Chapter 11. Fred’s Case: Tragic Misdiagnosis
11.1 Screen 1
Strange, false beliefs that a person firmly holds despite evidence to the contrary.
1. Individual displays substantial decline in at least one of the following areas of cognitive function:
• memory and learning
• attention
• perceptual-motor skills
• planning and decision-making
• language ability
• social awareness.
2. Cognitive deficits interfere with the individual’s everyday independence.
(Information from: APA, 2013)
1. Individual displays the features of major or mild neurocognitive disorder.
2. Memory impairment is a prominent feature.
3. Genetic indications or family history of Alzheimer disease underscore diagnosis, but are not essential to diagnosis.
4. Symptoms are not due to other types of disorders or medical problems.
(Information from: APA, 2013)
1. Over the course of hours or a few days, individual experiences fast-moving and fluctuating disturbances in attention and orientation to the environment.
2. Individual also displays a significant cognitive disturbance cognitive domain.
(Information from: APA, 2013)
What happened to Fred?
Fred
- Seems confused
- Bad stomach pain
Family
- Wife says he’s generally healthy
- He’s worked part time since age 65
- Severe stomach pain after lunch → supervisor took him to hospital
- Niece reports Fred waited hours to be seen
- Initial diagnosis urinary tract infection (UTI)
- Put on IV, given painkillers, Valium
- Became disoriented and angry
When did the family get to Fred?
Fred
- Alone and scared, hard to sleep
- Hospital staff gave him a lot of medication
Family
- Couldn’t get to Fred until next morning
- Niece not satisfied with answers from hospital staff
- Fred went into surgery the next morning
Why did Fred have surgery?
Fred
- Difficult remembering or expressing himself
- Prostate
Family
- Enlarged prostate → Urinary tract infection (UTI)
- Surgery to open up urethra
- More meds → more distress
- Didn’t recognize niece
Why does Fred have a guardian?
Fred
- Doesn’t know or understand
- Seems confused
Family
- Hospital social worker – thought Fred had some sort of disorder
• Niece told her he lives with his wife with no one to help them as he recovers
• Social worker saw Fred was confused and worried he couldn’t care for himself
• Referred to psychiatrist
What did the psychiatrist evaluation find?
Family
- Psychiatrist made niece leave room
- Did mental status exam → took only 5 mins
• Fred had a hard time answering
• Psychiatrist didn’t review chart → missed that Fred had fever
• Diagnosed as neurocognitive disorder, possibly Alzheimer’s
- Social worker referred Fred’s case to judge → went to court → guardian appointed
What happened next?
Fred
- Happened so fast
- Seems confused
- Happy to see Angie
Family
- County social worker talked Angie into coming
- Guardian chose nursing home without consulting them
- Angie worried the nursing home is too expensive
- Fred still had infection → back to hospital, more meds
- Niece worried they aren’t going home soon
1. For a 2-week period, person displays an increase in depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day.
2. For the same 2 weeks, person also experiences at least 3 or 4 of the following symptoms:
• Considerable weight change or appetite change
• Daily insomnia or hypersomnia
• Daily agitation or decrease in motor activity
• Daily fatigue or lethargy
• Daily feelings of worthlessness or excessive guilt
• Daily reduction in concentration or decisiveness
• Repeated focus on death or suicide, a suicide plan, or a suicide attempt.
3. Significant distress or impairment.
(Information from: APA, 2013)
The cognitive model proposes that we can best understand abnormal functioning by looking at cognitive (thinking) processes. The cognitive perspective holds that abnormal functioning results from the person’s maladaptive, irrational and inaccurate thoughts about and interpretation of a situation. Cognitive theorists and therapists believe that by substituting more realistic, rational thoughts for these irrational ones, clients can change their outlook on life and thus improve their symptoms.
The biological model adopts a medical disease perspective on psychological disorders. The main focus of this model is that psychological abnormality is an illness brought about by malfunctioning parts of the organism. Typically, the biological model focuses on genetic predispositions for disorders and abnormalities in brain anatomy or chemistry. To treat psychological disorders, the biological perspective argues that abnormalities in the brain must be addressed through medication or other treatments that act on brain chemistry or circuits.
The behavioral model argues that our actions are determined largely by our experiences in life. Behavioral theorists focus on principles of learning, in particular how abnormal behavior might be learned by observing others or reinforced by contingencies in our lives such as avoiding discomfort. Behavioral theorists and therapists are more interested in observable behaviors and environmental factors than the inner workings of the mind. To treat psychological disorders, the biological perspective argues that abnormalities in the brain must be addressed through medication or other treatments that act on brain chemistry or circuits.
