Well, hello. I'm Dr Leslie Kernisan board certified geriatrician and founder of Better Health While Aging dot net, where I share practical, medically accurate information to empower older adults and their families. In this video, I'm going to explain 21 signs and behaviors that are not normal aging.
And that may in fact, be signs of Alzheimer's or another form of cognitive impairment in older adults. These are the symptoms that I myself check for. If an older person is showing signs of memory loss, or if a family is getting concerned about an aging parent.
I do have a particular interest in educating people who are concerned about aging parents, so in this video, you'll hear me mainly refer to that scenario, but of course you can use this information, if you're concerned about your older spouse, another older relative, a friend, or even if you want to learn more about your own memory and thinking, and what might be concerning. Now, please note that you cannot and should not use these signs to attempt to diagnose your aging parents. Only a qualified health professional can do this, but you can learn what signs and behaviors are concerning and might indicate that something really is wrong and requires attention.
So checking on these signs can help you figure out whether you really should be concerned or not. And then if you do end up trying to get a medical evaluation, and if you are noticing many of these signs, I highly recommend you pursue that. This information will be really valuable to health professionals who are doing the evaluation.
In fact, it will be essential to getting your parent's care on the right track. So in the rest of this video, I'm going to take you through my list of concerning signs, symptoms, and behaviors. I've counted.
And I have 21 to share. None of these should be considered normal aging. And then once we've gone through the list, I'll tell you how I recommend you use this list and I'll share some tips for taking next steps, if you find your aging parent is showing many of these signs.
Also, if you are someone who's been worried about your aging parents, you can find this list as one of the many helpful cheat sheets that I provide as part of my book, "When Your Aging Parent Needs Help: A geriatrician's step-by-step guide to memory loss, resistance, safety worries, and more. " Let me now take you through my list of 21 concerning signs and symptoms associated with memory loss and thinking problems in aging adults. And as we go through this, for each sign, I want you to ask yourself whether you've been noticing this in your older parents, never, sometimes or often.
And if you have been noticing these signs sometimes or often, ask yourself, when did this seem to come on and does it seem to be getting worse over the last few months or a few years? we want to pay special attention to signs that have come on later in life for your parents. Now, number one, have you noticed any signs of what we might call poor judgment?
This means behaviors or situations that suggest bad decisions. So some examples might include worrisome spending, not noticing a safety issue that others are concerned about. If it's striking you and many other people as bad judgment and maybe worse judgment than your parent used to have, I would count this for your parent.
Number two, have you noticed reduced interest in leisure activities? Have you noticed that your parent has become less interested and involved in their usual activities, especially in the ones that were hobbies or things that they enjoyed. And you should pay special attention to this if there isn't a physical health issue interfering with doing the activity, because of course, as people get older, they can develop pains.
They can develop mobility issues. And sometimes that interferes, but if you're not really seeing a pain or physical mobility reason that they're not engaging the activity as much, then you definitely want to make a note that this could potentially be a concerning sign related to memory loss or thinking problems. Number three, on my list is repeating oneself.
Now I hear about this from families and other providers all the time. Oh, my parent is fine. She just keeps repeating the same questions over and over again, or keeps saying the same stories over and over again.
That is actually not normal. That is considered a red flag in geriatrics when it comes to memory loss and thinking. So if your parent has been repeating questions or stories, especially in the same conversation, make a note of this.
Number four, have you noticed any difficulty in them learning to use something new? Now, it's true that just as part of normal aging, as people get older and older, it does take them longer to learn new things, but they still should be able to learn new things. So if you've noticed that your parent is having a lot of trouble with a new kitchen gadget or appliance, ask yourself, do they seem to be having trouble learning anything else that's new?
And if so, this could be a worrisome sign. Number five is forgetting the year or month. Now, especially once one stops working and is retired, it can be easy to lose track of the date or even maybe the day of the week, but it's not normal to be confused about what month it is or what year it is.
So if your parent seems to be having more trouble keeping track of the year or month, or even maybe the day of the week, make a note of that too. Number six is, have you noticed them having any difficulty managing money or finances? So some examples might be having trouble paying the bills on time, having trouble balancing their checkbook or otherwise just seeming to struggle more with keeping track of their money or finances.
Now, for this one, it's really important to keep in mind, how has your parent usually done this? Because we're really looking for changes that are a decline compared to before. There are some people who for various reasons have never done much money management in their life.
And if that's the case for your parent, and now maybe they're having to manage money because of a change in the family, or maybe they've lost their spouse, you may not want to count this for them. But if it really seems like a decline compared to before, I would make a note of that. So number seven on the list is problems with appointments or commitments.
