This is a really great question. Alzheimer Dementia usually does not show any symptoms until a person is well in her/his 70’s or 80’s. Sure – there are cases of early onset dementia – but they are less common.
So when an elderly person does become a little forgetful – it is easy to become concerned about the person – thinking that he or she is starting to suffer from dementia. However, sometimes forgetfulness in old age is exactly that – nothing more.
It usually starts with not remembering where the keys are, or going to the shops without a list and only bringing back half the things you need, or forgetting an appointment. If that is all it is – there is no need for concern.
But when this forgetfulness becomes regular, then you need to be concerned. My mother-in-law started asking me if I take sugar in my coffee (I don’t and she always knew that). So now she does not ask but simply puts a spoon of sugar in my coffee. When my wife comes along as well she neatly places the sugar pot on the table – so that she does not have to ask and show that she forgets all the time.
When people constantly forget their passwords, phone numbers, what day of the week it is, then it is time to start testing.
Following the forgetfulness phase – I find that people start to show different levels of confusion. They now regularly forget what day of the week it is, cannot remember if they took their medication in the morning, cannot answer some simple questions – then the confusion level has set in.
At the same time, many elderly people start to recognize that they are becoming a little forgetful – but often laugh it of and suggest that this is just a part of becoming a little older. Laugh along with them – it is best to reassure them. I remember visiting my mother every week, who would often sort of recognize me. Most of the time I was her son from Australia, but often I was her brother or even her pastor and that is also how she would introduce me to anyone else in the room.
A friend of ours bought their mother a “complete large display clock”, one that tells the time, the day of the week, the date and year and so on. She loves it – and that is a great example of minimizing the confusion.
During this phase lots of people need extra support. They often get taken advantage of by dishonest people. My mother would go to the florist to buy a bunch of flowers. While she was chatting with the sales person, he would let her pay 3 or 4 times for that same bunch of flowers and she was non the wiser. This happens all too often.
My brother-in-law tested my mother on this issue. He suspected that this was happening based on her spending habits. So one day he went to buy a take-away lunch that she was paying for. He took the money, bought the lunch, came home and they ate. Five minutes later she said – “oh I better pay you for the lunch”. This happened 4 times in 20 minutes. Fortunately he gave her the money back – but many others don’t.
The sad part is that now quite a lot of brain cells have already died off and the disease will progress.
By now, many elderly people recognize themselves that something is wrong. They know they are forgetful and quite a few do not want others to know that they have this condition. So they accept fewer invitations to events or dinner parties etc. They tend to become a little reclusive and only attend events where they are less likely to be “found out”.
I witnessed this both with my mother and now with my mother-in-law. They much prefer to mind their own business in their own little apartment. In the early stages my mother loved to go out and see things but progressively this declined and the same in happening now with my mother-in-law.
My mother-in-law is happy to come to church – but does not come to our place for lunch or dinner as often as before.
As the disease progresses you will see mood changes developing. Many people become aggressive in their tone of voice and often towards their loved ones or primary care givers. Please recognize this is not because of you or anything you have done. This is often a case of frustration being expressed.
Patients do become frustrated that they are confused so often. They do not know why this is happening. They probably look for a reason. So when you ask a very innocent question, like “How are you today?” they may interpret that totally different. They may think that you are testing their ability or their memory and that is threatening to them.
That is why you may get a snappy answer or often an unfriendly reaction. My sister was the primary care giver to my mother and she was often verbally abused by my mother. I often found that indirect questions are less threatening or simple discussion about the weather are a better way to start a conversation.
More to come in my next post.
I welcome any experiences that you want to share.