Alzheimer’s and work

Wendy Mitchell, in her wonderful book Somebody I Used to Know: A Memoir, tells of her frustration when asking her supervisors in the UK National Health Service for accommodation for her early-onset Alzheimer’s disease. Wendy herself was a supervisor, but with her new cognitive impairment she was having trouble using a new database program. Otherwise, she was still able to do her job.  Her supervisors were flummoxed and sent her to the Occupational Health department. As she walked in to her appointment there, she saw the Occupational Health advisor reading online about What is Alzheimer’s disease? The only suggestion was early retirement.  Wendy felt that with some accommodation, she would be able to work successfully for a while longer.  When she told her own staff about her problem, they all pitched in to problem solve, making it possible for her to continue working a bit longer.

The intersection of work and Alzheimer’s can be fraught with misunderstanding, ignorance, and fear. Recall that Alzheimer’s disease is a continuum.  At one extreme is dementia. At the other extreme is preclinical Alzheimer’s disease with early deposition of amyloid plaques and neurofibrillary tangles in the brain decades before any symptoms occur.  In the middle is mild cognitive impairment, which as the name suggests, is mild memory loss or other cognitive issues that do not yet interfere with daily activities including work. 

Many people can continue to work with mild cognitive impairment and sometimes even with dementia.  This will depend on the requirements of the job, and the worker with cognitive impairment may need accommodation to succeed. Workers with dementia are protected in the US by the Americans with Disabilities Act, although this protection may be limited by severity of the dementia.  Some possible accommodation tactics include:

Memory: 

• Provide a voice activated recorder to record verbal instructions 
• Provide written information 
• Provide checklists 
• Prompt employee with verbal cues (reminders) 
• Post written or pictorial instructions on frequently-used machines or for routine procedures
• Provide templates or forms to prompt for needed information 
• Remove marginal job functions to allow more focus on essential functions 
• Use color-coding to indicate important information 
• Extend training time when significant workplace changes occur 

Organization: 

• Minimize clutter 
• Color-code items or resources 
• Divide large tasks into multiple smaller tasks 
• Avoid re-organization of workspace 
• Label items or resources 
• Use symbols instead of words 

Time Management/Completing Tasks: 

• Provide verbal prompts (reminders) 
• Provide written or symbolic reminders 
• Arrange materials in order of use 
• Use task list with numbers or symbols 
• Provide additional training or retraining as needed 
• Provide a timer and a recommended amount of time to complete tasks 
• Provide a watch with multiple settings 
• Rid desk or work area of clutter and items/materials not used 

Difficulty Performing Job Duties: 

• Retain as many job tasks as possible that the employee is familiar with and proficient in 
• Remove marginal job functions to allow more focus on essential functions 
• Incorporate simpler tasks from other employees’ job descriptions 
• Consider a reduction in the work hours 
• Alter when and/or how a job function is performed 
• Recognize that a reassignment to a position that better matches the skills and capabilities of the employee may be necessary 

As a personal example, I retired before I had any measurable cognitive impairment because I knew I was on the Alzheimer’s trajectory, and I wasn’t going to take the chance of harming a patient because of a cognitive slip up.  During the year following retirement, I volunteered at a free-clinic providing general medical care under the supervision of an experienced specialist in internal or family medicine. As time went on, I stopped seeing patients altogether, and I did not renew my medical license, but my fund of neurological knowledge was still robust so I was able to continue volunteer teaching on annual trips to Africa for another three years. Continued work will be possible for some, but it will probably involve evolving the job into one with more supervision, perhaps less stress, and by identifying strengths that remain and can be built upon.