Years ago, while interning at a large, state-run psychiatric institution, I first came into contact with patients suffering from what was called senile dementia. It commingled all forms and degrees of age related mental deterioration because there really wasn't much point in differentiating one syndrome from another. The treatment protocol was pretty much the same for everyone...supervised care and attention to secondary conditions if and when they developed. In short, about what you'd currently do for an aunt in the attic.
Today, there's far more of an effort to arrive at a differential diagnosis and a more specific therapeutic plan. But just how helpful is this new approach? Consider Ronald Reagan. As a President, one might well assume that he'd be on the receiving end of leading edge technology. Yet his decline in office was noticeable and, not much after that, he couldn't recall having been in office. Had he encouraged stem cell research two decades ago, medical science would probably be better able to treat senility and, who knows, maybe even have gotten Christopher Reeve back on a horse.
But that's in the past and here you are in the present wondering about a loved one. The coffee has boiled away on the stove and the car keys somehow wound up in the refrigerator. Is it Alzheimer's? Short of an autopsy, it's hard to know for sure. So here are a few, very simple tests you might want to try. They're not definitive but, then again, the price is right. The point here is not to reach a conclusive diagnosis but to at least give you an idea of just how much of a problem you may be facing.
You can begin by asking a question like: How do you feel about Sarah Palin? Don't ask about something that your subject might have decided upon ages ago. Keep it up to date. If the person says that Palin gives energetic speeches and would have made a good VP, it shows an ability to think through and express a position related to a current issue. That you might not agree doesn't matter. You're testing to see if the person is senile not smarter than a 5th grader.
What do you like to do is another good question. A vague answer such as, I like to read, calls for a follow up. What have you read lately? In short, you want to see if the individual is living in the present. If they start telling you about Beowulf, you might as well ask what else they like to do. There's no way anyone would pick up Beowulf if it wasn't included on a required reading list from half a century ago.
Finally, you might want to look in on your aunt's neural networks. How many clues does she need before arriving at an answer to a question? What's the name of that famous literary detective? Created by Arthur Conan Doyle; lived at 21-B Baker Street; in London; mid-nineteenth century; his friend was Dr. Watson. The beauty of this approach is that the subject need not know she's a subject. For all intents and purposes, aunty is merely helping you recall a name that's on the tip of your tongue.
One advantage you have over a professional in this matter is that you don't have to worry about moving on to your next patient. You can take your time. I once sat in on a session where a gentleman was asked about his combat experience during WW2. He told a really interesting story about landing at a field after it had been taken by the enemy. Realizing his error, he pushed open his canopy, stood up and gave a smart salute to some thoroughly confused troops. Then he sat down, taxied back to the runway and took off. The Doc gave the old airman high marks and went next door. So I counted to ten and then asked the man if he'd ever been in the war? He told me, word-for-word, the exact same story. In this case, the patient had a clear memory of an event from sixty years ago but couldn't remember that he'd already told the tale less than six minutes ago.
All in all, such an at-home session can't hurt and can give you a bit of insight. Keep in mind that some medications can make symptoms seem worse than they really are and that you don't want to disagree if a family anecdote comes out mangled. In such a case, trying to set an older person straight on the facts can lead to hostility and even more confusion. In short, try to see it as a social time with anything you learn as a bonus. The main point is to see if they remember what they learned in the past and if they're learning anything new in the present.
