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Dementia: Myths versus Realities

Misconceptions about aging.

In my first blog, I discussed the myths of normal aging. Here, I present misconceptions about abnormal forms of aging—specifically dementia. With respect to the prevalence, causes, and symptoms of dementia, many of us could use a tutorial:

Myth #1: Dementia only affects other people...it cannot happen to me or to people I know. Dementia affects only the patient, not his or her family.

Fact: Uncertainty or confusion about the causes and effects of dementia may provide someone a rationale to deny that a family member has the illness because they do not belong in the "at risk" group. 6%-8% of people over age 65 have dementia and 33% of those over age 85 have some dementia symptoms.

Myth #2: People with dementia act in a certain way because of prior negative life experiences or childhood difficulties. People with dementia can control their behavior and do things deliberately. Failure to act properly is a result of laziness, stubbornness, resistance, or lack of motivation.

Fact: Illnesses such as dementia which lack obvious physical signs may lead people to misattribute someone's behavior to poor effort, malevolent intent, personality traits, or prior life experiences. If people assume behaviors are due to lack of morals, they may resort to reasoning with or re-educating the person.

Myth #3: People with dementia may act in a certain way because of a mental or learning disability.

Fact: People with dementia are not insane, crazy, necessarily psychotic, or learning disabled.

Myth #4: People with dementia are usually drowsy.

Fact: Normally, people with dementia are awake and alert during the day. Drowsiness can signal a drug interaction, malnutrition, depressed mood, or sleep disturbance.

Myth #5: It is just a simple fall.

Fact: Few elderly people are admitted to the hospital after a fall simply because they have slipped or tripped. To merely assume the explanation is a problem in the environment may indicate that vital predisposing conditions like macular degeneration are overlooked.

Myth #6: You should expect violent behavior from someone with dementia.

Fact: Aggression may occur because the person misunderstands or misperceives the actions of others and then lashes out due to feelings of fear, anger, or mistreatment. The person may also feel frustrated at being unable to do something he/she was able to do before. Agitation may also occur because of hunger, thirst, physical discomfort, poor lighting, or unsafe surroundings.

Sudden aggression in someone who was never violent before may suggest drug toxicity, or metabolic infection.

Myth #7: Use restraints and sedatives to calm someone agitated.

Fact: Restraints and sedatives may worsen a situation. Try having the doctor reduce medication, ask another family member to help orient and reassure the person, or use simple language to calmly and slowly explain what you want him to do.

Myth #8: Forgetfulness is likely to indicate the onset of dementia.

Fact: Memory loss can be caused or exacerbated by medication interactions, medical conditions, or by depression related to life events. Other changes to look out for include spatial disorientation, poor problem-solving ability, or impaired multi-tasking skills.

Myth #9: He speaks well. Therefore, he cannot be demented.

Fact: Cognitive disabilities can be subtle and may not be initially displayed in the presence of others. Language ability can remain intact despite real deficits in other skills.

Myth #10: All people with dementia are incompetent.

Fact: People with dementia are not necessarily incompetent. People in different stages of dementia may still be competent to make decisions in certain life areas. Those with mild dementia can comprehend and appreciate information they are given and reason adequately to make a choice regarding their health (i.e. health care proxy, conservatorship).

Simon Tan, Psy.D., A.B.P.P., is a clinical neuropsychologist specializing in geriatric neurological and psychiatric disorders at Stanford University Medical Center.

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