Alzheimer’s Shrinks Ralph’s World and Ralph



I have been focused a lot recently on my reactions to Ralph’s slide along the Alzheimer’s continuum. But after a weekend apart, I am struck anew how much Ralph’s world has changed.

His memory seems to be holding, at least as far as facts are concerned. Not that it is good or anything like normal, but it remains generally on the same plateau it’s sat on for a while now. He repeats himself; he asks the same questions over and over. He remembers certain details from a conversation and obsesses on them. And he repeatedly forgets not only conversations but also what might seem large basic facts. While I was away he spoke on the phone to a friend who was disturbed that Ralph seemed to think I was home. “He’s never seemed confused that way before,” she said to me with concern. His forgetting can seem like confusion, but really it is not. When he called me to ask me to pick up some dog food (which I had forgotten to do before leaving for the weekend) and I joked that I could get the dog food in New Orleans, he laughed and admitted he’d forgotten and then went on with following his daily routine “life list” perfectly well.

But while he has remained on this memory plateau, the sands have been shifting beneath him. The lack of memory has changed who he is.

So while I would define his forgetting for the moment that I was not in town as a memory problem, not a confusion problem, I have seen him confused, and I think he is more prone to confusion than he used to be. When he can’t remember, he grows anxious, and when he grows anxious he has even more trouble remembering. A spiral top starts spinning. Similarly, sometimes he can’t grasp what I’m trying to explain because his anxiety about not understanding twists him into an emotional knot. (And I realize that when I talk to others now, I tend to over-explain out of habit, but that’s another subject.)

He is also fearful–in part because his weakening memory leaves him uncertain from moment to moment, but also because he’s become a person with a very limited world and like many confined to limited worlds he has a fear of the unknown.

And hand in hand with fear is a sluggish passivity, a disinterest in what lies beyond the immediate scope of his memory . He has less and less physical, mental or emotional energy to engage with others. I have noticed that his sister and oldest son, both of whom  used to talk to Ralph frequently and enthusiastically, seldom call now. And I understand. It is hard to talk to someone who only wants to repeat the same few conversations over and over. Patience wears thin. People have their own lives to get on with.

Of course, I often resent and feel trapped by Ralph’s limitations myself. But today I am sad–for Ralph and for how his identity is being chipped away in small but steady increments. Does he know? I’m not sure. It feels as if I were watching the act of sculpture in reverse—the vibrant image of a man being returned to stone in slow motion.

8 thoughts on “Alzheimer’s Shrinks Ralph’s World and Ralph

  1. I hated seeing Dad’s world shrink and it was just as you describe Ralph’s shrinking world. He used to read a lot but we noticed he never looked at a book. He once told me it was frustrating because he couldn’t remember what he’d read and kept re-reading the same paragraphs, knowing he’d read them but not retaining the information. He was once able to discuss all manner of topics then he had nothing to say on anything. I could understand why people were reluctant to visit because holding a conversation seemed a pointless activity and yet, he did seem to enjoy people being around.

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    1. Thanks for this. Just before reading I received a phone call from an old friend who told me Ralph used to call him once a week, then twice a week and now has begun calling three times a week at last. I can’t tell if he was annoyed or just letting me know. But Ralph has not mentioned talking to him at all…..

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      1. He probably doesn’t remember making the call. At least he is trying to keep in touch with people. Dad went through a phase of saying, ‘I must phone so-and-so.’ He’d take out a piece of paper with the person’s number on it and then put it away again. I thought he’d forgotten how to use the telephone and offered to put the number in but he’d just repeat the ‘must phone so and so’. He never did – at least I don’t think he did but who knows?

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  2. You might gently remind sister and son that if they don’t call or visit, he won’t remember them. Richard had that problem with all his friends but us. We were the only folks who visited every day. At his 85th birthday, he had no idea who his visitors were, but boy was he polite.

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  3. Hi Alice –
    I have a growing understanding of the changes you see in Ralph.

    My symptoms remain pretty invisible to people who don’t spend a lot of time with me. However, sometimes I find myself wondering if I’ve said the same thing already in a conversation and starting more sentences with the phrase, “Apologies if I’ve asked you this before, but . . .” To the extent that I thought about it at all, I assumed that other people would understand and be fine with this. But the facial expressions of people on some occasions made clear that sometimes others are getting a little annoyed with me and my still nascent memory issues. It is embarrassing for me, I suppose, in addition to frustrating. So to avoid awkward moments, I change the topic, end the conversation, or find another way to hide that I’ve become a bit lost because I’m not sure of my memory. I pull back into my shell and maneuver so that the conversation moves ahead without me.

    Maybe because I’m not as far down the road as Ralph yet, I’m not sure how obvious my social retreat is to others – probably more than I think it is. I think it’s part of a broader unconscious coping strategy to manage my symptoms to a degree by withdrawing.

    Another example is how I find myself behaving in social situations. Even when I’m with family and friends, sometimes I get a little confused and even anxious as I work to keep up with lots of activity all around me, especially if the event goes on for awhile. Somehow I discovered that it helps me get through to kind of go into “wallflower mode” and fade into the background. I remain physically with the group, but not really part of it. I take every opportunity to just sort of nod and smile when I can’t keep up to do my best to keep the conversation flowing but without me a part of it. When I start feeling like the situation is getting too intense for me, I’ll spend some time doing some chores or with the dogs – something that doesn’t look too antisocial but leaves me more as a spectator than a player in whatever is going on. It’s just easier being on the outside looking in than a full participant.

    I’ve written enough, but before winding up also have to compliment your word pairing of “sluggish passivity”. Man, I feel that way. Some days it’s as if I’m dragging a 50 pound rock behind me all day. I can still do pretty much everything I always could do, but every blooming thing is a little more difficult, a little more tiring, than it was just a couple of years ago. So once I check off the “must do” things on my daily list, increasingly it’s hard for me to resist the Call of the Couch to just sit and do nothing. If I ever was a go-getter before, I am not now!

    Heading Somewhere

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    1. As usual, your comment strikes to the heart of the matter. Your ability and courage in articulating the experience humbles me. I don’t want to think about you “withdrawing” but totally understand it as a coping strategy…for Ralph too. Your description of your “wallflower mode” rings so familiar, exactly what I sense Ralph does. And now I don’t push so hard for him to attend social activities that I know will cause him stress, but I worry that I have not found the balance for him–when participating may be worth the anxiety and when not. As for Call of the Couch–how would you (or Ralph) not be exhausted from the effort. I’m exhausted too and my guess is your wife is too. We are all expending a lot of energy….

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