One of the most common symptoms of early onset dementia in a person is the personality change that seems to herald its arrival. Mild mannered, good natured individuals seem to become sullen, short tempered and angry. Naturally this causes a lot of heart ache and confusion for those that love them; wondering what happened to the person they always new to be patient, friendly and the life of the party. Naturally this isn’t the rule, but it happens often enough to be notable. But what causes this sudden shift in behaviour? Why do those that have seemingly never displayed such a short fuse before become this way when dementia first starts to manifest?
As biological creatures, we all have a natural, in-built sense when something is off; often referred to as a gut instinct1. This intuition tells us when something is wrong even when we have no conscious idea what or why that could be. The current psychological consensus as to where intuition comes from is that it originates in the sub-conscious. The sub-conscious is constantly taking in information and comparing it to past experience, seeking for patterns in order to predict outcomes. All of this is going on without us being actively aware of it. Think of your computer; if you open up the task manager, in the first tab will be all the programs you currently have open and are working on. If you switch to the next tab though, you will see an incredibly long list of background tasks and programs running just to keep the whole system online. In the same way, while our conscious mind may be busy doing a cross-word or making a sandwich, our sub-conscious is wiling away in the background, monitoring everything going on around us, comparing what we’re doing right now with past experiences and drawing conclusions to ensure the best outcome. But what happens when all of that background processing detects something wrong with the system, without being able to identify what it is?
While speaking about conscious, subconscious and unconscious minds may seem somewhat metaphysical, all of this is still very much related to the biological makeup of the brain2. The brain is the repository of the mind and when something goes wrong with it, the mind picks up on the fact. The mind recognises that neurons don’t seem to be firing as effectively as they used to, that there seem to be gaps in the ability to process information. Therefore, the subconscious begins throwing signals. Even after a patient becomes consciously aware of the problem through a diagnosis, the mind will continue to signal danger, that something is wrong. But whereas usually these signals would enable a person avoid or escape the problem, this time it isn’t some external danger. This time the problem is coming from within the system itself.
Anger is a natural emotion that all of us possess. While many may behave badly due to anger, it doesn’t change the fact that it is a completely natural emotion that serves a purpose. Anger is a response to us believing something is wrong. We can get angry at injustice, mistreatment, anything that we believe shouldn’t be happening. This includes our own minds turning against us. This shouldn’t be happening, and even before we’re consciously aware of the problem, our mind is and it’s signalling us to be aware of it. When a patient becomes easily angry, frustrated, short tempered, it’s because their mind is working furiously in the background to warn us of the problems it’s detecting. It can be heart-breaking to see this change to our loved ones, but just know it’s almost a form of self-defence and they likely are just as upset by the change coming over them.
But knowing this means that while we can’t take the frustration away, we can lessen its impact. When a patient is becoming frustrated because we disagree with what they know to be true, they need to be ready to pick their uncle up from the airport, despite their uncle being dead for seven years, instead of reminding them of this fact, just agree with them for a while. Play along and find ways to work around their interpretation of reality instead of shattering it. If nothing else this will reduce the amount of frustration being felt by the patient, not permanently but just enough that some of the old person can still shine through. Do this with the advice of a qualified mental health professional; they will be able to give guidelines on what should be enforced and what can be humoured. Your last memories of your loved one don’t have to be tainted by anger and frustration, with just a little bit of patience and understanding instead.
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