One of the most frequent questions I receive about dementia is, “How is dementia different from ordinary forgetfulness?”
I can explain this from my own experience as a caregiver. My mother has both Alzheimer’s disease and vascular dementia, and over the years I have witnessed firsthand how dramatically dementia can affect memory, communication, judgment, behavior, personality, coordination, and the ability to perform ordinary daily tasks.
It is important to understand that everyone forgets things occasionally. Forgetting why you walked into a room, having someone's name temporarily escape you, misplacing your keys, or struggling to remember a word that is “on the tip of your tongue” can happen at any age and does not, by itself, indicate dementia.
Dementia is different because the changes become more persistent and begin to interfere with a person's ability to function and understand the world around them.
Memory and Recognition
In the earlier stages, it can be difficult to distinguish dementia from normal age related forgetfulness. As dementia progresses, however, the memory problems become much more profound.
A person with dementia may walk into their own bedroom and no longer recognize it as their bedroom. They may wonder why the room is messy without realizing that the belongings belong to them. They may forget that they have lived in the same home for years or insist that they need to “go home” even when they are already there.
This is very different from simply forgetting where you left your keys.
Language and Communication
Dementia can also affect language in ways that go beyond occasionally forgetting a word.
For someone who is bilingual, language abilities can change unevenly. A person may lose the ability to express a word or thought in one language while still being able to express it in another. As dementia advances, they may have difficulty finding even familiar words, including the names of people they have known for decades.
Someone may know that a person is familiar to them but be unable to produce that person's name. In more advanced dementia, even simple conversations can become difficult to follow.
For example, I might tell my mother:
“Today at work, I had a pregnant client, and she is due in three weeks.”
My mother might hear the word “pregnant” and respond, “You're pregnant?”
Or she might hear the word “work” and ask, “Are you going to work?”
She was not following the conversation as a whole. She was responding to an isolated word that she recognized.
This can make ordinary conversations extremely challenging for caregivers because the same information may have to be repeated several times, sometimes in much simpler language.
Losing and Misplacing Things
Everyone misplaces something occasionally. Dementia can take this to another level.
A person with dementia may repeatedly lose possessions because they have placed them in unusual locations or hidden them and then forgotten where they put them. They may put cash inside a shoe and then throw the shoe into the garbage. They may put leftover food under the bed, a toothbrush in a sock drawer, or mail inside an oven.
They may then become convinced that someone stole the missing item.
Sometimes the item itself may be something the caregiver has never seen before. A person may insist that someone stole a particular object, such as a vintage camera, even though no one else remembers ever seeing it.
To the person with dementia, however, the belief can feel completely real.
Repetitive Searching and Suspicion
When people with dementia become anxious or confused, they may repeatedly open and close drawers, cabinets, closets, or other storage areas. They may be looking for something but be unable to explain what they are looking for.
This confusion can sometimes develop into suspicion or accusations.
My mother, for example, became extremely preoccupied with what other people were doing. If I brought a friend into the house, she might accuse that person of being promiscuous. If my husband worked overtime, she might insist that he had taken my money and gone to a casino.
Simply telling her that she was mistaken did not necessarily resolve the situation. Instead, she might become increasingly distressed and try repeatedly to convince me that her version of events was true.
These behaviors are not simply stubbornness. Dementia can affect judgment, perception, reasoning, and the ability to distinguish between what is actually happening and what a person believes is happening.
Changes in Behavior and Personality
Dementia can cause noticeable changes in a person's behavior and personality.
Someone who was previously polite and reserved may begin saying things that would have been completely out of character for them. They may make inappropriate comments, insult other people, use language they would never have used before, or behave in socially inappropriate ways.
In some people, dementia can also cause disinhibition or hypersexual behavior, including inappropriate sexual comments, propositions, touching, or public nudity.
These behaviors can be shocking to family members because they may seem completely inconsistent with the person's lifelong personality.
It is important to remember that the disease can impair the parts of the brain responsible for judgment, impulse control, and social behavior.
Changes in Personal Care and the Home
Another noticeable difference can be a decline in personal grooming and household organization.
