Recognizing Dementia can be Tricky
Recognizing Dementia can be Tricky
When to Have the Critical Conversation? Issues in Planning for Persons with Dementia and their Caregivers
When to Have the Critical Conversation? Issues in Planning for Persons with Dementia and their Caregivers
2012 Canadian Consensus Conference on Dementia
2012 Canadian Consensus Conference on Dementia
The Art of Listening Again and Again
It was a replay of a common interaction. I was telling my daughter some story from my past to make one point or another and she responded with, “I know, I know, you have told me that before.” At that moment I realized what a common occurrence this sort of interaction was and explained to my daughter, “Even if you have heard the story before remember that it is important to listen again because first of all I may not remember that I told you the story before and more importantly the telling of the story may have as much meaning and significance for me as it might have for you.”
As I thought about the issue I realized how often in my geriatric medicine practice one of the salient complaints by families is how often their loved one tells them the same thing over and over again, and they use that symptom as do we in practice as geriatric health care providers, as possible evidence of cognitive decline and the inability to recall what was said previously. I am beginning to believe that this symptom, although very common, and often indicative of a decline of cognitive function is also a manifestation of a very common human propensity to focus on the narrative of one’s life and to recall and recount that narrative as part of one’s process of self-identity and validation. The question is; what is the separation between the normal and very common attribute of story-telling and the narrative of one’s life, and the pathology of cognitive impairment that interferes almost completely with the awareness that a story or occurrence has been recently recounted to a loved one?1,2
What most of us understand at some level is that the telling of stories is a very important part of our existence. Some do it more than others, but in normal relationships and conversations we spend much of our efforts recounting events of our life and experience to others. And the propensity to be repetitive is quite universal as anyone in a long-standing relationship will admit. In fact, if one were to track the topics of conversation between spouses and family members over a period of time I predict that one would find the same topics in one form or another repeated. This includes the common topics related to work, especially when there are conflicts or important decisions to be made or about important family members that includes children or parents depending on one’s age. I would suspect that if there were a prohibition on the repetition of topics to be discussed between partners and other family members there would be very little to be discussed.
A very common point of evidence to this phenomenon is the discussion of newsworthy items and political views. Any member of a couple usually knows pretty well the political views of the other partner. When in a social setting the topic comes up they often patiently listen to their partner express their views to presumably a new audience (although this to the chagrin of some friends or family members is not always the case) without interrupting the narrative with statements such as “we have heard your views before—if you do not have a new one just stop talking”. That would be considered extremely rude and likely the basis of the disruption of a social or personal relationship.
The question and challenge for those facing the extremes of repetition in a loved one who is developing or already has evidence of dementia is what to do? Those in such situations usually learn very quickly to avoid conflict that interrupting the recounting of an event already recounted with a “you told me already or I know” usually results in some element of conflict with a denial that the conversation in fact has taken place. Also, in the context of normal aging, family members may find that the propensity to retell and recall one’s life narrative occurs more and more frequently. This is partially because it is one of the ways all of us validate our lives which is important as the past becomes increasingly important compared to the likely options for the future. It is because of this human need to tell our narratives that there is such an interest by many in writing autobiographies and memoirs and an interest in readers in learning about other people’s lives, some because they are “famous” and others because they are deemed to be interesting or unusual and at other times because the reader finds the particular narrative congruent with their own life experience. The recognition that another’s life story in some way intersected, overlapped or was in parallel to one’s own is a very powerful way of validating one’s own life and confirming its relevance and importance.
A special dimension to repeating stories and recalling the narrative is when those stories are associated with great suffering and pain. Those of us that deal with Holocaust survivors, or those who have lived through other atrocities as have occurred in many parts of the world in the last century may be plagued by the content of those stories and the retelling may be associated with great emotional reactions. This can be very disconcerting to a family member especially as each retelling of the story becomes in essence a re-living of that particular horrific episode in that person’s life.3
The best recommendation that I can make about this inevitable process of repetition of a loved one’s “stories” is to find ways to be patient with them and accept that even though you have heard the story before, actually acknowledging it and expressing an interest in it is helpful and even therapeutic to both of you.