If you notice your parentis having more trouble keeping track of appointments or missing appointments, or just having more trouble with their schedule, you should make a note of that as well. Number eight would be daily struggles with memory or thinking. So again, it is normal as people get older for things to slow down a bit in the brain.
And that means that it often takes older adults a little bit longer to remember something. But if it seems that your parent often can't remember things that have happened, especially recent things - because even when people are developing memory loss or thinking problems, they often retain a quite good memory for long ago things - so we're really looking at recent things, things that happened today, yesterday, last week; if it seems like they're often having trouble remembering those things or that their short-term memory has become poor, make a note of this because that is probably not normal. So that is eight signs so far.
Now there are several more that I want to tell you about, but I want you to know that the eight that I just described have actually been clinically validated. Those eight signs were included in something called the AD8 informant interview, which was developed in the early two thousands by neurologists who wanted to identify practical questions that families or other informants could answer to help check for possible Alzheimer's or another form of dementia. And what they found is that the more of those eight signs were present, the more likely it was that the person actually would get diagnosed with a problem such as dementia.
They actually found that having two or more of those signs was a useful cutoff. So those signs are known to be especially important. And I always start there, but we also know that there are many other behaviors and signs that are associated with memory and thinking problems, especially in the early stages.
So I do use an expanded list. And let me now take you through the other signs that I check for and that you can check for as well. So number nine, this is something families ask me about a lot, it's paranoid or suspicious thoughts.
This means basically having thoughts that are fearful or distrustful of others. Common examples would mean questioning the motives of others or worrying that somebody's stealing from you, worrying about intruders, that kind of thing. If you've noticed that, that is not normal with aging, it can potentially be a sign of something more significant going on with memory or thinking.
And I would definitely make note of it. Number 10, on the list is delusions. Delusions can have some overlap with paranoia, but basically a delusion means believing something that isn't true or real or that most other people wouldn't agree is true or real.
So believing that a family member is an impostor or a stranger is a type of delusion. Again, there can be some overlap with paranoia. So it's not uncommon for some older adults to start accusing family members or others of taking or stealing their things.
Is that paranoia or delusion? Either way, I would make note of it as a concerning symptom. You could potentially give them a check for each number.
Eleven on my list is visual or auditory hallucinations. So hallucination means seeing or hearing something that others don't see or hear. It turns out that seeing things that other people don't see, especially children or small animals is a classic symptom associated with certain forms of brain decline, such as Lewy body disease.
It can also be related to changes in vision and not necessarily brain health. So don't jump to the conclusion they have Lewy body disease, but if your parent is seeing or hearing things that other people don't seem to notice, you'll definitely want to make a note of that. Number 12 on my list is personality changes.
So ask yourself, has your parents started to behave really differently? Like almost seeming to become a different person. Maybe they've become more easily annoyed or agitated, whereas they used to be really calm and relaxed, or maybe they used to be really outgoing, and they've now gotten kind of quiet.
If you've noticed that, then definitely make note and add it to the list. Number 13 on my list is embarrassing behaviors. Has your parents started saying socially inappropriate things, maybe blurting out things that maybe they were thinking, but didn't use to say, like comments about other people's appearance?
Or have they otherwise begun behaving in a way that's embarrassing. This is sometimes referred to as becoming unfiltered and it's not normal. It is potentially concerning.
And I would definitely make a note of it if you've noticed it. Number 14 on my list is what we call lack of insight. So this generally means showing a lack of awareness of one's difficulties.
So denying that they're having a problem that seems obvious to others, maybe denying that they're forgetting things, denying that they're having trouble with things. It can also mean a poor awareness of how their behavior is affecting others around them. So when they blurt out something inappropriate, do they not realize they did it or that it was inappropriate?
Or do they say, oh my gosh, I can't believe I just said that, I don't understand what happened. If they can't even acknowledge that what they did was strange, that would be a lack of insight. Number 15 on my list is verbal or physical aggression.
So has your parent become a lot more aggressive? Examples of verbal aggression would include threats, name-calling, insulting others. And again, we want to ask ourself, is this worse than it used to be or new for them?
There are a few people out there who have always been kind of aggressive. And if your parent has a lifetime pattern or lifetime history of this pattern of behavior, then you wouldn't notice it as a worrisome change quite in the same way. But if it's new, definitely make note of it.
Same thing goes for physical aggression, like throwing things, hitting, biting, or kicking, especially if it's not something that they used to do as often. Number 16 on my list is significant fluctuations in mental abilities. So what I mean by this is have you noticed that sometimes they have moments, usually within a single day, when they seem practically normal and others in which they seem really confused or really spaced out or really unable to pay attention.
