"The Safe"
A wealthy elderly woman had a number of small strokes. Afterward,
she wrote multiple checks for the same item, impulsively bought large quantities of items she never used, and gave away her
possessions to strangers. Her family was concerned, but granted her latitude as long as she spent only the monthly interest
accruing from her investments - approximately $30,000 per month. They decided intervention was necessary when she began
spending more.
During our meeting, her children mentioned that she recently convened all her house
staff, and announced, "Someone has been taking money from my safe. I will not stand for this! I demand the money be
returned! Now, I want you all to know what has happened, and know this will not happen again. I have ordered the
combination on the safe be changed." She then added, "The new combination is . . ." and she read off the numbers.
Upon questioning, she has difficulty remembering what she had said, and has no awareness of the inappropriateness, or the
likely consequences, of telling potential thieves the safe's new combination.
Applying PARADISE-2
This woman displays a change from her pre-stroke behavior, and now has impairments
in several areas: problems with understanding abstract concepts; planning and strategizing; memory (writing multiple checks
for the same item/bill; not remembering what she told people regarding her safe); and understanding the objective impact of
her behavior.
This behavioral history/description immediately clarifies that this woman has impaired
memory and impaired "executive functions" (refer to the section on "Dementias" on the "Mental Capacity" web page). By
definition, she has a dementia. Review of her medical records confirms she has had several pinpoint strokes in the frontal
lobes of her brain over the previous five years (the frontal lobes are found behind the forehead - and are the center for
executive functions). Her diagnosis is therefore "Vascular (or 'Multi-Infarct') Dementia." Her prognosis is poor,
for it is known that vascular dementia becomes progressively worse. The progression is erratic and unpredictable.
Medication may slow the progression, but she is unlikely to ever again be competent to oversee her own finances.
Question: One of the maids told this lady she had promised to send the maid
on an all-expense paid trip throughout Europe and include her in an updated Will. What do you now think of these claims?
Click here for the story of Mary Ellen Bendtsen. (WARNING: This will take you to a different website).
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