Items in Caring Currents tagged with Alzheimer's

Holi-Daze Made Happier: How to Hang Out With Someone Who Has Dementia

Paula Spencer — Fri, 21 Nov 2008 08:00:00 -0000

Before I knew anything about Alzheimer's, a kind of helpless anxiety used to throb when I visited my Gram, whose dementia was very progressed. What do I say? How should I act? I lived far away; she changed from visit to visit. I didn't interact with her day to day.

I bet many people whose holidays will involve a relative or friend with dementia are familiar with that apprehensive feeling. Even adult children have it. It's called being human.

What helps?

If the person has early dementia:

Don't be afraid. Your mantra: The person hasn't morphed into a disease; the person is the same person. Be yourself; that's the best way to make the person feel comfortable and happy.
Be inclusive. Take care not to talk about the person as if he weren't in the room. Ask direct questions instead of waiting for the person to join in.
Skip simple "yes or no" questions in favor of open-ended ones. Just don't make the questions feel like tests: "How do you like these decorations?" not, "What did you think about the election?"
Offer conversational crutches. It's okay to supply the right word if the person seems to be having trouble, so long as you aren't patronizing about it. Caring.com has more how-to-say it tips.

If the person has moderate dementia:

Approach gently. To avoid startling the person, approach from the front. Touch her lightly. Work in an introduction even if you're very close: "Hi Grandma, it's your favorite granddaughter Mary!" "Hey Bob, your cousin Sam has come to see you."
Go for the one-on-one. It's hard for the person with mid-dementia to track a group conversation. Sit close and chat, just the two of you. Use eye contact and smile. Good opener: "Tell me a story about when you were a kid." (Early memories last longest.) If the person can't, offer prompts: "I love dogs; I think you used to have a dog named Dandy."
Be kind about repetitions. Don't point out that you just heard that story. Try offering a bridge to a different topic: "That reminds me…" "That sounds like my…"
Speak sincerely. Claudia Strauss's handy book Talking to Alzheimer's offers nice "Do say" phrases: "Thanks for telling me!!" "I wish I could be as funny/caring/feisty as you."
Offer to be the designated carer. Parties, with their noise and new faces, can quickly overwhelm. Tell the caregiver that you'll be the person who stays by the person's side throughout. Casually guide him to another room for conversation, cards, napkin-folding, or another quiet diversion when things get rowdy.

If the person has late dementia:

Give the "ministry of presence." I've always loved this lovely phrase I learned from Kristi Marie Gott. Simply being there and offering a hand squeeze ministers to the person and says, "I'm here for you, I care."
Try a serenade. Holidays are a natural excuse for music. After my post about the lasting power of music to soothe and connect, reader Amy G shared how her grandmother joined in hymns long after she couldn't speak coherently. Another inspirational example: In spite of having advanced Alzheimer's, the mother of one of Caring.com's founders continued to take piano lessons until the week before she passed away last Saturday. It's never too late to share this language of the soul.

For everybody:

Hey, say thanks. Tell the person how you're grateful to him or her. Don't forget their daily caregivers. Blogger tenderlovingeldercare says it beautifully: "If you can’t find the words or feel awkward saying them, this video is absolutely right -- a hand gesture, a wink of the eye, or even a special smile can get your message of appreciation across."

Don't miss that video. Happy Thanksgiving travels.

Vintage Thanksgiving postcard by Flickr user riptheskull, used under the Creative Commons attribution license.

11 Kinds of Music to "Soothe the Savage Beast" of Dementia

Paula Spencer — Thu, 13 Nov 2008 08:00:00 -0000

Why is it that I can remember the lyrics of every awful 70s pop tune I catch the merest snatch of while turning a radio dial, but not the name of the street two miles away? The answer is good news; that is, if you spend time with someone who has Alzheimer's, dementia, or Parkinson's Disease.