Now, that kind of fluctuation where sometimes they seem off and other times totally normal is another known sign that is associated with certain forms of brain decline and certain other kinds of causes of cognitive impairment. So it would definitely be worth making note of if you've seen that. Number 17 on my list is difficulty paying attention or focusing.
So if they seem often spaced out or unable to pay attention to what you're saying or doing, make a note of that as well. Number 18 on my list is getting lost in familiar places. So this can happen either because they're on foot or if they're driving.
If this is happening, that's not normal with aging, you should definitely make a note of it. Number 19 on my list is have you noticed the driving getting much worse? So some of the common problems that come up might include difficulty parking, confusion at intersections, poor awareness of other vehicles on the road, or confusing the gas and brake pedals.
I would also make a note if you're seeing new scratches or dents in the car or worse yet, actual accidents. Lastly, if your parent seems to be getting lots of traffic tickets, that would also be concerning, especially if that's new or worse than their previous driving history would suggest. Number 20 on my list is signs of depressed mood.
So for instance, have you noticed that now your parents seems more down or glum than before? Or do they often cry or seem unhappy, or have you noticed that they seem kind of indifferent or unaffected by things that used to bring them joy, like visits from grandchildren or favorite activities or just situations that they used to seem to really enjoy? If you've noticed any of those kinds of signs, definitely make a note of that.
And then number 21 on my list is increased anxiety or worry. Does it seem to you that your parent has become more nervous, stressed, or worried compared to before? Maybe they seem to be worrying about trivial things or just more anxious or stressed out.
If you've noticed that I would also jot it down. And so that's my list of 21. Now I want to say a few words about the last two: depression symptoms and anxiety symptoms.
These are common in people of all ages and do come up in late life and often are not necessarily related to memory loss and thinking problems. So if you're noticing depression signs or anxiety signs, but nothing else that was on the list, then I wouldn't necessarily worry that your parent is having a memory or thinking problem or early Alzheimer's. I would actually encourage them to get more evaluation for possible depression or anxiety, both of which are conditions that come up for older adults.
However, if you see depression symptoms or anxiety symptoms in the context of the other abnormal signs that were on the list, it's really important to bring up those other signs to your parent's doctor, and not just tell them you're concerned about depression. Because as health providers, we think about what is going on with a person's mood and brain function differently, if they have just the mood symptoms, versus mood symptoms and also signs of other cognitive difficulties. So now how can you use this list?
So what I recommend is that you make a plan to observe your parents for a few days. You can also review the list with others who see your parent often, such as siblings, neighbors, other family members. And again, either for yourself or as a group, you want to make note of whether these signs and symptoms are coming up never, sometimes, or often, because again, the signs are not generally seen in people who are experiencing normal aging.
And it's important to not assume that they're normal aging, it's not normal. It's the sign of something going on and really should get evaluated. Also, if you are seeing some of these signs, please don't panic, and please don't jump to the conclusion that your parent has a chronic condition such as Alzheimer's disease or dementia.
Now I'll be honest, especially as people get older into their eighties or nineties, if they've developed these signs and behaviors, especially if it's been going on for weeks or months or longer, it often is actually an underlying chronic condition such as Alzheimer's or another form of dementia. But there are lots of medical conditions that can cause these symptoms or make them worse than they otherwise would be. In fact, I have a related video in which I cover the 10 most common causes of memory loss and thinking problems in older adults.
So if you're seeing these signs, I would recommend checking out that video, because if you're seeing these signs, your parent really should get a medical evaluation. And actually, in the related video, I not only cover the 10 common causes, but I also go through what doctors should check, if an older person is brought in for memory loss and thinking problems. And most of those things that the doctors should check can be done by a primary care provider.
So in terms of taking next steps after that, especially if you're thinking about how do you get your aging parent in to the doctor, or how can you talk to them about what you're observing, I do have a free online workshop for families. I'll post a link below. And in that workshop, I explain just how you can talk about safety, getting evaluated or other issues that come up when an aging parent has memory loss.
So you'll find a link to that just below this video. And so that's it. I hope this video has helped you understand what's normal and not normal when it comes to aging brains and when to truly be concerned about memory loss or thinking problems.
Thank you so much for watching and for taking the time to learn more about what to look for when it comes to the brain health of aging adults. If you like this video, I hope you'll subscribe, as I plan to make more videos, and otherwise take care, and hopefully we'll see you soon.
