Dementia Case Study: Navigating Memory Loss with Compassion and Care
Patient Information:
Age: 76
Gender: Female
Background: Retired teacher; lives in a suburban neighbourhood outside of Mumbai with her husband of 52 years.
History or Cause:
Neera (a pseudonym) was a long-time elementary school teacher. She was beloved for her cheeky sense of humour, love of the written word and commitment to education. She retired six years ago, at the age of 68, and was active. She volunteered at local libraries, took reading with children programmes, attended library book clubs, and nurtured her garden.
Neera started to show subtle signs of decline around 72. She misplaced common items such as keys and glasses. She had trouble remembering the names of friends she had known for years and would sometimes repeat the same questions in a conversation. Her family started to worry but dismissed it as a common part of ageing. Over the next year, things began to progress. Neera became confused driving to familiar locations and, on one occasion, even left a pot on the stove running overnight.
By 74, the decline was growing. During this period, she began confusing dates, it became obvious she was not remembering conversations, and there were marked personality changes; a calm patient had become a cranky, withdrawn person. Her husband expressed concern and noted that Neera was incredibly anxious at social events and said that she was paranoid about people "talking behind her back". Neera's daughter, who is a nurse practitioner, recommended the start of a full neurological workup. That began a long, emotionally difficult, but ultimately empowering care journey.
Diagnosis:
Neera was referred to a neurologist and geriatric psychiatrist in Mumbai, and a complete diagnostic work-up was begun, consisting of cognitive screening, blood work, neuroimaging, and psychiatric assessment.
Assessment Tools Used:
- Mini-Mental State Examination (MMSE): 22/30
- Montreal Cognitive Assessment (MoCA): 17/30
- Geriatric Depression Scale (GDS): Mild depressive symptoms present
- Clock Drawing Task: Visuospatial impairment present
- MRI: mild-moderate atrophy in the hippocampal region
- Lab results: no vitamin B12 deficiency, no thyroid dysfunction, no infections
Final Diagnosis:
- Alzheimer’s Disease (early to moderate stage)
- Based on DSM-5 criteria for major neurocognitive disorder due to Alzheimer's
- Based on DSM-5 criteria for major neurocognitive disorder due to Alzheimer's
- Mild, comorbid depressive disorder (related to insight into her decline)
- Based on DSM-5 criteria for major neurocognitive disorder due to Alzheimer's
While the diagnosis was devastating to the family, it also provided clarity and a way forward.
Treatment:
Jagruti Rehab treatment model was focused primarily on quality of life, independence to the extent possible and slowing the rate of cognitive decline, using a combination of pharmacological, behavioural, and environmental strategies.
Program:
1. Medical Management:
- Donepezil (Aricept): Begun at 5mg daily with crossover to 10mg daily.
- Memantine (Namenda): Agonist starting second month for neuroprotective effects and executive functioning.
- Mild SSRI (Sertraline 25mg) for mood symptoms.
- Blood pressure and cholesterol medications are ongoing for cardiovascular risk management.
2. Cognitive Rehabilitation Therapy (CRT):
- Neurological consults for weekly sessions, working on attention, memory, and sequential tasks.
- Memory aids included labelling items around the house, electronic reminders, and arranged calendars to support everyday living.
- Free word recall tasks and storytelling to exercise language centres.
