The Caring Generation® Signs of Dementia Checklist
The Caring Generation® – Episode 11 October 2, 2019 On this caregiving radio program, Pamela D. Wilson, caregiving expert, talks about the Signs of Dementia Checklist. Special guest Dr. Jonathan Graff-Radford from the Mayo Clinic talks about the Risk Factors for Dementia.
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Signs of Dementia Checklist Radio Show Transcript
00:04 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation with host, Pamela D. Wilson is here to focus on the conversation of caring. You’re not alone, in fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.
00:46 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. How is everybody today? You are listening to The Caring Generation radio program coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. The Caring Generation focuses on the conversation of caring, giving us permission to talk and laugh — we must remember to laugh –about aging, being a caregiver, health, well-being, work, life, family balance and everything in between. You’re not alone. Please invite your family, friends, co-workers, and others to join us each week on The Caring Generation where we talk about how to be proactive, to avoid surprises about health, well-being, caring for ourselves, and loved ones. Helpful information for caregivers and aging adults is on my website at PamelaDWilson.com in my caregiving library, online support groups, and online courses. This week, we’ll be talking about memory loss. How do you know if the memory loss you are seeing is normal memory loss or something more serious, like a diagnosis of dementia or Alzheimer’s disease?
02:02 Pamela D Wilson: I’ll share my signs of dementia checklist during the show, and we’ll also get a medical perspective in the second segment of this hour from Dr. Jonathan Graff-Radford, Associate Professor of Neurology from the Mayo Clinic in Rochester, Minnesota. Dr. Graff-Radford specializes in mild cognitive impairment, vascular cognitive impairment, Alzheimer’s disease, Lewy body dementia, and frontotemporal dementia. He is a co-investigator in the Mayo Clinic Alzheimer’s disease research center and the Mayo Clinic study on aging. He has an amazing background and information you won’t want to miss coming your way in our next segment about the risk factors for dementia and Alzheimer’s disease. As we talked about last week, caregivers will continue to do more and more related to medical type tasks and have more responsibility for the care of loved ones. It’s better to be prepared to reduce the stress and worry that many caregivers experience by responding to all of these unexpected situations and caregiving crisis. Some of these crises result from the shock of learning that a loved one has dementia or Alzheimer’s.
03:16 Pamela D Wilson: How might this happen? An aging parent causes a serious car accident. They drive on the wrong side of the road, cross lanes of traffic, or they get lost. How many of you have ever imagined that you might receive a call from the police 100 miles away from your parents’ home, and you are being asked to go pick them up and take them home? I have 20 years of examples. The point is that unless you know the signs of memory loss and are with a loved one on a regular basis to notice the signs, an aging parent or spouse may be experiencing memory loss and you will never know. Small changes over time might be slight. These changes are easier for a spouse to notice, because of being with a husband or a wife over a long period of time, and day in and day out. What do you look for? Very early signs are, difficulty with numbers, managing money, balancing a checkbook, disorganization, or struggling to do a task that was previously very easy to do. Here’s an example: I had a client whose wife was the organizer of the church newsletter. The newsletter was created and emailed every month for years, no delays, no errors.
04:39 Pamela D Wilson: All of a sudden, his wife was having difficulty using the computer. The newsletter was late, there were mis-spellings. For his wife, who did this task routinely, this was a major change in her abilities and behavior. This change indicated the very early beginnings of Alzheimer’s disease. Another example is a much younger individual who was a salesperson at a computer company. He traveled, attended meetings, and went to conventions. All of a sudden, colleagues and co-workers were coming up to him talking about a meeting that happened yesterday, or a report that was due, and he didn’t remember. He took these lapses of memory very seriously and was diagnosed with early-onset Alzheimer’s. Let’s talk about memory loss that happens but isn’t related to Alzheimer’s or dementia. We all worry about having memory loss about being forgetful. We misplace our keys or other items, forget an appointment. If you are a caregiver, this forgetfulness may result from stress and trying to do too many things at once. Many caregivers don’t get enough sleep at night. Our brains need restful sleep to process everything that’s going on in our minds. Some medications can also affect memory.
