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We develop skills in reasoning and judgment our whole lives. In most healthy individuals, the brain becomes a powerful decision-making machine from our toddler years when we first learn not to touch a hot stove, to our teenage years when we learn how to drive in traffic, to our adult years when we learn to make sound personal and financial decisions.

But Alzheimer’s and other types of dementia take it back. Dementia is a thief. It steals what we knew, what we learned over the years, the cognitive skills we take for granted. This common Alzheimer’s and dementia symptom mirrors what some may consider “normal” losses in reasoning and judgment associated with aging.

Yes, that’s true. But you may have noticed reasoning and judgment regressions are much worse in your loved one living with dementia. As care partners, we’d love to foster a free and independent environment as long as possible. But it often gets to the point where they require 24/7 assistance to avoid hazardous outcomes.

Understanding Poor Reasoning & Judgment Among Common Alzheimer’s and Dementia Symptoms

As with any of the common Alzheimer’s and dementia behaviors and symptoms we’ve been covering in recent months, care partners must understand what’s happening inside their loved one’s brain to offer proactive solutions.

Dangerous Situations

Let’s say your sister has always been a great driver. Her awareness behind the wheel — speed limits, traffic signs and other rules of the road — was a well-developed life skill. Maybe she never even had a ticket.

Then something scary happens. Early in her dementia diagnosis, she still has her driver’s license and enjoys the freedom to come and go as she pleases. But she pulls out into traffic and gets T-boned by another car. She’s OK (and insurance will cover the damage), but even she’s unsure what happened. She swears she remembers who had the right-of-way and other traffic rules at that intersection. Her reasoning and judgment may be slipping regarding timing and awareness in unsafe scenarios.

What else could’ve gone wrong? Dementia is more than memory loss. Changes in vision and perception are very common in many persons living with dementia. The oncoming vehicle may have appeared farther away than it was. It may have been difficult for your sister to judge its speed to time a safe merger. Perhaps the color of the other vehicle was difficult to see in a certain lighting condition. A random blur or diminishing sightline could obstruct her peripheral vision.

While driving is one of the most dangerous daily activities, many others can be just as dangerous as one becomes spatially disoriented due to dementia. Imagine walking around a pool deck and not being able to tell if the edge is 8 inches or 8 feet away. A shaded area on a walking trail could blur your loved one’s vision and cause a misstep down a steep embankment. 

Care partners must remember their loved one may no longer perceive the visual world as it truly is.

Personality Traits

Now, let’s say your nephew is the kindest, most genuine soul you know. He speaks the truth. He takes time to be considerate — and keeps quiet if he has nothing nice to say. 

Loved ones may act out of character with Alzheimer’s and certain types and stages of dementia. Where they were once quiet and reserved, they could become boisterous and opinionated. Where they were once considerate and kind, they could become selfish and abrasive. Where they were once cautious and alert, they could become careless and inattentive.

That’s impaired reasoning and judgment. We most often see poor decision-making and impulsive (even childish and inappropriate) behavior in conditions like frontotemporal dementia, which affects the part of the brain that governs personality. It could have harsh consequences for personal relationships and day-to-day decisions. A loved one may act rudely to a close family member or friend. They may also make ill-advised financial decisions.

Have compassion and be aware. They don’t know any better — and that’s not their fault.

Action and Consequence

Eventually, regressions in reasoning and judgment in later stages of Alzheimer’s and dementia often require 24/7 monitoring. Losing a lifetime of memories and cognitive behaviors drops people back in their youngest years. Of course, that’s well before they learned through experience that touching a hot stove would burn; before they could reason for themselves that not paying attention by stairs could cause a painful fall.

In these stages, your loved one is likely unaware of action-and-consequence, cause-and-effect relationships. The logical conclusion, “If I touch this knife, it will cut me,” no longer springs to mind. Attention spans may last seconds, at most.

Some may consider the final stages to be a state of “childlike dependence.” Person-centered care avoids such degrading language. Despite their diminished capacities, they’re still an adult entitled to dignity and love.  

Changes in Reasoning & Judgment with Alzheimer’s and Dementia

Studies show reasoning and judgment are “intimately linked” to problem solving and decision making. Unfortunately, those capacities become greatly diminished as Alzheimer’s and dementia progress. Care partners must plan for when routine activities become not-so-routine — and even dangerous.

