Contrary to what you may have heard, the first signs of early dementia may involve speech and word abilities more than overt behavior. We have all seen the TV ads and heard the stories about leaving the car keys in the refrigerator and getting lost on the way to the hairdresser. Some people show much more subtle early signs in their speech and language.

Even after they began exhibiting these speech/language symptoms many of these individuals are able to score well on simple assessment tests of memory that also test verbal ability. Asking someone in the very early stages to name a "watch," or a "pen" can easily miss these very early signs.

Using familiar "good for every occasion" words more frequently. Long before he was diagnosed, John's wife says she noticed the word "Amaaaaazing!" cropping up in his speech several times a day. A little word like "amazing" was one John could insert into any conversation, from politics to dessert. It appeared that he was part of the conversation, yet it absolved him from having to contribute in a deeper, more meaningful way. Only after his symptoms became more severe did his wife realize that "Amazing!" was probably a very early sign.

Difficulty finding the right words, using "wrong" words, or inventing new words. Margaret remembers being nonplussed the first time her father called the windshield of his car the "window." When he put fertilizer on the "floor" instead of on the "ground" she began to pay more attention.

Although she could still cook a gourmet meal, Marie couldn't seem to remember the words "stew" or "casserole." She invented the word "obnglobbn" for any dish with several ingredients. Her family has actually adopted the word - they think it's rather descriptive.

Yesterday her daughter reported that Marie, "put it for Floos" when she fed the cat. No one is quite sure where "Floos" came from.

Using gestures instead of words. Marvin likes to putter his workshop. When he began to simply gesture while saying, "hand me that," instead of saying, "hand me the wrench," no one paid much attention. When he began to get agitated when someone would ask "What?" or "Which?" the family began to wonder.

Reverting to an earlier language. Esther emigrated from Poland as a child. As an adult she was completely fluent in English and spoke Polish only to her mother and several aunts. In the earliest stages of her dementia, before anyone was aware that her memory was slipping, her family noticed that she began talking to herself in Polish. This was new behavior, but not particularly worrisome. As she descended deeper into the disease she preferred Polish to English, but that was much later.

Everyone has had episodes of losing a word. Many a frustrated mother has called one of her children by the wrong name. This is no sign of dementia. Stress...yes. Dementia...no. However, if you begin to see a pattern, it's time to start keeping notes.

In the very earliest stages the doctor will most likely not see the same things you do. It will be helpful to have a record for yourself, so you can track frequency and progression. If you do begin to see a pattern, before you seek a medical diagnosis or treatment, be sure that you have helped your loved one do the things that should be completed before there is a formal medical record of a dementia or Alzheimer's Disease diagnosis.

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