Is Grandpa Crazy Or Does He Have Dementia?

It's too bad that we are so prejudiced about dementia. I know, everyone's terrified. Use the word "Alzheimer's" round healthy elders to watch them run.

The problem with that projection is that people who need expert help may not be getting it. I look after people with dementia, I don't diagnose them. However, I can often tell when something doesn't look like normal dementia. And yes, Virginia, there IS a normal dementia -- variable as it is.

Here are the things not part of normal dementia. Hearing voices when no-one is speaking, having night terrors, being wildly over-active throughout the night, calling the police at all hours complaining about non-existent intruders, presenting variable personalities at various times of the day or week, having a very good memory with the ability to accurately describe recent events, being aggressive without any triggers.

Confusion can well be a part of dementia. Misinterpretation of things said, living in a past time zone, possible dream visitations from dead family members -- these are all very common and normal. But feeling threatened, pursued, being aggressively over-active and being violent when unprovoked are indicators that a better diagnosis is needed.

It is not unusual for mentally-ill elders to be categorized as having dementia. Indeed, just to be confusing, an elder could have both dementia and a mental illness. Unfortunately, however, it is still quite usual for a whole range of threatening, weird, acting-out and crazy behaviors to be accepted as dementia.

I suppose we can thank Hollywood for that.

Here's the problem. One, almost all resident-caused violence in which another resident is injured or killed usually is actually one seriously mentally-ill resident attacking a resident with regular normal dementia. So, we really don't want to see those with dementia being forced to live side by side with those who have serious schizophrenic or psychotic conditions. I don't anyway.

Two, is that even a seriously mentally-ill elder could be helped to have peace in the final years of life with the right psychiatric intervention. I'm not a big believer in psychiatric medications, because they do a great deal of lasting damage, but they also do buy peace. An elder with PTSD or a lifelong undiagnosed mental illness could be offered a chance to live without demons in pursuit.

I think the chance of peace in the last years of a long life is a very real reason for making sure everyone has the right diagnosis.

So, back to your dear but troublesome Grandpa. Is he insane? Well, I don't know and it's not my job to know. Get a referral to a psychiatrist to have him checked out.

I'll tell you this much. I have noticed that when families are asking that question -- is Mom or Grandpa crazy, mad, mentally ill -- it certainly indicates that everyone is pretty uneasy about what's going on. That might be an excellent indicator. We aren't all medical specialists, but we often have a reasonable idea of what's in the range of normal and what is very questionable.

So let me urge you to get your elder to the right place for the right diagnosis. Then you know. Then you can make decisions.

And then maybe for the first time ever, this person can live peacefully, without being pursued by inner demons.

Frena Gray-Davidson, Alzheimer's caregiver and author of five caregiving books, including her latest book "Alzheimer's 911: Hope, Help and Healing for Caregivers", available at http://www.amazon.com. Frena teaches care families and professionals to decode the language of dementia and achieve successful behavior interventions. Go to her website at [http://www.alzguide.com/] and sign up for her free monthly online newsletter for all involved in dementia care. Email her at frenagd@gmail.com.