Music lodges uniquely deep in the recesses of the brain -- and therefore can still be tapped long after other abilities have failed. Musical memories are a complicated code of primal emotions, cognition, movement, and language. It both calms and provides sensory and social stimulation. But there's an even better reason to bring singing, listening, playing, and dancing into the life of someone with a dementing illness: to provide them with the deep pleasure and reassurance brought by enjoying moments of wholeness and clarity.

For a person with a neurological impairment, music can "stimulate a sense of identity as nothing else can," says neurologist Oliver Sacks, who writes about the evocative powers of music in last year's bestseller, Musicophilia, and in the November O magazine.

Longterm care facilities know this and use "music therapy." But it struck me that home caregivers or family members might not realize this remarkably effective tool that's right under their noses – or rather, ears.

Some ideas to try:

Heyday favorites. Unsure what the person has long liked (jazz, big band, classical)? Google "music era" with the decades during which the person was a teenager or in his or her 20s (1920s, 1940s, and so on).
Christmas carols. 'Tis the season (so stores already tell us). Start with classics: Bing Crosby, Nat King Cole, Elvis, Rudolph the Red Nosed Reindeer.
Nursery rhymes. When I was a brand-new mother, I didn't know any proper lullabies. So after I sang all the carols and Beatles songs I could think of, I went through Mother Goose. You'd be surprised how sing-songy and satisfying rhymes like "Jack and Jill" and "Hey Diddle Diddle" can be.
Hymns. Ask to borrow a hymnal from a place of worship to help you sing or play familiar standards on the piano.
Funny songs. Add the benefits of laughter with corny tunes like Tiny Tim's "Tiptoe Through the Tulips" or my dad's old favorites, "Mares Eat Oats" and "Hello Mudda, Hello Fadda" (by Allan Sherman).
Musicals. Listen to a soundtrack, or rent the movie version. Turn it up when Julie Andrews croons "My Favorite Things."
TV-show theme songs. Google those words and you'll find many CDs. After all, tunes like Archie and Edith Bunker's "Those Were the Days" duet were the soundtrack for many an evening.
TV shows about music. One of my Dad's favorites is "Don't Forget the Lyrics" (Fox). There's also "American Idol."
Wandering minstrels. Sounds farfetched but it's fabulous if your area happens to have a wonderful program like "Music for Seniors," which musician and caregiver Sarah Martin McConnell founded in Nashville to bring area performers to seniors in care locations, day centers, and at home. (She says it's the only such program she knows of, but she'd love to see it nationwide. As for me, I love it!)
Musical instruments. If the person played one, he possibly still can. Alternatives: plucking a child's zither or working a tambourine or xylophone.
Don't forget to sing, use hand motions like clapping, and dance. People with Parkinson's disease especially benefit from dancing.

What am I leaving out? Please share what's worked for you!

This May Be the Most Useful Alzheimer's Advice

Paula Spencer — Fri, 07 Nov 2008 08:00:00 -0000

Here's the first step to solving countless behavior problems presented by someone with Alzheimer's: Ask, "Why is this happening?"

I'm not referring to the rhetorical question, "Oh why is this happening to me?" although it's sure understandable if that one crosses your mind. But when you're faced with upset, a refusal to cooperate, or even a catastrophic reaction, don't write it off to the craziness of the disease. You can usually solve the matter by stepping back to consider, "Why is this behavior happening? What might be triggering it?"

I first grasped this concept from Joanne Koenig Coste, whose insightful 2003 classic, Learning to Speak Alzheimer's, describes her theory of "habilitation care." Her basic idea: You can't rehabilitate someone with Alzheimer's, but you can habilitate them -- step into their world and adjust things accordingly in order to help them be as capable as possible. (Coste's husband developed early Alzheimer's at 44, when she was pregnant with their fourth child, and she cared for him until his death four years later.)

Then this week came this insightful account of Cameron J. Camp, an experimental psychologist in Ohio who's spent 20 years adapting the learning principles of Montessori preschools to people with Alzheimer's. Because the mind's first-developed abilities are the last to go, cognitive similarities exist between adults with dementia and preschoolers. (Both respond well to sensory input, for example.) This insight illuminates the path to many solutions.

