Dear Mary,

My father has an aggressive, incurable cancer. He has never been very communicative about his feelings, what is going on in his head, etc. Occasionally he shares stories about growing up. I would love to have something to give to my kids so that they may know their grandfather better when he is gone. I was thinking of trying to come up with some questions that I could ask him that might reveal more about who he is, what is important to him, some childhood stories, etc. I am looking for some help in coming up with these questions. Can you help me?

Thank you.

I am so sorry to hear about your father’s illness. Yes, there are ways to get him to communicate more. Prompt him with open-ended questions that avoid yes or no responses. Reminisce with him about your childhood experiences and encourage him to tell you of his. The time spent reminiscing will be special for both of you. If your children are old enough, have them join you. Your father may be more open to story telling with them present and prompting him with questions. Your children will also gain wonderful memories of their grandfather. You can use the direct approach, too. Explain to him that you are putting together a family history journal and need his help. God Bless.

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Dear Mary,

Can you provide to me and my family advice or guidance about the decision process and ways to approach a potential patient of Alzheimer's? Our issue is that symptoms are very apparent like short-term-memory lapses. She can't remember who attended an event with her that happened yesterday, asks the same question three or more times in the space of 5 minutes, is generally anxious and can't sit still. She also has occasional loss of "the right word" to describe something. Though she has only 3 of the 10 symptoms listed on the Alzheimer’s Association site, could this be the early stage?

This person is scared to death of contracting the disease that took her mother and grandmother. Do we honor her stated wish that she'd just as soon not know (she doesn't seem to be aware of her symptoms), or do we do her a disservice by delaying potentially helpful treatment?

Thanks in advance for any assistance you can provide.

A thorough medical and psychological evaluation is needed to determine if this person is suffering from Alzheimer’s disease. Although her symptoms appear consistent with it, there could be other causes for her behavior.

As a general rule I believe the person should be told. Knowing early will give her an edge on making decisions about treatment and future care. But you need to ask yourself, would she want to make those decisions or would she be content with someone else making them?

Whether or not to tell her is a mixed bag. The knowledge may be so upsetting that she becomes distraught and more anxious. If her memory is very impaired she may forget she has been told. But some people can retain emotionally charged new memories for quite some time. It is more commonly seen in persons taking a cognitive enhancer medication like Aricept or Exelon.

You also said that she stated she did not want to know. If you feel this is what she truly desires, then obey her wish.

The first step is to have her thoroughly evaluated by her physician. If she does have Alzheimer’s disease, a cognitive enhancer may help her function better for a longer period of time.

The second step is to have her write an Advance Directive for Healthcare and assign Durable Power of Attorney to someone so her family can provide her with appropriate care. Good luck.