S2E18. Subtle Symptoms?

Those of you who have been with me from the beginning will recall that the initial purpose of this blog was to record changes in my cognitive status over the years in the hope that it might be useful to a future researcher in helping to understand the differences between normal aging and prodromal dementia. So here’s an update on a few things I’ve noticed over the course of the last month or so.

1. Reading font. 

Strange choice for a possible symptom, right? Bear with me on this one.

We encourage the use of technology to help us with our daily activities, things like calendars and reminders on our computers and smart phones. Technology is our friend.

One of those wonderful technological advances is the introduction of ebooks and the programs used to read them. I’ve now completely abandoned real books and switched to their electronic versions.

One of the nice things about reading a book on my computer is that I can control the font size to make it easier to read. Although my vision has been fine since I had my cataract surgery last year and I can read 12-point type with ease and without magnifiers, I discovered that I really like reading with a much bigger font. In fact, with an enormous font!

The normal setting in the ‘Books’ app on my MacBook Pro uses a font that shows 2 pages on the screen, just like a real book. But I found that to be intimidating. Just looking at it, I felt a little twinge of ‘this is too much work.’ It took me by surprise the first time I noticed it, but after a while, I realized that keeping my eyes focused on the line I was reading and moving to the next line would be effortful. So I tried a bigger font.

And then I tried an even bigger font.

And then I tried even bigger fonts until there were only about 2 paragraphs on the screen…about half of one page.

That was comfortable…and easy to read…and I had a sense of accomplishment when I turned the page every 15-20 seconds or so!

As I thought about why this might be, it occurred to me that it could be a matter of focused attention. Apparently, I was finding it harder to maintain attention over a sustained period of time.

The ability to keep one’s attention focused is housed in the prefrontal cortex, so this change in my preference might indicate a subtle change in the efficiency (i.e., a decline in performance) of that brain area. 

Reinforcing this notion that there might be a problem with focused attention, I’ve notice that I sometimes skip a line of music when I’m practicing the recorder. It’s right there in front of me on the computer screen, but my eye skips it.

I think the two problems are related. I’ll keep an eye on it.

2. Talking less.

I’ve mentioned this before. I seem to be talking less when we’re out with friends. I can’t really put my finger on why that might be. I follow the conversation just fine, I can hear myself thinking about what is being said, and I come up with things I might want to say. But then I don’t say them.

Could it be that my timing is off? That while I’m waiting for someone to finish their comment, I wait too long and someone else jumps in? It’s possible. I can think of several times when conversations moved on to other topics before I had my say.

At other times, though, I just don’t feel the imperative to talk. I’m more than happy just to listen…but that’s not very sociable, is it?

Sally has also reflected back to me that I’m not talking as much at home when it’s just the two of us. Again, I’m thinking all the time, but I neglect to express my thoughts out loud. Or maybe I don’t think what I’m thinking is worth mentioning?

Bottom line: although my intention is not to isolate, I might be coming across that way. And although I’m feeling very comfortable and at ease, my silence can be uncomfortable for others.

Another thing to watch.

3. Perseverance and frustration.

If you do The New York Times crossword puzzle every day, you know that they start out quite easy on Mondays and then get more difficult as the week goes on. I breeze through Monday, Tuesday and Wednesday, then find Thursday more interesting (you usually need to discover a trick to solve it), but I have to work hard to get the Friday and Saturday puzzles.

In solving these latter two, I find that I’m now losing patience when I can’t solve them in short order. There was a time when my patience was endless. I might walk away and come back an hour later, but I would stick with it. I would persevere until I solved it.

Not anymore. Now I find I’m quick to hit the ‘check’ button which tells you which of your answers are incorrect. 

I didn’t used to do that, but I have very little tolerance for frustration these days.

Like focused attention, perseverance and frustration management are functions of the prefrontal cortex.

Is it possible that there is a pattern here?

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