Dementia is all about change.

Accepting change. Adapting to change. And (hopefully…maybe…sometimes) thriving through change.

But there has to be change. Or it’s not dementia.

Let me tell you why I say this…

People often ask me a question that goes something like this: “Does (insert something random) mean you have dementia?”

I will give you some examples. Does not being able to balance your checkbook mean you have dementia? Does forgetting people’s names mean you have dementia? Does not being able to smell peanut butter mean you have dementia? Does losing the remote mean you have dementia? (If I had a quarter for each time I’ve been asked the one about the remote control, I’d have enough money to put a hot tub on our deck.)

I have to smile at some of the very specific versions of this question. Does putting your diet Coke on top of the car and driving off from the gas station and watching it spill down your windshield mean you have dementia? Does forgetting you put on a face mask to make your skin look younger until you are horrified when you look in the mirror two hours later mean you have dementia? (These are easy ones. No, you don’t have dementia because you did something stupid once.)

With questions like these that refer to a mysterious “you,” I have to be careful with my responses. Because “you” sometimes means “I.”

The vagueness of “you” doesn’t tell me if they are asking a question that pertains to a family member, a neighbor, someone they once met at a party….or maybe it’s something they saw on online or heard on John Tesh Radio Show or saw on Facebook. I’m in the dark about who we are talking about. I’ve learned to tread lightly when I don’t know.

Sometimes, when a person asks a question like this, the “you” doesn’t refer to another person. They are telling me that they are concerned that they have dementia.

A while back I had a speaking engagement at a community center. I gave what I refer to as my 101 presentation–a basic overview of Alzheimer’s and related dementias. I answered a few questions from the podium, and the event wrapped up. I had to use the restroom before I walked to my car.

A guy who was probably 65-years-old was waiting for me as I walked out of the restroom in the basement of the building juggling my car keys and cell phone.

“If you keep messing up your money, does that mean you have dementia?” he blurted out.

My first thought was that I wasn’t sure who “you” was. My second thought was that I wasn’t sure what “messing up your money” meant.

I decided to pursue the latter in hopes it would get me to the former.

He told me that he has had the power shut off at his home a few times because he forgot to pay the bill. He also has habit of writing bad checks. He often forgets to cash checks and his checking account is overdrawn. He can never remember when his credit card bill is due, so he’s run up a bunch of interest and late fees. He said it’s not that he doesn’t have money. It’s just that he never has it in the right place, and he always forgets to pay what he needs to pay.

Yeah, I’d say that qualifies as “messing up your money.” And by “your money,” he definitely meant “his money.” Now we were getting somewhere.

He came to my presentation out of curiosity but a few things I said made him think that perhaps his troubles with money were due to dementia. I had mentioned poor judgement, unpaid bills, losing track of time. He’d been sitting there growing more and more worried that he had dementia.

I wasn’t sure where to go with this. First of all, it was almost 9 pm, and I was standing outside a restroom in a dark community center basement. They had literally already turned out the lights in the building. It didn’t seem like a place to have a life-changing conversation with someone.

Second, I was concerned. Financial mismanagement can be a sign of dementia. Obviously, I can’t make a diagnosis–nor do I want to. My only option is to make a suggestion that he see his doctor for a check up.

And that’s where I started. It’s always where I start when there is a concern. Go to your regular doctor. Check out any potential medication interactions. Get bloodwork done. Make sure you are not deficient in any vitamins or minerals.

I explained to this guy that I certainly didn’t have enough information to know whether or not he might have dementia, but I would recommend he take his concerns to his doctor. At the very least, he would have some baseline information for his future healthcare.

So we talk.

I put down my purse and lean against the wall because I’ve worn these heels that are so uncomfortable. Every time I wear them, I swear I’m going to get rid of them, but I never do.

The man was married but his wife passed away years ago. He has what he describes as a “kind of sometime girlfriend.” She refuses to marry him because his finances are a disaster. He recently tried to buy a car but his credit was so bad that he gave up on the process. He seemed like a really nice guy, and I started to realize his financial missteps are negatively impacting his life in a big way.

We talked some more.

He told me he worries that if he does have Alzheimer’s or another type of dementia that he won’t have anyone to take care of him. He mentioned that he has two kids that live across the country, but he’s not close to them. He even asked me how people pay for nursing home care. I explained how Medicaid works. He told me about the end-of-life experiences of his wife, who passed from cancer at a local nursing home. The care they provided didn’t impress him.

It gets real deep real quick.

So I listened. I had not eaten dinner. I was starving. But I kept listening.

(If you are reading this and thinking women shouldn’t be hanging out in dark basements alone with men they don’t know, that’s a fair point, but I didn’t think of that at the time. In fact, I didn’t think of until I was editing this post for the final time.)

When the conversation seemed to reach a natural stopping point, I picked up my purse and give him one of my business cards. I scribbled my cell phone number on the back. We started walking toward the door. We had been talking for at least 25 minutes. I am positive he would’ve talked to me for another 25 minutes, and I felt guilty for my attempt at a get-away.

Then he said something that changed everything:

“Thanks for all your help, Dr. Eshbaugh. I’ve always been terrible with money.”

WHAT. Always?

I stopped him and asked for clarification.

As he is unlocking his car door, he said he dropped out of college for not being able to pay the bill; he had blown the money on beer and pizza. He told me that his parents had to take control of his checking account in his 20s because he couldn’t manage it. Several decades ago, he had to go to jail for writing bad checks.

I almost had to laugh when he said, “I’ve been a disaster ever since my parents gave me my first allowance.”

I had made a mistake in my assessment of the situation. If you remember…dementia is about change. I had assumed that his financial management issues had been more recent developments. I had assumed they were a change.

Nope.

I wasn’t sure what to say. And I’m not sure what I said was the right thing. But I do think it made him feel better.

“Sir,” I said. “I don’t think you have dementia. I just think you are really terrible with money.”

He smiled and said, “Well, good then.”

And that was that. No goodbye or anything. He drove away in a rusty station wagon with wood paneling on the sides. I never even knew his name.

I got in my car and picked up an ice cream cone from McDonald’s for my drive home. I was sad for this gentleman whose financial issues were so challenging, but I couldn’t help but laugh to myself about the way our long conversation ended.

If you’ve had poor judgment your whole life, you don’t have dementia. You have poor judgment.

If you’ve been bad at remembering names your whole life, you don’t have dementia. You are just bad with names.

If you’ve been irritable your whole life, you don’t have dementia. You are just a miserable, irritable person.

And if you’ve been awful with money your whole life, you don’t have dementia. You are just ridiculously bad at managing your finances.

Dementia is about change.