Sudden changes in mood, memory, personality, or behavior are not typical of a cognitive disease progression and may instead indicate the presence of something treatable. All too often, however, when a person has dementia, the care team is quick to blame the disease progression for every other thing that goes wrong. If a resident hits a staff member, they assume he did so because “he has dementia.” If another resident struggles to eat, staff are quick to attribute the shortcoming to “dementia” and to begin feeding her themselves. If a third resident starts having trouble walking over the course of a week, care team members rationalize that “it happens with dementia.” Yes, it does—but not in a week. In all of these cases, there are many other questions to ask before settling on a dementia disease process as the sole cause—or even as the primary one.
In contrast to diseases which cause irreversible damage to the brain, certain conditions can produce the same dementia symptoms that may abate or reverse with proper intervention. In this way, the following conditions are, in a sense temporary dementia. That is, when the underlying condition is treated, the dementia symptoms it has triggered will decrease, and the affected person will return to their baseline. These conditions include:
- Pain, (which, as discussed in “The underemphasized effects of pain” later in this chapter, is often underdiagnosed)
- Deficient or excessive thyroid hormone
- Dehydration (the number one reason that older people end up in the emergency room)
- Deficiency in vitamins, especially B12
- Medication interactions and reactions
Being cognizant of these less-heralded causes of dementia can inspire care teams to conduct investigations more readily when new symptoms surface. Staff need to be trained to investigate the root-cause of symptoms in order to provide the best care in an assisted living, or any, setting.
-Excerpt from Serving Residents with Dementia: Transformative Care Strategies for Assisted Living Providers by Kerry Mills