by Trish Mathis
My grandmother is 94 years old and in an assisted-living facility in a small New Hampshire town. I drive up to see her as often as I can. On my most recent visit, she told me her good friend Peggy just died. I was speechless with shock.
I had seen Peggy only a few weeks earlier on a previous visit with my grandmother. I noticed then that Peggy had become forgetful, repeatedly asking her bridge mates what game she was playing, writing down her meal choices on sticky notes so she could keep track, having a staff member come get her for scheduled outings, and so forth. Although she had been a full decade younger than my grandmother, I nonetheless assumed that because she was an older adult that some cognitive issues were to be expected.
And that was exactly the problem—all the facility staff, nurses, and other medical professionals seemed to make the same assumption. There is a critical difference among everyday memory problems, cognitive impairment from underlying medical factors, and cognitive decline indicative of dementia. Early—and correct—diagnosis of the latter is key to successful treatment that maintains independence and preserves quality of life. Yet misdiagnoses are all too common in gerontological health care for a variety of reasons, including not only personal biases but also differences in the assessment methods used and pathological criteria applied. This is a prominent theme throughout the newly published APA Handbook of Dementia. Indeed, the authors of Chapter 2 on epidemiology note, “the diagnosis of dementia is currently based on a clinical evaluation for which there is no gold standard” (p. 15), and the authors of Chapter 13 on Alzheimer’s disease state that evaluative “criteria are susceptible to diagnostic errors” (p. 265). Authors in Volume 1 of the APA Handbook of Clinical Psychology touch on similar points, stating some providers “fail to adequately diagnose and treat health problems in older adults because they are attributed to ‘old age’” (p. 166), while authors in Volume 4 point out that “diagnosis tends to lag symptom onset by 2–3 years in many cases” (p. 255).
It turns out Peggy had a slowly leaking vessel in her brain. Blood was accumulating in places it didn’t belong and compressing nearby structures, which in turn caused the apparent cognitive decline we all witnessed. If someone had made the effort to look past assumptions for another cause, Peggy likely would still be alive today and winning at bridge. I think about her often and realize that we owe it to our loved ones to never overlook any possibilities, now or in the future.
Norcross, J. C., VandenBos, G. R., & Freedheim, D. K. (Eds.). (2016). APA handbook of clinical psychology: Vol. 1. Roots and branches. Washington, DC: American Psychological Association.
Norcross, J. C., VandenBos, G. R., & Freedheim, D. K. (Eds.). (2016). APA handbook of clinical psychology: Vol. 4. Psychopathology and health. Washington, DC: American Psychological Association.
Smith, G. E. (Ed.). (2018). APA handbook of dementia. Washington, DC: American Psychological Association.