The humanistic model believes in the inherent worth of every individual and that all people have the capacity to strive towards bettering themselves. Those who endorse the humanistic perspective argue that psychological disorders occur when people encounter “conditions of worth” in their lives – unrealistic expectations that others create as conditions that must be met in order to gain love and respect. To counteract this problem, humanistic or client-centered theorists and therapists focus on creating a supportive, genuine environment in which the therapist offers unconditional positive regard – support no matter what the client does.
A conversational treatment used by psychodynamic therapists that includes techniques such as free association, or letting the client talk about whatever comes to mind, and therapist interpretation, which involves giving insight and offering an opinion on patterns noticed in the client’s free association and other things such as dreams. A psychoanalyst would treat Fred by seeing him 3-5 times per week for several years. Psychoanalysis is costly and it requires a large time commitment.
Interpersonal therapy focuses on problems in significant relationships in the patient’s life. Interpersonal therapists treat patients by focusing on their current relationships with the most important people in their lives. These people include partners and spouses, parents, children, and other close relatives. For Fred, this is likely his wife.
Behavioral therapy involves helping patients change maladaptive behaviors, by using learning principles from classical and operant conditioning, as well as modeling. Behavioral therapy would focus in changing Fred’s behaviors, likely with a series of rewards for desirable behaviors.
Medication involves taking a chemical agent prescribed by a medical doctor to address physical problems, such as infections and alter brain chemistry, which subsequently alleviates psychological symptoms. A physician or a psychiatrist, who has a medical degree (MD), would be able to prescribe patients medication to treat, respectively, their physical and psychological symptoms. For Fred, this would involve medication to manage his current symptoms and medical care. Ideally, timely medical intervention would have stopped Fred’s symptoms much sooner and reversed his cognitive decline.
Author: Taryn A. Myers, Ph.D., Virginia Wesleyan College
11.2 Screen 2
Please note: Clinical Choices allows you to enhance and test your understanding of the disorders and treatments covered in your textbook, in a simulated case study environment. It is not intended to replicate an actual intake interview or therapy session or provide training on therapeutic techniques. Clinical Choices is for educational purposes only and is not intended as a substitute for clinical training.
11.3 Screen 3
The receptionist hands you the psychological consultation paperwork prior to your interview with your new client, Fred, who was referred to you by his attorney, George Roberts. Fred was hospitalized, and while he was there, the hospital petitioned the court to appoint a guardian for him as a person unable to make decisions for himself. Fred’s attorney tells you that he thinks the hospital might have misdiagnosed Fred, making the guardianship unwarranted, and he wants your opinion. Fred is now a resident of a nursing home, where you visit with him. His wife, Angie, and his niece, Bernice, are present during the interview. Click on the button below to review the paperwork before you begin the interview.
New Client
Fred: Case #11018
Golden Years Retirement Community
Psychological Consultation Paperwork
Client Name: Fred
Age: 72 years old
Gender: Male
Ethnicity: African-American
Occupation: Worked part-time at the county health authority until hospitalization
Current living situation: Lives in nursing home with wife, Angie
Why are you seeking services at our clinic?
Fred was hospitalized following abdominal pain. While in the hospital, he was diagnosed with neurocognitive disorder, possibly of the Alzheimer’s type. This may be a misdiagnosis, as he has been put on several different medications that may have increased his symptoms. Following a request by the hospital, Fred now has a court-appointed guardian who makes financial and medical decisions for him.
- George Roberts, JD, Attorney-at-Law, for my client, Fred
11.4 Screen 4
You will now ask Fred and his family a number of questions you would typically ask during the psychological consultation. As you conduct the interview with Fred, begin to think about his symptoms, what his diagnosis might be, and later, what type of treatment might be most helpful to him. Click the “play” button below the illustration to hear Fred’s and his family’s responses to your questions. To read the transcript for these answers, click on the “transcript” button. Take notes in the box provided as you listen to their responses.
11.5 Screen 5
“Hello Fred, Angie, and Bernice. As you know, your attorney, Mr. Roberts, contacted me and asked me to evaluate Fred. I’m going to ask you a series of questions to try to determine what is going on with Fred’s health and his diagnosis. I hope to be able to answer all of the questions that we all have to figure out how best to help Fred. Because Mr. Roberts hired me, I want to let you know up front that anything you share with me may also be shared with him and used in any legal action that you and your family decide to take in consultation with Mr. Roberts. Does that all make sense? Let’s start. Fred, can you tell me why you had to be hospitalized?”
