Can Dementia Be Reversed? Conditions That Look Like Dementia but Are Treatable

Every few weeks a family tells me their father has dementia and then, when I ask, it turns out nobody has done a full workup. He was confused in the hospital, a discharge nurse used the word, and the family has been planning around it ever since. Sometimes the word is right. Sometimes he had a bladder infection and a new sleeping pill.

Alzheimer’s disease and the other true dementias cannot be reversed with today’s medicine. But a number of conditions produce the same symptoms and can be treated, and when they are, the person often improves. The only way to know which one you are dealing with is a complete evaluation by the doctor before any big decision gets made.

The short answer: true dementia no, look alikes yes

Dementia caused by Alzheimer’s, vascular damage, Lewy bodies or frontotemporal degeneration is progressive and, as of today, not reversible. Treatments can ease symptoms and, for some people in the early stage of Alzheimer’s, newer medicines may slow the decline; ask the neurologist what applies. No treatment restores what the disease has taken.

Reversible dementia is a different thing. It means a medical condition is producing memory loss, confusion or personality change that looks like dementia, and treating the condition clears or improves the symptoms. Published research puts these cases at a minority of people evaluated for dementia, but a minority worth finding, because the alternative is placing a parent in memory care for something a prescription change could have fixed.

Conditions that look like dementia but can be treated

These are the look alikes that doctors check for, and the ones I ask about when a family calls me after a sudden change.

Condition	What it can look like	How it is found
Medication side effects and interactions	Confusion, drowsiness, memory gaps, especially with sleep aids, anxiety drugs, bladder drugs and strong pain medicine	Medication review by the doctor or pharmacist
Infection, often urinary	Sudden confusion, agitation, hallucinations	Urine and blood tests
Depression	Withdrawal, slowed thinking, poor concentration, answering every question with I do not know	Screening questions, trial of treatment
Thyroid and vitamin deficiencies	Slowed thinking, fatigue, memory loss	Blood tests for thyroid, B12 and others
Delirium after surgery or a hospital stay	Fluctuating attention, sudden onset	History of the event, observation over days to weeks
Normal pressure hydrocephalus	Shuffling walk, urinary urgency and memory trouble together	Brain imaging and specialist evaluation
Hearing and vision loss	Seeming confused, not following conversation, withdrawal	Hearing and eye exams
Sleep apnea and poor sleep	Daytime fog, irritability, memory complaints	Sleep study
Alcohol, dehydration, poor nutrition	Confusion, unsteadiness	History, blood tests, dietary review
Blood clot on the brain after a fall	Gradual confusion and headache weeks after a minor fall	Brain imaging

I keep a longer list in conditions that can imitate Alzheimer’s disease, and depression gets its own post in is it depression or dementia, because it is the look alike I see most often in a widowed parent.

How doctors sort it out

A proper workup is not a ten minute memory quiz. It is a history from the person and the family, a review of every medication and supplement, a physical and neurological exam, blood tests, cognitive testing and usually brain imaging. The doctor is looking for anything on the table above before settling on a diagnosis of Alzheimer’s or another dementia.

Ask the primary doctor for a referral to a neurologist or a geriatrician if the first evaluation was brief. Bring a written timeline of when things changed and what else happened around then: a fall, a new prescription, a hospital stay, a death in the family. The timeline is often the clue. Sudden hallucinations during an infection, for example, are a different matter from the stage of dementia that brings hallucinations. Talk to the doctor about anything on the list that has not been checked.

What reversible really means

Reversible usually means partial. When an infection is treated or a sedating medication is stopped, most people improve over days to weeks, and some return fully to where they were. Others improve but reveal an underlying dementia that the illness had uncovered or worsened. Older brains take longer to clear delirium than younger ones, and a hospital delirium can take weeks or months to settle.

That is why I ask families not to make a permanent decision during a bad month. A person in the fog of a hospital stay may look like a memory care resident and, six weeks later, be reading the newspaper in assisted living or at home. The pace of true dementia is a different story, covered in how fast dementia progresses.

What treatment can and cannot do for true dementia

For Alzheimer’s and related dementias, medicines may ease symptoms for a time, and newer treatments for the early stage may slow progression for some people, with real side effect risks that the neurologist will weigh. Treating hearing loss, blood pressure, diabetes, depression and sleep problems also helps people hold their level longer, according to published research. None of it turns the clock back. Families often ask me next whether dementia is hereditary.

What does change day to day life is structure, safety and skilled care. That is the honest case for memory care: not that it reverses anything, but that a trained team with a steady routine gets more good days out of the disease than an exhausted family can. My guide to memory care explains what that looks like on Long Island and in Queens, where about 47 programs operate, 42 inside larger assisted living communities and 5 free standing.

What I tell families while they wait for answers

Do not sign a long admission agreement based on one bad month. If safety at home is the issue right now, ask about a short respite stay in a community so your parent is cared for while the workup finishes. Keep the doctor’s appointments moving, even when a parent does not see the problem; a two month wait for a neurologist is normal here, so get on the list the day the word dementia is first used.

And start the paperwork regardless. A power of attorney and health care proxy signed while your parent can take part protect the family whether the diagnosis turns out to be treatable or not. An elder law attorney can do this quickly, and I would rather a family have documents they never need than need documents they never signed.

Steps before you decide on memory care

Here is the order I ask families to follow, and I ask them to resist skipping ahead.

1. Get a complete evaluation: history, medication review, blood work, cognitive testing and imaging as the doctor advises.
2. Treat whatever is found, and give it weeks, not days, to show its effect.
3. Reassess with the doctor once the person is stable.
4. If the diagnosis is a true dementia, get the stage, the type and the doctor’s view of the likely pace.
5. Call me, and let us look at assisted living with a memory care neighborhood if the stage is early, or memory care directly if it is not.
6. Choose with the next 18 to 24 months in mind so the next level of care is in the same building.

Families who follow this order either avoid a placement that was never needed or make the right one without a second move. My post on assisted living or memory care helps with step five.

Get the diagnosis right, then call me

Assisted Living Locators of Long Island helps families across Nassau, Suffolk and Queens find the right setting once the medical picture is clear, and the help is free to families; communities compensate the advisor when a family moves in. I hold a dementia care certification, I have toured more than 90 communities, and I follow up after the move.

My office is at 42 Prospect Ave, Glen Cove, NY 11542. Call me once the doctor has weighed in.

Questions readers ask

Read next

• How Fast Dementia Progresses, and Why Mike Plans 24 Months Ahead
• Do People With Dementia Know They Have It? Anosognosia for Families
• What Stage of Dementia Brings Hallucinations, and How Memory Care Staff Respond