Most of the information about dementia tells family and caregivers not to take it personally when your loved one says something mean or hurtful. But is it really dementia talking?

It is hard to tell when they are still verbal, especially in earlier stages. It seems like them talking, just a very nasty version of them. They may holler, scold or tell you how awful you are. It may sound like them, but why are they saying these things?

Our brain’s frontal lobes control executive function. This is what is commonly damaged even before the memory loss becomes noticeable. This function controls planning, self-monitoring, working memory, time management, organization, thinking adaptability, and self-control. 

These losses start out very insidiously and slow and are barely noticed. Even later, it just looks like they are getting older and aren’t as functional as before.  The loss of thinking adaptability is a bigger problem than we imagine. It means it will be difficult for you to convince them they might be wrong. That might be where it becomes apparent they have also lost impulse control when they demonstrate run-away emotions. This is dementia talking even though they may still seem like themselves.

Then there’s early delusional thinking. When they believe someone has stolen from them, that they are being talked about behind their back or you mean them harm. Paranoia is a run-away emotion they can’t control. And because of damage to thinking adaptability, it causes them to believe they are in danger or conspired against despite all the reasoning you try to provide. This is dementia talking.

When their irrational thoughts or emotions take over, it’s not always easy to separate this from who they usually are. Your loved one might have had a temper or suspicious nature before dementia so, it still seems like what they are saying might be them. They use familiar words, tone of voice you’ve heard them use before and their same mannerisms. But don’t be fooled.

I advise families to just believe the mean, nasty words are dementia, and when they are kind, funny, and loving, it’s them. Don’t try to decipher when it is dementia and when they are themselves. Just assume the negative is dementia. In this way, it will be easier for you to emotionally weather the storms regardless of if it is really them or just the dementia talking.


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