Can You Say “Dementia” to a Client? Will You?
As a professional in mental health I can guarantee you will see dementia in your practice. The question is if you will recognize it early enough to provide the client and his/her family with the resources they need to cope.
Dementia symptoms can be so subtle initially that your client will acclimate to them, as will you. Denial is a key issue in the early stages; nobody wants to say the word “dementia” out loud, especially about themselves.
Patients frequently recognize they are having symptoms, and are so scared by them that they won’t tell anyone. The stigma and fear of dementia is so great they won’t tell their doctor and depression mimics many of the early stage symptoms.
When their doctors tell them this is “all in their head,” you have the opportunity to work with them to really assess all the symptoms and to find the line between depression and dementia.
It really is in their head, but it really is dementia. Some dementias are accompanied by depression because of the impact on the brain chemistrie, and some because of the impact of such a life changing diagnosis.
As a therapist, I facilitate a dementia support group in my community and I am active in my community’s Purple Cities Initiative, which is working to make our town a safe place for those with dementia and their families and educate about dementia so medical professionals, businesses, houses of faith and really anyone in our town will have resources to both recognize and respond to dementia.
Dementia is, at its core, a disease of isolation for both those who have it and those who care for them.
I work with families who cannot find a therapist who knows dementia and who can appreciate what they face with every loss and every change in behavior.
What Exactly Is Dementia?
Dementia is a collection of symptoms that impact memory, communication and thinking, and diagnosis requires two or more types of symptoms that are severe enough to affect daily functioning.
Age-related cognitive decline, in contrast, is not dementia, because it does not cause significant problems for the person or the people around them.
The leading cause of dementia is Alzheimer’s disease. Dementia is also caused by brain damage incurred from an injury or stroke, Huntington’s Disease, Vascular Dementia, Cruetzfeld-Jacob Disease, Frontotemporal Dementia, Lewy Body Dementia, Mixed Dementia, Parkinson’s Dementia, and Wernicke-Korsakoff Syndrome. (Some neurologists will subdivide the categories in up to 27 additional categories) .
Every dementia is different and every dementia is ultimately a terminal illness. Some, like Alzheimer’s, Parkinson’s, and Huntington’s, carry genetic links that you can include in an assessment.
I guarantee you will be surprised at how complicated and different each disease process is and how similar each is to other mental health disorders you diagnose on a daily basis.
The Warning Signs
Memory Loss: This symptom is the main one associated with dementia, but it’s not always consistent. Be sure to keep track of how often they forget and whether they can recall it later.
When advanced, memory loss is the key characteristic of dementia. Memory loss affecting day-to-day activities is a hallmark to look for – forgetting things often or struggling to retain new information; difficulty performing familiar tasks – forgetting how to do something you’ve been doing your whole life, such as preparing a meal or getting dressed.
In addition to difficulty remembering, the patient may also experience impairments in language, communication, focus and reasoning,
Mood Swings: Feeling anxious and agitated is a common characteristic among individuals with dementia. It is a hallmark of Lewy Body Dementia. Agitation is not what it sounds like: lashing out verbally or emotionally; insisting on doing things that are no longer physically safe, causing falls and injuries; accusing loved ones of poisoning or stealing or other crimes; trying to get out of the house to go “home”; trying to open a car door when the car is in motion; throwing things in frustration.
The disorientation that comes from memory loss can often leave someone confused when being moved from place to place or even when waking or moving from one room to another.
That confusion and fear can cause mood swings. So does the change in the chemistry of the brain as the dementia advances. Lewy Body dementia is often misdiagnosed as late onset bipolar disorder and depression, especially in women.
Poor Judgment: People with dementia often make poor decisions. These can include dressing inappropriately for the weather, making uncharacteristic choices, having a hard time handling money and forgetting to pay bills.
