Marking Ralph’s Alzheimer’s Six Years In

brain

Ralph usually has his annual cognitive check-up in July, but not this year. Because of Covid we have yet even to meet with our new neurologist.  After several rescheduling, our telemed introductory appointment is now set for the end of August and obviously won’t include intensive testing (at least I hope not—Ralph testing by phone would be a nightmare; zoom is going to be challenge enough).

Gauging where Ralph sits on the continuum these days is not easy. Between his hospital stay and slow recuperation, the long preparation for our relocation, the actual move one day before Louisiana went into quarantine, our new home/life under Covid, and Ralph’s anxiety in adjusting, not to mention my own, I have lost perspective. 

Last year’s check-up was uneventful, so uneventful that I wrote no more than a sentence about it in my journal. I had been concerned that Ralph seemed a little fuzzier in daily interactions but he scored pretty close to what he’d scored the previous years. We were assured he was maintaining a steady but unusually slow progression.

By then I was already house-hunting, and our practitioners felt we were moving at exactly the right time, with Ralph was still able to adapt and adjust to a new place.  I remember discussing that I should teach him the route to the nearest stores and coffee shop, then make sure he carried good, explanatory ID and introduce him to storekeepers and others in the neighborhood so they’d know his situation in case he got lost on a cigarette run. 

Fat chance. In the five months since we moved here, Ralph has taken one brief walk with me three blocks around the corner and back. Cigarette runs are unnecessary because he has forgotten smoking all together, thank goodness, and he has absolutely zero interest in leaving our porch. He has been to dinner at my daughter’s house once, seen his internist once and been to a hospital lab for blood tests once. Otherwise he has been in the house. We did spend a week away with my daughter’s family at a house with a pool to escape the heat, making no stops on the way and never leaving the house once we arrived saw how few others were wearing masks; Ralph enjoyed watching the rest of us splash around though he didn’t dip a toe in the pool himself, preferring to follow his usual routine of wake, eat, nap, eat, nap eat, bed.

But does his increased inactivity mean anything under the circumstances. He seems to function fairly well as long as he sticks to his rote routine, which is not that different than it used to be. The big change is swapping in BoyRalph visits for cigarettes, a clearly positive change. 

The less positive changes are all in the gray, hard to decipher margins.

He has never returned to a life list. He had been getting sloppy about following it and then he was so out of it during his recuperation from the blood infection, and so helpless.  Now I don’t trust him to mark thinks off. Or remember where the list is Or maybe the truth is that I find it easier to give him his pills myself, to tell him to shower, to track his meals that I would to nag him about the list plus the actual behaviors it tracks. He can still make a sandwich for himself at lunch but often asks me moments later if he’s eaten yet. I’ve also taken over feeding his dogs, a minor chore he used to like but never thinks about now. I worry that I’m coddling him, but then I try to stretch his world by asking him to do a minor chore like takeout the recycling and he gets slightly but noticeably befuddled.

He hasn’t paid attention to the world for a while, but now he seems to have lost his visual acuity a certain ability to react and judge. I’ve been filling bookcases the last few days and he doesn’t notice the difference between objects arranged on a shelf or placed there helter-skelter to get out of the way. In some ways those shelves are like his thought process, a random organization of discrete thoughts. He doesn’t always button his shirt correctly–true, neither do I on occasion, but then I am mortified; he could care less. 

But I need to take into account that everyone’s memory is worse these days. Everyone is a little depressed and a little disconnected.  A little spacier than usual. A little sloppier. Where does Covid Brain stop and Dementia begin? 

Thinking about that way, I tell myself that nothing I’m describing here about Ralph sounds that much worse than a year ago. But it is worse. I just can’t articulate or even pinpoint the deeper shift–a letting go, a deterioration. Not only of remembering but in comprehending. Conversation is gone which is sad. More depressing, so is my trust in his reasoning, in his ability to care for himself, to think clearly. Less than a year ago, I was able to leave him with his life list for days at a time. Now I am afraid to leave him alone in the house for more than an hour or two.  I’m afraid that is a marker more important than any test. 

10 thoughts on “Marking Ralph’s Alzheimer’s Six Years In

  1. Amazing as life can be at times, my husband stated this very morning that our next home would be a single level and not nearly as big… I came back with, “Away from the train tracks??” And he said, ‘yes. Maybe that lot up on the corner — there are two graded lots for sale within a 3 block range of us. I’d never thought we’d ever move again, but never say never!’

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    1. I’m smiling……Small is good. I love our new house but it is bigger than I wanted and has stairs. I chose it based on what I thought were Ralph’s needs, but his needs have already shrunk.

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  2. Thank you so very much for this. At once, I feel for you and what you’re going through, and at the same time, i realize I’m half a step behind you. My husband still surprises me at times when he’s lucid and able to do things around the house without being asked. I wonder how long this will last. Has Ralph had any episodes of Aphasia (inability to vocalize speech)? My husband did a couple of weeks ago and when we saw his neurologist a week ago, I mentioned it to him. The neuro added a new pill, one I’d heard of from several members of my local support group. I hope it helps. The dr. also added physical therapy because he mentioned not being able to maintain his balance. I hope they can do something to help him.

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    1. Ralph has not had Aphasia yet. And he does have those lucid moments–today he made our bed. But then he ate lunch twice and I think would have gone for a third if I didn’t stop him. Physical therapy sounds like a great idea. Thanks for checking in.

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  3. Sort of a perfect storm of strangeness – health problems, moving, Covid quarantines – guaranteed to flummox a person with dementia. Or, bring ’em to a grinding halt!

    Must be very hard to tell how much is circumstantial and how much is the biological processes of memory loss.

    I do hear you as you point out that last year you could leave him home for a few days, and now it’s not clear that even a few hours is safe or wise.

    Hope your new community has some resources for caregiving spouses – support groups, counselors familiar with the situation, hotlines, day programs (maybe, eventually!), etc – so you can make friends with folks in the same basket, so to speak.

    Meantime, wishing you well as you manage each day.
    Take care!

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  4. We are on the same track with my husbands slow steady changes. Your blog makes me feel less lonely. We too are in the process of moving but not much help from my husband as it doesn’t enter his mind that things need to be done. Happy to see your blog once again. Stay strong.

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    1. Oh I feel for you re moving. I realized early it would all be on me. Ralph took no part. A warning: because he was so uninvolved (and at the end barely aware we were moving), I did not bring his tool box, which he had not used in two years. Now, every day he asks where the tool box is and if we can go back to our old place for it. I wish I had inventoried better what he might care about.

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