Cedars-Sinai Blog
Ask a Doc: Is it Dementia?
When older adults experience cognitive problems such as memory loss, confusion and brain fog, dementia might seem like the obvious culprit. But Sarah Kim, MD, a geriatric psychiatrist at the Cedars-Sinai Alzheimers and Memory Disorders Program, said a host of treatable conditions, from vitamin deficiency to urinary tract infection, could be at the root of the cognitive difficulties. And, unlike dementia, these symptoms are reversible with proper treatment.
Here’s what patients and their loved ones should know—and do—about symptoms that mimic dementia.
Sarah K. Kim, MD
"If you have memory or cognitive concerns, go to your primary care provider and get evaluated. It might not be dementia, but instead a reversible condition."
What Is Dementia?
Sarah Kim, MD: Dementia is a progressive neurodegenerative disorder. There are several types, with Alzheimer’s disease being the most common. Alzheimer’s is primarily a memory disorder, and the main change that people notice is memory impairment. Often the most recent memories go away first.
Other types of dementia include vascular dementia, frontotemporal dementia, Lewy body dementia and Parkinson’s dementia.
While some treatments can slow the progression of dementia, there is no cure.
What Is Reversible Dementia?
SK: Reversible dementia is when the memory problems typically attributed to dementia occur instead due to a treatable condition or issue. The symptoms will largely look like dementia. The patient may experience a slowing of their thoughts, maybe some attention and concentration problems, recall memory problems and perhaps trouble finding their words. The onset is insidious—it’s usually gradual and prolonged over weeks and months.
What Causes Reversible Dementia?
SK: There are many causes of reversible dementia, including:
- Deficiencies in vitamins B12 or B1 (thiamin), especially in people with alcohol use disorder
- Untreated hypothyroidism (underactive thyroid)
- Untreated or advanced syphilis or human immunodeficiency virus (HIV)
- Poor quality sleep due to obstructive sleep apnea, especially in people with certain other conditions or habits, such as obesity or smoking
- Psychiatric problems, most often depression, insomnia or anxiety disorders
Cognitive problems due to depression used to be called "pseuodementia," as some of the core features of depression—poor concentration, poor sleep quality, psychomotor slowing, lack of energy and motivation—can also mimic dementia.
What Other Conditions Can Mimic Dementia?
SK: If symptoms develop quickly—within just hours or days—and include delusions, hallucinations or other psychotic symptoms, the altered mental state might be caused by an acute illness. This is called toxic metabolic encephalopathy, or delirium. Common causes, especially for older adults, include urinary tract infection, pneumonia and other infections, exacerbation of chronic obstructive pulmonary disease (COPD) or heart conditions, low blood sodium and also certain medications.
When Should You See a Doctor for Dementia-Like Symptoms?
SK: If you have memory or cognitive concerns, go to your primary care provider and get evaluated. It might not be dementia, but instead a reversible condition.
Basic laboratory blood tests can rule out reversible causes related to nutritional deficiencies, thyroid function or disease. Doctors can also screen patients for depression and sleep apnea. If the symptoms are more severe, a physician can order a full medical workup to rule out other medical issues.
Treating these reversible conditions—with vitamin supplements, thyroid medication, antidepressants or antibiotics—can make a huge impact on a patient’s quality of life.
