I have permission to post this. Both the husband of my patient and my patient read it with me in the room. It was very hard to watch her read it.

To Whom It May Concern:

I am writing with Mr. and Mrs. X's permission about Mrs. X. She is having progressive memory loss. I have been following her for this since February of 2006. She has more than one cause of memory loss: a combination of small strokes in the past, a low B12 level, but the largest cause is Alzheimer's. I did testing for treatable causes for memory loss in 2/06. Her B12 level was a little low, but giving her B12 did not help with her memory. She has not had evidence of more strokes but instead has had the steady decline associated with Alzheimer's. Her mental status test gives us an approximate way to track this: Out of a possible 30 points in 2/06 she scored 26/30, in 8/07 19/30 and today 13/30. The test corresponds to neurons in the brain. In mild dementia short neurons are lost with a loss of short term memory. In moderate dementia medium neurons are lost with people forgetting how to do tasks, dirctions, and daily activities. In 8/07 Mrs. X could no longer balance the checkbook. In severe dementia (as the score drops below 10) executive function is lost, so that people lose the ability to make decisions. They stop recognizing family members and eventually forget to control their bladder or bowel movements and lose interest in baths and often stop speaking.

Mrs. X has dropped approximately one point every 3 months. She is not quite in the severe range yet but soon will be. She is on medication which helps to slow decline over a year, but it does not stop it. She has stopped driving and cooking and Mr. X is doing the household care and finances and handling her medicines. He has done a wonderful job in taking care of her but there soon will be too much care for any one person, no matter how young and healthy. I have encouraged him to seek more help at home and to take care of himself.

I would encourage any family members to spend time with Mrs. X sooner rather than later while she is still able to recognize and interact with them. I think of this sort of memory loss as people traveling back through their memories until they eventually act like a baby and then beyond that to where they no longer care for food or drink. In the end Alzheimer's does lead to death, but it is unpredictable. The average lifespan is 7 years from diagnosis. I find that it seems harder on the family than on the person who has it. One of my patients described it by saying that her husband "is gone now, but he's left his body behind. He doesn't know me at all."

There are three common reasons for people needing to be moved from their homes to an Alzheimer's care place. One is incontinence, a second is behavioral changes and a third is if a person no longer recognizes family members at all.

Alzheimer's can be a difficult illness and frightening to families. The Alzheimer's Foundation can give you more information and there are often support groups at hospitals where you can ask questions. You may also be able to meet with your own physician to ask questions. I hope that this letter clarifies Mrs. X's health and future challenges.


Dr. Y

I wrote this letter at the request of the husband. He was her second husband and wanted it for her children, to let them know. I thought about it and suggested he bring her in for a visit and I would give them the letter at that visit.

Both of us were startled when she asked to read the letter. We both felt very uncomfortable, but gave it to her. She read it and then placed it on the exam table. "I don't have to think about anything over there," she said, waving at the exam table.

"No, you don't have to. I am giving your husband a copy of the letter." I said.

She nodded. Her husband and I both heaved a sigh of relief and they left with the letter.

One of her children responded and one did not.