MILD COGNITIVE IMPAIRMENT – NOT ALWAYS EARLY DEMENTIA

“I think mom might have early Alzheimer’s disease” says the worried son. “I saw the other day that she had left the burner on the stove on, and walked into another room.” I wouldn’t worry too much about one incident the dementia specialist said, “sometimes I do things like that myself.”

The dementia specialist is over sixty-five herself, and knows she has a problem with distraction. As a person ages they begin to become more easily distracted. The classic story is always about walking into a room and forgetting what you are there for. If someone talked to you while you were going to get something, or you answered the phone on the way, you became distracted. I frequently remind people of times they might have forgotten where their car was parked.

The concerned son should keep his eyes open for other changes. How is his mom doing cooking? If she always was a great cook and made many things from memory, and still does, nothing to worry about there. If on the other hand she now has problems with things like measuring, getting confused with familiar recipes or putting together a meal, these could indicate a problem.

If his mom always followed the news, and now seems to be having trouble remembering news and recent events, this would indicate a problem. The problem comes when there is a change. If the person never was interested in the news, this is just in line with their personality.

If mom never was much for handling finances, then her lack of money sense is just her. However if mom always knew the price of everything on her shopping list, and now shows problems with handling money, it is time to take a close look.

If mom knows what day it is, doesn’t get lost in familiar places and recognizes people around her, and there are no other noticeable changes, then the stove incident was a simple lapse. Yes, a potentially safety issue, and mom should be as concerned as everyone else that she had this lapse. She should vocalize, that she will make an effort to focus more on what she is doing. But if there are indications in the kitchen that there have been other safety events. Such as burned cutting boards, charred pots, pans, cooking utensils, or possibly missing items because they were discarded after an incident. It is now time to closely monitor mom.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

READING BETWEEN THE LINES, IS THE REAL STORY OF ALZHEIMER’S DISEASE

“Harvey died just before Thanksgiving,” his widow wrote, this is his story.

“Harvey showed signs of memory loss three or four years ago. Then after Christmas last year it got worse. In April he fell off our front step and all tests were negative, then it seemed to escalate. Through the summer the nights were really bad. Pills were not working. The month of August after what seemed like hundreds of phone calls we found a care center. Harvey had two good months there. Then one night he wanted to get up to go to the bathroom. Afterwards, the staff took him back to bed and he died in his sleep. What a blessing!”

One brief paragraph, nine short sentences, not really enough to tell the story of Harvey. But maybe it is, his story is like so many others.

Just a few years when the family identifies his memory loss?  We know he was struggling for longer than that. The time of mild cognitive impairment, when the person is mildly confused, yet functioning, can be many years. Years when the person doesn’t need any help dressing, bathing, eating, but might be having trouble remembering a word or an event. He could remember how to drive the car, and as long as his wife was giving him directions, they didn’t get lost. By having a routine to life and sticking to the routine, it makes it harder to see the changes, they just creep up on you.

The 3-4 years of memory problems she remembers, was most likely when his struggles were becoming more obvious. Especially if other people now noticed. Having a fall, any injury, infection, anything to change the normal routine tends to escalate the symptoms. And the person no longer bounces back to their previous level of function.

Pills were not working. No, medications for Alzheimer’s disease tend to only help for a period of time.

Nights were really bad. So many people caregiving for someone with Alzheimer’s disease come to that place where they are looking for a care center because the nights are bad.

But it wasn’t all bad. Between these few lines you know there were holidays and birthday celebrations. Grandchildren were born and many family get togethers were enjoyed by Harvey. The elderly couple enjoyed going to a movie, or out to eat. They were faithful members of their church, where Harvey was well known. He died at the age of 85, and only lived those last two months in a nursing home.  What a blessing!

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

ARE YOU AFRAID OF LOSING YOUR MEMORY? NORMAL AGING MEMORY LOSS

You can’t remember where you parked your car!  You arrive at the shopping center with your friend. You park, walk in, and are in conversation about where you might want to eat lunch. Hours later, when returning to that store, you don’t remember which door you came in. Not only that, once you remember the door,  you walk outside to try to get your bearings, and you still have no idea where your car is. Lucky for you, you have a key fob and can locate your car by the beeping horn.

In the same way, you may constantly be searching for; keys, pen, glasses, cell phone, pretty much anything a person lays down without thinking. You start wondering if you have Alzheimer’s disease. You start to question yourself, and worry about past lapses in memory.

The truth is, that as we age we can start to have problems with distraction. The memory is like a bank, you make deposits and when you need that information you make withdrawals. In this scenario, you never made that deposit into your memory bank. Due to the distraction of talking to a friend you never made a mental note of where you parked.  Which door you came in, and what merchandise was located at that entrance.

The inability to think or reason your way out of this situation could be a sign of mild cognitive impairment, but could more likely be due to stress. The awareness that you are having trouble focusing, and thinking through this problem are good things. Awareness is a good thing. When a person no longer thinks things through, weighs the pros and cons, uses critical thinking and their common sense seems to be out the door, that is the loss of reason. Losing the ability to reason, is cause for concern, not occasionally forgetting where you parked.

So should losing your car in parking lot, lead you to making an emergency appointment with your doctor? Probably not, what is more telling is how you handled it.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

MILD COGNITIVE IMPAIRMENT AND REASONING

Dorothy is 80 years old and anyone would say she looks just great. Today she is volunteering at her local nursing home, as she has done for the last 15 years. Her hair looks perfect, her clothes always matching and becoming. She has her usual great smile and good humor for all of the residents.

However there had been a particularly bad snow and ice storm the night before. A nurse seeing Dorothy remarked that she was surprised to see her out on such a bad day. Dorothy seemed unfazed by the weather. “Aren’t you afraid of falling?” the nurse asked. Oh no, Dorothy assured her she never falls. Looking down at Dorothy’s feet the nurse commented on the dress shoes with 2 inch heels,  Dorothy was wearing. Pointing to all of the snow and ice patches still on the driveway, the nurse asked why she was going out in those shoes. As the conversation continued it was clear that Dorothy was not connecting the dots between safety, caution, weather, common sense and those very pretty and impractical shoes. In fact, Dorothy showed signs of losing her good humor, if pressed on the subject.

Mild cognitive impairment is considered a condition that might indicate that the diagnosis of Alzheimer’s disease will be next. It is considered a condition that really doesn’t interfere with normal life or activities. Mild cognitive impairment may improve, stay the same or progress. Mild cognitive impairment involves issues like searching for words, losing your train of thought in a conversation, mild forgetfulness, feeling sad or overwhelmed. Many things can account for these such as poor diet, anxiety, depression and especially loss of sleep can cause many of these problems in the elderly.

But the decline in reasoning and judgement are particularly worrisome. Reason involves thinking through a problem and coming up with a solution. It involves higher thinking abilities such as applying logic, verifying facts and making sense of a situation. When the loss of judgement or reasoning skills is lost, this now does interfere with normal life and activities. The loss of reason can have consequences, like Dorothy in her pretty shoes sliding around on ice.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing