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Forgetfulness is Not Always Ageing: Brain Tumours Often Misdiagnosed as Dementia

When elderly individuals become forgetful or stubborn, it is often perceived merely as a sign of ageing. However, clinical medicine indicates that certain dementia-like symptoms, which appear irreversible, may actually stem from treatable brain conditions such as brain tumours. Brain tumours represent a highly misdiagnosed hidden crisis. Dementia is caused by chronic pathological changes in cranial nerve cells and is largely irreversible; conversely, cognitive abnormalities resulting from brain tumours or hydrocephalus are temporary and reversible. Therefore, early examination can distinguish the underlying aetiology, preventing patients from missing the optimal window for treatment.

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Distress Signals of an Impaired Brain

When the elderly present with the following symptoms, they should not be solely attributed to old age. There are several high-risk core warning signs that are most prone to misdiagnosis and misjudgement, requiring particular attention:

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  • Rapid decline in short-term memory: Frequently forgetting recent events, repeatedly asking the same questions, and experiencing continuous deterioration.
     

  • Sudden personality and mood changes: Uncharacteristically becoming apathetic, irritable, suspicious, or anxious.
     

  • Difficulty executing familiar tasks: Suddenly failing to manage previously familiar chores or financial matters.
     

  • Spatial and temporal confusion: Getting lost in familiar environments and being unable to distinguish dates or day and night.
     

  • Other common warning signs: Speech hesitations, misplacing objects, diminished judgement, loss of initiative, and abnormal spatial awareness.

Three Common Types of Dementia

  • Alzheimer's disease (approximately 70%): Characterised by protein accumulation leading to nerve cell death; the progression is gradual and irreversible.
     

  • Vascular dementia: Caused by strokes or vascular lesions, presenting a step-wise deterioration; managing high blood pressure, high blood glucose, and high cholesterol can delay its progression.
     

  • Lewy body dementia: Accompanied by hallucinations and physical stiffness, with significant fluctuations in the patient's condition.

Dementia vs Brain Tumours

Dementia and brain tumours may appear similar but are fundamentally different in nature. The early symptoms of brain tumours closely mimic dementia, yet the key differences are:
 

  • Speed of onset: Dementia is generally slow, progressing over years; brain tumours frequently deteriorate rapidly within weeks to months.
     

  • Accompanying symptoms: Brain tumours are often accompanied by headaches, morning vomiting, an unsteady gait, and unilateral weakness.
     

  • Reversibility: Following prompt surgical intervention for brain tumours, cognitive functions can often partially or substantially recover.

Why Are They Easily Confused?

The symptoms of a brain tumour primarily depend on its anatomical location. Different regions of the brain govern distinct functions; when a tumour compresses these areas, it produces manifestations akin to dementia:
 

  • Tumour compressing the frontal lobe: The frontal lobe controls emotions, personality, and judgement. Compression easily causes sudden personality changes (such as apathy, irritability, and suspicion), closely resembling the emotional issues seen in late-stage dementia.
     

  • Tumour compressing the temporal lobe: The temporal lobe is responsible for memory, as well as language comprehension and expression. Compression frequently leads to a significant decline in memory, difficulty in finding words, and an inability to comprehend conversations, which are highly similar to the early symptoms of Alzheimer's disease.

The Necessity of Brain CT or MRI Scans

Because the symptoms of brain tumours and dementia are highly similar, it is impossible to distinguish them objectively through medical history inquiries and behavioural observations alone. Therefore, doctors usually arrange neuroimaging examinations such as a brain Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). The objective of these scans is to utilise concrete imaging evidence to rule out treatable causes like brain tumours, hydrocephalus, or chronic haemorrhaging.
 

When a family member experiences rapid, unexplained cognitive decline or personality changes, one must not self-diagnose it as merely ageing. It is imperative to consult a neurologist immediately to arrange brain imaging examinations.
 

Besides relying on medical examinations, individuals can also actively maintain brain vitality through daily habits. Regular aerobic exercise promotes cerebral blood circulation, whilst a Mediterranean diet aids in reducing inflammation. Furthermore, maintaining social interactions and continually learning new things can stimulate neural connections. Controlling hypertension, hyperglycaemia, and hyperlipidaemia, alongside abstaining from smoking and alcohol, further reduces the risk of vascular lesions. If any abnormalities are detected, recording the time and frequency of symptoms will assist the doctor in accurately assessing the condition.

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