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By Ann G. Thomas, Rd.D.

The woman and her family were regular chiropractic patients, but the woman’s mother, here for a visit, had not been in the office before.

"Thank you for seeing us on such short notice," the woman said. "I have no idea what happened, and mom can’t remember."

The doctor turned to the elderly woman.

"Did you fall?" he asked.

"I don’t know," the woman answered.

"That’s all mom ever says if anyone asks her a question," explained her daughter. "It must have happened yesterday. That’s the only time I haven’t been with her."

The mother, who we’ll call Mrs. Brown, had been diagnosed six years ago with Alzheimer’s disease, one of several forms of dementia, which is a term used to describe a group of symptoms that affect between six and nine million Americans.

Mrs. Brown’s inability to provide either the doctor or her daughter with any information is characteristic of a dementia patient brought to a chiropractor because of a physical trauma. Whereas most patients can interact with a doctor, providing both background information and feedback, the person whose dementia has progressed beyond Stage 1 is dependent on the doctor’s diagnostic skill.

As a result, doctors must rely on observation, orthopedic and neurological tests and X-rays, along with their own intuitive knowledge and experience, in order to provide effective care for these patients.

An examination of Mrs. Brown showed pelvic unleveling, with L4 and L5 subluxations, and displacement of three ribs, along with subluxations of T7, T8 and T9 and C1 and C2. This corresponded with the pattern of bruising in the shoulder and right hip area. X-ray pictures ruled out a hairline fracture that the doctor had suspected, since fractures are one of the most common injuries among elderly women and a frequent cause of falls.

Recognizing Signs of Dementia

While Mrs. Brown was in an advanced stage of Alzheimer’s disease, a chiropractor may also see patients who are beginning to experience the first subtle signs of a dementia. Dementia is often undetected at this point, in spite of the fact that an early diagnosis sometimes allows intervention that could reverse or slow the dementia’s progression. With long-term patients, a chiropractor is in an ideal position to recognize changes that merit referral for diagnosis.

Mr. X is a good example. As a regular patient for years, he and the doctor were on good terms when he began to show up late for appointments, then he began forgetting them. Lateness and missed appointments were a radical departure from his usual behavior, and when it happened he was upset.

Then, one morning, he phoned his office to say, "I’m at the dentist’s office, and they say I don’t have an appointment. I know I’m supposed to be somewhere this morning. Do I have an appointment with you?"

He and his chiropractor were able to have a talk, during which Mr. X expressed his anxiety and concern about his growing forgetfulness. Afterward, the chiropractor referred him for evaluation.

In this case, there is, to date, a happy outcome. Mr. X’s forgetfulness was a result of a minor, undetected stroke and what appeared to be a progression of dementia symptoms was the result of anxiety. Along with this reassuring information, Mr. X was given some tools for reducing anxiety and handling the minor memory loss and, three years later, there have been no further problems.

Other early warning signs of dementia that merit a referral, besides an impairment of short-term memory, include speech and language difficulties, difficulty with abstract thinking, impaired judgment, agitation, personality changes and impaired motor skills.

Obviously, any one of these symptoms could signal something besides dementia (most chiropractic patients have impaired motor skills, for example), so the chiropractor must look for patterns, departures from how a patient has always been and symptoms not explained by, nor responding to, chiropractic care, along with individual/family feedback.

Many patients, because they feel safe with their chiropractor, will open a conversation by saying something like, "You know, the strangest thing happened ... "

Working With A Dementia Patient

Statistics tell us that as a person gets older, their likelihood of suffering from some form of dementia also increases. Nearly half of all those over age 90 have Alzheimer’s disease, which is only one form of dementia. It is only in the final stages of Alzheimer’s or another form of dementia that individuals become nursing home residents.

Since more individuals with dementia are living either in their own home or with family, it seems obvious that most chiropractic practices will include one or more dementia patients. The doctor and staff members can do several things that will make this interaction more successful. Armed with the understanding that a dementia impairs the individual’s ability to think, understand, reason and remember, the doctor knows to schedule more time with this patient, since communication is slow and the more the patient feels rushed, the more confusion and poor memory result. Verbal instructions may need to be repeated, as well, then written down, and it is important to verify that the person understands what they should do.

Routine and stability help a person in the early stages of dementia. If this is a patient who will need to come into the office frequently, it will help to establish a regular time.

Reassurance is especially important. When people develop dementia, they are no longer able to trust themselves in ways they have previously taken for granted. It is important that your decisions are ones they now can trust. Accepting that you care and are offering respect in spite of the symptoms of dementia will strengthen the bond of trust they so desperately need at this time of their life.

It is important to develop a relationship with the person’s family in order to communicate with them. This, however, places the doctor in a position of needing to keep a balance between the family and the patient. Older people, even those with dementia, are understandably resentful when they are being talked about, rather than talked to. It is important that patients are never eliminated from any decision they are still able to make and that they hear information about themselves (even if they’ll quickly forget the information).

When a patient’s dementia progresses, I still give information directly to him or her, but include the relative in the room so they also hear what I am saying and have an opportunity to ask questions.

Finally, doctors may find themselves in a position of being coordinators, so contacting the local Alzheimer’s Association, the Office on Aging and other doctors in the area who work with older patients will be of great help.

The dementia patients a doctor sees may take more time and even become a source of frustration to running an efficient and busy office. It is interesting, however, to know that as cognition and speech disappear, the emotions appear to remain and intensify.

I have seen patients in group settings dance for joy at the sound of some beautiful music or weep along with someone who was grieving, although they had no information in words about the other’s loss. Sometimes, I feel that my time with a dementia patient is a "time-out" from the rushing world and an invitation to stop a minute for a connection of the soul. That connection is their gift to the doctor.

About the author: Ann G. Thomas, Ed.D., is a psychotherapist in private practice in California. An internationally noted lecturer, workshop leader and educator in the areas of mental health and aging, she is the author of numerous magazine articles and the recent book, The Women We Become, which describes the psychological considerations of aging. She is currently working on a book on grandparenting. Inquiries may be addressed to her at 724 Danville Blvd, Danville, CA 94526; call (925) 820-7921; or E-mail athomas724@mac.com.