Ralph had his yearly mental check up yesterday. A slow learner, after four years I have finally realized that there is no reason to bring up appointments ahead of time. So when he woke up at eight, I announced we had to be ready in two hours to head to Atlanta to see his doctor at Emory. Of course, Ralph was a little tense on the drive in, but less anxious than he would have been if he’d had more time to worry. And I didn’t have to have the following conversation in the car more than a few times.
Head or hands? he asked. (We have seen a dermatologist at Emory recently as well so asking this was a positive sign.)
Head.
What are they going to do?
Ask you some questions probably.
Will it take long?
I don’t think too long.
I am not looking forward to this.
I nodded but secretly I have come to look forward to our Emory visits with Nurse Practitioner Stephanie V. While Ralph gets his testing, Stephanie always meets with me alone for an update, a conversation that I find strangely comforting. She asks my impressions, and then lets me ramble a bit. Her advice tends to be straightforward and useful. She never fails to ask how I am doing. I always get not quite teary but close. I always leave feeling reassured that I am handling things better than I thought.
As for the appointment results… Amazingly, they showed exactly what I told Stephanie I’ve sensed: that his objective memory, for words for instance, seems to be holding steady; but that he seems to be having more difficulty carrying on conversations or activities like following directions that require more complicated processing.
In the testing Ralph actually improved his memory for words, remembering more animal names and more words beginning with the letter F. (At least that’s my memory of the results—in fact as soon as I leave Emory my own memory of what has been said becomes a bit of a blur.)
What dropped was his ability to connect the dots when he had to include numbers and letters, i.e., go from number to letter to number. The test, which he completed without errors last year in 70 seconds, took him 120 seconds this year with several mistakes. In other words he is having more trouble with more complicated linkage.
I am not sure how to read this reversal in strength and weakness and don’t think it matters too much. Basically, the holding pattern we have been in still holds and will keep holding until it doesn’t.
Alice in Memoryland 
My 3rd annual neuropsych testing (3 sessions, 2 hours of tests each session) with my neuropsychologist starts tomorrow and continues on the following two Tuesdays, with results in late August. My self-assessment is that my memory remains pretty much intact, and my memory test results also improved slightly in the 2nd year compared to the 1st.
However, like many EOAD patients, my visual-spatial and language abilities are slipping even while my memory hangs in there. Last spring, I messed up for the first time the same “connect the dots” test as Ralph during a visit to my neurologist. About a month ago, I became completely disoriented for about a minute driving my usual route to the hardware store. More recently, my wife and I visited a store together. As I looked at a woman who I took for a stranger talking to the cashier, I suddenly recognized that the “stranger” was my wife. Very unsettling.
I’ve been on 10mg Aricept for about 6 months now. I understand that for most people its peak efficacy occurs at about half that time, and then the symptoms start to progress again. So my Aricept honeymoon probably is over and my symptoms probably have or soon will resume their inexorable progression.
I empathize with Ralph feeling tense as you drove to his annual testing. At times I’m pretty apprehensive about what my tests might show, and I’m definitely not looking forward to how mentally tiring I know the tests themselves will be, but mostly I’ve come to accept and be at peace with where my path inevitably is leading. My faith has been important to me for most of the last 30 years and I have felt God’s presence by my side many times, but never more strongly than this year. As I circle the airport in my own holding pattern, it’s nice for my caregiving spouse and me to have a co-pilot. The fuel gauge may be dropping and for sure we’re going to crash, but we leave it to him to pay attention to that while we try to enjoy the view for as long as we can!
Heading Somewhere
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Thanks for writing. Always good to hear from you and get your perspective. I can’t comment on the quality of your memory, but your capacity for thoughtful perception is strong as ever. You might ask your doctor if you should add Namenda or the generic version that you take twice a day. Ralph definitely got a lift when he added to the Arecept, and he has continued for three years to hold steady. I am sure those “unsettling” moments were not pleasant. The fact that you can discuss them so honestly is a gift, to yourself and to those who care about you (myself included). And what I have noticed, at least with Ralph, is that there is a balance (not necessarily even) between the unsettling moments of smokey fog and moments of startling normalcy. Take care. I think of a lot.
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Thanks, Alice. I think my neurologist actually is considering adding trazadone, an older antidepressant with a good safety record that recently has attracted some attention as a possibly useful drug treating AD. It’s also used sometimes for insomnia. Sleep is becoming a bit of an issue for me because I seem to be one of those for whom intense dreaming is an unwanted side effect of Aricept. I also have a sleep study scheduled later this month to rule out sleep apnea as a contributory cause to the fogginess that Ralph, I, and so many others with AD share.
My best to you and Ralph and all your growing family!
Heading Somewhere
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Am pleased for you and Ralph that his overall function is in a “holding pattern” — actually increasing recall of some animal words and those starting with “F” — even though complicated language more challenging. Expect your efforts to incorporate what you learn about how best to talk with him into your daily interactions positively contributes to his status, so give yourself some credit. Glad you have someone caring for you as well as your husband.
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Thanks for your encouragement. Hope you are doing ok too….
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That’s what’s happening here, too. Small, subtle changes over the last year or two – most evident when I offer multi-part remarks – much more difficult for J to follow what I’m asking or saying. I’m learning to think before speaking, so as not to set up a predictable difficulty. Thanks, Alice.
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I too am learning the art of limited conversation. Have not mastered yet. We sometimes seem to be having two different conversations, or the same conversation on two different planes. Thanks for writing. Knowing others are in the same place really does help, doesn’t it?
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Good that the holding pattern is still holding a year on from his last test. Stephanie sounds like the best kind of Nurse Practitioner.
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We are very lucky to have her in our lives. Thanks….
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