As I See It

AD continues its slow, steady invasion of Helen's brain. Thank God Scott got that one button coffee maker. She is shying away from all machines. She can't play her Don Williams anymore, she doesn't know which buttons to push. Same with the other appliances. Aside from reading, I can see when I go there what she does when she is alone in the evening. She straightens the house. She moves books/DVDs/Videos to different places and stacks them very neatly. I may start companioning a bit more, now that I know Dorothy can take a day twice a month so I can recover myself. The job is tedious. I mean, just being there, but you know all that. It's just that she needs another human being there and not be wandering about the house all alone straightening things. Amy found an excellent book dealing specifically with the early stages of the disease, although we may not be "there" that long if the current pace of the disease doesn't slacken. Her comfort zone is shrinking. She doesn’t want to go anywhere. Perhaps that’s the weather of late, perhaps not. She does want new fingernails put on. One of you women folk may want to do that, though I will. It is, after all, something she wants to do and it will get her out. The weather forecast is good for this week. (1/11/10)

Basically, any new thing/situation or information is what she can't assimilate. I'm not even sure she is understanding 100% of my end of our conversations as she doesn't pick up on the fact that I've changed the subject. So having said all that, I'm still using a "loose rein" approach to my companioning, letting her control what she can control, and do the lengthening list of things she can't do anymore myself...except give her a bath, of course, which she has quit doing also. She's showing the same exact symptoms that are in every book about the disease. The course of the disease is relatively predictable save for what time any new symptoms will manifest themselves, and they will. I wonder if she still does her own laundry? I'll ask Amy.

Good Day

Just thought I'd enter an upbeat post for a change. Today, Monday the 4th, Helen had a perfect day. She was well-groomed, her appetite was good, her memory was good, her mood was good. It was just a good day all around. R.

explaining the ups and downs

Hope, et. al. In most (not all) cases, Alzheimer's moves steadily and inexorably (like a glacier) and behavioral changes are only noted over time. What seems to be happening now are mini-strokes. I, too, have witnessed scenes such as you describe just last week, like an angry "who are you and what are you doing in my house" look and others, like telling Scott to get a plumber to fix the toilet then giving Gary money to go buy a new toilet 10 minutes later. It was all very upsetting. Mini-strokes alter behavior when they happen, "all of a sudden" if you will. But then, you still have AD at work too and it can at times be hard to distinguish which one is the culprit. Both, I suppose. Like I said, the CT scan was extremely telling. There is a lot (and I mean a heck of a lot) of mini-stroke damage and also a heck of a lot of AD damage as well. It left me wondering how is Helen even functioning and fretting about how much worse this is going to become over time.

It is emotionally hard as heck on me and you all, too. An RN with clinical depression caring for a loved one with progressive dementia. It would be comical if it didn't hurt so.

Hey Rob,
Thank you for the information. I did not know that mother has had mini-strokes. Some how I got out of the loop on that one. It causes me to wonder what else I might have missed.
Last time Sam and I visited Mother (Dec. 5 and 6) she exhibited some behaviors that were really a lot more pronounced than they have been before. I caught her looking at Sam once or twice in a way that made me think she was having trouble remembering who he was. She looked a little scared. So I used his name in the conversation and she seemed to relax.
And then she told us the story of how she and Daddy met, fell in love, married, lived on Thompson Place with Grandad. Of course we know she repeats things but this time she repeated the story almost word for word immediately after she finished the first account of it. I enjoy listening to her stories about the love she and Daddy shared ; I'm glad that that is the way she remembers her life with Daddy. I tend to remember Daddy with fondness myself.
The other happening was Saturday night. Scott had come to visit us and check to see whether Mom had taken her medication. It was around 8:30 to 9:00 . He stayed for 45 minutes or so just chatting with all of us. He left us around 8:45 to 9:30. About 10 minutes later Mother picked up the phone, called Scott (who was in bed already) , and told him that we were visiting and and asked if he wouldn't like to come over and visit with us . I don't know what he told Mom but he seemed to satisfy her. She didn't seem confused or hurt after she hung up the phone. As it was getting late we all said goodnight and went to bed - while Mother chose the couch.
Anyway, we took Mom out to Cracker Barrel on Sunday and she seemed to have a good time.
I know Sam and I did. Mom seemed to have a hard time remembering it was Sunday but that was easy to deal with - who really cared if it was Saturday or Sunday?!
Sam and I will try to come up to visit again early in February. And as always, we have you in our thoughts, and are grateful for the time and tender care you give our Momma.
Sincerely,
Hope and Sam Peeples

As time goes by

Rob,
Thanks for keeping me educated on these heartaches : - ((

Becky

Mini-strokes 101

Hope, read my comment to your question on "immovable object."

There are more nerve connections in the brain than there are stars in the universe. Each nerve cell is ultimately fed by blood vessels that would make a human hair look thick. This is why a person can have so very many mini-strokes, as Helen has had, and because they are so tiny, why the person never knows it even is happening, nor does anyone else. What showed up on the CAT scan were the dead brain cells whose blood supply was cut off by one of these mini-strokes. Depending on which of these countless cells dies, let's say it's the cell that knows my phone number, Helen would no longer be able to remember it.

To complicate matters, all of these nerve cells are interconnected, so that a particular system, let's say the one that governs Chuck's name loses a cell vital to that connection, she'll not remember Chuck's name, as she did with me day before yesterday. Fortunately there are a lot of "connections" that can also remember the name "Chuck," only by a different pathway with different associations. Your mom has AD and, as we all suspected, severe vascular dementia.

What worries me is that Alzheimer's is a slow, steady process and vascular dementia, that is a new mini-stroke, often produces an instantly recognizable change, and I think your mom has had several this week. She's not like she was last week. She seems more readily "lost" and wandering around. Also, new things (like going to the Doctor or a wedding) will produce the same confusion....something that's out of her comfort zone, something "new" where she has to reason out, like tonight, how to get ready for a wedding. It could be both AD and Vascular dementia to blame for this. She was clearly agitated, but not in a nasty way.She put on her High heels and then wondered aloud how she was going to get her bluejeans off over them. It never entered her mind to remove the shoes first. Lesson: Explain in detail when you are getting her out of her comfort zone what you are doing and why. She may understand, she may not.

There are mini-strokes, strokes, and massive strokes. Helen has the first one. In spades. She has probably been having them for years. The second would only serve to paralyze her, God forbid. The third will send her on to Greener Pastures. Strokes generally, but not always, happen at night while the person is asleep, I think I told you all that. My best guess is that since she walks so little, clots will form in the vessels behind the knee and will at sometime break off ("throwing an embolus") and, due to it's size will lodge in a brain vessel that feeds life-sustaining cells and she simply won't wake up. Then again, she might outlive us all. God Knows.

It's because there are trillions of connections in the brain that even evidence of massive mini-strokes having taken place plus the ability of the healthy parts of the brain to do "double duty" that your mom's behavior doesn't act like what it looked like it should be having viewed the CAT scan. Your mom always had an exceptionally good head on her shoulders, so I, for one, am not surprised. R.

Hope Read my comment on Irresistible force. R