The patient who is not “sleeping”July 28, 2022
“No need Doctor…”February 28, 2023
Patient 1 – “ …and one more issue” he adds after I have addressed his concerns with his medical illnesses. “I have some mild problem with my memory. I keep forgetting simple things. Maybe, it is age related…”.
“He speaks very little at home”, said his wife. “especially when others are around. At home, he speaks a bit more to me than he would to others. But does not reply all the time. I think it is a hearing problem. But it is not always. Maybe he is avoiding answering all my questions” she suppressed a smile and answered. Patient 2– just sat there silently.
“He screams all the time. Does not let me go even to the toilet” lamented the wife of Patient 3. If I am away from his vision, he gets all jittery. He keeps calling me ‘ammi’ thinking I am his mother.” Patient 3 sat on the edge of his seat, holding the edge of her saree, his eyes darting all around my clinic, disturbed by everything.
All of the above are patients with some cognitive impairment. While patient 1, may only be having Subjective Cognitive Decline”– a state where he knows he’s forgetting and is yet able to manage his activities. A precursor of Alzheimer’s disease, this is often brushed aside almost always by the family, and sometimes by the patient himself.
Patient 2 has obvious signs of dementia. His speech is affected and he shows disinterest in all activities. Often mistaken as depression, hearing loss or plain boredom, it would take a while until his loved ones realize that he has been losing his brain cells.
When a patient with dementia begins to exhibit Behavioral and Psychosocial disorders (BPSD), this can be quite distressing and is probably the only reason when the family is truly concerned about his failing cognitive functions or memory, as in Patient 3.
This year, we need to try and find the person behind the disease, rather than contend that it is impossible to do something for a patient with dementia- a term called Therapeutic nihilism in medical jargon.
There is a lot that can be done.