A recent analysis by the Dementia Commission has revealed that approximately 36% of individuals in England living with dementia are unaware of their diagnosis. This finding originates from a comprehensive new report, which outlines actionable strategies for healthcare and social care practitioners to enhance the early identification of dementia symptoms. Furthermore, the report addresses crucial questions for those who suspect their partner may have the condition: what steps can be taken, and how can this sensitive subject be introduced?
Should concerns arise regarding your partner’s cognitive health and the possibility of dementia, enlightenment on several key aspects will prove beneficial.
Dementia is not a singular disease but rather an umbrella term encompassing a spectrum of conditions (such as Alzheimer’s disease) that progress over extended periods (months to years). These conditions manifest as impairments in memory and reasoning faculties, challenges with communication, alterations in personality, and a diminished capacity to manage day-to-day tasks like shopping, personal hygiene, financial management, or meal preparation.
The presentation of dementia is highly individualized; therefore, understanding what constitutes normal behavior for your loved one is paramount. Observing a formerly meticulous and organized individual begin to falter presents a distinctly different scenario compared to a person already prone to absentmindedness becoming slightly more so.
While emotional distress and stress can temporarily affect memory, they do not necessarily signify the onset of dementia. However, these factors can also obscure the initial signs of dementia, a phenomenon termed “diagnostic overshadowing.”
Cognitive changes are also a natural part of aging. For instance, older adults generally require more time to learn new information. Yet, a singular event, regardless of its magnitude, does not automatically equate to dementia. The focus should be on identifying a consistent pattern of cognitive decline.
If these observed changes occur rapidly, within weeks or days, it is improbable that dementia is the cause. Such a scenario warrants immediate medical scrutiny due to the possibility of a more serious underlying condition.
A Prevalent Apprehension
Dementia is frequently cited as one of the most significant fears of our era. The dread associated with a perceived loss of self can inadvertently lead to avoidance of the topic, unproductive discussions (characterized by criticism or unintentional embarrassment), or discussions held with other family members rather than the individual exhibiting changes.
Over time, such approaches can erode trust. It is generally most effective to address memory concerns openly with the individual, either at the moment a memory lapse occurs or if they themselves broach the subject. This approach undoubtedly requires fortitude and necessitates confronting one’s own vulnerabilities.
Occasionally, an individual may exhibit denial or a lack of insight into their memory difficulties – a symptom that can be indicative of dementia, though not exclusively so. If someone expresses concern about their memory, it is strongly advised not to dismiss their feelings, as admitting such concerns often demands considerable courage.
An anecdote illustrates this point: a relative remarked to my mother, “Oh, you left the stove on. I misplaced the car in the multi-story car park the other day.” My mother was experiencing dementia; the relative was not.
When an individual is resolute in their denial of concerns, the situation becomes more complex. A potential strategy involves stating, “I understand you are not concerned, but I am, and I was wondering if you would consider consulting a doctor to alleviate my worries?”
Furthermore, explaining that memory difficulties can, to some extent, have reversible causes underscores the importance of a medical consultation to rule out such possibilities. It can also be constructive to ask the individual, “If there is an issue with your memory that will progressively worsen, would you wish to be aware of it?” (The majority of individuals respond affirmatively to this question).
Consulting a General Practitioner
Should your partner agree to a consultation with a General Practitioner (GP), preparing beforehand by maintaining a week-long journal detailing memory-related (or other) issues, the circumstances surrounding them, and their impact, can be highly beneficial. This record can then be shared with the GP to facilitate their understanding of the situation.
Upon hearing even the suggestion of dementia, individuals are confronted with the profound uncertainties regarding their future: what they stand to lose, what they can retain, and what their ultimate circumstances will be. These anxieties are frequently shared among family members. However, research indicates that the positive outcomes associated with a timely diagnosis ultimately surpass the initial fears.
Concurrently, memory impairments or confusion often give rise to ongoing stressors. These challenges can complicate daily life, strain familial relationships, and make mutual support difficult.
Maintaining transparency and open communication is the most prudent course of action. Expressing a commitment to face challenges together, offering support, and resolving to confront whatever arises can be immensely helpful. If resistance is encountered, it may be beneficial to identify another family member who might be better positioned to assist the individual.
Kate Irving, Professor of Clinical Nursing, Dublin City University