As Camp says, "We don't say they're crazy, we say this is where they are in the developmental sequence...you only come up with the fix if you say, 'Why is this happening?'"

Some examples of this idea in action:

* A man stops using the toilet and has an increase in accidents.

Why is this happening? Depth perception fades for someone with Alzheimer's. A white commode fades into a beige wall and is easily overlooked -- therefore not used.

Solution: Instead of concluding incontinence, paint the wall behind the commode a bright red to make it stand out. (from Coste)

* A person becomes upset, claiming that she's being watched, especially in the bathroom.

Why is this happening? The person has lost the ability to understand that the mirror is showing a reflection of herself, not of another person.

Solution: Instead of trying to soothe the distraught individual over and over, cover the mirror or install a shade over it. (from Cameron)

* A woman continually asks why her daughter never visits -- beginning five minutes after her daughter just left.

Why is this happening? She's lost her working (short term) memory and truly doesn't remember.

Solution: Instead of trying to explain the truth, the daughter can keep a logbook of her visits, writing loving notes about each and when she'll visit next. When the mother feels abandoned, her caregiver can direct her to the sit in a comfortable chair with the logbook. This not only calms her in the short term, but eventually builds a positive association with that comfortable chair -- a kind of learning Cameron says people with dementia are still capable of because it builds on remaining cognitive strengths.

Alzheimer's may be maddening, but it can be made less mysterious.

Image by Flickr user annnna, used under the Creative Commons attribution license.

Let's Call It National Alzheimer's Disease Coping Help Month

Paula Spencer — Sat, 01 Nov 2008 07:00:00 -0000

The 25th annual National Alzheimer's Disease Awareness Month kicks off November 1. But perhaps it's time for a new name. Awareness is no longer the problem it was 25 years ago. Everybody knows a family touched by the long arm of Alzheimer's, it seems. More than twice as many people are now afflicted, from under 2 million back then to more than 5.2 million today.

A more apt name? National Alzheimer's Disease Coping Help Month. Okay, that's a clunky mouthful. But the critical issue today is coping day to day. Yes, research toward a cure is a priority, but frankly, this is extremely unlikely to happen in the lifetime of those who are currently afflicted. Prevention is also critical, if a little tricky because we don't exactly know the cause mechanism for Alzheimer's, and so far the biggest risk factor is one we can't control: age. Again, too late for our elders.

The pressing need is for help in the here and now. Here are three quick things you can do that didn't exist even a year ago (let alone a quarter-century ago):

Check in with your stress. The Alzheimer's Association unveils its new caregiver stress self-evaluation November 1. The idea isn't just to tell you what you already know but to point you to specific resources that can help.

Reach out to just one other person also in your shoes. It's amazing the degree to which just talking about tough matters makes them easier. Beyond that, the group talk with like-minded others, at Caring.com's Discussion Groups, for example, can bring a fresh eye to specific problems.

Trust your instincts. I learned from raising kids that the gut is usually right. No, parenting your parents or someone else with Alzheimer's isn't exactly like parenting your kids. And yet, speaking as someone who spent the first 15 years of her writing career covering parenting, and who has four children in addition to my caregiving experiences with my own parents, don't be too quick to dismiss the overlap. Children and seniors with Alzheimer's share, for example, the same coping mechanisms, like taking it one day -- or with some folks, one minute -- at a time.

Image by Flickr user JustinsPhotos, used under the Creative Commons attribution license.

Should Someone With Dementia Vote?

Paula Spencer — Fri, 31 Oct 2008 07:00:00 -0000

Will you be escorting someone with dementia to the polls on Tuesday? No law specifically forbids a person with Alzheimer's disease or dementia from voting. There's no federal eligibility standard. But no sensible person could ignore that it's a problematic, case-by-case question.

Add it to the list of tough calls caregivers are forced to make. Don't feel guilty, though, if you decide, after thoughtful contemplation, that it's time that this great right and privilege joins the list of traditions and pleasures that the person in your care, sadly, can no longer partake in.

