Abstract
In diseases marked by anosognosia, a neurologically based unawareness of deficit, and otherwise good health, there is often literally no complaint for the neuropsychologist to address were it not for the observations and assistance of the multigenerational family system. Because we rely on the family as a rich, ongoing source of clinical information to guide dementia diagnosis and as the primary avenue for carrying out recommendations over the course of the disease, our clinical focus during the initial clinical interview and feedback session must necessarily include the patient’s extended family. This chapter will address strategies for harnessing and nurturing the insight, observations, and caregiving network of the multigenerational family system in the initial clinical interview and feedback sessions to facilitate assessment and management of dementia patients. Understanding the pressures and strengths of the family dynamics is complicated for clinicians as changing societal expectations and the diversity inherent in different cultures and unique family dynamics result in an almost limitless variety of presentations. Clinicians must therefore design our assessments to specifically ask families about dynamics, preferably in person, and be prepared to utilize that understanding to improve diagnostic accuracy and support the multigenerational family system as care plans are developed and carried out.
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Notes
- 1.
Recall that all members of the family system are “listening in” when you speak directly to an individual family member in the room. The power of an overheard communication can be consciously utilized to send messages to other targeted family members without the friction of direct confrontation.
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Postal, K. (2019). The Multigenerational Family System in Dementia: Assessment and Feedback. In: Ravdin, L.D., Katzen, H.L. (eds) Handbook on the Neuropsychology of Aging and Dementia. Clinical Handbooks in Neuropsychology. Springer, Cham. https://doi.org/10.1007/978-3-319-93497-6_9
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