dementia – Page 6 – Mistakes on the Journey to Nowhere

S1E23. Why Am I Writing This?

It was a fair question that my nephew Zach (Sally’s sister Lynn’s son) asked me over cake at the graduation party for my great nephew Nate (Sally’s brother Tad’s daughter Skye’s son).

I had already explained my motivation back in December in Episode 3: My Life Is Now An Experiment (https://tinyurl.com/4epzfffc), and so it seemed like a good time to reflect back on a half year of blogging to see if I still felt the same about this project.

Zach (a political science professor at Haverford College) had raised the question in the broader context of the meaning (or lack of it) of the things we do and the notion of ‘legacy’ or what will be remembered about us (if anything) two, three or four generations from now.

We had already agreed that not much of what we do in our lifetimes will last very long into the future (to whit: think about what you know about your great grandparents)…but that that didn’t really matter. We do things that have meaning for today…and that’s enough.

My primary reason for writing this blog is to provide data that might be helpful to researchers trying to diagnose and treat age-related cognitive decline and dementia. My hope is that by tracking and reporting my mistakes over the course of a decade, I will leave a record that either describes normal aging or the onset of dementia, and no matter how it turns out, that such a first-hand report will have value.

That assumes an awful lot, though. What are the odds that such a researcher will (1) stumble across my notes, (2) discern a meaningful pattern in what I recorded, and (3) convert that insight into a useful tool for diagnosis or treatment? As Sally is fond of saying in these situations, the likelihood lies “somewhere between zip-a-dee and doo-dah!”

Over these first 6 months, though, one thing I’ve learned about myself is that I also do this—and I’m being brutally honest here—for the clicks. It appears I’m a click junkie!

Each week, I spend money to advertise the new post on Facebook and Google. Whenever someone clicks through to the site, I can see on my WordPress blog dashboard not who they are, but which episodes they read and what country they are from. It’s exciting to know that there are folks all across America who have stopped by, and people from Ireland, Canada, India and Sweden who are frequent readers, too.

It’s comforting when they leave comments describing their own experiences that are similar to mine. They make my journey less lonely and it’s nice to know that I’ve made someone else’s journey a little less lonely, too.

I especially appreciate it when a reader signs up to follow the blog. It’s the ultimate validation for me as a writer: you liked the content enough to want to see more and to have it delivered directly to your inbox every Friday to make sure you don’t miss an episode.

And in the blogosphere, the number of followers you have is the gold standard for measuring success. Success would be nice, but I have a long way to go to achieve it and I don’t really expect it.

Managing the blog (e.g., rooting for content each week, writing a 600+ word episode, converting it to a podcast, refining and implementing the advertising plan, interpreting the results, and interacting with readers) keeps me busy in ways that push my cognitive envelope. In itself, it should provide a measure of protection against decline. But I also find it intriguing to monitor myself so I can catch as many errors as possible, try to better understand what causes them, and to divine what clinical implications (if any) they might have.

It’s work, but it’s fun.

Getting back to Zach’s question, after six months, several reasons for writing this blog have emerged: a desire to help in some small way, the rewards of having my work read and appreciated, and the joy of doing it.

Thanks for asking, Zach!

S1E22. Making Coffee Isn’t Hard…Is It?

One of the first lessons I learned when we opened our B&B on the 4th of July weekend in 1986 was that the coffee had to be good. It was a guest’s first culinary impression of the quality of our food and set expectations for the breakfast to follow.

I spent a good deal of time researching how to make good coffee, experimenting with various beans and brewing methods. I settled on dark French Roast beans that I grind fresh every morning. I learned that the strength of the coffee is determined by the amount of beans used, how long you grind them (grind them long enough and you get espresso!), and the volume of water you brew.

I buy my beans in a 5 pound bag, fill an air-tight glass container for use over the course of the next week or two, then put the rest in the freezer to preserve their flavor.

For 35 years now, my routine has been pretty much the same. I fill my coffee grinder with beans and then grind them for 15 seconds. Then I place a paper filter in the brewing basket and pour the ground beans into the basket, being oh so careful not to spill a speck. Next, from the tap, I fill the coffee maker’s carafe to the 8 cup line (which is really only 6 ½ cups), pour the water into the reservoir, set the empty carafe on the hot plate, press the ‘brew’ switch and wait.

It’s neither rocket science nor brain surgery nor difficult, yet this week, I found a way to screw it up.

