Senator Reveals Struggle with Dementia
> 10/8/2007 1:10:34 PM

Senator Pete Domenici (R-N.M.) has served tirelessly in the Senate for over 30 years, but he announced last week that he will not seek another term. He revealed that he has been conflicted about what to do after receiving a diagnosis of frontotemporal lobar degeneration (FLD) several years ago. While he was optimistic at first, he was sobered by a recent test showing significant deterioration. Now, he wants only to finish the term that ends in January 2008.

Senator Domenici can do the country at least one more service by raising awareness of the difficult decisions thrust upon those with dementia. Dementia, most commonly striking in the form of Alzheimerís Disease, is a general term for a number of problems that diminish brain function. Frontotemporal lobar degeneration affects the part of the brain that controls speech, planning, judgement, and personality. While it does not usually come with the memory problems so feared in Alzheimerís Disease, many of the symptoms are extremely unsettling. Sufferers often encounter difficulty communicating, and their behavior becomes erratic and impulsive. Previously considerate and wise people may lash out angrily or make foolish professional and social decisions. What makes FLD particularly frightening is that the brain damage usually renders sufferers unable to perceive their own deterioration. They are often unable to tell when they are acting differently, and should rely on family and friends to monitor their condition.

The terrible symptoms of FLD worsen until death, which occurs sometime between two and ten years. There is no cure, nor even a way to slow down the inexorable deterioration. Thus, the only remaining decision is how to spend the last years of life. Senator Domenici has chosen to try and maintain his daily routine in the short-term while planning to retire at a convenient break in his career. Staying active and maintaining routine can be helpful with some forms of dementia. For dementias with severe memory problems, keeping to familiar places and patterns can reduce confusion. Senator Domeniciís decision is questionable though, because FLD impacts judgment more severely than memory, and because it has a very unpredictable course. Even though colleagues have not reported any notable deterioration in performance in the past year, debilitating impairments could strike suddenly.

Most doctors recommend that patients with FLD quickly relieve themselves of important responsibilities. Dr. David Knopman from the Mayo Clinic acknowledged that he did not know the particulars of Senator Domeniciís case, but he told CNN that he would give the Senator the same advice he gives all of his patients with FLD. "They would be prone to have poor judgment and make mistakes. I would encourage them to leave their employment." This creates something of a paradox; if Senator Domenici steps down now then he will display a wisdom that makes his decision somewhat overcautious, but if he does not step down, voters will be left to worry that he is obstinately hanging on because his judgement is impaired.

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