Diagnosing Early Dementia: The Slippery Slope of Getting Your Loved One to the Doctor

When the behavior of someone close to you changes, finding out what the underlying cause is can seem daunting and unsettling. But, doctors are able to offer solutions that can improve the quality of life for your loved one and the people they care about.

The earliest stages of dementia are tricky to diagnose and identify. At times, the person seems completely normal. They can function physically. They communicate. They can care for themselves. But loved ones know differently. They can’t pinpoint what’s wrong, but they know that something is not right and the person doesn’t always seem himself or herself.

When dealing with an unknown medical issue, the best remedy is to schedule a doctor’s visit. However, with people experiencing early stage dementia, this is easier said than done. They may be aware that they are having trouble remembering, but they are afraid to find out what could be causing it. Early dementia causes confusion and clouds rationality, making it much harder to reason with them about visiting the doctor.

“One of the biggest challenges is getting someone in the door,” said Helena Chang Chui, MD with the USC Memory and Aging Center at Keck Medicine of USC and an internationally recognized Alzheimer’s disease expert.

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Having dealt with patients and their families in this situation, Dr. Chui has the following recommendations:

  • Mention the appointment informally just before visiting the doctor rather than discussing it in advance. “Because the patient’s reality is altered, you have to use little half truths,” she said. “You can say something like, ‘Let’s go out to breakfast and stop by and have our annual checkups.’”
  • Use other physical problems as an excuse. Seeing a doctor for a knee problem is different from going in for memory loss.
  • Confront the topic when you know the person is lucid. People with early dementia slip in and out of lucidity. Rather than exacerbate the problem when they are confused, gently bring it up when they have a moment of clarity.
  • Avoid arguing. “You can’t argue with your loved one, because they don’t know what they are doing,” Dr. Chui said. As hard as it is, being generous and compassionate will have better results.
  • Schedule the appointment for “yourself” and ask your loved one to tag along. Tell them that having their support would be helpful. “We tell families that at times, you have to be a little bit of an actor, but that it’s for a good cause,” Dr. Chui said.
  • A caregiver or someone close should go to the appointment with the patient. This is not the time for the patient to go alone, since they might not be able to accurately report what is happening for them, and they may not remember what the doctor recommends.

Remember that the patient’s perception of time and reality are different from yours. They may think that an event that occurred 20 years ago happened yesterday and arguing the point won’t help. “Someone with memory loss is not always grounded in reality,” Dr. Chui said. As a result, caregivers must be savvy in their reasoning.

Additionally, there are things a caregiver can do to make the appointment go smoothly:

  • Prepare the doctor in advance. Call ahead, discuss your concerns and ask for a memory screening. This prevents you from having to do so in front of your loved one.
  • Keep a journal. Document changes in personality and differences that you have observed in their daily routine and communication. Keep a list of questions you may have as well.
  • If you need consent, handle paperwork at home. It will be easier to discuss it with your loved one than when they are stressed from being at the doctor.
  • Bring in a list of current medications. This will help rule out any drug allergies and reactions.
  • Think ahead to how your loved one might react and be prepared. Bring distractions such as snacks or an iPad to keep them from focusing on being at the doctor’s office. If they tend to cry or get angry under stress, take someone with you who can go in first and notify you when you can go directly back to the doctor’s office.

Living with someone who has dementia is a new experience for all involved, but with understanding and patience, there are ways to improve their quality of life – as well as yours.

For more than 30 years, Keck Medicine of USC physicians and researchers have made major contributions to understanding Alzheimer’s disease, vascular brain injury and memory problems. If you are in the Los Angeles area and are looking for exceptional care from some of the top Alzheimer’s specialists in the world, be sure to schedule an appointment by calling (800) USC-CARE (800-872-2273) or by visiting http://neuro.keckmedicine.org/request-an-appointment/.

By Heidi Tyline King