Archive for October, 2012

One way to understand progressive changes resulting from dementia is to compare them to the changes that occur as a result of human development.  Dementia unfolds as reverse development.  As a general rule, those skills we learn later in life (e.g., managing investments, complex technology, doing a checkbook, and writing poetry) decline earlier than those learn earlier in life (e.g., toileting, dressing, and language).  The major difference is that as we develop from infancy, we constantly learn new skills and information.  The opposite is true for most dementias.  Learning new skills becomes increasingly difficult or impossible.   Those who are demented must be managed based on skills that are already there and those skills progressively deteriorate.  Dementia is a backward moving target. The good news is that we can learn a lot about managing dementia by understanding and using principles of […]

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I have had a number of clients who have sought out advice after coronary artery by-pass surgery. They, their spouse, or their children often report that everything was fine mentally until after the surgery. I often see these clients within the first year after surgery. The concern is always the same. Mom, dad, my husband or my wife has physically recovered from the surgery but now has memory problems they did not have prior to the surgery. A recent study (Journal of Behavior Medicine, 2012, 35, 557-568) provided memory training to patients recovering from coronary artery by-pass surgery. They assessed cognition by neuropsychological evaluation one week, one month, three months, and four months after surgery. 65% of patients displayed memory deficits one month after surgery and 41% continued to have deficits after 4 weeks. Memory training focused on use of […]

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Last July I discussed the differences between delirium and dementia. To review, by the dictionary a delirium is “an acute mental disturbance characterized by confused thinking and disrupted attention usually accompanied by disordered speech and hallucinations.” By the same dictionary dementia is “usually progressive condition marked by deteriorated cognitive functioning with emotional apathy.” The critical thing to know is that a delirium has a sudden onset and is reversible in time. A dementia often has a gradual onset and is irreversible. A new study (Archives of Internal Medicine, 2012, August 20 online) demonstrated that there are enduring effects of hospital-acquired delirium in patients with Alzheimer’s disease. The rate of decline is about two times faster in those who developed an in-hospital delirium when compared to those who do not. Delirium is thought of as a transient condition that clears and […]

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