Treatable conditions that look like dementia

Not every memory problem is dementia. Many health problems can cause forgetfulness, confusion or slow thinking. Some of them are common in later life, and many can be treated.^1,2

This page walks through the most common look-alikes. It explains the clues, how doctors check for each one, and what treatment can do. If you are worried about your own memory or a loved one's, this is a good reason to see a doctor soon rather than wait.

Why checking for look-alikes matters

The Alzheimer's Association says most brain changes that cause dementia cannot be undone. But memory problems caused by depression, medicine side effects, heavy drinking, thyroid problems or low vitamins may get better with treatment.² That is why a good memory checkup always looks for these causes first.

Doctors usually start with a health history, a list of medicines, a physical exam and memory tests. Then they order blood and urine tests to rule out treatable causes.¹⁴ A brain scan, such as a CT or MRI, can show fluid buildup, bleeding, strokes or tumors. See the first doctor visit about memory and brain scans.

Do not let anyone, including yourself, wave off new memory problems as "just old age." A careful checkup may find something that can be treated.²

The common look-alikes at a glance

Sources for the table: see each section below.

Low vitamin B12

Vitamin B12 helps keep nerves and blood cells healthy. Low B12 can cause depression, confusion, poor memory and even dementia. It can also cause tiredness, numb or tingling hands and feet, and balance problems.³

Older adults are at higher risk. Many make less stomach acid, which the body needs to absorb B12 from food. Estimates of how many older adults have low B12 range widely, from about 3 in 100 to more than 4 in 10.³ Other risks include:³

• Long-term use of acid-reducing medicines for heartburn, such as omeprazole, lansoprazole or cimetidine
• Metformin, a common diabetes medicine
• Weight-loss surgery or other stomach or bowel surgery
• Celiac disease or Crohn's disease
• A vegan or strict vegetarian diet
• Pernicious anemia, an immune problem that blocks B12 absorption

A simple blood test can check B12. Low B12 can harm the nerves even before blood counts change, so treatment should start soon once it is found.³ Treatment may be shots or pills, chosen by your doctor. Do not stop a diabetes or heartburn medicine on your own. Talk with your doctor or pharmacist first.

Thyroid problems

The thyroid is a small gland in the neck. It makes hormones that set the body's pace. An underactive thyroid (hypothyroidism) can slow thinking. In older adults, memory loss or duller thinking may be the only sign, and it is often blamed on age.⁴

An overactive thyroid (hyperthyroidism) can also fool families. In older people, it may show up mostly as depression, a shaky hand and pulling away from friends.⁴

A blood test called TSH is the main check. A slightly high TSH can be part of normal aging and does not always need treatment. Your doctor decides based on the numbers and your symptoms.⁴ An underactive thyroid is usually treated with a thyroid hormone pill, with blood tests to fine-tune it.⁴

Medicines

Medicines are one of the most common and most fixable causes of confusion in later life. As we age, the liver and kidneys clear many drugs more slowly. Drugs can build up, and they interact with each other more.⁷

Some kinds of medicine are well known for clouding thinking in older adults:^6,7

• Anticholinergic medicines. These include some drugs for overactive bladder, allergies and depression, and many over-the-counter sleep aids. They can impair thinking, especially in older people.
• Benzodiazepines and other sedatives, often used for anxiety or sleep
• Opioid pain medicines
• Some antipsychotic and antidepressant medicines

Taking five or more medicines is called polypharmacy. Between 1999 and 2012, the share of Americans over 65 taking five or more prescription drugs rose from about 1 in 4 to about 2 in 5.⁷ When a medicine is the only cause of the thinking problem, memory is expected to recover once the drug is removed.⁷

Our page on medicines that can worsen memory goes into more detail. See also medicines that can affect mood and memory.

Depression

Depression and anxiety can make it hard to focus, remember and make decisions. These memory problems usually ease once the depression is treated.^1,2

Depression is treatable at any age. Talk therapy, medicines, exercise and more time with others can all help. Depression can also happen alongside early dementia, so the doctor may treat the mood and keep watching memory over time. Read more on depression in later life and apathy and depression in dementia.

If someone talks about wanting to die or not wanting to be here, call or text 988, the Suicide and Crisis Lifeline, any time. If there is immediate danger, call 911.

