Part of the reason that I think so many people struggle with the personality changes associated with dementia is you can't 'see' them in the way you can see a physical problem. Whilst physical changes can be very distressing - for example if a person becomes immobile, loses weight, loses teeth, wears a catheter or needs help to eat - we associate that type of change with a need to care for that person, helping to minimise any discomfort and keep them as well as possible.
Personality changes in the general discourse of life are bracketed under the 'mental health' banner, and as such have an additional stigma attached to them, before you even add in dementia as a factor. We also make a lot of assumptions when associating personality changes with dementia, most notably:
• That
every person who develops dementia was a 'nice' person before they developed
dementia. It may be unpalatable to admit it but we are all different, and some
people just don't get on with other people of contrasting personalities no
matter how much we might want them too - be they other residents in a care
home, health and social care staff or even their own family. That, as they say,
is life.
Personality
changes can be temporary or permanent for a person with dementia, depending
upon the damage to the person's brain (for example a stroke may mean an instant
change for a person), the type of dementia they have (for example people with
a form of frontotemporal dementia may have more pronounced personality
changes), and other factors such as who is around the person (the company of some
individuals may trigger different reactions), their environment, other health
conditions, side-effects of medications, and even issues like changes in the
seasons (increased darkness in winter for example) or memories of certain times
of the year, events, people or places.
Personality
changes encompass as many differences as you can imagine. Examples include:
•
A
previously relaxed person becoming very anxious or angry (or vice-versa).
•
A
previously more detached person becoming much more emotional (or vice-versa).
•
A
previously tough person becoming a lot 'softer' and showing their feelings more
(or vice-versa) - This was true for my dad.
•
A
previously private person becoming more of an exhibitionist (or vice-versa).
•
A
previously tolerant person becoming intolerant (or vice-versa).
You
may recognise someone you love, or yourself, as having undergone such a change,
even a more subtle one, as a result of developing dementia. What I think those
of us without dementia, and particularly family carers and health and social
care professionals, need to understand is that:
•
Change
is ok, even changes that we perceive as difficult. The more we worry, try to
correct, mourn and yearn for the person 'as they were' the harder we make it
for the person with dementia and ourselves. Adjustment is hard, I know that
only too well, but failure to adjust is harder still.
• If
we can adapt our approach and interactions with the person, we have the ability
to offer the mental equivalent of what I wrote about above in relation to
physical changes, namely to; "Care for that person, helping to minimise any
discomfort and keep them as well as possible". Examples of how to do this
are through person-centred care, life-story work, reablement, occupation, sensory therapies (including touch), making spiritual connections, music, our approach to personal care, and even by something as simple as modifying the way we communicate.
• Don't
automatically view medication as the answer - often the first resort for any 'negative'
personality changes is to assume that the person is depressed and put them onto
anti-depressants. Medication may be suitable in a few situations, but
generally the answer is greater understanding, care and support on the part of
those around the person. Again, it goes back to the points about adjustment and
adaptation.
Every
day can, and often is, very different. Sometimes the changes in a person's
personality may be more, or less, pronounced. If they become less pronounced,
you may feel like the person is 'returning to their old self', only to see the
'reversal' of that the next day, week or month. It can seem cruel, and is a
fertile breeding ground for the 'blame game', where the person with dementia,
or a carer or family member, feels such changes very personally. If changes can
be linked to a particular aspect of the person's life, then mitigating against
that trigger could obviously be very beneficial, but sometimes there is no
apparent 'reason' apart from the unpredictability of dementia.
During
my dad's latter years with dementia I saw him cry more than I had in all of the
years prior to that. I saw anger and anxiety too, which I wouldn't have
associated with my dad prior to his dementia. With the power of hindsight,
however, I can also see reasons for these differences in him, ways in which I,
and others, may have contributed to them, not to mention environments like hospitals
and care homes, and some medication he was given.
That's
not to in any way exclude how vascular dementia affected my dad's brain - so
much of what he experienced was, from the perspective of the physical changes
in his brain, beyond our control. Coming to terms with that, whilst trying to
provide the very best care and support you can, is a balancing act that is as
fine as any personality change can be.
You can follow me on Twitter: @bethyb1886
