Any suggestions for helping my husband accept that he may have Alzheimer's?
When the second of my husband's sister's was institutionalized with symptoms of dementia/alz and passed away due to heart issues, my husband was in his late 50's and at my encouragement went for baseline testing. Every 2 - 3 years he repeated the testing, even though he hated it as it kept getting harder for him. The last time he was tested was 3 - 4 years ago and at that time we were told he had definite signs of ALZ and were advised to go to a neurologist. There are not any neurologists covered under his medical plan that specialize in ALZ, so we went to who we could find. That person also stated that my husband had early onset ALZ but that the MRI didn't show anything. At that time my husband rushed around telling his children (this is a second marriage for each of us), some friends and family that he now has ALZ. In the mist of all this, his brother was diagnosed and is now institutionalized and not in good mental shape. I believe watching his brother deteriorate has really had a profound affect on my husband. About 2 years ago he became very angry at me for making a reference to his ALZ, stating he does not have ALZ and why would I make such a statement. He takes the meds to prevent getting it! Well I was so stunned at his outburst that I just backed down....he normally very easy going and very rarely reacts that way with me. Now I have to tip toe around his diagnosis and just don't know what is best to do. I believe he knows he has it but is in total denial. More recently he's been disturbed about memory loss he's become aware of but never acknowledges it could be ALZ. Our PCP thinks we should go back to a neurologist to have it confirmed for him again, but he's so distressed at watching his brother...he does everything we hear about to prevent it: exercise, diet, won't retire from his business and he is 72, vitamins and medicine...I don't know if having him admit to having ALZ is the best or not. Any suggestions?
Expert Answer
Although it might appear that your husband is in 'denial' about his diagnosis, it is also possible that his dementia has progressed and has compromised both his memory of getting the diagnosis and his insight into reality. At an earlier point of time, he understood and accepted the diagnosis and demonstrated insight and good judgment as he told others. Now, that period appears to be gone and he is existing in a different space of time with more compromised cognitive faculties especially in reality perception.
The question about whether to foster reality orientation for a person with dementia is an on-going debate. Some believe that the individual needs to be in 'the present' and be aware of the three spheres of reality: time, place and people. In contrast, others recommend allowing the individual to 'live in his own reality' unless it is harmful to him. Reminding him that he has AZ or that "this is his home" or "today is Wednesday" can often precipitate anger and conflict and will be forgotten soon thereafter.
I think that if your husband's present regimen of diet, exercise and work give him comfort and a sense of dignity, then he should be encouraged to maintain this. If he believes this will help avert the disease, and this misperception is not harmful, then it should be enabled.
It is recommended he visit his neurologist periodically to assess his present stage and care needs. He may now be entering a phase where he is less able to manage independently at home and at the job; this needs to be further evaluated.