Are midday confusion episodes a sign of early dementia?

Question

Hello doctor,

I am a 66-year-old female with an active professional lifestyle. About two months ago, I began experiencing sudden episodes of mild confusion. These episodes typically occur around midday, last for one to three hours, and sometimes return later in the evening. At times, I also have difficulty finding the right words.

Initially, recurrent transient ischemic attacks (TIAs) were suspected, but all investigations have been normal. These include MRI and CT scans of the brain, blood tests (including a delirium screen), echocardiogram, carotid angiogram, Holter monitoring, and a chest X-ray. I also scored 30/30 on a cognitive assessment with a stroke specialist.

Despite this, my symptoms have persisted and seem to fluctuate. Over the past month, I have noticed mild memory issues, and my voice occasionally sounds unusually nasal. I also feel more fatigued than usual, have been told I look pale, and have noticed some hair thinning.

I am currently taking Natrilix for blood pressure.

Other ongoing issues include:

Occasional pancreatitis (over the past 12 months).
GERD (12 months).
Restless legs syndrome (five months).
Insomnia (five months).

I am concerned about what could be causing these symptoms despite normal test results.

Could you please advise on possible causes and next steps?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out and sharing these detailed concerns. It is clear you have already gone through a thorough evaluation, and I understand how unsettling it is when symptoms persist despite normal test results.

Based on what you have described, and considering that all major scans and cardiac evaluations are normal, one possibility we need to keep in mind is an early stage of a neurodegenerative condition, such as Alzheimer’s disease or Lewy body dementia.

At very early stages, it is quite common for MRI (magnetic resonance imaging) or CT (computed tomography) scans to appear normal, and symptoms may be subtle and fluctuate, as you are noticing.

The fact that vascular causes (like repeated transient ischemic attack, also known as TIA, a temporary blockage of blood flow to the brain causing stroke-like symptoms that usually last a few minutes to an hour) have been ruled out by normal imaging and tests is reassuring, especially given the history of hypertension. This makes vascular dementia less likely at this point.

That said, it is still early, and these symptoms can evolve over time. The best next step would be a detailed clinical evaluation by a neurologist, who can assess for early signs of cognitive disorders and guide further monitoring or testing if needed.

For now, I would suggest:

Keeping a close watch on her symptoms, especially any worsening confusion, memory decline, or changes in behavior.
Not leaving her alone for long periods if confusion episodes are frequent.
Avoiding medications like neuroleptics unless specifically prescribed by a doctor, as they can sometimes worsen symptoms in certain conditions.

At this stage, no additional urgent investigations may be required, but a repeat MRI after a few months can be helpful if symptoms progress.

Possible considerations include:

Early Alzheimer’s disease (a progressive, irreversible neurodegenerative disorder and the most common cause of dementia, characterized by memory loss, cognitive decline, and behavioral changes).
Lewy body dementia (a progressive neurodegenerative disease caused by abnormal protein deposits (Lewy bodies) in the brain, affecting thinking, movement, sleep, and behavior).
Frontotemporal dementia (less likely but still worth considering).

Please monitor for any new or worsening symptoms and follow up with a neurologist for a more detailed assessment. Early evaluation can make a meaningful difference in planning care and support.

You are doing the right thing by seeking clarity early.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.