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“Why did I do that!?!” Caring for a person with impaired judgment and decision-making ability.

Confused Senior No matter what our age, I’m sure we’ve all made decisions or judgment calls that we realized later were not in our best interest. I know I have. However, as I’ve watched my father age, I’ve seen him do things I know he would never have done, even into his early-eighties. During his working years, he held many important business positions, managing purchasing, planning and carrying out projects all over the U.S. and South America. He was always appropriately dressed. As the father of nine children, he had to be very careful with money. I doubt that anyone ever took advantage of him. Then, slowly, he began to change. What I observed is what scares me the most about my own aging process.

Dementia: Decision-Making and Judgment

Let me share a few of my non-clinical observations of my father with you. One of the first things that changed was his ability to make good judgments about people and the things he saw advertised, in print or on TV. He began to trust other people more than himself. Unfortunately, this doesn’t always apply to family members. He often thinks we are over-reacting, and he sometimes hides his behavior from us, thinking he is right, but somehow sensing that we wouldn’t approve. For example, he got caught in one of those “You’ve won the lottery/bad check” schemes and lost $4,000. Because my name is on his checking account, I noticed some unusual transactions, but he refused to tell me what was going on until it was too late. Then he could not believe that someone who seemed like “such a nice young man on the phone” would do such a thing to him. He started to believe all the ads that tell him he can improve his memory, his eyesight his libido, his hair growth, his muscle strength and get rid of all his aches and pains. He thinks he just has to take the right pill(s) and he will feel and look 30 years younger! He has paid thousands of dollars for pills, services and things he does not need and cannot use. Various family members have found him “sun bathing” and walking around his house in the nude, even when he supposedly knew he might get “caught.” When asked why he does it, he simply says “It feels good.” He seems to have lost the ability to judge when nudity is appropriate and when it’s not.

All of these “symptoms” have progressed as my father’s dementia, or what we used to think of as  short-term memory loss, has increased. But what interests and alarms me is that they can and do appear before memory loss is noticeable, at least to the extreme that one would classify it as an illness. Will I recognize when it is happening to me? Probably not.

In preparation for writing about this topic, I found a very enlightening website, www.dementiaguide.com/ The full name of the site is Dementia Guide: Helping People Affected by Dementia. It includes a Symptom Library with one entry on Judgment and one on Decision Making, both of which have confirmed and helped to explain my observations. I encourage you to go to this website, if you have a loved one or patient who exhibits these symptoms. Here is just a taste of what I found:

Decision Making

“All dementias affect what is called ‘executive function’ chiefly by affecting the frontal lobes – the reasoning part of the brain – so that it is difficult for the person to make sound decisions. Being a good decision maker requires the ability to move from one perspective of a problem to the next and make a reasoned decision about what is the best option. When the frontal lobes are involved – and they are involved especially early in Frontotemporal Dementia – the person lacks the ability to hold competing thoughts. They also lack the ability to follow through until completion. Where this person had been quite capable and confident in the past, the confidence may continue but the decisions made are often opposite of what the person would normally have made. [You] may notice a large change in the person’s ability to make financial decisions, such as compulsive spending. They may no longer have the ability to recognize the consequences of their behavior. It is possible that this will lead the person to riskier behavior, due to the lack of ability to recognize threats to their safety.”

Judgment

“The ability to exercise judgment, weigh facts, and organize and sequence information is progressively affected in all dementias, and can be an early sign of Alzheimer’s disease. As a result, the person you care for…may find themselves in a situation that they are not prepared for because of poor judgment (e.g., going shopping in their pajamas). They may even find themselves in a situation that puts their safety at risk. For example, they may get into the car of a stranger if they are tired and do not want to walk home. Often, the cause of poor judgment is that the person cannot predict the outcome of their decisions. Difficulty with judgment is part of the problem of executive function.  As judgment becomes impaired, risk taking behavior increases. The person is unable to understand the outcome of his/her decisions. In situations where the person is still employed or controls the finances, poor financial judgment can produce additional, troubling situations for families.”

Decreasing Risks for Your Patient or Loved One

The intent of this blog is not to give medical or care-giving advice for patients or loved ones who show signs of decreased ability to make wise decisions or sound judgments. It is only to make you aware that these behaviors can be the very early signs of Alzheimer’s disease or other forms of dementia. I encourage you to seek professional advice as to how to best treat and protect those you love and care for. My sister and I joke about writing a letter that we will give to our children for them to give back to us as proof that we want their intervention, when they can see that our decisions are going outside the bounds of what is reasonable and in our best interest. It’s probably not such a bad idea!

To “Increase Your Understanding of Alzheimer’s Disease,” scroll down to see our first blog in this series.

by Marti Lythgoe, Freelance Writer & Editor

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