Why shouldn't someone with dementia vote? Five possible reasons:

* It's illogical: If a person can't manage their finances or legal affairs because of cognitive erosion in thinking and judgment, how can they evaluate the issues and make a political decision?

* It's possibly unethical: Even if you "know" someone impaired is a dyed-in-the-wool Democrat or Republican, voting for him (say by absentee ballot) is not the same as an individual casting his or her own vote. It's you voting twice.

* It's potentially fraudulent: If a person with mental impairment needs help to cast a vote, the helper might "nudge" him toward her favored candidates. I'm not saying you would. But already in Ohio and Iowa there have been reports of nursing home staffers registering residents with advanced dementia and voting for them. Many groups (AARP, disability rights groups) say there should be someone on hand to help a voter with a disability -- but when the disability is in the mind and the mind is what's needed to make a choice, what kind of help are we talking about?

* It's possibly illegal: Holding someone's power of attorney doesn't automatically enable you to vote on the person's behalf. You can only do so if the state permits it and/or if the Power of Attorney document specifically spells out that you can register or vote for the person. In many states people under guardianship cannot vote.

* It might just be too hard, at this point: Polls tend to be hectic places with lots of people and activity, not generally great environments for people with moderate dementia or worse. Lines, the various voting steps, and electronic or other new ballots involved may be confusing.

My big "however": If we're talking mild cognitive impairment or an early diagnosis for someone whose memory lapses and cognitive decline don't yet affect everyday life, sure they should vote -- if they’ve been following current events and the election or at least talking about voting. Interest is a useful gauge.

Hot, slippery topic, I know. How will you make the decision?

Image by Flickr user cursedthing, used under the Creative Commons attribution license.

New Reasons Memory Screenings Are a Smart Idea

Paula Spencer — Fri, 24 Oct 2008 07:00:00 -0000

Untold thousands of families live in limbo: They notice there's something wrong with a family member's memory but don't know for sure what's up. They haven't made the leap from vague suspicions to formal assessment. Well, we all make mistakes…she's just getting older…it couldn't be that horrible Alzheimer's.... (Maybe it will go away....)

Too bad universal screening for dementia hasn't been universally adopted by the medical community. Why? Because people are often reluctant to ask for evaluations themselves or for their family members, according to a new survey of adults over age 55, commissioned by The Alzheimer's Disease Screening Discussion Group (ADSDG), a multidisciplinary consortium of aging experts. Nearly 95 percent of those surveyed agreed they would encourage someone in their care to seek early diagnosis upon suspecting signs of Alzheimer's -- yet fewer than 1 in 10 of those who were in that situation actually did so.

Routine screening is still a bit controversial because it hasn't been conclusively proven that early diagnosis changes outcomes, ADSDG co-chair Paul Solomon told me last year when the group announced a push for more and better memory screening. There's concern that people who are found to have possible cognitive impairment might feel depressed, stigmatized, or unsupported if they get inadequate follow-up. Yet research shows most people are glad to know.

Here's a huge reason to get an expert involved if you suspect something's not right with a relative: More than 90 percent of adults over 55 could not identify the difference between early Alzheimer's symptoms, late symptoms, and symptoms unrelated to the disease, the survey also found. (Although more than three-quarters had believed they could.) So along with fear and denial, there's a lot of confusion out there.

Which is why right now may be a good time to take a moment to brush up on symptoms of Alzheimer's.

And on screenings, too -- do it in honor of National Memory Screening Day (November 18):

When should I seek a memory screening? When you're concerned. Or even when you're not. ADSDG advises everyone over 65 to request a memory screening during routine exams. The group also urges memory screens be made standard to the "Welcome to Medicare" physical and for admittance to assisted living and long-term care facilities.

What does a screening do? Important: It doesn't diagnose Alzheimer's. It's a win-win quick first step that lets you know if you should pursue a more thorough evaluation. If you show no cognitive problems, you get peace of mind plus a baseline for comparing possible later changes.

