Today we are taking mum and dad to see the Psychogeriatrician, Dr Humerus. It was our case manager who suggested to Rachel that we do this, though there is no specific reason. She also suggested that we send the doctor a short history beforehand. Here is what Rachel and I prepared:

Irene and Donald Pritchard: recent developments related to dementia - 17/09/07

Medication

IP

Recently stopped taking Aricept, since there was no detectable deterioration in her after her initial prescription had run out. Continues with Risperidone on an ad hoc and as-needed basis; she is visited three or four times a week by family members who each decide on the degree of her current anxiety or aggression whether to administer a tablet. This is usually a 0.5mg dose, but can be a 1mg dose if deemed necessary.

DP

His Aricept medication was restored since most of us thought he had worsened once he had been off it for a short while. The difference in behaviour was not marked however.

Behaviour

IP

Her production of speech has continued to deteriorate and now even stock phrases are becoming rare. Now she generally makes noises rather than jumbles words. It also appears that her understanding of speech has deteriorated. She may answer 'yes' to two contradictory questions, such as 'are you hot?' and 'are you cold?'

At meal times, she has attempted to eat off other people's plates, drink sauce, suck tea from the teapot spout, swallow unopened sachets of sugar, etc.

Her aggression seems to have stabilised rather than worsened. The social services visitors have noticed this, as well as the family. This may be due to Risperidone. However, there has been evidence, such as bruising on her arms, that Donald has at times had to restrain her. Falls have become more frequent, though her physical condition has been such that no serious injuries have resulted.

DP

Unlike pre-dementia days, he now speaks continuously. This is fairly coherent, but he has become rather fanciful in his recollections, which now include trips to the north and south poles, climbs of Mt Everest, and walks across China and through Africa.

He is competent to eat in restaurants, providing the ordering is done for him. He seems most times able to dress appropriately for the weather.

Memory

IP

It is hard to declare anything with confidence about her memory these days. It seems that she is at times liable to forget where the toilet is, despite having lived at her current address for over 20 years. She does not recognise Donald as her husband, and is probably not aware of which of the several visitors she receives are family and which are not. She secretes food and other items in peculiar places and evidently then forgets about them.

DP

He remembers very little of what he is told. He now telephones repeatedly to ask the same questions, including 'why am I calling you?' He frequently loses his house keys. They are being replaced about every two weeks. Spare keys that have been chained to the door frames to ensure they are always present are being removed, along with their chains, and lost. He denies doing this. Irene is probably not competent to do it, but he indicates that she must be the one to blame.

Competence

IP

Her ability to identify objects and what to do with them is fast waning. She occasionally has trouble holding and using eating utensils appropriately – she will eat off her knife and try to cut with a spoon or fork. Prompting her by example has little to no effect.

She will eat if brought to the table but has lost the concept of dinner before dessert and will happily combine the two on her plate to be eaten together. Her appetite is still quite healthy when she is given food she likes.

She has no idea what to give the cats. They were once fed dish-washing detergent.

In the last month she has become incontinent at night (urinary), and this is exacerbated by what appears to be inability to find the toilet. There is also some evidence of occasional lack of control over bowel movements.

Her personal hygiene is practically non-existent as she refuses to shower or bathe even when given much encouragement by family members, e.g. a bubble bath is run for her.

She occasionally has trouble getting dressed appropriately - either forgetting underwear or wearing two blouses or cardigans.

She was found wandering on one occasion, but this was as a result of being cajoled out for a walk with Donald, which then ended up in them getting split up (following an argument, apparently).

DP

Earlier this year he could walk to the Mall (over a kilometre away) to buy milk, bread, apples, biscuits, etc. He no longer does this, and appears to no longer want to do it – since his requests for cash have almost stopped. However, he still frequently walks around the block, sometimes even further.

He is having difficulty now in recognising food left in the fridge for them, e.g. fruit or a prepared sandwich. If for some reason he and Irene are not provided with an evening meal, after some anxiety and effort he will put bread or biscuits on the table and make tea.

Though he claims to be 'managing all right' he is unaware that cooking, cleaning, laundry, gardening, medication, paying of bills, and shopping are all being done by others for him and Irene.

He dresses himself, claims to have a shower every Tuesday (the evening before attending day care), and is continent.