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Decision Making | Common Signs

  • Cannot decide, regardless of the number of choices
  • Can decide when there are only a few choices
  • Can make small, trivial decisions (e.g. what flavour ice cream they want), but cannot make large, significant decisions (e.g. who gets the family home)
  • Makes choices that put their safety at risk
  • Is never satisfied with their choice
  • Needs assistance with making decision
  • Forgets past decisions they have made
  • Has difficulty making a decision with the outcome far in the future. (This is an example of the symptom of impaired planning)
Decision Making | General Description

Each of us makes decisions all the time. Being able to decide on our own, and to be responsible for them, is at the heart of being free. It is what the philosophers sometimes refer to as being "independent for self-regarding conduct". But with Alzheimer's disease , or with any other of the dementias, decision-making becomes impaired as the disease progresses. The person you care for may be able to make decisions in some situations, but not in others. They may easily be able to make an informed decision when there are a small number of choices or when the outcome does not have a serious consequence. For example, they may be able to decide what shoes to wear or what they want to drink. However, they may become overwhelmed when faced with too many options or when the choices are not right in front of them.

Commonly, the most difficult decisions for the person you care for are those in which the possible outcomes are far in the future and hard to picture. Your assistance in decision making is often needed to offer them a reminder of the choices and the outcomes. Assistance is also necessary to prevent wrong or dangerous decisions if the person you care for misunderstands a situation or uses poor judgment. There is no way to do this but by intruding, to some extent, on the freedom of the person you care for. That is an inevitable part of dementia, and one of the main reasons that dementia induces so many mixed feelings in caregivers. Even with the more politically correct "care partner", there is no getting around that the partnership is unequal and it is often unequal in a way that neither party wants. Feelings of pity become mixed with feelings of being responsible for more than seems fair. It is natural to have these feelings, and most people find that they deal with them best by having someone to talk to - someone in whom they can confide.
All dementias affect what is called "executive function" chiefly by affecting the frontal lobes - the reasoning part of the brain - so that it is difficult for the person to make sound decisions. Being a good decision maker requires the ability to move from one perspective of a problem to the next and make a reasoned decision about what is the best option. When the frontal lobes are involved - and they are involved especially early in frontotemporal dementia - the person lacks the ability to hold competing thoughts. They also lack the ability to follow through until completion. Where this person had been quite capable and confident in the past, the confidence may continue but the decisions made are often opposite of what the person would normally have made. They may notice a large change in the person's ability to make financial decisions such as compulsive spending. They may no longer have the ability to recognize the consequences of their behavior. It is possible that this will lead the person to riskier behavior due to the lack of ability to recognize threats to their safety.
Impaired frontal lobe function also results in an impaired ability to plan. Problem solving and abstract reasoning become impaired. Examples of this would include difficulty planning and coordinating the cooking of a meal, or making a shopping list and performing necessary errands.

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See Also:
About Dementia > Alzheimer's Disease > Natural Progression and Staging
Symptom Library > Thinking & Judgment > Unsafe Actions
Symptom Library > Thinking & Judgment > Judgment
About Dementia > Alzheimer's Disease > Executive Function
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Last updated January 13, 2019
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