Recognising Seizures vs. Dementia or Stroke Symptoms
26th September 2025
Epilepsy is increasingly recognised among older adults, yet many of its symptoms can be mistaken for other conditions such as dementia or stroke. Because these conditions may present with overlapping signs – confusion, memory loss, or sudden changes in speech or movement – it can sometimes be difficult to tell them apart.
Understanding the differences is important for older people living with epilepsy, their families, and carers. While only a healthcare professional can provide a diagnosis, being aware of what to look out for can help you seek the right support quickly.
Why symptoms can appear similar
- Confusion or memory gaps may follow a seizure but are also common in dementia.
- Sudden difficulty speaking can occur during certain types of seizures but is also a hallmark of stroke.
- Weakness or unusual movements may happen after a seizure, yet strokes can also cause muscle weakness or paralysis.
- Changes in awareness – such as staring spells, zoning out, or seeming “not present” – could be a seizure, but might also resemble moments of cognitive decline.
Because of these overlaps, it’s not unusual for seizures in older adults to be misinterpreted as something else, especially if epilepsy is a new diagnosis.
How seizures may present in older adults
Epilepsy can look different later in life compared to younger years. Common seizure features include:
- Brief episodes of confusion or unresponsiveness
- Sudden, repetitive movements (lip-smacking, fiddling with clothing)
- Staring spells or “blank” episodes
- Sudden speech arrest (inability to speak for a short period)
- Temporary weakness or confusion afterwards (sometimes called Todd’s paralysis)
These episodes are often short, lasting seconds to minutes, and may occur repeatedly over time.
How dementia symptoms may appear
Dementia develops gradually and typically involves:
- Ongoing memory loss that gets worse over time
- Difficulty recognising familiar people or places
- Struggling with decision-making, planning, or completing everyday tasks
- Changes in personality or mood
- Language problems that persist rather than appear suddenly
Unlike seizures, dementia symptoms are continuous and progressive, not brief or episodic.
How stroke symptoms may appear
Strokes are medical emergencies and usually develop suddenly. Key signs include:
- Facial drooping on one side
- Weakness or numbness in one arm or leg
- Slurred speech or sudden difficulty finding words
- Loss of balance, dizziness, or severe headache
A useful reminder is the FAST test:
- Face – is it drooping?
- Arms – can they lift both?
- Speech – is it slurred?
- Time – call 999 immediately if any of these signs are present.
Unlike seizures, stroke symptoms do not usually resolve after a few minutes. They persist and require urgent medical attention.
Key differences at a glance
| Symptom | More typical of a seizure | More typical of dementia | More typical of stroke |
| Onset | Sudden, lasts seconds to minutes | Gradual, progressive | Sudden, lasting hours or longer |
| Awareness | Brief loss of awareness, staring spells | Ongoing confusion, disorientation | Sudden confusion or loss of awareness |
| Memory | Short “gaps” around seizures | Ongoing memory decline | Sudden memory loss, often with other symptoms |
| Speech | Temporary inability to speak | Increasing difficulty with language over time | Slurred or lost speech, persists |
| Movement | Jerking, automatisms, brief weakness afterwards | Steady decline in coordination | Sudden weakness or paralysis, often one side |
When to seek help
Because seizures, dementia and strokes can overlap in their presentation, it’s vital to seek medical advice if you are unsure what has happened. In particular:
- If symptoms are sudden and severe, call 999 immediately – this may be a stroke.
- If episodes are brief and repeated, such as sudden spells of confusion or staring, tell your GP or neurologist, as these may be seizures.
- If memory or cognitive problems are gradually worsening, speak with your GP about assessment for dementia.
Never try to diagnose yourself or someone else at home. Only a healthcare professional can run the necessary tests – such as scans, blood work, or neurological assessments – to identify the cause.
If you are in doubt as to whether you or someone you’re with is having a seizure, stroke or experiencing the symptoms of dementia, it’s safest to seek medical help urgently. Whilst dementia doesn’t need urgent care, nor do the majority of seizures, a stroke is an extremely time sensitive medical emergency.
Final thoughts
For older people, epilepsy can sometimes be overlooked because its symptoms resemble dementia or stroke. While all three may share features such as confusion, speech problems, or memory issues, the duration, onset, and pattern of symptoms are key differences.
If you are ever unsure, it is always better to seek medical advice. Quick action can make all the difference, particularly in the case of stroke. For ongoing concerns about seizures or epilepsy management, speak with your neurologist or epilepsy nurse for tailored guidance.
By understanding the similarities and differences, you and your loved ones can feel more confident in recognising what may be happening and ensuring that the right support is accessed as early as possible.
