As we age, occasional forgetfulness like misplacing glasses or struggling to recall a name is a common and often normal part of the process. However, experts emphasize a critical distinction between these age-related cognitive changes and the onset of dementia, a condition affecting roughly 7 million people in the United States, with projections suggesting that number will double by 2060.
Crossing the Line from Mild Impairment to Dementia
Dr. Stephanie Nothelle, a geriatrician and associate professor at Johns Hopkins School of Medicine, clarifies the transition point. "The magic line that transitions someone from mild cognitive impairment to dementia is when one of their cognitive impairments is impairing function," she explains. This could manifest as no longer being able to drive safely, getting lost on familiar routes, or being unable to manage personal finances after a lifetime of doing so. When cognitive changes begin to disrupt daily life, it's a significant red flag.
Dementia itself is an umbrella term encompassing several forms of cognitive decline, including Alzheimer's disease (the most common type), vascular dementia, and Parkinson's disease dementia. While memory and thinking problems are central, the disease can also present with distinct physical symptoms that are crucial to recognize.
Key Physical Symptoms Linked to Dementia
1. Difficulty with Walking and Balance
While many physical signs appear later, Dr. Nothelle points out that changes in gait and balance can emerge earlier and worsen over time. "The ability to maintain your balance and walk smoothly actually requires a lot of brain power," she notes, as it involves processing multiple sensory inputs from your feet, eyes, and environment. Frequent stumbling, balance issues, and falls can be indicators, though they may also stem from arthritis or other conditions.
2. Altered Posture and Shuffling Feet
Dr. Jori Fleisher, an associate professor of neurological sciences at Rush University, highlights that Lewy body dementia (which includes Parkinson's disease dementia) is the second-most-common form. In these cases, one may observe a stooped posture, a shuffling walk, or a noticeably slower gait. While easy to attribute to aging or arthritis, a persistent pattern warrants medical attention.
3. Unexplained Changes in Taste or Smell
Although factors like COVID-19 or sinus issues can affect these senses, unexplained diminishment can be associated with dementia, particularly Lewy body dementia. Often, a family member might notice first—for example, if a loved one fails to smell burning food. This symptom should prompt a doctor's visit.
4. Problems with Swallowing (Dysphagia)
Individuals with dementia may start to have trouble swallowing, leading to frequent choking or having food and drink "go down the wrong pipe." Dr. Nothelle explains that this can allow bacteria-laden saliva or food particles to enter the lungs, raising the risk of aspiration pneumonia, a common and serious complication in later-stage dementia.
5. Loss of Bladder Control and Constipation
"Incontinence, unfortunately, can be a symptom of dementia," says Dr. Nothelle, as the nerves controlling bladder function degenerate. Similarly, Dr. Fleisher notes that new, persistent constipation in later life can be an early sign of Parkinson's-related conditions, sometimes appearing years before other symptoms.
6. Significant Sleep Disturbances
Dr. Fleisher advises watching for dramatic sleep changes, such as physically acting out dreams—punching, shouting, or talking during sleep. This may indicate REM sleep behavior disorder, a condition strongly linked to future development of Parkinson's or Lewy body dementia, sometimes years in advance.
The Power of Early Detection and Proactive Management
Both experts stress that while confronting cognitive decline is difficult, early diagnosis is empowering. "We are living in a time of innovation when it comes to dementia treatments," says Dr. Fleisher. Advances allow doctors to use biomarkers in blood or spinal fluid to pinpoint the dementia type and guide treatment plans.
Although current treatments are not a cure, they can help manage the disease's progression. Critically, an early diagnosis provides invaluable time for individuals and families to plan for future care, living arrangements, and finances. "Finding out early on can be really helpful for a lot of different reasons, including planning and just having a say in your future," Dr. Nothelle emphasizes.
To support brain health and potentially reduce risk, experts recommend a healthy lifestyle: following a nutritious diet like the MIND diet, engaging in regular physical activity, maintaining social connections, and managing chronic conditions such as diabetes, high blood pressure, and sleep apnea.
"As scary as we know that this is, a diagnosis and knowledge and early detection is power," Dr. Fleisher concludes. Paying attention to both cognitive and physical changes, and consulting a healthcare professional with concerns, remains the most critical step.
