The early signs of Alzheimer’s disease and other forms of dementia can be easy to overlook or misattribute to normal aging. According to the National Institute on Aging (NIA), these can include memory loss, poor judgment, disorientation, mood changes, and more.
In addition to this list, experts now say there’s another dementia red flag to watch for, especially if it represents a marked shift from the person’s normal behavior: wearing dirty clothes. Read on to learn why this subtle symptom can be so telling, and why it’s important to seek help if someone you love begins dressing this way.
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Though memory loss is often considered the clearest sign that someone is experiencing the early signs of dementia, experts say there are many others which may suggest neurological decline. Among them, the NIA lists hygiene changes, including difficulty bathing, as a sign of mild Alzheimer’s disease.
According to a 2018 study published in the journal Gerontology and Geriatric Medicine, another specific hygiene change—wearing dirty clothing—may also be a sign of dementia. In addition to simply forgetting to choose new clothing, “patients with dementia, particularly Alzheimer’s disease, may not recognize that their clothes are dirty,” the study authors explain.
For some dementia patients, this can result in wearing the same clothes for days or weeks on end, sometimes increasing their risk of infection or other health consequences.
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Researchers explain that one key reason that dementia patients often wear dirty clothing is because of agnosia, an inability to interpret sensations and to recognize familiar things.
“They may see the food stains and discoloration of the clothes and yet because of their agnosia are unable to integrate these observations and deduce that their clothes are dirty and need to be changed,” the study states. “They will, therefore, resist attempts to get them to change clothes, especially if these clothes happen to be their favorite ones,” the authors write.
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Many caregivers struggle with this particular aspect of dementia, says the U.K. based charity the Alzheimer’s Society. “Getting ready each day is a very personal and private activity—and one where a person may be used to privacy, and making their own decisions. As dementia progresses, they will need more help with everyday activities including washing, bathing, dressing and personal grooming,” their experts write.
Keeping in mind the delicate nature of this exchange between patient and caregiver, the study authors suggest focusing solely on health benchmarks, rather than aesthetic changes. For instance, while it is important for dementia patients to wash regularly to avoid infection, wearing dirty clothes such as a stained shirt for the second day is unlikely to cause any harm.
“Attempting to convince patients that their clothes are dirty and, therefore, need changing is rarely successful. Arguing with patients who have dementia is futile, as they are unable to retain the essence of the argument,” the study authors write. “The convincing facts… are based on the recognition that the dress is dirty because of the stains, wrinkles, and smell, which, when integrated, can only lead to the conclusion that the dress is dirty. Patients with Alzheimer’s disease, however, are not able to integrate these various stimuli and conclude that the dress is dirty.”
Experts say caregivers may be able to minimize the problem of wearing dirty clothing by establishing certain routines around washing and dressing. For instance, promptly removing dirty clothes from the room and replacing them with clean attire can eliminate the patient’s temptation to put unclean clothes on again.
“If the patient has favorite clothes, caregivers may want to purchase duplicate sets to use when one set is being washed. Alternatively, clothes could be washed when the patient is asleep and not wearing that particular outfit,” the study authors suggest.
Speak with a doctor if you notice substantial hygiene changes in a loved one—whether having to do with bathing, grooming, or dressing. Though there is no cure for dementia, early diagnosis and swift therapeutic intervention may help improve their quality of life going forward.