Aug 19, 2011

Before a Dementia Diagnosis, Try This

The bottom line is that what you’re seeing and what s/he are experiencing are not normal age-related changes.

By Cindy Keith

Let’s say your spouse is exhibiting some forgetfulness, and other symptoms you think could eventually be diagnosed as a type of dementia such as Alzheimer’s. Naturally, you’re terrified to even think about that diagnosis.

Maybe it’s just stress, or s/he is not sleeping well, or blood sugars are a bit high, or ...(fill in the blank). You will often use these excuses to avoid finding out the real diagnosis because of fear.

I understand that, but I don’t agree with it, because I advocate for early diagnosis and treatment.

Here is some advice on how to deal with some of the troublesome symptoms you may be seeing. If it works, great! Your life and their life will be calmer and less stressful. If it doesn’t work, you really haven’t lost anything. Keep in mind, that if memory problems worsen or don’t improve, then you will need an evaluation, hopefully sooner rather than later.

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Losing items and accusing you of taking or hiding them: Possibly s/he is starting to display some paranoia in thinking everything that goes wrong is your fault and your sole purpose in life now is to make life miserable. I would guess that you take issue with this every time and try to set things straight—which probably results in both of you becoming angry and upset and nothing is solved.

Then, does s/he forget about it the next day? Doesn’t that just irritate you even more? There goes your blood pressure again!

Try this: “I believe I did pick up your keys/wallet/hat/etc. and probably put it somewhere where I thought you would find it—I’m so sorry! I should know better than to do that and I promise I won’t do it again. Let me help you look for it now...”

Then, get busy and start looking for the item, all the while chitchatting about something else, and eventually s/he may even forget what you’re looking for, or you actually find the object.

How long could s/he remain upset with you when you take that kind of an attitude? Even if you NEVER touched the lost item, if you take the blame, apologize and promise to never do it again, you help everyone remain in control and be “right.” How would that feel for you? You’ve swallowed your pride and admitted to a crime you didn’t commit. I think if you do this once or twice, you will begin to see that everyone is mollified and agitation disappears. Then you can relax because s/he is more relaxed. Instead of anger and frustration, the atmosphere is much more relaxed. If s/he does indeed forget about the entire incident later, then you can too—just let it roll off—and your stress levels and blood pressure remain normal.

Lack of “get up and go:” Is your spouse now saying s/he doesn’t want to go places or do things they used to really enjoy? Does this make you crazy because you feel you have to also give up some of those enjoyable activities?

I would urge you to slowly start (or keep on) getting out and doing some relaxing and enjoyable things even if s/he refuses to accompany you. Always try to be pleasant and upbeat when asking and avoid saying things like “well, then I’ll just go by myself.” Instead, try saying something like “are you sure you don’t want to go to the park with me for just a short time? Okay, I can see you want to just relax here, so you go ahead and get some rest and I’ll be back in an hour or so (smile and kiss good-bye).” You really cannot mentally or physically afford to sit down and decline just because s/he has decided that’s what they wants to do. By giving in to requests to stay home all the time, you’re isolating them and yourself and it will eventually make you resentful.

Remaining concerned about comfort, and keeping a light and happy tone will help them accept that you will go with or without them, and that you’re not angry. If s/he becomes upset at the thought of being left alone, you might try to arrange ahead of time for a friend, neighbor or relative to be there “visiting” while you slip out. But do plan to get out on a regular basis.

Are you fearful that your spouse will want to drive the car when you go somewhere? If so, then it’s probably because you know their ability to safely judge distances, or even remember where to go has instilled that fear in you. Giving up the car keys, especially to a spouse, is something that is usually never done without an on-going battle. It’s a huge loss of self-esteem to admit you cannot drive safely any longer, and many elders really don’t realize just how unsafe their driving has become (and will likely never be persuaded by you). You could try stalling for time by saying “Sure, in an hour or so honey...” You could also try hiding the car keys.

With my father, who had Lewy Body dementia, we knew we had to beat him out to the car and be sitting in the driver’s seat, seatbelt on and the car running or else he would insist on driving. Once he got his hands on the keys, there was no convincing him to give them up. Disabling the car might be another option unless he’s a real Mr. Fixit and would discover how to make it go again. If it’s a social outing with other people, you could ask them in advance to drive. Your getting a sudden headache or stomachache and wanting to “rest a bit” before going might get someone to put the keys down while they wait, then when you’ve “recovered,” you would have possession of the keys. Then there’s always the option of refusing to ride with s/he which would likely result in angry words being exchanged, but you must weigh that against the possibility of a severe accident.

Perhaps you’ve noticed changes in your spouse’s moods or even wonder if their personality has changed—and not for the better. S/he may be very short-tempered and often accusing you of things you did or didn’t do. Please try to remember that if you’re noticing these changes your spouse is also feeling them on some level, and scared of what it means. Mood and behavior changes need to be discussed with a physician because they can often mean a clinical depression, or possibly a metabolic disorder of some type that can be improved with medication.

There are hundreds of different disorders that can mimic the signs of Alzheimer’s, and wouldn’t it be wonderful to hear that the worrisome changes you’re seeing are due to a Vitamin B12 deficiency, and the treatment would be a B12 shots on a regular basis? Until you get s/he checked out, try to avoid arguments. As difficult as it will be, in order to keep the peace and your sanity, you need to cater to a person suffering from dementia and take the blame when necessary. You will quickly see just how much less stressful that is for both of you.

The bottom line is that what you’re seeing and what he’s experiencing are not normal age-related changes. The longer you wait for a diagnosis, the more opportunity there will be for crises to happen and for whatever is causing the symptoms to worsen. I urge you to be proactive and find some answers so you can plan for what the future will hold for both of you. In the meantime, I hope these suggestions are helpful to you and result in a reduction of stress for you and your loved one while you are working up the courage to get a diagnosis.

You are not alone in this unless you choose to be, and I hope you reach out to all of us who stand ready to help you.

Cindy Keith, RN, BS, CDP has extensive experience working with Alzheimer's and dementia patients. As a nationally known speaker, Cindy regularly travels throughout the United States giving day-long seminars on the importance of facility staff training in all aspects of dementia care. Cindy is the author of Love, Laughter, & Mayhem - Caregiver Survival Manual For Living With A Person With Dementia. She an be reached through M.I.N.D. in Memory Care

More Insight and Advice for Caregivers

The Alzheimer’s Action Plan: The Experts’ Guide to the Best Diag­no­sis and Treat­ment for Mem­ory Prob­lems
The 36-Hour Day A Family Guide to Caring for People with Alzheimer Disease

Original content the Alzheimer's Reading Room