia, especially in Alzheimer’s disease. But what about those additional indicators that suggest early brain changes?

Sometimes, memory problems aren’t the main symptom, leaving the early indicators unnoticed for dementia. Along with the occasional forgetfulness, there are symptoms that while they don’t necessarily automatically point to dementia, should be taken into account when they occur together.

Driving Problems

Driving difficulties can be an early sign of dementia because they often reflect issues with cognitive functions critical for safe driving. Here are some ways driving problems might signal early dementia:

1. Poor Judgment and Decision-Making: Individuals may struggle with making quick decisions, such as when to turn or change lanes, which can lead to unsafe driving behaviors.
2. Memory Lapses: Forgetting familiar routes or destinations, even in well-known areas, could indicate early memory issues related to dementia.
3. Difficulty with Spatial Awareness: Misjudging distances, trouble navigating tight spaces, or confusion at intersections can be signs of impaired spatial perception, a common symptom of dementia.
4. Slower Reaction Times: Dementia can slow cognitive processing, making it harder to react quickly to sudden changes, like a pedestrian stepping into the road.
5. Increased Anxiety or Confusion While Driving: A person might feel more nervous or disoriented in traffic, leading to hesitation or erratic driving decisions, which could be an early indicator of cognitive decline.

These driving problems point to difficulties with complex, multitasking cognitive functions, which are often the first to be affected by early dementia. Look for scratches on your loved one’s vehicle, notice “fender benders” or the running of stop lights or stop signs. Does your loved one accelerate or brake suddenly seemingly out of nowhere? Are they uncomfortable driving at night, in bad weather, during rush hour? Would they rather drive alone?

While these signs can always be attributed to vision problems, medication side effects or simply old age, it is worth keeping an eye on especially when combined with other symptoms.

Sleep Issues

Sleep disturbances are often linked to early dementia because they can signal underlying changes in the brain. Here’s how sleep issues might be connected:

1. Disrupted Circadian Rhythms: Dementia, especially Alzheimer’s, can affect the brain’s internal clock, leading to irregular sleep-wake patterns. This might cause people to wake up frequently during the night or have trouble falling asleep at regular times.
2. Increased Daytime Sleepiness: Excessive daytime napping or drowsiness can indicate cognitive decline, as the brain struggles to regulate normal sleep cycles.
3. Insomnia or Restlessness: People in the early stages of dementia may experience insomnia, restlessness, or agitation at night, making it difficult to achieve restful sleep.
4. REM Sleep Behavior Disorder (RBD): In some cases, particularly with certain types of dementia like Lewy body or Parkinson’s-related dementia, individuals might act out their dreams (RBD). This abnormal behavior during REM sleep can be an early warning sign.
5. Sleep Apnea and Cognitive Decline: Untreated sleep apnea has been linked to an increased risk of developing dementia. Poor oxygen supply during sleep can impact brain health, contributing to cognitive impairment over time.

Sleep disturbances might not only be a result of early dementia but can also exacerbate cognitive decline by depriving the brain of restorative rest, creating a feedback loop that worsens overall brain function.

Again, sleep issues can be common with older age and can be completely normal. However, dramatic changes in sleep habits, combined with other symptoms, can be another early sign of dementia.

Financial Issues

Have your parents always taken amazing care of their finances, credit score, etc.? Now suddenly their credit scores are declining and they have money problems? Do they forget to pay their bills? Are they no longer able to stick to a budget? These issues are typically one of the first areas in cognition to crack because managing money requires complex cognitive functions.

Here’s how early dementia can impact financial behavior:

1. Decline in Executive Function: Dementia affects the brain's ability to plan, organize, and reason, which are essential for managing finances. People may struggle to keep track of bills, forget to pay them, or make unusual purchases.
2. Poor Judgment and Impulsivity: Dementia can impair judgment, leading to impulsive or irrational financial decisions. This might involve giving away large sums of money, falling for scams, or making risky investments.
3. Difficulty with Numbers: Cognitive decline may make basic math and financial concepts harder to understand. Someone in the early stages of dementia might struggle to balance a checkbook, calculate expenses, or mismanage accounts.
4. Memory Lapses: Forgetting important financial obligations, such as failing to pay rent or utilities, or repeatedly making the same financial mistakes, can be an early sign of dementia-related memory problems.
5. Increased Vulnerability to Scams: Cognitive decline often leads to a loss of awareness and skepticism, making individuals more susceptible to financial fraud or predatory schemes.