Transcript
Fred: [confused] Uh...I don’t remember... Pain? ... Stomach pain?
Angie: [warmly, to Fred] That’s right, dear. [to the therapist] He went to work, same as usual. He worked there for 54 years, then went part-time – I don’t know...5-6 years ago? He didn’t take on as many jobs after he turned 65. He’s always been the healthy one, not like me, you know. They told me that he felt severe stomach pains after lunch. His supervisor first told him to go home, but then changed his mind and took Fred to the hospital. He’s a good man. The nurse called me from the hospital. I couldn’t go right then ... I don’t drive. [shakily] I was so scared not knowing what was happening to Fred! I wanted to be there with him!
Bernice: [indignant] After Uncle Fred got to the hospital, he had to wait hours before he was seen by anyone. The doctor first thought it was a urinary tract infection, but she wanted to make sure because of his age. That’s why she admitted him. They put him on an IV because they thought it might be an infection, and I guess they gave him some painkillers, too – for the stomach pain. Then they left him by himself. [angrily] Can you believe that? Then they told us Uncle Fred became confused and angry. He didn’t know what was going on and was worried because Auntie Angie wasn’t there. Who wouldn’t be? Apparently the nurses told the doctor and she gave him Valium, on top of everything else they gave him. They told us it was to calm him down. Little good that did him.
Question 11.1
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What happened to Fred?
Fred
- Seems confused
- Bad stomach pain
Family
- Wife says he’s generally healthy
- He’s worked part time since age 65
- Severe stomach pain after lunch → supervisor took him to hospital
- Niece reports Fred waited hours to be seen
- Initial diagnosis urinary tract infection (UTI)
- Put on IV, given painkillers, Valium
- Became disoriented and angry
11.6 Screen 6
“When was the first time one of you was able to join Fred at the hospital?”
Transcript
Fred: [shakily] I was all alone ... I didn’t know what was going on. I couldn’t sleep. Every time someone came in they gave me more and more medicine. [muttering under his breath] ...doctors...nurses...doctors ... Ahh!
Angie: [reassuringly to Fred] It’s okay, sweetheart. It’s okay... I’m here now...I won’t leave you... [Distressed, tearful] Why is he like this now? Why?
Bernice: [annoyed] I talked to everybody who walked in that hospital room ... I did not get a straight answer about what happened from anybody.
Angie: I couldn’t get there that first day because I don’t drive. [guiltily] Bernice, I should’ve called you, but I… [sadly] I thought he might come home so I waited until the next day.
Bernice: You know you can always call me for help, Auntie! You know I love you two and I would do anything for you and Uncle Fred.
Angie: I know. I know... You’re working and the kids... I didn’t want to bother you again, but... [softly] I didn’t know who else to call.
Bernice: [To the therapist] I went as soon as she told me the next morning. He was going into surgery. Auntie was so scared.
Question 11.2
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When did the family get to Fred?
Fred
- Alone and scared, hard to sleep
- Hospital staff gave him a lot of medication
Family
- Couldn’t get to Fred until next morning
- Niece not satisfied with answers from hospital staff
- Fred went into surgery the next morning
11.7 Screen 7
“Why did Fred have to undergo surgery?”
Transcript
Fred: [trying to remember] Urr… urr… pros... pros... prostate. My prostate.
Bernice: The tests the doctor did showed he had an enlarged prostate. They said it came from the infection. They said it was minor surgery. They had to open up his urethra. Doesn’t sound minor to me! They said they gave him some general anesthesia, which put him out so he wouldn’t feel anything. When he woke up from surgery, he was so confused and angry. The nurses gave him more meds – painkillers, antibiotics, Valium, they just kept pumping it into him, and he kept getting more and more upset. He wanted to know where Auntie Angie was. He kept calling for her. He didn’t even know who I was. [distressed] Uncle Fred’s known me since I was born!
Question 11.3
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Why did Fred have surgery?
Fred
- Difficult remembering or expressing himself
- Prostate
Family
- Enlarged prostate → Urinary tract infection (UTI)
- Surgery to open up urethra
- More meds → more distress
- Didn’t recognize niece
11.8 Screen 8
“How did Fred end up with a court-appointed guardian?”
Transcript
Fred: [confused] I don’t know. What do you mean? Who? Why am I here?
Angie: That meddling social worker!