3. Occupational Therapy:
- A safety assessment for Neera’s home and modifications where needed:
- Auto shut-off stove
- Non-slip mats, medication organisers, and motion sensor lights
- Auto shut-off stove
- Non-slip mats, medication organisers, and motion sensor lights
- Working with Neera to adapt to her new cognitive boundaries to define her routine (e.g., simpler meal preparation)
- Auto shut-off stove
- Non-slip mats, medication organisers, and motion sensor lights
4. Behavioural & Routine Structuring:
- Developed a "daily rhythm" chart that included set walking, eating, resting and activity times
- Steered clear of overwrought sensory patterns to promote calm
- Relatively trained in redirection techniques, validation therapy (vs. confrontation)
5. Supportive Psychotherapy:
- Weekly sessions with a geriatric therapist in Mumbai to work through her grief of losing her old self
- Work on life review therapy helped to solidify her identity and self-worth
- Talked about legacy-building, creating a memory book for her grandchildren
6. Family and Carer Training:
- Neera's husband & children attended a series of dementia care workshops from the Alzheimer's Association
- Learned communication skills (short, succinct communication, calm voice, giving extra time)
- Engaged in a monthly support group for dementia carers
Therapy:
Cognitive and Behavioural Focus:
- Continued cognitive games, word association, and basic math
- Repetition-based strategies: Neera practised saying her schedule and naming family members daily
- Emotion-orientated therapy: Revisited family photo albums, listened to her favourite music, and made art.
Mindfulness and Physical Therapy:
- Gentle yoga and tai chi for balance and relaxation
- Weekly guided breathing exercises assisted with agitation, especially at night (sundowning times)
Reminiscence Therapy:
- Neera attended splitting reminiscence groups once a week, with peers
- The topics included her teaching career, childhood stories, and her favourite reads
- There were moments of clarity and emotional joy that occurred, which boosted her confidence
Improvements/Recovery Timeline:
Week 1-2:
- Started medications, a little nausea and adjusting dose
- She voiced relief that she was "seen" and treated seriously
- Mood was stable with the start of antidepressants
Week 3-4:
- Started cognitive rehabilitation therapy (CRT) and occupational therapy.
- Improved daily routine reduced confusion and agitation.
- Neera began keeping a "Good Day" journal, documenting her successful memory and recall experiences.
Week 5-6:
- Was showing success with cognitively structured activities.
- Wandering episodes and nighttime agitation have been considerably reduced.
- The quality of social interaction during family visits increased significantly.
Month 3:
- Was able to name neighbours and therapist with no prompts
- Verbally fluent, instigated spontaneous conversation
- Was able to participate in a return to a library storytelling event—her first public event in over a year
Months 4-6:
- Medication limits being taken, stabilised medications, did not have any side effects
- Maintained 85% of daily schedule independently; friend assisted with household tasks
- Greater emotional stability amongst reduced crying sessions and outbursts. Family commented that she "seems more herself again, even if it isn't every day."
Jagruti Rehabilitation Centre Success:
Impact on Neera’s Life:
While Alzheimer’s is a progressive disease, Neera’s story is a momentous example of how early intervention, support, and individualised treatments can create a life of dignity and fun.
She did not regain her memory, but she regained something more important: her connections, her intention, and her peace of mind. Her anxiety about "disappearing" was replaced with fleeting moments of clarity, laughter with grandchildren, and morning tea with her spouse.
She welcomed memory aids, and for the first time, she did not think of them as weakness but as companions in her journey.
Family and Community:
In that time, Neera’s husband was trained, and he learnt that after feeling lost and overwhelmed, he was a better carer; the adult children learnt to feel empowered in learning that emotional changes were not necessarily to be judged with frustration and to practise empathy in an intense emotional context.
The community took on the gap that Neera's dementia created by encouraging neighbours to stop by for brief visits and sending supportive letters and poems that her former students wrote, reminding her that hinted at all the life lived. After witnessing the bond between Neera and her family, Neera's granddaughter decided to go into geriatric nursing.
Neera has become a quiet lighthouse in her community, advocating for others to know that a dementia life is not a tragedy; it can be a different life, slower, softer, but still meaningful.
The Final Thought:
Overall, while this dementia case study legitimised dementia as challenging as it is, Jagruti Rehab hope the most important message of this dementia journey is that dementia is not the end of the narrative; it is a new beginning, a new beginning in care, compassion and reconnection.
Neera's journey reminds us that whilst memory may become dulled, love, dignity and purpose can remain. The pathway to effective dementia care does not end.
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Jagruti Rehabilitation Centre is a leading facility specializing in mental health, dementia, and addiction recovery. The team of psychiatrists, psychologists, and caregivers is committed to empowering individuals on their journey to recovery.