05:53 Pamela D Wilson: Examples are Paxil, Cimetidine, Oxybutynin, Amitriptyline, Nortriptyline, even cold or allergy medications, and some blood pressure medications. Ask your doctor or check with your pharmacist if you start taking a prescription, and all of a sudden you’re having lapses in memory. A too slow or too fast thyroid can cause a long list of problems, including memory loss. A blood test can diagnose thyroid concerns. Ask your doctor. Depression, which is very common in caregivers and older adults can also result in memory loss, as well as apathy, which is just not caring about anything. Then you have excessive sleep, under or overeating. Let’s add to this, substance abuse. Drinking too much alcohol can interfere with short-term memory loss. There is such a thing as alcohol-related dementia. I have had clients who were lifelong drinkers who had this diagnosis. Other substances can also cause memory loss. Having a vitamin B12 deficiency can result in memory loss. Some pain medications and cholesterol medications can do the same. If you’re taking any of these, do not stop. Ask your doctor about the possibility of medication causing the memory loss. Ask to have your memory tested.
07:11 Pamela D Wilson: There are some very basic tests with the acronyms of MMSE, SLUMS, and MoCA that can indicate very early memory loss. One of the main reasons that people have dementia that is undiagnosed is that they don’t want to know. People will avoid talking about memory loss and will never report the issues to a doctor for testing. This type of thinking, in the long run, will result in care issues for family or loved ones or even care neglect, if there’s no one to notice or to assist. The situations where someone has memory loss that goes undiagnosed are very sad, especially when a serious accident or harm happens to the person who becomes unsafe to live alone and at home. Many of these individuals became my clients. I was appointed their guardian through the court system, and because there was no one else to care for them. Not wanting to know, not getting a diagnosis can place you in a situation where you will eventually give up control of your life to someone else. You must hope that this someone else is responsible, ethical, honest, and not someone who will take advantage of you or neglect your care because that happens all too frequently. After this break, we’re going to talk more about risk factors for dementia and Alzheimer’s disease. Dr. Jonathan Graff-Radford, he’s an Associate Professor of Neurology at the Mayo Clinic in Rochester, Minnesota. He is going to be joining us. Stay with me. We’ll be right back after this break.
11:02 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, I’m your host. You’re listening to The Caring Generation coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. We are back to talk about risk factors for dementia and Alzheimer’s disease with Dr. Jonathan Graff-Radford, Associate Professor of Neurology from the Mayo Clinic in Rochester, Minnesota. Doctor, welcome, thank you for joining us.
11:28 Dr. Jonathan Graff-Radford: Thank you so much for having me here.
11:30 Pamela D Wilson: You are a neurologist who specializes in memory loss. Some of our listeners may not know what a neurologist is. Can you explain why seeing a neurologist is beneficial if somebody suspects that they have memory loss?
11:45 Dr. Jonathan Graff-Radford: Yes, so a neurologist is a medical doctor who specializes in treating disorders of the nervous system, which includes the brain, spinal cord, and peripheral nerves. And some neurologists sub-specialize in dementia, and they may be called cognitive neurologists, or behavioral neurologists. And usually that requires a little bit of extra training. And getting to your second question of why it’s important to be seen if you’re having memory loss, it turns out there’s several different types of providers that may have differing comfort levels with memory problems, but geriatricians or geriatric psychiatrists and neurologists, all may have a lot of expertise in getting to a diagnosis and treatment plan for these disorders. And it’s important to get evaluated, because for several reasons. First, there may be reversible causes of memory problems that can be identified during evaluation, and certainly we’d want those to be identified. But also it’s important if you do have a condition like Alzheimer’s disease as the cause of your memory problems, to get an early diagnosis, so you can plan accordingly, and set up a treatment program as early as possible and start making important lifestyle changes that may even potentially slow down the course of the disease.
13:23 Pamela D Wilson: And I do a lot of research, I’ve been reading, and there’s some studies out there that say that memory loss can begin 10 to 20 years before a diagnosis. What steps do you take to diagnose memory loss?