Bernice: Auntie Angie, she was just trying to do her job! But this really did happen because of her. I guess in those big hospitals they have a social worker come around before discharge to see what kind of help patients might need when they’re ready to leave.
Angie: And apparently her job is to coop people up and steal their money!
Bernice: Auntie!
Angie: Well! That’s what she did, isn’t it?
Bernice: I do think she had good intentions. I’m sure it was her job to see if Uncle Fred needed to go to a nursing home or rehab place before he went home. When she saw that he was confused, she thought he was suffering from some disorder. To her credit, she said she didn’t think it was Alzheimer’s.
Angie: But she did call in that psychiatrist.
Bernice: The social worker talked to me first. I explained that Uncle Fred lived with Auntie Angie, taking care of her and the house.
Angie: I love our home! Two bedrooms, my vegetable garden out back ... we’ve lived there for over 40 years. And Fred took good care of me. His health is [sadly] ... was ... better than mine, you know. He does ... did ... the cooking and the cleaning and all.
Bernice: Uncle Fred was confused, so the social worker called in the psychiatrist. She was worried that he couldn’t take care of the both of them.
Angie: But, she didn’t even tell us...
Question 11.4
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Why does Fred have a guardian?
Fred
- Doesn’t know or understand
- Seems confused
Family
- Hospital social worker – thought Fred had some sort of disorder
- Niece told her he lives with his wife with no one to help them as he recovers
- Social worker saw Fred was confused and worried he couldn’t care for himself
- Referred to psychiatrist
11.9 Screen 9
“What happened when the psychiatrist evaluated Fred?”
Transcript
Bernice: When he showed up, he made me leave the room. He was only in there for 5 minutes or so. I could hear him asking Uncle Fred questions about how old he is, what day it is, who the president is, the season, and things like that.
Angie: [sadly] Fred couldn’t answer any of their questions … he only got his name right. He said he was 68. He’s 72!
Bernice: The psychiatrist didn’t even look at his chart. If he looked, he would have seen that Uncle Fred had a fever since the surgery. And after those 5 minutes, he just diagnosed him with … [pause while she remembers the diagnosis] “neurocognitive disorder, probably of the Alzheimer’s type.” I guess he didn’t even listen to the social worker either. I have a copy of the chart right here.
Angie: That social worker called the hospital attorney and took it to court!
Bernice: I told her I could make sure they were taken care of, but she just ignored me. She told me I could “discuss it with the judge.” That Friday, we went to court. That judge had only read the psychiatrist’s report. The attorney for the hospital said they should declare Uncle Fred incompetent. The judge appointed a lawyer to be a guardian. I tried to tell all of them that I am looking out for my aunt and uncle, but the judge said I had to take it up with that attorney. This stranger makes all the decisions for my uncle, just like that!
Angie: [sadly] What do we do now?
Question 11.5
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What did the psychiatrist evaluation find?
Family
- Psychiatrist made niece leave room
- Did mental status exam → took only 5 mins
- Fred had a hard time answering
- Psychiatrist didn’t review chart → missed that Fred had fever
- Diagnosed as neurocognitive disorder, possibly Alzheimer’s
- Social worker referred Fred’s case to judge → went to court → guardian appointed
Question 11.6
How could the psychiatrist who examined Fred have made an accurate diagnosis? Check all that apply.
| bI0LPa9lfHQ+dYqk | He could have reviewed Fred’s chart to examine how Fred’s problem began. |
| wCfH0QtRgXJ8o+c+ | He could have ordered a brain scan. |
| bI0LPa9lfHQ+dYqk | He could have conducted a thorough assessment to test Fred’s cognitive and psychological functioning. |
| wCfH0QtRgXJ8o+c+ | Nothing. The psychiatrist’s procedure was appropriate. |
Hint
Think about what information the psychiatrist needs to make an accurate diagnosis.
11.10 Screen 10
“What happened next? How did you end up here at the nursing home, Fred?”
Transcript
Fred: [confused] I don’t know. It all happened so fast. I…I… was still sick. Angie...Angie...but it was good to see you.
Angie: They sent him to this expensive nursing prison – I’m sorry, this is not a “home” it’s a prison! And what kind of money do they think we have? The judge sent another social worker, from the county I guess, to talk me into coming here too.
Bernice: This guardian has control of their bank account.
Angie: We’ve always been so careful with our money, and now ... there go our savings ... we worked so hard to save this. And once Fred got here, they had to turn right around and take him back to the hospital.