#WeAreDementiaStrong. If you need help, Caregiver Support and Resources, LLC has over 25 years of experience with all aspects of life-care planning including dementia care. We’re happy to guide the process in a caring and compassionate way.

You hear your brother in the kitchen, fumbling around with some car keys. “Shoot, he found them,” you whisper to yourself as you try to intervene. His doctor estimates he’s in the middle stages of mixed dementia, and everyone on the care-partner team (your brother included) agreed several years ago it would no longer be safe for him to drive.

But in recent months, he’s taken on some suspected manipulation tactics — common among Alzheimer’s and dementia behaviors. “But you said I could drive to the store if I finished the dishes,” he sometimes says, or, “But we agreed it would be OK to drive to the beach.” Was there an agreement? Probably not. Were dishes, the beach or any other variable part of the equation? Not likely. Does he remember it would be unsafe to drive? Maybe or maybe not.

For loved ones with Alzheimer’s and other types of dementia, manipulation can be a frequent behavior for a variety of reasons ranging from bargaining for things they want to legitimate confusion. As with any of these behaviors we’ve been writing about recently, it’s helpful to understand the states of mind behind them to address sensible and meaningful solutions. (And a word of caution: It’s regrettably common for care partners of persons living with dementia to be manipulative for things they want, as well. So this conversation requires some serious, two-way honesty.)

Understanding Manipulation as a Common Alzheimer’s and Dementia Behavior

As we’ve often said on this blog and elsewhere: Dementia is so much more than memory loss alone. While memory loss may indeed be a root cause of confusion around whether an activity is safe or reasonable, many other factors could cause actions or statements to appear or sound manipulative.  

Here’s a more detailed understanding:

Filling the Gaps 

Your loved one goes for the keys or tries to explain why she’s wandering in the yard. “You told me I could go to X, Y or Z” or “I wanted to see the neighbor’s flowers” might be some likely responses. Perhaps they’re confused or disoriented, thinking they’re heading to a former workplace. Or maybe they’re uncomfortable and aggravated, trying to find “home” even if they’re already at home.

They may rely on some fibbing, when asked, to fill in the gaps in memory or to reach for a reason they can’t express.  

Bargaining Chips

Living with advancing stages of dementia doesn’t mean living without needs and desires. An individual may simply be incapable of expressing or acting accordingly to achieve them. A loved one may understandably want a taste of freedom — to drive off and watch a sunset, visit an old friend, pick up a bottle of wine, anything  “normal” that was once routine.

They may resort to slight dishonesty, bargaining to get what they want. “If I did X, you said I could do Y or Z.” Of course, there was no agreement, but in their mind a this-for-that transaction works logically and fairly. Some who are still relatively cognizant may even bend or distort reality. Some may feign confusion, taking advantage of their own condition to earn sympathy points. “Since when do I need permission to withdraw from my bank account?” they may say, knowing full well a relative with power of attorney set up precautions against poor financial decisions.

Type of Dementia

Different types of dementia affect different areas of the brain, well, differently. Frontotemporal dementia, for instance, damages the frontal lobe, which governs self control and good judgment. Vascular dementia from brain tissue damaged by blood loss (i.e., stroke, heart disease, vascular disease) may cause impaired concentration and memory loss.  

Thus, vastly different behaviors may result from specific styles and areas of deterioration.  

Stage of Dementia

In an early stage of dementia, your loved one may not experience any negative personality effects at all. They’ll be cooperative and supportive of their care-partner team. They’ll almost certainly show respect and appreciation for the immense responsibility and sacrifice the journey will bring.  

With time, sometimes even a few short years, they’ll likely grow increasingly confused and even combative, at which point manipulation may become a personality trait beyond control.

Personal Characteristics

A loved one “just isn’t the same person anymore.” I hear that from clients so often. But I always assure them their loved one’s soul still lives in there, but their mind is just transitioning through a different stage. That said, they’re not wrong. Alzheimer’s and/or other dementias can arouse new characteristics and amplify old traits. 

Dishonesty and manipulation may be out of character for someone who lived by a strict moral code. Perhaps they are a genuinely caring person who always spoke the truth and served others before themselves. Likewise, someone with a gruff and self-centered nature could grow worse with time.

