The first sign of dementia may be a quirky change in behavior. Moodiness, depression, frustration, confusion—in fact, even more subtle personality shifts—may be signs. Short-term memory loss, searching for the right word, frustration with problem-solving, and changes in spatial awareness can easily be overlooked or attributed to the natural aging process, and even an examination by a neurologist may be ambiguous.
But the progress of an Alzheimer’s type dementia is relentless. Over time, complicated tasks become daunting; more and more help is required, and confusion grows. An individual may become unresponsive and uncommunicative, impulsive and unpredictable. In the end, basic functioning deteriorates, and, as mobility, swallowing, and breathing are compromised, patients die from related medical complications.
‘Dementia’ describes a group of shared symptoms. The underlying causes may differ significantly.
Alzheimer’s disease accounts for 70% to 80% of dementia cases—estimated at more than five million people in the United States. The remainder may be classified as Lewy body dementia (caused by abnormal protein deposits called “lewy bodies”), or vascular dementia (the result of reduced blood flow to the brain). A variety of diseases, and reversible conditions—malnutrition, dehydration, depression, and infections—can also be culprits. In some cases, an individual may be diagnosed with mixed dementia, a condition caused by more than one factor.
Dementia’s challenge to physicians, in the absence of a preexisting diagnosis, is identifying the underlying disease because symptoms are so similar. An early symptom of Lewy body disease, for example, may by a sleeping disorder. Parkinson’s and Huntington’s can cause memory and speech impairment but may be pinpointed when motor control falters.
Mild, Moderate, and Severe: The Progress of Alzheimer’s Disease
Alzheimer’s progression is not always predictable, and its evolution from mild to moderate to severe does not adhere to a timetable. Initially, even though cells are being damaged, there may be no noticeable change in behavior or capability. In some cases, individuals may attribute small changes to the natural aging process—or conversely, attribute minor symptoms of aging to the onset of dementia.
At a certain point—usually within the first seven years—there is an often unspoken acknowledgment that “something isn’t quite right”. Tasks may become daunting, and it is difficult to master new ideas and skills. It is not unusual for individuals or their families to develop coping mechanisms that in the short term address this decline, but as the rate accelerates, misplacing a lost object or forgetting a name becomes an inability to manage finances, follow complex conversations, or complete a series of small tasks. At this point, more support is needed, and families may consider a move to a more supportive environment.
It should be noted that the ability to enjoy exercise, music, dance, a television program, or other leisure activity may continue well into the moderate or even the moderately severe stage even as they need assistance with managing the minutiae of day to day living. They may enjoy staying busy but are not sure what to be busy with. Their relationships with others begin to suffer, and embarrassment about cognitive losses can turn to anger, jealousy, suspicion, most often against those closest and most trusted. They may still be able to take care of personal hygiene, but not to select appropriate clothing for the weather, until, eventually, even those tasks become too difficult.
The Questions of ‘When’ and ‘Where”
Caregivers who witness the decline of their loved ones are filled with conflicting feelings. Sadness, anger, denial, and guilt accompany them on the journey, and the associated health risks of caregiving are well-documented. It’s extremely difficult to face the fact that someone you love might need more intensive ‘round-the-clock care than family members are prepared to provide.
Geriatric care managers generally understand these situations and are of immense value in helping families decide the level of care required and the best place to provide that care. These professionals bring knowledge, expertise, and sensitivity to families wrestling with weighty decisions about next steps.
Judi Cleary, Linden House Executive Director, is a Certified Dementia Practitioner, a Licensed Assisted Living Administrator and a nationally-certified Activity Director. She has worked with people with dementia for over twenty-five years and has provided Dementia Training Programs for over 10 years. Contact Linden House Assisted Living to schedule a consultation.