Individual Therapy for Patients with Dementia.

Many patients who are diagnosed with dementia often need to process the diagnosis, the stages of the dementia and how it will effect their day-to-day functioning.  When the diagnosis is made for patients who are young and still working the diagnosis affects their self-esteem, their role as a provider and/or parent, and how they interact with their co-workers, friends, and family.

Patients often know that something is wrong cognitively with the loss of short-term memory, impaired concentration, and problems with orientation.  One of the individuals that I interviewed for my dissertation reported that he drove from Los Angeles to San Diego, took the wrong freeway and it took him five hours to get home.  He made this drive every week.

Robert was diagnosed at the age of 48 with frontal-temporal lobe dementia.  He was the Captain for the LAFD, one of the busiest firehouses in Los Angeles.  He started questioning his judgment in decisions that involved the safety of his firefighters.  His son Bill was at the same firehouse.  Bill and Robert met with me shortly after his diagnosis.  He knew that his insight and judgment were becoming impaired.  Should he tell his Chief? Should he resign his position?  We processed not only these decisions, but also how he was coping with the diagnosis and the daily losses that he experienced.  He experienced ongoing depression and anxiety.  We discussed these losses, coping strategies that would help him on the job and at home.  He would discuss major decisions at a fire with his son.  As the dementia progressed he retired as a Captain for LAFD.  

Many patients in the early stages of the disease are able to use some compensatory behaviors to try to mask their symptoms. S/he may become less involved socially, may not join in conversations because of the inability to track the conversation or interjecting comments that do not fit with the subject being discussed.  Robert reported being embarrassed around friends and even his grandchildren.  Upon his request I met with his son, daughter-in-law and four of his grandchildren.  We used Maria Shriver’s book What’s Happening to Grandpa?  as a guide to educate them about Robert’s dementia.

I continued to meet with Robert on a weekly basis until his word finding problems made it too difficult for him to engage in individual therapy.