Bernice: He still had the infection. He was in the hospital for three more days. They kept giving him antibiotics and painkillers. And ... now because they say he has this “neurocognitive disorder,” they put him on a stronger anti-psychotic medication.
Angie: That guardian, who doesn’t know the first thing about Fred, made all those decisions. At least when he got to this nursing prison, I was here. [sadly] At least we were together. We cried when we saw each other. And the nursing home said I can stay here with him until he’s stronger and ready to go home.
Bernice: [sadly, quietly so Angie cannot hear] It’s just killing me to see what they’ve done to my auntie and uncle. They’re like my second parents -- they helped me go to college! They haven’t spent a night out of their home ever. They’ve been married 52 years – they were high school sweethearts. Now they’re stuck in this nursing home they can’t afford. [much quieter] I’m not going to tell Auntie Angie, but I don’t think they’re going home any time soon.
Question 11.7
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What happened next?
Fred
- Happened so fast
- Seems confused
- Happy to see Angie
Family
- County social worker talked Angie into coming
- Guardian chose nursing home without consulting them
- Angie worried the nursing home is too expensive
- Fred still had infection → back to hospital, more meds
- Niece worried they aren’t going home soon
11.11 Screen 11
Question 11.8
Which of the following symptoms is Fred currently experiencing? Check all that apply. Use your interview notes to help you remember!
| bI0LPa9lfHQ+dYqk | disturbance in orientation to the environment |
| wCfH0QtRgXJ8o+c+ | substantial, long-term decline in memory |
| bI0LPa9lfHQ+dYqk | disturbance in attention |
| bI0LPa9lfHQ+dYqk | disturbance developed quickly |
| wCfH0QtRgXJ8o+c+ | substantial decline in visual perception |
| bI0LPa9lfHQ+dYqk | disturbance represents acute change |
| bI0LPa9lfHQ+dYqk | change in cognitive domain, such as memory |
| wCfH0QtRgXJ8o+c+ | substantial decline in decision-making |
| wCfH0QtRgXJ8o+c+ | substantial decline in language |
Hint
Review your notes from the interview with Fred and his family to review his symptoms.
11.12 Screen 12
From the File. You remember a former patient who shared symptoms similar to Fred’s. You review this case to help you as you think about Fred’s case.
Question 11.9
X2QP3G7qA2Hzef4kWUMdL1HmGzV9hBxHbyljH2LMv9O8EysWdfwBa747nfpgSYu1NwPUQnT2gjf1a+Bt3dvmcVp3eeKVyNBqFoNq0udDSIKZXVdmMUQcW4kNAys7MJjcHcDDghnsrWd1KMD9Lko0Zg==11.13 Screen 13
Question 11.10
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- Problems with orientation to the environment
- Condition developed over a short period of time
- Condition related to a health issue
Hint
Think about the following symptoms Fred exhibits in making your choice:
- Problems with orientation to the environment
- Condition developed over a short period of time
- Condition related to a health issue
Question 11.11
Hy9lKZ9/1LQOIEhiHYWRrJ6q5xrjyGZ1THeLBjAnKypjZNxzFKBw/yQ9br8x71rcNuJF8WLVPH2ocfvkaf7aKbjZxMtscZL8rL1jm3bq1Ziphc1RA98+yOdBOuwxUM+XAFNbGb89G9jwzVu7kfRauXJz2japutM0cT4xB2Lffzfw5i6f2ac56bWQ28L6wX8aQuestion 11.12
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
Think about the differences and similarities between delirium and major neurocognitive disorder.
11.14 Screen 14
Question 11.13
375N4LqVzPANZXtZuYhvCtnqpNj3+NcPeVhf4LqrNFK5T6EXOoNMi1XzF3yxmeBzMsO9DbbfTjmAYx1fqNaKzOa1UEnbkxLoCaxPIyXKxGoNZicEtQkoyY8nLdkse+GpeMbZ7UDeYP3Wsfj7/+oFMLW6gL/AkI3GwZpneY80RlgV9rKDb4gMgvJX5bRc13IUyYg2YQOGGKLg4a2S7oWoVg==Question 11.14
txctIyVyDzGZlibKhjoC7Db9ohY/FGO7myS9piKueRsyXlLcyuMQG2m0D4l0ONpmR76q3D8n9ENxHIBerCYuhdt0CNC4zcgkFxt7VA1A4RYToyFq2svGSVzUsutaVcmX2mITItP+WzI9lC5Kz8y6aqGEaA9UniX/mk4hQBxp5l9G442RAqzRCqYQThEgSuZADMSqpB7lqEh7t73J+MlKMIHUD4JmxocT11.15 Screen 15
Question 11.15
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
In making your choice, think about the type of treatments used on Fred and the main cause of his delirium.
