Forgetfulness, what is normal?

I once had a patient that would ask constantly if her varied bouts with forgetfulness or confusion meant she was “losing it” she greatly feared the beginning of the end. Unfortunately in her case (and I don’t believe she is alone) her obsession with memory loss increased her anxiety to the point that her forgetfulness did increase.

We all at one point or another struggle with mild confusion or forgetfulness. This is often related to stress, lack of sleep, or other physiological or environmental changes. In the example of losing our keys, most of us have a routine, we leave our keys subconsciously in the same place MOST of the time, except for when we don’t, usually when we are distracted by something we toss them somewhere else and they aren’t where we expect them the next time we need them. Eventually we are able to retrace our steps and find them.

As we age our cognitive functioning begins to slow leading to some delay in thought process and increased forgetfulness. As with the rest of our body we slow down and need a bit more help. To answer more extensively my clients consistent question. Here are a few examples of normal vs not normal:

• Normal: Occasionally forgetting plans especially when they are not routine.
• Not Normal: Consistently forgetting appointments or important dates such as birthdays or anniversaries.  
• Normal: Not keeping track of a conversation when you are distracted.
• Not Normal: Consistently forgetting recent conversations.
• Normal: Misplacing items you don't use often.
• Not Normal:Forgetting locations of familiar objects such as where the forks are kept.
• Normal: Occasionally forgetting someones name or finding the right word
• Not Normal: Difficulty finding the right word to use several times a day or speaking incoherently.
• Normal: Getting turned around or having difficulty following directions in unfamiliar situation. Not Normal: Getting lost in familiar places, for example on the way to the grocery store.
• Normal: Some difficulty in learning new things.
• Not Normal: Inability to cook a favorite recipe.
• Normal: Getting overwhelmed and having trouble coordinating when there is a lot to do, for example when moving or during a holiday.
• Not Normal: Inability to appropriately routine self care, meals, hygiene and finances.
• Normal: Trying new things.
• Not Normal: Being dangerously less inhibited or drastically different with language, actions or clothing choices.

Notice the key is recognizing when occasional becomes often. We all go off the tracks a bit occasionally but if we are unable to get ourselves back on track there may be a problem. Also if issues begin to threaten safety and well being it is time to seek help. Presence of these symptoms does not always mean dementia, it is not uncommon for some thought disturbance to be related to other physiological issues that can be treated. It is also important if there are signs of dementia that you or your loved one begin treatment as soon as possible for the best possible outcome.

The good news is that there is a lot that we can do even after a diagnosis to care for our brain. See my brain building blog 1,2,3,4. Living a life with healthy social connection, exercise, healthy eating, curiosity about the world around and hope makes our brain more strong and resilient even in the face of disease. If I could be of assistance in helping you and your family navigate challenges arising from memory loss please contact me. Here are also just a few fantastic resources in our area:

Senior Serv

Alzheimers Orange County

Alzheimers Association

Keep caring from your brain and brains of those you love.

Home for the Holidays, Facing Dementia

Coming home for the holidays carries with it many relational and emotional challenges. While there is hopefully some wonderfulness and childlike magic there are also expected and unexpected stressors. While I wish I could fully address all the many facets of emotional stress over the holidays all I will say is be gentle with yourself and others, its okay to find a closet or a parking lot to hide in for a while and ask for help when you need it.

Today I’m going to address a specific ‘home for the holidays’ stressor I rarely hear discussed at parties but I know to be a real and painful holiday experience.

When I worked in Geropsychiatry we often had a rise in admissions just after the Holidays when families would get together and realize “Dad’s not right”.  Dementia in all forms comes on gradually and it is often those closest to the individual who miss the early signs. After spending more time with them during family gathering it feels like all of a sudden Mom is not okay. I wanted to briefly go over some things to watch for if you are at all concerned. Its important to note that the primary difference between a normal age related forgetfulness and advancing dementia is consistency and impact on daily living. Here are a few things to look for.