13:34 Dr. Jonathan Graff-Radford: That’s a great question, and I think you’re referring to some of the longitudinal studies that have been funded recently where they’re taking people who have normal cognition, who may be at risk for developing Alzheimer’s disease and they’re following them over time and measuring their memory over time. And the first thing that they’ve been finding is that it turns out the proteins that cause Alzheimer’s disease, there’s two of them, one of them is called amyloid, and the other one is called tau. They’ve been able to determine that they start depositing in the brain up to 25 years before the first symptoms develop, and then, approximately five to 10 years before a diagnosis is made. If you’re following people, you’ll start to see a slight change in their memory. So, it does occur before diagnosis. And in the clinic, we might diagnose these memory problems by doing a bedside memory test, where we’re asking people to recall words we give them — a few minutes later. Or we may do a more formal memory test, where we do a four-hour neuro-psychologic evaluation. And the advantage of the longer memory test is we can compare a person’s performance to other individuals of their same age and sex and to see if they’re performing where we might expect them to perform.
15:07 Pamela D Wilson: And then let’s talk about heart disease. Does high blood pressure or high cholesterol over time contribute to memory loss?
15:15 Dr. Jonathan Graff-Radford: Yes, it turns out there’s been consistent studies that vascular risk factors like high blood pressure and high cholesterol increase your risk of memory loss and dementia. And it’s particularly important in mid-life. So that’s where the strongest evidence exists that these risk factors increase your risk for memory loss. And there’s actually a recent study published called “The Sprint Mind Study,” and they took people, and half of the group they treated to conventional blood pressure targets, and the other half, they treated to a very aggressive blood pressure target of 120/80. And the group that was treated aggressively, not only did they have better cardiac outcomes, but they also had a decreased risk of developing mild cognitive impairment. So, I think there’s continuing evidence that these are important risk factors for developing memory loss and dementia.
16:20 Pamela D Wilson: So, we all have to be very careful about our blood pressure it sounds like.
16:25 Dr. Jonathan Graff-Radford: Absolutely.
16:25 Pamela D Wilson: I’ve also had clients who had strokes, who then came down with stroke-related, dementia. Do strokes always result in memory loss?
16:35 Dr. Jonathan Graff-Radford: That’s a great question. So, there’s a specific type of memory loss, which we call vascular cognitive impairment, which is secondary to strokes. And these strokes can either occur in critical structures of the brain that are important for memory, and you can have a single stroke that results in dementia, or more commonly, someone might have multiple strokes and the damage builds up over time, and they develop memory problems in a step-wise fashion. So, they have a stroke. They get worse. They have another stroke, and they get worse again. But it turns out that not everyone who has strokes gets memory problems. So over the age of 65, about 25% of people have strokes, they don’t know about. And most of them don’t have memory problems, but they’re important to know about. Because they are a risk factor for developing these memory problems. And another good reason to treat your blood pressure and high cholesterol, because treating those will reduce your risk of stroke.
17:44 Pamela D Wilson: So, it sounds like high blood pressure and managing all of that can help not only prevent the memory loss but the strokes that go along with it. We are going to continue this conversation with Jonathan Graff-Radford after this break. I’m Pamela D. Wilson, your host. You are listening to The Caring Generation live on the BBM Global Network Channel 100 and TuneIn Radio. My goal is to make The Caring Generation available to you where you are, you can listen to the weekly podcast replays on my website, on iTunes, Google podcasts, and my YouTube channel. Stay with us, we will be right back.
20:43 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You are listening to The Caring Generation radio program for caregivers and aging adults, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. Let’s continue our conversation with Dr. Jonathan Graff-Radford from the Mayo Clinic in Rochester, Minnesota. Doctor, can you talk about the difference between Alzheimer’s and dementia?
