Living with Dementia

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Clock drawing of 78-year old male with advanced dementia
WESTBOROUGH, MA February 23, 2018 Dementia is an affliction that slowly robs patients of their capacity to remember new information. Meanwhile their personal history remains readily available to them. That is why so many are able to share stories sometimes over and over. The cost of living with dementia for those so diagnosed is not a singular phenomena.  It effects the entire family and the wider community in which the patient lives. For many living with dementia is a lonely experience with sometimes  overwhelming sadness seeing a loved one slowly transform into child-like dependency.  Caregivers are at high risk for burn out when they care for a loved one day-after-day.  For many living with a person who has dementia can be an unforgettable challenge that often evokes guilt, resentment and despair.
There are many myths associated dementia that are worth pointing out.  First, old age and dementia are not synonymous.  Patients always say to me “what do you expect I am 82 years old” when I first begin the assessment process.  Research according to the APA, has shown in the right environment memory should not fail solely on the basis of age.
Part of this post was first publish nearly 3 years ago in 2015 and remains a timely addition to the literature on dementia, its assessment and impact on quality of life for those involved.  I have made some changes to the post from 2-1-2016 to update it and introduce another post that will be published shortly about dementia.  Pleased stay tuned to this blog and learn all about the affliction of dementia and more on the use of clocks for the assessment of cognitive changes.  I have added a person story that is compelling and has to do with this topic.  Thanks – I hope you like the upcoming posts.

“For many living with a person who has dementia can be an unforgettable challenge that evokes guilt, resentment and despair.” Michael Sefton 2018

The assessment of dementia is often stressful and the diagnosis is difficult to make.  The stress comes from the rare times that psychologist must give “bad news” to families of patients suffering with changes in their mental faculties. Unlike our physician brethren, psychologists rarely  have to give family members bad news or news that reflects a change in life expectancy.  One might expect this as normal from a physician who specializes in cancer or tumor treatment.  But in general, our discipline is not called upon to provide such subjective prognostic diagnoses very often. Dementia is one of those conditions primarily diagnosed by neuropsychological testing that has obvious impact on the life expectancy and the overall quality of life of those afflicted with it.
This clock above was drawn by a 78-year old man who was referred for outpatient neuropsychological assessment to determine the extent of change in dementia from his initial testing 24 months earlier.  You can learn quite a bit from the drawings of people thought to be suffering from dementia.  In this case, the patient was friendly and compliant.  He put forth a good effort and worked with diligence and earnest.  The task is the same for all cases – “draw a clock, put all the numbers on it and set the hands for 11:10.”
This clock effectively demonstrated the decline in the gentleman’s neurocognition.  It was poorly organized.  There was some neglect of the left hemi-space.  He had no self-monitoring or internal executive capacity to guide his construction.  He seemed surprised when I pointed out his work.  The numbers were not correctly placed. The slash marks were meant as minute marks and not number 11.  However, there were repeated numerals and reversals.  No hands were placed.
I learned about cognitive testing while an intern at Boston City Hospital – now B.U. Medical Center in the South End.  I loved my time there.  I wrote a blog about clocks and the utility of the clock drawing about a year ago called “All this from a Clock”.  If interested in the clock drawing take a look at the link I posted.  There is growing from clinicians around the world about dementia and using the clock as a screening tool.  The ABC in Australia recently chose one of the clocks recently published to feature on an upcoming program on dementia it is not clear when the program will be broadcast in Australia but I will post a link to the show once it is ready for broadcast. Stay tuned to http://www.concussionassessment.wordpress.com and Michael Sefton for further details.
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One thought on “Living with Dementia

  1. […] WESTBOROUGH, MA July 7, 2016 The clock drawing is something that I have grown quite fond of using to assess patients who might be impaired in their thinking skills. Here is the clock of the week for early July, 2016. Some patients become suspicious when the neuropsychologist gets involved often saying “What do they think I am crazy?”  No not at all.  But the clock drawing can provide a great deal of important clinical information about their cognitive functioning.  I have written about the clock drawing and other visuospatial functions for a few years now.  As you can see by the clock of the week for July 7th the patient who crafted this clock missed the boat.  I needed to prompt him for everything including placing the numbers around the clock.  The clock is nonthreatening.  Patients sometimes believe that the tests we use in our assessments require a high level of education.  Not true.  I published a post in January about the impact of dementia on caregivers […]

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