“So my forgetfulness is age-related memory loss and nothing to be overly concerned about. I’m going to look at my lifestyle and try to figure out how I can up my game. But now I’m worried about Great-aunt Margaret…”
What other issues should concern you? We talked about the instrumental activities of daily living which take more planning and thought, and which should be of concern if they become difficult to perform independently. To review, these are using the phone, shopping for and preparing meals, managing transportation, money and medications. Difficulty with any one of these should indicate the need for a trip to the doctor.
Judgement and Problem Solving
Poor judgement might involve things like dressing inappropriately for the weather (leaving home without a coat in winter) or forgetting to turn off the stove after use. Problem-solving difficulties may show up in areas like not being able to do work or a hobby that used to be easy and enjoyable. The elder may indicate they no longer have an interest when in reality they are struggling to understand.
Orientation
Although not often a first sign, getting lost in a familiar area is alarming. In the movie “Still Alice,” Alice is going for a run in her neighbourhood as she does almost every morning when she realises she doesn’t know her way home. Julianne Moore skillfully portrays the anguish and panic which wells up in Alice as she tries to find home.
Language
Again, not often the first indicator, language can be affected. Elders may have word-finding difficulty, where they are searching for a word in the middle of a sentence. All of us have this problem at some point. In fact, hesitation in speech has been a problem for me since my teenage years. This is not that. But the constant searching for words, repeating certain words or sounds or using the wrong word on a consistent basis can indicate a problem. If poor eyesight or hearing are added to the mix, communication becomes a complicated swirl of challenges.
Mood
Here is where it gets incredibly complicated. People with dementia can become depressed, people with depression may or may not have dementia and the symptoms can be easily confused for each other. This is true of other problems such as anger or aggression. Was that outburst just Mom being her grumpy self, or is something else going on?
As you can see, you need a doctor. In fact, the best option is either a GP who has extensive experience with elders or a geriatrician. Diagnosis is complicated.
Two Cautions
- People with dementia become amazingly skilled at covering how they are struggling. The best way to get a feel for the situation is to spend some time with them. This is especially true when they are outside of their comfort zone. Spend a few hours with Great-aunt Margaret and then, if possible, invite her to a meal at your house. Include her in family gatherings and social situations. Observe.
- Don’t make it a witch hunt. “Is this a sign? Was that a sign?” Approach the situation with love and concern, looking for ways to help someone who may be struggling. And if you feel they are, even a little, call the doctor. A doctor’s appointment may show an underlying cause totally unrelated to dementia.
Finally, encouraging news from the Mayo Clinic:
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