Is the Dementia Diagnosis Always to Blame?


As I get to know more persons with dementia and their care givers over time, I have realised one thing: we always need to apply the 5WH rule to all things that are out of the person’s ordinary day and routine. The quicker we get into the pattern of doing this, the easier it will be for the person with dementia and their care giver.

What do I mean with out of the ordinary? Any sudden changes – which may include a change in bowel movements, energy levels, eating habits, mobility and behaviour. Working in a dementia facility immediately puts me in the ‘dementia frame’, which means I try and reason with dementia always at the forefront and as my foundation. I need to consciously tell myself to question other possible reasons for changes in the person with dementia. Yes, sometimes it is the progression of the disease and we can expect certain changes, but many times it is something else and we need to put our ‘investigator hat’ on to get to the bottom of it. We cannot rely on subjective information alone as the person with dementia may have challenges communicating with you regarding their situation.

Things that may possibly lead to (sudden) changes in the person with dementia:
  • Depression and anxiety- This may be a long standing diagnosis or an acute onset and should be seen to and treated sooner rather than later.
  • Pain- Check for tooth pain as this is something we sometimes miss. Finding the source of the pain may be difficult. Look out for the following which may indicate that there is pain present: specific facial expressions, negative vocalisation, and changes in body language, changes in activity patterns and changes in socialisation.
  • Constipation – Known to lead to frustration and feelings of irritation.
  • UTI –  Bladder infections should be the first screening if there are behavioural changes and confusion.
  • Weather changes
  • Sleeping pattern changes - Being tired. 
  • Any infection
  • Deficiencies -Iron, Vit B-12, Vit K, Vit D, folate, zinc and calcium.
  • Change in environment – Including those around the person with dementia and his/her physical environment.
  • Medication changes/current medication – During the later stage of the disease there may not be a need for medications that assist the person with frustration and anxiety as they may not have these challenges anymore, speak to your Dr regarding this matter.
  • Gut health
  • TIA/Stroke- Ensure that the person with dementia has frequent health checks to ensure that they are in optimal physical health.
  • Vision problems – cataracts, macular degeneration or just old spectacles
  • Hearing problems
There may also be a combination of things and this is why it is vital that the person with dementia is under the care of a dementia specialised doctor.

Lou-Ann van Heerden 
Occupational Therapist 


Location: South Africa 1 Derry St, Vredehoek, Cape Town, 8001, South Africa

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