Delirium

Delirium is sudden, severe confusion caused by a fast change in how the brain is working. It starts over hours or days. It tends to come and go, often better in the morning and worse at night. A person may be sleepy and slow, or restless and agitated, or switch between the two.⁵

Common causes include:⁵

• Infections, such as a urinary tract infection or pneumonia
• Medicines, including pain medicines, sedatives and anticholinergic drugs
• Alcohol or drug use, or stopping them suddenly
• Surgery and anesthesia
• Imbalances in body salts and other chemicals
• Severe lack of sleep

Delirium can happen on top of dementia. Treatment focuses on finding and fixing the cause. Glasses, hearing aids, clocks, calendars and good lighting also help a person stay oriented.⁵ Delirium often lasts about a week, and full recovery can take several more weeks.⁵ Most people are expected to recover, but it depends on the cause.⁵

Delirium is common in hospital stays, especially in intensive care.⁵ See hospital stays and emergency rooms for ways families can help.

Sleep apnea

In sleep apnea, breathing stops and starts many times during sleep. Signs include loud snoring, gasping and feeling sleepy in the day. Often a bed partner notices first.⁸

Untreated sleep apnea can cause trouble focusing, remembering and making decisions. It may also raise the risk of dementia in older adults.⁸ A sleep study can confirm it. Treatment may include a PAP machine that keeps the airway open with gentle air pressure, or a mouth device fitted by a dentist.⁸ Read our page on sleep apnea.

Hearing loss

About one-third of older adults have hearing loss.⁹ People who cannot hear well are often wrongly thought to be confused or uncooperative.⁹ They may miss parts of a talk, answer the wrong question, or pull back from people.

Hearing loss is also linked to a higher risk of dementia and faster memory decline.⁹ In a large study of nearly 1,000 adults aged 70 to 84, hearing aids did not slow thinking decline overall. But in people at higher risk, hearing aids slowed decline by almost half over three years.¹⁰ Promising

A hearing test is quick and painless. Over-the-counter hearing aids are now sold without a prescription for mild to moderate hearing loss.⁹ See hearing, vision and brain health and hearing loss, loneliness and the brain.

Normal pressure hydrocephalus (NPH)

NPH is a buildup of fluid in the spaces inside the brain. It is most common in older adults. It causes three main problems: memory and thinking decline, trouble walking (feet may feel stuck to the floor), and trouble controlling the bladder.¹¹

NPH is often mistaken for Alzheimer's or Parkinson's disease.¹¹ Doctors use a brain scan and other tests to confirm it. Treatment is surgery to place a shunt, a thin tube that drains extra fluid. Early diagnosis improves the chance of getting better.¹¹ Read our full page on normal pressure hydrocephalus.

Chronic subdural hematoma (a slow bleed on the brain)

A subdural hematoma is blood that collects between the brain and its outer covering. The slow, chronic type is more common in older adults. It can follow even a minor bump on the head, and symptoms may not show for days or weeks.¹²

Signs can include confusion, drowsiness, memory decline, headache, trouble walking or talking, weakness and behavior changes.¹² Risk is higher for people who take blood thinners or aspirin, drink heavily or fall often.¹² A CT or MRI scan can find it. Draining the blood through a small opening in the skull often clears the symptoms.¹²

Older adults with new memory problems should get checked, even if no one remembers a fall.¹² See preventing falls.

Other causes doctors may look for

Doctors may also check for kidney or liver problems, infections or tumors in the brain, past head injuries, poor nutrition, and alcohol or drug misuse.¹ Long-term heavy drinking can damage the brain, and some of that damage can improve with stopping. See alcohol-related brain damage and alcohol in later life. Memory that gets worse over weeks or a few months needs urgent checking. See dementia that gets worse fast.

Questions to ask the doctor

What could be causing these memory problems?

• Could this be caused by a medicine, low B12, a thyroid problem, depression or poor sleep?
• Which blood tests are you ordering, and what do they check?
• Do we need a brain scan, a hearing test or a sleep study?

If you find a treatable cause, what happens next?

• How soon might thinking improve, and how will we know?
• Could there also be an early dementia? When should we test memory again?
• Which medicine changes are safe, and who will guide them?

A memory notebook can help you jot down when problems began, what medicines changed and what you notice day to day. That record helps the doctor find the cause.

When to get help

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.