21:07 Dr. Jonathan Graff-Radford: Yes. Those are two terms that often get intertwined, but they are different. So, dementia is a syndromic term for anyone who has cognitive issues, usually involving two cognitive domains, for example, memory and language problems, or memory and visual-spatial problems. And these cognitive problems are bad enough that they interfere with them performing their typical activities of daily living. So they may interfere with managing their medications by themselves. It may cause them to get lost while driving or missing paying bills, missing appointments. So, it doesn’t refer to any specific cause, it’s just the syndrome of cognitive impairment, and it is an umbrella term that encompasses multiple ideologies or causes. And Alzheimer’s disease is the most common cause of dementia, so Alzheimer’s is defined by the presence of two hallmark abnormal proteins that deposit in the brain, and they kind of attack your brain cells or neurons. Those are the amyloid protein and the tau protein. So, because Alzheimer’s disease is by far the most common cause of dementia, those two terms often end up getting used interchangeably, but they are different because there can be other causes of dementia as well.
22:35 Pamela D Wilson: A listener wanted me to ask you if there is a link between Alzheimer’s and Parkinson’s disease? Is there?
22:41 Dr. Jonathan Graff-Radford: Yes, there is a link. So, there actually is a specific form of dementia where people have features of both Parkinson’s disease and Alzheimer’s disease called dementia with Lewy bodies. And when we’ve looked at the brains of these people who have participated in research studies and donated their brains for research, they have both pathologies often present. They have pathologies associated with Parkinson’s disease present and pathologies associated to Alzheimer’s disease present, and it causes a unique constellation of symptoms. So, in addition to Parkinson’s symptoms, they may get hallucinations, fluctuations in their cognition, and they may get an unusual symptom called dream enactment behavior. Where, while sleeping they punch, kick, yell, or scream. And all of those, kind of make this form of dementia characteristic.
23:48 Pamela D Wilson: There is this, “don’t ask, don’t tell” perception about doctors and memory loss. Where is the line between a patient having to ask if they have memory loss and the duty of the physician to diagnose and explain the consequences? So, like you said, at the beginning, so that people can plan.
24:04 Dr. Jonathan Graff-Radford: Yes. I think that’s a great question and a big misconception, because in my experience, in our experience here at Mayo Clinic, the vast majority of patients want to know what’s going on when they’re having difficulty with memory. There are a subset of people who aren’t aware of their memory problems. But when they are, they typically want answers, because they do want to plan as you said, and they do want to look for potentially reversible causes. And if there’s not a reversal cause, get put on a treatment course to manage the symptoms. And as you mentioned, be able to think about what they want in the future. So, I agree, there is this misconception, but I think when you talk to actual patients, they really do want to know.
25:01 Pamela D Wilson: And then another research statistic I found where the 50% of older adults over 85 have dementia or memory loss, but they’re not diagnosed, is that true and why?
25:12 Dr. Jonathan Graff-Radford: So, there’s some confusing data out there. And so, I think, I always go to the Alzheimer’s Association puts out great data every year. And so, I think if you think about it, by age group that is helpful. So, about 3% of people, 65 to 74 will have Alzheimer’s dementia, that increases to 17% from 75 to 84, and 32% from age 85 and above. And I think where that 50% comes from is this idea that I alluded to early in our conversation It’s that people get the deposition of the amyloid protein and tau protein years and sometimes decades before they have a first clinical symptom. So, if you include people who have these proteins, but have no symptoms, then the number can escalate to that 50% number. But keep in mind, not everyone who gets these proteins in the brain will develop dementia. They may die from something else. And so, I might think more accurately the number is around 30% over age 85. I hope that clears that up.
26:31 Pamela D Wilson: Okay. And then, just quickly, we’ve got about a couple of minutes left, in your opinion, what can the average person do to avoid being diagnosed with Alzheimer’s? And then, if you can give your website page, that would be wonderful.
