Piano World Home Page Forums Our Most Popular Forums Piano Teachers Forum Addressing an older student's cognitive decline

This isn't actually a piano student - I teach another instrument - but I thought you all might have some useful advice.

My student is a male in his late sixties. He is fit and active but has been having heart problems over the last few years. I see him fortnightly; he is a relatively competent player and our relationship is more mentor/mentee rather than student/teacher.

Recently I have been noticing memory lapses - he will repeat the same anecdote, even in the same lesson, forget names of well-known players or composers, and so on. His practising, which was very structured, appears to have become much more haphazard and unplanned. He has also missed lesson appointments or turned up at times when I wasn't expecting him. Finally, last week he went through a whole set of new material with me - except we had gone through that same new material in the prior lesson. Later that day he emailed asking if he'd left behind an accessory he hadn't brought out or used during the lesson.

Of course none of these are serious things in themselves but it seems out of character. I have a suspicion that the nature of playing music is such that if there is an issue here, I might be the first to be seeing it.

Would you address this? If so, how?

I am considering ensuring that I have some free time spare at the end of our next lesson, and at the end of the lesson have a brief discussion about it, and then send a follow-up email that he can read after he's had to time to think about it.

I can only give you my experience from my personal life: let it go; your mentioning it to him is not likely to have a good outcome. You mention you may be the first to have recognized this but if he has any friends, or family, they would have noticed this long before you.

I don’t intend to sound callous but I was in the same situation. I struggled over whether to get involved and, if so, when. When I mentioned the memory lapses to his wife, she told me ‘yes, I’ve seen some of the same’ but in a tone that signaled me to back off... and quickly. A. neurologist friend has advised there is Generally little that can be done.

I know you want to help.... so did I.

I have been in the same boat. There is really nothing you can do, but to be KIND to the person.

Yep, same answer here. Cognitive problems can indeed start this way. Just accept that your student might suffer from this from now on, even though it can vary quite a bit from week to week. Sometimes everything gets back to normal for a while. Simply continue to enjoy the relationship while accepting the new possible limitations when the student is suffering more.

Are you my teacher?

Seriously, just be kind.

Tough call. If he's your friend, and you would want a friend to raise such an issue with you, then give it a try. But it likely won't accomplish much, except to strain your relationship.

This is one of the saddest situations in which we as teachers can find ourselves. You, your student, and his family all have my sympathy.

As his teacher, it would be entirely appropriate to address this part of the situation



by writing more detailed notes and practice instructions corresponding to his materials.

Unless he's very isolated you are not the first one to notice it.

People have told me similar stories - in one case a tuba player who still plays well including gigs but has had significant decline. He has a friend who now helps him remember dates, drives him to the playing jobs, and helps him deposit the checks.

I think the most I would do is talk to him about improving the structure of his practice, something many of have to do as we age.

Oh......and no more recitals from memory!

Pardon my jumping in -- I'm usually just on Pianist Corner but saw this listed on "Active Threads"....

As someone who works in that field, I have to say that I think there's more that you can do than what has been said here.

First of all, I want to say that you have observed the situation extremely well, very perceptively, and you describe it extremely well. It is definitely some kind of cognitive issue.

Especially in view of the kind of feel that you have for this, I think it's quite possible that you could make a good contribution by saying something.

First of all. it's important to realize, it's not true that little can be done. There now are medications that can slow the progression of cognitive decline in certain deteriorating illnesses, but that's not even the main thing that I mean. (I think those medications are over-prescribed, and that they don't help most people who take them.) The main things I'm talking about are:

-- Sometimes it's not a deteriorating condition, but some other kind of thing that is well treatable, or even just side effects of medications. While one might figure that for sure the person's doctors are on top of this, it's not necessarily so, including because many people don't go to their doctors regularly enough, or at all.

-- Even when it is the kind of condition that seems to be assumed here, people usually can be helped to function better within that condition, with guidance and training by the right kinds of professionals.