Why is an early diagnosis better? Because the person gets quicker access to medications and lifestyle supports that have been found to delay cognitive declines in many people. It's a gift of time to get a game plan in order. And surprising research earlier this year found people are far more relieved than anxious to know the truth about an Alzheimer's diagnosis.

Where can I get a memory screening? Typically, from your family member's doctor, a psychologist or psychiatrist, a medical center or clinic specializing in Alzheimer's, or a memory clinic. Or ask your local Alzheimer's Association for suggestions.

How can you get someone evaluated who doesn't want to be? Ah, the zinger. Look for ideas in my post tomorrow.

Image by Flickr user khoppdelaney used under the Creative Commons attribution license.

10 Ideas for Getting a Reluctant Person Checked for Alzheimer's

Paula Spencer — Sat, 25 Oct 2008 07:00:00 -0000

How do you find out if someone has Alzheimer's? It's a myth that there's one single test you pass or flunk. Alzheimer's is diagnosed through a thorough evaluation by qualified clinician, using various measures to rule out other possible causes of dementia symptoms.

But there is a related "test" you may have heard about -- a memory screening test. It's a quick exam that evaluates memory, language skills, thinking ability, and other aspects of intellect to indicate whether you'd benefit from a thorough medical evaluation. It simply tells you, "OK, you're probably just fine!" or "Well, there's some cognitive impairment and you should see a specialist to try and figure out why." (Many things can cause memory loss.) It doesn't diagnose Alzheimer's, but it can lead affected people to help -- and healthy people to peace of mind. It provides a baseline for a person to compare with future changes.

All good. If, that is, you can get the person you're worried about to actually get checked. That's what trips up many families. The person you worry about may be afraid, indignant, or in denial. You may be uncertain and afraid of making a mistake. But a memory evaluation can actually make everyone feel better.

Some ideas for forging ahead:

Appeal to the budget-minded. Screenings are free at participating sites around the US on the fifth-annual National Memory Screening Day, November 18, sponsored by the Alzheimer's Foundation of America. Find a location and sign up now.
Acknowledge fear. What you might need to say: "It's not very pleasant to think about. I'm a little nervous myself. But if we can figure out what's causing your mix-ups, then we might be able to fix them, and you can continue to live on your own."
Enlist a regular doctor directly. If you have HIPAA clearance and accompany the person in your care to checkups, call ahead to ask that a note be put in the chart for a memory screening at the next visit. Or bring it up in the doctor's presence: "I've heard people over 65 should have a memory screen. Is that true?" Waggle your eyebrows meaningfully as you speak. Most will take the hint. Or ask for a referral to a neurologist.
Enlist the right influencer. Maybe the suggestion carries more weight coming from a trusted attorney, a best friend, a longtime doctor (who might decide it best to make a referral to a memory clinic), or another family member.
Play to pride and preferences. "This clinic is where so-and-so celebs/local elites/etc. go." That tip from The Alzheimer's Action Plan, which notes one woman finally conceded to see a specialist with a "Christian" medical practice, and another man agreed to an evaluation at a certain institution because it had once "saved his father's life." Show an ex-academic a news article about the doctor or clinic you have in mind.
Make it an issue about you. "I worry about you living alone, and seeing what the doctor thinks would make me feel better."
Pitch prevention. (Even if you already have your suspicions.) "I heard there are some new things older people can do to avoid memory loss -- let's find out what we can do now."
Make it a group effort. "I heard that everybody should have a baseline memory screen. Why don't you, Dad, and I all go together? Let's treat ourselves to a nice lunch afterwards."
Don't call it Alzheimer's. Some cultures have a strong taboo against the disease. If euphemisms will make your relative less defensive, suggest going for "a general tune-up."
Persist gently. If you get resistence, drop it. The last thing you want is a power struggle. Try later with a new tactic.

Image by Flickr user khoppdelaney, used under the Creative Commons attribution license.

Scenes From (Caregiving) Marriages

Connie Matthiessen — Thu, 23 Oct 2008 07:00:00 -0000

How is caring for a spouse different from caring for an elderly parent or other relative?

