Maria Brown: Witnessing Memory Loss BACK

Published by AFAR

Twenty-first birthday, wedding day, the birth of one’s first-born child, these are moments we all hope we will never forget. Unfortunately and sadly, some do.

I arrived in Baltimore for the MSTAR program not knowing exactly what to expect. I had previously been exposed to geriatrics, though only in a small way. I came with most of my clinical experience in pediatrics and family practice, but still very open to expanding my interests to geriatrics and care of the older population. My first clinical experience was today, working with a doctor in the memory clinic. The day’s events were not what I was expecting. I was able to see multiple patients each along the spectrum of memory loss. The first patient was a younger woman in her mid 40’s; she came with her mother, whom she believed was beginning to show signs of dementia and was afraid she herself was suffering from early-onset Alzheimer’s disease. Fortunately, the daughter’s memory troubles were most likely associated with her use of dicyclomine, an antimuscarinic prescription drug used to treat her irritable bowel syndrome. One of the side effects of the drug is short-term memory loss and her symptoms were not typical for dementia. She was clearly relieved. Her mother, however, was displaying classical early symptoms of dementia, which the doctor believed to be caused by Alzheimer’s disease. She was in her late 60’s and presented with certain memory lapses: she was forgetting conversations with her daughter, she forgot to pay bills, and she had to set reminders for all of her prescription drugs or she would forget she had medicine to take. The mother was oblivious to the fact that she had a problem with her memory. Today she began a new chapter in life, coming to grips with the reality of her condition.

The last patient, an older man in his late 70’s, came in with his wife, who was also responsible for the care of her mother who was suffering from Alzheimer’s disease. When given the Mini-Mental State Examination to screen for dementia, he failed to correctly answer many questions testing his arithmetic, memory and orientation. When asked to draw a clock, he could not correctly place the numbers on the face of the clock or draw the minute and hour hands correctly. He was very frustrated and apologetic, stating that he knew he was drawing it incorrectly but did not know the correct way to do it. His wife then told the doctor that her husband had been doing their taxes for the past nine years, however this previous tax season he could not prepare the taxes, and did not even remember doing them in the past. He then told us with frustration and tears in his eyes, “I don’t remember, I just don’t remember. She says I’ve done them before. I didn’t believe her. So she took out the tax returns from the last couple of years and showed me. I saw my handwriting, I know it was my handwriting, but I just don’t remember doing it. I just don’t remember.” The room was silent. It was in that moment that I realized geriatrics is not just taking care of “old people”. It is caring for a vulnerable population that was once you and I. They were once young and vibrant and told jokes and were, and many still are, the life of the party. They are that same amazing soul, just in an older body. The older gentleman and his wife left with a prescription that may have an impact on slowing the progression of Alzheimer’s disease. I left with a new sense of what it meant to be a geriatrician.

Maria D. Brown
The Ohio State University College of Medicine

 

"Diary of an MSTAR Student" follows scholars in the 2011 Medical Student Training in Aging Research (MSTAR) Program, highlighting their summer experiences. As they continue their path of research, training and clinical practice, read their daily thoughts at www.afar.org/mstarblog. New diary entries are posted every day, so check back soon.