26:44 Dr. Jonathan Graff-Radford: Yes, great questions. So, I think we’ve already talked about earlier, but there are certain lifestyles that, based on epidemiologic data have consistently been shown to reduce the risk of dementia. Many of those include treating vascular risk factors as we mentioned, high blood pressure, high cholesterol, diabetes. Additionally, there continues to be evidence that exercise, particularly cardiovascular exercise, where you’ll get your heart rate up, can slow down cognitive decline and now that they have very sophisticated ways to measure structures in the brain, they’ve actually shown that if you take people over age 65, and you put them through a cardiovascular exercise program consisting of walking on a treadmill — so nothing too rigorous — you can increase the size of your hippocampus, which is the memory structure of the brain that’s targeted in Alzheimer’s disease. And so, the combination of treating vascular risk factors and exercise can be very potent. And,
27:55 Pamela D Wilson: And then, I hate to interrupt you, but we’ve got to get out to a break. Can you give your website really quick, so we don’t miss that?
28:00 Dr. Jonathan Graff-Radford: Oh, absolutely. So, you can find all of our information at mayoclinic.com and search for the dementia topics under that. Thank you very much.
28:11 Pamela D Wilson: Doctor, thank you so much for joining us. It was such great information; I so appreciate having you with us here tonight. We are headed out to a break; we’ll be right back.
30:38 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, I’m your host, you are listening to The Caring Generation radio program for caregivers and aging adults, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. We’re back talking about my signs for dementia checklist. Are you noticing that aging parents or spouses are forgetting conversations? Do you receive multiple phone calls at work in the same day? Did you tell your parents that you’re going to visit, and when you show up, they’re asking you why [chuckle] you are at their house? Are they forgetting doctor and other appointments? Have you checked the voicemail on their phone? There might be messages there that are months old because they forgot how to check their voicemail. Then, are there little sticky notes all over the house to serve as reminders, because they kind of know that they are starting to forget information? Are you noticing piles of mail or stuff collecting on the kitchen table or in other parts of the house? This means that your loved one may be having difficulty organizing and sorting through mail. It also might be possible that bills are not being paid. Will your parents let you look at their checkbook and credit card statements, just to check?
31:55 Pamela D Wilson: If so, look for checks written to charities, which can indicate poor judgment. Look for bounced checks. Look for unusual charges on credit card statements, or late charges telling you that the bill wasn’t paid on time. Difficulty with math and managing money are very early signs of memory loss that can be disastrous, if important bills like health insurance go unpaid and lapse. I’ve had this happen with some of my clients, and it takes a lot of work to resolve the issues. Then start looking around the house. Was your mom a great housekeeper, and now there’s dust and dirt everywhere? What are you noticing that is out of character? Were your parents usually always neat, and now everything is disorganized? Trash isn’t being taken out? The pets aren’t being cared for? There might be spoiled or dated foods in the refrigerator and in the cupboards. Has your aging parent lost weight? That may tell you that they’re forgetting to eat, even though they tell you that they do eat. Put them on the scale and check out the results. If they take medications, look at the bottle and check out the last order date and count the number of pills. Forgetting to reorder and take medications is very common with memory loss. It may be something that you need to take over managing for them. Are you noticing multiple purchases of the same item stacking up?
33:22 Pamela D Wilson: That usually means that a parent went to the store, forgot that they already had two jars of peanut butter or two boxes of cereal, and they bought more. Speaking of going to the grocery store, how is their driving? Are you noticing dents in the car, scratches, any type of damage? Would you go on an errand and trust your parent to drive you? If not, it might be time to have that conversation. Taking away the car from a parent who has memory loss is traumatic for the caregiver and for the aging parent. That car represents independence. How many of you remember when you got your driver’s permit, and you couldn’t wait to learn to drive? Your parents were probably worried about car accidents and skyrocketing insurance premiums. Today the roles are reversed. You have the same worries about accidents. It’s essential to have a plan for a parent when they can no longer drive. If they give up the car, how will they get to the grocery store and doctor appointments? Will you be that transportation or are there other alternatives? Know that this decision will probably be one of the biggest battles you will have as a caregiver, unless your aging parent has already had a few scares, and they realize that maybe they shouldn’t be driving anymore.
