How Do I Know if it's Dementia?

One of the most frequent questions I receive about dementia is, “How is dementia different from ordinary forgetfulness?”

I can explain this from my own experience as a caregiver. My mother has both Alzheimer’s disease and vascular dementia, and over the years I have witnessed firsthand how dramatically dementia can affect memory, communication, judgment, behavior, personality, coordination, and the ability to perform ordinary daily tasks.

It is important to understand that everyone forgets things occasionally. Forgetting why you walked into a room, having someone's name temporarily escape you, misplacing your keys, or struggling to remember a word that is “on the tip of your tongue” can happen at any age and does not, by itself, indicate dementia.

Dementia is different because the changes become more persistent and begin to interfere with a person's ability to function and understand the world around them.

Memory and Recognition

In the earlier stages, it can be difficult to distinguish dementia from normal age related forgetfulness. As dementia progresses, however, the memory problems become much more profound.

A person with dementia may walk into their own bedroom and no longer recognize it as their bedroom. They may wonder why the room is messy without realizing that the belongings belong to them. They may forget that they have lived in the same home for years or insist that they need to “go home” even when they are already there.

This is very different from simply forgetting where you left your keys.

Language and Communication

Dementia can also affect language in ways that go beyond occasionally forgetting a word.

For someone who is bilingual, language abilities can change unevenly. A person may lose the ability to express a word or thought in one language while still being able to express it in another. As dementia advances, they may have difficulty finding even familiar words, including the names of people they have known for decades.

Someone may know that a person is familiar to them but be unable to produce that person's name. In more advanced dementia, even simple conversations can become difficult to follow.

For example, I might tell my mother:

“Today at work, I had a pregnant client, and she is due in three weeks.”

My mother might hear the word “pregnant” and respond, “You're pregnant?”

Or she might hear the word “work” and ask, “Are you going to work?”

She was not following the conversation as a whole. She was responding to an isolated word that she recognized.

This can make ordinary conversations extremely challenging for caregivers because the same information may have to be repeated several times, sometimes in much simpler language.

Losing and Misplacing Things

Everyone misplaces something occasionally. Dementia can take this to another level.

A person with dementia may repeatedly lose possessions because they have placed them in unusual locations or hidden them and then forgotten where they put them. They may put cash inside a shoe and then throw the shoe into the garbage. They may put leftover food under the bed, a toothbrush in a sock drawer, or mail inside an oven.

They may then become convinced that someone stole the missing item.

Sometimes the item itself may be something the caregiver has never seen before. A person may insist that someone stole a particular object, such as a vintage camera, even though no one else remembers ever seeing it.

To the person with dementia, however, the belief can feel completely real.

Repetitive Searching and Suspicion

When people with dementia become anxious or confused, they may repeatedly open and close drawers, cabinets, closets, or other storage areas. They may be looking for something but be unable to explain what they are looking for.

This confusion can sometimes develop into suspicion or accusations.

My mother, for example, became extremely preoccupied with what other people were doing. If I brought a friend into the house, she might accuse that person of being promiscuous. If my husband worked overtime, she might insist that he had taken my money and gone to a casino.

Simply telling her that she was mistaken did not necessarily resolve the situation. Instead, she might become increasingly distressed and try repeatedly to convince me that her version of events was true.

These behaviors are not simply stubbornness. Dementia can affect judgment, perception, reasoning, and the ability to distinguish between what is actually happening and what a person believes is happening.

Changes in Behavior and Personality

Dementia can cause noticeable changes in a person's behavior and personality.

Someone who was previously polite and reserved may begin saying things that would have been completely out of character for them. They may make inappropriate comments, insult other people, use language they would never have used before, or behave in socially inappropriate ways.

In some people, dementia can also cause disinhibition or hypersexual behavior, including inappropriate sexual comments, propositions, touching, or public nudity.

These behaviors can be shocking to family members because they may seem completely inconsistent with the person's lifelong personality.

It is important to remember that the disease can impair the parts of the brain responsible for judgment, impulse control, and social behavior.