It's a delicate thing, for sure, and unless you happen to be somewhat knowledgeable and perceptive and sensitive about these things, indeed it would probably be a non-starter to try to do anything. But you are all of those things. I wouldn't blame you if you decide it's best to take a pass on it, but I say, go for it. See if you can gently convey some of this to him and/or to whatever family you might be in touch with.

+1. You mentioned that your student has been having heart problems, in this case his cognitive decline may be connected to a decreased blood supply to the brain. I observed a kind of mental decline in my grandfather after a heart attack and following congestive heart failure. Brain functioning may be improved in this case by treating heart failure.

It could also be other things that seem unrelated. For example, when my grandmother was in her late 90's, she had a significant cognitive decline when she became dehydrated from the effects of lactose intolerance. When her gastric issues were resolved, her cognitive function significantly improved. This decline and improvement happened over a short period of time - about 4 weeks.

Along these lines, mentioned by Mark C and Tyrone Slothrop, respectively:

"Sometimes it's not a deteriorating condition, but some other kind of thing that is well treatable..."

"It could also be other things that seem unrelated."

Urinary tract infections, fairly common in the elderly, can cause temporary cognitive decline. If your student's memory lapses are a recent phenomenon, I'd wonder whether he might have a UTI. If he does, treatment for that may help restore his lost functioning, or some of it.

Disclaimer: I'm not a medical professional; I only have experience with aging parents (mine, and those of my husband's and some friends') who have been afflicted with these things.

Good luck to you, u38cg. I can't advise you on whether or how to speak with your student about the decline you've noticed, but if you do, it might be worth a shot to mention the above possibility.

I agree with the later posts. I work with people with cognitive issues all the time. It’s true that straight up dementia does not respond terribly well to medicines, but there can be other causes of an acute change in cognitive function as others have pointed out. There could be a metabolic cause, a hormone imbalance, an electrolyte or kidney problem, an infection, etc etc. It could be a sleep deprivation issue or a medicine problem.

Even if it is just dementia, there are programs that can help improve function and support that the person might not know about.

I think the best way to handle the situation is to point out that you’ve noticed some memory lapses, repetitiveness, and confusion that seems unusual for him/her, and suggest that he/she sees his / her doctor to get checked out.

(BruceD pointed out my memory lapses twice just this week!)

See something, say something. You just might save a life.

#dementiaprevention

It is a good idea, imo, to go very carefully with the conversation so that the student doesn't automatically jump to the "A" word and panic. Perhaps say something to the effect, "I noticed your practicing seems a bit disjointed [or that you seem to be having trouble with remembering your lesson schedule] and I was wondering if you've had a change in medications or your health status that might be causing these problems. I'm not asking you to tell me, just pointing out some changes I've noticed and that you might want to follow up with your doctor."

Most people equate forgetfulness with dementia and dementia with Alzheimer's and that is a blow. Do what you can to soften it (and it might well be something other than Alzheimer's).

What a heartbreaking post

I agree with what others have said. The best thing you can do is to be kind and supportive

Amen!

How I wished people would have said something when I started to lose weight like nobody's business. Maybe I would've gotten treatment earlier, and would be in a different place now.

I hope you have gotten treatment now!

I know one couple where the wife either has a serious glandular problem or is anorexic, and I wonder if the husband has ever intervened in any way. Because it just seems terribly wrong. But I must admit, possibly the problem in your case is society as a whole frowns on people commenting on other people's weight, and doubly so if it is a man commenting on a woman's weight.

BTW, my late wife was anorexic. And yes, I intervened multiple times but she was very good at hiding the things she would do to reduce the calorie count to zero. But she ended up dying - anorexia was one of the complicating factors. It's a very difficult problem to address. She was 5'10" tall and under 100 lbs when she died.

I’m sorry about your late wife. Anorexia is so tough to treat. It’s not like you can throw meds at it.

I’m healthy now. Very grateful for that.

I'm sorry to hear that, it must have been so tough on all concerned at the time Tyrone.