How Do You Know It’s Dementia When Dad Can Still Do the New York Times Crossword?

The onset of early dementia is not always obvious. Especially when your loved one is smart and can compensate for memory loss, or is clever and determined to hide symptoms, it can be difficult to know whether what seems “off” is really so.

Maybe your dad has always been a dapper dresser, and you notice him wearing a stained shirt on more than one occasion. When you mention it, he shrugs it off and says he’s having his eyes checked next month (despite the fact that he has no trouble surfing the Internet on his smartphone).

Or your mom, ever the vigilant money manager, who always paid bills ahead of time, has some unopened, month-old invoices on her desk. You point them out, and she laughs and informs you she’s now paying online (even though she’s always mistrusted online fund transfers).

Or perhaps your great aunt, the most punctual person you have ever known, comes late to a luncheon date without calling. Once she reassures you that she’s fine, she explains that she misplaced her car keys and also missed the turn for the restaurant (where you always meet).

How Have Things Changed?

For all three scenarios, the explanations may seem logical, possibly true. But if the incidents repeat often enough to indicate a pattern of unusual behavior, it’s time to be more vigilant about the real chance that something more serious is at play.

At the crux of the issue is determining how your loved one’s behavior has changed relative to what has been normal for that individual. For someone who is smart and able, the changes may be subtle. And even if there are notable changes, he or she may be able to compensate creatively and still be able to do the New York Times crossword. Then the question becomes how much loss of ability is too much.

For example:

Can he still manage his own medications? Warning signs include a pill minder box with lids open out of order, pills not taken that should have been, or empty pill bottles that have not been refilled.

Does she leave bills unpaid or stacks of mail unopened? Especially for someone who was once very organized, increased clutter can be a warning flag. Missed payments, tax returns that were never filed, a bank account that hasn’t been balanced in months—all add up to a decline in cognitive functioning.

Is he at risk driving? Aside from slower reflexes, declining sight and increased fatigue—all good reasons to have driving skills evaluated—your loved one may evidence poor judgment, confusion or forgetfulness, all of which could endanger his safety and others on the road.

Has her appearance changed? Again, the standard of comparison is how your loved one normally presented herself to the world. If she always wore meticulously applied make-up, had every hair in place and dressed impeccably, and now seems less attuned to her appearance, she may have decided that she doesn’t want to bother with it all anymore. But she may also be less aware.

What’s at Stake for You?

Recognizing that your loved one is declining brings challenges beyond mere observation. There is a significant emotional hurdle to overcome: recognizing that your aging parent is vulnerable, admitting to yourself that his or her time on earth is limited, accepting that the status quo no longer works. You may have a lot of other demands on your time, and the idea of taking this on can seem overwhelming.

It can also be extremely difficult to confront your loved one with your observations, depending on the history of your relationship. A parent who has always maintained the upper hand, who insists on control, or who is belligerent and critical when challenged can be a nightmare to deal with.

For all of these reasons, if you suspect that your loved one is showing signs of dementia that could put her at risk, consider having an Aging LifeCare Professional® conduct an independent assessment. This information can provide the basis for informed—and mediated, if necessary—discussions with your loved one about next steps. And you may be surprised that you’re not the only one who is relieved to finally address the issue. Your loved one—whether or not she admits it—may be, too.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care® manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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