Someone who once took pride in their appearance may stop maintaining their hair or makeup. Clothing may be worn incorrectly, such as shirts or sweaters being inside out, pants being backward, mismatched socks, or shoes being placed on the wrong feet.
Personal hygiene may decline as well.
The home may also become increasingly disorganized. Mail can accumulate, trash may not be thrown away, clothing may be left in piles, food can spoil, and ordinary household clutter can become overwhelming.
What once would have been recognized as garbage or something that needed to be put away may no longer be identified that way.
Unusual Behaviors and Beliefs
Dementia can also lead to behaviors that appear completely irrational to someone who does not understand the disease.
My mother, for example, once had a large supply of baby powder from the dollar store. She would pour it over herself, into her bed, and onto the floor. She genuinely believed it helped keep the house cool.
From the outside, the behavior made no logical sense.
From her perspective, however, there was a reason for doing it.
That distinction is important when caring for someone with dementia. Arguing about whether the behavior makes sense often does not solve the problem because the person's reasoning and perception have been altered by the disease.
Changes in Eating
Eating habits can change significantly as dementia progresses.
A person may suddenly dislike foods they once loved or begin eating foods they previously disliked. They may eat only small amounts or lose interest in meals altogether.
They may also forget that they have eaten.
Someone can eat breakfast and lunch and later insist that they have not eaten anything all day. To the caregiver, this can be frustrating, but the person is not necessarily lying. They may genuinely no longer remember the meals.
Safety and Falls
Dementia can also create significant safety concerns.
People with dementia may become more prone to falls because of problems with balance, coordination, judgment, spatial awareness, or physical weakness. They may also have difficulty recognizing hazards that would previously have been obvious to them.
Other accidents can occur as well, including burning food, spilling liquids, dropping objects, leaving appliances on, knocking things over, or attempting activities that are no longer safe.
Driving can become particularly dangerous when memory, judgment, reaction time, or spatial awareness are impaired.
Difficulty Following Instructions
As dementia advances, even simple instructions can become difficult to process.
For example, you might tell someone:
- Get a pot.
- Put water in the pot.
- Put the pot on the stove.
- Turn the stove on.
- Wait for the water to boil.
A person with dementia may not be able to retain the sequence. They may hear the word “water” and simply turn on the faucet, without understanding the rest of the instructions.
This is why caregivers often have to break tasks into very small, individual steps.
Aggression and Emotional Outbursts
Dementia can also cause dramatic changes in emotional regulation.
My mother never hit me as a form of discipline when I was growing up. Yet during caregiving, she has experienced episodes in which she bit or kicked me, threatened to throw ceramic coffee mugs, or screamed intensely.
These behaviors can be extremely upsetting for family members because they are so different from the person they remember.
Again, this does not mean the person has suddenly become a different human being. The disease can affect impulse control, emotional regulation, judgment, and the ability to respond appropriately to frustration.
Hallucinations and Psychosis
Some people with dementia can also experience hallucinations, delusions, or other forms of psychosis.
My mother has seen people and things that nobody else could see. She has insisted that someone was present when there was no one there. She has talked to the ceiling, walls, and even her pillow.
This was not part of her personality before dementia.
Experiencing these symptoms as a caregiver can be frightening, particularly when the person is completely convinced that what they are seeing or experiencing is real.
The Difference Is More Than Forgetfulness
So, what is the difference between ordinary forgetfulness and dementia?
Ordinary forgetfulness happens to all of us. Dementia progressively interferes with a person's ability to remember, communicate, reason, recognize familiar people and places, perform familiar tasks, regulate behavior, and safely navigate everyday life.
A person who occasionally forgets where they put their keys is experiencing something very different from a person who puts their keys in the refrigerator, forgets doing it, becomes convinced someone stole them, and can no longer understand why the refrigerator is not an appropriate place to store keys.
Dementia is not simply “forgetfulness.” It is a progressive condition that can affect nearly every aspect of a person's functioning.
These examples are based on my personal experience as a caregiver. Dementia does not look exactly the same in every person, and symptoms vary depending on the type and stage of dementia and the individual.
But after years of caring for my mother, I have learned that there is a profound difference between occasionally forgetting something and losing the ability to understand, remember, and safely interact with the world around you.