11.16 Screen 16
Question 11.16
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
In making your choice, think about what caused Fred’s problems.
11.17 Screen 17
EPILOGUE
You were very glad that Bernice thought to contact Fred’s attorney, who put the family in touch with you as well as a neurologist, Dr. Gunstad. You and Dr. Gunstad had to be particularly careful in your assessment procedures, reports, and diagnoses because the legal system was already involved in this case (you were hired by Fred’s attorney and there was a court-appointed guardian). As a psychologist who often works closely with attorneys such as Mr. Roberts, you had to be aware of the relevant laws for this case. In addition, you made sure that you were up-to-date on the most recent literature and assessment techniques so that if any of your findings were questioned in court, you would be able to back them up. Because Mr. Roberts hired you, you were very clear with Fred, Angie, and Bernice that anything they shared with you would also be shared with Mr. Roberts.
Collaborating, you and Dr. Gunstad determined that Fred did not have a neurocognitive disorder at the time of the examination. He was suffering from delirium. But Fred had been so compromised by the drugs, the hospitalization, and the removal from his home to a strange place, that he was now suffering from medication-induced major neurocognitive disorder that was likely to get worse. If left untreated in the elderly, delirium can also lead to a type of neurocognitive disorder. Therefore, Fred would now be diagnosed with major neurocognitive disorder due to multiple etiologies, as his disorder stemmed both from the untreated delirium and the consequences of the medications he was placed on while hospitalized.
By now, Fred was not able to manage his finances or make good decisions about his medical care. He was in no shape to go home and try to keep house and cook for Angie. Bernice researched all of the available options for care for Fred and Angie, including in-home care with a live-in nurse or a healthcare worker who would make occasional home visits. After carefully weighing all the options, Bernice believed the best and only solution was for Fred and Angie to stay at the nursing home, where they had round-the-clock care, prepared meals, and engaging activities, for what would probably be the rest of their lives.
Mr. Roberts, Fred’s attorney, was able to get Bernice named as Fred and Angie’s guardian. Eventually, he won a lawsuit against the psychiatrist and the hospital, but it was too late for Fred and Angie. They would never return to their home. After several years, Fred died in the nursing home and his beloved Angie passed away in her sleep a few months later. Fred never regained the mental or physical health he had on the day he last worked that nice fall day in September.
Question 11.17
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Hint
Think about the most severe of Fred’s symptoms.
11.18 Screen 18
Real World Application
Watch the following video about another disorder of aging, major neurocognitive disorder due to Alzheimer’s disease, then answer the questions.
Transcript
23:46:04 TERRY MORAN
(OC) More than five million Americans live with Alzheimer's disease.
It's a long, hard road, not just for those who suffer from the disease but
also for the caregiver, children tasked with caring for an increasingly
dependent parent. Four years ago, ABC had the chance to put cameras
inside a Texas home as a couple took on this terrible challenge, and my
co-anchor Cynthia McFadden has followed the family ever since. Cynthia?
23:46:30 CYNTHIA MCFADDEN, ABC NEWS
(OC) Terry, one of the things we learned over these years is just how
little most of us really understand about the disease itself. I thought I
knew a lot about Alzheimer's, but after Blane and I took part in an
experiment simulating what it's like to have the disease, I found out I
didn't. It was 12 minutes that changed my life.
23:46:51 BLANE WILSON, SON
I love you, mom.
23:46:52 CYNTHIA MCFADDEN
(VO) Blane Wilson's mother Lawanda came to live with him four years ago.
He had just married his new wife, Georgia, five weeks earlier. Blane soon
learned it was much harder than he thought.
23:47:06 GEORGIA WILSON, WIFE
Oh, god. Blake. She's going to drive her car.
23:47:10 CYNTHIA MCFADDEN
(VO) And later, she did. She lit fires. She wandered off. But Lawanda
doesn't look sick and she often seems fine. Which makes it hard for Blane
and Georgia to understand how limited she really is. And that leads to
frustration and resentment.
23:47:30 GEORGIA WILSON
Just tell her to wash her clothes, I'm tired of washing them. I'll bet
you a hundred bucks she knows what to do. Are you afraid? I mean...
23:47:38 BLANE WILSON
No, I'm not afraid. You know, I mean, it's my mother. You don't
understand.
