Dementia

Dementia

Dementia is a loss of mental ability memory, judgment, and ability to think. While there are numerous causes of dementia, Alzheimer's disease is the most common. For someone with dementia, life is confusing; it's difficult to remember so many things; personality may change. Medication can help control behavior problems, and some drugs can slow the rate of decline.

Recently Answered

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    AHealthyWomen answered
    Here are a few things to keep in mind if you'll be visiting someone with Alzheimer's disease or dementia:
    • Understand your feelings. It's important to admit and articulate to yourself and to other family members why you're stressed and upset.
    • Manage your expectations. Although it sounds Scrooge-like, it's wise to hope for the best while preparing for the worst.
    • Acknowledge the elephant in the room. Discuss with others you're close to the possibility that your relative with Alzheimer's or dementia may become sicker or even die. You might be surprised to learn that they've considered the same possibility.
    • Educate yourself. Learn how people at various stages of Alzheimer's or dementia handle different levels of interaction and activity. Check with her caregiver to make sure you understand what's normal for your loved one. 
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    ALinda Ercoli, PhD, Psychology, answered on behalf of UCLA Health
    If you think a loved one with dementia is not driving safely, you could have conversations about his or her driving: short conversations, such as asking, “How did it go on your way to the store today?” This way, you can find out how your loved one actually feels. Did he or she have any nervousness or any near-misses? You can use these conversations to see if he or she feels confident in his or her driving.
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    ALinda Ercoli, PhD, Psychology, answered on behalf of UCLA Health
    One of the first things you can do if you think a loved one with dementia is not driving safely is to actually observe him or her driving. The next step is to have conversations about his or her driving. Then, over time, one can strike up longer and more serious conversations.

    You may have to actually address him or her when a time comes when he or she cannot drive safely. The idea is to have this conversation earlier rather than later. This is a process, and it’s important to begin early. Start with a small conversation, and work your way up to a more heartfelt conversation. Share your concerns with your loved ones, and be frank. For example, “I’m worried about how you merged onto the freeway -- I am concerned that you could get into an accident.”
     
    When discussion fails or in situations where driving must stop immediately, one can take the keys away, disable or sell the vehicle or remove the vehicle from the premises. If the car is removed, some caregivers will explain that the car is in the repair shop (and it stays there essentially indefinitely).  Because literally taking keys away can be upsetting. Another approach is to replace the working keys with a set of imposter keys.
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    ALinda Ercoli, PhD, Psychology, answered on behalf of UCLA Health
    One of the first things you can do if you think a loved one with dementia is driving unsafely is to actually observe him or her driving. Have the person drive with someone in different areas and situations, and take notes on how the person is driving in certain situations. How is he or she driving at intersections? Intersections and turns are some of the most high-risk situations for someone who is driving with dementia. That may mean taking a left turn into oncoming traffic or not yielding to the right of way -- for example, not paying attention to who was in the crosswalk while making a turn. Does the person stay in the lane while on the road? How does he or she behave with activity around him or her on the road, such as cyclists or pedestrians. How are people managing at crosswalks? Are people checking their blind spots? How do they manage merging onto the freeway? These are the things you can take note of if someone is having a problem in these kinds of circumstances.

    You would want to go on a few ride-alongs because this is not about having one bad day driving. Some people may not have problems driving in familiar areas, while other people might. So you want to get a good sense of someone’s driving ability across numerous situations.
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    ALinda Ercoli, PhD, Psychology, answered on behalf of UCLA Health
    There are a few warning signs that are associated with dementia and dangerous driving. Sometimes a single question might help address this, and it’s simply: Would you let your child ride with your loved one by themselves? If the answer to that question is no, then you need to ask yourself why you don't feel comfortable with that. This will help you determine if you have concerns with your loved one being a safe driver.

    There are three very important signs that somebody should stop driving immediately. The first would be confusing the gas and the brake, and this is a very serious problem. The second is somebody needing a copilot -- people should be able to drive by themselves and navigate without having problems. Determining if there are people in the crosswalk and having problems judging if they should make a turn or not are examples of this. Having a copilot in the car to help somebody make those decisions is a sign of dangerousness or higher risk. The third sign would be stopping in traffic for no apparent reason, and this is a sign of very high risk.

    There are other signs that you may have noticed in a loved one or may have seen on the road in your travels -- for example, riding the brakes, not noticing road signs, rolling through stop signs, taking a right turn where not allowed, near misses or scrapes and dents appearing on the car are all signs. Some drivers with dementia may hit the curb or receive poor reactions from other drivers who may honk their horn. This makes people feel like they’ve lost confidence in driving, and this is very important. If somebody feels like they can’t drive anymore and don’t want to drive anymore, then they shouldn’t be pushed to continue driving.