•   Forgets significant dates (birthdays, anniversaries).
•   Forgets routes to familiar locations.
•   Unable to follow a familiar recipe or balance a check book.
•   Demonstrates difficulty finding the right word in conversation.
•   Unable to remember the name of a family member or close friend.
•   Unable to keep appointments straight or remember what day it is.
•   Poor judgement in dressing (short sleeve shirt to the snow).
•   Poor judgement in spending.
•   Increased clumsiness or small vehicle accidents.
•   Losing items and unable to retrace steps to find them or finding them in odd places.
•   Mood swings.
•   Repetitive speech, talking in circles.
•   Loss of initiative, seeming to give up.
•   Paranoia or suspiciousness.
•   Constant crying or tearfulness with no obvious prompt.
•   Change in personality or behavior.
•   Unable to make simple meals.
•   Decrease in self care (bathing, grooming, changing clothes)
•   Not maintaining household duties (cleaning ect.) that are within physical abilities.
•   Gets lost in familiar areas.

If you checked more than 4 items or if the items you did check are to the point of impacting daily life and safety it would be a good idea to check in with your loved one’s doctor. Again look at the consistency or extremity. We all can forget a word occasionally but if its several times a day that's a concern. While all of the above are indicators of dementia they could also be caused by other things such as poor diet, not taking medication correctly, grief, stress, depression, infection, other physical issues.

We always want our loved ones to be okay and it is very common for us consciously or subconsciously to attempt to will them to be better, to rationalize or ignore signs. Currently there is no cure for Alzheimers disease but there are medications that slow the progression when caught early, there are also simple lifestyle changes that can improve quality of life when attended to early. The more proactive you can be before it becomes a crisis the better.

Any transition or shift in family situations can be difficult, recognizing your loved ones need for increased care impacts the entire family. It is very common to experience feelings of fear, anger, anxiety, depression and guilt. Such shifts can also revive, intensify or initiate family tensions or unresolved relational issues. It is important to seek help for yourself as you seek help for your loved one. I would love to accompany you on this journey or help you find someone who can, contact me here.

A few resources to get you started are the alzheimers association with local chapters in orange county  and LA county if you are in the orange county area, Senior Care 101  is a monthly informational seminar on senior resources, for more information on alzheimers, the alzheimers family center  is offering a mind boosters series in January.  I won't overwhelm you with reading options but I will recommend The 36-hour day  and I have to confess I’m a fan of the dummies books there's no shame in it, they are clear, thorough and comprehensive.

This is a lot of information and I'm really just scratching the surface. I plan to do more entries on Dementia and aging. If you have questions or specific topics you would like to hear more of contact me or comment below.  I truly hope that your holiday season is one of grace and joy and that despite it all you are able to rest, enjoy a cookie, laugh with a friend, breathe in the smells and embrace what is good about right now.

16 Christmas's in Mental Health

16 Christmas’s working in mental health have taught me a thing or two...

It is extremely important to me in this discussion that my reference to mental illness is to be viewed as one of respect.  I have been honored to work with people who struggle each day with this condition and see them as heros. Mental illness is defined as a condition that affects a person's thinking, feeling or mood. Such conditions may affect someone's ability to relate to others and function each day. by the National Alliance on Mental Illness (NAMI).  The holiday season is not free of challenges in relating or functioning and I hope to give a perspective of what I have learned so as to help you in your own journey as well as increase empathy for others.

For years sitting in groups, and working individually with patients and their families in mental health facilities I have come to observe topic patterns. The following three stand out the most to me and demonstrate the blurred lines of mental health.

Loss

Many of us have experienced loss, devastating losses, a loved one, a job, a relationship, a dream...  whether it was in the last month or years ago, this season magnifies that loss. The emptiness is constantly present and severely painful. Here is a great list of things you can do to manage grief over the holidays, here is a list of suggestions to help others through their grief and here is one more great resource and article just for good measure.  

While personal loss and grief is a consistent topic throughout the year in mental health the more predominate loss that comes up around the holidays is the loss of‘normal’ the loss of what could have been.  There is a perception that there is an elusive “normal” and whatever it is, its not me or my experience. I believe we all carry this with us to some extent but don’t feel allowed to verbalize it. We silently grieve the loss of the vision, what the season is “supposed” to look like if only _____ (fill in your losses and absences here).  

Once we acknowledge the grief we can begin to celebrate the now,  the real, the imperfect and messy us. We can find beauty in the snowflakes of our individuality.  We can sing off key and begin to believe that we are whole in our own uniquely beautiful “normal”.