Changes in Personal Care and the Home

Another noticeable difference can be a decline in personal grooming and household organization.

Someone who once took pride in their appearance may stop maintaining their hair or makeup. Clothing may be worn incorrectly, such as shirts or sweaters being inside out, pants being backward, mismatched socks, or shoes being placed on the wrong feet.

Personal hygiene may decline as well.

The home may also become increasingly disorganized. Mail can accumulate, trash may not be thrown away, clothing may be left in piles, food can spoil, and ordinary household clutter can become overwhelming.

What once would have been recognized as garbage or something that needed to be put away may no longer be identified that way.

Unusual Behaviors and Beliefs

Dementia can also lead to behaviors that appear completely irrational to someone who does not understand the disease.

My mother, for example, once had a large supply of baby powder from the dollar store. She would pour it over herself, into her bed, and onto the floor. She genuinely believed it helped keep the house cool.

From the outside, the behavior made no logical sense.

From her perspective, however, there was a reason for doing it.

That distinction is important when caring for someone with dementia. Arguing about whether the behavior makes sense often does not solve the problem because the person's reasoning and perception have been altered by the disease.

Changes in Eating

Eating habits can change significantly as dementia progresses.

A person may suddenly dislike foods they once loved or begin eating foods they previously disliked. They may eat only small amounts or lose interest in meals altogether.

They may also forget that they have eaten.

Someone can eat breakfast and lunch and later insist that they have not eaten anything all day. To the caregiver, this can be frustrating, but the person is not necessarily lying. They may genuinely no longer remember the meals.

Safety and Falls

Dementia can also create significant safety concerns.

People with dementia may become more prone to falls because of problems with balance, coordination, judgment, spatial awareness, or physical weakness. They may also have difficulty recognizing hazards that would previously have been obvious to them.

Other accidents can occur as well, including burning food, spilling liquids, dropping objects, leaving appliances on, knocking things over, or attempting activities that are no longer safe.

Driving can become particularly dangerous when memory, judgment, reaction time, or spatial awareness are impaired.

Difficulty Following Instructions

As dementia advances, even simple instructions can become difficult to process.

For example, you might tell someone:

1. Get a pot.
2. Put water in the pot.
3. Put the pot on the stove.
4. Turn the stove on.
5. Wait for the water to boil.

A person with dementia may not be able to retain the sequence. They may hear the word “water” and simply turn on the faucet, without understanding the rest of the instructions.

This is why caregivers often have to break tasks into very small, individual steps.

Aggression and Emotional Outbursts

Dementia can also cause dramatic changes in emotional regulation.

My mother never hit me as a form of discipline when I was growing up. Yet during caregiving, she has experienced episodes in which she bit or kicked me, threatened to throw ceramic coffee mugs, or screamed intensely.

These behaviors can be extremely upsetting for family members because they are so different from the person they remember.

Again, this does not mean the person has suddenly become a different human being. The disease can affect impulse control, emotional regulation, judgment, and the ability to respond appropriately to frustration.

Hallucinations and Psychosis

Some people with dementia can also experience hallucinations, delusions, or other forms of psychosis.

My mother has seen people and things that nobody else could see. She has insisted that someone was present when there was no one there. She has talked to the ceiling, walls, and even her pillow.

This was not part of her personality before dementia.

Experiencing these symptoms as a caregiver can be frightening, particularly when the person is completely convinced that what they are seeing or experiencing is real.

The Difference Is More Than Forgetfulness

So, what is the difference between ordinary forgetfulness and dementia?

Ordinary forgetfulness happens to all of us. Dementia progressively interferes with a person's ability to remember, communicate, reason, recognize familiar people and places, perform familiar tasks, regulate behavior, and safely navigate everyday life.

A person who occasionally forgets where they put their keys is experiencing something very different from a person who puts their keys in the refrigerator, forgets doing it, becomes convinced someone stole them, and can no longer understand why the refrigerator is not an appropriate place to store keys.

