Soapbox By Kay

Mother and the Dementia Paradigm Shift

Source: Journal of Clinical Neurology

This past Tuesday, Mother and I headed over to USF for her first-ever MRI.  She did wonderfully, and they got very good images, which they then handed to us on a CD to carry to our later appointment at the Byrd Alzheimer’s Institute. After a nice lunch at Panera, we were able to make our noon appointment with Dr. Fargher with 10 minutes to spare.

While I waited in the lobby, Dr. Fargher escorted Mother back for an MMSE and evaluation. Afterward, it was my turn in the doctor’s office to talk about the results. Mother scored higher on the MMSE this time than she did when we visited two years ago. This does not usually happen. What made the biggest difference was one item that last time Mother didn’t even try, saying “I can’t”, that this time she attempted and got 4 out of 5 points for. I told Dr. Fargher that when we had visited before, Mother had only just started going to the Neighborly Care Network senior center, and for the past 1.5 years or so, she has been attending three days per week.

With the report Dr. Fargher had received from the imaging lab, and the CD I had in hand, we looked at the brain images together which showed some overall shrinkage (not uncommon given Mom’s age), very little shrinkage in the areas of the brain normally connected with Alzheimer’s, and a couple of spots indicating small strokes (ischemic incidents, for you medically-oriented family members). This indicates that most of Mother’s dementia is actually vascular in origin.

We also talked about Mom’s hearing loss, and the doctor mentioned that she had to resort to using a pen and paper to clarify some of the questions, and Mother was able to easily understand and answer, even doing fairly well on remembering a set of three words, after they were written down. The doctor suggested we keep a whiteboard handy at home for times when Steve or I didn’t feel like we were getting an idea across. We decided that Mother’s current meds were all good, and that there was no reason to set up regular appointments, but to call if any additional problems arose.

This really changes everything! 

The length of time from diagnosis of Alzheimer’s to death is usually 3-7 years, depending on what stage the person is when evaluated. Since Mom’s initial diagnosis for Alzheimer’s-type Dementia back in 2007 (no MRI done at that time), I’ve been worrying about how I would handle her inevitable decline, starting with having to work part-time so I’d be home with her anytime she wasn’t at the senior center, and of not being able to leave her alone even for short periods of time. I’ve been waiting for the horrible eventuality of Mom deteriorating into some mere shell of herself, not remembering anything or recognizing anyone.  

For vascular dementia, if the stroke risk is addressed, then relatively normal functioning can be maintained indefinitely. All this time, I just thought that her meds were working really well, as the decline we’ve seen is really minimal, and the memory loss patchy and not interfering that much with her daily functioning. (You don’t really need to remember what a hush puppy is in order to fix yourself a sandwich for lunch.)

With the realization that a lot of Mom’s seeming inability to grasp what we’re telling her is probably directly linked to her hearing loss, my falling-off-to-sleep self wondered last night about the possibility of us all learning some basic sign language. I already know how to sign “thank you” and “good morning” – maybe Mom and I will start working on that today.