Dementia gradually changes the mental state of the afflicted person over time. In the early stages of the illness very little seems wrong, perhaps just the suggestion of some memory difficulties. As months pass there may be very little if any noticeable changes. Then one day, something new develops that wasn't previously observed. Maybe the memory problems have worsened or some new issue has developed. Whatever it is, it becomes a new item that is now part of the overall condition. My mother's doctor has characterized this situation as a "new phase" of her illness.
These "new phases" occur at different intervals for different people. The changes can occur over a long period of time or just a matter of a few months. The introduction of medications can resolve some troubling issues in these new phases. If delusions or hallucinations develop, a drug therapy may resolve this trouble for some. This has been helpful in my mother's case and has restored her mental clarity and cognitive ability, while reducing the scary hallucinations and delusions. It hasn't resolved the false beliefs, but it has made her life much calmer and eliminated the fear that had dominated her thinking for over a month.
There are also false phases to contend with. These can be attributed to a number of different reasons. Among some other possible causes, a change in thyroid hormone levels, a drug interaction, a urinary tract infection, dehydration, or a change in medication effectiveness, can lead to behavioral changes or physical changes that incorrectly suggest the onset of a new phase of the illness. These can be difficult to identify, but doctors can order a number of tests to find the cause and take a corrective action to remedy it. Once corrected, the dementia patient usually returns to the previous state of mental ability.
A new phase may be characterized by some change that arrives without explanation and is here to stay. The change might be incontinence, anger, agitation, speaking difficulties (finding the right word or trouble completing a sentence), the ability to swallow (remembering how to chew between bites of food or a physical swallowing difficulty), standing up or walking, etc. Each of these issues are alarming and troubling to everyone involved. Doctors will attempt to compensate for these deficits by using therapists, ordering medications to be pulverized and swallowed with liquid or sometimes chewed and making different care arrangements like assisted feeding, dressing, bathing or transportation. Medical appliances like walkers, wheelchairs or roller-walkers are sometimes ordered to prevent injuries from falls.
While unfortunate, these changing phases aren't preventable. They will vary from one person to another and not all people will have the same issues to contend with. The timeline for new phases will vary between individuals and while some may progress rapidly, others will not. These phases are mostly elements within a given "stage" of the illness. These stages can usually be identified by the new phases (or changes) as they are examined collectively. There can be overlap between stages when the new phases don't neatly fit within a specific stage category. This is frequently the case, in fact.
Hi Joe,
Your post has described the process so well! It is exactly what has happened to my father-in-law. In early 2005/2006, we were not sure about it but suspected it until he was diagnosed in late 2006.
Now he is aware that he needs to walk with the cane and he knows something is wrong with his brain at times - but never admits he has dementia, not to mention Alzheimer's. At times he asked my husband if he has hope and that he wants to come to be with us. Note that he still wants to "work" with my husband thinking all the delusional things that he may do. Like getting a mate or jogging again and etc. One thing that will stay for sure is his wanting to work with my husband. He thought my husband is in the same field and can help his Dad to do things. My FIL always is a little bit on the Asperger syndrome side all his life so he will never see it from our points of view.
When he feels there is no hope, he asked if he can die. Well we cannot kill him but he gets depressed. It is like a rollercoaster - up and down.
We can only do the best to distract him or play games with him to make him happy for the moment.
Regards,
Nina
Hi Nina, Thank you for replying to my post. I'm sure that many people with dementia have a similar experience to what I've described in my mother's case. The progression of the illness does lead to depression and a feeling of doom when the dementia patient is able to realize the extent of their mental failings. Denial is typical and is always used defensively to avoid any kind of commercial care situation. Ideally, the loved one wants to move in and live with a family member instead of assisted living or a nursing home. That's not always practical and can be more dangerous than the commercial alternatives. How do you leave someone alone in your home who might wander off or turn on the stove and forget it? These are difficult questions with serious consequences. You can't be there with them constantly and that's the real problem. Incontinence and lack of physical coordination adds to the risks and dangers for many and makes leaving them home unattended impossible. As new phases of the illness develop, more care is often required. It's a tough situation. -- Joe --