Wednesday, August 16, 2017

When You Are Worried That an Attorney Has Alzheimer’s

Gayle Klaybor, Ph.D. LCSW recently presented a on a panel regarding dementia and Alzheimers for the Texas Bar Association. This blog is an overview of the essential points of the presentation.
According to the American Bar Association, more than one-third of practicing attorneys are over the age of 55. With that demographic and the prediction that the number will grow, issues related to aging become increasingly more important. Maybe some of the most troubling issues related to difficulties in aging are dementia and Alzheimer’s Disease. As we grow older, it is normal to notice changes in memory and cognition. For someone suffering from true dementia, however, these changes are significant and cause real impairment. If you are concerned about a colleague or law partner, the consequences of allowing an impaired attorney to practice law are very serious. Malpractice suits and diminished quality of representation and outcomes are just two.

Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities. Alzheimer's disease, the most common form of dementia, accounts for 60 to 80 percent of cases. Alzheimer’s disease is a progressive brain disease but other kinds of dementia can be successfully treated or slowed. Before Alzheimer’s can be accurately diagnosed, other disorders need to be ruled out. For example, abuse of drugs (prescription or illegal street drugs) or prescription side effects can cause behaviors that look like dementia. Impairments in memory decision making, concentration, self-care, confusion and judgement can all be signs of drug and alcohol issues. When the addiction is treated and sustained sobriety occurs or a medication is removed, the symptoms go away. Mini strokes and other circulatory problems can also cause brain changes.
At this point in time, Alzheimer’s Disease can only be truly diagnosed post-mortem. But by looking at behaviors and administering specific tests, neurologists, psychiatrists and neuropsychologists are able to make the diagnosis while a patient is living. The number one risk factor for getting Dementia or Alzheimer’s Disease is aging. One in 10 people over the age of 65 will be diagnosed with Alzheimer’s. By the time a person reaches age 85, there is a 50% chance of being diagnosed with this disease.

It is important to distinguish early dementia symptoms and behaviors from those of normal aging. For attorneys, these behaviors might become particularly apparent in the workplace. Practicing law demands a good memory, clear thinking and excellent problem- solving skills. When there is decline, changes are even more noticeable. They are usually first noticed because there has been a significant change from previous behaviors. For example, a once highly competent and conscientious attorney becomes extremely forgetful and confused.

According to the Alzheimer’s Association, there are in general 10 early signs and symptoms of Alzheimer’s and a description of typical age-related changes:

1.   Memory loss that disrupts daily life. For a practicing attorney, that might mean missing filing deadlines, forgetting important information, or asking for the same information repeatedly.
Typical aging: Sometimes forgetting names or appointments, but remembering them later.

2.   Challenges in Planning or Solving Problems. An attorney might be unable to follow a plan especially related to numbers or taking much longer to accomplish tasks.
Typical aging: Making occasional errors in math or needing to make a list to remember.

3. Difficulty completing familiar tasks at work. Attorneys might not remember important points of law or how to complete legal documents.
Typical aging: Temporarily forgetting a legal point or letting filling out a document slip your mind but soon retrieving the mental information.

4.    Confusion with time or place. An attorney with Alzheimer’s can lose track of dates, seasons and the passage of time and neglect important deadlines. He/she might forget where there are or how they got there.
Typical aging: Taking a few moments to remember the day or time.

5.    Trouble understanding visual images and spatial relationships. An impaired attorney might have trouble reading legal documents or driving.
Typical aging: Vision problems because of cataracts or other issues of eyesight.

6.    New problems with words in speaking or writing. People with Alzheimer’s have trouble finding the right name for something, stop in the middle of a conversation and have no idea about how to continue. An attorney might struggle to find a common legal term or have trouble making a cohesive argument in court.
Typical aging: Sometimes having trouble finding the right word or remembering a name

7.    Misplacing things and losing the ability to retrace steps. People with Alzheimer’s may put things in unusual places (like car keys in the refrigerator) and not be able to retrace steps to find it.
Typical aging: Misplacing things and being able to retrace one’s steps.

8.    Decreased or poor judgement. An affected attorney might use exceptionally poor judgement or decision-making in handling a case. There may be a significant decline in grooming and hygiene.
Typical aging: Making a bad decision or having a bad hair day once in a while.

9.    Withdrawal from work or social activities- People with Alzheimer’s might withdraw from previously enjoyed activities because they have difficulty keeping up and tracking what’s going on. For example, following the action in a football game or play.
Typical aging: Sometimes feeling tired of socializing at work or with friends.

10. Changes in mood and personality. An attorney with Alzheimer may become very irritable, suspicious, depressed, anxious and fearful (significantly different that previous behaviors) with colleagues, clients, or in court.
Typical aging: Becoming irritable when a behavior is interrupted.

