2 May 2019

How do I know if someone I love is developing dementia?

Many people imagine that memory issues are the only indicators of dementia, but this is a common and misguided error.

People with dementia show a variety of early and sometimes quite unique signs of a developing illness. Of course, forgetfulness and misplaced items are part of the issue, but relatives can be surprised and challenged by some of the less well-known indicators.

Personality changes such as aggressive, out of character outbursts are common, and can surprise and upset family members. People with a progressive dementia can show a tendency to become quieter in big groups, as they find increasingly difficult to follow conversations. They may withdraw from work or social activities as their motivation decreases and their enjoyment of these events begins to fall. Other mood and personality changes include increased anxiety, depression and paranoia.

Language difficulties, in both processing and expressing words, are common.  People with dementia might start to lose track of what they are saying mid-sentence, or forget the name of a common object.  They will find ways to disguise this issue by describing an object - such as saying a watch is “that clock you wear on your wrist”. Sometimes they will blame hearing problems on their deteriorating ability to understand what is being said to them, but it can simply be that their information processing is changing.

Spatial problems are a very common indicator of the start of a dementia process. People might increase in their tendency to have small accidents, like spilling drinks, burning themselves, or have difficulty judging stairs. If they are still driving, judging distances or losing their ability to manage speed humps and roundabouts can become an issue. They might prefer not to read anymore, due to issues with colour and contrast.

Planning and problem-solving issues can manifest in many ways. One of the most obvious issues is that people with dementia seem to take forever to get ready to go out, and are never quite certain if they have everything they need. They may stop using recipes, lose interest in hobbies or start to muddle regular payments e.g. of monthly bills. Even familiar tasks at home or work might start to become challenging for them, and they could forget the rules of a well-known game, like bridge, or become flustered in a household emergency, whereas once they had been extremely competent.

Orientation to time and place is a problem, so that people start to say they are not interested in the date or the day, or even the year.  They will say: “Oh, that doesn’t matter now I’m retired”.  So, instead of becoming offended if someone who cares about you forgets your birthday realise that it could be an early sign of a memory deterioration.  And a common sign it that you might get a call to say they are lost when driving.

Losing things and developing signs of paranoia occurs very frequently with people developing dementia. They might start to lose objects, put kitchen items in the wrong place, and forget how to properly dress themselves.  They might show signs of not caring as much about the way they look. And, to justify their increasingly frustrating behaviour, they might start to become sure that others have stolen their property. Sadly, paranoia can be directed to other loved ones. For example, sometimes people who have been married a long time will believe that their partner is having an affair.

Motivation decreases, along with the ability to make good judgements. People with dementia will be more gullible, and believe telemarketers.  If someone in your family starts to donate more money, or says they might win a car in an online competition, take notice.

Managing money is a problem with people developing dementia.  They will find it more difficult to count small change, so if a relative suddenly has a purse full of coins, you could start to observe them for other signs of impairment. People have been known to take large sums of money from the bank for “safe-keeping” but forget where they have put the cash – or even leave it at the telling machine.  Money management is a sensitive issue for people who have been independent all their lives, but it is important to have things in place such as an Enduring Power of Attorney (EPA) so you can take over when things become too difficult for your relative.

Of course, we all have little foibles and you might say that everyone has some of the above problems from time to time.  But a person with dementia will be more consistent in their inconsistencies, and love, understanding and patience are the only helpful ways to manage these new, puzzling and sometimes frustrating behaviours.