Dementia is not simply “forgetfulness.” It is a progressive condition that can affect nearly every aspect of a person's functioning.

These examples are based on my personal experience as a caregiver. Dementia does not look exactly the same in every person, and symptoms vary depending on the type and stage of dementia and the individual.

But after years of caring for my mother, I have learned that there is a profound difference between occasionally forgetting something and losing the ability to understand, remember, and safely interact with the world around you.

Cold and Flu

This is about colds and the flu, and after nearly 30 years as a massage therapist, I cannot count how many times clients have scheduled appointments while they were actively ill.

There is a common misconception that massage can somehow “push an illness out” of the body. It cannot. Massage does not cure a cold, eliminate the flu, or force an infection out of your system. If you are experiencing active symptoms, your body needs time to recover.

If you are coughing, sneezing, experiencing fever or chills, vomiting, dealing with significant congestion, or otherwise feeling acutely ill, please reschedule your massage. A massage therapist is not the person who needs to determine whether you are contagious. If you are unsure, consult your physician and follow their advice.

For me, this is especially important because I have family members who are more vulnerable to illness. My husband has Hyper IgE syndrome, also known as Job syndrome, an immune deficiency that can make infections more difficult for him to manage and can aggravate his asthma. My mother is also elderly and has advanced dementia. When I become sick, I am not only dealing with my own illness. I risk bringing that illness home to the people who depend on me.

Even without those personal circumstances, I would still prefer not to provide massage to someone who is actively sick.

There is also a practical consideration that is sometimes overlooked: massage is close contact. Your face is positioned directly into the face cradle, which is also used by other clients. If you are coughing, sneezing, or otherwise producing respiratory secretions, that creates an additional sanitation concern for the treatment room and equipment.

If I know that a client has been actively ill, I may need to take additional cleaning and sanitation measures before the space can be used by someone else. Depending on the circumstances, I may also need to wear a mask while working. Massage therapy is physically demanding, and working while masked can make an already strenuous job more difficult for me.

I also take hand hygiene seriously. Thorough handwashing and appropriate use of hand sanitizer are part of maintaining a clean professional environment, particularly when there has been potential exposure to illness. I want to protect myself, my next client, and my family when I leave work.

Please Do Not Feel Guilty About Rescheduling

If you are sick, please stay home and recover. Rescheduling your appointment is not an inconvenience or an insult to your therapist. It is the responsible thing to do.

Massage will still be here when you feel better.

If I become sick, I cannot work. My clients depend on me, and my family depends on me. I am sure you would not want me providing your massage while I was coughing, feverish, or otherwise ill.

So please give yourself permission to rest.

If you are sick, stay home. Get better. Then come see me when you are well.

Rest In Peace Jamie Lopez - Babydoll Beauty Couture

Photo of Jamie via her personal Facebook profile

About a decade ago, I was introduced online to a young woman named Jamie Lopez. Jamie was a nail technician, makeup artist, and hairstylist living in Las Vegas, Nevada. We connected professionally because she was planning a Spa Day for Supersized Women, and the idea was for me to travel to Las Vegas and provide massage therapy for some of her guests.

Unfortunately, the spa day never came to fruition, so I never made the trip to Las Vegas to work with her clients. The possibility remained open, however, in case she decided to organize another event in the future.

Jamie was, in every sense of the phrase, a larger than life woman. At her highest weight, she weighed more than 800 pounds, yet what I remember most was not her size. It was her presence.

She was beautiful, charismatic, and full of personality. There was something about her spirit that seemed even larger than her physical presence. Her warmth and genuine kindness came through in the way she interacted with people, and that is what stayed with me.

Jamie eventually began a remarkable weight loss journey and shared much of it through her personal and business social media accounts. I watched as she worked toward improving her health and mobility. After being largely bedbound for an extended period, she was eventually able to walk again. She also shared aspects of her daily life, including the foods she prepared and the ways she incorporated movement and exercise into her routine.