One obvious -- and enormous -- difference is that becoming a caretaker for your spouse creates a fundamental change in your primary relationship. If you have a good marriage, your spouse is your romantic partner, your soulmate, your constant companion, and your best friend. All this can be wiped out -- or dramatically altered -- by accident or serious illness. In recently published memoirs, two women describe what it means to "lose" the husband they loved, and the steps they took to rebuild their lives and their relationships.

In her book, To Love What Is: A Marriage Transformed, Alix Kates Shulman writes about her husband, who was a vital 75-year-old until four years ago, when a fall left him with a disabling brain injury. The two first fell in love as teenagers, when they attended summer school at the same college, then reunited years later after both had weathered marriages, childrearing, and divorce. They had a rich, fulfilling life together -- until the night Scott fell nine feet from a sleeping loft. The fall left him with a brain injury that resembles advanced Alzheimer's disease. He has no short-term memory and can't be left alone or care for himself.

Shulman's narrative alternates between the story of Scott's accident and its aftermath, and flashbacks to their courtship and marriage. This structure adds to the poignancy of Shulman's situation, because it reveals how central this relationship was to her life and how much she's lost.

The remarkable thing is that Shulman's story is sad, but it isn't miserable. She doesn't gloss over the difficulties -- or her own frustration and, at times, despair. But it's clear that her marriage remains at the center of her life, despite Scott's disability, and as the title of the book indicates, she deeply loves him. She also cherishes her life away from her husband: her writing, her many interests, her friends and family.

Shulman refuses to assume the role of martyr, and I think this is what allows her to maintain her optimism and pleasure in life. Friends tell her she has the patience of a saint, but Shulman rejects this praise: "Those who see me as saintly assume that I've sacrificed my life for him, as a saint sacrifices hers for Christ. But I haven't -- nor could I, nor would I. As long as I can work and think, I have my life."

In An Uncertain Inheritance, a collection of essays on caretaking, writer Ann Harleman describes her painful decision to put her husband, who has multiple sclerosis, into a nursing home. To her surprise, Harlman found that stepping away from the caregiving role actually brought them closer. "Because I'm no longer his physical caregiver, I'm no longer implicated in his illness. His resentment of his body, his despair over his inability to command it, his shame -- these no longer extend to me. Because our bodies don't connect, our hearts can."

Of course, every caregiving situation is different, and each requires a delicate balance between the needs of the loved one and the caregiver. If the focus goes too far in either direction, someone is hurt. But. as these writers so powerfully demonstrate, whether you're caring for a spouse or a parent, looking after yourself is one of the most valuable -- and difficult -- things a caregiver can do.

Image by Flickr user Soul101 used under the Creative Commons Attribution license.

Dietary and Herbal Supplements and Alzheimer's: What Works?

Paula Spencer — Fri, 17 Oct 2008 07:00:00 -0000

People often turn to vitamins and herbal medicines in the desperate search for something – anything – to stave off the symptoms of Alzheimer's disease once they begin. Unfortunately, the science to date mostly says "save your pennies."

This week marked another dead end: this time, of the once-promising idea that B vitamins can minimize brain deterioration. High-dose supplements of folate and vitamins B6 and B12 showed no effect on the symptoms of people with mild and moderate Alzheimer's in a clinical trial reported in the Journal of the American Medical Association. B vitamins reduce homocysteine, an amino acid that's found in higher amounts in people with Alzheimer's. In the trial, homocysteine levels did indeed drop in the subjects who took the supplements, but it didn't change their symptoms. It's unclear why.

Which begs the question, does any supplement work?

Vitamin supplements: Earlier this year, a study in the Journal of the American Geriatrics Society reported that using supplements of either vitamin C or vitamin E, or both of these antioxidants together, failed to slow the advance of Alzheimer's. This echoed previous studies. Vitamin E, still sometimes prescribed, has fallen out of favor since several major studies in 2005 discount its effectiveness. What's more, megadoses of vitamin E are linked to heart failure.

