Did You Know Dementia Has Physical Signs Too? Here’s What To Watch For

Getting older comes with many changes, not the least of which are occasional memory lapses, which tend to worry many people in the moment.

These cognitive changes can be totally normal, so there is no need to panic if you occasionally forget your sunglasses or the name of your son’s former teacher. But there is a clear difference between age-related cognitive changes and dementia.

Roughly 7 million people in America have dementia, and it’s expected that number will double by 2060. Experts say cognitive impairment becomes something more severe at a certain point.

“The magic line that transitions someone from mild cognitive impairment to dementia is when one of their cognitive impairments is impairing function. For me, that’s one of the key parts of defining when someone has transitioned to dementia,” said Dr. Stephanie Nothelle, a geriatrician and an associate professor at Johns Hopkins School of Medicine in Baltimore.

This could mean no longer being able to use a car, getting lost while driving a familiar route or not being able to do one’s taxes after decades of doing them, she said. If cognitive changes make it tough to get through a normal day, that’s a red flag, she added.

Dementia is an umbrella term that describes multiple forms of cognitive impairment, including Alzheimer’s disease (the most common form of dementia), vascular dementia and Parkinson’s, according to Nothelle.

The exact manifestations of the disease depend on the actual diagnosis. And while cognitive impairment is a common thread, there are also some physical symptoms that tend to be associated with dementia. Here’s what they are:

“I find that a lot of the more physical manifestations happen later in the course of dementia,” Nothelle said. But there is a physical issue that occurs earlier on and gets worse throughout the course of the disease, she said, and that’s “someone’s ability to walk and maintain balance.”

“The ability to maintain your balance and walk smoothly, actually, it requires a lot of brain power because you have to process a lot of different inputs,” Nothelle noted.

You have to process sensations from your feet, you have to process what your eye is seeing in the environment around you and more. “You have to quickly react to these things, and so it’s a very cognitive task to be able to walk,” Nothelle said.

Because of all of this, trouble walking, trouble balancing and falling frequently is a sign of dementia. (But note that these issues aren’t only a sign of the disease; they can be due to arthritis or even clumsiness.)

The second-most-common form of dementia is Lewy body dementia, said Dr. Jori Fleisher, an associate professor of neurological sciences at Rush University in Chicago. This describes a few types of dementia, including Parkinson’s disease.

In this manifestation, you may notice posture changes, feet shuffling or that someone is walking slower than they used to, Fleisher said.

While it’s easy to chalk these issues up to getting older, not paying attention or arthritis, “if we’re seeing a pattern of that, we want to pay attention to it,” she added.

A change in your sense of taste or smell can be attributed to many issues, such as a COVID-19 infection or a history of sinus problems, but outside of known factors, unexplained changes in these senses can also be related to dementia.

“Sometimes the person doesn’t notice it themselves, but their loved one is going, ‘Hey, something on the stove and was burning and you didn’t smell that,’” Fleisher explained.

This is a symptom that should push someone to see a doctor. While it may not be a sign of all forms of dementia, it is associated with Lewy body dementia, according to Fleisher.

People with dementia may also experience trouble swallowing food and drinks.

“People will be eating or drinking, and things will have a tendency to accidentally ‘go down the wrong pipe,’ so to say,” said Nothelle.

In this case, the food actually does go down the wrong pipe, she said. “If you have food or fluid that goes down your windpipe into your lungs, that’s not supposed to be there,” Nothelle noted.

Saliva helps us swallow food and drinks, and “our mouths are full of bacteria,” she said. While some of the bacteria is good, some of it is not-so-good (hence cavities and gum disease) and if that bad bacteria ends up in your lungs with your food, it can set you up for infection, she explained.

“We call that aspiration pneumonia, and that’s why pneumonia is relatively common in the later part of dementia,” Nothelle explained.

“Incontinence, unfortunately, can be a symptom of dementia,” said Nothelle.

A lot of nerves are required for bladder control, “and those nerves degenerate as dementia progresses,” she said.

Similarly, folks may experience new constipation later in life, according to Fleisher.

“That can also be a sign of Parkinson’s and related conditions, and often precedes the other symptoms by years,” Fleisher noted.

According to Fleisher, sleep changes are also important to look out for.

The person experiencing sleep changes may not notice, but if you live with someone and find they’re moving around a lot at night, punching, shouting or talking in their sleep, it’s important to let their health care team know, Fleisher said.

“That may be something called REM behavior disorder, which often can come years before a person has Parkinson’s or Lewy body dementia,” she added.

It can certainly be hard to admit to any health problems or changes, especially when it comes to cognition — but it’s important to do so.

We are living in a time of innovation when it comes to dementia treatments, said Fleisher.

“There’s lots of different research going on right now to try to find treatments and pharmaceutical options for people,” Nothelle added.

Doctors can check biomarkers in blood or spinal fluid to determine what kind of dementia someone has and make treatment decisions based on that, Fleisher said.

No matter what, it’s best to start treatments or interventions early on in the course of the disease, both Nothelle and Fleisher said.

The treatments aren’t a cure, but can help with disease management. More, an early diagnosis can also help families (and individuals) best prepare.

“Finding out early on can be really helpful for a lot of different reasons, including planning and just having a say in your future,” said Nothelle. If you find out early, you often can still make some decisions, whether that’s your care, where you’ll live or financial choices.

This all makes it important to pay attention to any signs of dementia (either in yourself or a loved one) and reach out to a doctor if you notice concerning changes.

“As scary as we know that this is, a diagnosis and knowledge and early detection is power,” said Fleisher.

Whether you have any of the symptoms above or not, there are things you can do to reduce your dementia risk or slow down disease prevention. These include all of the things that go into a healthy lifestyle, both experts said.

To lower your chance of dementia, it’s helpful to follow a nutritious diet (Fleisher recommends the MIND diet), exercise, socialize with loved ones and manage chronic conditions like diabetes, high and sleep apnea.

Experts predict that 42% of Americans over 55 will develop dementia in their lifetime, but there are things you can do to prepare for the disease if you get a diagnosis and things you can do to help lower your risk.