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“Bob has seemed more confused recently,” his wife, Sandra, my 77-year-old psychotherapy client, tells me. “There are days he can’t seem to remember anything.”
She had expressed similar worries several times in recent months, and we had speculated what his forgetfulness might mean. Today I ask her gently, “Have you given any more thought to having his thinking skills tested?”
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She frowns slightly and says, “I know I should, but it would crush him if he were diagnosed with Alzheimer’s dementia.”
It would hurt them both, I am sure. She is afraid the diagnosis would make him give up on himself. Even the thought of asking him to undergo a neurological or neuropsychological evaluation triggers her guilty feelings. Her instinct is to protect Bob, not confront him. She knows she is protecting herself, too, from what would be devastating news and an upturning of their lives. Yet she still worries.
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Spouses and adult children have always struggled to know what to do in these situations. Should they seek an assessment and hope that their concerns about a relative’s memory lapses are groundless or that the lapses are due to some correctable cause — for instance, a medication interaction or hormone imbalance? The risk, of course, is receiving the hard blow of a dementia diagnosis. Or should they avoid noticing increasingly frequent “senior moments”? That would risk ignoring a brewing family crisis.
In my experience, family members, such as Sandra, most often choose avoidance, at least early on, saying, “Why should I make my relative get diagnostic testing for a condition for which there are no good treatments?” But since 2021, two new drugs, Aduhelm and Leqembi, have become available to potentially slow the progression of mild to moderate Alzheimer’s dementia. Though evidence suggests they are only modestly helpful — and studies assessing their effectiveness are ongoing — the drugs herald a dawning age of more effective treatments for the disease when it is addressed in its early stages. Putting off diagnostic testing — thereby delaying the start of treatment — could reduce their ultimate benefit.
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