Dementia – the moderate stages
I have to be careful talking about the clinical presentation of dementia, as I’m not a clinician; I’m a specialist elderly client solicitor. However I have met lots of people with dementia and in my work in respect elderly client issues, I have experience with working for people with dementia, either directly or via their attorneys.
So having discussed the early stages, I will go on to the mild to moderate stage
Dependant upon which type of dementia will depend on what exactly is happening in the brain in terms of physical damage. I’ve been advised that in some types of dementia it is more an issue of loss of brain cells, whilst in others it is more a question of how the cells communicate to each other and work together. The detail of the functioning of the brain is not my specialist area, but I have seen the outcome of the presentation of this loss of function in the brain.
In the moderate stages of dementia the person will know that they are confused, they will know that they don’t know and may well get angry, frustrated, depressed and afraid, amongst many other emotions.
The confusion will take the form of loss of memory and loss of ability to plan (otherwise known as “the executive function”). So they may struggle with names of people or the nature of their relationship to them. At this stage they may well still have some sense of familiarity to family members, but the nature of their relationship to that person become unclear. At this stage families often get upset that their loved one does not remember them or only vaguely remembers them. They will not understand what time it is or what day it is.
As far as their executive function goes they will probably have difficulty in working out what they need to do get dressed, what order their clothes go on in or how many pairs of pants is the right number to wear. If they are still at home, they will have difficulty making a cup of tea.
Their speech will be clearly muddled, but they will still retain some level of speech. The big issue for them is their ability to risk assess. At this point in time they still usually retain a certain level of functionality and if they cannot risk assess, they end up with all sorts of problems. If they don’t know the safe way to cross the road they can be run over, they have difficulty in understanding something in their way and can fall as they have not perceived the obstruction. Their inability to risk assess is a very dangerous time and can prove fatal in some circumstances.
They can however still recognise food when it is put in front of them, they are likely to need some reminding, but should be able to feed themselves. They should still recognise that they are hot or cold and ask for some help to resolve their discomfort. They will be able to have pleasure in small things, like pretty flowers, chocolate or music. They do still retain some functionality, but it will be starting to wain.
By this time, if they have not got it already, they should definitely be in touch with specialist services to support them.