Thursday, 30 October 2008

Insight

Over the last few months I've had a rather significant number of folk who've had insight but haven't wanted it.

Several people with dementia have been on treatment for this which has maintained their thinking, memory, concentration and function for a goodly length of time.

As time's marched on, their deficits have progressed. They know they're losing their memory. They know they're losing their attention span. They know they're losing their orientation. They know they're losing their organisational skills. They know their decisions are less considered. They know their function is deteriorating (e.g. no longer being able to dress themselves since they can't manage shirt/blouse buttons). They know they're losing weight since they don't appreciate feelings of hunger/satiety so much now. They know their mood's got worse, being pretty glum and anxious. They know they can't recognise friends they see less frequently now.

Their dementia is progressing. They know.

This insight causes feelings of disquiet, of anxiety, of frustration, of dismay.

This has resulted in a slew of folk wishing to stop their medication, since it was holding them in an unhelpful place, where they had memory problems yet had insight and couldn't forget the woe. The burden was unpleasant. They sought to be relieved of that, to be allowed to forget.

To a one, they've all faired better from stopping their medication. Of course, their cognition and Mini Mental State Examination scores are significantly worse, but they're all, all much more relaxed and less distraught. The knowing is less.

Just sometimes, the loss of memory can be a blessing.

4 comments:

Northern Doctor said...

Fascinating - it is utterly refreshing to hear tales of how the drugs don't work and how they don't have all the answers without lapsing into an attack on conventional medicine.

The increasing media obsession with magic bullets can be so detrimental and this is a beautifully elegant example of the wider options for people.

Pem said...

Ouch! Any of them have Lewy Body Dementia? I've heard never stop the Aricept because the resulting slide is so steep and dramatic.

I will really miss just this kind of blog post, though I am afraid I am the kind of reader who worries you. http://livingwithlewybody.blogspot.com/

Lola Snow said...

My Grandmother & Grandfather had just celebrated their 50th wedding anniversary when he died, one of those "young love lasts forever" couples. She was never the same afterwards. A few years later she was diagnosed with Alzheimer's, and then a little later with terminal cancer. As things progressed she steadily got more and more confused, some days she would still think he was alive and ask for him, or she was sketchy on the details of her cancer, or had forgotten the Alzeheimers. She had to be reminded that he was gone and about her cancer over and over again, but I believe there were days when she was blissfully unaware of his death or of her future. She was just waiting for him to come home to her.

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