The Expat Dementia Dilemma in Costa Rica

by Katya De Luisa

Retirement arrived, and you finally live the pura vida dream in Costa Rica in your forever home. The initial honeymoon phase seemed like paradise, but ultimately reality set in. Living in a foreign country can be just as challenging as living anywhere. It’s simply life, and the "stuff" you bring isn't always just the furniture.

Despite the bumps in the road (literally), you eventually became adept at handling the banking, bureaucracy, immigration, medical challenges, cultural differences, and maneuvering through life without knowledge of the language. Now, after several years, you finally feel at home.

The unexpected is something one learns to expect in Costa Rica. However, I wonder if many of you would see this one coming.

Gradually you begin to notice you or your significant other begins to have memory problems. At first, it’s just misplaced items, forgetting appointments, or someone's name. Nothing to be concerned about because this is what happens when we get older. But the forgetting gets worse, and it’s becoming apparent something else is happening.

Not only are there memory lapses, mood swings, and some terrible decision-making complicating matters. These changes are usually first noticed by the spouse. Unfortunately, the person experiencing it is commonly in denial, and they blame others or fabricate some pretty good excuses. This certainly isn’t the “happily ever after” you planned for your Costa Rica life together.

You start to fear this could be the beginning of dementia. Maybe someone in your family had it, and this is the worst you can imagine. Your family is in another country, and your friends don't seem to have any answers. The situation escalates, and you feel very anxious, alone, and frightened. What can you do?

First, find out

The initial step is to get a medical diagnosis, preferably from a gerontologist, neurologist, or geriatric psychologist. Dementia isn’t always the dreaded Alzheimer’s; you need to find out. Alzheimer's is the number one cause and, unfortunately, incurable and progressive. Vascular problems are the second cause of dementia, and TIAs (small strokes) are the cause and are usually progressive. High blood pressure or heart issues create a high risk and usually precedes this type of dementia.

We have a Facebook group called Expat Dementia Support- Costa Rica.

There are some genetic dementias such as Huntington's and Pick’s disease, and a form of genetic early Alzheimer's, which generally begins in one's 50s or earlier. But most Alzheimer's dementia — no matter how many people in your family have had it — is not genetic.

Most cognitive conditions causing dementia are incurable; however, not all. Alcoholism is a significant cause, and commonly, stopping alcohol consumption slows or stops the progression. Also, deficiency of vitamin B12 and thyroid imbalances can create dementia symptoms and are reversible.

In Costa Rica, residency requirements dictate the CAJA inscription in the national medical system. Most foreigners have both private insurance and CAJA. In my experience, most general practitioners don’t have the specialized knowledge of a senior professional, and most CAJA system doctors are just out of medical school. You'd go to a pediatrician for children, and you should see a gerontologist for the elderly. So, find a professional.

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Katya De Luisa is a dementia educator, caregiver coach, and author of "Journey through the Infinite Mind," the science and spirituality of dementia, available in English or Spanish. Contact Katya for more information: kdeluisa@yahoo.com