Others, like seed sown on rocky places, hear the word and at once receive it with joy. –Mark 4:16
There was no end to all the people who were before them. But those who came later were not pleased with the successor. This too is meaningless, a chasing after the wind. –Ecclesiastes 4:16
Happy Friday to all! We have swashbuckled our way through the pirates of the week with gusto and now stand at the edge of the weekend, parrot on shoulder, with a smile….or do we?
I was just thinking about dementia on the way to work today…go figure! Have you ever wondered just how much a loved one with the disease truly knows what is going on? I am sure you have if you are like the hundreds who ask me the question on social media and other places. Isn’t it intriguing that we have to use our brain to tell if our brain is acting up? That would be like having a messed up car computer and using diagnostic tests that check with the car computer to determine what is broken. You have a semi-reliable or unreliable witness. Further, since it is a huge issue today in dementia, in caregiving, and in like during COVID, I directed my attention to depression as well as I drove.
So, can a person who is demented truly tell they are demented and can a person depressed truly tell they are depressed? This is a matter of debate…intense debate at times. First, I want to give you some self-study, because I am NOT a psychiatrist, a psychologist, a pastor, or an expert on much in this world. I am closer to this:
Here are some helpful links on depression:
Here are some interesting links on the general topic of Anosognosia (denying one is sick) and others on whether you know or don’t that you truly have dementia and how to address the topic:
There are hundreds of great articles to be found on these two conjoined at the hip topics. It is worth your study time, it truly is.
Here is my opinion, worth exactly if not less than the price of visiting my blog. My “answers” are a little back and forth because of how the topic intertwines a little, so forgive me if they seem slipshod:
- Quote from this link: “There are cases where people don’t recognize anything is wrong. You may hear this referred to as anosognosia which is thought to be the result of cell damage in the right pre-frontal lobes and the parietal lobes. This can happen during a stroke or as cells decline due to Alzheimer’s and dementia.” Application: In both the case of dementia and depression, there are physical elements involved. (Note: Dementia is a degenerative, physical condition that is not technically the same as a mental illness, but they share some things…). Please tread lightly in thinking someone either doesn’t know or doesn’t want to know and is in denial. In many cases, the decision whether to know or not is out of their hands.
- Compounding this, from the same link, :”Convincing someone there is a problem won’t make them believe you, so try to avoid arguing. It doesn’t help them understand the situation, and can also lead to agitation, distrust and fear – all common side effects of Alzheimer’s and dementia.”
- Stages/progression varies by the patient. It varies in a way that isn’t always easy to see as well. One day he/she may appear better than another day, but that may be appearance or reality.
- I believe it is critical for the loved one to be able to continue doing anything they used to do as long as they can do it safely. This, to me, slows the symptoms of the disease and helps with ensuing depression. Example: If they can fold laundry, even imperfectly, let them. There are a million examples. Here is a website that I helped with in a small way through Trial Match that addresses a few major concerns in this area: Safety Link
- I feel safe in saying that it is better, in dementia, to assume they know more than less. Empathize as if it is so. Treat him/her with dignity and respect, not as a child but as an honored member of the family.
- Anosognosia can and does cause people to feel as though they do not need to take valuable meds. Be prepared and have solutions. My mom tried to stop taking her meds several times, not necessarily because she felt as though she didn’t need them, especially later in the mid-stage of the disease. She was certainly confused earlier as I discussed in this sad piece: Article. We ended up pureeing her meds into pudding and/or yogurt with no problem since. These meds, while imperfect at best, are the best we have in some cases, to mitigate the symptoms and help enhance their quality of life.
- Always attend all doctor’s appointments when there is a concern. Always. Here is one reason why: LINK “A recent survey of old age psychiatry consultants showed that most of them “rarely” or only “sometimes” informed their patients about the diagnosis and almost never about the prognosis. Providing information seemed to depend on the level of impairment. In all, 38% of consultants “nearly always” informed patients with mild dementia, but in those with moderate and severe dementia, only 13% and 6%, respectively, discussed the diagnosis with their patients. However, 98% of the respondents “nearly always” informed patients’ families and carers about the diagnosis and prognosis.1 Similar practice has been observed among geriatricians, although they tend to tell their patients with mild dementia more and their carers less than psychiatrists do.2
- Since experts don’t agree on how many people know what is going on in these issues, we have to make assumptions. Assuming they know too much can be dangerous. Assuming they know too little can be dehumanizing. Empathy will guide you.
- In depression, stay involved. Ask questions. Empathize, don’t inadvertently criticize. Don’t assume it is just a funk they are in or that it will be something that will go away on its own. Ask for help or ask them for permission to help them get help….and keep asking.
- Depression in Dementia is common and can certainly lead to suicidal thoughts and actions. Never discount statements made stating such. Here are some worthy links for your perusal: Link Link Link Link Link
- Depression can certainly be an indicator or dementia and likewise. (Link again)
- I think we have a much better handle on recognizing that we have depression. While it can be debilitating, it isn’t typically the hide-and-seek champion that dementia tends to be in our own minds. Other mental illnesses can be harder for us to recognize, but the warning signs of depression are universally recognizable.
- Depression, however, does a better job of hiding its extent than its existence whereas dementia hides all. There is a difference in being sad and being clinically depressed. Often it takes help to find that line…but once you do it is as clear as can be.
I would love your take on these topics…please comment below. I want to hope mom isn’t sad over her dementia. I hate her being sad for any reason. We simply need to redouble our efforts to cut off this at its roots and #EndALZ once and for all!
Update: I had a nice visit with mom on Thursday. It was short, but she stayed awake for the most part. Honestly, I fall asleep when listening to me talk too sometimes, so I get it. She had a little bit of a wheeze, but not as bad as some days. She is about the same as she has been…wonderfully oblivious to the dangers of the world, the pandemic, and the rest of the nightly news. As much as I hate this for her, she is not in pain and is relatively happy awaiting her eternal home and reward, so there are worse case scenarios for sure…
Fundraiser update: I will shoot to restore my pace on running tomorrow. 🙂 It may be in the stinking rain, though. I just can’t do 22 miles on a treadmill…I have my boredom limits. The fund is up to nearly $2000 ($1850+$85) now on a goal of $5280. Got an extra buck, two, or thousand? Here is the link to read more or to unleash the funds: LINK
Thank you all for a great week and for your love and support. 🙂 Oh, and speaking of support, our virtual support group meets Tuesday. The next month we may shoot for an in-person version too. 🙂 We are working on it. 🙂