Let’s reconsider the specific nature of Mrs. B.’s problems. The neuropsychologist recounted that Mrs. B. knew who and where she was and understood test instructions. Results of tests of her ability to remember information both immediately after learning it and after a 30-minute delay were normal for her age, which indicated that she probably did not have Alzheimer’s disease or another disease that involves significant memory impairment. Instead, the neuropsychologist suggested that Mrs. B.’s problems reflected a mild dementia (possibly a mild vascular neurocognitive disorder) combined with depression and chronic pain. The neuropsychologist wrote in her report:
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Feedback to Mrs. B. reinforced her belief that her current memory problems do not suggest [Alzheimer’s disease]. She was asked about activities that she enjoys, and we explored ways of increasing her opportunities for these activities with her attendant (e.g., she has recently visited a senior day-care program and hopes to attend one or two days a week). She was encouraged to give her current living situation a longer try, working with her daughter and staff to improve the most bothersome aspects of the situation. Written reports were provided to the daughter (who is Mrs. B.’s legal guardian) and other medical professionals involved in her care. Feedback was also provided by telephone to the daughter and the referring psychiatrist to answer questions about results and to further discuss approaches to care. Recommendations included continuing psychotherapy and antidepressant medication, negotiating brief written contracts between Mrs. B. and staff members at the board-and-care home to clarify mutual expectations in problem areas, and considering low-dose antipsychotic medication in the event that aggressive and accusatory behaviors escalated despite behavioral intervention. Neither returning home nor moving into the daughter’s home was recommended….
For Mrs. B., things got worse before they got better. Her “fit” in the board-and-care home continued to deteriorate, and after much discussion, she moved back to a nursing home. For a time, she was taking multiple psychoactive medications and her cognitive function deteriorated at a rapid rate [which might be considered a major medication-induced neurocognitive disorder]. [She was taken off her medications] and her [cognitive functioning] rebounded. A year later, after an intervening small stroke, her memory function is slightly worse, but her mood is brighter, she communicates well, and she has fewer complaints about staff and other residents than she did in the board-and-care home.
(La Rue & Watson, 1998, p. 11)