34:40 Pamela D Wilson: Driving and talking about money, these are what I call the hot potato subjects. [chuckle] It’s easy to get burned if you’re not careful how you start these conversations. If you approach either in a blaming or shaming manner, it’s not going to work. Your parent may know that they’re having difficulty, and the last thing they want is one of their children telling them things that they are doing wrong or places where they might be failing. The best approach is a compassionate approach. Something like, “Mom or dad, I know this must be really hard, especially to have this conversation with one of your children. I’m worried about you driving the car, your bills not getting paid, you not taking medications.”Name whatever the issue is, and then ask them what they think about having you help. Something like, “Mom or dad, how would you feel about me helping you with this project?” That is a subject that you might have to re-approach a few times, or give them some time to think about the subject. And honestly, they may even forget. If they do, that tells you that the situation is even more serious than you originally thought. At this point, I would also recommend going to the doctor with them to have memory testing completed and ask to have a referral to a neurologist.
36:00 Pamela D Wilson: Remember our conversation earlier in the show with Dr. Jonathan Graff-Radford, he’s a neurologist from the Mayo Clinic. Specialists are the best at diagnosing memory loss. Your primary care physician isn’t an expert, and the earlier that memory loss is diagnosed, the more proactive everybody can be to make sure that loved ones are safe and that a plan exists for what you are going to do when memory loss gets worse. And at that point, you want to be sure to talk about medications. There are so many mixed feelings about taking medications for memory loss. My personal opinion based on 20 years of being responsible for loved ones is that the medications for memory loss, for dementia, for Alzheimer’s disease, they do make a difference. Some healthcare providers want to reduce costs, and so, they may not want to prescribe. This is an area where you have to advocate, and I do say advocate very strongly. This is the life of your parent or a spouse. Don’t be swayed into not getting the care and the medical treatment and the medications that are needed that can be beneficial for your loved one. After this break, we’re going to continue to talk more about the signs of dementia checklist. A reminder that you can share this program with others. Podcast replays of each week’s show and the show transcripts are on my website at PamelaDWilson.com.
37:27 Pamela D Wilson: You can go to the Media Tab and then The Caring Generation radio program. Please share this show with everybody that you know so that we can make caregiving something that we talk about. You can also follow me on social media, on Facebook, I do daily live videos. You can follow me. My page is PamelaDWilson.page, on Twitter, I am Caregivingspeak, on Instagram, I am WilsonPamelaD. I am everywhere. On [chuckle] LinkedIn you could also find me as pameladwilsoncaregiverexpert. This is Pamela D. Wilson, caregiver expert. I’m your host. You are listening to The Caring Generation live from the BBM Global Network Channel 100 and TuneIn Radio. Please do share the show. Share the podcast with everyone that you know, so that we can make caregiving something that we talk about. We’ll be right back after this break.
40:31 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. Please share The Caring Generation with your friends, family, co-workers, the companies where you work, your social groups, at church, and everywhere. One in four people that you know are caregivers looking for hope, help, and support that is here every Wednesday night on The Caring Generation, and on my website at PamelaDWilson.com. Let’s continue talking about the signs of dementia checklist. In our last segment we talked about the importance of getting a diagnosis so that you can plan for care. Extremely important. But let’s say that you waited too long to go to the doctor, or some sort of accident maybe a car accident happened, and this is what caused you to go to the doctor. You are in one or two stages, and I’m really hoping that you’re in the earlier stage, which I will call scenario A, where your loved one can still have a conversation about memory loss. This is beneficial, because you can talk openly about being forgetful. “Gosh, mom or dad, being forgetful must be awful. I totally understand.”
