My blow dryer broke today and I remembered I’d seen another one at the bottom of the linen closet, so I retrieved it. It was still in the box and looked all shiny and new. As I was taking it out, I noticed a Christmas tag in the bottom. It read, “Merry Christmas, Phyllis. Love, Dad and Mother.”

As I was drying my hair I thought about the gift card and I began to wonder if I might be the first person to actually use the dryer. After all, I don’t remember Mother ever washing her own hair, let alone setting and drying it. She always had a weekly appointment with the hairdresser, where I learned early to pick her out from the lineup of alien faces peering out from under those dome dryers.

Then there was its condition – it was mint – no smudges, no scratches! The cord wasn’t warn or kinky. And it worked just fine.

So how old was this dryer, anyway? Since my grandfather died in 1962, this must have been given to Mother in the late ‘50s, before we moved east!

Mother saved things because, as she used to say, “You never know when you might need it.”  Well, after 55 years, I needed it!  Thanks, Mom!

It has been a challenging four years since Mother passed away – four years ago Friday, to be exact. And I’m still going through her things – things she just couldn’t part with.

At first it was easy to toss the piles of magazines, newspapers and mailers she had meticulously stacked on the fireplace hearth. Then I found the boxes of Arizona Highways and Sunset Magazines on a closet shelf. Her macular degeneration had prevented her from reading them, but they were “brand new” and, as she had told me, “I might want to read them some time – they look so interesting!”

“But, Mom,” I complained, “you have so much stuff that you never use.”

“Well, I can’t help it. I’m a saver,” she responded.

And I think she really couldn’t help it. She grew up during the Great Depression and I know that had an effect on her. As a child I remember watching her carefully wash and smooth out aluminum foil to use again and again until all it was good for was wrapping baked potatoes. I interviewed her once in highschool for a modern history paper about her experiences during the Depression. If I find that paper I’ll share it here. After all, I am her daughter.

A person’s gait could be early sign of Alzheimer’s

As the child of a mother and great-grandmother who both had Alzheimer’s disease, I was interested in reading the USA Today article entitled, A person’s gait could be early sign of Alzheimer’s. I had associated slow, unsteady walking with the aging process and had never thought that it could be an early sign of dementia. Sometimes the answers can be right in front of us if only we could see them.

A friend drew my attention to this 2008 article by Dr. Mary Newport. I’m not surprised that there may well be a nutritional cure for Alzheimer’s Disease. Take a look at the article and share your thoughts with me:  http://www.coconutketones.com/whatifcure.pdf

It’s been more than two years since Mother passed away and this year we celebrated a quiet Christmas with friends. The entry below highlights the moment when we knew something was terribly wrong with Mother’s memory. Up until this point, Mother had been able to mask her memory problems.

Christmas Day 2007

We won’t be putting a wreath on the door or draping the evergreens with lights this year. There will be no Christmas music in the air or a tree in the living room or warm, familiar smells wafting from the oven because I won’t be baking Grandma’s famous pecan pie. I did all that last year when Mother came over for Christmas, but she won’t be joining us this year.

Mother was having trouble living alone the last few years and had finally agreed to move to a retirement home where she would still enjoy living in a spacious apartment among her cherished furnishings and memories, but have the support of a caring staff to help her. She would still be able to sleep as long as she wanted each morning, putter around in her red bathrobe over coffee, read the newspaper until noon, attend exercise classes, play cards, watch a movie if she felt like it, and join the other residents for cocktails and dinner each evening in one of two swanky dining rooms.

It had been four months since she’d moved from her house. After two months in her new residence she offered, “Why don’t you and Steve move into my house and look after it for me. It makes no sense for you to rent a house and for mine to sit empty.”  So we did. Which is why we so looked forward to having her over for Christmas. She hadn’t been back to see her house since she’d moved out and we thought she’d really enjoy the homecoming.

I phoned her from work on December 24^th and said I’d be over by 5 pm. At 4:30 I arrived and checked her apartment. She wasn’t there. So I walked up to the lobby and there she was, waiting for dinner to be announced. She seemed surprised to see me, but went with me to her rooms. I helped her pack and as we made the 25-minute drive to the house she commented on all the holiday lights.

