Special Issues in Memory Loss, Alzheimer’s Disease, and Dementia

Quick Start

Some Patients Do Not Want to Have Their Memory Evaluated

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Help patients understand that the goal is to improve their memory and allow them to continue doing the activities that they enjoy.
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Explain that there are a number of medications available that could help them.

Some Patients Do Not Want You to Talk to Their Family

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A few patients are able to manage the disease on their own, at least for a while.
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For the majority of patients, involvement of family or friends is a critical part of the patient’s care, helping him or her to deal with and manage memory loss due to Alzheimer’s disease or another dementia.

Talking to Adult Children of Patients About Their Risk of Alzheimer’s Disease and What They Can Do About It

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Having one parent with the disease increases the lifetime risk of developing Alzheimer’s disease by between twofold and fourfold
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  We stress, however, that Alzheimer’s disease is common: everyone is at risk.
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Activities shown to reduce the risk of Alzheimer’s disease include:
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  Participating in social and cognitively stimulating activities
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  Performing aerobic exercise.

The Patient Who Does Not Want to Come to the Appointment

Difficulty in convincing patients to come to appointments to evaluate their memory can sometimes be one of the biggest obstacles faced by families. Patients do not want to come to the appointment for a variety of reasons. Some patients may not want to come to the appointment because they are fearful of the diagnosis of Alzheimer’s disease, particularly if they watched their parent, spouse, or friend suffer with this disorder. Others may not want to come to the appointment because they are afraid they will be sent to a nursing home. And some may simply not want to come to the appointment because they do not recognize a problem and cannot be bothered with coming.

We admit that we have not been able to convince every patient to come to an appointment. We have, however, been successful with a couple of strategies. The most reliable of these is to explain to the patient (typically on the phone) that our goal is to improve their memory to allow them to continue doing the activities that they enjoy, and that there are a number of medications available to help their memory, and even to delay the onset of Alzheimer’s disease. Sometimes it is not even what you say, but just spending a minute and making a connection with the patient helps to make the appointment less frightening.

A number of families will grab us in the hallway prior to the appointment and say something like, “Please measure her blood pressure … the only way I was able to get her to you was to pretend that this was for her routine blood pressure check.” Although we do not condone deception as a way to bring a patient to an appointment (in part because it may lead to mistrust, in part because of the ethical implications), patients brought in this way typically do just fine. These patients discover that a memory evaluation is quite similar to other medical evaluations, not as frightening or threatening as they had feared.

The Patient Who Does Not Want You to Talk to Their Family

Sometimes it happens that patients come to the clinic and they do not want you to tell their family about their memory difficulties. Should we agree with respecting their desire for confidentiality, despite the difficulties and potential danger in which they may be placing themselves and others? Or should we insist that their family be involved? Our answer is that it depends upon the circumstances (see patient examples below). For the vast majority of patients, the involvement of family or friends is a critical part of the patient’s care, helping him or her to deal with and manage memory loss whether due to Alzheimer’s disease or due to another dementia. There are a few patients, however, who are able to manage the disease on their own, at least for a while.

Case Study

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