It's become
common to incorrectly use the term Alzheimer's to describe all
kinds of dementia. Dementia is the loss of memory and the
ability to think, to solve problems, and to use reason. It
affects memory, intelligence, judgment, language, and behavior.
There are a
number of subcategories under this broad term, including
Alzheimer's, multi-infarct dementia (which is stroke-related),
senile dementia, and alcohol-related dementia. Historically, all
the types of dementia were called "senility."
An older person
with some form of dementia "became senile." Certainly your
care-receiver has heard of and known people who have "lost their
minds" (to use another common expression) as they have aged.
Even if your loved one is seriously incapacitated because of
physical problems, he or she may proudly and thankfully state,
"At least I still have my mind."
Of course he or
she is worried about Alzheimer's. The disease has become well
known, and it—or any form of dementia—takes a horrible toll.
These are some
points to consider:
--Dementia
impairs functioning. Some memory loss is common as we age.
What's not normal is significant memory loss, but it can be hard
to tell what's "significant." If Dad's memory loss impairs his
daily activities, if it affects his independence, it's serious
enough for concern. In the case of dementia following a stroke,
the changes may be obvious and sudden. If brain cells are
damaged by a series of small strokes, the changes may be
difficult to notice because they're so gradual.
--You may see
changes in your loved one's personality. Your wife was once so
prim and proper, but now four-letter words are part of her
speech. Your husband was always so gung ho, but now he just sits
quietly.
--Dementia will
affect your care-receiver's daily activities. He may be confused
about what time of day it is. If she is out and about, she may
get lost even in a familiar place.
--It's
frightening. If the decline is gradual, your loved one may be
aware of it in its early stages and be very frightened. He knows
something is wrong. He may feel frustrated, depressed, and angry
and want to isolate himself.
--A doctor can
help. While there may not be a way to positively confirm
Alzheimer's disease, your mother's doctor can eliminate other
possibilities with a CT scan or an MRI. If she's suffering from
memory loss for reasons other than dementia, it may be possible
to stop and reverse what's happening. (Dementia, on the other
hand, is a progressive decline.) The cause could be a new
medication, a combination of the medications she's taking, or a
change in her metabolism that's altered the side effects of a
medication she has been taking for some time.
--You shouldn't
accept an on-the-spot diagnosis of Alzheimer's. Ask for
additional testing. Ask for a second opinion. Ask for a
psychiatric workup. Ask if there's a nearby university medical
center conducting dementia assessments.
And if your
loved one is diagnosed with dementia, these are some suggestions
for you:
--Get support
for yourself. Become educated. The road ahead won't be easy, but
it may be less frightening or surprising if others are there to
help you and if you know what, typically, dementia can bring.
Remember: while dementia is progressive, it doesn't follow a set
pattern or time schedule.
Having gone
through a particular stage doesn't mean your loved one won't
return to that problem or show those symptoms again.
--Help your
care-receiver with modest memory loss. In the early stages, you
can help him with his remembering by writing notes, setting up a
calendar, leaving messages, and so on.
--Remember that
this is out of the person's control. As the condition
progresses, keep in mind that Mom can't control what's
happening. She may need to be constantly pacing or to repeat the
same question over and over. It doesn't do any good to say to
her, "I just answered that." Instead, keep your response short
and simple and then try to help her move on to another subject.
--Be aware that
the person may exhibit what's known as confabulation. Your
husband may make things up to fit the circumstances. If he's
lost his wallet, then "someone broke in the house last night and
stole it." If he's been standing on the wrong corner waiting for
a bus that never came, then "the bus company changed the route
and didn't tell anyone."
--Try to accept
the facts. Your wife may not remember all that you've been doing
for her lately. And, in fact, she may tell others that you've
neglected her. It can help to look at your spouse's dementia the
same way you would view any physical illness: if she had had a
stroke and was no longer able to get out of bed, you wouldn't
hold it against her that she didn't come to the dinner table. At
the same time, it hurts when we do something for someone and we
feel we're not appreciated. Remember, it isn't that she isn't
grateful for what you've done; she simply doesn't remember it.
--Realize that
communication may be affected. Your parent may experience
aphasia, the inability to come up with the right word at the
right time. This will make expressive language difficult. If Mom
has trouble with complicated questions ("What did you have for
breakfast today?"), substitute a series that can be answered
with yes or no. ("Did you eat breakfast today? Did you have
toast? Did you have fruit?")
--Don't jump to
conclusions. If you live a distance from your aging parent and
he's been complaining about the treatment he's receiving from
family members or professional caregivers, don't jump to any
conclusions. Check it out. Maybe he needs help, or maybe he just
doesn't remember all the good help he's getting.
--Stay
positive. If your aging parent doesn't remember the things
you've been doing for her or the times you've visited recently,
don't scold her about it or test her. Calmly mention the meal
you shared a few days earlier or the television program you
enjoyed together. There's no point in trying to get her to admit
she was wrong, to admit that you're helping. Just state the fact
and gently move on.
--Look into
arranging respite care for your loved one. This could take place
overnight, for several hours at home during the day, or for a
full day at an adult day center.
--Remember that
dementia is progressive. Your care-receiver will experience a
loss of present skills and the ability to learn new things. He
or she is going to become more and more dependent on you.
--Do the best
you can in providing care but accept the fact that your loved
one may reach a point where you're no longer able to be the
primary caregiver. He or she may need to move to a skilled-care
facility.
--Don't be
surprised if you begin to grieve before he or she dies. One of
the great heartaches of dementia is that your loved one can slip
away long before his or her body quits working.