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FEATURE:
10% of all dementias. N’s diagnosis was based on lack of judgement,
disinhibition and lack of ability to focus. His memory loss was se-
lective in the sense he was completely not aware of his behavior.
There was no remorse, regret or guilt.
A Geriatric Psychiatrist was highly recommended by a friend of
ours, a psychiatrist herself. He was an older physician, and was very
calm and confident. He had read N’s history from his chart. I was
allowed to stay with N during the visit. The psychiatrist took a com-
plete history and then started doing a battery of tests that included
a list of questions. One of standard components of the test was to
draw a clock and indicate the time. N was no artist, but the clock
he drew was egg-shaped and the clock hands were of equal length,
however he did indicate the time. He made several errors in short-
term memory; several objects were named and after an interval of
doing other things the doctor would ask N to recollect and name
the objects. I was struggling to remember the words myself. N made
many errors. I ached inside: N’s ability to remember was one of his
greatest assets. He remembered chemical formulas, the anatomy of
the nervous system, botanical names of plants, dates of events, bank
account numbers, the dress I wore to a party, street address of every
house we ever lived in and, of course, passwords. He was my virtual
web site. The psychiatrist explained his working diagnosis. He said
it was a little late in age for N to show symptoms of FTD, however
based on the Neuropsychiatric testing and the behavioral symptoms
FTD would be the working diagnosis. N asked him how he had
done on the test, and was told that he had failed the exit test. N was
not happy with the answer. He was placed on medication starting
at a very low dose. Since the end of January he had been advised not
to drive, and that was reinforced.
N was a voracious reader and an avid grower of fruit trees. He has
planted more than 100 fruit trees in our yard. He always mowed
our lawn and took care of his trees; He tended to his trees with as
much care as he used pointing a needle towards the stellate ganglion
for a nerve block. Pruning, grafting, vitamins and minerals, a lot of
TLC (and, I suspect, a little singing at times) made these plants blos- meditation. I promise to write all about it next time.
som. Since we returned from our trip he had not stepped into the
garden. When I suggested that he should try reading he said that a
book was going through his mind every hour and he is unable to
focus. However the tennis matches on TV kept him engaged for the
duration of the match. I tried playing a TV serial on DVD every
night which he watched with interest.
Our son and daughter came and stayed several days. February and
March were the darkest periods of my married life. For N these two
IN REAL TIME
months were an abyss into which he was slipping rapidly, and of
which he had no inkling.
In this paragraph, I am sharing the insight I have gained about
how important it is, particularly for women, to understand and to
be aware of and involved with the family’s finances. All I knew was
that my paycheck was automatically deposited to an account. I had
an intuitive internal budget that I would not exceed. The rest of our
finances were handled by N, who was meticulous and efficient.
There was only one thing I had been stubborn about; that my
money be handled by a different financial company. N often pointed
out to me how conservative this person was and that my money was
not growing. True it did not grow, but I am thankful that it is there.
It is probably the influence of my mother who would say to me and
my two sisters “Never put all your eggs in the same basket”. Very
quickly we had to work on the medical and financial powers of at-
torney, access to bank accounts and what seemed like a million
pieces of paper. Adversity is a brilliant teacher. I learned quickly to
handle finances. This financial indiscretion is a classic symptom of
FTD. Amidst all this cloud there was always a ray of hope. N in
some remote way knew that we had to do many things. He actually
helped me to organize the investment files, cooperated when I had
to get the powers of attorney. He did help me pay bills on line, and
when I could not recall passwords he asked “Who has dementia?”
I was struggling to create a routine so we could both be engaged
without stress for N, but at the same time not shutting ourselves
completely from society. We attended special lectures at the UT
Health Science Center, visited museums, attended festivals. We
avoided parties and large gatherings. N’s sleep disturbance was get-
ting worse. His talked continuously when someone visited. N, for
reasons unknown to me, was obsessed with a Filipina web site. I can-
not write explicitly about certain behavior issues yet. The purpose
of this narrative is to raise awareness. It suffices to say that “disinhi-
bition” is a hallmark of FTD. Then N’s brother came to visit and
threw a completely different perspective into the mix, the effect of
Suggested Reading:
http://memory.ucsf.edu/ftd/overview/ftd/treatment/single.
http://jpubhealth.oxfordjournals.org/content/early/2014/10/20/pub
med.fdu080.full
Rajam Ramamurthy, MD,
Professor Emeritus, Pediatrics, UTHSCSA