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It’s common for people to attribute gradual decline over many years to Alzheimer’s or other dementias, or even old age alone. But it’s crucial to remember that many other factors can cause gradual decline, and not all of them are related to aging or dementia.
The picture hints at a situation that clearly illustrates this, as I explain in the following story.
A woman was brought by her family to one of the nursing homes where I was working at the time. They said her dementia had progressed to the point she could no longer take care of herself, and they did not have the ability to provide the care she needed at home.
Also, they said, she hadn’t spoken for a year.
I went through my usual head-to-toe initial evaluation. I tried to talk to her and she didn’t respond to my questions, but her eyes were bright and seemed to watch attentively everything I was doing. “Doesn’t seem like advanced dementia” I thought to myself.
For the last part of the exam, I dug into my little black bag. I grabbed my otoscope to check her ears. I couldn’t see her ear drums, but what I saw was many, many years of wax accumulation on both sides. Going back into my bag, I took out a curette and pulled out two large plugs firmly lodged in her ear canals.
I asked, “How are you doing?” To my amazement, she replied, “I’m okay.”
After a year of silence, she spoke. She hadn’t spoken for the past year because she couldn’t hear anything anyone was saying.
This is a striking example of how something as simple as ear wax can cause a person to be misdiagnosed.
Gradual development of other common conditions like overactive or underactive thyroid, vitamin B12 deficiency, or anemia can also cause symptoms easily mistaken for dementia.
Depression is another major factor that often goes undiagnosed, especially in older people. Depression can cause withdrawal, a lack of interest in activities, and a general decline in mental sharpness. Indeed, this syndrome was defined in my geriatric training as “pseudo-dementia”, or “false dementia”.
The key takeaway is that gradual decline in older people may be caused by common issues that cause similar symptoms.
It is essential to rule out all of these underlying issues before jumping to wrong conclusions that prevents someone from getting the real treatment they need.