If you’re an older adult experiencing memory lapses, lack of focus or confusion — or you have a loved one with those symptoms — it’s natural to worry about dementia or Alzheimer’s disease. A recent AARP survey found that nearly half of adults 40 and older think they will develop dementia — a share far greater than the condition’s actual prevalence.
Other treatable conditions can cause similar symptoms, and they can be easy for doctors to miss, says Ardeshir Hashmi, M.D., a geriatrician and section chief of Cleveland Clinic’s Center for Geriatric Medicine.
“Sometimes there’s just a very superficial workup, and then [the doctor says], ‘Here’s a pill for Alzheimer’s,’ ” Hashmi says. (Although there is no cure for Alzheimer’s disease, the most common form of dementia, there are several federally approved medications that can help manage its symptoms. Two medications have made it to the market that could slow the progression of Alzheimer’s, though studies measuring their effectiveness are ongoing.) “Before you make that conclusion, you should rule out all the other things that can be confused with dementia — things that are easily reversible.”
Here are some common medical problems that can be mistaken for dementia.
1. Medication interactions or side effects
If someone complains of memory problems, Hashmi says his first question is always, “Did you recently start a new medication?”
Older adults are more likely than younger people to develop cognitive impairment as a side effect of a medication, and drug toxicity is the culprit in as many as 12 percent of patients who present with suspected dementia, research shows.
Many types of prescriptions and over-the-counter drugs can affect your cognition, but the most common include those for sleep, urinary incontinence, pain, anxiety and allergies. Taking too many medications (called polypharmacy) can affect your ability to think clearly and remember things, Hashmi says.
An April 2023 report from the National Poll on Healthy Aging found that 82 percent of adults ages 50 to 80 take at least one prescription medication; 28 percent take five or more medications. The same report found that 80 percent of older adults taking prescription medication said they would be willing to stop taking one or more if their doctor said it was possible.
Even a prescription you’ve been on for many years can trigger confusion. The reason, Hashmi explains, is that your kidneys and liver become less effective at clearing drugs from your body as you get older, so a medication can build up in your system and cause problems.
2. A respiratory infection (including COVID-19)
Any untreated infection, Hashmi says, can cause delirium — a sudden change in alertness, attention, memory and orientation that can mimic dementia. When you have an infection, the white blood cells in your body rush to the infection site, causing a chemical change in the brain that makes some older adults feel drowsy, unfocused or confused.
Respiratory infections are harder to diagnose in people 65 and older because they are more likely to lack classic symptoms, such as a fever or a cough, Hashmi notes. In one study published in 2020 in JAMA Network Open, 37 percent of older COVID-19 patients who went to the emergency room with delirium had no typical COVID symptoms, such as fever or shortness of breath.