Dementia is a condition that affects the brain in ways that make it harder for people to think clearly, remember things, and make decisions. When someone has dementia, their ability to make decisions quickly, especially about medical matters, can be greatly affected. This is because dementia damages the parts of the brain that are responsible for reasoning, understanding, and processing information. As the disease progresses, these problems become more noticeable and can make it difficult for a person to respond to medical situations in a timely and thoughtful way.
One of the main reasons dementia makes decision making harder is that it slows down how fast a person can process new information. When a doctor explains a treatment option, someone with dementia might need more time to understand what is being said. They may also have trouble remembering details from the conversation, which makes it harder to weigh the pros and cons of different choices. This is especially true when the information is complex or when there are many options to consider. For example, if a person with dementia is asked to choose between different medications, they might struggle to remember the names, side effects, or benefits of each one. This can lead to confusion and delays in making a decision.
Dementia also affects a person’s ability to think about the future and understand the consequences of their choices. When making medical decisions, it is important to consider not just what feels right in the moment, but also how a decision might affect health in the long term. People with dementia may have trouble imagining future outcomes or understanding how their current choices could impact their well being later on. This can make it difficult for them to make decisions that are in their best interest, especially when those decisions involve risks or trade offs.
Another challenge is that dementia can make it harder for people to communicate their thoughts and feelings. When a doctor asks a patient what they want, someone with dementia might have trouble finding the right words or expressing their preferences clearly. This can lead to misunderstandings and make it harder for medical professionals to know what the patient really wants. Sometimes, a person with dementia might say yes to something just to avoid conflict or because they do not fully understand what is being asked. This is why it is important for doctors and caregivers to take extra time to make sure the person understands and feels comfortable with their choices.
There are also emotional and psychological factors that can affect decision making in people with dementia. For example, someone with dementia might feel anxious or overwhelmed when faced with a medical decision. They might worry about making the wrong choice or feel pressure to please others. These feelings can make it even harder to think clearly and make a decision quickly. In some cases, a person with dementia might avoid making a decision altogether because they are afraid of the consequences.
Despite these challenges, it is important to recognize that people with dementia can still make decisions, especially in the early stages of the disease. Many people with mild dementia are able to understand information, weigh options, and express their preferences, although they may need more time and support to do so. As the disease progresses, however, their ability to make decisions independently may decline. This is why it is important to involve family members, caregivers, and medical professionals in the decision making process. These people can help explain information, provide emotional support, and ensure that the person’s wishes are respected.
One important aspect of decision making for people with dementia is the ability to designate a surrogate decision maker. A surrogate is someone who can make medical decisions on behalf of the person with dementia if they are no longer able to do so themselves. Research has shown that even when people with dementia lose the ability to make complex medical decisions, they may still be able to choose a surrogate who understands their values and preferences [1]. This is why it is important to have conversations about surrogate decision making early in the course of the disease, before the person’s ability to make decisions declines too much.
There are also tools and strategies that can help people with dementia make decisions more easily. For example, doctors can use simple language, provide written information, and give the person time to think before making a decision. Visual aids, such as pictures or diagrams, can also help explain complex information. In some cases, it may be helpful to involve a social worker or counselor who can provide additional support and guidance.
It is also important to recognize that decision making is not just about understanding information and choosing an option. It is also about feeling empowered and respected. People with dementia should be treated as active participants in their own care, even if they need help with certain aspects of decision making. This means listening to their concerns, respecting their preferences, and involving them in discussions as much as possible.
In addition to the challenges posed by dementia itself, there are other factors that can affect decision making in medical situations. For example, stress, fatigue, and pain can all make it harder for anyone to think clearly and make decisions quickly. People with dementia may be more sensitive to these factors, which can further complicate the decision making process. This is why it is important to create a calm and supportive environment when discussing medical decisions with someone who has dementia.
Finally, it is worth noting that decision making is not a one time event. As a person’s condition changes, their preferences and priorities may also change. This means that decisions may need to be revisited and updated over time. For example, someone with dementia might initially choose to pursue aggressive treatment for a medical condition, but later decide that they want to focus on comfort and quality of life instead. This is why ongoing communication and regular check ins are important for ensuring that decisions continue to reflect the person’s wishes and needs.
In summary, dementia affects the ability to make decisions quickly by slowing down information processing, impairing memory and reasoning, and making it harder to communicate and understand complex information. However, with the right support and strategies, people with dementia can still participate in decision making and have their preferences respected. Early conversations about surrogate decision making, the use of simple language and visual aids, and ongoing communication can all help make the process easier and more meaningful for everyone involved [1].
References
[1] Devan Stahl, Jason Adam Wasserman, Lauren Barron, Sally P Weaver, et al. A Novel Tool to Assess the Capacity of People with Dementia to Designate a Surrogate. Gerontologist. 2025 Nov 21:gnaf259. doi: 10.1093/geront/gnaf259.
