STEPHEN CHOW KNEW something was off when he started making more typos and spelling errors in his work emails. This was in 2010, and Chow, 51 at the time and living in Scarborough, was an IT specialist for Ontario’s Ministry of Government and Consumer Services.
He tried to ignore the mistakes at first, but the situation became more obvious when attempts to punch in his password kept failing. He found it gradually harder to focus and perform simple, familiar tasks, such as calculating numbers or putting his signature on a document. “Everything was all messed up, and I didn’t know what to do about it,” he says. Not wanting his wife, Eva, and two adult sons to worry, he kept it a secret from them, hoping he could just muddle through.
Instead, over the next several years, more alarming symptoms appeared. As Chow made the daily 90-minute drive to and from work, he had trouble seeing the centre line on the road, as well as the cars beside him. In early 2014, his patchy vision almost killed him when he couldn’t clearly discern the road’s edge and slid into the ditch during a snowstorm. He was unharmed, but his anxiety mounted, and he decided to talk to his family doctor.
When Chow described his difficulties with typing and driving—both related to motor skills—his physician initially referred him to a specialist in Parkinson’s disease. That condition was ruled out because he didn’t have hand or leg tremors. In May of 2014, Chow got an appointment with Dr. Carmela Tartaglia, a cognitive neurologist specializing in early-onset dementia at Toronto Western Hospital.
Tartaglia suspected Chow’s symptoms were visual-spatial processing problems, a warning sign of Alzheimer’s disease—and she noted one subtle but telltale clue. “Stephen’s writing difficulties became more apparent in Cantonese,” she says. “It’s his first language, and Cantonese is a more visual language than English.”
Weeks later, an MRI showed a shrinkage of cortical tissue in the back of his brain—the region involved in processing what and how we see—and biomarkers identified in his cerebrospinal fluid 18 months later finally confirmed, six years after Chow first noticed his symptoms, that he had early-onset Alzheimer’s disease.
CHOW IS ONE OF about 700,000 Canadians living with dementia. Although the rate of people who develop dementia has been declining for decades due to healthier lifestyles, the total number is still projected to double over the next 15 years because of the aging population. Each year, more than 75,000 Canadians are diagnosed with some form of dementia. Around 10 per cent are under the age of 65.
Early detection of dementia is important so that the person diagnosed, and their family members, can take steps to slow and mitigate the effects of the disease through lifestyle changes. Ideally, that would mean seeing a family doctor, undergoing specialized testing and receiving a formal diagnosis within six months or a year after noticing symptoms. But according to an Australian study, on average, it took two years for people to make an initial visit to a doctor and over three years for a firm diagnosis.
People often associate dementia with memory loss, but in many cases this is not the first sign. In fact, dementia can affect many different areas of the brain, and scientists now understand that symptoms differ based on where in the brain changes occur. With this knowledge, doctors now use advanced tools, such as brain scans and protein biomarkers, to make earlier, more specific dementia diagnoses.
But getting to that stage requires noticing that something is wrong— and letting somebody know.
“The first time I knew Steve had a problem was when he called me from Dr. Tartaglia’s office,” says Eva. Once the diagnosis was made, she realized there had been indications. She just wasn’t aware of what to look for.
Here are 13 signs that you should be assessed for dementia:
1. YOUR PERSONALITY CHANGES
Inappropriate behaviour is an early symptom of damage to the brain’s frontal lobes, which regulate our social judgment.
“People with this dysfunction might undress in public, talk about people’s private parts or say ‘That person is stupid,’” explains Dr. Robin Hsiung, neurologist and associate professor at the UBC Hospital Clinic for Alzheimer Disease and Related Disorders. “They lose social graces and forget that what they’re saying or doing isn’t right.”
These symptoms are often seen in frontotemporal dementia (FTD), but also when Alzheimer’s or vascular dementia affect the frontal lobes. If they’re not recognized, they can be particularly unsettling.
“The worst symptoms for families to deal with are when there is a personality shift and the person becomes increasingly agitated or even paranoid and suspicious,” says Carrie Bourassa, a professor at the University of Saskatchewan’s college of medicine who specializes in dementia and aging in Indigenous populations.
Unusual behaviour can sometimes be confused with psychiatric conditions, such as bipolar disorder or schizophrenia, and brain imaging can help rule out or support a diagnosis of dementia.
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