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Mild to moderate dementia: Recognize the signs? (Counselling Articles)

I recently helped a good friend transition her mother, who has mild to moderate dementia, into an assisted living program. As one of the first steps, I wrote a letter to the mother’s primary care physician, documenting the signs of dementia that I observed when I spent a week with her at her cottage this past summer.

The mother’s dementia went undetected for several years by people who are close to her, which is not unusual. I am sharing sections of the letter I wrote to her physician in the hope that it will help you to interpret the signs you are observing in your own family member in an appropriate light.

*All identifying information has been altered.

19 August 2013

Dear Dr. Regehr,

RE: Mrs. Ruth Stewart, 8330 Macleod Street, Goderich, Ontario

I promised to send you a fax, documenting observations I recently made concerning Mrs. Stewart’s cognitive functioning and living situation. I was in Mrs. Stewart’s company from Tuesday, August 13 through Saturday, August 17. I picked her up at her home and we drove to her cottage on the Tuesday, returning to her home on the Friday.

I have documented several observations I made while with Mrs. Stewart. It is my hope that you will be able to use these observations to help arrange for her to obtain an appropriate level of care based on her current cognitive and physical capabilities.

  1. Mrs. Stewart and I spoke about four days before I was scheduled to arrive at her home to drive to the cottage. She told me we could not go to the cottage because she did not know how to get there, even though she has been “going to the cottage” for over 50 years. She said her son-in-law had promised to give her driving directions but that she did not have them yet and doubted she would receive them. I told her I have a GPS in my car, but was unable to explain how a GPS works. Mrs. Stewart remained agitated at the end of the call. She had two written sets of directions on her kitchen table when I arrived to pick her up.
  2. Mrs. Stewart told me she did not recognize me when we met. She said she had not seen me “since your mother died,” which was in 1970. I am 50 years old. A framed photograph of me hangs in her living room. I am 27 years old in that photograph.
  3. I came downstairs at the cottage, where I was staying with Mrs. Stewart. She had turned on the front element of the stove and had the oven door open to help warm up the kitchen. She said she thought she had turned the oven on. It took her several moments of staring at the dials on the stove, with my prompting, to understand that she had turned on the front element and not the oven.
  4. I took Mrs. Stewart to the emergency room at the local hospital because she was complaining about problems urinating. She was diagnosed with a urinary tract infection and prescribed antibiotics. She was incapable of identifying that she had an infection, even though she has been treated for several urinary tract infections in recent years.
  5. Mrs. Stewart said she would not take the antibiotic prescribed to treat the urinary tract infection when she learned the antibiotic could interact with the heart medication she takes. When I told her she needed to take the antibiotic, she said she would modify how she takes the heart medication. Mrs. Stewart appears to not take her medications as prescribed. She told me she will not use a blister pack for her medications because of the cost.
  6. Mrs. Stewart does not appear to understand money. She was upset when a cup of coffee cost $2.25. She put forward four two-dollar coins to pay a $4 bill. She was unable to calculate that four two-dollar coins are worth eight dollars.
  7. Mrs. Stewart was incontinent of bowel when we were out together. She told me she thought about “crawling into the woods” to clean herself up after voiding her bowels in the living room of a friend, even though a bathroom was available in the house.
  8. Mrs. Stewart walks with a cane. She is unstable on her cane. I saw her stumble at least four times, with a significant risk of falling. She frequently “started off” without taking her cane with her. When we returned to her house from the cottage, I learned that we should have taken her walker with us. Mrs. Stewart had refused to do so when I suggested we take it.
  9. Mrs. Stewart told me she does not want to go to “a home” because she does not want to eat “with 85 people.” What I witnessed, however, is that she is highly social and enjoys being in the company of others. She laughs easily and often. Mrs. Stewart talked constantly while I was with her. She and I visited two of her neighbours, at her prompting, while we were at the cottage. Her daughter told me that Mrs. Stewart’s normal condition is to sit alone in her living room during the day.
  10. Mrs. Stewart was unable to find the keys to the cottage on five separate occasions. I let her look for the keys in her purse until she became frustrated, and then easily extracted them from her purse for her each time.
  11. Mrs. Stewart`s weight has been falling at a rapid rate. She is not consuming regular meals, which is dangerous in part because she is diabetic. Her daughter has documented Mrs. Stewart`s weight loss over the past several months and will provide this documentation to you upon request. 

Dr. Patricia Turner, Registered Psychologist, Calgary, Alberta

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