Distance

Another subject that comes up is disconnection with family, and friends.  Irregardless of the diagnosis I have often heard described a feeling of being outside looking in. Whether real or projected those with mental health diagnosis believe themselves to be outsiders, not fully included and misunderstood. Am I the only one who has felt that way too? Our insecurities and misperceptions can mess with us, we can believe ourselves to be outsiders, unloved, uninvited. A few things to ask yourself if you identify with this feeling (we all do at one time or another):

1. - How real is it? what is my proof ?  Are there other explanations for what happened? Sometimes it helps to have someone you trust to help you reality test.  Someone with true paranoia will whole heartedly believe in their misperceptions but with some self awareness they can assign people they trust to tell them the truth and choose, despite themselves, to believe it. How wonderful to have that - someone we can trust to tell us the truth despite our firm belief in our own misperceptions. Be honest with yourself and allow yourself to trust in others, it is easier for us to assume rejection rather than trust but with trust comes reconnection.
2. - What part am I playing in this positioning? Is my own depression, shyness, fears or anti social tendency keeping me separate?  Am I pushing people away while longing for them to stay?  Are my fears of rejection or unworthiness prompting actions that in turn prevent me from being included?
3. - Where do I really want to be? Where do I feel safe? How can I make that happen?  We often feel that with family is where we are supposed to be over the holidays but for many of us this is not a emotionally safe place to be. Look at this honestly and see what can be changed. Make a plan A, B and a exit strategy. Now, don’t go saying you’re not going to your in-laws because I said you don’t have to, but look at what adjustments can be made to increase safety and connection.  Many of us only go in with a plan to grin and bear it and year after year it goes horribly wrong. Make a plan ahead of time and if possible communicate your plan to others.    

Discombobulation

Don’t you love that word? It means to confuse or disconcert; upset, frustrate.  A common theme around the holiday season is extreme anxiety over, well, all of it. There are changes everywhere which I think is often also the draw for many of us - we love christmas music and egg nog for exactly 4 weeks and then we are done with it for a whole year.  We don’t all deal with change or loss of routine in the same way but I think if we are honest with ourselves, even those of us hard core Christmas/Hanukkah ninjas can admit to holiday discombobulation to some degree. The lesson here for all of us is simply to be gentle with ourselves. Understand where we are in life and who we are. Take some time to really look at what is overwhelming and what is life giving and make real changes accordingly.  

Hope

This really just scratches the surface of the complexities of emotions we all experience over the holidays. There is hope in recognition. I have seen countless times how hope is able to grow only when challenges are faced. The important thing is to know yourself , accept yourself, verbalize your needs, seek help and find balance.  Here are two more great articles and resources, NAMI on managing holiday blues and Psych Central has several articles addressing specific disorders and challenges. If any of these challenges feel too big and you need help working through them please contact me or someone and get the help you need. Attaining hope is doable but you are the only one that can take that first step.

Now, a deep life giving breath and on to the good stuff, there is joy to be had, songs to be sung.  I hope you are able to embrace the season, to find the magic in the twinkle lights and breath in peace. I would love to hear how you are honoring the season.

Warmline

I had the privilege of attending the County of Orange Mental Health Board meeting this morning. I feel blessed to be in a state that is constantly striving to seek and attend to the needs of the mentally ill. It is a huge undertaking. They have a lot of information and volunteer opportunities available. 

A representative from the National Alliance on Mental Illness (NAMI) highlighted their Warmline, which in contrast to a hotline attends to the non-emergent mental health concerns. Think of it as a urgent care as opposed to a ER.  They strive to provide a non- judgemental listening ear by a peer support counselor. For those who may find themselves in or near crisis but are reluctant to call a hotline this is perfect.

OC Warmline:
9 a.m- 3 a.m. (Mon.-Fri.)
10 a.m. - 3 a.m. (Sat. - Sun.)
Text or call 714-991-4412
Chat: namioc.org

LA Warmline
10 p.m. - 6 a.m.(Mon.- Sun)
Local Number: 855-952-9276

Suicide Prevention Hotline
800-273-8255

Click Here for OC crisis line and Chat

Nami is also an amazing resource for individuals and their families

Click Here for more hotlines and resources

These are excellent and invaluable resources for all of us who find ourselves in crisis at one point or another but they do not replace the long term benefit of on going treatment and therapy.  Please follow-up with your physician and therapist for continued healing. If you don't have a therapist contact me here I would love to help you work through finding long term solutions. It is important to find a therapist that is a good fit, if for what ever reason that is not me you can search therapists here for someone who is right for you.