Fear of loss of mental function is an overwhelming dread among those of advanced age. Everyone experiences moments when our minds don’t respond as we would like. As we age, those moments are more dreaded as the looming specter of years of vegetation rears its ugliness. No one wants to end their days in a locked ward or in the misery of circular confusion.
The fear that we keep to ourselves, though, is something that we may try to keep hidden from others. We all have coping mechanisms, developed most likely in childhood, that allow us to preserve our sense of self-worth even when we find ourselves a bit short of the mark. We may respond with congenial laughter to a remark by another that we are having trouble grasping. Or, we may retreat into comfortable caves of patterned thinking – liberal or conservative; mocking of societal novelties; discomfort with new technologies – hoping that our patterns are shared by others. No one wants to be rendered irrelevant by advancing age.
The trouble is that those who are actually afflicted by cognitive loss often deny their own decline as they grasp at self-worth. That is difficult for those around them. The signs can be subtle. Four years ago, a friend of mind took time to study a complex concept, and he emerged a master able to teach others. Today, at age 86, he struggles to maintain the same kind of authority but the result is meandering irrelevancies. No one is so impolitic to tell him to relax into aging. He, like many, is struggling to still matter despite the encroachment of age which saps the former acuity of his mind.
This is tragic. It is particularly difficult in the early stages when even those closest to the afflicted person may rationalize the emerging signs of change as having no import. The tragedy deepens with time. You can read a poignant, poetic story of loss due to Alzheimer’s at the bottom of this webpage
That still leaves us with the question, though, of how best to cope with our fear. Fear and anger are primal human emotions, which is why they are often evoked by people trying to manipulate our thinking whether in a political or selling context. Raw emotions are not good guideposts to follow in setting our life course. We’re better served to move beyond simplistic reaction toward rational coping.
Faced with the challenges of mental decline, many aging people turn to brain games. That’s fine. The brain maintenance quality of Bridge, for instance, is often attested, though unfortunately Bridge seems to be losing popularity as a younger generation of residents begins to move into senior living. Profit oriented entrepreneurs – Dakim™, Lumosity®, iN2L – to name just a few are making a living catering to the fear of seniors. Whether those proprietary approaches are better than more mainstream brain exercises like Chess, Bridge, or Monopoly® is a hotly debated question. Exercise, weight control, and good eating may be equally effective.
More difficult, though, is how best to accept the slide when it comes. Those of us living in CCRCs all know people who are in denial about their loss. It’s hard for people who have lived independently all their lives to accept dependence for matters that require discernment, knowledge, or sound judgment. It’s easier to accept physical infirmity than loss of mental cognition. And, yet, diminishing cognition is a challenge that in its mildest forms affects many of us.
While we may wish for an easy answer to this challenge, there is none that we know of. The author of this introduction looks to the example of his Great Aunt Bella, born in 1882, an independent woman who never married and who continued to earn her own living as a church organist until she was nearly 90. She graduated from Smith in 1908, after working first to save to pay for her education.
She was remarkable. But, with time, she would leave her home and forget how to get back. After three calls from the police, it was evident that a person, who can’t remember where home is, can no longer live independently. Fortunately, the wonderful Isabella Geriatric Center was nearby, and Aunt Bella lived out her days with moments of lucidity among a cloud of confusion but happily tended by caring people.
Perhaps, that’s the best that any of us can hope for. We’d like to hear from you about how you and those you know are coping with this dread of cognitive loss.
in the video of an actual case of dementia diagnosis to the right, you will gain new insights into this dreadful affliction.
Gary Small: Dr. Gary Small, (Los Angeles, CA) is a professor of psychiatry and director of the UCLA Longevity Center* at the Semel Institute for Neuroscience & Human Behavior. His research, supported by the NIH, has made headlines in the Wall Street Journal and the New York Times. Scientific American magazine named him one of the world's leading innovators in science and technology. Dr. Small lectures internationally and frequently appears on the Today show, Good Morning America, PBS, and CNN. He has written six books, including the New York Times best seller, The Memory Bible.
In the video to the right he speaks of research into aging. The video is one hour long.
In the video to the right the Reverend Gene Wetzel, an ordained clergyman in the United Church of Christ, a professional counselor, and a CCRC resident provides comfort and understanding for those who are faced with the tragedy of Alzheimer's Disease. The video is one hour long..
In the video to the right Dr. Ray Killeen, a physician and a CCRC resident, reflects on how memory can be impacted by age. The video is half an hour long..
On March 25, 2015, the U. S. Senate's Special Committee on Aging convened to hear testimony from researchers, Alzheimer's Disease patients, and others..
Alzheimer’s — the pronouncing of a dreaded sentence. For Martha, my wife, the sharp picture in my memory is from eight or nine years ago. She was in our bedroom, the door open, getting ready to go out. I looked through from the living room and saw, unbelievingly, that she was trying to put on her hose over her slacks and shoes. A cold wave washed through me. Trying to keep my tone natural, half-bantering, I said, “That won’t work, will it? But you’re already dressed.”
