The White Room

I lie on the bed

in the white room

They sit around me

These strangers with familiar voices

I think we are waiting for something

or someone.

These strangers, they look at me

They mutter words I don’t understand

A man in a white coat walks in

He stands next to my bed.

He speaks not to me,

but to these strangers

They are talking about me, I know.

About what, I don’t understand.

Irritated, I kick off the covers.

Mother! They chide me and pull them back.

About the poem: This is a poem about dementia, the hallmark of the disease being loss of memory. I write about a scene I came across during my rounds in the hospital—an elderly woman in the advanced stages of dementia is lying on the bed surrounded by her caring relatives. It’s difficult to know what’s going on in the poor woman’s mind because she has lost the ability to speak, even comprehend. Yet it’s apparent she’s unaware of her ailment. She doesn’t even know where she is or who she is with.

Dementia is a syndrome that results in gradual and progressive decline of previously acquired mental abilities that results in a loss of social and occupational functioning and ultimately to loss of independence. It is imperative to distinguish this from normal aging- normal aging never results in loss of independence.

For the diagnosis of dementia there should be impairment in at least 2 of the following-

•  memory/learning new information
• executive function (ability to perform usual tasks such as handle finances that one was able to do before
• perception (recognize people, hallucinations)
• motor abilities (ability to write, draw, walk, coordination)
• language, social cognition.

Causes:

• Alzheimer disease is the most common type (60-80%)
• Vascular dementia (in people who have suffered strokes).
• Lewy body, Parkinson’s dementia, frontotemporal dementia are less common.

Risk Factors:

• Aging is the major risk factor.
• For vascular dementia risk factors are diabetes, Hypertension, heart disease, smoking and obesity (same as for heart disease).
• Other risk factors include history of head injury, APOE e4 allele, mid-late life depression, alcohol and drug abuse, thyroid disease, Vitamin B12 deficiency, HIV infection.

On the other hand, higher education and occupational advancement can lead to reduced risk or delayed onset of dementia. Dementia also results in reduced life expectancy–an average of 4 yrs for vascular and 8 yrs for Alzheimer’s and Lewy body dementia.

Dementia can be devastating not just for the person affected but for the family and the society as well. Imagine the pain of watching your loved one deteriorate from a happy functional person to someone who is dependent on you for everything including simple things like feeding and bathing.

Therefore, if you are aware of someone who is:-

• missing appointments and arriving at the wrong time/date all the time
• is not able to follow instructions
• is losing weight
• is failing to thrive
• has new or worsening depression and or anxiety
• is exhibiting changes in behavior, poor judgment, loss of initiative

he or she could have dementia and it is important gets an evaluation. Particularly to rule out conditions which are associated with dementia and can be potentially reversed. 

Though at present there is no specific pharmacologic treatment that can halt or reverse neurodegeneration there are a few drugs that have been shown to slow down the symptoms of dementia. What is most important is understanding what a loved one with dementia is going through and providing them support and a loving and safe environment.

Here is an excellent website that provides guidance for caregivers.

Please join my Facebook Group HealthWise to know more about dementia and other health conditions and learn about nutrition and other things that can help you live a long and fulfilling life.

I am Dr. Simi K. Rao, a board certified internist and hospitalist currently practising in the Denver area, CO, USA. I have a special interest in preventive medicine. I am also a published author of four novels. My newest book of poems and short stories ‘Under the Shade of The Banyan Tree’ was published in October, 2019. Learn more about me at https://simikrao.com//