Throughout the year, News Director Eric Douglas has been reporting on caregiving issues involving older parents in a series of stories called “Getting Into Their Reality: Caring for Aging Parents.” Coming into the holidays, when families come together, it might be a good time to pay attention to the signs of the onset of Alzheimer’s and dementia.
It’s important to note that Alzheimer’s and dementia can affect anyone. Ronald Reagan had Alzheimer’s Disease. Sandra Day O’Connor retired from the U.S. Supreme Court to care for her husband who had Alzheimer’s. Just last week, she also died from complications from the disease.
Douglas spoke with Teresa Morris, program director for the West Virginia chapter of the Alzheimer’s Association, and she outlined the 10 signs to look for.
This interview has been lightly edited for clarity.
Douglas: What should I, as a family member, know or be on the lookout for? What are some of the early warning signs?
Morris: The Alzheimer’s Association has 10 warning signs that we have established and that most physicians use as a precursor to more testing.
The first would be memory loss that impacts daily life. Maybe the person starts forgetting important dates, or events, they might forget a doctor’s appointment.
Douglas: It’s not just dropping a word, right?
Morris: Maybe you’ve told the person that they have a doctor’s appointment tomorrow, and you’ll be there at nine o’clock, and you get there and they’re still in bed, because they don’t recall you telling them that they had a doctor’s appointment.
We’re going to look for challenges in planning and problem solving. Maybe someone starts having trouble with their bills, someone that has always kept their checkbook pretty tight, and then all of a sudden, you go in, and there’s a stack of bills. And they’re just not able to process or be able to complete the functions of, oh, this is a bill, I need to write the check.
Someone might start having difficulty completing familiar tasks, and that might be organizing a grocery list, it might be needing help with the TV remote. Now, I often need help with the TV remote. But we’re talking to someone who used to be able to turn their TV on, get to the channel they want, or now they can’t turn their TV on.
They might start having confusion with time or place and getting confused about the day of the week or not knowing the exact date. That’s normal. We all do that. But these folks can lose track of important dates, even of the seasons, like they have trouble with passage of time.
They might have trouble understanding visual images and spatial relationships. So they might start having trouble with balance and even reading.
Douglas: We’re talking depth perception?
Morris: We’re talking about depth perception, we’re talking about judging distances, we’re talking about determining different colors and contrast. So these folks might even start having some trouble managing stairs, because they don’t see them like you and I would.
They might have trouble walking through thresholds, like maybe from carpet to tile on the floor. That change of flooring might throw them off a little bit. You might see a few falls because of that.
New problems with words and speaking and writing. You’re going to notice that these folks have trouble coming up with the words that they’re wanting to say. They might stop in the middle of a conversation, sometimes, because they really have no idea how to continue. They maybe have forgotten what the topic was.
Douglas: We’ve all lost our train of thought, but they just get lost. You can see the confusion in their eyes.
Morris: I always say, with any of the symptoms that I’ve talked about, it’s when those symptoms start impacting a person’s ability to function independently.
Douglas: I think that’s an interesting distinction as a family caregiver. I’ll forget a word. You forget a word that you know clearly, right? But that’s not what we’re talking about.
Morris: Say your mom, who has cooked her whole life, and all of a sudden she’s not for sure how to express that she’s cooking biscuits. They might become something else. They might become flour rolls. But again, not something that happens once a day or even twice a day. But when it is severely impacting a person’s ability to communicate. So these folks will also start having trouble finding things or they start losing things. You and I do it all the time, I cannot find my phone. But if I retrace my steps, I know what I’m looking for.
These folks might lose something. And they might walk into another room, but then they forget what they’re looking for. Or they can’t retrace their steps at all. They may accuse people of stealing, but it’s really they’ve put something somewhere, and nobody can find it.
Douglas: I’ve heard that story. I’ve not dealt with that personally, but I’ve definitely heard those stories. Even if you have a part-time caregiver coming in and, “That person stole this from me.”
Morris: These folks are going to start having decreased, or very poor, judgment in their finances. They might start paying less attention to their grooming, and keeping themselves clean. They don’t see why a bath is important. They don’t see why paying their bills on time is important.
I think this is where some of these folks become victims of some of the elder or the geriatric scams out there. Someone tells them, “Oh, you need this or this is for your daughter,” and they’re like, “Oh, okay.”
Douglas: I saw that with my mom where she got these amazingly convincing-looking letters in the mail. “This is important.” It was a scam. It was trash. It’s disturbing how often that happens, actually.
Morris: And sadly, especially in these early stages, someone who’s starting to show, they probably know something’s a little bit wrong, but they don’t want anybody else to know. So they’re not telling you, “Oh, I just paid $3,000 to Publishers Clearing,” or whatever, because they don’t want you in their business.
Douglas: I’ve seen that too, actually.
Morris: The last two signs are withdrawing from work or social events. And a lot of that is because these folks can’t engage in conversation like they once did. And they recognize that, so they don’t want to be a part of it. It’s the embarrassment again. They’re having trouble thinking of the words they’re trying to say. They might not be able to follow the conversation. So they just naturally withdraw.
The last thing we talk about are changes in mood and personality. Oftentimes, when these changes are happening, especially in the early stage, they become maybe confused, they become agitated, they might be fearful, they might be anxious, and those characteristics would be new to the person. If someone has typically been a little sad and a little anxious their whole life, then that’s not necessarily a change, right?
But if you have someone who wasn’t exhibiting those characteristics, then that’s when it’s time to think maybe something’s going on.
Douglas: Say I’ve seen, hypothetically, six of these things, what do I do?
Morris: So your first first step would be to go to your family doctor. Just talk to the doctor. Tell them what you’re seeing in the person that you’re talking about. And then the doctor should run some physical tests, make sure it’s not a urinary tract infection. Make sure lab work, everything is good. Make sure there’s no vitamin deficiencies. Make sure blood pressure is OK. Those things need to be cleared.
They’ll rule those out, and then we know, “OK, maybe this is a cognitive issue.” At that point, most family doctors have the ability to do what we call cognitive screen. Maybe ask questions of the family member, and get an idea if their issues are leaning toward dementia. Some family doctors will treat someone with early stage or mild cognitive impairment. But you really probably need to get to a specialist who specializes in dementia, specializes in dealing with dementia, because there are some tests that a doctor can do to narrow down the type of dementia that someone has.
Douglas: There’s no cure for this decline, but there are some medications that will slow things down a little bit or help out a little bit.
Morris: We do not have a cure yet. We have stepped into this era of treatment really just last year, that we are seeing some treatments and therapies that are promising in dealing with someone with Alzheimer’s, true Alzheimer’s.
Currently, we have some treatments on the market that address the symptoms of the disease. They don’t do anything with the biology of the disease. These new therapies are given intravenously. You have to be at a specialty center. There’s a list of testing and markers that have to be discovered in a person before they’re even eligible for the treatment.
