Denial and Avoidance: The Enemies of Early Detection of Dementia

Melissa Tanner, Ph.D.

The prevalence of dementia is startling. Today, over 7 million Americans have dementia, and another 7 million have mild cognitive impairment. It is estimated that these numbers will double by 2050.  As of right now there is no cure. This is terrifying, particularly to older adults and adults with a family history of dementia. When faced with the likelihood of dire consequences and no foreseeable solution, people often react with denial or avoidant coping.

“Everybody starts forgetting things when they get older. There’s nothing wrong with me. I’m just having a ‘senior moment.’”

“There is no cure for dementia, so why bother getting tested for it?”

These are common reactions when people first notice signs of cognitive decline. In fact, studies show that there is an average gap between 1.9 and 3.5 years from first signs of dementia to first medical consultation (Chrisp, Thomas, Goddard, & Owens, 2011; Speechly, Bridges-Webb, & Passmore, 2008; Drebing et al, 2004). Why do people deny and avoid? Research on help-seeking behavior in general suggests that doubts about the usefulness of the help and individual preferences for self-reliance are common barriers. With respect to dementia, there is also a fear of the consequences of seeking help and a desire to preserve one’s autonomy. What many do not realize is that avoiding detection and potential interventions that come from a diagnosis actually increases likelihood of dependence. Individuals living with undetected cognitive impairment are more likely to experience falls and other negative outcomes that place them at greater risk for hospitalization or residential care placement.

myMemCheck™ offers an ideal bridge to close the gap between first signs of cognitive decline and first medical consultation. It is a low-cost, easily accessible screening tool that take approximately 3 minutes to complete. Upon completion, an immediate written report that can be shared with healthcare professionals is provided. myMemCheck™ is available online and can be completed from the comfort of your own home. This reduces the potential anxiety involved in visiting a doctor’s office, which may be an additional barrier to seeking help. Validation studies suggest that myMemCheck™ is highly predictive of memory and other cognitive problems. It is intended to be used as a screening tool to determine whether a more comprehensive assessment from a healthcare professional is warranted.  

Based on further assessment, family members can work with healthcare professionals to develop plans to provide their loved ones assistance with the functional skills and activities of daily living that are likely to pose a challenge. For example, consider Harriet, a woman with very mild deficits to memory and executive functions. If she takes multiple medications at different times of the day, Harriet occasionally may struggle to remember when to take which pill. Upon realizing that Harriet has mild cognitive deficits, her daughter, Carrie, may divide Harriet’s pills into a pill box at the start of each week to simplify things for her. If an updated cognitive assessment suggests that Harriet’s cognitive deficits have become more advanced, Carrie may hire an aide to spend a few hours a day with Harriet, both for companionship and for assistance with activities of daily living. The aide can monitor Harriet’s afternoon pill administration, and Carrie can call Harriet each evening to remind her to take her evening pills. The next day, the aide can ensure that all of the evening pills were taken. These types of interventions can help the Harriet and older adults like her age in place and maintain as much autonomy as possible, for as long as possible. In this case, the knowledge obtained through cognitive assessment is power.

Those who do not exhibit objective signs of cognitive impairment on myMemCheck™ but may experience “normal age-related changes” in cognitive functioning should not view this as a free pass to forget about dementia entirely. The ENRICH® program strongly recommends adopting a lifelong, brain healthy lifestyle. ENRICH® provides an ideal blueprint for minimizing risk of developing dementia and preserving current level of functioning. As recommended by ENRICH®, one should always take steps to exercise regularly, avoid smoking, practice routine cognitive stimulation, manage symptoms of depression, control hypertension, and maintain a healthy weight and body fat percentage.

While we may not have a cure for dementia at this time, we do have many useful assessments, approaches, and interventions that can be used lower risk, slow the rate of decline, and help preserve autonomy and quality of life. If you or a loved one is ignoring early warning signs or thinks that there is no point in getting tested for a disease that has no cure, urge them to reconsider. The best place to start is with myMemCheck TM  and ENRICH®.