I was Talking to the Little Dog

Around Grandpa one has to become accustomed to non-sequitors and free flowing activity. The protein plaque builds up on his brain as Alzheimer’s progresses and it becomes an increasing struggle for his brain to function. Two results of this are the failure to properly process information, which leads to non-sequitors, and the inability to follow a course of thoughts and action, which leads to free flowing activity. These two problems are very, very, common in his daily life. It is at the point where they are more common activity than normal environmental interaction (whether with people or objects)

Grandpa wakes up often every night to go to the bathroom. A good trip is when he gets up to use the bathroom, does so, and comes back promptly and gets back into bed–all without turning on the light. Usually a bathroom trip isn’t so good. Grandpa usually can leave the bedroom without turning on the light, but just as often needs to turn it on when he gets back. Obviously having the light turned on is disruptive for me, but worse is that with the light on Grandpa is far more likely to see something that will derail his train of thought and instead of going directly to bed he will start doing something else. Maybe he will see a bit of junk on the floor that needs to go into the garbage. Maybe he will decide he needs to neaten his bed. Or maybe he will decide he needs some toilet paper off the roll beside the bed and he will spend a few minutes carefully folding a few sheets of paper. Or else he will decide to organize the top of the dresser. These are the common derailing activities the slow the process of going back to bed. For me it is very easy to see how his eyes rests on these various objects and he thinks something about them that gets his mind on a different track from going to bed. Usually his derailment doesn’t last more than a few minutes, but at 2:00 AM a few minutes with the light on feels much longer.

Last night when Grandpa came back from the bathroom he turned the bedroom light on and his eyes fell on a sweater lying on his bed. He picked it up and began to put it on.

“Grandpa,” I said. “Do you really want to put the sweater on?”

“I might get cold,” he said. (Which is certainly the thought prompted in his mind by seeing the sweater, but in reality he wasn’t going to get cold in bed.)

“All right,” I said. When I see him get derailed I generally try to prompt him with questions to help keep him on track but if he insists on his derailed thought I will usually let him go on with it. I feel this better respects his dignity.

He was halfway through putting on the sweater when the non-sequitor came. “You awake?” He said.

“Yeah,” I said. “I’m awake.”

“No,” he said. “I was talking to the little dog over there.”

“Oh,” I said. There were some objects in the direction he pointed. Perhaps one of them looked like a dog to him. Sometimes Grandpa is clearly mis-seeing objects (or not correctly interpreting what he sees,) other times his statements are so far removed from the reality of the situation that one might wonder if it is a complete hallucination. I presently don’t think Grandpa has visual hallucinations. We all must interpret what our eyes tells us–for normal healthy adults this is an instantaneous process that most of the time we don’t even think about. Not so for Grandpa struggling under the stifling protein plaque killing his brain. He struggles to understand what he is seeing, and compounded with that is a mental detachment. I think these combine to create the seeming hallucinatory occasions. Somehow he saw something that struck him as looking like a dog, and in his mental detachment there seemed nothing strange about such a sight in his bedroom.

After he got his sweater on he sat down on the edge of his bed and saw his socks beside the bed. So he put them on.

“Grandpa, you’re getting into bed,” I prompted. “Do you wear your socks to bed?”

“Sometimes,” he said.

I let it pass. Ten minutes after he was back in bed with the light out he sat back up and took the sweater off. Sometime later in the night I think he took off the socks as well.

**

Another example of derailment was this afternoon. Grandma sent Grandpa to mail two letters. As best I can reconstruct it he went down to the mailbox and saw the empty garbage can there. Then he checked the mailbox and saw the mail had already come. So he took the garbage can back up to the garage. Then, since he couldn’t open the garage from the outside, he went back into the house by the front door and went down to the garage. But now in the garage he couldn’t remember what he was doing, so he took something out of the garage into the house. I heard all of the door opening and shutting and went down to check on him. I found him in the garage with the letters still clutched in one hand, moving a jug of windshield washer fluid around.

“Need any help?” I asked.

“I don’t think so,” he said.

Since he declined the offer of help and wasn’t getting into any dangerous trouble, I let him be. A little later he came up and asked me where he should put the letters. After a little questioning I managed to determine that there was mail already in the box and he didn’t see any point in putting the letters out until tomorrow morning. Perhaps he had a brain freeze and couldn’t figure out how to take the received mail out of the box and put the out-going mail in at the same time and so reasoned that the letters didn’t need to go out yet. I told him he could put the letters by the telephone to go out later. Then Grandpa decided he would go outside to get the mail that had arrived.

When he came back inside with the mail he saw some specks of dirt on the carpet. So he put the mail down on the floor and got on his hands and knees to pick up the flecks of dirt. I sorted the mail and Grandpa went to take his little flecks of dirt down to the trash can in the garage.