Early financial troubles can signal the beginning of dementia, as these behaviors reflect declining problem-solving, reasoning, and memory skills that are critical for handling money responsibly.

Personality Changes

Personality changes can be an early indicator of dementia because the disease affects the brain regions responsible for regulating mood, behavior, and social interactions. Here’s how these shifts in personality might signal early cognitive decline:

1. Increased Irritability or Anger: As dementia progresses, individuals may become easily frustrated or angered by situations that wouldn’t have bothered them before. This may be due to confusion or difficulty processing information.
2. Withdrawal from Social Activities: People in the early stages of dementia may lose interest in activities they once enjoyed or withdraw from social interactions. This could be a result of increasing confusion, anxiety, or embarrassment about cognitive difficulties.
3. Apathy or Lack of Initiative: Early dementia often results in apathy, where a person becomes indifferent or disinterested in things they used to care about, including hobbies, social events, or personal responsibilities.
4. Changes in Mood and Emotional Reactions: Dementia can cause unpredictable mood swings or emotional responses. Someone might become unusually sad, anxious, or fearful without an obvious cause, reflecting changes in emotional regulation.
5. Impulsive or Inappropriate Behavior: Cognitive decline can impair judgment and self-control, leading to impulsive actions or socially inappropriate behavior. A person might act out of character, such as being rude, making inappropriate comments, or taking risks they wouldn't normally take.
6. Paranoia or Suspicion: In some cases, early dementia can lead to paranoia or delusional thinking. A person might become suspicious of loved ones or believe people are stealing from them, which can be attributed to memory gaps or confusion.

These personality shifts occur because dementia affects parts of the brain responsible for controlling emotional responses, social behavior, and self-awareness.

Loss of Smell

And last but not least, loss of smell, or anosmia, can be an early warning sign of dementia because the olfactory system is closely connected to brain regions that are vulnerable to neurodegenerative diseases. Here's how it relates to early dementia:

1. Damage to the Olfactory Pathway: The ability to smell relies on structures in the brain, including the olfactory bulb and the temporal lobe, which are among the first areas affected by dementia, particularly Alzheimer’s disease. Early damage to these areas can impair the sense of smell.
2. Link to Amyloid and Tau Protein Buildup: In Alzheimer’s, abnormal protein deposits (amyloid plaques and tau tangles) accumulate in the brain, including in regions associated with smell. This buildup can interfere with the brain’s ability to process and identify odors, leading to a diminished or lost sense of smell.
3. Sign of Cognitive Decline: Research has shown that individuals with an impaired sense of smell are more likely to experience cognitive decline over time. A poor sense of smell has been linked to the early stages of Alzheimer’s and other dementias, often before noticeable memory loss occurs.
4. Predictive of Other Symptoms: Studies suggest that smell loss may precede other dementia symptoms by several years, acting as a red flag for potential cognitive issues. Those who struggle to identify specific odors or notice a gradual decline in their sense of smell may be at higher risk for dementia.
5. Brain Degeneration in Key Areas: The regions of the brain that control smell perception are near areas responsible for memory and learning. As these areas degrade due to neurodegenerative diseases, both the sense of smell and cognitive functions deteriorate in tandem.

The loss of smell, though subtle, can be an early clue that dementia-related changes are occurring in the brain long before other symptoms like memory loss or confusion become apparent.

Early indicators of dementia, such as driving difficulties, sleep disturbances, poor financial decisions, personality changes, and loss of smell, often stem from cognitive decline affecting different parts of the brain. While these signs may seem unrelated or minor on their own, they can collectively point to underlying brain changes. Recognizing these subtle symptoms early on is crucial for timely medical evaluation and intervention, potentially slowing the progression of dementia.

For more information regarding all things related to hearing loss, tinnitus, diabetes, and dementia, please visit us as www.excellenceinaudiology.org or www.askdrdarrow.com  for questions and/or concerns.