Caregiver Manipulation of Loved Ones with Alzheimer’s and Dementia

This section requires some honesty. Admittedly, caregivers (or care partners, as we prefer to call them) sometimes use dishonest tactics for goals that may or may not be so helpful. Caring for persons living with dementia can be a long and complicated dance. Despite our best efforts, we may step on some toes learning the steps.

A range of possible scenarios can occur daily, requiring careful consideration of another’s dignity, feelings, wishes and best interests. The line may be fuzzy between what’s appropriate and what’s necessary when one may no longer think or execute decisions for themselves. 

‘Therapeutic Fibbing’

As dementia progresses, managing routine tasks like eating, bathing and taking medications can become very difficult. Your loved one may refuse beneficial tasks. They may become argumentative, combative and even aggressive. Care partners sometimes resort to “therapeutic fibbing” to avoid confrontation or ease the process.

But is it lying to withhold information or distort the truth? If a loved one takes a pill or eats a meal, do the ends justify the means? Is it deceptive to withhold an upcoming doctor appointment to avoid many repeated questions and anxiety? Sometimes the daily tightrope between right and wrong is so thin and wobbly, it’s hard to make the distinction.

Honoring the Trust Bestowed 

Somewhere in the process, your loved one trusted and chose you to serve a primary role in the care-partner team. Somewhere around receiving a dementia diagnosis — maybe even when first they noticed subtle changes in memory and cognition — you worked together to set a plan in motion. This plan likely involves many progressive steps maintaining independence and dignity as long as possible.

Your loved one picked you knowing you’d be responsible for making very difficult decisions and fighting daily battles. Entering the mid- and final (terminal) stages, they may not be able to remember or express their appreciation, but your responsibilities for care, comfort and strong judgment in tough situations live on. 

The Test: Who Benefits Most?

So in situations that may require stretching the truth or withholding information, a good care partner must assess reality. Who benefits? Are you not bringing up an upcoming doctor appointment because your loved one’s questions and anxiety will be tougher for you or them? Are you trying to get them to eat, bathe, take a medication that will help you or them? Should they have the ability and opportunity to decide? Do they still have the capacity?

Manipulation: The Alzheimer’s and Dementia Behavior that Goes Both Ways

#WeAreDementiaStrong. If you need help, Caregiver Support and Resources, LLC has over 25 years of experience with all aspects of life-care planning including dementia care. We’re happy to guide the process in a caring and compassionate way.

Your husband’s out in the living room watching TV, and you’re busy pushing through your chore checklist. In his advancing stages of dementia, it’s been increasingly necessary for you to plan and perform daily tasks. You’re about to put away his laundry and you stumble across one of the most common Alzheimer’s and dementia behaviors: collecting and hiding objects.

You’re taken aback as you open his top dresser drawer. You count no fewer than a dozen forks. “So that’s where those went,” you say to yourself, poking through some clothes to also find a moldy, half-eaten PB&J sandwich. As if his ever-growing stack of newspapers weren’t enough, it seems your hubby has actually begun stashing things away — for reasons that aren’t exactly clear.

Like any other behavior associated with Alzheimer’s disease and/or other types of dementia, it’s often helpful to understand the underlying reason(s) to begin planning and enacting solutions.  

Collecting & Hiding Objects Among Alzheimer’s and Dementia Behaviors

So let’s discuss a few of the most common reasons for hiding away objects. Some would go so far as to refer to severe cases as “hoarding,” but emphasis on person-focused care language in recent years has us steer clear of such negative connotations. It’s a common Alzheimer’s and dementia behavior — and, yes, it can be problematic or even sometimes dangerous — but it’s more helpful to first assess the “why” to develop the most positive and proactive plan possible moving forward.    

1. Collection Hobbies

Many people develop and nurture hobbies throughout their adult lives. It’s quite enriching and fulfilling to find something all your own. Did your loved one have a collection hobby earlier in life? Perhaps they collected stamps from around the world, Little League championship pins, or celebrity cookbooks.

As many forms of dementia progress, these activities may become lost to memory, yet the itch remains to gather things for their enjoyment. Especially in middle-to-late stages, when losses in memory and cognition become most severe, your loved one’s collecting habit may lack logical reasoning. (Who would want a dresser drawer full of forks?) But always remember, it makes sense (in whatever way) for the person living with dementia. 

