When does forgetfulness become dementia?

Having a diagnosis is beneficial because

• the medication for dementia only works in the early stages - so if you leave it until later then medication is not an option
• family can respond to the person appropriately - respect the skills they do have, work round the ones they don’t, communicate effectively (eg “look here’s John” rather than “ooh look who’s here?”)
• you can look ahead and plan for what’s coming next; the person can make their wishes for their future healthcare clear in advance; plan for future care needs; have the conversation about driving and so forth
• you can access what support is available and research financial options so you’re a step ahead.

Getting a diagnosis can take time. Yes it can be heartbreaking, but at least you know what’s what.

Oh no, the anti “label” brigade have moved on from being against diagnosing autism to being against diagnosing dementia? That seems a very strange conclusion to take from this conversation.

Surely having a diagnosis vs not having a diagnosis makes a tremendous difference to the way one approaches an elderly person’s level of care and support in their final years? Not in my experience, no. The care and support system is needs based not diagnosis based.

But there is a big difference between everyday forgetfulness and the degenerative aspect of dementia. Pretty well everything is degenerative in old age, not just dementia.

Oh no, the anti “label” brigade have moved on from being against diagnosing autism to being against diagnosing dementia?

Surely having a diagnosis vs not having a diagnosis makes a tremendous difference to the way one approaches an elderly person’s level of care and support in their final years?

Of course I accept that, for someone in their late 80s, some degree of forgetfulness and cognitive decline is “normal”. But there is a big difference between everyday forgetfulness and the degenerative aspect of dementia.

I can only say when the dreaded penny finally dropped for me. A Dsis had said she’d noticed signs when they were on holiday, but having been through it all already with FiL, I couldn’t face it again.

One day when I was visiting, however, my DM phoned her bank about something. She’d always been very clued up about money, used to check her (modest) shareholdings every Saturday in the paper.

But on this occasion, she could not remember, literally the instant she’d put the phone down, what they’d said. I don’t mind admitting that my heart sank.

Perhaps more tellingly, whereas (as a habitual worrier) she’d normally have been in a terrible tizz about such a thing, within seconds she had forgotten the incident completely.

With normally clean and tidy FiL, the first signs were failing to shave, wearing grubby clothes, and doing daft things like putting tins of soup in the freezer.

I'm just popping on to check that you have both a finance AND a health PoA. They are 2 separate powers and the latter is absolutely vital when trying to establish how (un)well a parent might be.

My DM was always desperate to please the memory clinic and doctors, so would give them the answers she thought they would be pleased to hear, rather than reality.

You mention your DF "reads" the paper. I can forgive him for losing track of who might be the PM if he is "self selecting" articles to read in the paper. Could you try asking him "were you just reading about XYZ, Dad?"

I noticed that my DM (who developed quite severe dementia during lockdown and sadly died) stopped reading books and switched to quiz/talk shows in preference to drama once her memory started to fade. A few years before, the radio would be on, but she wouldn't be following it.

UTI's (prob less common with men, but could it be a prostate problem) along with struggling to sleep could make her increasingly depressed.

Your DF might be secretly terrified.

Sending a handhold

I’m a MH nurse who’s worked for Older Persons Mental Health. In general, a dementia diagnosis requires a low enough score on a cognitive test plus a brain scan (usually CT) showing changes in line with dementia. A frequently used cognitive test is the ACE III with a score of 82/100 or lower normally indicating dementia. I’ve attached a copy of the ACE III for you to have a look at, just for reference really. https://neurovascularmedicine.com/ace.pdf

how much does it bother you / them ?
what would a label do for you all ?

forgetfulness is really normal. Worth getting assessed if it’s troublesome or you would be able to access something you currently can’t.

meds for dementia aren’t really all that good overall so unless person was really keen I wouldn’t bother for that.

optimise everything - new specs and ordinary bugs hearing aids seem to have helped our relative a lot ( needs prompting / teaching re aids every day though 🤣)

we are going through this got a relative - already in care home but looks “ better “ than he is - you can have a really good chat for quite a while till it dawns that you are getting AI like politeness without any “ substance “ which is interesting. Always been watching documentaries - what about - wildlife - tell me more - well what they do - what wildlife - animals. Yknow etc 🤣

reasons why for us - already in a home but as appears “ok” doesn’t get the prompting needed and choices are encouraged that he can’t really make etc. Eg he’s sent to wash / shower but no toiletries are needing replacing after months ….
also forgets can’t walk that well … and I couldn’t drop at outpatients , go and park and expect him to be where he should be 🤣 so we are taking taxis everywhere. Need a blue badge really.

Make sure you have Power of Attorney for both parents.
Good advice regardless.

For us, it was the combination of some of those kind of things ...

No longer using people's names e.g. "your husband did X for me".
Relaying stories about being in local shop & seeing people - which we knew to be untrue. But passed off to us as "news" of what was happening locally!
Lack of logic to normal things e.g. if a pen or book couldn't be found, the immediate response was that someone had broken in & stolen it.
People reported as being "unkind" and not speaking to him - but in reality it was him not paying attention to conversation.
Asking the "wrong" person the "right" question e.g. "how are your kids" asked of the relative without kids.

But then again, knowing what was happening in the news / in his local area, and stories of his youth - perfect.

I'm going back a few years now, but we just knew the time had come that the balance of good v bad days wasn't right. There was a point when we knew we had to seek formal diagnosis, to kick off the care system process.

In terms of what to do ... I think that's different for us all, depending on circumstances. Is it the GP you need, to formally diagnose perhaps dementia? That might be because you're thinking care package, possibly moving him? Or is it more that your mum needs some practical support - or does she not see this and therefore not seeing a need for support / change. Can you have an honest conversation with the both - perhaps on the back of "having read an article" about getting power of attorney sorted whilst everyone is still of sound mind etc

Sending best wishes - sadly it won't be an easy time.

I think that it would be worth a gentle encouragement to go to the GP for some formal tests, this goes through the difference in dementia and normal age related memory changes.
In conversation, if you go off topic will he follow or is it a matter of a great conversation if you stick to his preferred subject? Did he reliably know the grandchildrens names before and sees them regularly enough in small numbers to really reinforce names or does he see a group of children where its easy to lose track a bit?