How to help a close friend seek help with possible early onset dementia

Question

I have a close friend who is genetically predisposed to early-onset dementia. My friend is relatively young (mid-30s), but has been having concerning unexplained behavioral shifts, such as:

• Forgetting basic things mid-conversation. (We'll be talking about something, and then my friend will seconds later say, "hey have you heard about...", and say something pretty much what we were just saying.)
• Becoming inexplicably verbally aggressive with family and friends to the point that many of their relationships have suffered a great deal of damage.
• Other signs of confusion, along with stress and extreme defensiveness.

Others also care a great deal for this person, and have also witnessed these behaviors. I am not a doctor and therefore cannot assume I know this has anything to do with my friend's potential future dementia, but whatever the cause, their behavior is causing them damage in their life, and I'm not sure they recognize it. I want to help by suggesting they see their doctor.

How can I raise the issue in a supportive/caring/loving way?

In the last couple years, my friend has started responding to fear and criticism by lashing out and becoming aggressive, followed by anything they can do to justify their previous thought or action. The reason for fear doesn't have to be legitimate, and the criticism need not be strong or even intended at all. It's all in how my friend perceives it. This has been observed by others as well, no matter how they approach this person, and no matter the topic. Stress and the pandemic have exacerbated the issue in recent months. (Although, this problem started to exist before the pandemic as well.)

I have no doubt that if I were to even mention the observed behavior, that my friend would become aggressive. I suspect if I were to suggest seeing a doctor about it, my friend would be extremely offended. At the best case, I think my friend would become terrified and perhaps overreact before talking to a doctor and getting some facts.

I considered discussing this with other friends/family of this person, but feel that my friend would feel betrayed.

How can I approach this, with the goals of:

• Showing support for the friend, no matter what they do, even if they choose to not seek medical help
• Encouraging the friend to seek medical help in a way and pace they deem appropriate (i.e., I don't want to dictate specifically what my friend does, I just want to provide feedback from the outside perspective and suggest that they do something to address it.)
• Reducing the chance of damaging the relationship if my friend takes offense to my suggestion

Answer 1

This is going to be hard, especially if it really is dementia. The lashing out and aggressiveness are then likely symptoms of it, and if they have been going on for a couple of years already, this might mean your friend is already gone. A relative of mine has dementia, and there's nothing left. You can pretend to be the nicest person in the world, all you'll get in return is abuse. This may seem harsh, but I really need you to realize that no matter what you do, if it fails, it is very, very likely it isn't your failure, just your friend being gone, beyond any reason. It's an important thing to keep in mind, to keep yourself safe and keep your own sanity.

Our family has shared tips from this Dutch site when dealing with the relative. And while my parents did most of the work, the steps required to get him to accept help are also described on that site, on this page. Some of the steps we took may be harder for you to follow with your friend (like visiting the doctor together or talking to their doctor first), but a few might be helpful to you:

• Talk to your friend about the changes you noticed in their behaviour, without any judgment. So, you need to pick your words very, very carefully and be wary of saying their memory got worse, or that they are forgetting basic things mid-conversation.
• Ask your friend to go see a doctor/do something because you are worried. Be open about your worries about the health of this individual. Especially if you've talked with them about their genetic disposition before, this might get them thinking. It's a thing that can easily backfire too, though, if your friend is prone to thinking they're being manipulated.
• One more thing you could do in such a conversation is to remind your friend about the benefits of getting a diagnosis, as soon as possible. For example, a diagnosis rules out other diseases, it opens the potential of getting treatment that may delay the progress of the disease or treat symptoms, it could be reassuring to have an explanation for the behavioral changes, both for your friend and their friends/family. In some countries, an early diagnosis even gives you chance to arrange for euthanasia because you're still considered mentally competent.

A few other general tips about dealing with refusal of help can also be applied when encouraging someone to seek professional help:

• Don't be pushy. If your friend get's too agitated or aggressive, try again later. Getting them to seek help will be a process that's always going to be longer than you'd like.
• Take small steps, suggest one thing at a time. Your idea of suggesting they 'do something' over dictating what they should do seems to be in the right spirit here, though perhaps you can come up with a concrete small step you'd like them to take, like just talking with their doctor at a next checkup/going for a checkup generally.
• Mind your non-verbal communication as much as the verbal communication described above. If your body language (posture, facial expression) indicates that you are ready to fight, you might get a self-fulfilling prophecy and get your fight.
• Mind your own safety and boundaries. Always keep in mind that if your friend is a hazard to themselves or their surroundings, you might just have to bite a bullet and push through, or remove yourself from their life for your own protection.

All of this eventually helped to get my relative to get help, and get a diagnosis. But it was an excruciatingly long process (almost a year), and it required most of the family, to try these conversations repeatedly. So don't expect any wonders from your talk with your friend... All these tips can do is help you do your side of the conversation as well as possible. Sadly, if this really is dementia, that's all you can do, and any conversation you have could just as well go wrong, there's no guarantee your friend will seek help, or that your relationship with them won't take some very, very serious damage.