Any reader who has followed the posts on this Blog over the last few days would see that M’s presentation is changing.  There are more frequent periods of confusion and ‘acting out of character’.  It is all guesswork but it is important to ponder over the causes of the changes: we have seen the effect.  Buddhism is close to my heart and I am much persuaded by the logic of dependent arising.

Lets take the starting point for M’s diagnosis of dementia: stroke.   We know that she has suffered brain damage resulting in changes to her functional capacity and mental processes.  Dementia as we know is a progressive condition.  I would contend that this is fundamentally different to mental illness which is a response to environment: particularly in the case of mild to moderate depression (Kirsch, Kinderman).  Therefore  the changes that have emerged in M’s presentation in the last few days must have a cause.  I want to explore changes in her environment that may have had such a drastic effect.

Firstly, we have had a very hot spell: the weather has been much warmer than usual.  Heat can lead to exhaustion exacerbating changes in mood and presentation.  Secondly, several new faces have been in our house that have thrown M as she is aware that they are from the past but she can’t really work out where they fit into her life.  Thirdly, she has been ‘packing for home’ on most evenings and has expressed genuine disappointment when she finds herself here the next morning.  Fourthly, she has a vague idea that her birthday is coming up but cannot work out when it actually is.  Fifthly, she had a telephone conversation with her son yesterday, that became like a memory test rather than a supportive interchange.

I would contend that all five environmental changes have led to M’s presentation taking a downward spiral.  More sleep than ever has led to additional confusion when she wakes up and always thinks it is morning and time for breakfast.   My concern now is that viewed through the eyes of Mental Health staff  her mood will be the focus. They may well ignore environmental changes and see medication as the panacea. In my view that would lead us down a very risky path, rather than help us back on the road to a life with dementia.  ‘It is the environment stupid’; comes to mind.  Why on earth place dementia under the umbrella of Mental Health?  That decision does seem plain stupid.

References:

Kirsch, I: The Emperor’s New Drugs – Exploding the Antidepressant Myth (2009)

Kinderman, P: The New Laws of Psycholgy  (2014)