    Now, all of us might do these activities now and then. For example, I’m sure we’ve had somebody honk the horn at us. We all hit the curb now and then when we’re trying to park or making a turn that’s too close, but this is not about having a bad day. This is about driving patterns that are evident in a person and not a once-in-a-while thing.
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    ALinda Ercoli, PhD, Psychology, answered on behalf of UCLA Health
    Families can be very influential in getting a person with dementia to stop or cut back his or her driving, but they might be hesitant to intervene. First of all, people are afraid that if they bring up the topic they’re going to damage their relationship with their loved one. This can happen, and people get into arguments over this topic. Feelings get hurt and people get defensive, so a lot of family members feel like they can’t bring this up.

    Another reason that families are conflicted about this topic is because if somebody does have to turn in his or her keys or stop driving, then the burden is placed on the family to provide transportation for that individual. This means more burden, more expense and more time. People have very busy lives, making it difficult to do this.

    Finally, people sometimes just don’t know how to intervene. They don’t get a lot of help or education in this area, so they may want to but not know how to approach their loved one.
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    ALinda Ercoli, PhD, Psychology, answered on behalf of UCLA Health
    If you would like to stop a loved one with dementia from driving, the very first thing is to acknowledge that it’s very hard for somebody to turn over his or her keys and stop driving for any reason -- it’s not just people with dementia. Other groups of people can be required to stop driving by the Department of Motor Vehicles (DMV), such as people who have seizures, strokes or visual impairment. It is hard for anyone; it’s a great loss of autonomy and independence, so a lot is at stake.

    Our society has a very high proportion of older adults. So these older adults are highly mobile and need cars or good transportation to get them around to meet their needs. Turning in the keys and stopping driving can greatly influence their ability to go to the store and doctors’ appointments. It can also affect people socially, including meeting with friends. It’s been shown that sometimes when people stop driving, they become socially withdrawn and depressed. There are ways to reduce and limit driving to help offset and try to prevent some of these losses of autonomy.
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    ALinda Ercoli, PhD, Psychology, answered on behalf of UCLA Health
    Driving with dementia can pose a safety risk for other people, but it’s a safety risk to the driver as well. People with dementia who drive are at a higher risk for danger, and that includes death and injury due to getting lost while driving. People can end up in strange locations, and they can also end up being exposed to the elements -- getting lost when there’s extreme heat or extreme cold, for example. Others can also prey upon them when they’re lost, so this is a safety risk for everyone in the public, including the individual with dementia who is driving.
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    ALinda Ercoli, PhD, Psychology, answered on behalf of UCLA Health
    Driving with dementia is a public safety problem, and it can be a serious one. As adults age (and because dementia is a disease that most of the time is associated with age), the risk of becoming demented increases. Therefore, because most people over 65 do drive, the number of people driving with dementia is likely to increase. It’s estimated that nationwide about 30% of drivers with any type of dementia are still driving.

    What is meant by dementia in this case is a severe cognitive problem that interferes with your daily life or daily functioning. Alzheimer’s disease, Lewy body dementia, vascular dementia and frontal temporal dementia are serious disorders. It is, however, important to clarify that this does not include somebody who has age-related mild forgetfulness and who may not be functioning as efficiently as they were 20 years ago. Rather, it’s people who have such a bad memory or cognitive problem that it interferes with their daily lives, and one of these activities is driving.

    Statistics show that people with dementia have a higher crash risk, and in fact, some statistics show that even people with earlier mild Alzheimer’s disease have a higher number of accidents than drivers who are of the same age but don’t have Alzheimer’s. The accidents can be similar in frequency to teenagers, who have a very high risk of having accidents while driving. For people with dementia, there are 19 to 27 crashes per million miles traveled, and statistically that’s very similar to teenagers. If you survey caregivers and tally up what they’re saying about their loved ones who have dementia, the reports show that people with dementia have up to an eight times greater risk of crashing, and again this is compared with people of the same age who do not have dementia.

    One study looked at the brains of older drivers who died in crashes, and about 33% of those brains showed abnormalities, or pathologies, that were indicative of having Alzheimer’s. In most of those cases, the ill driver was at fault for those accidents.
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    ALinda Ercoli, PhD, Psychology, answered on behalf of UCLA Health
    People with dementia are at higher risk for auto accidents because cognitive and physical changes that are associated with dementia can render someone unsafe to drive a car. Although some individuals with dementia feel it's unsafe to drive and therefore time to stop, some individuals continue to drive and do so in an unsafe manner.

    People who continue to drive often have lost the awareness of their own neurological or thinking problems associated with dementia. In fact, that’s part of dementing disorders: People lose self-awareness. They might lack or lose the ability to really determine when they should stop driving. In fact, sometimes people with dementia might make excuses or blame other people for driving problems.