Alzheimer's and Dementia

2+2=4. . . So What?

Have you ever had the experience of hearing a brilliant speaker share a truth with you that wrings your gut? The kind of feeling you get when you find out that the car you bought has the worst service record in automobile history, or the company whose stock you bought will be declaring bankruptcy? You double up inside, like you just got punched in the gut. It’s a sick kind of “AH HA! moment.” Well, this is what happened to me while listening to University of Pennsylvania neurologist Dr. Jason Karlawish speak to a group of lawyers about clients who may have Alzheimer’s disease or some other type of dementia. During the last eight years as an attorney I have specialized in long-term illness.  Every day I learn more about the subtleties and surprises within the elder care journey. At Law Elder Law we often work with families who have a loved one affected by some type of dementia. As we non-medical people observe folks with memory loss, we assume that the individual is losing his or her memory on a constant downward sliding path.  According to Karlawish, however, that is not the right way to think about memory loss. Dr. Karlawish taught us that we need to change the way we look at memory loss.  He helped us understand that different brain functions are affected with differing rates of decline. “Attorneys are linear thinkers. You are trained to think in a linear and logical fashion, and so you believe that if your clients can give the correct answer to a fact based question, then they are still capable.  You assume that if they know that 2+2=4, then they are capable of managing their affairs.” He shook his head and stated, “Nothing could be further from the truth.” It turns out, someone who is suffering from dementia can retain their linear thinking, but lose their ability to comprehend the consequences of what that answer means. As I listened to him speak, it hit me that this was exactly what was happening with one of my clients. This client was responsibly caring for his wife, but the family was continually calling to tell me that “Bill” was making foolish decisions with money, and it was running out at a frightening rate. But when Bill came into my office, nothing seemed to be wrong; he drove himself, he brought his accounting books and we would go over his records together. He seemed capable of handling all his affairs because he gave me all the right answers. Nonetheless, within the next day or two he would do something as bizarre as hiring an $800 ambulance service to get his wife to her weekly hair appointment. Suddenly I realized that although Bill was able to tell me how much was in his bank account, he could no longer understand the meaning of those numbers. If someone you know seems to be on that slippery slope of memory loss, but you keep reassuring yourself that they’re okay because they understand that 2+2=4, it’s time to consider that they may not know what the implications of that solution means. If you are perplexed about a family member’s actions, it may be time for a visit to a neurologist.