I tried to speak to some patients with dementia today. Their level of cognitive decline was vast and they were scoring 1/30 on their mini mental state examination (MMSE).
This was the first time I had carried out an MMSE and it was difficult. I felt like the patients didn’t understand what I was saying. It’s quite sad when you think about it as that is someone’s relative who was fully functional with a personality some time ago, but now they seem like an empty shell, as harsh as that might sound to some.
I find myself being quite impatient with the patients who have dementia. I feel like as doctors, we rely on communication quite a lot when we talk to the patients and take a history. However, with demented patients we can’t. We need to speak to their relatives (take a collateral history) and speak to the staff such as nurses and occupational therapists who will have observed their behaviour and can comment on how they have been.
I have learnt a few skills though for trying to get a response out of the patients. I feel you need to be very brief and direct in your questioning. Sometimes you need to go up really close to them and hold their hand. I feel that you can connect more in that way and I have observed the staff act in that manner too so I learnt from them.
I don’t think old-age psychiatry would be for me personally. Dementia is a sad illness as it is not reversible. It will just gradually get worse and people will lose their relatives but will still have them around while not being able to really connect with them. There is no treatment for it but all you can do is try to look after them in the best way possible and manage their distress/troubling behaviour as much as you can. The medications you provide won’t treat the dementia itself but it can provide some symptomatic relief like when giving antipsychotics to treat the hallucinations, giving benzodiazepines to treat the agitation or even antidepressants to treat the mood element. Then there is the whole social side of things such as self-care/hygiene, accommodation, legal issues such as power of attorney, etc.