With so many different types of dementia, symptoms can vary from person to person. The first sign of trouble could be anything from difficulty with daily tasks like driving to an increase in financial problems. The wide range of potential precursors for dementia often make it hard to pinpoint a diagnosis—but one body part may provide some foresight into the future: your nose.
Dung Trinh, MD, an internal medicine specialist and founder of the Healthy Brain Clinic, tells Best Life that when it comes to dementia, our sense of smell might be one of the first things affected. “Knowing what to look for when it comes to changes in smell can provide important clues that may be useful for diagnosing dementia,” he explains. Read on for five signs of dementia that Trinh and other experts say your nose might detect first.
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If the smell of crisp apple strudels is also one of your favorite things, you might struggle to recognize it in the years leading up to a dementia diagnosis. A change in your smell memory is a common symptom of cognitive disease, according to Trinh. This may manifest as “difficulty in recognizing familiar smells, such as not being able to recall the smell of a favorite dish or perfume,” he explains.
Scents may get distorted as a result, causing you to perceive familiar them “as different or unfamiliar,” says Danny Dorsey, a mental health expert and founder of the health treatment facility Everlast Recovery Center. You might also develop an “inability to smell common scents like peppermint and orange” altogether, adds Manisha Parulekar, MD, the division chief for geriatrics at Hackensack University Medical Center in New Jersey.
The intensity of certain smells can also change as a result of dementia, according to Trinh. You may notice the smell of particular odors appear “too strong or too weak,” he says.
Dorsey adds that you might also develop a heightened sense of smell overall, which is known as hyperosmia. “This can make overwhelming and unpleasant smells unbearable,” he explains, noting that this might lead you to experience “an increased sensitive to certain smells, such as perfumes or cleaning products.”
Another precursor to a dementia diagnosis could be “poor odor identification,” according to Parulekar. This is because cognitive decline may cause you to lose “the ability to distinguish one scent from another,” she explains.
Trinh refers to this as a change in “smell identification.” In other words, you might notice you are starting to experience “difficulty identifying smells, such as distinguishing between certain fragrances, or differentiating between a pleasant and an unpleasant smell.”
Dementia can distort your sense of smell, making scents you once enjoyed now smell terrible to you—but this is not the only change you could experience.
According to Trinh, you may also develop “smell hallucination,” which is known as phantosmia. This means you are “smelling unpleasant odors that are not present, such as foul smells or burning smells.” These hallucinations “almost always consist of unpleasant smells [like] rotten fish or eggs, gasoline, [or] excrement,” according to Science Direct.
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You may experience a myriad of smell changes as a result of dementia, but one of the most common—and earliest—symptoms is losing your sense of smell altogether.
“When we take smells, the signals travel from the front of the brain and through the hippocampus—the part of the brain responsible for memory. If the cells of the hippocampus are degenerated or damaged, then the smell signals won’t be processed,” Nancy Mitchell, RN, a registered nurse with over 37 years of experience treating patients with dementia, tells Best Life. “We’re saying that there’s a disconnection in the communication pathway to process that sense of smell. The decrease in cell health in these key areas is often due to plaque buildup, thus impairing regular functions.”