23:47:43 CYNTHIA MCFADDEN
(VO) The more we watched the tapes, the more it became apparent how
little Blane and George really understood what was happening to Lawanda's
mind.
23:47:51 CYNTHIA MCFADDEN
(OC) Do you feel you understand the world your mother now lives in?
23:47:56 BLANE WILSON
No.
23:47:56 CYNTHIA MCFADDEN
(OC) What's going on in her head, her brain?
23:47:59 BLANE WILSON
I have no idea. I have no idea. I need to understand that then. I need
to know what it's like.
23:48:07 CYNTHIA MCFADDEN
(VO) So I told Blane about an experiment developed by PK Beville and
administered by her colleague, Laurie Labishak. The experiment helps
families and caregivers actually experience what it's like to have
Alzheimer's.
23:48:20 CYNTHIA MCFADDEN
(OC) I understand it's a pretty rough experience.
23:48:22 BLANE WILSON
It needs to be experienced. If it'll help me to understand I would love
to.
23:48:29 CYNTHIA MCFADDEN
(VO) I agreed to go do the experiment with him.
23:48:32 LAURIE LABISHAK, SECOND WIND DREAMS
Could you have a seat, please.
23:48:33 CYNTHIA MCFADDEN
(VO) Our journey into another world begins here in this bedroom where
Blane and I are suited up with some deceptively harmless looking devices.
Goggles simulating macular degeneration, glaucoma, and cataracts,
conditions that older people with Alzheimer's often have. Likewise, latex
gloves are placed on our hands and our fingers to taped to make our hands
feel arthritic, clumsy, hard to bend. A substance is placed inside our
shoes to make it harder for us to walk.
23:49:02 BLANE WILSON
Oh, that is uncomfortable.
23:49:05 CYNTHIA MCFADDEN
(VO) And on our heads, they place earphones, which emit an incessant
jabbering. A clamor of noise that some Alzheimer's patients say is
constant.
23:49:16 LAURIE LABISHAK
Individuals with dementia say we're hearing all this stuff and they can't
turn it off.
23:49:22 CYNTHIA MCFADDEN
(VO) Then, we're each given five tasks to perform and only 12 minutes to
accomplish them.
23:49:27 LAURIE LABISHAK
I would like you to find the tie and put it on.
23:49:31 BLANE WILSON
I can't hear you.
23:49:31 CYNTHIA MCFADDEN
(VO) Blane has a hard time concentrating from the start.
23:49:35 LAURIE LABISHAK
Your time begins now.
23:49:37 CYNTHIA MCFADDEN
(VO) As he enters, Blane is immediately disoriented. He staggers.
Reminding us of the way his mother looked on our tapes. Blane tries to
accomplish his first task, clearing the dishes off the table. But when he
goes to put them away, he can't find the kitchen. So he gives up.
23:50:01 BLANE WILSON
I don't, I don't know where to put them.
23:50:03 CYNTHIA MCFADDEN
(VO) Blane finally finds the kitchen but he can't remember why he's
there. And again, the similarities to his mother were astounding.
23:50:11 BLANE WILSON
She would open the cabinets and then she would shut them. Mother, what
are you doing? Nothing.
23:50:17 CYNTHIA MCFADDEN
(VO) But Blane is doing a lot better than I am.
23:50:19 CYNTHIA MCFADDEN
(OC) What the heck is this?
23:50:21 CYNTHIA MCFADDEN
(VO) It's only about two minutes into the experiment and the noise from
the headset is driving me crazy.
23:50:29 CYNTHIA MCFADDEN
(OC) God. So annoying.
23:50:32 CYNTHIA MCFADDEN
(VO) As I try to accomplish my first task, find a white sweater, I work
myself into a frenzy.
23:50:38 CYNTHIA MCFADDEN
(OC) White sweater.
23:50:39 CYNTHIA MCFADDEN
(VO) Remember, what I'm hearing is this. And believe me, it drives
everything else out of your head.
23:50:47 CYNTHIA MCFADDEN
(OC) All right. Annoyed.
23:50:50 BLANE WILSON
This is tough. I felt confused. Kind of panicky. If I had to go
through very much of that I just might go crazy.
23:50:59 CYNTHIA MCFADDEN
(OC) All right, that's not a sweater. That's not a white sweater.
23:51:02 CYNTHIA MCFADDEN
(VO) You do understand why people do start talking to themselves.
23:51:05 CYNTHIA MCFADDEN
(OC) This is not a white sweater.
23:51:07 CYNTHIA MCFADDEN
(VO) I was trying to organize my mind by saying okay...
