May 8, 2024

A cohort was sharing an experience the other day that caught my attention. She related a story about a couple in her Alzheimer's support group. The wife shared that she was upset that her husband was no longer balancing the checkbook. Her frustration led her to question and berate him for his seeming confusion. His lapses of ability and seeming ambivalence didn't jibe with his previous dedication to this, and other household responsibilities. Try as she may, she could neither cajole nor encourage him to complete these, and other, once familiar and accepted tasks. Without understanding the cognitive deficit indicators of this, and other subtle, yet progressive signs of mental/functional decline, she was at a loss as to what to think; what to make of it. She expressed her dismay in a support class, saying she didn't know what to do. In touching simplicity, head down, he haltingly stated, "I just want love."

And so it goes, in countless scenarios, the confusion, the perplexity, when faced with a loved one evidencing early signs of cognitive decline. The trajectory of dysfunctional clues can take years, sometimes, before the frequency of warning signs and symptoms become evident enough to cause concern.  

There is a difference between a normal age-related symptom and Alzheimer's disease, a chronic condition. Memory loss is not always a "normal sign of aging." If memory loss disrupts daily life, tasks, or general functionality, it may be a symptom of Alzheimer's disease or other dementias. The key, as with any diagnosis referenced in the DSM 5, (the Diagnostic and Statistical Manual for Mental Disorders) there must be present the criteria of loss of functioning (from an individual's baseline functionality) in the performance of the tasks of daily living and general cognition. Normal signs of aging might be evidenced as a temporary loss of the car keys; while chronic dementia might question what a car key is for.

Alzheimer's is the most common type of dementia, and it affects memory, thinking, and behavior. Early signs of dementia can vary, but here are some common indicators to watch out for:

1. Subtle Short -Term Memory Changes:

• Difficulty with memory, especially short-term memory
• Forgetting where items were placed or why they entered a room
• Struggling to complete tasks they started, like forgetting to turn off the stove after cooking

2. Difficulty finding the Right Words:

• Trouble expressing thoughts or finding appropriate words
• Stopping in the middle of a sentence without knowing how to continue

3. Changes in Mood:

• Mood swings, anxiety, or depression
• Fearfulness or increased agitation due to changes in routine or unfamiliar situation
• Shifts in personality

4. Apathy (Listlessness):

• Loss of interest in previously enjoyed activities
• Reduced desire to go out or spend time with friends and family

5. Difficulty completing Tasks:

• Struggling with complex tasks, such as managing finances or planning
• Gradual decline in ability to perform everyday activities

WHAT TO DO IF YOU ARE SEEING THE SIGNS:

If you notice any of the above signs or symptoms, it's important to take action. It's ok to be afraid. Some people may even feel embarrassed or ashamed. But communication with family, friends, and health care providers can lead to better understanding with greater potential for increased mental/physical support. If cognitive decline is suspected, please refrain from shaming and correcting deficits and behaviors. Bear in mind that if cognitive decline is indeed present, it is then a matter of can't, not won't. It may seem as if a loved one is being oppositional or defiant, when indeed, perhaps they may feel as confused and disoriented as you are in that moment.

An Alzheimer's disease diagnosis is a multi-step process, and it starts with a conversation with your physician to determine if Alzheimer's disease can or cannot be ruled out based on symptoms experienced. Taking the first steps does not mean a loss of agency.

• Talk to your doctor about a screening
• Meet with a specialist for a formal diagnosis
• Make plans for your future

According to the Take on Alzheimer's website, funded by the California Dept. of Public Health, there are 10 warning signs and symptoms that should be discussed with a doctor if they are noticed in oneself or a loved one:

1. Memory loss that disrupts daily life.
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks at home, work, or at leisure
4. Confusion with time or place
5. Trouble understanding visual images and spatial relations
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or prevalence of poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality

A WORD TO THE CAREGIVER/PARTNER:

The diagnosis of Alzheimer's or other dementia will herald the beginning of a new chapter for both you and your loved one. Reach out to the Alzheimer's Association for support and education. Surround yourself with understanding and empathic loved ones and friends. Distance yourself from fear mongers and those dispensing judgemental "advice". No one can know the challenges, confusion, and fears that you may be experiencing. There will be good days, and not-so-good days. Treasure the good ones, and know that the not-so-good will pass. Seek out and join a support group. Make plans based on the understanding that a dementia diagnosis entails a progressive disease process. Plan for future needs and care prospects that include future care and support for both yourself, and your loved one. Explore your mutual health and financial concerns before needs dictate action.

Loneliness and isolation can be daunting. Among fellow caregivers, you can experience an understanding and acceptance of folks who "get" you. They are there to support and be supported. In that regard, there is room for you and your circumstances, devoid of judgment. Thus, there is no need for explanation. It is never a pity party! You stand to be accepted, unconditionally, into a community dedicated to healing and being healed.   

As you realize that you are embarking upon the "toughest job you will ever have," you are promised a membership into a community of unconditional care and support... yes, and love. Come as you are!

— Karen Kelleher, M.A.

DayBreak Family Caregiver Support Coordinator

Your support can transform lives today. With your help, we can provide vital resources and assistance to elders and caregivers who need it most.

DayBreak is dedicated to empowering elders and providing unwavering support to family caregivers. If you know an older adult in need of our comprehensive care and coordination services, or a caregiver seeking assistance, please encourage them to reach out to us at:

510-834-8314