Unexpected Pharmacy Workflow Challenge...Sound Familiar?
This past week during a visit to perform one of my consultant complimentary independent pharmacy workflow assessments, the pharmacist/ owner offered...almost immediately before we started the assessment..."I have Alzheimer's". Momentarily taken back, I then asked: "Why do you believe this?" The individual said: "My memory is failing. I go to do one thing and get distracted by something else and wind up doing something different. I only remember what I went to do when I come back to where I first had the thought". Sound familiar?
Working Memory and General Memory (Short and Long Term)
Together we went to a separate private counseling area where I shared a recent learning of mine. Many professionals, who work in an environment with high stress...and relentless continued multi-tasking... are unaware that working memory can only allow us to maintain a maximum of seven distinct "things or thoughts" simultaneously. With each second or two past the initial decision, many new thoughts initiate and the original first thought of the seven is displaced...particularly when moving to a different location. Does your busy pharmacy workflow require almost constant movement? My work environments have always seemed to demand this. I now know to separate this "forgetfulness" from memory failure.
Am I Entering Dementia?... Practice Essentials
There are approximately 5.4 million individuals diagnosed today with Alzheimer's (AD) and perhaps another 1.5 million with other forms of dementia...including vascular. As pharmacists know, the disease progression often takes 20 years through the mild, moderate and severe stages with death as the final outcome. Cognitive and behavioral impairment from AD is due to developed plaques in the hippocampus, a structure deep in the brain that helps to encode memories, and in other areas of the cerebral cortex that are used in thinking and making decisions. Whether plaques themselves cause AD or whether they are a by-product of the AD process is still unknown.
The pharmacy owner and I spent some time reviewing the risk factors often associated with Alzheimer's disease:
- Family history of dementia
- Insulin resistance (diabetes)
- Perceptual motor problems
- Traumatic brain injury
The pharmacy owner had none of these risk factors. I did suggest that physical and mental tests offered by neurologists might add further comfort. The pharmacist and I agreed to reconnect in 4-6 weeks. I did offer to the individual a book that might be read (Brain Rules by John Medina) that discusses how the brain accepts memories and how it is we retain memories. It's a good read.
Additional Practice Essentials
A patient with preclinical AD may appear completely normal on physician examination and mental status testing. Specific regions of the brain (eg. entorhinal cortex, hippocampus) probably begin to be affected 10-20 years before any visible symptoms appear. Late in 2014, an article describing results from a cross-sectional study with 168 patients found that a particular neuronal protein is detectable in blood and may be able to predict AD up to 10 years before the appearance of symptoms (www.medscape.com/newarticle/835489).
When was the last time you left your keys in the refrigerator?... just one of the first signals of mild AD.
Outside-the-Box Thoughts...Way Out?
With continuing technology advance, could our current brain content be captured when first diagnosed with AD and re-admitted to our brain during the moderate stages of AD?