From the Dementia Friendly Community Initiative: The Three Clocks of Dementia

The question every dementia family asks is “How long do we have?”

Reza Hosseini Ghomi, MD, MSE, a neuropsychiatrist and health tech expert, used to give textbook answers about averages and stages. Now he tells them about the Three Clocks.

Clock #1: The Medical Clock
This is what families expect doctors to discuss. Stages, timelines, progression rates. The answer is “mild cognitive impairment progresses to dementia at the rate of 10-15% annually.” But this clock is largely useless for real-world planning. What does that mean for Tuesday’s grocery shopping? Nothing.

Clock #2: The Functional Clock
This is what actually matters for daily life. When will driving become unsafe? When will living alone become risky? When will complex financial decisions need supervision? When will medication management require help? This clock runs differently for everyone. Some patients drive safely for years after diagnosis, others need to stop driving immediately.

Clock #3: The Family Clock
This is the clock we don’t talk about but everyone lives by: How long can the spouse manage caregiving alone? When will siblings need to have “the conversation”? How much time before difficult decisions become urgent? When will family dynamics crack under pressure?

Here’s what Dr. Ghomi has learned after 1,000+ dementia consultations:

The Medical Clock gets all the attention but provides the least useful information for families.
The Functional Clock determines actual quality of life and safety.
The Family Clock determines whether the first two clocks matter at all.

Averages and generalities are not of much use to families dealing with dementia. The three questions they need answers for are: What shall we watch for? What specific milestones? How do we prepare as a family to face these changes?

The most important clock isn’t ticking in the patient’s brain. It’s ticking in the family’s capacity to adapt. When families ask “How long do we have?” they’re really asking “How do we make the most of whatever time remains?”

This article is submitted by Dementia Friendly Community Initiative, a program of Whitewater Seniors in the Park to help educate the community about dementia and to support patients and caregivers. New committee members are very welcome!

Contact Jackson@whitewater-wi.gov or call Jennifer at 262 473 0535
https://www.whitewater-wi.gov/273/Seniors-In-the-Park

For more information on family dynamics and dementia: https://www.caregiver.org/resource/holding-family-meeting/