It is interesting to see how the mental aspect of Grandpa’s Alzheimer’s progresses. We can divide the mental function of the brain into two categories: (1) Dealing with outside stimuli, and (2) Processing one’s own internal thoughts and reflections. It is hard to judge how Alzheimer’s affects the latter–we can’t see into the mind of others, and we really don’t understand how our own thoughts process or work very well either. But on the first matter, that of the failing mind of an Alzheimer’s victim dealing with outside stimuli, and the breakdown of that ability, a close observer gets a front row seat to the effects of deteriorating cognitive ability.
For Grandpa, his ability to understand what he saw began failing before his ability to understand what he heard. Long ago I wrote about how he would see imaginary people and things. At times there were quasi-plausible explanations for the imagined people–a pillow or a blanket or some such thing that could be interpreted as a person by someone who was nearly blind or unable to make sense of what he was seeing. Other times there were no obvious triggers for the imagined things he saw.
There is a strange kind of tension between the sickness of the failing mind and the retained cognitive ability. The failing mind cannot keep itself anchored within the present, so people and things suddenly appearing are sometimes accepted without question. Thus Grandpa can suddenly start talking to an imagined person sitting on the couch, without any thought that it might be strange to have someone appearing in his house who he didn’t remember coming, and may not even recognize. The only thing that matters is that the person doesn’t respond to Grandpa’s conversing, and he can become indignant or hurt.
But then other times Grandpa does doubt himself. He will look in some direction and say, “Is there really [such-and-such] there?”
And I will say, “No, Grandpa, that is just a [chair, or whatever he is looking at]”
Then he will say, “Oh,” and look very perplexed because while what he saw didn’t make sense and so he questioned it, it was still what he thought he saw.
And sometimes he will say in despair, “I don’t know why I see things that aren’t there. It doesn’t make sense. I guess I don’t know nothing.”
Grandpa’s visual understanding of the world around him is not consistent. Some times he is better, other times he is worse. The trend is downward, and one think I notice in that downward trend is that, while he hasn’t lost things he had before, it is getting harder and harder for him to understand what he sees. For you and me we naturally interpret and understand what we are seeing. For Grandpa it is something he must work at. Recognizing people and things is mental effort much akin to how you or I might attempt to solve a difficult problem. And when it becomes too much work, or he is not paying attention, Grandpa doesn’t interpret or make sense of his surroundings. He ends up just being “someplace” with “things” around him. At such times he doesn’t know where he is, and he doesn’t know where anyone else is. In a very real sense, he finds himself alone. This is manifested when he talks to Grandma as if she was right there with him when she isn’t in the room, or asks her where she is when she is sitting right in front of him. He asks people where they are, and ask them where he is, and asks him where things are–and understands none of the answers.
“I’m sitting in my chair,” Grandma says.
“Where is that?” Grandpa says, looking right at her.
“Why don’t you sit on the couch,” Grandma says.
“Okay,” Grandpa says, standing beside the couch. “Where is that?”
That is Grandpa at his worst. He is as good as blind then–worse actually, because a blind man still knows how to orient himself in space but for Grandpa not only does he not understand what he is seeing, but he can’t relate things to each other within space. At a doorway he can turn left or right, but has no understanding which direction will take him where or why he would want to go in either direction. He simply goes on impulse, or faint memories–which means when he comes out of the bathroom he is just as likely to go to the bedroom as the living room. When I take him to the bathroom he says, “Okay, which way are we going, this way or that way?” and points in two different directions. He has no idea of the destination, and no surety even in the direction. You can’t point things out to him, or explain to him how things are done, because what he sees has no meaning.
That is Grandpa at his worst. He is not at his worst all the time, but rarely is he at his best. Most of the time he hovers somewhere in the middle, understanding some things, being able to understand some things, but existing in a limited state of awareness of his surroundings.
For a long time Grandpa’s hearing was his great support. Though his eyes deceived him, his ears would reassure him. If he called for someone and they answered he would be able to place them in relation to himself and would be comforted. Recently, his ability to understand what he hears has begun to noticeably fail. Sometimes he will call and someone will respond and he will say, “Where are you?” sounding very much like a person lost in a great dark void–when in reality the person responding might be sitting across from him in the living room, or just in the kitchen. He is losing the ability to spatially place sound.
He is also losing the ability to distinguish sounds. We recognize people when we see them, and we recognize people when we hear them. Grandpa has increasing ability recognizing who he sees–his own sons and daughters, and even increasingly Grandma–and now this is spreading to his hearing as well. I must distinguish between recognizing and knowing. So far Grandpa hasn’t demonstrated any forgetfulness that he is married and has children, grandchildren, and even great grandchildren. His failure, presently, is that he cannot recognize, or recall, who he is seeing. For example, he might say, “Who is that?” And I say, “That’s Daryl [his daughter, one of my aunts]” and he will say, “Oh, how are you doing Daryl,” and may even ask about her daughters, showing that he truly knows who Daryl is–he just didn’t place who he knew to be Daryl with the person in front of him.
