Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Disorientation
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
Doesnt The Person Know That They Have Dementia
They may not. What can be perceived as denial or being stubborn can actually be a lack of awareness that there are any deficits. The medical term for this is anosognosia and it means without knowledge of disease. When anosognosia occurs there is a limited ability to have insight into ones true abilities. This can be selective or complete, and it can impact their memory, general thinking skills, emotions and physical abilities. This is a neurological problem resulting in damage to certain parts of the brain. As a result, the person you are caring for may not be able recognize the symptoms of dementia because:
- They may have forgotten the diagnosis due to the effects dementia can have on their memory and so will not have insight into any dementia related symptoms.
- They are not aware of the impact that dementia related symptoms have had on their day to day life and may lack the awareness to understand that they cannot manage independently.
What Not To Say To Somebody With Dementia
A poor choice of language can be both hurtful and frustrating. Here we look at some words and questions to avoid using.
For somebody living with dementia, language and communication can become more difficult over time.
How and when language problems develop will depend on the individual, as well as the type of dementia and the stage it is at. While the person living with the condition may have issues with recall or finding the right word, the words that other people use are important too.
Good communication can be key to helping somebody to live well with dementia. Here are a few of the words and questions to avoid in conversation.
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Encourage Them To See Their Doctor
If youve noticed that someone close to you is showing symptoms of dementia, its important to encourage them to see their doctor to talk through whats been going on.
Talking to someone about changes youve noticed in them can be difficult. It can help to have the conversation in a space where both of you are comfortable, are able to hear each other clearly and speak freely. Health Direct recommends starting the conversation by talking about what youve noticed and the other common reasons this might be happening. For example, you might say youve noticed the person has had trouble with their memory recently, and ask if theyve been stressed or not sleeping well. Then you can suggest that its time to see a doctor to find out whats happening.
If you dont have a close relationship with the person, you might talk to someone who knows them well about what youve noticed, see if theyve noticed the same things and ask them to bring it up with the person.
If a person remains resistant to following up about changes in their memory or behaviour, Dementia Australia recommends finding a different, physical reason to encourage the person to see the doctor, like an overall physical check-up, a blood pressure test or diabetes check. You can see more suggestions on what to do if the person you are concerned about does not want to see their doctor on the Dementia Australia website.
Should You Keep Trying To Communicate
Family members may frequently ask, How often should I visit?, or, Should I visit at all, because they dont seem to be understanding what were saying, most of the time they dont seem to recognize me, etc. Caregivers can encourage family members to visit because its important to them. Also, the person with memory loss may catch some things on some days, and if family members can make the interaction a pleasant moment, it can be rewarding for both.
Communication amongst family becomes particularly difficult when the person with dementia and/or Alzheimers doesn’t recognize family members anymore. In this situation, a spouse or children can think that it doesnt do any good to go talk to the personthat anyone could talk to him/her because they dont remember who they are. But there is a richness that happens because of family history together, something that can only come from people that have been family or friends for a long time.
The type of communication families can get out of visits can be pulled from the strength of the patient and/or loved ones long-term memories. They can still talk about the past, and for family members, to hear those things are perhaps a worthwhile gift.
Even though the patient and/or loved one can no longer communicate the way they used to, there are still other ways to enjoy time together. There is beauty and simplicity in being in the present moment.
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How To Tell The Patient
James McKillop , who has dementia, said: Being told of the diagnosis at the right time, in the right place, by the right person who has thoughtfully allowed plenty of time for explanations and any questions is essential. The right time can be difficult to establish, but a sooner-rather-than-later approach will give the person the opportunity to process the information and to begin considering care options while cognition allows.
The pace at which information is given may be more important. Some people may find it easier to deal with this on a step-by-step basis, while others will prefer to know everything as soon as possible so their future can be planned. This is likely to be difficult as the progression of the disease varies between individuals, and not everyone with a diagnosis of dementia is likely to experience all the same events as the illness progresses.
Professionals may be inclined to put pressure on patients to consider their prognosis while they are able to make informed decisions. The dilemma for the professional is that they need information from the person about their preferences for future care while they are cognitively able to provide it.
