The medical term for senility is dementia. Dementia refers to a set of symptoms, not a single illness – a generally progressive, irreversible decline in memory, reasoning, thinking. A number of diseases produce this inexorable intellectual deterioration. Though it has now become the popular catchword for everything, Alzheimer’s disease is only the most common of them.
When people have dementia (caused either by Alzheimer’s disease or by another illness) an early sign is trouble in remembering the ongoing events of daily life. A woman may forget she just made a phone call and call her daughter back. She may not remember driving to the store an hour earlier and may make a second trip.
Sometimes the first symptom is a change in personality. The person withdraws, becoming apathetic, abstracted. Or a life that had been tightly ordered seems to unravel. A fastidious housekeeper begins leaving the dinner dishes in the sink; her immaculate house is now in disarray. A dapper, punctual man regularly shows up at work hours late, disheveled, with a stained tie.
Changes like these are almost always either isolated incidents (How many of us have never blanked out on a phone call we made two seconds ago?) or signs that something is wrong with the emotional side of life. Personal problems may be preoccupying us, affecting our memory, our mood and our ability to handle life competently. It is very difficult to be sure a person is suffering from a dementing illness when the condition is in its earliest stages.
Strange or unusual behavior is often seen in retrospect as the first sign of the disease when, as the months pass, the victim’s mental processes deteriorate. For instance, when University of Michigan researchers interviewed family members of dementia victims, many said they had interpreted early symptoms in their loved ones, later diagnosed as Alzheimer’s disease, as emotional problems. When their mother became forgetful, children decided she was depressed or deliberately tuning them out. When a husband started behaving strangely, his wife might worry about their marriage. Some women even went for counseling or considered divorce.
Even if a family sensed what was really happening early on, they were often unable to articulate exactly what was peculiar or amiss and so had trouble convincing the doctor to take their worries seriously. Months might go by before the true condition was diagnosed.
If the problem is a dementing illness, things do get worse; eventually it becomes obvious that something is very wrong. As the illness reaches its middle stages, a person’s reasoning becomes strangely concrete. A man may be unable to follow simple instructions such as “turn right to Main Street” or “twist the cap to open the jar.” The advice to “just dive in” may be greeted by the puzzled comment, “I’m not near a swimming pool!”
Simple calculations become difficult. A woman may first have trouble making change, then forget that four quarters make a dollar, then not understand the word dollar. She may be unable to name objects correctly or remember their function – calling forks spoons, spearing steak with her knife, cutting food with her spoon. Judgment becomes increasingly unreliable, alarming family members. Children, worried at first that Mom might cross Main Street against a red light and be hit by a car, months later may find that their anxiety multiplies: “Will she run out on Main Street undressed?”
In the final stages there is profound disorientation, an inability to locate oneself in time or space. People are often unable to dress or feed themselves, control their bowels, remember their names, or recognize their families.
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GENERAL HEALTH
