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Mom got her diagnosis of vascular dementia about a year ago; then some weeks later the Alz. disease was confirmed. The family knew for several years something was wrong. Mom kept repeating herself over and over, asking the same questions, losing stuff, putting stuff in weird places, up all night going through cupboards, sorting through trash, rummaging through other people's personal stuff (which I don't think she used to do). Irrational fits of anger. Extreme paranoia.
When she first got the diagnosis she was in early-to-mid stage, approximately stage 4 with some elements of stage 5. She mourned her diagnosis at first: "Why is this happening to me?" "I wish I could die," etc. but you could actually discuss her condition with her.
As the weeks went by her dementia worsened, even with Aricept and Namenda. Ever so gradually, Mom lost her grasp of reality, insisting it was I and not her that had dementia! A couple of months ago she was worked up by a neuropsychologist who staged her at moderate to moderately severe dementia (5 to 6 on the Reisburg scale). She was taken off the Aricept because the side effects were worse than any benefit we could see, but kept her on the Namenda. I never reference her disease as "Alzhemer's" or "dementia" any more. Big mistake. She will really fly off the handle, insisting she has no such thing. On the other hand, she still says she wishes she could die, which is really sad. She was started on Lexapro for anxiety and depression about a month ago. It seems to have helped some.
I have always had minor small slips mentally however now I have just the repeated simplest things that haunt me daily like only remembering to turn the heater off because I hear it running not because I recall turning it on or walking into a room and forgetting why. I usually remember why however it takes me a few seconds. I know it seems normal on some levels, its just the frequency that worries me. I have twins almost 13 now and for me it's all about them. Saddens me to think one day I would be here physically however not mentally for them. We are so close.
Honestly don't know that staying alive for loved ones without mental recollection is better than passing away from something more sudden. Mental illness seems to be nearly the saddest of them all beyond sick children.
Anyway my answer is unless someone went past mild dementia so fast that they didn't get the chance to absorb these types of symptoms then I believe there must be a few years that they absolutely know something is going on.
In an early lucid period my husband said, "I took good care of my heart all these years for THIS?!! My brothers got to die quickly of a heart attack. I exercised and ate right and saw my doctors and took meds so that I get to lose my mind slowly! I envy my younger brother who died while tying his running shoes."
Not everyone is articulate enough to express this thought, especially after dementia sets in, but I suspect it is a common way of thinking.
My mom thought the rest of the world was the problem, not her declining condition. Everybody in 10 miles was Stupid, Idiot, Jerk, and some things I can't print here. Not once did she ever attach her frustration with her conditions.
The doctor was just a "stoop" (stupid). She's always said it that way, so I can't blame dementia.
She never educated herself on her diagnosis so many years ago. She ran from it, thinking she could out run it, which is foolish, but typical mom. She had no idea what to expect, so she didn't recognize change in herself, the house, or her habits & abilities.
She to this day insists that everything happening is completely normal and nothing has changed except that she lives in this weird "house" (memory care ward) that has holes in the floor (her vision deteriorating) and dog that meows when it's not a cat barking (misinterpreted visual stimuli).
I think it was a generational thing or a regional thing because mom's older & younger sisters are exactly like this. Completely out of touch with the aging process.
She would not take any help either, even to the point of putting herself in danger. She would rather everyone in the community believe she's a weird old kook than an elderly lady in need of help with the activities of daily living.
Her sister is the exact same way. Better to be a shut in than let somebody in town see you with a cane or walker. I don't get it.
I want flames painted on my canes & walkers. My scooters & wheel chairs. I'll carry a bull horn with me to shout "get out of the way! Here comes granny!"
As for a mentally incompetent person that's a different story. There are many reasons for mental incompetence. Dementia is just one of the many causes. So to say that a mentally incompetent person is aware that something is wrong is not necessarily accurate, it depends on the cause of the incompetence. An example of another cause of mental incompetence would be psychosis related to schizophrenia or bipolar disorder. In this case most of these folks are unaware that their thinking is off. Hope this helps.
During my Mom's journey, she visited with (long deceased) brothers and sisters. She was suck in her late teens/early 20s. Hadn't met my Dad yet so he (also long deceased) was never mentioned . My Mom was always a kind 'lady' but helping her stay in HER present I believe helped her. She described her new cars and vacations to me in vivid detail. I thought she was having (for the most part) a reasonable life. She spent her final years in a memory care center and told me stories of her adventures. She enjoyed telling them and I enjoyed listening. I urge everyone to 'go with the flow'.
My Dad has age related decline at 93, so his mind isn't as sharp as it use to be.... and I found it interesting the other day when he admitted that he's not thinking as quick as he use to, that it must be his age. Heck, it takes me longer to remember names of people, and sometimes it will be at midnight when I do recall a name :P
My boss's wife had Alzheimer's for 15 years, but he had noticed that a few times a day his wife would be *in the moment* where he could ask her a question and she would answer him. It's kinda like the brain is in a loop but that loop is damaged except for a very tiny moment where it is clear.
Too bad there isn't someway we could see what it is to have severe memory loss through the eyes of the person who has that loss.