Diagnosis: Dementia
- 4 hours ago
- 5 min read
By Dr. Nancy Fishman / Morgan Hill, Calif.
It started with misplaced household items. The hand mixer never found its way back to the appliance garage until her husband retrieved it from the refrigerator and returned it to the place it had occupied for 40 years. The car keys that were always on the entry table next to the coat rack had grown wings and were discovered at times in the dishwasher, behind the toaster, and in the trash. Missed appointments and meals, lack of hygiene and cleanliness were early signs that changes were happening to a woman whom I will refer to as Ellen.
This was more serious than forgetting names of people, books or movies. It was more alarming than walking into a room to do something, only to forget the intended task. It was oddly eccentric, quirky really. These incidents would have been laughable, but Ellen’s’ husband, whom I will refer to as Larry, and two adult daughters and their families could no longer ignore the ways she attempted to coverup her memory malfunctions.
Sadly, Ellen could not admit she was struggling. If she forgot to show up to a luncheon, she would blame Larry for not telling her it was on the calendar. There was never an attempt to take responsibility for her missteps; after all, if she did, Ellen would be admitting she was in decline.
This family, like millions of others, was watching a loved one lose cognitive abilities. That’s not like the instant change a stroke can cause, but rather a slow decline that allows room for rationalization and denial. Ellen’s family asked me to help them mediate the difficult, but necessary conversations they were having about her.
In my practice as a psychologist and strategy consultant, I have worked with countless families on issues that evoke tension and conflict. This family was particularly challenging for me because some of them were in serious denial about the likelihood that Ellen had some type of dementia. This was illustrated by the following conversation between her two adult daughters:
First daughter: Mom sure is forgetful lately. She must have a lot on her mind. She needs more sleep. Second daughter: Do you think she has dementia? First daughter: No! It’s just a little forgetfulness. All her friends are like this.
The term “dementia” is common in our vernacular. Since I am not a medical doctor, and dementia is not my field of expertise, I did research to provide me with the knowledge I needed to help this family in crisis.
What I learned is that there are actually several types of memory loss we often group together and call dementia:
The most common is Alzheimer’s disease. The Center for Disease Control’s website states that Alzheimer’s comprises 60-80 percent of memory loss cases.
Alzheimer’s begins with short-term memory loss. The U.K.’s Alzheimer’s Society asserts that Alzheimer’s begins years before the first symptoms appear and causes damage to the brain, which presents as memory loss, language problems, thinking skills, everyday tasks, and mood alteration.
The second most common type of memory loss is vascular dementia. Symptoms include difficulty in planning and concentration, sudden confusion and problems completing sequential tasks.
A third type of memory loss is called Dementia with Lewy Bodies. Symptoms of this type include delusions, lack of focus, and problems with sleep and movement.
A fourth type of memory loss is Frontotemporal dementia. Sometimes referred to as “Pick’s Disease,” its symptoms include difficulty with language and personality changes.
Dementia can also be diagnosed as mixed, a combination of more than one type.
There are also less common, but very specific types of dementia, such as Parkinson’s Disease dementia, alcohol-related dementia, and others related to cognitive impairment and learning disabilities.
After I had several conversations with the family, they all agreed Ellen needed an evaluation Their choice was to accomplish this without telling her the real purpose of her doctor appointments, which they creatively made to ease her anxiety. Ellen believed that most people her age had exams like these to prevent memory loss. She gladly agreed to have the evaluation..
At the conclusion of the evaluation, she was diagnosed with mixed dementia--a combination of Alzheimer’s and vascular dementia.
The family opted to withhold this information from her believing she would suffer too much anxiety if she had an actual diagnosis. They knew she would be happier and easier to be with if she were less agitated. They pulled together and designed a schedule of caregiving that would allow her to live a normal life with proper care and nutrition. They adopted a way of talking to her that minimized her anxiety about forgetfulness.
For example, when she repeated herself, they would no longer remind her she was being repetitive. They simply removed any shame and allowed her to be the person she has become, even if the repetition became annoying.
Dementia should be diagnosed by experts in the field, usually through a series of exams performed in a medical setting such as interviewing, cognitive testing, and brain imaging. Only with a comprehensive diagnosis can a person with dementia receive proper care.
The first step in the treatment of dementia is the family’s awareness and admission that there are very real changes occurring in their loved one. Like the family in this story, some family members usually recognize the problem while others prefer to believe the symptoms are merely typical signs of growing older.
Dementia is a family issue. When one family member has it, all are affected. Approaching evaluations and solutions in a concerted effort yields the best outcomes. Seeking professional help to have guided conversations can bring families closer together as they share the burdens and privileges of caring for a dementia patient.
This column is devoted to psychological topics that speak to the human condition, such as relationships, family, love, loss, and happiness. The ideas, thoughts, philosophies, and observations expressed here are personal and not meant as professional advice. Names and identifying information have been changed to protect the privacy of real people.
Dr. Nancy Fishman moved to Santa Clara County in 2016 from Michigan, where she was a practicing psychologist. Currently, she is a strategy consultant to individuals, families, businesses, family law attorneys and their clients, working on coping, managing, reorganizing, pivoting and innovating. She is the founder of Forgotten Harvest, one of the nation’s largest food recovery operations. She is also the creator of Silicon Valley’s A La Carte food recovery and distribution initiative, and the organizer of Feeding Morgan Hill. Nancy lives on a family compound with her husband, sisters, brother-in-law, and a pack of dogs.
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