Anxiety, aggression, and making crude remarks on ‘checklist’ for signs of dementia

Memory loss may not always be the first warning sign that dementia is brewing — changes in behaviour or personality might be an early clue.

Researchers have outlined a syndrome called “mild behavioural impairment” that may be a harbinger of Alzheimer’s or other dementias, and proposed a checklist of symptoms to alert doctors and families.

Losing interest in favourite activities? Getting unusually anxious, aggressive or suspicious? Suddenly making crude comments in public?

“Historically those symptoms have been written off as a psychiatric issue, or as just part of ageing,” said Dr Zahinoor Ismail of the University of Calgary, who presented the checklist at the Alzheimer’s Association International Conference in Toronto.

Now, “when it comes to early detection, memory symptoms don’t have the corner on the market anymore”, he said.

Alzheimer’s, the most common form of dementia, gradually strips people of their memory and the ability to think and reason.

But it creeps up, quietly ravaging the brain a decade or two before the first symptoms become noticeable. Early memory problems, called “mild cognitive impairment”, or MCI, can raise the risk of later developing dementia, and worsening memory often is the trigger for potential patients or their loved ones to seek medical help.

It is not uncommon for people with dementia to experience neuropsychiatric symptoms, too — problems such as depression or “sundowning”, agitation that occurs at the end of the day — as the degeneration spreads into brain regions responsible for more than memory.

Previous studies have found that people with mild cognitive impairment are at greater risk of decline if they also suffer more subtle behavioural symptoms.

The concept of pre-dementia “mild behavioural impairment”, or MBI — a term that describes specific changes in someone’s prior behaviour that might signal degeneration — is starting in brain regions not as crucial for memory, he said.

Dr Ismail is part of an Alzheimer’s Association committee tapped to draft a checklist of the symptoms that qualify — new problems that linger at least six months, not temporary symptoms, or ones explained by a clear mental health diagnosis or other issues such as bereavement, he said.

The following is a checklist for a syndrome called “mild behavioural impairment”. Among the questions are:

  • Has the person lost interest in friends, family, or home activities?
  • Has the person become less spontaneous and active — for example, is he/she less likely to initiate or maintain conversation?
  • Does the person view herself/himself as a burden to family?
  • Has the person become more anxious or worried about things that are routine, like events, visits?
  • Does the person feel very tense, having developed an inability to relax, or shakiness, or symptoms of panic?
  • Has the person become agitated, aggressive, irritable or temperamental?
  • Does the person hoard objects when she/he did not do so before?
  • Has the person recently developed trouble regulating smoking, alcohol, drug intake or gambling, or started shoplifting?
  • Does the person say rude or crude things or make lewd sexual remarks that she/he would not have said before?


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