During Wednesday’s Neuropsychology tutorial the guest teacher Jamie impersonated patients so that we could administer tests and come up with diagnoses. It was one of the most fun classes of the semester. For each of the three imaginary patients we were given the same information: She is 65-years old and her family has been complaining that she has trouble remembering things and performing day to day tasks. Her life history is that she has had nine years of education, that she worked at her family’s corner store until she got married at age 21, after which she worked at a RV Park with her husband until he passed away one year ago. Her son is her closest relative. The stipulations were that each class member got to ask the son one question, and we each got to ask the patient one question, along with administering standardized tests. We also got to name the patients/sons. The first characters were: “Bob” and “Mary” and Jamie said that those are almost always amongst the first names.
It was obvious upon interviewing Mary that she did not remember what had happened five minutes ago, and that semantic memory was impaired (for instance, she called cornflakes “golden crunch bits.”) Her results on word memory tests showed that she had an encoding problem, indicating hippocampal damage, and her copy of the Rey Osterrith Complex Figure showed constructional errors relating to a suspected disturbance in the parietal lobe. Although the brain scans were purportedly normal, hippocampal damage can be difficult to pick up in an MRI due to the angles of the scan. The hippocampus was obviously damaged in this case and based off of behavioral evidence – the class was certain that imaginary-Mary had Alzheimer’s Dementia.
The next patient was “Joe” with her son “Thomas.” The verdict from both characters was that Joe was severely depressed after the death of her husband, and had some memory disorder that was either caused by, or went along with the depression. The class’s verdict was a probable case of Depressive Psuedo Dementia.
Betty was the last patient, and her damaged orbitofrontal cortex was a relief after the heaviness left in the room from Jamie’s convincing portrayal of depression. There was a lag before anyone came up with the son’s name, so I suggested the name primed in my mind: “Clarence Clancy Jr.” I felt vindicated when the room began to roar with laughter and asked: “What do we call him for short?” So it was that CCJ began to tell us of his mother’s troubles. Betty had been arrested for shoplifting some fifteen years prior, and this marked her decline into socially inappropriate behavior. Betty was drawing boobs on the dry-erase board when the first question was asked: “How are you feeling.” To which Betty replied: “ I was bored until I saw you handsome, now I’m feeling just fiiiiiine.” She was distracted by the things in her immediate surroundings and spent the interview spinning on her chair, turning the lights on and off, and going into descriptions of her sex life. When it was my turn I challenged her to attend to the rest of the interview/test, because it was “all about her.” This held up until the standardized tests, which were wrought with evidence of short-term memory loss, erratic executive function, and obsessive behavior such as repeating phrases and turning everything into a rhythmic pattern. Betty was diagnosed with Fronto-Temporal Dementia, but one wonders if she didn’t always have some orbitofrontal disturbance, naming her son “Clarence Clancy Jr.” and all.