Friday, June 20, 2014
Care Manager Reverses Alzheimer's Diagnosis Decision
My client, we'll call him Walter, sat through an intensive three hour interview with his new doctor. I was impressed with how thorough the session was. After all, this was one of the reasons I referred Walter to this particular physician.
Walter, at 90, holds a PhD in Electrical Engineering. His mind is beyond active! He has worked all over the world during three different wartimes. Top secret research has been his specialty. When he moved to Arizona he brought over 400 boxes of books with him. He believes in God and the angels and extraterrestrials. He forgets all about himself while making his mission his obsessive center of focus. He doesn't care what anybody thinks of him. The clock is ticking and he needs to complete his mission before he leaves This Place.
Before I meet with new clients and their families, I ask them to sketch out some basic goals to get a head start in preparing a customized plan of care. At our initial meeting, Walter was prepared. He had typed up five pages of goals!
Most people want help preparing meals, cleaning the house or getting to church. Some need help getting out of bed in the morning... or need inspiration to face each day. Walter had five pages of goals related to complex and continuing research with his ultimate goal: To find a way to save human civilization. He had already met with the nearby Hopi Elders to learn their thoughts about how they have survived since the Dawn of Time.
Sounds far out, yes. Walter was far out. But he was clear as a bell. He was brilliant beyond brilliant. Some people are so intelligent that they just don't handle the mundane things very well.
When the doctor created Walter's initial file, the diagnosis of COPD was first and "Dementia: Probable Alzheimer's Type" was secondary. I was floored. Granted, the interview was all over the place because Walter was trying to teach the good doctor about what was important in his Great Scheme of Things. I could see where the doctor was coming from. The doctor remained firm in his opinion that Walter was fighting severe dementia.
This is where a Geriatric Care Manager can come in very handy as an advocate. I took Walter back home that day and, with his eager cooperation, we completed a Mini Mental Assessment to determine the level of his "dementia". The tool assessed him in 30 different areas of cognition. His final score on the test: 29 out of 30. Early in the process I asked him to remember three things -- Pencil, Shoe, Watch. At the end of the test, when I asked him to recall the three, he missed the shoe. That was the one and only point Walter missed.
On our next appointment we presented the doctor with the test results and he agreed that it was appropriate to remove the dementia diagnosis from Walter's chart.
Click here for the Folstein 30 question MMSE assessment. This 10 question format, a much simpler assessment, is available for people who have higher degrees of dementia.
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