(Help Sheet 1)
What Is Dementia
First off, it is important to understand what dementia means.
Many upon hearing the word "Dementia", become confused and think that it is a disease.
However, "Dementia" is not the name of a specific disease, but is a word used to describe the mental condition of a person whose memory is impaired, and whose problems with processing information are severe enough to interfere with his or her ability to function normally. Dementia is not part of the aging process, and is termed as a progressive condition. In other words, over time, the persons abilities will deteriorate.
If you are wondering whether someone you know may have or may be developing dementia, the following information of possible indicators is offered as a guideline. Some of the things may seem to contradict each other, so it is important to remember that none of these things, by themselves, prove that someone is suffering from dementia. Only careful tests of mental functioning, administered by a professional, can determine the extent of any individual's cognitive losses. However, any person who exhibits an overall pattern of changes or behavior similar to the ones on the following list, is probably a worthy candidate for such testing. Keep in mind that even if a person is found to have dementia, that person will most likely not display every single symptom on the list.
The important question in terms of any single symptom is the degree of trouble it is causing. Losing our car in a parking lot doesn't prove anything, but for someone who owns the car, but does not recognize it...that is where the difference lies. It is also important to note that individual strengths and weaknesses must be taken into account as well.
The reasoning difficulties of a person with progressive dementia become more understandable if we keep in mind that they are increasingly unable to process new information. At the same time, they are losing the ability to retrieve and use information they have accumulated throughout their lives. Their behaviors become more understandable, also, if we view their actions as those of a person who, on some level, feels profoundly insecure, and is trying to maintain some sense of control and security in their lives.
The symptoms of early dementia fall into the following categories:
1. Personality changes
2. Loss of problem-solving skills
3. Communication problems
5. New and unfamiliar behaviors.
1. Personality Changes:
* Frustration, Anger, and Irritability
It is not hard to recognize that anyone who is losing their ability to understand what is going on around them might very well feel stymied and overwhelmed by the tasks of daily living, and irritability and anger are logical outgrowths of that frustration. A person may not even be consciously aware that their mental capacities are slipping, so they may feel baffled or annoyed as a result of their deficiencies.
* Emotional Lability
This term describes the state of a person whose moods are unstable and changeable. A sense of solidity is missing, and the person overreacts to seemingly trifle, inconsequential events. Sudden crying spells or inappropriate laughter might also indicate emotional lability.
* Paranoia, Suspicion, and Jealously
Paranoia, arises when the person's sense of reality is under assault. We all know what it feels like to open a drawer and not find the item that we know we put there. If this sort of thing happens to someone many times a day, the person will very likely make an attempt to structure an explanation for it. Paranoia and suspicion go hand in hand. The person who can't make sense of a conversation may conclude that people are talking about them. It they are confused by a business transaction, they may decide that the business person is trying to cheat them. Someone who can no longer balance their checkbook or write checks to pay their bills, may accuse the person who steps in to help, of stealing from them. All of these feelings stem from the sense of loss of control over one's life. Someone who unconsciously realizes that they are becoming more and more dependent upon someone, may become jealous of them, may question them about their whereabouts when they are away, or may even make unjust accusations.
* Insensitivity to Others
It is often reported that a person who suffers from dementia, seems to be unaware of other people's problems and feelings. They may even appear to be very "cold hearted". For example, a man may ask his wife, who has just come home from the hospital after having surgery, why she is so tired or when dinner will be ready. The ability to empathize with someone else, is decreased.
* "Flat" Emotional Responses
This symptom can show itself as a generalized leveling out of emotional expressiveness. Speech patterns may become more monotonous, and someone who used to have a good sense of humor may no longer laugh easily.
* Loss of Inhibitions
The loss of inhibitions can take many forms. People may lose their "self-sensor" in terms of what acceptable behavior is---going outside or answering the door dressed only in their underwear would be an example of this; or making a blunt remark like, "my you're ugly" to another person would be another. That same lack of awareness can cause a loss of sensitivity to conversational appropriateness, and the person may cross beyond a boundary of social propriety in ways such as revealing the details of the family finances to casual acquaintances.
* Fear of Being Alone
One of the things spouses often notice early is that the person wants more togetherness than is comfortable for the other person, and clinging behavior may be in evidence. A wife may find that it becomes hard for her to go out of the house or pursue her own activities as her husband acts more and more forlorn whenever she leaves. It is not unusual for a woman in this situation to run to the grocery store for a loaf of bread and be told by her husband upon her return that she has been "gone for hours".
2. Loss of Problem-Solving Skills
* Inability to do Familiar Tasks
People who start having difficulty doing things that were second nature to them, like a carpenter who can't figure out how to assemble a simple piece of cabinet work, is displaying a serious sign.
* Inability to Make Connections
The ability to see relationships between things, whether on the abstract or concrete level, is a critical component of problem solving. For a person who suffers from dementia, things are becoming disjointed. The connection between a hammer and a bag of nails lying next to each other on a workbench is no longer obvious or apparent. They may pick up the hammer and be unable to determine what it is used for. This loss of awareness of common associations makes it virtually impossible to figure anything out logically, or to use cues from the environment to gather usable information.
* Inability to Make Decisions
Those who suffer from dementia, also lose their ability to think abstractly. They become increasingly focused on practical matters, and on things that are immediately visible to them. The sense of the relative significance of things is gradually being lost, so that small decisions take on an overwhelming importance in the person's mind. The very concept of "choice" itself is foreign to someone who is less and less capable of abstract thinking.