I don’t know exactly when his hearing ability began to fail in the same manner. Leading up to my realization of this, Some months ago–probably about early summer–he almost spontaneously started calling for his brother Gene all the time. Obviously this itself was a clear manifestation of cognitive decline, as his brother Gene lives about a half hour or so away in Pennsylvania and hasn’t been up to visit in all the time I have been living with Grandma and Grandpa. But the call for Gene doesn’t have a single simplistic explanation–I don’t know that there is just one reason he calls for his older brother. At least part of the time the call seems to find it root in an emotional impulse–Grandpa is feeling lost, lonely, uncertain, confused, or any number of other things, and the impulse is to call for someone to set it right, to explain, or whatever. But sometimes Grandpa does want something concrete, and he will call for Gene in that situation also.
Initially when Grandpa called for Gene I would answer, “He’s not here. What do you want?” which would get varying responses.
“I want Gene.”
“Where is he?”
Or sometimes Grandpa would tell me what he wanted, or make something up. As Grandpa began to consistently call for Gene it grew tiring to constantly say, “He’s not here,” before inquiring what Grandpa wanted. And I also began to suspect that Grandpa was in the beginning stages of conflating me with Gene. So instead of informing Grandpa that Gene wasn’t present, I took to simply answering his call of “Gene!” with, “What do you want?”
At first, maybe fifty present of the time Grandpa would say, “You’re not Gene.” And I would say, “No, but Gene isn’t here, so I’m answering for him. Now when Grandpa calls for Gene I answer, and rarely does he say, “You’re not Gene.”
Discovering how much simpler it made life for me if I simply answered Grandpa when he called for someone I started answering when he called “Ma!” Realizing that I haven’t been in Grandpa’s life long enough for him to ever get in the habit of calling for me, I have begun answering for whoever is called.
Again, while at first Grandpa would say, “You’re not Ma” when I answered he began to do so less and less. I initially thought he was becoming accustomed to someone answering for Grandma, but then an incident revealed that in truth he was having trouble distinguishing who answered him.
One evening he said, “Hey Ma!”
“What?” I said.
“Why don’t you come sit down beside me,” he said.
“Okay,” I said and got up from the computer to go over and sit down beside him.
“Not you,” Grandpa said, seeing me approach. “That woman said she would come sit with me.”
“No that was me who answered you,” I said.
From that point on it became increasing clear that Grandpa often could not distinguish who answered him. This discovery made life much easier for me because now when Grandpa would call incessantly for someone (usually Gene or Grandma) I could answer for either and quiet him. If he said, “Ma, how are you doing?” I could say, “Just fine,” and he would be satisfied. Or if he said, “Ma, where are you?” and I would say, “Over here,” and he would be appeased.
It is not as if he never recognizes who is speaking, just as he can still recognize things he sees. But I think he has to be very much paying attention to distinguish who is speaking.
However, things have continued to deteriorate. A few weeks ago one evening Grandpa was hollering “Ma? Ma? Ma?” so I came over and said, “What do you want?”
Grandpa stared at me for a long minute. “Well?” he said. “She asked you what you wanted.”
That was a new one for surreal exchanges where I somehow ended up being responsible for carrying on both ends of the conversation as two (or perhaps three?) different people.
Again, more recently, Grandpa was calling for Gene but seemed to have no particular want in mind because when I came and inquired he muttered and mumbled stuff while pointing at the chairs and objects around him. I assured him that everything was all right.
“Well, yeah, okay . . .” he said, and turned back to his fussing. Ten seconds later, “Hey, Gene!”
“Yeah, what do you want,” I said. “I’m still standing right behind you. I came last time you called.”
“Oh, geez!” Grandpa said, startling, having already forgotten I was there. “Yeah, I guess you did. Well how am I going to distinguish between when you and I speak?” he said, very well summarizing his problems.
And that is where we are now.
I was going to finish off with a recounting of how Grandpa was sick last Saturday, but I’ve already spent too much time on this, and anyhow it seemed like it might have turned out too much sounding like a “sob-sob pity me and my trials” kind of thing, which it wasn’t and not the kind of attitude one wants to project. Suffice to say just being a little bit sick robs Grandpa of what senses he still has, and rendered him nearly unable to eat, drink, or function. All the result of a minor head cold. He also peed on the kitchen table.
Not sure how comprehensible that entire post was, but I wrote it fast and now I gotta go.
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