A DIFFERENT KIND OF COGNITIVE TEST: REAL LIFE

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After writing about Ralph and my experience with organized cognitive tests, I watched Ralph in action in a different kind of cognitive challenge last Friday.

Living in the country without door-to-door garbage service, I travel weekly to the recycling center. I drive Ralph’s truck and take along Lola the dog for company. I drink a diet soda on the way and occasionally (read every time) treat myself to a candy bar afterwards. There is something oddly satisfying about coming home with empty cans and baskets.

But recently I pulled a back muscle grandmothering a bit too exuberantly and have avoided bending/lifting ever since. Meanwhile our garbage began piling up.

On Friday I couldn’t stand it any longer and announced to Ralph that after lunch we were heading to the dump. Now Ralph usually helps me load the garbage into his truck. Once or twice he has driven with me to the recycling center, which happens to be across from the location of his art classes. On those two occasions he enjoyed sitting in the truck with his dog and cigarette watching me unload, a choice I made because I figured I would be faster. He has never participated in throwing stuff away.

Recycling is does not require much detailed thought. After throwing unrecyclable garbage that’s been put in county bags, into a dumpster, I mindlessly divide everything else to toss in the marked bins. You probably know the drill: aluminum, plastic, newspaper, junk mail, cardboard, and glass by the color.

For Ralph our recycling trip was a challenge.

The dogs didn’t help. We decided not to bring them because old Zeus has trouble climbing into the truck these days so Lola needed to stay behind to keep him company. But then Zeus hid under the house so there was a bit of a kerfuffle until he showed up as we were backing out of the drive way  and we got him into the house. Ralph, already nervous—he’d called me three times while I was running to the bank beforehand to ask what he’d have to do—and now he was worrying about Zeus’s health as well as the garbage.

Usually I drive us everywhere these days, but driving Ralph’s truck with a bad back was not an option. It has been awhile since I sat in his passenger seat with him behind the wheel. He drives very carefully, going 35 in the 45-mile-an hour zone until I suggested, with mild (I hope) impatience, that he might consider the speed limit. (He does drive very carefully so if you are asking, as I do frequently, Is it safe for him to drive?, the answer is I think so as long as he doesn’t have to worry about finding his way alone. I hope I’m right)

In any case, we arrived safe and sound. But our time at the recycling center was not fun. Despite large clear labeling on the bins, Ralph could not keep track of where anything went. His difficulty was that I was asking him to combine several unfamiliar activities at once. I could feel his frustration mounting. I took a deep breath, had him bring the recyclables to me at the biggest bin, did as much emptying as I could manage and directed him hither and yon.

No stops for candy bars on the way home. But I thanked him profusely for his help. And Ralph was like a small boy desperately wanting to do well at a chore that was slightly beyond him and thrilled when he made it through.

Seeing him react, I realized that I have been letting him slide. If a situation might be difficult, I’ve avoided it. But Ralph can live with a little anxiety, and a gentle challenge enlivens him. So the next day, Saturday, I announced to Ralph that we were going into Atlanta to see the Andy Warhol exhibit at the High Museum. Painting is one of Ralph’s only activities after all.

He wasn’t thrilled but again he reluctantly agreed.

I drove.

On the way, when Ralph announced he was hungry, I got him to eschew his standby fast food choice. Instead we had lunch at the museum café. Suddenly Ralph got into the spirit. He talked about the courtyard artwork with enthusiasm, he ate with a gusto rare for him these days, he wandered through Warhold exhibit reading all the placards and studying the pieces. He tried to get me to buy stuff in the gift shop. Afterwards we paid a short visit to friends who live near the museum, and he was sharp as a tack.

Of course he doesn’t remember the trips to the dump or the museum or the friends. But I remember for us.

(PS Coming soon: The Tractor Drama unfolding as I type)

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14 thoughts on “A DIFFERENT KIND OF COGNITIVE TEST: REAL LIFE

  1. Thanks for sharing, it’s a good reminder to try and keep loved ones with cognitive impairment engaged for as long as they are interested and able, even if it does slow things down or make things more complicated. I guess I never realized you were near Atlanta, I pass by the High Museum every day on the way to work. Glad you guys had a nice trip.

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    1. Joy,I’m surprised we’ve never crossed paths. The fact is it is sometimes difficult to keep any elderly person engaged. But every little experience an older or cognitively impaired person has–I was involved for years with an impaired cousin my own age–helps improve his/her life.

