Last week the New York Times reported on a psychologist who made a careful plan and ended her life after her doctors diagnosed Minimal Cognitive Impairment (MCI)
MCI is one of the three stages of Alzheimer’s disease (AD.) In this early stage, family and friends may notice problems with brain function; the senior may even be aware, but the typical tests are either normal, or have abnormalities that do not meet the full criteria for dementia.
Researchers are not exactly sure what percentage of people with MCI go on to full Alzheimer’s disease (the estimate is about 20 %,) except for the amnestic form of MCI. This form of the disease primarily affects memory, and the risk of Alzheimer’s disease may be as much as 90%.
Despite the research and the very expensive, widely advertised drugs, Alzheimer’s disease and other dementias are still terminal illnesses. Yes, people die of dementia, but death can follow up to twenty years of decline. I always say that dementia is easiest on the people who have it because they are not aware of their decline. Every minute is new; they have limited memory of their previous minutes.
This is not true for MCI, or early forms of dementia. People can be terrified. They may notice difficulties, but are not able to wrap their minds around exactly what is wrong (Remember, the organ they’d need to figure it out is the one that’s broken.) This can be terrifying for people who fully understand the implications of a dementia diagnosis, and know what is coming. It can be earth-shattering for people whose brain function is source of their income, or the primary sense of self-worth.
Several NFL players allegedly ended their lives because of dementia, related to repeated head trauma. The media also reported that anticipated mental deterioration may have been a factor in several of the celebrity suicides in the past few years.
My mother died of mixed vascular dementia and AD in her 70’s. A maternal aunt and a maternal uncle died of dementia in their 90’s. My paternal grandmother died of vascular dementia related to poor diabetes control in her 70’s. This does not suggest a genetic risk for me (except the genetics of hypertension and diabetes,) but I still worry. The most important life function to me is being able to think and communicate. I have told my family that I do not want life-prolonging treatment unless I would retain full mental function, but don’t know that I would have the courage to do what these people did. Would you? Let me know what you think.