Dementia - When Questions Repeat
My mother had lived alone for ten years after the death of my father in 1999. She moved from the family home into a condominium and gradually socialized, making 4 or 5 new neighbor friends. She would visit with them and chat on the telephone to pass the time. Between them and her brother and sister, she was well socialized and generally happy with her life. Toward the end of the decade, things were changing. Her brother had passed away from Alzheimer's disease after a significant struggle with it, and her younger sister had been diagnosed with it. She remained healthy until stricken by a mild stroke in October of 2007.
The stroke didn't seem to have a great affect on her except for two conspicuous changes. She had developed a small droop in the corner of her mouth, appearing to be a smirk, toward the left side of her face, and she tired very quickly every afternoon. These things seemed "fortunate", because strokes can cause a number of serious disabilities. In the year following the stroke, her life continued without any significant noticeable changes. At least, that was my perception. Her neighbors probably noticed a few things, but attributed it to her advancing age and normal forgetfulness.
In January of 2009, my mother had a serious injury accident. She had lost her balance while stepping out of her shower and fallen over backwards. The result was a fractured L2 vertebra, which went undiscovered at the hospital emergency room until a relapse occurred 18 days later. She was sent home to recover with bed rest and pain medication. I moved in to her spare bedroom and took care of her over what was expected initially, to be a three or four week recovery. It was much longer. This is where the story begins.
As I was taking care of mom, we had many conversations while doing her physical therapy exercises, having meals, and watching television together. Except for the back pain, she seemed to be fine in every way, except for one. She would ask me a question about something and I would answer her. I noticed that she started to ask the same question a short time later. In the days that followed, I observed that I was being asked a question, sometimes as often as three or four times an hour. It was always the same question, followed by my same answer.
At first, I just joked with her about her absent mindedness, never thinking that anything was wrong. She laughed about it, blaming it on her old age, since she was 88. It became apparent that something might be wrong after having spent a few weeks together. I decided to discuss it with mom as a serious matter. She looked me straight in the eye and said "I suppose that you think I have Alzheimer's." I replied that I didn't think that, but was concerned about her repeating questions and her newest issue of repeating normal comments to me, also. She was getting a little irritated by my concerns. Her sister had passed away from Alzheimer's disease about three months earlier, and I believe that she was very afraid that she might be next.
Since my mom had visiting nurses through her healthcare plan, I was able to convey my concerns to them when they visited her for the back injury follow-ups. Soon, we had an appointment with mom's doctor. The doctor recommended a memory test and I took mom to the appointment. She struggled with several of the memory questions and I knew that this had to be bad news. The doctor reviewed the report and suggested that the problem could be caused by a thyroid hormone imbalance. If this turned out to be true, it would have been very good news and she would have made a full recovery from the memory difficulties, eventually.
Despite attempts to reverse the memory problems with medication adjustments, change was not to come. The problem escalated and a trip to a neurologist was ordered. A diagnosis of "Unspecified Dementia" was the result, due to the CT scan revealing some atrophy of the brain. Perhaps we were seeing Vascular Dementia related to her stroke or early signs of Alzheimer's disease. Another comparison CT scan would tell us more in the months ahead. Sadly, this could be both types of dementia together. That would be immensely unfair.
Anyone observing the behavior of repeating questions or frequently restating the same remarks, in a friend or loved one, should be alert to the possibility of dementia. Some forms of dementia are reversible and treatment should be sought as soon as possible. If the result is a diagnosis of dementia, early treatment can improve the quality of life for that person. If the dementia is not reversible, there will be many progressive stages of change and many challenges ahead. It is a heartrending journey for all concerned.
My mother is now in the latter stages of the illness and her world is fraught with delusion and misunderstanding. Each new day brings bouts of frustration, confusion, anxiety, tension, hallucination, incontinence, paranoia, false beliefs, agitation, anger, and depression. We've come this far in as little as ten months. The rate of progression varies among individuals. Her body remains strong despite the progression of the illness in her brain. In the final stages of dementia, the body will begin to fail as brain function falters. It will be a very solemn and saddening thing to witness.