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  2. I’m always caught between the goal of minimizing my partner’s confrontations with the growing deficits, and the desire to keep her engaged. Cooking was a huge part of her day, but is no longer safe because of the tendency to forget what she has just done or is about to do. So, I feel caught, again, between the value (and the work!) of breaking out parts of the cooking tasks that are not dangerous, and the need to not awaken too much expectation of her doing the cooking.
    It’s a little like letting a person do a little driving….almost better to quit altogether than wonder if the person will try to drive, or cook, when I’m not right there.
    Thanks again for this thoughtful entry, Alice.

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    1. It is a never ending puzzle to me frankly. Sometimes I get it right. More often, I’m afraid, I don’t. And for each person, as well as for each moment in each life, the balance is slightly different. Thanks so much for sharing. Funny how similar yet different all our struggles seem to be.

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  3. Such a key point allowing a person do as much as possible for themself as possible. Expect just because they’re able to do something once you can’t always be confident they’ll be able to do it another time.

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  4. This is a good post raising lots of issue and I really appreciated reading the comments from Anonymous and Carole. On the subject of doing things ourselves because it’s quicker, I still remember my feelings of shame when I was slicing a banana on dad’s breakfast cereal. He looked me in the eye and asked, ‘Have I really become so helpless?’ I handed him the banana and the knife. He got on with the job – but so very slowly I’m sure the cornflakes must have been completely soggy by the time he finished.
    Driving – well, we had to bite the bullet eventually when dents and scrapes appeared regularly on Dad’s car, which he claimed must have been done when the car was parked in town. It was one of the most difficult decisions we ever made because we knew how much the loss of his independence would mean.
    Oh, god, reading over what I’ve written here, I feel like a prophet of doom. Sorry. There are always joys to be found, especially if dogs are around.

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    1. Not doom. Just reality. The car issue is the one I dread most. By keeping his driving limited, I hope to prolong it. So far no dents and no getting lost (except once and that stopped his driving alone beyond a three mile radius).I love when the comments gets comments, the sense of community and sharing.

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  5. Great post, Alice. You hit on 3 very important points.

    First, it is so important for MCI/AD patients to keep doing as much as we can do. It is important because it helps us to exercise our brains, to preserve our abilities as long as possible, to maintain our dignity and sense of self-worth, to keep out of care centers and nursing homes until that’s the only option. I’m not a caregiver and so I really can only speculate, but it seems it is important for caregivers to lighten your load, to give you more time to take care of yourselves, to let you enjoy life and even whoever you’re caring for a bit more. I’m sure it’s challenging to find the right balance between what to leave to us to do and what to do because we can’t, but it’s important for caregiver and patient alike. Don’t coddle us.

    You also wrote about driving. About 2 months ago I was driving a familiar route when I became completely disoriented for a couple of minutes, like I was suddenly transported into downtown Shanghai at rush hour. Last week, I was riding the Metro home from work like I had a thousand times before. The doors opened, I stepped off my car onto the platform, and there I was in Shanghai again. Both times, my arms and legs and hands did what they were supposed to do., and I never felt unsafe. I think I can safely drive when this happens. But I wonder whether when I become disoriented like that I am so focused on figuring out where the hell I am that I would miss someone making a lane change in front of me or that a light was changing to red. I don’t know the answer to that. I don’t want to stop driving before I need to, but I also don’t want to stop driving until after I rear end a car filled with Mom and her kids because I was swiveling my head back and forth desperately searching for a familiar landmark.

    And you wrote about your dogs. I think one of my first comments to one of your posts remarked about how important my two dogs have become to me, and it sounds like yours are important to Ralph. I’ve noticed that dogs play prominently in many posts on many of the Alzheimer blogs I follow. Maybe it’s because we never worry when it’s just us and the dogs if our words came out quite right or if we’ve already told them something a couple of times, but my dogs are special to me.

    Sorry to write so much, but you got me going.

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    1. Do not apologize. I hope lots of people read what you say. Your perspective is so important to me and to other caregivers. We cannot get inside the brains and thought process of those we live with who have cognitive issues. We can try to empathize but you give us a special entry. Thank you thank you thank you.

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  6. That sense of accomplishment is so important. I certainly know it for myself, but I find I need to remember to provide accomplishment activities for my hubby. I have to fight the urge to do things myself because it is easier quicker.

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    1. I know, Carole, it is really hard not to go for the easier route. A constant struggle for me. On the other hand, sometimes I screw up by assuming he can handle something–or hoping he can since I don’t want to–and then realizing, sometimes too late, that he is out of his range. The balance is so delicate and always changing….Thanks for writing.

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