23:51:10 CYNTHIA MCFADDEN
(OC) Okay, all right, all right, all right. Not a white sweater. Not
there. I don't know about that.
23:51:20 PK BEVILLE, SECOND WIND DREAMS
You're doing great.
23:51:21 CYNTHIA MCFADDEN
(OC) PK was in the room and at one point when I sat down in frustration
on the sofa and she said, you're doing great.
23:51:27 PK BEVILLE
(OC) Why don't you start with finishing setting the table?
23:51:30 CYNTHIA MCFADDEN
(OC) And she told me what else I was supposed to do.
23:51:33 CYNTHIA MCFADDEN
(OC) I'll remember that.
23:51:35 PK BEVILLE
The reinforcement.
23:51:36 CYNTHIA MCFADDEN
(OC) Yeah, 'cause you feel so alone. And you feel so frustrated and
there's - you know, you don't know what you're supposed to do. And it's
so dark.
23:51:45 CYNTHIA MCFADDEN
(VO) Reluctantly I go back into the kitchen to try to find the plates.
23:51:49 CYNTHIA MCFADDEN
(OC) Glasses. How long have I been doing this? About 20 hours? I'm not
doing great. I'm not doing great.
23:51:55 CYNTHIA MCFADDEN
(VO) And once again, I get distracted and go looking for that white
sweater.
23:52:00 CYNTHIA MCFADDEN
(OC) This looks good enough. This is like - okay. It's not exactly a
sweater. All right. I'll put it over my shoulders.
23:52:09 CYNTHIA MCFADDEN
(VO) And I end up looking a little eccentric.
23:52:12 PK BEVILLE
Her son's going to say mamma, you can't go out like that. You're getting
a little off here.
23:52:18 BLANE WILSON
God.
23:52:18 CYNTHIA MCFADDEN
(VO) In the meantime, Blane has moved on to the bedroom where he's
supposed to match six pairs of socks.
23:52:24 BLANE WILSON
I don't know, man.
23:52:28 CYNTHIA MCFADDEN
(VO) Instead, he starts folding everything in sight.
23:52:31 BLANE WILSON
A sweater, man, this is crazy.
23:52:34 CYNTHIA MCFADDEN
(VO) By now, Blane seems to have forgotten his list of chores. He was
supposed to have found this tie, for example, and put it on. Instead, he
folds it along with everything else.
23:52:44 BLANE WILSON
Shoot.
23:52:45 CYNTHIA MCFADDEN
(VO) It reminded us of the time Blane's mother set out to cook something
for lunch, then got distracted washing dishes and didn't remember until
the pot was burning.
23:52:56 CYNTHIA MCFADDEN
(OC) Plates.
23:52:57 CYNTHIA MCFADDEN
(VO) After 12 excruciating minutes, the experiment was over.
23:53:03 CYNTHIA MCFADDEN
(OC) I give up.
23:53:05 PK BEVILLE
Blane? Your time is up.
23:53:07 BLANE WILSON
Huh?
23:53:09 PK BEVILLE
Your time is up.
23:53:09 BLANE WILSON
Oh, shoot.
23:53:11 CYNTHIA MCFADDEN
(OC) What an unpleasant experience.
23:53:14 BLANE WILSON
Damn.
23:53:15 PK BEVILLE
Yeah.
23:53:16 BLANE WILSON
I couldn't do anything.
23:53:19 CYNTHIA MCFADDEN
(VO) Blane was visibly shaken.
23:53:22 BLANE WILSON
What a way to try and get through each day and kind of scary.
23:53:27 PK BEVILLE
In what way?
23:53:28 BLANE WILSON
Well, almost like a panic.
23:53:31 CYNTHIA MCFADDEN
(VO) For both of us, new insights.
23:53:34 BLANE WILSON
It's a deep sense of confusion.
23:53:37 CYNTHIA MCFADDEN
(OC) The thing that shocks me the most is that I couldn't remember five
simple instructions.
23:53:43 BLANE WILSON
I couldn't imagine living like that.
23:53:45 CYNTHIA MCFADDEN
(OC) It's life-altering.
23:53:47 BLANE WILSON
They need your help. They need your understanding.
23:53:54 ANNOUNCER
(OC) Amen. Despite the experiment, Cynthia reports that stress was too
much. Lawanda is living with her sister and has had almost no contact
with her son. Good luck to them. Our thanks to Cynthia for that. And
you can find more Alzheimer's resources on our website at ABCNews.com.