Saturday, September 17, 2016

Alzheimer's Dementia and Verbal Fluency

Just an update.
There is a new study out that reinforces my observations that dementia, Alzheimer's Dementia in particular, involves more than just memory loss. In this study, researchers found that speech problems are early markers of AD. These problems worsen with progression of the disease and are labeled as Primary Progressive Aphasia (PPA), "aphasia" being a medical term for the loss of verbal expression.

Word Finding or Word Searching means the inability to immediately speak the correct word. We say "it's on the tip of my tongue" and while it happens to all of us at times, it is more common in people with neurological disorders like AD. Other verbal signs of PPA include a decrease in fluency and gramaticality, repetition, and difficulty naming things.

If someone you love starts developing these symptoms, try to get professional help. It is difficult because the person with early Alzheimer's will be the last one to recognize and acknowledge the problem. In fact, you may find yourself in a defensive position which, believe me, is not fun. The rest of this post is from an earlier one on the same subject.

I am in the age group where many of my friends are now dealing with aging parents. Many of the latter have some form of dementia which complicates not only their health issues but also our ability to help and support them. “Dementia” does not only refer to memory loss. It also includes defects in reasoning, decision making, judgment, and language. Keep all of those factors in mind since there is an interplay between them and the affected person’s own personality.
One difficulty we face is that our parents often refuse to acknowledge that they have a problem. They can be very good at covering-up memory lapses such as joking about them (“if my head wasn't screwed on I swear I’d forget where I put it”) or even denying they have a problem. Sometimes the problem can be evident to us and sometimes they’re good at covering up. This is where I want to take you in this series of blogs: how can you identify dementia using the other symptoms? What does early, untreated dementia mean to you and your relationship with your parent? And what can we do about it?
Dementia is not a disease per se but rather a set of symptoms that cause difficulties in any or all of the following mental capabilities:                                  
1.       Memory
2.       Reasoning
3.       Judgment
4.       Decision Making
5.       Language (not only expressive but importantly, receptive)
Developing these five areas is what growing up is all about. Becoming proficient in them is what being an adult is all about. We gain better judgment because of what we remember that works and does not work. Because of that judgment, based on our experiences, we become better at reasoning and decision making, and “decision making” is the active result of reasoning whether it is in what we say or what we do. In this first part of the series, I want to focus on language or what we say (“expressive”) and what we understand others say to us (“receptive”).
Perhaps a better word than language is communication because only a percentage of what we communicate is auditory while a large part is body language, voice pitch and rate, and facial expression.  For a more detailed explanation, check into Neuro-Linguistic Programming (see “Recommended Reading” at the bottom of this page). In a nutshell, what a person hears is not necessarily what we believe we speak. Older people automatically have a disadvantage since the sense of hearing naturally worsens as we get older. Secondly, people with dementia have poorer memories so what they REMEMBER hearing is often not what was said. Thirdly, there becomes a disconnect between the communication received and that person’s reasoning, judgment, and decision making.  As a result, how they respond (say or do) can be totally unexpected based on what we spoke to them.
Some people naturally have difficulties with this processing and it becomes worse with dementia. We have to be careful: is the unexpected result because of that personality defect, the dementia, or the dementia making the defect worse? One true example: I have a friend whose mother is naturally stubborn about going to seek medical attention. As she gets older, she also needs more help but refuses to believe she has any problems that warrant going to her physician. She also has early dementia and has become lost several times. Still refuses help. When he phoned me last he was actually in town from California and the stress in his voice was undeniable. After helping arrange his mother’s affairs he suggested that he take her to get medical help the next day. She understood this to mean that he considered her weak and unable to take care of herself. She blew up at him and kicked him out of the house.
I think about scenarios like this a lot. Does anyone have any suggestions on how to handle mom or dad in a situation like this? My own advice is if there is more than one sibling involved, that they all stick together and not encourage or enable the demented parent to act on irrational judgments, reasoning, and decision making. Gently correct, be supportive of reasonable actions and words, and try not to blame each other or the parent for bubbles in the road.

Early stage dementia is the best time for medicinal and nutritional intervention. Get the parent’s doc involved. Consider gingkobiloba, Omega-3’s, and Vitamin E, all of which have been shown to help dementia but not necessarily prevent it. Mind exercises are good, too as is exercise and sleep. Consider getting help with anxiety and depression which often accompany aging and dementia itself. 
Click here for more information about dementia: Dementia Pictures Slideshow.

Wednesday, September 14, 2016


How can we stay sane in a sociopathic society? How do we create a sane, empowering society when we ourselves have disordered personalities? I try to answer these questions in my newest book Mythomania: A Psychodrama. Think of it as a Prequel to My Worst Thanksgiving Ever since I describe the forces that conspired against me to destroy my clinic, finances, reputation, and eventually my marriage. Are you curious about how Angie ever got to the point where she thought that convincing the U.S. embassy in Nicaragua to abduct Ben away from me was a good idea? Worse yet, that she truly believed what she did was the only right thing to do?

I use Dr. M. Scott Peck's classic People of the Lie as a framework for my book. 30 years ago he tried to marry psychiatry with religion in an attempt to heal not only broken lives but also a broken society. In essence, what happened to me before the events of that Thanksgiving weekend was my own personal My Lai.

While there is precious little hope for People of the Lie, I do believe that we can take measures at all levels towards healing ourselves and our country. At the end of the book I offer a "Treatment Plan" with several suggestions that I feel are necessary for this process to be successful. Once again, enjoy and learn!