She sat in the living room watching Christmas specials with Steve while I made our traditional Christmas Eve fare, chili. The next morning we opened presents under the tree. We exchanged the red slippers I had bought to go with our matching red bathrobes that she had purchased 20 years ago and which had become our mother-daughter hallmark. During her afternoon nap, I put the finishing touches on the turkey, dressing, green bean casserole, potatoes, and gravy. We ate at 5 pm and I took her “home” about 8:30.

Mother seemed to have had a nice time, though she’d been distant at times. She’d asked, “Is this my house?” When I said, “Yes, does it look familiar?” she’d replied, “Sort of.”

The next day at work I received a call from Mother. “Barbara, what time are you coming for me?”

“Oh, I didn’t realize I was coming over today.”

“Yes, to get me for Christmas!”

“But Mother, Christmas was yesterday.”

There was a pause on the other end of the line. “You mean I missed Christmas?”

Thanksgiving 2007

When we sold our house in Denver and went overseas our plan, when we returned to the States, had been to relocate near Mother. That way we could visit her often and spend the holidays together.  The first several years we were together, I made nice, traditional turkey dinners for Thanksgiving and Christmas. When Mother moved to assisted living and no longer remembered the significance of the holidays, we would join her there for holiday meals.

A few months before her Alzheimer’s was diagnosed she had moved to a very nice senior residence nearby.  She decided to spend Thanksgiving with my brother and his family in Southern California. So we obtained her airfare, helped her pack, and drove her to the airport. We checked her in and, since we couldn’t escort her through security to the proper gate, we requested wheelchair assistance for her. My brother Dewey met her in LA.

While she was there she seemed distant, Dewey’s wife reported.  She would follow him to the door when he left for work and then go back to her bedroom. She showed little interest in conversation or activities. We used the opportunity to fly to Seattle to spend Thanksgiving with our children and grandchildren – a much-needed and welcomed break.

Thanksgiving 2008

Thanksgiving 2008

The following year Dewey came up for Thanksgiving and we joined Mother at her assisted-living residence for their lovely and plentiful dinner. We particularly enjoyed the meal because the facility never charged for the meals family members shared with the residents. We only had to let them know we wanted to stay and places would be set for us. Of course, in this case, we had to sign up in advance for seating. Although Mother didn’t seem to realize quite what Thanksgiving was, she was pleased to see us. We didn’t know it at the time but that was our last Thanksgiving together.

I have been a subscriber to Wordsmith.org’s A.Word.A.Day e-newsletter for a several years. Today’s word – anosognosia, a noun meaning “unawareness of one’s disease, disability, or a defect” – made me wonder whether suffers of Alzheimer’s disease were aware of their memory loss and, if so, to what degree. My online research brought up an article on the AlzOnline Caregiver Support Online site that addresses those questions and more. The article’s called Anosognosia (Unawareness of Decline or Difficulties), prepared by Leilani Doty, PhD, Director, University of Florida Cognitive & Memory Disorder Clinics.

Looking at the Anosognosia Rating Scale copied below, I was able to recall incidents in Mother’s decline that correlated with the four categories, though the ones that stand out the most were the times she angrily insisted that she had no memory problems at all. The fact that she had forgotten to pay the water and waste disposal bills for a number of months only surfaced when she received notice that these services were to be suspended and even then she denied ever having been in arrears.

Anosognosia Rating Scale

1. Easily admits memory loss
2. Admits (sometimes inconsistently) to small amount of memory loss
3. Not aware of any impairment in memory
4. Angrily insists that no memory problem exists

The article also helps to identify the range of self-awareness the person experiences, further illustrated by examples of coping strategies which can include making excuses and confabulation. Confabulation is not a lie but a condition where a gap in a person’s memory is replaced by a falsification that he or she believes to be true.

Most helpful are the sections that follow on Caregiver Challenges and Interaction Tips which give examples of how to approach, interact and speak to someone who has anosognosia.  If only I had seen these tips at the time – they would have greatly smoothed our day-to-day interactions.