2. Previous Occupations

On a similar note, long-engrained activities and habits gained during years in the workforce may sneak into your loved one’s collection habits. Perhaps you notice they have an inordinate amount of pens and pencils stashed in a nightstand, purse or briefcase. Might a longtime desk job compel them to seek office supplies for use later? Maybe they’re gathering cooking utensils, sugar packets, or salt and pepper shakers? Might they have worked in a restaurant or school cafeteria earlier in life?

Again, persons living with dementia may not even realize they’re doing it. But the activity makes sense for whatever “work tasks” they feel upcoming. 

3. Forgetfulness & Confusion

OK, admittedly, we often say that dementia is so much more than memory loss alone. That’s true. But memory loss is at the heart of most dementia diagnoses.

Your loved one may take objects around the home (or from elsewhere) and place them somewhere, only to forget they had them in the first place. Or while picking up a common household item in a state of confusion, they may lose track of its rightful place. So you may find a bath towel stuffed under a couch cushion or a television remote in a medicine cabinet. 

4. Delusions, Hallucinations & Paranoia

Many persons living with dementia experience wild hallucinations and delusions as the neurons in their brains disconnect and malfunction increasingly with time. They see people and things that aren’t there — sometimes manifestations of their worst fears or bad experiences.  

Paranoia tends to increase as an individual no longer recognizes the people around them — whether they be medical professionals in an assisted-living facility or even their own family and friends. Your loved one may distrust anyone around them, believing that “strangers” would steal their “valuables” or prevent them from eating meals. This self-preservation instinct may explain why you would find spoiled food hidden away and forgotten in a drawer or under their bed.

Uncovering Reasons Behind Alzheimer’s and Dementia Behaviors Like Collecting & Hiding Objects

The effects of dementia disorders may seem unpredictable and haphazard. As my life partner/care partner Brian (who lives with Alzheimer’s and vascular dementia) and I often say, “If you know one person with dementia, you know one person with dementia.” Indeed, symptoms and behaviors often vary greatly among persons living with dementia, even those with similar diagnoses.  

But no matter your loved one’s Alzheimer’s- or dementia-related behaviors, it’s helpful to understand the reasons behind them. Care-partner teams must develop a plan to control the loss of items and mitigate “hoarding risks” like fire and health hazards. To do so, you must understand and appreciate your loved one’s present and past experiences.  

#WeAreDementiaStrong. If you need help, Caregiver Support and Resources, LLC has over 25 years of experience with all aspects of life-care planning including dementia care. We’re happy to provide referrals and guide the process in a caring and compassionate way.

Your husband sits at the kitchen table, thumbing through an old golf magazine for the umpteenth time. It’s about noon. You’ve prepared a nice, little lunch for him — just his favorite soup and sandwich. He looks it over, but 20 minutes later the soup is cold and he hasn’t even touched his sandwich.  

You knew his dementia would likely cause appetite loss. After all, eating difficulties and weight loss are common for most people in advancing stages of dementia. But you didn’t expect it to affect your husband — who is in an earlier stage and still relatively cognizant — so soon.  

Appetite loss can span all stages of Alzheimer’s disease and other types of dementia. If this sounds familiar, you and your loved one are experiencing one of the most common Alzheimer’s and dementia behaviors.

7 Reasons for Appetite Loss with Alzheimer’s and Other Types of Dementia

In order to address appetite loss (and related weight loss and physical weakness), you must first understand the reasons behind it. Here are a few:

1. Depression

Your loved one’s appetite loss could likely stem from depression. Persons living with dementia experience depression, especially in early and middle stages.  

Put yourself in their shoes. They’ve likely received a relatively recent diagnosis — perhaps just a few short months or years ago. Even if they expected it, due to genetics, they may feel powerful emotions like sadness, hopelessness, disinterest and fear associated with anticipating the worst effects and mortality of their condition. 

And then in advancing stages, depression may progress from an emotional condition to a neurological one. The areas of the brain associated with moderating mood may no longer function properly.

2. Confusion & Disorientation

A healthy person with an equally healthy appetite will sit down to a meal and know what to do. Grab the fork. Stab the slice of cucumber. Twirl the spaghetti. Cut the meat. Put it in your mouth. Take a drink. Repeat. 

