“He’s just getting forgetful—it happens in old age.”
“Dad always lost his keys; don’t make a big deal out of it.”
If a loved one is getting older, chances are you’ve said one of these phrases, or a variation of them, at one point or the other. But in the back of your head, you’re still worried. You are scared that they are showing signs of dementia, and confidently bluffing as a way to imagine hope.
There is a flipside to this as well. There are some people who see signs of Alzheimer’s every time an older loved one forgets the name of a high school teacher or what color their best friend’s car was in 1974. And really, these can be the same people, going back and forth in the emotional maelstrom that develops from loving someone and being scared for them.
Both, while 100% understandable, can be harmful. Ignoring signs is dangerous, but reading too much into everything can be irritating and alienating (and it can make you ignore real dangers, like depression, that might not be actual dementia). So it is important to have a firm footing on what Alzheimer’s actually looks like before making any seat-of-the-pants diagnosis.
There are free cognitive tests for older adults and caregivers that can help you understand if your loved one is showing any actual signs, or if they are just forgetful. We want to emphasize that these are not actually diagnostic, and they shouldn’t be treated as strictly medical. But they are meant to show if there are signs, to prompt a follow-up visit to a medical professional. But mostly, they are meant to start taking away guesswork, bravado, or fear. They’re meant to start showing you the truth.
What Are Basic Signs of Dementia?
As we said, there are some signs of early cognitive impairment to be aware of (or mild cognitive impairment, but the adjective “mild” can make people not realize it is a potential prelude). These signs include:
- Memory loss: This is the most common, or at least most well-known, but far from the only sign.
- Time disorientation: Forgetting the date, not being aware of the time, unsure what day of the week it is.
- Directional disorientation: Forgetting how to get from one place to another, whether it is among rooms in the house or to a familiar restaurant.
- Changes in mood: It could be more than just “mom’s getting cranky.” This can be a sign of mental health issues. The brain is a complicated place, and Alzheimer’s has complicated effects.
- Language disorientation: Misplacing words, trailing off in sentences, struggling to find the right thing to say. Obviously, this is more or less noticeable for some people. It’s all relative, so don’t rush to assumptions.
- Decision making: When the brain starts to function differently, executive impairment can follow. Poor decisions, uncharacteristically bad judgment, and poor organizational skills can be a sign of cognitive impairment (again, relative to normal).
That’s where these tests come in. They are an objective way to understand if these functions are impaired.
Cognitive Tests to Assess Memory
Here are a few tests that can shed light on cognitive functions. Remember, these aren’t literally diagnostic, but they can help you decide if you should seek a professional evaluation.
The Self-Administered Gerocognitive Exam (SAGE) was developed at Ohio State as a basic way to test basic cognitive functions. This is an easy, 12-question form that should take no more than 15 minutes. The test asks some medical and personal questions, as well as some riddle-type ones, such as:
- Are you a man or woman?
- Have you ever had a stroke?
- How far did you get in school?
- How are a watch and ruler similar? (There is no “right” answer here.)
- Identify these pictures (volcano, wreath, etc.).
- What is today’s date?
There are five different versions of this test (here’s one sample), so you can retake it several times without giving your loved one the chance to memorize answers. The SAGE creators say, rightly, that if there are more than six wrong answers, the results should be taken to a professional for further examination.
This is an incredibly simple test that is also incredibly revealing. All you need is a pencil and paper. Ask your loved one to draw a clock, with the hands pointing to the correct time. You can tell them the time since this isn’t a time disorientation test but rather a way to see if they can make the connection. You want them to draw the numbers and the hand. There is also a simple point system:
- One point for a closed circle (and it has to be close to a circle—an oval or a blob doesn’t count and can actually be indicative of Parkinson’s disease).
- One point for putting in all 12 numbers.
- One point for having numbers in the right place.
- One point for having hands point the right direction.
Anything under a score of four is cause for concern. This shows someone losing the basics. Don’t panic, of course. The patient could be momentarily psyching themselves out. This is why you should administer the test a few times under different and non-stressful conditions.
The Simple Word Memory Test
This is another very simple test you can do at home. All you have to do is cite three objects in the house (for example, a bookshelf, a fish tank, and the TV) and ask your loved one to repeat them back to you. Then, ask them to do a simple task. Some people have recommended to do the clock test at this point, but others say even just having a brief conversation about something that requires mental energy is better.
After that, ask them to repeat the three objects back. If they can’t, that might be a sign of cognitive impairment.
Or it might not! It might just be that they had been thinking about the mantle all day because it was dusty, so the mantle was in their head. One test isn’t indicative, and even all the tests combined aren’t diagnostic.
But do a few, and if signs are pointing in one direction, go to a doctor. While there is tragically no cure for Alzheimer’s, early diagnosis can delay the symptoms and lead to a better life. You owe it to your loved one, and yourself, to take this seriously. That doesn’t mean panic, and it doesn’t mean bravado. It means handling your loved one’s potential sickness with love, with compassion, and with clear eyes. You might be entering a new world, but you are doing it together.
At Institute on Aging, our programs and services help older adults, their families, and caregivers explore aging together, through good times and bad, as an adventure and a journey. Connect with us today to learn more.