* Inability to Initiate or Complete a Project
The family of someone who displays this symptom will often mistakenly accuse the person of being lazy. What they don't recognize at first is that even relatively simple jobs require doing things in a remembered sequence, or making decisions about how to carry out a job. In the case of washing a sink full of dishes, for example, a person must decide how much water and soap to use, how hot the water should be, which dish they should wash first, etc. It is quite possible for any one of those decisions to "derail" a person who suffers from dementia.
3. Communication Problems
* Problems Finding Words
Most of us know what its like to have a word or name on the tip of our tongue, but not be able to retrieve it. For a dementia person, the ability to recall or correctly apply the word they want to use is often lost. If this experience becomes a regular occurrence, it can cause a great deal of embarrassment and frustration. Occasionally, the person may say something like "Look out the mirror" when they mean to say, "Look out the window".
* Inability to Follow a Conversation
An impaired person who may still be able to communicate adequately in a one-to-one situation may have great difficulty functioning conversationally in a group. As the attention span becomes shorter, and the ability to focus and concentrate is gradually lost, following the thread of a conversation becomes more and more difficult. The higher noise level, interruptions, and cross talk occur when more than two people are talking together are just to confusing. Accordingly, withdrawal in a social situation is often a signal of a developing cognitive problem. This withdrawal can be very subtle, and the spouse or primary caregiver may be the only person who is aware of it at first. Eventually though, the person may try to avoid social encounters completely. Not everyone withdraws, however. Some people reveal their inability to comprehend what is going on by periodically interjecting a remark that has nothing to do with what the rest of the group is saying. Still others will deliver a monologue that allows no interruption. This "running commentary" strategy is adaptive in the sense that as long as the person himself is the one doing all the talking, he will not be called upon to make any responses to anything anyone else has to say.
* Repeating the Question
Someone who is not retaining information will not remember the answer to a question they might have asked an hour ago, or five minutes ago. A repeated question might not even be the real request of information, but rather for some kind of reassurance. For example, a repeated question like, "When are we leaving?" can be interpreted as a bid for reassurance that the person will not be late for an appointment.
* Disorientation to Time
The sense of time; of how long it has been since breakfast, of what time of the day it is, what day of the week it is, or what year it is right now, or of how long it will be until dinner, is eventually lost in a person who suffers from dementia. When the person loses their ability to process information, they are unable to take "cues" about what time it is. An example of such an occurrence would be a person who awakens when it's dark outside, and the late-night news is on television, but neither of those two pieces of evidence alert them to the fact that it is still nighttime. A person's sense of time is increasingly fragmented, so that they can only grasp what is happening in the present moment, and concepts like "soon", or "recently", or "later on" becomes meaningless, which can be very anxiety-producing. Keep in mind that a large proportion of repeated questions have a strong "when?" element.
* Disorientation to Place
Disorientation can also be evident in terms of place or location. Getting lost in a familiar neighborhood, or along a route one has traveled for years, is often the first tangible, frightening thing that happens to dementia patients. This disorientation is also sometimes evidenced by a near total inability to absorb information about a new place.
* Disorientation to Person
The inability to recognize familiar individuals is an important warning sign.
5. New and Unfamiliar Behaviors
* Neglect of Self or Property
A decline in someone's customary standards of maintenance can be a warning signal. A prizewinning gardener whose yard is full of weeds, or a formerly meticulous house-keeper whose house is dirty are each demonstrating an uncharacteristic neglect of his or her property. It is important to distinguish the causes for this sort of neglect. A frail older man may no longer be able to push a heavy rototiller, and declining vision may make it difficult to notice that dust is collecting on the venetian blinds. Therefore, what is significant here is not the actual state of the home, but whether or not the person seems to care, or even notice, that things have gone downhill. It is an attitude of disconnectedness and indifference to ordinary maintenance that may be indicative of a problem. A decline in standards of personal hygiene and grooming is another common symptom of early dementia. The person's sense of smell may have declined, along with the awareness that it is time to bathe. Bathing or showering become daunting tasks to be avoided, especially if an impaired person has already had an experience like inadvertently flooding the bathroom, or if they have been scalded in the shower. Inability to make decisions renders choices about what to wear overwhelmingly burdensome, and the person may wear the same outfit day after day, often putting it on directly over the pajamas or nightgown. The person may have lost the ability to determine when clothes need to be washed, or she may have forgotten how to operate the washing machine.
Many people have a garage full of junk, or a big stack of magazines they intend to read someday, but some people cross over a fine line and reach a point where it becomes impossible for them to get rid of anything. In the case of early dementia, this can be interpreted in two ways.
First, objects represent security to some people and dementia patients are nothing if not insecure. Second, throwing something away requires making a decision to throw it away. The person has lost the ability to distinguish between something of value and something that is worthless, and becomes fearful of discarding anything. Having a cluttered, messy house certainly does not mean that someone has dementia. However, if a junk collection gets so large that it starts to take over the house, or if it presents a fire or health hazard, it is not a good sign. If the person has a panicky reaction to any suggestion about "getting rid of some of this stuff", that can also indicate a problem. The same insecurity that leads to hoarding behavior can also reveal itself in the form of painful anxiety about money matters, or in an apprehensive reaction whenever any money must be spent.
Patricia Brown Coughlan (C) copyright 1995
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