Do Not Ask Your Parent To Remember Something
As you carry on this challenging conversation, you might tend to ask your parent if they remember a person or event. Keep in mind that they are in the throes of dementia and do not remember things as they once did. All you would accomplish by asking them to remember something is to embarrass or frustrate them.
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Who Is This Dementia Quiz For
Below is a list of 10 questions designed for people who are concerned about memory loss. The questions relate to life experiences common among people who have been diagnosed with dementia, a neurocognitive disorder, and are based on criteria in the DSM-5 .
Please read each question carefully, and indicate how often you have experienced the same or similar challenges in the past few months.
The Case Against Disclosure
The main arguments against disclosure centre on concern, mostly by relatives, that it would lead to depression, anxiety and possibly suicide .
Maguire et al suggest that this may be compounded by relatives reluctance to deal with the patients knowledge and grief. A clients daughter begged this papers author to stop the consultant disclosing a diagnosis of dementia to her mother, as the daughter would be the one dealing with the consequences and she felt she would not be able to cope. But Maguire et al found that people who were opposed to telling a family member wanted to be told if they had the condition. The reason they gave is that they had a right to know their diagnosis, and apparently saw no paradox in their views. Similarly, Holroyd et al found that more people would want to know the diagnosis if it were their own than felt a relative should be informed. Other arguments against disclosure included that it is of no benefit because there is no cure and that the person would forget anyway .
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Say What You Need To Saykindly
Dont bombard your mom or dad with questions right away. Cover one thought or idea at a time and give them plenty of time to respond. They will likely be overwhelmed by the news and may not be able to process all of the details. Instead of getting upset, focus on speaking with kindness and validation. Using validation to communicate through dementia is an effective way to accept their reality and reduce agitation.
As the disease progresses, if your parent isnt getting what you are trying to say, dont repeat the same question. Instead, try putting things another way. For instance, show them a photo of someone you are talking about. It can also be helpful to stick with questions that can be answered yes or no.
What Symptoms Can Be Mistaken For Dementia
Both play an important role in the functioning of the nervous system. If someone does not get enough of either of these vitamins, they may have some symptoms that could be mistaken for dementia. These include confusion, memory loss, irritability, difficulties with problem-solving, depression and irrational thoughts.
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Do Make Sure That The Dementia Patient Gets Enough Rest Food And Water
Fatigue, hunger and thirst may cause combativeness. Ensure that the person with dementia is well fed, hydrates enough, and gets adequate sleep and rest. In line with this, they should also have enough bathroom breaks. Research also shows that it may help to reduce loud noises as well as clutter in the space where the patient spends most of his/her time, as both loud noises and clutter tend to over-stimulate people with dementia.
How To Talk To A Parent When They First Show Signs Of Dementia
Is your mother or father acting differently? Do you suspect that something is off and that your loved one might be displaying dementia symptoms? There are a number of tell-tale signs that your family member might be having more than just a bad day.
Youve probably heard that older people may have excellent recall about things that happened decades ago, but will struggle to find the right words to say or remember why they walked into the kitchen. Treasure the former and take note of the latter.
Some symptoms of dementia are not related to memory problems. For example, you could notice someone becoming moodier. Emotional issues including depression often crop up during the early phase of dementia. Personality changes with dementia are also common, but there are ways to cope and understand what your loved one is going through.
You might also observe a lack of interest in things your family member always enjoyed. They could become confused more easily, or have a habit of repeating themselves.
Have you noticed one or more of these things? If so, are you having an imaginary conversation in your head where you discuss it with your parent? If you are like many adult children, you are scared to have this difficult conversation in the real world.
Being fearful is understandable. On the other hand, waiting to talk about it might delay treatment options that could help your parent.
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If You Notice A Decline
Families are more likely to notice small or marked changes in their loved ones abilities if they have not seen them for several months. That might mean noticing early signs of dementia or worsening symptoms if theyve already been diagnosed with it.
So this can be a delicate conversation to have with your loved one.
Many people can be defensive or in denial about changes, put it down to old age, and are afraid about having dementia.
You might need to have the conversation several times to get them to see the doctor. Call the National Dementia Helpline on 1800 100 500 for advice.
