This holiday season, take a good look at Mom and Dad

It's that season again: fall turning to winter, bells jingling in the crisp cold air and "the kids" — adult children with their own kids in tow — heading home to see Mom and Dad after a long time away.

Ah, the holidays! They bring us together — and they pull us apart. One of the sure things that will pull families apart this year is the discovery that a parent's mental abilities are slipping. Keeping in touch by telephone — even weekly — often fails to reveal the beginning of a parent's cognitive decline. Early symptoms are subtle and easy to miss. Also, the healthy spouse might cover up the other's lapses. What's required is personal observation stretched over many days — like when faraway children come home for the holidays.

Here are some things to think about if you face this dilemma:

First, realize that forgetting things occasionally is as normal as rain at any age. As we get older, we often have more trouble remembering lots of things — our friends' names, where we left the car, why we walked into a certain room — and it's OK, within bounds.

But like the rest of our bodies, our brains can become diseased as we get older. Just as a heart or hip can wear out, so can a brain. Serious memory loss is different from occasional forgetfulness. Over time it becomes constant.

There are more than 100 causes of memory loss in older adults. The good news is that many are temporary and can be treated if accurately diagnosed. These include medication mix-ups, bladder infections, thyroid problems, depression and inadequate diet and water intake (especially common among older folks).

The bad news is that some causes of memory loss are permanent, progressive and incurable. The two most common are Alzheimer's disease and small strokes, accounting for about 70 percent of today's cases. The umbrella word that covers all severe, permanent memory problems is dementia.

Whatever the cause, dementia results in impaired thinking, reasoning, learning and memory. It's the most common reason an older person can no longer live alone — or why their families have such a long, difficult time providing care. The person's judgment becomes faulty, and he or she slips in simple matters, such as driving and getting lost or not remembering to eat. As the disease progresses, significant and unpleasant changes occur in personality, mood and behavior.

But the person continues to look the same — there's no outward sign of the disease. Nor does he recognize there's a problem and, in fact, will vehemently deny anything's wrong, making it extra difficult for family and friends to take action.

Second, face the truth. This is imperative for several reasons. First, you need to learn the cause — and, if it's temporary, get it treated. See a doctor. Second, if the diagnosis is dementia, there are significant decisions that the affected person and family must make, information to be gathered, financial and legal matters to attend to. Some tasks — such as preparing a will or a health-care directive — are legal only if the person is competent when he or she signs them.

Third, medications are now available that can postpone (but not stop) dementia's progression, and they're more effective earlier in the disease than later.

Fourth, you'll need to develop plans for someone who has dementia for both the short and the long term. This includes making lists and learning about local services that can help at home — getting groceries, housekeeping, preparing meals and other tasks, then, ultimately, about residential facilities that care for people in the later stages. (Because this disease is so difficult, I recommend looking only at facilities that train their staff in dementia care.)

Finally, researchers are working to uncover ways to stop or prevent dementia, and they need people willing to participate, usually early in the disease process. One of the country's leading research sites is the University of Washington's Alzheimer's Disease Research Center.

If all this sounds daunting, it is.

Which is why I urge all families facing these difficulties to get in touch with their local Alzheimer's Association. This year the national organization celebrates its 25th anniversary — and the chapter serving Western and Central Washington is four years older. Compassionate, knowledgeable staff is available by telephone day and night and, through the national office, can speak up to 40 languages.

"There's so much needless suffering because people often call us too late," says Nancy Dapper, Executive Director of the Washington chapter. Offering a wealth of services — lists of physicians experienced in diagnosing dementing illnesses, advice on dealing with difficult behaviors, a library of books and videos, classes and support groups and many others, the Alzheimer's Association can be a lifesaver.

To contact the office in Seattle, call 206-363-5500 or toll free at 800-848-7097; or on the Web at www.alzwa.org.

You can learn about offices elsewhere in the country by calling the Seattle office or their headquarters in Chicago toll free at 800-272-3900.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she's worked with thousands of families and their elders. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.