In her "Ten Year Journal" of her seventies, Beverly notes with unease that her mental abilities seem to be slipping:
September 1, 2005
To tell myself the truth (but no one else) I have been a little discouraged by niggling health problems lately… my memory for names and facts seems to be getting worse.
September 15, 2005
So why do I feel so edgy lately? Mostly, I think, it's my own little stumbles through the days, and the doubts that I'm going to be able to continue to handle it all. This morning was an example, when I stopped at the post office on the way back home to get some postage stamps. There were many cars and people there going in and out, and I tried four times to get my car parked within the parking lines, but each time I was so far off that I felt I couldn't leave it at that. Finally I just gave up. Such a little thing to feel so discouraged about. But there are so many other minor things that happen. My spelling has deteriorated quite far from that whiz that I used to be, and my typing which was never really good is terrible. Often the computer puzzles are too much for me to resolve... Other "small" issues that loom large are my lack of memory for vocabulary, particularly names. I spend a lot of time looking for my glasses around the house, as well as the magnifying glass I depend on for small print, or the handkerchief I try to keep with me for my running nose and eyes. Factual details escape me frequently, such as something I just read a little while ago. To sum it up, I feel afraid. Afraid that my cognition is slipping a cog or six, that something worse may be on the horizon. Yet, to reassure myself, I seem better able to manage the larger issues.
April 25, 2006
Actually I don't enjoy [small social gatherings] as much as I did before my surgery, partly because it is more of an effort to get myself ready, as well as being sure I will be feeling well enough to go. Also, possibly the main reason is the trouble that I've had with my memory, and not being able to be a sparkling conversationalist.
June 19, 2006
My keeping of this journal has fallen on hard times, with medical troubles from my knee surgery, and a couple of months with my everlasting difficulties with this computer. But I've vowed now that I will go on with more resolution and write a little every few days, since my computer is new and has been working well for several months, and my health has improved well enough to manage most of my needs. Writing on this computer will possibly help what is my worst problem now, the difficulties I have with talking and remembering words and spelling them. That is a combination with my language that hurts me the most now, and I need to keep trying to improve that any way I can.
As one of her neighbors remarked, my mother was never the same after her knee surgery. She clearly had an episode of delirium that was strong enough to freak out of her friends and trigger phone calls of alarm to the East Coast. At the time, I made little of it, since I knew that episodes of delirium were common among elderly people receiving general anesthesia for surgery.
This last week, I ran across an eye-opening featured article in Nature, The Link Between Delirium and Dementia. The author, Carrie Arnold, noted, "In the past decade, long-term studies have revealed that a single episode of delirium can increase the risk of developing dementia years later, and accelerate rates of cognitive decline in those who already have the condition." My mother certainly was fitting into this last group, and the description in the article fit her to a T, before, during, and after the hospitalization.
I highly recommend the article.
– Paul Nordberg
September 1, 2006
September rolls over, and on the 17th I'll have my 80th birthday. Perhaps it will be my last entry for the closing of my "Ten Year Journal" begun on September 2, 1996. This tenth year has been a hard year, with random entries, sometimes written not too clearly. Mostly that was because of my knee surgery on October 8, when I didn't feel well much of the time, and didn't think very well after that anesthetic. Now, almost a full year later I'm getting better and better with my physical condition, but my memories still slip and slide...
On the whole my social life has dwindled these last months, nor do I have the records and memory from that much of the time. I know that Barbara has been in my life many times through those days, with dinners, impromptu visits, and a couple of well-planned excursions.
As I wrote in January 2010, things were indeed going down a slippery slope. – Paul Nordberg
During the last years of my father’s life and for a couple more after that, my mother and I corresponded by e-mail twice a week, routinely on Monday and Wednesday mornings at 8:00. I regret now that I did not keep all of her letters. (I found out later that she did about the same with her mother’s letters, saving them only once her parents had moved into a nursing home.)
In about 2006, she began to develop difficulty in finding words that left her self-conscious. She stopped going to her history book club for that reason, and similarly steered away from other social situations involving people other than her close friends. This was unfortunate, because she had always been a very gregarious woman and had more place for outside social contact after Bob’s death. In retrospect, the mild aphasia was the first sign of developing Alzheimer’s.
By 2008, it was apparent in her e-mail that her difficulties with communication were beyond the routine frustrations older – and younger – people experience with computer technology. I began, sporadically at first and systematically later on, to save her e-mail in the recognition that a finite time was remaining for such things.
At Christmastime that year, at her request I helped her to terminate her e-mail service with America Online. By that time, her cognitive difficulties were such that she could not report her date of birth so that AOL could verify her identity over the phone. She was eager to have me pay attention to an insurance policy and gave me the folder for it. After a little while, I realized it was the long term care insurance policy she was thinking of. That was in a different folder, but the idea was clearly becoming relevant. For eligibility, there would have to be a medical determination that she was unable to take care of her daily needs for herself. Beverly had an appointment with her PCP scheduled for February, and I began to consider asking for that physician’s support with a determination of incapacity.
We tried a routine of talking on the phone twice a week after the termination of the e-mail, with partial success.