It was not until after her death that I fully realized just how much Jamie had accomplished professionally and how widely she had become known. She had her own reality television series, Super Sized Salon, which aired on WE tv and brought her story and her business to a much larger audience.

I had gone years without owning a television, so I never had the opportunity to watch the show or witness her rise to television fame firsthand. I suppose I was aware of the show because I remember sharing it on social media, but I did not realize the full extent of her popularity.

Even so, Jamie was already a star to me.

She built Babydoll Beauty Couture, a salon created with the needs of plus size women in mind. She understood that people deserve to feel comfortable, respected, and cared for when receiving beauty services, regardless of their size. Her business provided a space where women who might otherwise feel overlooked could enjoy beauty treatments and the experience of being pampered.

That is the Jamie I remember.

I am grateful that I had the opportunity to know her, even if our friendship and professional connection existed primarily online. Sometimes people come into our lives briefly, yet leave an impression that lasts much longer than the amount of time we actually knew them.

Jamie Lopez was a talented businesswoman, a beauty professional, and a television personality, but to me, she was also a kind and compassionate woman who cared about making other people feel beautiful and welcome.

She was a star long before I ever saw her on television.

Jamie Lopez
June 19, 1985 – December 18, 2022

Rest in peace, Angelita.

Internal Review

My workplace sends guests a review form after they receive a massage, and I remember the client who wrote this particularly wonderful review.

She was interested in trying cupping during her massage. When I initially applied the first cup, she found the suction too intense, so I immediately adjusted it. Client comfort is always important, particularly when introducing someone to a technique they have never experienced before.

The cups I use are made of silicone, which allows me to control the amount of suction by gently squeezing the cup before placing it on the skin. Once applied, the cups can either remain stationary or be moved across the skin with a controlled gliding motion. When used as part of a massage, gliding cupping can provide a different type of sensation and can be incorporated into work involving areas of muscular tension and restricted soft tissue mobility.

I particularly like silicone cups because they give me a great deal of control over the intensity of the technique. They can be adjusted quickly based on the client's comfort level, which makes them a practical option for introducing someone to cupping.

I also have my own set of silicone cups at home and have used them on myself and, when appropriate, on family members.

The first cups I ever encountered were glass cups used with a suction gun. The gun creates the vacuum inside the cup, allowing it to adhere firmly to the skin. Depending on the amount of suction used, this type of cupping can feel considerably more intense.

For someone who has never experienced cupping before, I generally prefer the control and adjustability of silicone cups. They provide an opportunity to experience the technique gradually rather than immediately beginning with strong suction.

As with any massage technique, communication is essential. Cupping should be adjusted according to the individual's comfort level, and there is no reason for a client to endure excessive discomfort simply because a technique is supposed to feel “deep” or intense.

A good massage is not about how much pressure a therapist can apply. It is about using the appropriate technique, at the appropriate intensity, for the individual client.

Hygiene

One of the most common concerns I hear from massage therapists, including myself, is personal hygiene.

Massage therapy involves close, hands on contact with the skin. Good personal hygiene is therefore important not only for the comfort of your therapist, but also for maintaining clean linens, equipment, and a professional treatment environment.

You do not need to arrive at your appointment smelling like a luxury spa. You simply need to arrive clean and reasonably prepared for close contact.

Here are a few things to keep in mind.

Hair Products

If you are receiving a scalp massage, please avoid heavy amounts of gel, pomade, hairspray, or other styling products immediately before your appointment.

Massage oil and hair products do not always mix well. When combined, they can create a sticky residue that transfers onto the therapist's hands and potentially onto other areas of your body.

If you know your massage will include significant scalp or head work, freshly washed hair with minimal styling product is ideal.

Spray Tan

A spray tan is not necessary for a massage, and freshly applied tanning products can create some challenges.

Massage lotion, oil, or gel can cause tanning products to smear, particularly when there is prolonged contact and friction. The product can also transfer onto massage linens and potentially stain the therapist's clothing.

If you have recently applied a self tanner or received a spray tan, consider allowing it to fully develop and showering according to the product's instructions before your massage.

