My mother in law is in early stages of dementia. She has Anosognosia, she doesn't realize she has an illness. I can understand that. What is surprising to me is that when a large bit of info is forgotten, like when she forgets that her grand daughter is away at college, she isn't surprised of frustrated that she didn't remember it. Is that part of it? Last Christmas she asked why they were coming to our house and we said "for Christmas Day, mom" and she didn't respond at all. Why isn't she like, "wow, I can't believe I forgot tomorrow is Christmas!"
Yes, I know exactly what you mean. Executive Reasoning and Initiative are very related.
It scares me, but this thread is really helping me in gaining a new perspective. It's a new (difficult) language that I have to learn.
I think that's a good analogy. The tips and tools we use to recall things that we know we may forget don't mean anything to those with dementia. If we had planned to call our accountant at noon, but, forgot it, we would certainly remember it by later that day and feel terrible that it slipped our mind. We would eventually recall the plan, but, with dementia, I don't think that the plan will ever return to us.
I also learned with my LO how her initiative left. For example, a LARGE sign in the bathroom that said, PULL FOR HELP, meant nothing, because she had no initiative to read the sign. And if she did read the sign, it was meaningless to her.
I think Windyridge completely nailed it, it must really have to do with the Executive Function being damaged. Some sort of missing link in connecting the dots.
I keep wondering why my mother, who's losing her memory by the day, doesn't carry a notepad with her at all times to write things down. Or why I have to constantly remind her to walk with her stick, given that her balance is very bad and she looks like she can fall at any moment.
Sometimes I get so frustrated cause it almost seems like she doesn't care to forget appointments or to fall... but no, is the missing Executive Reasoning link (which I didn't know existed, thank you for this Windyridge!!).
I would carry a notepad, I would keep a stick with me cause I can still see the link between the problem and a possible executive solution, perhaps my mom just doesn't see it anymore. So hard to even wrap my mind around this.
She is convinced that she could return to her SF apt. but, when I say, "OK, let's stand up (she can't ) and go pack" she drops the subject and says "Oh, never mind." and closes her eyes. I think she knows she's failing but can't understand how or why. Fortunately, she forgets all about it in a couple of minutes.
It's a matter of pride, also. It's humiliating (even if you don't have much of your mind) to admit you just soiled your diaper and had to have "this person" (me-her daughter) clean you up. There is still some cognitive function but at a very basic level. If all what they can remember is in the past, then that's their reality. They were able to care for themselves then and that's how they think in the present.
If she keeps quiet when alerted to Christmas being the next day, that way she doesn't have to admit that her memory is going. Some folks, like my dad, laughed about it. Others, like my mom, get mad at the accusation, others remain silent so they don't acknowledge it. Unfortunately, no matter HOW you react, the darn disease marches on.
The panic that WE would feel if we forgot Christmas is not present.
In some dementias, there is a heightened sense of anxiety and dread.
Have you seen any imaging of her brain? Early in my mom's vascular dementia, an ER doc showed us a CAT scan of mom's brain. More space than brain. It was a sobering image and explained an awful lot.
My dad readily acknowledges that his memory is not very good and will laugh at himself about forgetting holidays or his birthday. But otherwise he thinks he and mom are just fine. In reality they are just hanging on by the thinnest of threads.
Dad would be aghast to be told he had dementia. NO, I JUST FORGET A LITTLE BIT.
It's not denial really. One must understand something to deny it. The ability to connect the dots is not there any longer. The executive reasoning is simply gone and you will not convince him otherwise. No point in trying. But I do remind him gently that his memory is not good and that he is pushing 90 and that's to be expected. He seems to accept this until he forgets the conversation 5 minutes later.
So far with my Dad I'm lucky in that even when he's confused and forgetful he does not get angry. But that could change as more and more I have to make changes he won't like to keep he and mom safe.
From everything I read this is typical of most types of dementia.
If she is content, why even bother trying to "fix" it? This is just the way dementia works. People forget stuff. Time means nothing to them, nor the changing seasons, nor family events. It's NOT personal, it just is what it is.