- Bursack, CB. What to Do When a Parent Repeats the Same Things Over and Over? Aging Care.com, http://www.agingcare.com/Articles/elders-repeating-the-same-story-146023.htm
- Mild Cognitive Impairment (MCI); What do we do now?, Prepared by the Center for Gerontology, Blacksburg, VA October, 2006; http://www.gerontology.vt.edu/docs/Gerontology_MCI_final.pdf
- Gordon M. Dementia and the Holocaust: What to do with those memories? January 29, 2012, HealthPlexus.Net: /blog/dementia-and-holocaust-what-do-those-memories
Dr. Michael Gordon is currently medical program director of Palliative Care at Baycrest, co-director of their ethics program and a professor of Medicine at the University of Toronto. He is a prolific writer with his latest book Late-Stage Dementia: Promoting Comfort, Compassion, and Care and previous two books being Moments that Matter: Cases in Ethical Eldercare followed shortly on his memoir: Brooklyn Beginnings-A Geriatrician’s Odyssey. For more information log on to www.drmichaelgordon.com
Common Lumps and Bumps in Children: A Colour-coded Differential
Common Lumps and Bumps in Children: A Colour-coded Differential
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
Mainpro+® Overview
Post-test: Paediatric Lumps and Bumps
Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.
| Questions | 5 |
|---|---|
| Attempts allowed | Unlimited |
| Available | Always |
| Backwards navigation | Forbidden |
Pre-test: Paediatric Lumps and Bumps
Common Lumps and Bumps in Children: A Colour-coded Differential
| Questions | 3 |
|---|---|
| Attempts allowed | Unlimited |
| Available | Always |
| Backwards navigation | Forbidden |
Thoughts on the WHO's Dementia Report
Thoughts on the WHO's Dementia Report
Three Highly Distinguished Physicians Join the Dementia Educational Resource Advisory Board
Health Plexus.net, the leading Canadian Network of Health Education resources is pleased to announce the addition of three highly distinguished physicians to its Dementia Educational Resource advisory board.
Dr. Howard Bergman was recently appointed the position of Chair of the Department of Family Medicine, at the Faculty of Medicine, McGill University. Dr. Bergman was also the first Dr. Joseph Kaufmann Professor of Geriatric Medicine and is Director of the Division of Geriatric Medicine at McGill University. He is also Director of the Division of Geriatric Medicine of the Jewish General Hospital and an investigator at the Centre for Clinical Epidemiology and Community Studies and at the Bloomfield Centre for Research in Aging of the Lady Davis Institute at the Jewish General Hospital in Montreal. He is also Adjunct Professor in the Department of Health Administration at the Université de Montréal and Invited Professor in the Faculty of Medicine at the Université de Lausanne in Switzerland and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
In the area of dementia and Alzheimer’s disease, Dr. Bergman’s research interests focus on early diagnosis. He is the founder and co-director of the Jewish General Hospital/McGill University Memory Clinic and is a Past President of the Consortium of Canadian Centres for Clinical Cognitive Research (C5R). In November 2007, Dr. Bergman was asked by the Quebec government to set up and chair a task force with the mandate to propose an action plan on Alzheimer’s disease and related disorders: from prevention to end of life care, including the research agenda.
Dr. Fadi Massoud is an internist-geriatrician who received his medical degree from the University of Montreal in 1992, and completed his internal medicine residency and geriatrics fellowship at the Universities of Montreal and McGill in 1997. He then did a research fellowship in cognitive impairment at the Sergievsky Center at Columbia University in New York under the supervision of Dr Richard Mayeux.
Since his return to Montreal in 2000, Dr Massoud works as staff geriatrician at the University of Montreal Health Center (CHUM) and the Montreal Institute of Geriatrics. He is associate professor of medicine in the Department of Medicine at the University of Montreal. His main topics of interest are cognitive ageing and dementia. He is scientific director of the memory disorders clinic at the CHUM. He is member of the Quebec Consortium for Alzheimer’s Disease and Related Neurodegenerative Disorders, and primary investigator of the CHUM at the Consortium of Canadian Centers for Clinical Cognitive Research (C5R). He participated in the Second Canadian Conference on Antidementia Guidelines in 2004 and in the Canadian Consensus on the Diagnosis and Treatment of Dementia in 2006.
Dr. Noel Rosen is a family physician in active practice in Toronto. Lecturer in the Department of Family and Community Medicine at the University of Toronto. He is also the Medical Director of the Valleyview Long Term Care facility in Toronto, as well as attending physician, Seniors' Health Centre, North York General Hospital, and active staff, and member of Department of Family and Community medicine Executive Board, North York General hospital, Toronto. In addition he is a Member, Continuing Medical Education Committee, North York General Hospital in Toronto.
About Health Plexus:
Comprised of 1000s of clinical reviews, CMEs, bio-medical illustrations and animations and other resources, all organized in the 34 condition zones, our vision is to provide physicians and allied healthcare professionals with access to credible, timely and multi-disciplinary continuing medical education from anywhere and on any media consumption device. The Dementia Educational Resource is the compilation of high quality clinical reviews, online CME programs, library of original visual aids, interviews, roundtable discussions and related conference reports.