How Long Do Dementia Patients Live After Diagnosis
Dementia symptoms typically progress slowly. People with dementia will progress from mild to severe dementia at varying speeds and may be diagnosed earlier or later in life. Some people with dementia may live for up to 20 years after their diagnosis, though according to the Alzheimer’s Association research shows that the average person lives for four to eight years after a diagnosis of dementia. It’s important to point out that the diagnosis of dementia is often missed, delayed, or diagnosed when the illness is moderate or advanced. The impact of that variable may not be accurately reflected in the research regarding the years of life post-diagnosis.
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Talking With A Doctor
After considering the persons symptoms and ordering screening tests, the doctor may offer a preliminary diagnosis or refer the person to a Cognitive Dementia and Memory Service clinic, neurologist, geriatrician or psychiatrist.Some people may be resistant to the idea of visiting a doctor. In some cases, people do not realise, or else they deny, that there is anything wrong with them. This can be due to the brain changes of dementia that interfere with the ability to recognise or appreciate the changes occurring. Others have an insight of the changes, but may be afraid of having their fears confirmed.One of the most effective ways to overcome this problem is to find another reason for a visit to the doctor. Perhaps suggest a check-up for a symptom that the person is willing to acknowledge, such as blood pressure, or suggest a review of a long-term condition or medication.Another way is to suggest that it is time for both of you to have a physical check-up. Any expressed anxiety by the person is an excellent opportunity to suggest a visit to the doctor. Be sure to provide a lot of reassurance. A calm, caring attitude at this time can help overcome the person’s very real worries and fears.Sometimes, your friend or family member may refuse to visit the doctor to ask about their symptoms. You can take a number of actions to get support including:
- talking with other carers who may have had to deal with similar situations
- contacting your local Aged Care Assessment Team
Ethical Theories And Telling The Diagnosis
Two schools of ethical thought address these dilemmas. Deontology assumes that lying and deception are wrong in themselves and that clinicians, like everyone else, have a moral duty to tell the truth. Competent patients have a right to know their diagnosis this information belongs to them, and they should be told the truth regardless of the consequences. Consequentialism insists that the decision to tell or not to tell depends on the details of the clinical situation, and the physician should decide which course of action might be least harmful and produce the best results for the patient.
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What Causes Dementia To Progress So Quickly
Dementia symptoms are typically mild at first and progress over time to moderate and then severe, over several years. The speed as which dementia progresses varies between individuals, but some factors can cause dementia to progress more quickly. These include the persons age, the type of dementia, and other long term health problems. Dementia tends to progress more slowly in people over 65 compared to younger people below 65.
Things Not To Say To Someone With Dementia
Speaking to an elderly loved one with dementia can be difficult and emotionally draining. Alzheimers and dementia can lead to conversations that dont make sense, are inappropriate or uncomfortable, and may upset a family caregiver. However, over time, its important to adapt to the seniors behavior, and understand that their condition doesnt change who they are.
For senior caregivers, its important to always respond with patience. Here are some things to remember not to say to someone with dementia, and what you can say instead.
1. Youre wrong
For experienced caregivers, this one may seem evident. However, for someone who hasnt dealt with loss of cognitive function before, it can be hard to go along with something a loved one says that clearly isnt true. Theres no benefit to arguing, though, and its best to avoid upsetting a senior with dementia, who is already in a vulnerable emotional state due to confusion.
Instead, change the subject.
Its best to distract, not disagree. If an elderly loved one makes a wrong comment, dont try to fight them on it just change the subject and talk about something else ideally, something pleasant, to change their focus. There are plenty of things not to say to someone with dementia, but if theres one to remember, its anything that sounds like youre wrong.
2. Do you remember?
Instead, say: I remember
3. They passed away.
Instead
4. I told you
Instead, repeat what you said.
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What Information To Share
As a general guideline a number of things will need to be explained:
- An explanation as to why the symptoms are occurring.
- A discussion of the particular form of dementia, in terms that are appropriate to the persons level of understanding.
- Any possible treatment for symptoms.
- The specialised services and support programs that are available for people with dementia.
Informing a person that they have dementia is a serious matter, which needs to be handled with great sensitivity and dignity.
It can be a very stressful time for everyone. Dont forget to look after yourself.
Dementia Australia offers confidential counselling and support for families, carers and people with dementia.