Even through the dark and hazy eyes of the person with Alzheimer's disease, there are flashes and dashes, speckles and glimmers of remembrance.
These moments bring hope, even though as the speckles diminish the hope becomes weaker. It is unfathomable that one morning life rolls out smoothly as the loved one with the disease arises with a smile, dresses with shirt on frontward and pants zipped.
Breakfast flows by with syrup topping the pancakes and coffee sipped with quiet delight. It seems as if the disease has vanished, or that at least it is on the retreat.
Then 10 am approaches. While it is just a few hours later, the ordinary life retreats into a jumble. Arguments erupt over stolen keys even though the keys are on the hook by the door where they are always hung after a trip.
A bill is opened and a refund check within is glanced at and then tossed into the fireplace. The formerly lovely cup of coffee is dumped on a plant and the empty container is placed in the closet, not rinsed or washed.
All right, "Little things happen" and so the rest of the day should be better. With jackets buttoned and hats pulled snug against wintry blasts, caregiver and loved one head out to the warmed car.
Climbing in and fastening seatbelts are a breeze as the click of the belt, the door, the lock signal all is safe to set out on the road and a trip to a physician for a mental health checkup.
While Mom is nervous about the doctor's appointment, that is because it is a variation for her routine. She knows her mind is fine and that dear daughter is simply over reacting.
While the long wait in the "waiting room" (how perfect!) adds some kicks of Mom's feet again the table nearby and an occasion grunt, "Why are we here?" daughter reassures that this is just a visit to learn about Mom's forgetting and to make sure that medications are balanced and her blood pressure and vital signs are strong.
More nervousness with twinges of agitation become louder and more evident until finally "Emelda Gray" is announced by the nurse. You enter and sit and wait some more until the doctor finally ventures in.
"How are you, Emedla?" Dr. Gleevers asks.
Mom smiles gently and responds, "Perfectly fine. And very healthy! That last medicine has really done the trick. Thanks for your thoughtful consideration."
Thoughtful consideration!?! You wonder. Where did that come from? She chokes it down with difficulty and expresses only exasperation at the requirement of ingesting it.
But this is only the beginning of her charm.
Vision and hearing - good.
Dress and hygiene - excellent
The weather, the President, the year and date, names, prescriptions, past visits. Every one of these posed questions is responded to with precision, no faltering, and never a misstep.
"You are fine, Emelda," pronounces Dr. Gleevers. "Keep up the good work."
"I know and I will," Mom beams triumphantly.
And you mutter, "But, this morning when and yesterday after and just last week... " But your daughterly, loving intervention is ignored. The doctor has stated and Mom agrees: All is well. No need to worry or stress.
Defeat invades your already weary soul as you and Mom trounce out of the examination room and head for the coatrack.
Suddenly confusion re-intervenes. Mom wrangles her arm into her coat that she has bragged and is holding upside down. She rips her arm out then forces the coat on again, but this time it is backward.
Her warm hat falls to the floor and so she kicks it under a chair. When you reach for it, the well aimed kick lands on your arm. "Ouch!"
However, Mom cannot hear as she is headed out the door. You find her staring blankly at the elevator buttons, tears rolling down her cheeks as she weeps. "What is happening to me?"
You'd like to stomp back into the office, shouting, "Are you kidding me?" but you recognize it as a worthless expenditure of energy.
Mom has her secrets and she also has an uncanny way of masking her forgetfulness as it invades her cognition. Explaining this control as opposed to other moments when control is nonexistent is part of the problem of a correct diagnosis.
Mom has been triumphant - why would she go back for another examination? Dr. Gleevers is kind and understanding so why return needlessly? Had Dr. Gleevers been loud or cruel or abrupt, why would she subject herself to a repeat performance?
Getting a loved one to a doctor once is an achievement. Getting her there twice when she does not admit a problem exists? Good luck.
This scenario exemplifies many a visit with an Alzheimer's victim in the early stages of the disease, especially when s/he is in denial, refusing to admit or recognize a problem at a time when it is most vital that she speaks up.
It is exceedingly beneficial that you as caregiver and loving family member or friend know that life is not right, that there are too many errors of living that are also dangerous, and that regardless of the potential repercussions from every direction, a proper diagnosis is critical. Here are some tips to help you through this agony:
- Keep a record of changes - in hygiene, in performing daily functions, in conversing or driving or preparing meals
- Note eating changes - leftovers left for weeks, no food in the house, meals eaten one after the other after the other with no memory of any of them
- Observe and jot down changes in behavior - sudden anger, intense emotional discharges, withdrawing from favorite social activities
- Talk with your physician and share your concerns (Power of Attorney for Medical Care allows you to discuss your concerns for a loved one one-on-one).
- Schedule an appointment with a neurologist who is specially trained in dementia, elder care, and Alzheimer's disease
- Ask for an extended appointment so that there is a thorough examination of your loved one and time for you to talk with the physician privately
- During the examination, do not interrupt, answer for your loved one, or correct errors and/or misconceptions. Reserve these for your private conversation
- Do not be content with quick prescriptions or flippancy. You care for your loved one and you want the best for him/her
- Contact a local Alzheimer's disease support group or the Alzheimer's Association (http://www.alz.org) to learn more about the disease and to assure yourself that you are not alone
Glimmers of cognition are wonderful reprieves from the downward spiral of Alzheimer's disease. Appreciate these moments as you marvel as a loved one's ability to reason and react reasonably in one instant and to melt into oblivion in the next.
As the disease progresses periods of cognition become shorter and shorter until a millisecond fills the space. That is part of the cruelty of this long trail to death.
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