Misplacing Items: Normal aging causes all of us to misplace things. Individuals with dementia are known to misplace items in unusual places. You may find keys in the freezer or a remote in a kitchen drawer. You may find a clock in the freeze, or cat food in the dryer. The inability to retrace their steps can lead to confusion and suspicion on their part potentially leading to hostile mood swings.
Getting Lost: People with dementia wander. Not being able to recognize familiar people, places or objects can lead to further confusion and feeling “lost” in their own home. They may ask where they are and tell you they want to go home. Vision is impacted by dementia, which creates a confusion that can’t easily be described to loved ones.
Subtle Short-Term Memory Changes: Trouble with memory can be an early sign of dementia. The changes are often subtle and tend to involve short-term memory. Your loved one may be able to remember years past, but not what they had for breakfast.
Difficulty Finding the Right Words: Another early sign of dementia is struggling to communicate thoughts the way you want to, reaching for the right words, but not finding them. Conversations with someone who has dementia can become difficult and frustrating to both of you.
Apathy: You may notice that your client or loved one is starting to lose interest in hobbies or activities. They may not want to go out anymore or to do anything fun. They may be losing interest in spending time with friends and family and may seem emotionally flat. This is frequently misdiagnosed as depression, ending medical intervention with a prescription, not trying to assess if there is more to it.
Difficulty Doing Normal Tasks: A subtle shift in the ability to complete normal tasks may indicate an early sign of dementia. This usually starts with difficulty doing more complex things like balancing the checkbook or playing games that have a lot of rules. Along with the struggle to complete familiar tasks, you may notice a struggle to learn how to do new things or follow new routines.
Confusion: Someone in the early stages of dementia may often show signs of confusion. When memory, thinking, or judgment lapses, confusion arises as your loved one can no longer remember faces, find the right words or interact with people normally. Confusion can occur for a number of reasons. For example, missing car keys, forgetting what comes next in the day or trying to remember who someone is.
Difficulty Following Storylines :Just as finding and using the right words becomes difficult, people with dementia also sometimes forget the meanings of words they hear. Struggling to follow along with conversations or TV programs is a classic early warning sign. It may look like boredom or lack of interest. It’s actually an inability to remember enough to keep track of what is being said.
A Failing Sense of Direction: Sense of direction and spatial orientation is a common function that starts to deteriorate with the onset of dementia. This symptom can mean not recognizing once-familiar landmarks and forgetting regularly used directions. It also becomes more difficult to follow a series of directions and step-by-step instructions.
Being Repetitive: Repetition is common in dementia because of memory loss and general behavioral changes. You might notice repeating the same questions in a conversation and a circular thought process.
Struggling to Adapt to Change: For someone in the early stages of dementia, the experience is frightening. Suddenly they can’t remember people they know or follow what others are saying. They can’t remember why they went to the store and get lost on the way home. As a result, they may crave routine and not want to try new things. Having difficulty adapting to changes is a typical sign of early dementia.
What is Your Role?
As a clinician, you have the opportunity to do an outstanding differential diagnosis that can lead to the right referrals, the best suppor, and that shortens your client’s journey to a real diagnosis without the heartache of the average six specialists to get there.
You can reduce their family’s frustration, buy them time to get legal documents drawn up and prevent unnecessary chaos and heartache.
You have the responsibility to educate yourself about the dementias in the DSM – it’s our book too, and this time, it can help a family get the assistance they need.
Our website has links to assistance and support, and we can provide educational programs for your staff to prepare you for the ever increasing numbers of dementia patients in the coming years.
Jill Johnson-Young, LCSW, is the co-founder of Central Counseling Services in Riverside, CA. She is invested teaching other professionals to recognize dementia and to provide services for those affected by it because of her many years in hospice work, and because she lost her second wife to Lewy Body Dementia (the reason for Robin Williams’ death).
Central Counseling Services is a state-approved CEU provider in California. www.centralcounselingservices.com
See a video of Dementia 101 presented by Jill to the City of Riverside.
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