“Losing It” Is Not A Diagnosis

“Mom is losing it.” I hear this phrase often, and it always makes me cringe.

Why? Because it reflects a common misconception that loss of cognitive abilities among older adults is inevitable and … that nothing can be done about it.

Research does not support this. Yes, certain areas of thinking may show a normal decline. But interventions can help to slow this down and other cognitive functions stay remarkably stable. Here is what’s normal:

  • Intelligence gained through knowledge or experience accumulated over time tends to remain stable.
  • Recall of past events that have been stored in memory over years remains intact; recent memories or the ability to make new memories may be vulnerable.
  • Focused attention doesn’t suffer; the ability to divide attention may.
  • Vocabulary is generally fine; word-retrieval and speaking may slow.
  • Solving new problems may become difficult.
  • The processing of cognitive and motor information may slow. So while many activities can be performed, they might take a little longer.

Factors that affect cognitive aging

One of the problems with using a catch-all term like “losing it,” is that it typically results in inaction on the part of family members and caregivers. As things progress – and nothing is done about it – this may lead to a diminishment in quality of life for the older adult and more work for the Care Partner.

Here are some factors that affect cognitive aging:

  • Medications may cause side effects, such as drowsiness and mental dullness.
  • Medication interactions. It is not unusual for my older adult clients to be taking over 20 prescribed medications and supplements. The likelihood of an adverse interaction is high.
  • Sensory changes, such as the loss of hearing or eyesight, can be misinterpreted.
  • Health changes that cause pain can result in difficulty concentrating and processing information.
  • Undiagnosed depression and anxiety.
  • Undiagnosed medical issues such as infections or vitamin deficiencies.

What to look for

Pay very close attention to the older adults in your life and be astute to subtle changes. In the case of my client, for example, it was an accumulation of mail on his desk – noticed because he had always been extremely neat and paid his bills accurately and on time – that led us to suspect cognitive changes.

That led us to investigate further, whereupon we discovered that he was no longer taking his medications regularly or as directed, and that his well-thought-out system for “keeping it all straight” was no longer working.

Lastly, he’d begun to withdraw from the community, no longer making plans to meet friends for dinner.

What to do first

Here’s what I suggest you do if you encounter a similar situation:

  • Don’t ignore it or relegate it to normal aging. Early intervention is critical.
  • Talk to the older adult about your concern and specifically what you’ve observed.
  • Talk to other members of the support team. In my client’s case, I shared my observations with his son who lives locally, so we could develop a strategy together.
  • Bring your specific concerns, including observed behaviors, to the attention of the primary care physician. She/he will evaluate the older adult to rule out medical issues that could be contributing. In addition, office-based cognitive testing can be done to objectively and quantitatively evaluate cognitive abilities.*
  • Develop a treatment plan that may include medication, support for activities of daily living, continuous re-evaluations, etc.

    (*A common test administered is the Montreal Cognitive Assessment [MoCA]. Based on the results of the MoCA, further evaluation may be indicated by a neuropsychologist, who can conduct more elaborate testing to further identify the degree and type of cognitive decline.)

What to do next

In the past, it was thought that nothing could be done to slow down the changes that occur in our bodies and our brains as a result of aging. We now know that is not true. Here are some recommendations:

  • Maintain good health with regular visits to your doctor. Medications should be continuously re-evaluated for potential interactions and it is always helpful to be sure no other underlying medical issues are going on. My client was started on Aricept, a drug that has been shown to slow the progression of mild cognitive impairment.
  • Reduce stress. My client’s son planned to come over at a set time every week, so they could review the mail and pay bills together. We also increased the scheduled times a companion came by to assist with errands, housekeeping, etc.
  • Incorporate aerobic exercise into a routine. My client happened to live in a facility that had long corridors and an indoor gym. He began to meet with an athletic trainer every week to work out in the gym and to review a home program that included walking.
  • Follow a diet rich in fruits and vegetables. My client’s companion began to assist with food preparation, so that healthy foods were in the refrigerator and prepared for breakfast and lunch.
  • Stay mentally stimulated. Fortunately, my client enjoyed activities that were readily available where he lived, such as playing bridge and attending a weekly book group and adult education courses.

It’s now been two years since my client’s initial diagnosis of cognitive decline; numerous discussions and tweaks to his care plan have been made along the way. I’m happy to report that he continues to enjoy a very full and engaged life.

I realize, of course, that I have described an ideal situation: my client was willing to acknowledge his decline; his family was engaged; he has financial resources that allow us to execute his wishes. All of these things helped us to PLAN and PLAN.

You, on the other hand, may be dealing with a more challenging situation. And so in future newsletters, I’ll discuss things you can do when you meet resistance and encounter other hurdles in caring for an older adult.

Whatever your personal situation, remember that’s it important to do what you can!!