In the early stages of dementia, distinguishing dementia from normal aging can challenge families and friends. Initially dementia can be fairly innocuous as most people compensate for minor mental slip-ups with notes, reminders, and "rational-lies".

Since social skills are generally the last to go, short visits with someone who has early dementia may not reveal anything wrong. She may look as she always did, chat about old times, and socialize as usual. Caregivers, who don't want to believe that something might be wrong, often dismiss inappropriate appearance, changes in behavior, and memory lapses without realizing it.

At some point, however, the problems become more obvious. Dementia begins to interfere with relationships, work life and daily tasks. The person might lose a particular skill. For example, an avid crossword puzzle fan may have difficulty filling in the blanks or a pharmacist may not be able to remember the names of the drugs or the dosage on prescriptions she has to dispense. If you suspect dementia, think carefully about what the person was like before. Although people with dementia react individually and uniquely to the illness, the following include common signs and symptoms of beginning dementia:

Short-term memory loss - important details of recent events are forgotten frequently and permanently.

Self neglect - personal hygiene is neglected, such as mouth care, brushing hair, or wearing the same or soiled clothing.

Erratic emotional responses - the person becomes more anxious, restless, or tearful.

Speech difficulty - one word is confused for another; finding the right word is more difficult.

Impaired abstract thinking- counting and balancing the checkbook becomes increasingly challenging, the person may pay bills twice or forget to pay some bills; a lifetime golfer may have more difficulty choosing the appropriate club.

Poor judgment- the person makes unsafe or unusual decisions, he may not remember to make sure traffic is clear before driving or walking across the street.

If Caregivers suspect dementia, the family should consult an eldercare doctor, and a psychologist or social worker for a possible diagnosis. This hunch may be wrong. If not, keep in mind at least five percent of all cases of dementia are partially reversible. The sooner they are diagnosed, the sooner and more easily they can be treated. Nestor Galvez-Jimenez, M.D., neurologist for the Department of Neurology at Cleveland Clinic in Florida, explains that over-medication, adverse drug reactions, Vitamin B deficiency and thyroid gland disorders include some of the reversible causes of dementia. He explains that in the elderly, depression can also mimic the early phases of dementia, causing a disorder known as pseudodementia.

If the illness cannot be cured, symptoms often can. Tearfulness, sleeping problems, and anxiety can be treated. A diagnosis forces the family to face the situation and effectively plan for the future while their loved one can still be part of the planning. Learning the biological reasons for a loved one's behavior can increase patience, empathy, and tolerance. Acknowledging overwhelming and harsh realities may be extraordinarily painful, but it is the only way to move forward, away from "rational-lies-ing" and excusing potentially harmful or distressing behavior caused by dementia.

Sherri Issa, LCSW, DABCM  is the founder of TheraCounsel Senior Counseling and Advocacy. For more information about Sherri visit her website at www.TheraCounsel.com

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