Important Considerations When Faced with a Decline in Memory and Functioning

February 7, 2013
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Experiencing a slight lapse in memory every once in awhile is normal especially within the aging population, but when a person loses their ability to think, remember, and reason to the extent that it is interfering with their daily life it could possibly indicate dementia. If you suspect the possibility of dementia, you should consult a doctor immediately as some types of dementia are treatable and the symptoms can be reversible. These types of dementia are often caused by other medical conditions such as nutritional deficiencies, certain infections, hormonal imbalances, alcohol or drug use, lack of oxygen, depression, and certain types of hydrocephalus. Although some other types of dementia are not reversible, such as Alzheimer’s disease, early treatment may minimize some of the symptoms and help the individual and family prepare properly for the next steps . Research has shown that timely diagnosis gives people with dementia and their families the time to plan and prepare for the future, leading to more positive outcomes for both.

The following are 10 warning signs for dementia created by the Alzheimer’s Association:
1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks at home, at work, or at leisure
4. Confusion with time and place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking and writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood or personality

If you or a loved one displays these symptoms it is crucial to seek a medical evaluation. Just telling a medical doctor that your memory is failing and being prescribed a memory enhancing medication is not the optimal treatment and may not get at the underlying reason for the symptoms. In addition, it is ignoring the support and guidance the individual and family member may need during this trying time. Despite this, many individuals are being prescribed medications with the potential for severe side effects without a proper evaluation. A full diagnostic work up looking for all the possible causes should be the norm and a diagnostic evaluation should include the following:
• A careful medical and social history gathered from a family member
• A physical and neurological examination
• A thorough psychiatric interview
• An objective assessment of cognition and functional abilities
• Ancillary tests – which may include VDRL, Lyme titre, ESR, B12, folate, thyroid, blood chemistry, drug screen, urinalysis, brain scan – may be ordered
• Neuropsychological testing or consultation may be requested
• Counseling and education should be provided to the family
• Information and referral to support groups and outreach programs should be made available to support the family
• Arrangements made for periodic reevaluation

Long Island Residents can turn to the following Memory Disorder Diagnostic Centers:
The Neurwith Memory Disorders Center for Patients and Caregivers: 516-470-8447
Alzheimer’s Disease Assistance Center of Long Island: 631-632-3160

If it is determined that an irreversible dementia is present, it is necessary to begin planning as soon as possible. In planning for those with dementia, the sooner the planning begins, the more likely that the person with dementia will have the opportunity to participate in the process. A person needs to have sufficient mental capacity in order to legally agree to the plans put in place. Sufficient mental capacity means that he or she is able to understand the meaning of the legal documents they may be signing and has the ability to make rational decisions and understand the consequences of these decisions.

If the possibility of dementia is suspected at all, it is advised that you speak with an Elder Law attorney immediately to begin planning. However, you may still be considered to have sufficient mental capacity while you are in the mid-stages of dementia. An Elder Law attorney can help determine if you or your loved one can legally make the decision for certain documents.

If it is decided that you are in good mental capacity, certain documents can be created to ensure that your future wishes are met and to better prepare your loved ones who may be caring for you in the future. One important step will be to create a Durable Power of Attorney. The person you appoint as Power of Attorney should be a trusted individual. This person will be expected to make legal and financial decisions for you when you can no longer do so for yourself. Unfortunately, when dealing with dementia this is absolutely necessary because of the decline in mental abilities that will inevitably occur. If you do not have a Durable Power of Attorney at the point when you are no longer able to make decisions for yourself, the only option will be for your family to petition the court for the appointment of a guardian. This is not a simple process and will likely require more time than would be ideal for your loved ones to act in your best interest.

A Health Care Proxy and a Living Will are two additional documents that should be created. These will allow you to express your health related wishes and beliefs and appoint someone to act on your behalf if any health decisions need to be made under the circumstance that you cannot do so for yourself.

It is also important to remember to verbally express your wishes and beliefs to your loved ones so that they can carry these out for you in the future. The person you appoint as your Power of Attorney or your Health Care Proxy should be aware of what decisions you would want to be made in different situations that may arise.
Since those with dementia generally require long term care, it is also advised to begin planning financially. Oftentimes people do not plan in advance and therefore fall victim to the strict rules of Medicaid. Even in early stages of the disease a home aide for assistance with activities of daily living may be necessary. Eventually twenty four hour care and supervision may be needed in order to maintain the health and safety of the individual. Although many dementia patients do not develop serious physical problems until later stages of the disease, planning ahead for these possible future health care costs is vital. An Elder Law attorney can work with you to conserve your existing financial resources. It is crucial to understand that it is never too late to plan. Even if you did not plan ahead, an Elder Law attorney can still help you obtain Medicaid or preserve your assets by using certain strategies and techniques. This can even be done after the person with dementia has already begun receiving long term care.

For the caregiver:
Caring for a loved one with dementia can be an extremely difficult task. It is helpful to be informed about dementia. Better understanding the disease will help you to better handle it. Useful information can be found at the following websites:

There are also support groups on Long Island specifically for those caring for someone with Dementia.
Nassau County –
Suffolk County-

Written and Compiled by Suzanne Paolucci, LCSW, Elder Care Coordinator & Jennifer Wilson, Social Work Resource Assistant

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