Ruth D. Watkins-Leech tells us that her memoir, You Have to Laugh or Else You’ll Cry, was written “to let others who have loved ones with Alzheimer’s disease know they are not alone” and that help is available for both the loved one and the caregiver. The Introduction and Addendum include the warning signs of Alzheimer’s and reference online help and information sites. But the centerpiece of the story is Aunt Alice, whom Ms. Watkins-Leech cared for during the last four years of Alice’s life.

Writing in the first person, in an easy, conversational style, Ms. Watkins-Leech begins each chapter with a joke that shows a lighter side of aging, like memory loss and driving issues, with a few surprises thrown in. She then leads the reader through the last few years of her Aunt Alice’s life, with frequent flashbacks capturing incidents that help to frame Alice’s personality and character. It is during these earlier episodes that the author suggests that Alice’s responses and behaviors might have been indicators of her developing Alzheimer’s disease.

The chapters provide snapshots of Alice, first at her husband’s funeral, then coping with the loss of her mobile home, living with family and moving into a succession of assisted living residences. As Alice’s physical needs increase and her judgment and disposition worsen, the author takes on more and more responsibility for Alice’s care.

This story honestly addresses the many concerns of the Alzheimer’s patient, as well as those of the caregivers – oftentimes family members who find themselves coping with a situation they could never have anticipated.  Having gone through similar experiences in caring for my mother with Alzheimer’s disease, the core elements of Ms. Watkins-Leech’s story ring true to my own. The sections that dealt with having to move Alice into assisted living especially resonated with me as we, too, had to face the fact that Mother could no longer manage alone and that assisted living was the best option for her.

The sequence of events in the story have universal appeal and Nevada County, California, residents will especially appreciate material in the Addendum which identifies local facilities with memory care units.

I would certainly recommend this book to anyone with a loved one suffering with Alzheimer’s or other dementias, even if they are not a caregiver. It will help them to understand the challenges facing both the loved one and the caregiver and give them the necessary background to give the caregiver the emotional support they so deserve.

Any reservations I may have deal with secondary matters. The lack of page numbers made sections in the book awkward to reference, though such navigation would be less of an issue in an electronic edition. Also, the cost of the book should be considered. It is laudable that the author is donating portions of the proceeds to three Alzheimer’s organizations, but the price seems a bit high for a book of this length.

___________________________________________________________________________________________________

You Have to Laugh or Else You’ll Cry by Ruth D. Watkins-Leech, (c) 2010, non-fiction, 62 pages, memoir recounting her experiences caring for her aunt  with Alzheimer’s disease, $10, available in both paper and ebook format on Smashwords.com .

The 21-minute HBO presentation on Identifying Mild cognitive impairment features Ronald Petersen, M.D., Ph.D., the Alzheimer’s Association Medical and Scientific Advisory Council Chair. Dr. Peterson “explains mild cognitive impairment and highlights the importance of distinguishing among the various dementias that can occur with aging.” It is interesting to note that Dr. Petersen was the physician who diagnosed former President Ronald Regan with Alzheimer’s.

The video gives two case studies of patients with dementia and discusses the differences between Alzheimer’s and other dementias. The first patient has another form of dementia – Lewy bodies. He is concerned about his memory because he loses his train of thought midstream and knows that this is new for him. The second patient was followed for 6-10 years in this study. He forgets last names and is aware he can’t remember them as he used to. His wife says he used to think ahead, but now he thinks in the past.

The video also provides some interesting statistical information, including one that states of those over 71-years-old who develop dementia:

70% have Alzheimer’s,
17 % have Vascular Dementia, and
13% have other dementias, including Lewy bodies.

I found this video particularly interesting in that these men admit that they are experiencing memory problems. Mother, however, never admitted that her memory had changed at all.

Today’s (Monday, 9/26/11) The Union newspaper features Kristy Paul, a Grass Valley, CA, area resident since 2005, who works with people experiencing all kinds of memory loss, including dementia and early to moderate Alzheimer’s disease. Her business, Mindful Memories, uses activity booklets to help clients reconnect with memories that she says are not really lost, just hidden. Paul is a certified Ashby Memory Method (AMM) provider who received her training through the Alzheimer’s Innovation Institute. Read the full article for details and contact information. (No link to the article is currently available.)