Excessive Sweating

If you experience hyperhidrosis, or excessive sweating, particularly of the hands and feet, please let your massage therapist know.

There are simple ways your therapist can make the session more comfortable. A small towel can be provided, or certain areas can be uncovered temporarily to allow the skin to dry.

Excessive perspiration combined with massage oil or lotion can make the skin extremely slippery, which can affect the therapist's ability to maintain appropriate contact and control.

There is absolutely no reason to feel embarrassed about excessive sweating. Just let your therapist know so they can work with you.

If you prefer to keep your socks on because of sweating or another personal concern, simply communicate that preference.

Feet

Your massage therapist may spend considerable time working on your feet, so please give them some attention before your appointment.

A quick rinse is not necessarily the same thing as thoroughly washing your feet. Feet accumulate sweat, bacteria, dead skin cells, and other debris throughout the day, even when enclosed in shoes.

Please wash your feet thoroughly before your massage and, if possible, wear clean shoes and socks.

Your therapist may not tell you that your feet have an odor. Instead, they may adapt their technique by keeping your feet covered with the sheet or using a different massage medium.

If your therapist suddenly changes how they work on your feet, there may be a very practical reason.

Good foot hygiene is beneficial for you as well. Regular washing can help reduce unpleasant odors and maintain healthy skin.

Your Back and Sunscreen

The back can be another surprisingly difficult area to keep clean because many people cannot easily reach it.

Some people rely on the water and soap running down their backs while washing their hair, assuming that is sufficient. Others simply cannot comfortably reach the entire area.

This can become noticeable during a massage, particularly when sunscreen, body products, sweat, and accumulated skin oils have built up on the skin.

I have occasionally applied massage oil to a client's back only to discover that old sunscreen or product residue begins rolling and collecting underneath my hands.

It can feel a little like trying to remove dried glue from your fingers. The massage medium does not necessarily remove the residue. Instead, it can cause the buildup to move around with the therapist's hands.

A thorough shower before your massage, particularly after spending time outdoors, can make a significant difference.

Exfoliation and Skin Buildup

Some clients also have significant amounts of accumulated dead skin or keratin buildup on the back.

When massage begins, friction can cause small keratin plugs or pieces of hardened skin to loosen from the surface. This is not the massage oil, lotion, or gel. It is material that was already present on or in the skin.

A gentle exfoliation during your normal bathing routine can help remove excess dead skin and keratin plugs and keep the skin's surface smoother.

You do not need to scrub yourself aggressively. In fact, excessive exfoliation can irritate the skin. Regular washing and gentle skin care are generally sufficient.

Full Makeup

I understand that some people do not feel comfortable leaving the house without makeup. Makeup can be an important part of someone's routine and confidence.

However, if you are coming in for a massage that includes facial, scalp, neck, or shoulder work, full makeup is usually unnecessary and can create a mess for both you and the treatment room.

During a typical massage, you may spend 30 minutes or more face down with your face resting directly in a face cradle. Your therapist may also move your head and neck, which causes your face to shift against the face cradle cover.

Foundation, mascara, lipstick, eyebrow products, and other cosmetics can transfer onto the cover.

Most spas use washable face cradle covers rather than disposable paper covers. Makeup stains can therefore become a laundry issue, and some products can be surprisingly difficult to remove completely.

If you are comfortable doing so, arriving with a clean face is ideal, particularly when facial or scalp work is part of your treatment.

And remember: you are coming to a massage, not a photo shoot.

Your therapist is much more interested in helping you relax than in whether your mascara is perfect.

A Little Preparation Goes a Long Way

Personal hygiene before a massage is not about judgment or expecting perfection. It is about mutual comfort, professionalism, and respect.

Take a shower, wash your feet, remove excessive hair products, give your back a good cleaning, and consider skipping heavy makeup if your face will be in the face cradle.

Your massage therapist will appreciate it, your linens will appreciate it, and your massage will be a much more pleasant experience for everyone involved.