The Importance of Diagnosing Early Dementia

When the behavior of someone close to you changes, finding out what the underlying cause is can seem daunting. A diagnosis, however, can a make a difference in your loved one’s quality of life.

The earliest stages of dementia are tricky to diagnose and identify. At times, the person seems completely normal. They can function physically. They communicate. They can care for themselves. But loved ones know differently. They can’t pinpoint what’s wrong, but they know that something is not right, and the person doesn’t always seem to be himself or herself.

When dealing with an unknown medical issue, the best remedy is to schedule a doctor’s visit. This is easier said than done, however, with people experiencing early stage dementia.
Although they may be aware that they are having trouble remembering, they may also be afraid to find out what could be causing it.

“Early dementia causes confusion and clouds rationality, making it much harder to negotiate a visit to the doctor. One of the biggest challenges is getting someone in the door,” says Helena Chang Chui, MD, chair and professor of neurology at the Keck School of Medicine of USC and an internationally recognized Alzheimer’s disease expert.

Having helped patients and their families in this situation, Chui has the following recommendations:

• Mention the appointment informally, just before visiting the doctor rather than discussing it in advance. “Because the patient’s reality is altered, you have to use little half-truths,” Chui says. “You can say something like, ‘Let’s go out to breakfast and stop by and have our annual checkups.’”
• Use other physical problems as an excuse. Seeing a doctor for a knee problem is different from going in for memory loss.
• Confront the topic, when you know the person is lucid. People with early dementia slip in and out of lucidity. Rather than exacerbate the problem when they are confused, gently bring it up, when they have a moment of clarity.
• Avoid arguing. “You can’t argue with your loved one, because they don’t know what they are doing,” Chui says. As hard as it is, being generous and compassionate will have better results.
• Schedule the appointment for “yourself” and ask your loved one to tag along. Tell them that having their support would be helpful. “We tell families that at times, you have to be a little bit of an actor, but that it’s for a good cause,” Chui says.
• A caregiver or someone close should go to the appointment with the patient. This is not the time for the patient to go alone, since they might not be able to accurately report what is happening for them, and they may not remember what the doctor recommends.

Remember that the patient’s perception of time and reality are different from yours. They may think that an event that occurred 20 years ago happened yesterday and arguing the point won’t help. “Someone with memory loss is not always grounded in reality,” Chui says. As a result, caregivers must be savvy in their reasoning.

Additionally, there are things a caregiver can do to make the appointment go smoothly:

• Prepare the doctor in advance. Call ahead, discuss your concerns and ask for a memory screening. This prevents you from having to do so in front of your loved one.
• Keep a journal. Document changes in personality and differences that you have observed in their daily routine and communication. Keep a list of questions you may have as well.
• If you need consent, handle paperwork at home. It will be easier to discuss it with your loved one then rather than when they are stressed from being at the doctor.
• Bring in a list of current medications. This will help rule out any drug allergies and reactions.
• Think ahead to how your loved one might react and be prepared. Bring distractions, such as snacks or an iPad, to keep them from focusing on being at the doctor’s office. If they tend to cry or get angry under stress, take someone with you who can go in first and notify you when you can go directly back to the doctor’s office.

Living with someone who has dementia is a new experience for all involved, but with understanding and patience, there are ways to improve their quality of life – as well as yours.

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