41:43 Pamela D Wilson: When you can talk about that, then you can talk openly about the progression of memory loss and actually have conversations about what your aging parent or spouse might want for care. And if the estate planning documents don’t exist, now is that time to complete the power of attorney—medical, financial— a living will, or a trust. The reason to have these documents and people assigned to these roles is that eventually your loved one won’t be able to make decisions or express his or her wishes, and the person appointed as the power of attorney in fact will be the person who makes all of those decisions. If you have more questions about power of attorney, visit my website PamelaDWilson.com. Go to how I help, and you can find information on my courses. So, let’s talk about scenario B. Let’s say that you take your loved one to the doctor, and because that memory loss is so advanced, they can’t even follow the conversation about the diagnosis. Your aging parent or spouse, they might be angry, might be denying that they’re forgetful. That can also happen under scenario A, but under B, it’s highly unlikely that they will even want to talk about having memory loss—and reasoning or trying to give details or explain—that doesn’t work. Because by this time, any type of detailed or lengthy conversation is frustrating for them. Because by the time you get to the end of the sentence, they have forgotten the beginning of the sentence.
43:14 Pamela D Wilson: At this point, the brain just can’t process too much information, and this is where the caregiver enters the picture in the signs of dementia checklist. The checklist for the caregiver is to learn about memory loss. Learn everything that you can. Because this is a journey that will test your patience, and on some days, make you feel like you are the person with the memory loss because of all of the stress. I’ve had caregivers tell me that they think that their aging parent is doing things to drive them crazy. These things, like forgetting information, asking the same question, repeating information, they’re not done purposely. This is where the brain just goes haywire. These repetitive behaviors also are called perseveration, and they can occur more often if your aging parent or spouse is feeling nervous or maybe they’re feeling uncomfortable. If you become upset, they will become more upset. People with Alzheimer’s have this sense of upset and danger. It’s like horses have horse sense. They see the look in your eyes, the frustration on your face, the frown on your mouth, and your parent or spouse becomes upset.
44:28 Pamela D Wilson: We’ll talk about how to respond to behaviors in another program in detail, but today we’ll talk about them a little bit. Because behaviors are a whole subject unto themselves, and if you are a caregiver for someone with Alzheimer’s or memory loss, you know this. We can talk about managing repetitive behaviors, and this is called re-direction. When a loved one repeats information, you are better off changing the subject or changing the scenery. Let’s say that mom keeps saying that she wants to go home, when she is home. She’s probably thinking of her parents’ home. A good response would be, “Well mom, tell me about your home,” to distract her. Or you can say, “You know what, I’ll take you home after we eat dinner.” After dinner mom will probably even forget that she wanted to go home. Some more items on the signs of dementia checklist, and these can be signs before the diagnosis, and if not, they will definitely happen after the diagnosis. Your parent was a neat dresser, always wore clean clothing, fingernails clean, mom had her hair set, she wore makeup. Today, they look like they’ve been wearing the same clothes for the past week. There are food stains down the front of a shirt or a blouse. The clothing is wrinkled. Your parent has a body odor, and you’re feeling a little embarrassed. This is actually more about you than them.
45:52 Pamela D Wilson: Another item on the list is they forget to change clothes, they forget to bathe. And if you ask, they will say, “Well honey, I took a shower this morning, I brushed my teeth. What are you talking about?” And you’re thinking, “Oh, I know you haven’t done this. What do I do?” Be patient, be kind, recognize that their memory is faulty, and suggest that maybe you help them take a shower or get some clean clothes out. They will either respond very well to this or they will respond very badly. If there’s any CNAs who work in care communities who are listening, you all know what is about to happen, and God bless you. Your loved one might have a violent reaction saying like, “Well, I’m not filthy. What are you talking about? I changed my clothes. I take care of myself.” Your parent or spouse might feel insulted. Changing clothing and bathing are common refusals of care by aging parents and spouses. Their brain is thinking, “Who are you to tell me that I’m not clean or that I can’t take care of myself? Because I have been taking care of myself my entire life, I don’t need you—my child—telling me what to do.”
47:05 Pamela D Wilson: You, on the other hand, are embarrassed about your parents, you might be thinking, “Oh my gosh, how am I going to get them to participate?” This is exactly why I continue to suggest joining a support group or taking a course. Both are on my website at PamelaDWilson.com. So many caregivers feel challenged, uncertain, and worried about caring for aging loved ones, when all of these unexpected things happen. This is all part of being a caregiver. The more quickly that you can accept that you don’t know everything, the easier it will be for you to seek help. Share The Caring Generation with others. Podcast replays of The Caring Generation are available on my website, at PamelaDWilson.com along with the show transcript, a few days after the show. After this break, we’ll talk more about refusing care, one of the things that happens when caring for a loved one with memory loss. I’m Pamela D. Wilson, your host. You’re listening to The Caring Generation live from the BBM Global Network Channel 100 and TuneIn Radio. We’ll be right back.
