Can Dementia Symptoms Come and Go?

Q. My husband, my kids, and I visited my mother this year for the holidays. Mom was diagnosed with dementia last year, so I took some of Magic the bunny’s advice from Critter Corner on how best to celebrate the holiday with her. We gave her space during the festivities, and for the most part, she was doing okay, although her behavior was sometimes erratic. On Christmas day, she spent most of the day sitting quietly in her bedroom and barely said a word. When I brought her lunch, she looked at me like I was a stranger. The next morning, she greeted me cheerfully and called me by name. Later that day, she was working on a NY Times crossword puzzle. I know it may sound like a miracle, or like I’m off my rocker, but I’m wondering. . . could it be that she’s getting better instead of worse?

A. Dementia is a degenerative disease that causes a progressive decline in cognitive function including memory, attention span, and problem-solving skills. Currently, dementia affects approximately 3.4 million Americans, or 13.9 percent, of the U.S. population ages 71 and older and is usually caused by brain damage associated with Alzheimer’s disease, vascular dementia, or Parkinson’s disease. The number of people living with dementia is expected to rise 66% by the time we reach 2031. Let’s hope a cure is found before then!

I honestly wish I could tell you that your mother is getting better. Unfortunately, dementia – once it has been officially diagnosed – does not go away. However, the symptoms can come and go and the condition can manifest itself differently depending on the person. While Alzheimer’s and other common forms of dementia are progressive in nature and cannot be reversed (not yet, anyway), sometimes symptoms fade and individuals can enjoy periods of relative stability.

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Dementia progresses rapidly for some people, while it takes years to reach an advanced stage for others. People with “mild dementia” may still be able to function independently, with memory lapses that have a minimal impact on daily life, such as forgetting words or where things are located. While people will experience dementia differently, most people with dementia share some of the same symptoms that may come and go. Studies have been done to explain why this happens.

In one study, charts of dementia patients were reviewed during a two-year period. The researcher scanned the charts for mentions of “good days and bad days.” Most of the patients were recently diagnosed with mild dementia and lived with their caregivers (typically their spouse). Good days most often involved enhanced mood, better concentration, and improved ability to perform IADLs (instrumental activities of daily living). Bad days were characterized by increased verbal repetition, anger, irritability, forgetfulness, delusions, and declining mood.

From what we know now, here are five considerations when thinking about why your loved one might experience increasing and decreasing signs of dementia:

Your loved one is in the early stages of dementia. The onset of dementia is confusing and frightening for patients and family alike. In early-stage dementia, memory problems and confusion come and go and may be accompanied by periods of completely normal behavior. One day the person may be calm, affectionate and functioning well, the next, forgetful, agitated, vague, and withdrawn.

Other medical conditions. It’s very common for those who suffer from dementia to have co-existing medical conditions that may worsen symptoms. For example, when an Alzheimer’s patient is also depressed, it may be that a deepening depression is to blame for emotional problems. Sometimes, treating the other condition will appear to “improve” Alzheimer’s.

Maybe it’s an under-recognized form of dementia. There usually aren’t major changes in cognitive function from day to day for typical Alzheimer’s patients as the disease progresses towards moderate and then severe. On the other hand, it’s common with another form of dementia, called Lewy body dementia. This under-recognized and under-diagnosed dementia often shows a fluctuation in symptoms.

Maybe it’s not Alzheimer’s or dementia at all. Not all confusion and memory loss indicate dementia, so it’s important to rule out other conditions. Some signs of dementia may be caused by physical problems versus mental. Urinary tract infections (UTI’s), nutritional deficiencies (vitamin D and/or B-12), dehydration, possible side effects from medication, excessive alcohol consumption, insomnia, changes to routine, or even dental problems can have an effect on cognitive ability. Be aware that if these health issues arise for a person already diagnosed with dementia, it can aggravate the condition.

Treatment with certain medications. While non-drug options such as counseling and support groups are the first line of defense for many, some patients respond favorably to dementia medicines, as well as other kinds of prescriptions such as antidepressants, anticonvulsants, antipsychotics, anti-anxiety drugs, and even sleep aids to help correct emotional and behavioral issues. While the disease can’t yet be halted, certain medications can help sharpen the mind for a time, especially in the early stages of the disease. Check with your doctor for more details about medications or other treatments.

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As you have experienced with your mother, people with dementia can often be very lucid, engage in perfectly normal conversations and seem to not have a problem with memory recall. The next day they are hallucinating and don’t know where they are. And then the next day they are doing the crossword puzzle peacefully. This can be challenging, if not maddening, for caregivers and family members but should be understood, expected and met with compassion.

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Regardless of the stage of dementia or how challenging it may be as the symptoms come and go, a person with dementia should be respected and treated as normally as possible while ensuring their health, safety and well-being. The more you can understand what to expect when a loved one has dementia and to accept the often-wavering levels of behavioral change, the more effective and loving you can be during difficult times. As challenging as it may be, try to maintain a sense of humor about the sillier, harmless things that can happen – such as putting keys in the freezer or milk in the microwave instead of the refrigerator – and try not get upset. When it comes to a loved one suffering from dementia, they truly do not understand the error in what they do much of the time. Be kind and gentle.

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If you have a loved one who was diagnosed with dementia, we at the Farr Law Firm are dedicated to easing the financial and emotional burden on those suffering from the debilitating disease and their loved ones.

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We help protect your assets while maintaining your comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance (for eligible veterans and their families). If and when you or a family member receives a diagnosis of any type of dementia, please call us as soon as possible to make an appointment for a no-cost initial consultation:

Alzheimer’s Planning Lawyer Fairfax 703-691-1888
Alzheimer’s Planning Lawyer Fredericksburg 540-479-1435
Alzheimer’s Planning Lawyer Rockville 301-519-8041
Alzheimer’s Planning Lawyer DC 202-587-2797

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