Family matters | What to do when memory loss goes beyond normal

My 83-year-old dad keeps misplacing things. Plus he can’t remember what he had for dinner last night, and he appears more withdrawn. As his adult daughter, should I worry that he is developing dementia? — S.H., Berkeley

Most of us baby boomers worry about whether our parents have or will develop an Alzheimer’s type of dementia. While we all have periods of forgetfulness throughout our lifetimes, as our parents get older, the concerns about “not remembering” can become more heightened, leading to fear and anxiety.

It’s important to realize that some normal forgetfulness comes with aging. Our bodies — including our brains — are changing, and the older we get the more accelerated these changes can appear. According to the Alzheimer’s Association, almost 40 percent of people older than 65 experience some form of normal memory loss.

Memory stealers are everywhere. Fatigue, stress and insomnia can wreak havoc on our ability to recall and function optimally. Having too many balls in the air or being overextended can contribute to “benign” forgetfulness. According to the American Medical Association and Harvard Health Publications, normal forgetfulness is neither progressive nor disabling. For example, while occasional word-finding difficulties may occur, one’s independence, ability to operate common appliances and social skills remain intact.

On the other hand, dementia is not a normal part of aging. According to the World Health Organization, in 2010 there were 35.6 million people affected by dementia worldwide. This number is projected to nearly double every 20 years to 65.7 million by 2030. The total number of new cases every year worldwide is 7.7 million: a new diagnosis every four seconds.

Dementia is not a single disease, but a term used to describe symptoms of certain neurodegenerative diseases like Alzheimer’s disease, frontal temporal dementia, vascular dementia and many others. Dementia is characterized by getting lost in familiar places, not being aware of memory loss, inability to operate common appliances, and personality changes such as socially inappropriate behavior. When someone is experiencing dementia, independent daily functioning will be compromised.

If you are concerned that your dad is experiencing some of these symptoms, the first and most important step is to have him see his primary care physician. A medical evaluation for dementia is very extensive and will involve a neurological evaluation along with lab work and brain imaging studies. Neuropsychological testing will evaluate memory, judgment, problem-solving and areas of thinking.

The constellation of dementia symptoms indicates that someone is ill, but not the reason behind the illness. Some dementia symptoms may be reversible if the underlying causes are associated with medication interactions, lack of compliance with medications, depression, vitamin deficiencies, thyroid problems, brain injury, tumor or infections.

If reversible dementia is ruled out in your dad’s evaluation, then the next step is to get an accurate diagnosis, which will help determine the appropriate ways to manage his treatment. Seek out experts and information from your local provider, the UCSF Aging and Memory Center (www.memory.ucsf.edu), the National Institute on Aging (www.

tinyurl.com/nia-other-dementias) or the U.C. Davis Alzheimer’s Disease Center (www.alzheimer.ucdavis.edu/faq/tests).

Once a diagnosis is obtained, it’s important for the person with dementia and their caregivers to get fully educated about the specific type of dementia that has been identified by the physician. The person with dementia will need extensive support, and it’s often a good idea to do a depression assessment.

While ongoing reassurance is provided, the next step for the professional is to empower the patient and their caregivers in developing short- and long-term care plans. Getting these in place early will ensure that the patient’s wishes and desires for medical management will be fulfilled. A geriatric care manager can often be of help in working with family members to develop these plans.

Of particular importance is organizing legal documents such as power of attorney, power of attorney for health care, an advanced directive and a living will. Through these documents, a person with dementia will express how he or she wants to be treated in future medical situations.

During this difficult time, it is important for you as a caregiver to try to understand the emotional needs of your loved one with dementia. People with dementia can still thrive with positive, supportive relationships and community engagement. When we are loved and cared about no matter what our state of health, we feel whole, with a sense of security and peace. This positive interpersonal approach to people with dementia sustains quality of life and inspires hope.

Remember, too, that there is lots of help out there for caregivers. Stigma around dementia is still prevalent in our society, often compounded by ageism. All of this can cause family members to self-isolate. Let yourself find and accept support. You don’t have to feel alone as you begin this process of caring for a loved one with dementia.

Rita Clancy, LCSW, is the director of Adult Services at Jewish Family and Children’s Services of the East Bay. Her columns appear in J.’s Seniors sections. Have questions about your aging parents? Email rclancy@jfcs-eastbay.org or call (510) 558-7800 ext. 257.

Rita Clancy
Rita Clancy

Rita Clancy, LCSW, is the director of adult services at Jewish Family & Community Services of the East Bay. Have questions about your aging parents? Email rclancy@jfcs-eastbay.org or call (510) 558-7800, ext. 257.