October 5, 2011

Alzheimer’s Disease and Decision Making

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Paul King, MD

Parkwood Behavioral Health System, Olive Branch, Mississippi


New diagnostic criteria view Alzheimer’s disease (AD) as part of a continuum. Progression moves from a preclinical stage to mild cognitive impairment (MCI) to dementia. Biomarkers may prove valuable in early evaluation, as well as tests of degree of memory impairment along this spectrum. The ability to assess the stage of neurocognitive degeneration is coming soon. The questions we need to ask ourselves concern how we may help or advise families when someone is diagnosed with AD.

Is continuing to work a wise decision or not? Pat Summitt, the women’s basketball head coach with the most NCAA career wins, will continue her job despite a recent early-onset AD diagnosis. What happens if the coaching staff truly believes that Summitt is making poor decisions? Singer Glen Campbell, who was also recently diagnosed with AD, will continue to tour, at least this year. What if AD is diagnosed during the term of office of a sitting American president? Did President Reagan have MCI or a preclinical condition during his presidency? He left office in 1989 and was diagnosed with AD in 1994.

Those of us in active practice may be asked by the family of a person diagnosed with AD about transferring his or her decision-making power to others. For example, if the patient happens to be a corporate CEO or a business owner, his or her decisions are critical to its success. The business could be losing money because of the executive’s bad decisions due to dementia.

We may be asked not only about business decisions but also about family decisions. Recently, Pat Robertson, founder of the Christian Broadcasting Network, stated on his television show that he would not “put a guilt trip on someone divorcing a spouse with Alzheimer’s disease.” He referred to AD as a form of death. This commentary brought reaction from the Alzheimer’s Association as well as from physicians and religious leaders. Certainly, mainstream America views staying together despite AD with pride and compassion, as evidenced by the actions of Mrs. Reagan with the former President and retired Supreme Court Justice Sandra Day O’Connor with her husband.

The issues that face spouses or adult children as their loved one with AD deteriorates, which have been portrayed in films such as The Savages and Away From Her, have no easy answers. What role does a physician play in helping patients and families with these issues?

Financial disclosure:Dr King had no relevant personal financial relationships to report.​

Category: Alzheimer's Disease , Dementia
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3 thoughts on “Alzheimer’s Disease and Decision Making

  1. Among the many huge challenges that Alzheimer’s and Related Diseases present is that decisions must be made ahead of time, when the patient still possesses decision-making capacity. The problem is that few patients in early dementia are asked in a way that they are able to respond, what preferences they have for end-of-life treatment. Some patients are worried about their own suffering; others, how much and long they will be a burden to others; many, about how they will be remembered. It’s not easy to have a broad conversation that covers all these issues. That’s why my colleagues and I developed a set of “My Way Cards.” The 48 card/items are illustrated, use almost no medical jargon, and are written at a third grade level of reading. More information is available from a free e-book that can be downloaded from and we at Caring Advocates welcome your comments.
  2. I am a retired pastor of a large Christian street mission for over 25 years. Through those years hundred and hundreds of folks have come looking for help. Most were abandioned by their families some of whom had just given up. They came from all walks of life seeking help. I have been a follower of Rev. Pat Robertson’s ministry since it began. Over the last few years, I have been trouble by some of his “Christian” advice he has given. His comments regarding the abandoment by divorcing one’s mate due to Alzheimer’s is especially troubling. to me coming from one who professes to be a Christian and believes in the Bible. Due to his remarks and others that done line up with what he has preached over many years would indicate to me that it is time for him to past the ministry to others. Today their are many programs to help both the patient and the caregiver. You see I too have Alzheimer’s and and I am in the early stages of it’s development. Over time I have seen some losses of memory, and spelling. I am happly married as is my spouse. We both go to different programs that help us cope with this terrible disease. As a result Rev. Robertson’s remarks are total wrong. My spouse is my caregiver and we have completed all the thing we had do while I was still in the very early stage of if Alhzeimer’s. Our affairs are in order legally and we welcome each day as a new opportunity to serve each other and the Lord. Thanks for the read.
  3. As a physician i have had to deal with patients with Alzheimer’s and it has always been wonderful to see families support their loved ones with this condition. It certainly makes a lot of difference and the patients fare much better with this support from friends and family.
    An incapacitated family member deserves support and not abandonment. Therein lies the true test of love that we all profess as Christians.

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