Nearly everyone who cares for someone with dementia has a story like this:
“Just yesterday, mum spent most of the day sitting quietly and barely said a word. When I brought her lunch, she looked at me like I was a stranger. This morning, she greeted me cheerfully and called me by name. A few minutes later she was working on a crossword puzzle. Could it be that she’s getting better?”
Dementia – once it has been officially diagnosed – does not go away, but the symptoms can come and go and the condition can manifest itself differently depending on the person. The symptoms and signs of Alzheimer’s or dementia progress at different rates. There are different stages, but it doesn’t ever “go away”.
Dementia progresses rapidly for some people, while it takes years to reach an advanced stage for others. People with “mild dementia” may still be able to function independently, with memory lapses that have a minimal impact on daily life, such as forgetting words or where things are located.
While Alzheimer’s and other common forms of dementia are progressive in nature and cannot be reversed (not yet, anyway), sometimes symptoms fade and individuals can enjoy periods of relative stability. This happens for a number of reasons.
How Dementia Seems to Come and Go
In one study, charts of dementia patients were reviewed during a two-year period. The researcher scanned the charts for mentions of “good days and bad days.” The most common characteristics? Most of the patients lived with their caregivers (typically their spouse). Most were recently diagnosed with mild dementia. About half were taking cholinesterase inhibitors, a category of drug used to treat Alzheimer’s. Good days most often involved enhanced mood, better concentration and improved ability to perform IADLs (instrumental activities of daily living). Bad days were characterised by increased verbal repetition, anger, irritability, forgetfulness, delusions and declining mood.
Why Dementia Symptoms Fluctuate
The common perception that symptoms come and go is an important area worthy of additional study. From what we know now, here are five considerations when thinking about why your loved one might experience increasing and decreasing signs of dementia.
- Your loved one is in the early stages of dementia. The onset of dementia is confusing and frightening for patients and family alike. In early-stage dementia, memory problems and confusion come and go and may be accompanied by periods of completely normal behaviour. As one writer puts it, “One day the person may be calm, affectionate and functioning well, the next, forgetful, agitated, vague and withdrawn.”
Co-existing medical conditions. It’s very common for those who suffer from dementia to have other diseases that may worsen symptoms. For example, when an Alzheimer’s patient is also depressed, it may be that a deepening depression is to blame for emotional problems. Sometimes, treating the other condition will appear to “improve” Alzheimer’s. This is why it’s important for loved ones as well as the medical support team to not make any assumptions as to why the patient seems better or worse.
- Maybe it’s not Alzheimer’s. There usually aren’t major changes in cognitive function from day to day for Alzheimer’s patients. On the other hand, it’s common with another form of dementia called Lewy body dementia. This under-recognised and under-diagnosed dementia can result in an apparent improvement in symptoms.
- Treatment with dementia medications. Some patients respond favourably to dementia medicines. While the disease can’t be halted, certain medications can help sharpen the mind for a time, especially in the early stages of the disease. The top five drugs for combatting dementia symptoms are Donepezil, Galantamine, Rivastigmine and Memantine.
- Treatment with other kinds of prescriptions. While non-drug options like counselling and support groups are the first line of defence, sometimes medications such as antidepressants, anticonvulsants, antipsychotics, anti-anxiety drugs and sleep aids can help correct emotional and behavioural issues. One elderly woman I knew went from mild cognitive problems to rapidly advancing symptoms in a single weekend, including wandering and hallucinations. Her doctor prescribed an antipsychotic medication that returned her to her previous state. She lived contently for nearly a year before the symptoms advanced.
In short, there is no script for what is and isn’t normal in dementia. In some forms of dementia, symptoms may appear suddenly or may come and go. People with dementia can often be very lucid, engage in perfectly normal conversations and seem to not have a problem with memory recall. The next day they are hallucinating and don’t know where they are; they are walking around the house with the dog leash and think the dog is attached but the dog is outside. And then the next day they are doing the crossword puzzle peacefully. This can be challenging, if not maddening, for caregivers but should be understood, expected and met with compassion.