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Reza Hosseini Ghomi, MD, MSE · Jun 26, 2025 · 2 min read

Three Clocks for Dementia

The question every dementia family asks me: "How long do we have?" I used to give textbook answers about averages and stages. Now I tell them about the Three Clocks. Clock #1: The Medical Clock This is what families expect me to discuss. Stages, timelines, progression rates. But this clock is largely useless for real-world planning. "Mild cognitive impairment progresses to dementia at 10-15% annually." 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. I've seen patients drive safely for years after diagnosis, and others who needed to stop 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 I've learned after 1000+ 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.
The Three Questions I Actually Answer
  • "What should we watch for?" (Functional Clock)
  • "When should we worry?" (Safety milestones)
  • "How do we prepare?" (Family system planning)
What Families Really Need
  • Specific skills assessment, not general stages
  • Safety milestone planning, not average timelines
  • Family system preparation, not medical predictions
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?" That's a question worth answering well.

Reza Hosseini Ghomi, MD, MSE https://www.linkedin.com/in/rezahg/
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