51:28 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation radio program for caregivers and aging adults, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. Let’s continue to talk about refusals. Refusing care happens even when memory loss isn’t present. How many of your parents will say, to you, “Oh, I don’t need any help,” when really, they need a lot of help? For persons with memory loss, refusing care is normal. You ask a question, “Are you hungry?” The answer, “No.” “Do you want to take a bath?” “No.” “You look tired, do you want to go to bed?” “No.” If you haven’t guessed by now, the secret is not to ask a yes or no question. If any of you listening are sales people, what do you know? A confused mind says, no. A fearful mind says, no. Convincing a loved one who has Alzheimer’s or dementia to do something that you want them to do, takes them to learn new skills. Imagine this. You’re at the doctor’s office, and your mom or dad has an incontinence accident. Fortunately, you thought to bring clothing, Depends, all of that. But your parent refuses to go to the restroom with you to change.
52:46 Pamela D Wilson: And you’re sitting in the middle of a crowded waiting room. You explain to mom or dad that you want to take them to change, and they throw a fit. Your parent starts to scream and yell. You’re so embarrassed, you want to crawl under a chair or be anywhere else, but where you are at the moment. The other people in the waiting room, they’re looking at you, because they don’t realize your mom or dad has Alzheimer’s. What do you do? You go to the front desk, and you say that you’re going to take your mom or dad to the restroom. But when you come back to your mom or dad, you tell them that, “Oh my gosh, the receptionist told me that we are going to have a very long wait and that you (the caregiver) wants to take a walk, because you have to go to the restroom. And your parent probably already forgot what you talked to them about two seconds ago. This fibbing or this tall tale is called therapeutic fibbing. Some caregivers might see it as lying and be concerned about misleading a loved one. But here’s the bottom line, if a little fib is going to encourage mom or dad to take a walk with you, that gets them to the bathroom so that you can change their clothing and clean them up, then you learn the skill of therapeutic fibbing.
54:01 Pamela D Wilson: It falls right in line with redirecting conversations. The other skill that you will quickly learn is that—telling the truth is not good. Let’s say it’s afternoon, and your mom is worried about getting home from school on time to be home for dinner. The last thing you say to your mom is, “You’re not in school anymore, and your parents are dead.” That would be cruel. Bringing your mom into your world serves no purpose. As a caregiver, your responsibility is to go where your parent is, and if it’s in school, then you say, “Mom, I’ll make sure that you are home in time for dinner,” and you give her a hug. We’ll [chuckle] continue to have more conversations about memory loss on future programs. If nobody has told you that you are amazing or hasn’t thanked you this week for everything that you do as a caregiver or in helping others, let me say thank you. Do something nice for yourself, even if it’s taking 10 minutes to go for a walk, listen to your favorite music, read a book that supports a positive attitude. Caregivers, I have to remind you, you must take care of yourselves, so that you can continue to take care of your loved ones.
55:10 Pamela D Wilson: And caregivers, those of you who work in care communities, it is the same thing, you have to take care of yourself. This is Pamela D. Wilson, caregiving expert. I’m your host, I thank you for joining me on The Caring Generation radio program for caregivers, and aging adults coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. Please do tell everyone you know about the show and the podcasts that are available on my website, PamelaDWilson.com along with the transcripts, a couple of days after the show. I look forward to being with you again next Wednesday night, invite your family, your friends to join us. God bless you all, sleep well tonight, and have a fabulous day tomorrow and a good week until we’re together again.
55:55 Announcer: Tune in each week for The Caring Generation with host, Pamela D. Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone here on Pamela D. Wilson’s The Caring Generation.