NCIS drama is nice holiday story, but bad medicine
8 p.m. Dec. 15
Special Agent Leroy Jethro Gibbs (Mark Harmon), head of the NCIS (Naval Criminal Investigative Service) team, is trying to figure out why his father (Ralph Waite) pays a surprise visit for the holidays. Gibbs’ father is withdrawn, uncommunicative, disoriented and exhibiting loss of memory. Gibbs is concerned that his dad has suffered a stroke or has dementia. But a doctor who comes to the house can find nothing neurologically wrong -- no sign of impaired recognition, no difficulty with speaking or writing (motor aphasia) or solving mental puzzles. He suggests that Gibbs Sr.'s problem is more likely due to an emotional disturbance, such as the loss of a loved one. Gibbs learns that his father recently had to shoot and kill someone who was robbing his store, in order to protect two innocent bystanders, and the process of doing so has affected him deeply, leading him to visit his son for reassurance.
The medical questions
Is depression or emotional disturbance a common cause of memory loss or sudden change of behavior in the elderly? How can this be recognized and distinguished from an acute neurological problem or dementia? How easy is this problem to treat?
It is possible that depression can impair memory, says Dr. Jeffrey Cummings, director of UCLA’s Alzheimer’s research center. This is more common in the elderly than in younger people, Cummings adds. However, it is unusual for the problem to be so severe that the patient becomes as disoriented as the senior Gibbs does; memory loss from depression or an emotional shock is usually less severe than that seen with dementia. Gibbs Sr.'s degree of impairment may be a clue that something else is going on in the brain. “I would follow Jethro’s dad carefully to see if dementia evolves,” Cummings says.
A new neurological problem such as a stroke, cancer or infection cannot be excluded without a work-up including an MRI of the brain, blood tests and possibly a spinal tap, says Dr. John R. Burton, director of the Johns Hopkins Geriatric Education Center at Johns Hopkins University in Baltimore. He, like Cummings, feels that the physician who examines Gibbs Sr. is too hasty in concluding that the shock from the robbery is the only issue here. Depression, he adds, can be the first manifestation of a developing dementia, and so the older Gibbs may not improve significantly even if he is treated with antidepressants and/or psychotherapy.
Reuniting with a loved one during a time of trouble is important but is not likely to be sufficient to cure a disoriented, depressed patient such as Gibbs. His courageous shooting of the store burglar and his heart-rending trip to see his son are nice premises for a fictional show during the holiday season, but the medical conclusions in the episode are not particularly instructive for a real-life son or daughter encountering a suddenly failing parent in the real world.
Siegel is an associate professor at New York University’s School of Medicine and author of the e-book “Swine Flu: The New Pandemic.”