Is detachment from old routines part of the disease process?

I’ve commented before how much dementia/Alzheimer’s and autism are alike. Here’s another example. It’s not so much a matter of willingness as it is that the step by step motor planning is just gone. Her brain can no longer organize what’s required to do the sequential steps of a task. So you will have to help her get started, and once she starts the task, you may be able to fade back.

Perhaps if she comments about something needing to be done in the garden, if needs to be weeded for instance, you could suggest let’s weed it, then do it with her. Or at least start the process with her. You could suggest going the a nursery and buying new plants for the garden.

The point is, it’s not necessarily apathy, depression or disinterest on her part. This hit home for me when my mother wouldn’t shower or change out of her obviously dirty clothes. She kept waving people off and saying it wasn’t necessary, or she didn’t care, or it wasn’t important to her or sometimes a direct, “leave me alone”. I finally realized she was unable to sequence how to take a shower and dress herself. After warming up with a nice visit (she’s stubborn and doesn’t like to be told what to do!), I asked her if she doesn’t Want to shower, or if she doesn’t know How. She admitted she cannot really remember How to do it. That was a game changer. I told her I’d help her. I got her into the shower and stood back to see what she could do. She just stood there and couldn’t get started. So I helped by verbally prompting her to turn on the water, get the soap & wash cloth, put soap on the washcloth, and wash her face & neck. Once all that got going, she was able to continue washing the rest of herself, but that’s what it took to get her going. I think it felt kind of empowering to her that she could do as much as she could.

We often have to break things down into smaller steps for them. What seems like a simple task to us (how many times has an 84 year old woman independently showered herself?!) may be overwhelming or puzzling to them so they don’t want to do it at all. Even those with dementia recognize they cannot do what they used to be able to do, and want to avoid facing the sad fact.

Hope that helps, and good luck to you!

You know, detachment from routine activities happens to all of us. If you break your leg you can no longer play soccer. So you are disappointed, but you adjust. If you retire you no longer get up at 6am, you adjust. All of last year we balkingly adjusted to Covid quarantines.
Is it causing her problems? Are you the one who is the most frustrated. Change, with age or disease is always at bay.
Prayers to both of you to navigate the next months and years.

While it could be depression, apathy or any number of reasons, could it also just be part of the dementia, an inability to think through the steps required to do what needs to be done? She still recognizes the "need", but doesn't follow through.

My mother always cooked, meals for us, lots of meals/dishes for parties, esp the pool parties. She loved making special meals, desserts and even, for quite a while, made elaborate wedding cakes! Some extended family members paid her to make theirs. During the later years, she pared back on these, but still cooked and made special treats. Eventually the "treats" came in a box where all ingredients are there, you just follow instructions to put it all together and bake it. By then she was into her Forman Grill and would grill up chicken and microwave veggies.

First was the repetition of questions and statements. Then it was inability to pay her bills correctly. I took over the finances at that point. After we took the car away, I had to help by delivering supplies and/or taking her grocery shopping. I tried making extra meals and freezing some for her, but I couldn't keep up! When I would show up for the next shopping trip, I'd find fresh veggies all shriveled up. I had to siphon old chicken out of the freezer and stop her from buying more! It was then I figured out she was relying on frozen dinners and boxed stuff. She wouldn't even buy enough to get through until my next trip (3hrs round trip for me!)

So, sometimes in the earliest stages, executive functions become difficult. Following instructions, even with tasks previously done, erode and while the recognition of need is there, the ability to follow through is gone. This may be where she is at now - knowing something needs to be done, but not how to attempt it. You could encourage her, but keep the steps simple and separated. One step at a time. Too many steps and she may get too confused and refuse to continue.

If you're taking her for testing, it may reveal this. Ask for recommendations to keep her engaged. Physical activity, even walking, is good. Social activity is good too, so long as it isn't too overwhelming, aka meeting up with another couple vs attending a big party. The results of testing should present some methods for keeping her active and more engaged.

Initiative leaves in some dementias. It sure has left my mother.

She says that she is bored, but isn’t able to make herself do anything to change that.

It hard to watch. I understand your concern.

Yes, it is part of the disease process - actually, of many disease processes that affected the mind. It's common for people to stop doing activities that used to give them great pleasure. It's all about the loss of executive function, where a person is no longer able to organize and follow the steps of doing something. For example, an avid cook may no longer be able to follow a recipe, a knitter may no longer be able to remember how to knit & purl, etc. It's embarrassing for them to admit that they no longer remember how to do it, so they just avoid it.

I don't mean to sound depressing - but I've known several people with MCI, and it eventually progressed to dementia in all of them. So, one must prepare themselves for that possibility.

You really need to spell out abbreviations at least once followed by () because most people do not know what MCI means. Mild cognitive impairment (MCI). My mom's Alzheimer's disease (AD) really started with MCI when her interests changed which was 15 years before she died. She lost interest in shopping, or taking care of the house. While this can be considered depression, for her it wasn't. She used to have good dental exams because she used to meticulously attend to her teeth..the dentist was another clue about behavior changes. Mom died age 90 but she was also insulin-dependent diabetic and died of the complications of chronic kidney disease -- I was mom's life support for years and years. She depended on me 100% for everything.

According to this article about 15 to 20 percent of people 65 or over have MCI which is at higher risk of fulminating to Alzheimer's.
https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment#:~:text=Mild%20cognitive%20impairment%20(MCI)%20causes,developing%20Alzheimer%27s%20or%20another%20dementia.

Age 56 is very young to have MCI. If she is not suffering clinical depression, she is at HIGH risk of getting AD. Now if she is on a lot of psychotropic medications or narcotics much increases the likelihood of AD as well.

Being disinterested in activities that someone was once engaged in, may be a sign of decline. MCI may or may not progress into dementia. Whereas MCI refers typically to some cognitive decline, dementia can be memory loss plus a loss of interest or the ability to do the things she once did. Her ability to still play solitaire and to read ( assuming with understanding and recall), however, seems to say she is still in the MCI phase.

As cwillie suggests, her apathy may be a sign of depression also. Mention what you notice to her doctor at her next appt. If he believes her MCI has progressed into dementia as a result of her tests, ask what the cause of the dementia is.

My mother acted like this when she was 64. We thought she was depressed, but it turned out she had a brain tumor. Please be sure she gets a brain scan if she hasn’t had one. This seems a quick turn of events for someone in such an early stage.

That is often seen as depression and sometimes treated that way but to me it sounds like apathy, which was previously an overlooked feature of dementia.

https://health.sunnybrook.ca/mental-health/apathy/

https://www.sciencedaily.com/releases/2019/07/190717105335.htm

My mother did exactly what you’re describing. It began with her after a couple of small strokes that she seemed to recover from both fully and quickly. I now know it was depression with her and that it’s common post stroke. I know your circumstances concerning diagnosis differ, but consider depression brought about by her MCI. I wish you both peace