Barbara’s Blog: The Diagnosis Appointment

“Can I show Dr Rachel a picture of your garden Dad?”“A picture of my garden?”“Yes, here look, this is your garden, I took the picture yesterday evening”.“Oh, yes. That’s my garden – potatoes, runner beans, cabbages, rhubarb, and that’s my compost heap, and those are wooden flower boxes that I made”.Dr Rachel looked impressed. “Do you do that all yourself?” she asked.“Yes, I do” said my Dad. “Apart from the greenhouse. My wife does the greenhouse”.Following my father’s memory assessment a few weeks ago, we were now sitting in the consulting room of Old Age Psychiatrist, Dr Rachel. She was quizzing my Dad, trying to marry up the results of the cognitive tests (in which he had scored poorly) with the man sat in front of her.“I get the sense that you are quite a physical man” she said, “and I understand that you used to be a boxer”.“Yes, that’s right” said my Dad. “I don’t want to show off, but I was a very good boxer. I represented the Army and I boxed in the ABA finals at the Empire Pool in Wembley. I was also a football player. I played for Forest Green Rovers for one season. We went to watch Forest Green in the playoffs at Wembley Stadium last year. It was a great moment to see my local team promoted to the Football League”.I was very pleased to witness Dr Rachel’s approach. She was keen to get a sense of my Dad in the context of his everyday life, rather than simply taking his memory test results at face value. She deduced (correctly) that my dad is functioning pretty well. He pays the bills and can handle cash. He travels around by bus and does the household shopping, not always exactly as instructed, but he does it. He collects his pension from the post office and can recall his PIN on most occasions. He goes to the local newsagent every day to buy a paper, which he reads quite thoroughly, especially the sports pages. He likes to be outside, in one of his many sheds, making things from wood, or in his garden, digging, planting, watering, weeding, mowing – and he loves a bonfire!There is no doubt that his memory is worsening. He struggles to understand anything out of the ordinary. He is used to his own home and familiar routines.Dr Rachel was concerned to ensure that his medications are managed well and we agreed to put a plan in place to make this easier.“It’s, perhaps, a bit too soon to give you a full diagnosis”, said Dr Rachel. “This is what I think: your memory test results do indicate some decline, but you are operating at a high cognitive level in many ways. I think you are on the cusp between having mild cognitive impairment and a developing dementia”.This seemed to me to be an accurate assessment and my Dad was happy not to have dementia just yet. He does know that his memory capability is less than 100%, but to have mild cognitive impairment at this stage was a palatable outcome.Dr Rachel will see him in six months’ time, but assured us that, if anything changed in the meantime, we could get in touch. I think my Mum might want to take up this offer: she is the one having to micro-manage my Dad’s everyday activities. Her feelings and experiences are valid too. It will be important for me to balance their needs and challenges.When I left my parents’ home yesterday, my Dad was in the shed. “What are you doing?” I asked.“I’m fixing a shovel” was his reply.Please do get in touch to share your experiences of memory assessment and diagnosis. Was the process handled well? Did you get the help you needed at the time of diagnosis? Or were you left with little or no support? We would like to hear from you, whether your story is a positive one or otherwise. You can contact me at barbara@liftedcare.com or by phone at the Unforgettable office.