Joyce's KP Adventure mikepasini.com headlines
At the Memory Clinic
12 December 2024
I met Joyce at the Memory Clinic this afternoon. She arrived a minute before David the Ombudsman popped out of the elevator. He and I discussed my concerns about transport billing before he copied some invoices and went to work on it.
Joyce was half an hour early for her appointment so she was starting to wonder what was going on. She had called me earlier in the day to tell me she was dressed and waiting for the transport to take her to the appointment so I knew she hadn't tried to cancel it.
I suspect she only canceled it yesterday because she got an email reminder on her phone and knew she couldn't get herself there. But she also didn't know what the appointment was for.
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SO THERE we were when Dr. Gayatri Khanna introduced herself to us and invited us into Exam Room 2.
She began by going over the questionnaire the clinic asks you to fill out before your first appointment. Which turned out to be very helpful in that it listed our concerns on the last page so they would be addressed even if we lost track of them.
She interviewed Joyce for a few minutes to get to know her and her history a bit before she asked me to leave the room so she could administer another MoCA cognition test. Here's the test.
Joyce's primary has given this to her, the occupational therapist who came to the house a few times also gave it to her and Cassie gave it to her two weeks ago. Dr. Khanna had Cassie's score.
The maximum score is 30 points. Above 25 is normal cognition, from 18-25 is mild cognitive impairment, 10-17 is moderate cognitive impairment and under 10 is severe cognitive impairment.
Cassie had scored Joyce at 14. Dr. Khanna had her at 17.
The diagnosis is dementia as a major neurocognitive disorder in the moderate stage. Given her other factors (family history, lack of drug use, brain scans, etc.), Dr. Khanna added, "We believe the most likely underlying cause for these symptoms is Alzheimer's."
She recommended that Joyce start on a low dose of Donepezil for one month. Unfortunately a side effect is decreased appetite. If that happens (since Joyce isn't eating enough now), she'll try Memantine instead.
I asked if Joyce's eight surgeries with anesthesia might have been a factor. She acknowledged that anesthesia is an issue in people over 64, particularly in long surgeries like heart bypass operations. She looked up Joyce's history and didn't think it was a cause.
The best things she can do for herself, though, are eat well (which she hasn't), exercise (another no), keep active socially (no), maintain blood pressure (OK), avoid alcohol (OK) and sleep eight hours a night (maybe).
It's also important to use your brain, Dr. Khanna said. Puzzles, drawing, amusing TV shows. Use it or lose it, she said.
She recommended Joyce talk to Blake the Psychologist at the nursing home to discusss her anxiety about standing up and walking.
She gave us a folder of information to read through and promised a video conference next month to check on Joyce's progress.
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RICK THE TRANSPORT DRIVER came to pick her up and offered me a ride home as the rain fell. He went to Mission High and knew the route home I recommended. "Just take Seventh Avenue," was all I had to say and he knew how to cut through the city.
He got Joyce back to Golden Heights after dropping me off. I texted her and she confirmed she got back fine. So it all went well.
But there are some days you'd just as soon forget.