Did we talk about it, then or later, facing together what such an incident might imply? Some couples would have. Our relationship was close; the love between us very strong, going back to one mild October night in 1940, on the porch of a house on a quiet street near the Princeton campus, when we made our commitment to each other. Martha was a sophomore at Westminster Choir College and I a graduate theology student. Over the years we shared in much of our work, and in the decisions of raising our six children; but this was not something we could discuss.
The children grown and gone, Martha and I were living in an adult community a dozen miles from Princeton. I talked with our family doctor and, encouraged by
him, went with Martha to see a neurologist. Martha submitted to a cranial MRI; she found the closed-in feeling and the noise unbearable and declared that she’d never go through that again. The neurologist, if he suspected Alzheimer’s, did not mention it. He took a low-key approach, evidently meant to be calming and reassuring. He wrote that he would be glad to see Martha again, but, for now, would treat her with “benign neglect.”
Was a problem becoming noticeable? I thought not, inclined to overlook some signs at home of misjudgment or forgetfulness. In our retirement community, Martha, a lifelong musician, was directing the chorus. I was startled one evening when one of the singers, whose husband was a fairly advanced Alzheimer’s patient, said to me privately after a rehearsal, “I know what you have ahead of you.”
I wrote and was directing a play for the ecumenical church, giving Martha a key role because she always had loved drama. But in rehearsal her crucial speech near the end kept coming out garbled, disconnected. “Just stick to the cue card,” I was telling her. “Read it; that doesn’t matter.” She wouldn’t, or couldn’t, seem to do that, even in the final performance.
I began to supervise, as casually as possible, Martha’s cooking and household chores. Routine tasks would get twisted, items misplaced. Reluctantly, I had to think about, and then gradually talk about, making a move. We needed to be closer to one of our children, and in a continuing-care retirement community (CCRC). Our daughter Marilyn lived in Voorhees, an hour’s drive south. We knew the area well. Marilyn told us about a new CCRC only a mile from her family’s home. Four months later we were moving in.
Things went well for almost three years. Martha slowly was losing ground, but still was getting around with a bit of help. We had kind friends, dinner daily in the pleasant common dining rooms, and activities, including a group for residents coping with memory difficulties. (Alzheimer’s was discussed only when we caregivers met separately.) Then, in a hair salon, Martha accidentally was bumped and fell, fracturing a hip — an almost inevitable chapter in this kind of story. Her surgery went well, but the trauma pushed her disease down the road.
Rehab followed in a skilled-nursing facility. Before Martha’s fall, speech had been growing difficult for her — finding the words for her thoughts and putting them together. Now, most of the words, and comprehension of them, seemed to be gone. I’ve always enjoyed writing poetry and found expression through it. This piece, “Evening,” was written as I sat in Martha’s room:
So we’ll talk no more, my love;
The moon is almost down.
Few words are left; none to express
What we have shared of loveliness,
Of swallows skimming grass at dusk,
And firefly sparks among the trees,
Of organ music in a shadowy nave,
One soft light only on your face and hands
And whiteness of the keys.
In our silence, now, I hold you, warm and dear
As always — hold you here, and yet not here —
Your smile flickering on the edge of time,
As you move deeper into the not-time
And I reach you less and less. Love, it’s still you,
Making the passage gently, by degrees.
I’ll make it, too, sometime — we still count time —
And we will talk again; or need no words
For perfect sharing — in God’s harmony.
Martha was now confined to a wheelchair, but we began to work determinedly at therapy — a few steps with a walker, then gradually more. I was able to move her back to be with me in our apartment — my heart’s desire. She could get in and out of our car and could walk into our daughter’s home. Her walking improved, so that she could manage the long corridors to the dining rooms, then leave the walker, to go in on my arm and find a table.
Occasionally there are surprising snatches of memory and recognition. After reading an article suggesting that coconut oil might have some benefits for Alzheimer’s patients, I began to add some to our diet — two tablespoons each, blended into our instant oatmeal every morning. No one claims a miracle, but family and friends remark that Martha often is brighter and more responsive.
Yet, there is the inexorable progress of the disease. It shows itself in sporadic moods of resistance, alienation, even hostility. These are sometimes made more disturbing by hallucinations — troubled ideas about people or things that are out there, beyond the windows and doors, and insistent demands that somehow must be attended to.
The words come in snatches, blurred, hardly comprehensible.
Martha generally knows me, sometimes clings to me. I’m grateful for that. But one recent evening, clutching my hand with almost fierce affection, she kept saying, “Call; can’t you call?”
“Whom do you want me to call?”
“Call Don; I need to talk to Don!”
It is as in the poem, “Love, it’s still you, making the passage gently, by degrees.” I dread that inevitable degree at which her passage carries her too far — when she no longer can know who I am for her.