Herbal/alternative supplements: Not much better news here. No large, well-run clinical trials have definitively shown an herbal remedy to reverse or slow Alzheimer's symptoms. The trouble with herbals is that they're less well-studied than vitamins or drugs. So we have less data (and more wiggle room for false claims). Grape seed extract research earlier this year showed promise and is being tested further, for example. Coral calcium is an alternative that's been dismissed.

Worth remembering: "Natural" doesn't mean "always safe." Why not just try all the alternative possibilities anyway? Because we don't understand herbals' side effects or drug interactions any more than their benefits. For example, ginko balboa, a tree-leaf extract that may have modest positive effects on memory, can be dangerous for people on blood thinners. Chinese club moss, another popular supplement now in clinical trial, can't be taken with the dementia drugs Aricpet, Exelon, or Razadyne.

Bottom line: Supplements should be approached warily for someone with dementia -- and ideally under the advice and supervision of a physician.

Finally, if you're looking to avoid dementia: The substances I've described have been in the context of treating dementia. Alas, there's scant evidence they can prevent Alzheimer's, either. Omega three fatty acids are among the preventatives being looked into, but, again, it's inconclusive.

Caregivers' best bet: Maintain a normal weight, take a multivitamin to help get all the basic nutrients you need, don't smoke or drink to excess, and, above all, stay heart-healthy to avoid high blood pressure and diabetes. For now, that's still the best prevention advice around.

Image by Flickr user thebaron03, used under the Creative Commons attribution license.

Dementia and Driving: Is It OK?

Paula Spencer — Fri, 10 Oct 2008 07:00:00 -0000

Can seniors with dementia drive? Sure they can. Whether they should is another matter entirely.

Surprisingly, there's no standard-issue medical or legal answer about whether a diagnosis of Alzheimer's or another cause of dementia should require one to automatically give up the keys. That leaves caregivers to finesse the situation.

The usual advice is middle-of-the-(ummm)-road. Some authorities say long-term "automatic" habits like driving may be retained for awhile after diagnosis. The Alzheimer's Association sides with those who say a diagnosis isn't sufficient reason to withdraw driving privileges.

Instead, individual assessments are usually recommended for those with mild cases. (Although in one Australian study, 63 percent of people with Alzheimer's flunked on-road tests.) Every-six-months follow-ups are urged. If you have any doubts, there are lists of warning signs you can use.

But there's also this:

Driving requires thousands of snap judgments and reactions, attention, memory, multitasking, spatial coordination, and other skills. All these things will progressively erode in someone with dementia. But no one can be sure when.
Drivers with dementia who take antidepressants, antipsychotics, or sleep meds are 50 percent more likely to have road accidents than people with dementia who don't take them, says a study on 8,700 drivers described in a letter in the current Journal of the American Geriatrics Society.
Drivers with dementia have double the accident rate in general, studies show.
People with Alzheimer's drive an average of 10 months longer than their caregivers think is safe, according to The Hartford Financial Services Group, a major insurer that joined with the MIT Age Lab to tackle this issue last year.

Yes, it's important that skill, rather than mere prejudice, is the deciding factor. But the safety of others on the road can't be compromised at the expense of a desire to preserve independence and dignity. I'll admit this hard-driving perspective comes from someone who also doesn't think 15- or 16-year-olds have the brain maturity to drive yet, and who feels the distractions of cell phones (hands free or no) and text messaging should be illegal for anyone in the driver's seat. I wouldn't let my father drive me anywhere for years, because even before his dementia diagnosis he seemed to have lost the necessary skills.

Call me a nervous ninny. But when two tons of fast moving steel are involved, overworrying -- and erring on the side of safety -- seems perfectly appropriate. If you're dealing with an Alzheimer' or dementia diagnosis, the question shouldn't be "whether." You should advance directly to how do I encourage this person to stop driving and how do I plan alternatives.

Image by Flickr user Hamed Saber under a Creative Commons Attribution license.