When these changes in behaviors are present and noticeable, what should a concerned person do? One of the most challenging manifestation of this disease is that the person showing the signs of Alzheimer’s disease doesn’t recognize the problem. There is a joke among mental health professionals that goes, “If you are worried that you have Alzheimer’s, there is a really good chance that you don’t.”  An attorney, probably with years of competence and experience, may become defensive or even hostile about being confronted about changes in behaviors or being called “crazy” or “demented.” Sometimes lawyers experiencing this decline in thinking go under the radar for a time They might compensate by having other attorneys, paralegals, or secretaries prepare legal documents and monitor filing dates. Family members, friends and colleagues are the first to notice changes in behavior. They are usually the people suggesting a professional evaluation.

Here are some suggestions for dealing with an attorney that you suspect may have Alzheimer’s Disease:
1.    Contact other professionals and family members who know this attorney in other situations. Find out if the behavior is pervasive. You can also find out if other factors are involved such as drug or alcohol abuse, other illness or medications.
2.    Talk with your colleague with a focus on concern for his/her well-being. Suggest that there have been changes in behaviors and that a visit to a physician might be a good idea. Remind the person that there may be several possibilities for the changes and that the symptoms might be treatable. Remember only a qualified doctor can make a diagnosis. Stay away from making guesses with the person.
3.    Contact resources for support. TLAP (Texas Lawyers Assistance Program) is an excellent organization to help you deal most successfully with this problem.
4.    Contact the Alzheimer’s Association for information and support.

Even though there is no cure for Alzheimer’s Disease at this time, there are tremendous reasons for hope. Major research is underway and progress is being made. Early detection is still important so the patient and his/her family receives the best care possible.

Sunday, August 13, 2017

Chronic Pain & Addiction: Medication Assisted Treatment (MAT)

The Sprintz Center for Pain and Recovery is an innovative treatment center helping people suffering from both chronic pain and dependency. Having worked in the area of pain psychology since 1987, I have worked patients suffering from chronic pain. In the past year, working with Dr. Michael Sprintz, Medical Director and Maggie Dickens, LPC, Clinical Director of Behavioral Health, we have developed programs in the Woodlands for to provide pain management tools, develop outcome measures, techniques and strategies to manage pain without use of addictive medications. You are probably aware that now more people die every day from overdoses from painkillers than any other reason. 1,000 emergency room visits per day. OMG.......
Well, the Sprintz center is doing something about it. We are going to be presenting our ideas, program and outcomes in LA at the EAPA 2017 World Conference on October 4th. This presentation is targeted toward companies, employees and eap practitioners. Program description below. 

My Upcoming Presentations

On October 3rd, I will be in LA for the Employee Assistance Professionals Association (EAPA) World Conference. I am excited to be presenting with my friend and colleague, Marina London. Marina is one of the best minds in the field of employee assistance. This is exciting for me to be presenting these two workshops. I have been a member of EAPA since 1989 and very involved with EAPA over the years in many capacities and offices.  Most importantly, I get to spend time with friends and colleagues developed over the years. These first two are pre-conference trainings of four hours each providing hands-on, state of the art social media ideas, and marketing strategies. In October, I will be in LA for the Employee Assistance Professionals Association World Conference. This is exciting for me because I have been a member since 1989 and presenting three different programs. The first two are pre-conference trainings of four hours each. The descriptions are listed below. 


Sleep...Time to Relax & Let Go

Begin your sleep hygiene with a regular, comfortable winding down from your day. You brain can help you if you train it with a dedicated routine every night. What do I mean? Prepare for bed at the same time each night, develop a regular schedule, stay away from ALL SCREENS in your preparation for sleep. Most research I have read indicates 7-9 hours per night is desirable. Take a look at your ability to get to sleep and stay asleep to decide what tools you may need to feel rested in the morning to take charge of the day. What helps to get you into the zone to sleep? Try some or all of the following:

  • Meditation
  • Mindfulness practice
  • Focus on gratitude recall from the day
  • Simple stretching
  • Calming music (sounds of nature scapes, Enya, or guided meditation)
  • Reading (but not the news
  • Gratitude journaling
  • Medication (prescribed or OTC)
  • Prayer
  • Visualization practice of a good, deep, restful sleep (like athletes visualize)
In the event of really poor sleep for an extended time, a physician consult or sleep study may be necessary. There are some very effective sleep medications but care needs to be taken on any extended use of these medications. Lunesta or Ambien are in this classification of medications and typically are only be taken on a short term basis, but always consult with your doctor about how to use it. Stress, anxiety, depression can cause the brain to have a chemical imbalance, so medication can be used as a reset strategy. Trazedone is a different category of sleep medication that may also be an option. 
 Enjoy a good night's sleep by being more deliberate about how you go about sleep and employ as many mechanisms as needed to get rest. 
I have created a Sleep Well podcast as another option for you to use at sleep time. I can email you a podcast of the Sleep Well, just send a email to:

Why Worry? Recently, a reprint of the book  Why Worry  by friend and prolific author, Eric A. Kimmel was recently released. Gayle and ...