Thoughts About Cognitive Assessment
There is this thing called the GDS or Global Deterioration Scale. I always get it mixed up in my mind with GPS. But in some ways the two are similar. They both help us identify where we are.
The GDS is an assessment tool that was developed by Dr. Barry Reisburg to describe 7 stages a person living with Alzheimer’s Disease typically passes through as the disease progresses. I think most family caregivers have the ability to use this tool and could find it helpful (caution: remember that progression is gradual and there will be time to plan for it).
Many professions use cognitive assessment to understand and educate about areas of deficit. In my own practice as an occupational therapist, I did this regularly. On the one hand, I observed family members relieved to know that yes, something is definitely not normal. It validated their observations and gave people the opportunity to plan for the future. Compassion often replaced impatience and frustration in those moments when the realization came that their spouse or parent was not intentionally being difficult. On the other hand, cognitive assessment typically focuses on disability, what a person can no longer do. What it often doesn’t pick up on is the remaining ABILITY.
I work with an artist named Penny.
Penny has early-onset Alzheimer’s Disease and is living at home with her spouse. We have been visiting Penny for almost a year and have watched her move through the stages of dementia. In her current stage, Penny should not be able to complete most multi-step activities and indeed she has difficulty using her cell phone, filling the bird feeder, paying for purchases and she can no longer safely operate a vehicle. BUT she can still create incredible artwork. There are 36 steps to one of her projects and it is truly amazing to watch her work.
How is she still able to do this? Is her cognitive score wrong? Probably not. What we are seeing is that some of Penny’s procedural memory, her ABILITY to tap into skills that have been repeated for decades, has been preserved. This is especially true when she is engaged in an activity that is enjoyable and meaningful to her.
My approach has shifted in this new line of companion care work where we focus on ABILITY rather than disability. We find the magical activities that shine light on the best our clients have to offer. And there still is a lot of ability there.