Dementia: “Of all the things in life I’ve lost, I miss my mind the most…”
By Greg Grafton, RN, BSN, MBA, Texoma LIVING WELL Magazine
For most of us this late night show one liner is sort of funny – we still have our health, our mind, our sense of humor. For some of us who have started catching ourselves not only forgetting where the car keys are, but when we find them we have trouble remembering what to do with them, it can be very scary.
Not too long ago my wife answered our front door to greet a local peace officer who asked if she knew the elderly lady next door. She stated yes, and asked, “Is she okay?” He stated she appears to be okay, but she thinks someone has stolen her car keys. My wife said, “That’s terrible, I will go over and talk to her right away.” To which he replied, “That’s good, because she thinks you did it.”
Many times family members don’t become aware of these changes until mom becomes lost in a town she has lived in her entire life. I worked with a psychiatrist who did his residency in Charleston, South Carolina and he would tell the story of a patient’s son who brought mom in and stated, “Hurricane Hugo made my mother crazy.” It wasn’t the hurricane that “made her crazy”; it was the need to break outside of her routine. As she lost mental function her world became smaller and smaller. She stopped venturing out and only went to places she was sure of like church, the grocery store, drug store, etc. When the hurricane was imminent and the evacuation was announced, she had to make plans, pack, board up the house and find a place to stay inland. That’s when the son realized mom had changed.
The hallmark symptom of dementia is developing significant problems with memory. Dementia is not a disease, but rather a group of symptoms that can include loss of mental functions, memory loss, problems with reasoning, judgment, emotions and personality to the degree that daily life is affected. Some dementias are very treatable, close to being curable, while others are a slow progression or decline that some call “death by inches.” Both the blessing and the curse for someone with the progressive dementia is they will get to the point they lose all awareness and “lose their mind.” With this dementia, the primary treatment is to slow down that progression as much as possible, trying to keep the person functional as long as possible. It’s truly the family member witnessing this decline who will continue to suffer.
There are more than 50 causes of dementia with the most common being Alzheimer’s disease. Determining the type of dementia occurs through a coordinated effort of health care providers with the doctor at the head of the team. Dementia can be very confusing because two people with the same cause of dementia may present very differently. Caregivers can really struggle with the diagnosis because the brain has good moments and bad. One day mom is great, just like herself, then the next day she is a total stranger. These changes can be through the day, good in the morning, then “sun down” in the early afternoon. Discovering the cause helps develop the treatment plan.
Typically it is your family physician who initiates treatment for most patients with dementia. As the symptoms progress and the patient exhibits more acute behavior such as hallucinations, delusions, paranoia, manic type behavior or severe depressive symptom is when they are typically referred to a psychiatrist. Having dementia does not necessarily qualify one for inpatient behavioral health treatment. It’s the disruptive behavior caused by the dementia that requires inpatient treatment. When behaviors place the patient in danger of causing harm toward themselves or others, such as when mom thinks everyone “is out to get her” and she barricades herself in the house, stops eating because she thinks someone is trying to poison her, or dad becomes convinced at 85 that his wife is having an affair and becomes combative, then inpatient hospitalization is often needed.
When this crisis arrives, the professionals at Texas Health –WNJ’s Behavioral Health Services are here for you and your family member 24 hours a day, seven days a week. Our team is trained to help handle this crisis. We are a new inpatient Behavioral Health Unit with 20 private rooms. We can provide a safe, therapeutic environment where our team of physicians, therapists and nurses will coordinate a plan of care with you and your loved one to improve mental function. Call 903-870-7322 to learn more about our services.
Author Greg Grafton, RN, BSN, MBA, is executive director of Behavioral Health Services at Texas Health Presbyterian Hospital®–WNJ.