Your loved one, especially in the mid-to-late stages of dementia, may gradually forget the process of eating. They may miss a step or tool to complete the job, which most of us take for granted as the easiest of human tasks. It’s easy to be discouraged with eating and lose interest altogether. (Imagine looking at your salad and having to decide between a spoon and a fork or forgetting steps from getting the soup in your spoon, lifting it to your mouth and swallowing.) Confused and disoriented with time and space, some may wonder why they’re eating dinner in what they think is the morning or why they’re eating a second lunch. 

Persons living with dementia may have a short attention span, allowing them to concentrate on a task like eating for only a few seconds. (Helpful hint: Allow plenty of time for your loved one to eat to account for distractions.)

3. Changes in Vision and Perception

Here’s a reason for appetite loss with dementia that often goes overlooked. Many types of dementia can affect vision and perception. It can be difficult for your loved one to see their food well enough to eat it. But this goes beyond getting new glasses.

With dementia, neurons responsible for transmitting sight signals to the brain and coordinating muscular response may misfire or fail to work entirely. Similarly, the inability for some to perceive depth, distance and color may also make it difficult to see the food or drink. (Try using plates or bowls that differ in color from the food or manually placing food/drinks in their hands or mouth, when necessary.)

4. Communication Issues

Inevitably, communication issues arise for most people with Alzheimer’s disease and other types of dementia. This may mean your loved one will have difficulty expressing thoughts about mealtimes with their care partner(s). While they may be able to communicate in other ways in advancing stages (eye movement, facial expressions, grunts, body language, etc.), it’s often hard for a person living with dementia to convey preferences about food and drink an otherwise healthy person would easily be able to express, like:

• Too hot or cold
• Displeasure with taste
• Overcooked or undercooked
• Too chewy, hard or soft

As hard as it may be for your loved one to communicate, it’s often equally difficult for their care partner(s) to perceive and comprehend the communication that does take place. 

5. Physical Limitations, Discomfort & Pain

Eating may be uncomfortable or even painful. Perhaps your loved one has a cavity or jaw pain that makes it hard to chew. Some simply don’t have the energy to gnaw through a big bite or steak or chicken anymore. Also changes in brain function as stages progress can slow or stop the natural chewing-and-swallowing reflexes, creating serious risks for choking. 

Changing the consistency of food and drinks is a tried-and-true solution. Some may require only that their more solid food items be cut down to smaller, bite-sized pieces. Foods also may be chopped, pureed or liquified to eliminate the need for chewing. Drinks may be served in different thicknesses (nectar thick, honey thick, etc.) to alleviate swallowing issues.

6. Medication

Prescription medications, specifically those for dementia treatment, may have a marked effect on appetite and weight loss. A recent study showed nearly 30 percent of dementia patients taking medications including cholinesterase inhibitors experienced “significant” weight loss (at least 10 pounds over a year) as a direct result. Side effects included appetite loss and various gastrointestinal conditions.

Unfortunately, that’s the catch 22. Do you treat the dementia and risk weight loss? Or do you forgo the treatment so your loved one may eat, only to lose them more quickly to the dementia? Consult their primary care physician for options that may improve appetite.  

7. Little to No Physical Activity

Food is fuel for the body’s activities — physical, mental and emotional. Even without strenuous physical activity, the body requires a minimum daily caloric intake just to energize activities we don’t even think about (brain function, breathing, heartbeat, etc.). But if there’s little to no physical activity happening on top of that, the body will gradually slow eating to eliminate the excess.

If possible, exercise (even a brief daily walk) may stir your loved one’s body to seek supporting nutrition.

The Reasons for Appetite Loss with Alzheimer’s and Other Types of Dementia

For many, appetite loss signals “the beginning of the end” for a loved one living with Alzheimer’s disease and other dementias. When a body no longer desires, needs or even refuses sustenance, it begins a sometimes lengthy — and debilitating — process of shutting down. But it doesn’t have to be that way. Extra effort to understand the reasons and plan accordingly can add many valuable years to a life worth living.

#WeAreDementiaStrong. If you need help, Caregiver Support and Resources, LLC has over 25 years of experience with all aspects of life-care planning including dementia care. We’re happy to provide referrals and guide the process in a caring and compassionate way.