Here in our new apartment, we noticed more chlorine in the water than we are used to, so we bought a Brita water filter to restore the taste. That introduced a very minor wrinkle into my coffee-making routine. Instead of filling the carafe from the tap, I take the Brita out of the refrigerator and use it to fill the carafe, returning it to the refrigerator before I continue making the coffee.

I went through my routine this past Monday morning, but to my disbelieving eyes, when I went to pour our coffee, the water was clear…not coffee at all!

I was baffled. How did the water pass through the ground beans and still remain clear? The ‘brew’ light was on, so I know I started the process. I lifted the lid to confirm the beans were there, and they were. I touched them and they were bone dry. I looked inside the reservoir to see if there was any possible alternative route for the water to travel. There was none.

Then I noticed that the water in the carafe was not hot. And I recalled that I had not heard the coffee maker percolating while it brewed, nor the gurgling, sputtering and steaming exhaust when it completed its cycle. Most importantly of all, I hadn’t smelled the glorious aroma of freshly brewing coffee.

And then it hit me:

“DOH! I never poured the water into the reservoir!”

I had filled the carafe from the Brita and put it down on the counter while I returned the Brita to the refrigerator. That one distraction was enough to sabotage my routine. When I returned to the counter, I picked up the carafe and just set it on the hot plate, forgetting to first pour its contents into the reservoir.

Mystery solved. Explaining what happened to Sally and feeling incredibly foolish wasn’t the worst of it, though. I’m really bothered, not so much by my forgetting to pour the water into the reservoir, but by my thought process when I discovered the water was clear.

The second I saw that the coffee hadn’t brewed, my immediate reaction should have been, “Shit! I forgot to pour the water into the reservoir.” But it wasn’t. I had ignored clues (no aroma and no percolating sounds) that should have made things instantly obvious. Instead, I wrongly assumed that the fault rested with the coffee maker. That’s the bigger error here: assuming I am right and the world is wrong. It didn’t get me into trouble this time, but this kind of thinking is an accident waiting to happen.

On the brighter side, my sleuthing to discover what caused the failure was pretty well-organized and I did accept responsibility once the evidence identified me as the culprit.

Post script: Once the coffee was finally made, Sally and I thoroughly enjoyed it!

S1E21. One Hundred Fifty Minutes

I’ve been running—on and off—since I was 14 and a freshman in high school. I wasn’t fast, but I worked hard. I never ran a mile in under 5 minutes, but I did earn my varsity letter running the 2 mile.

In 1966, I was among the first joggers to run in the road. People used to yell ‘Get a horse!’ The more creative among them yelled ‘Get a car!’ In the winter, some would aim at me and I’d have to jump into a snow bank. We’ve come a long way in 55 years, haven’t we?

Over the years, I always felt better when I was running. In my 30s, I tried to run the sub-5 minute mile that had eluded me in high school. I got down to 5:35 and was chagrinned at how difficult it was to run a 75-second quarter mile when I used to run them with the greatest of ease.

In my 40s, my primary care physician sent me for a stress test. I was told that I had a ‘runner’s heart’ with thick walls that had built up over the years. Apparently, heart disease (which runs on my father’s side of the family) was not my biggest risk factor.

On my 50th birthday, I was living in Lexington, North Carolina, while doing my Ph.D. internship at the Hefner VA Medical Center. I was jogging in a park a block from my house when I got the idea of setting a goal for myself: I wanted to be able to jog 2 miles without stopping every year until I was 80. That was considered pretty far-fetched in 2001, but it was a motivator for me. Each year for the past 19 years, I’ve been able to check that box.

In my middle 60s, I was in good enough shape to run 5K events. My best time was 30:50.

Jogging has been my go-to exercise when I need to lose weight or manage my cholesterol. According to the research, it appears that it will help preserve my cognitive abilities, as well.

Of all the things we don’t know about dementia and age-related cognitive decline, one thing we do know is that regular exercise is protective. It may not reverse losses, but it does appear to protect what you have and slow your rate of decline.

The latest guideline I’ve found is to shoot for exercising 150 minutes each week, e.g., 30 minutes/day x 5 days. The criterion for calling it ‘exercise’ seems to be ‘huffing & puffing’ and/or ‘breaking a sweat.’ So it’s nice if you go out for a walk, but it’s better if you step up your pace. The goal appears to be to keep the 400 miles of your brain’s blood vessels open and pumping nourishment to your 86 billion neurons 24/7/365.

COVID-19 really knocked me for a loop. No, I didn’t get it, but it closed the gym where I worked out and I gained 20 pounds. So now I’m starting my comeback. For years, a good weight for me has been 155, but now, at 186, I weigh more than I’ve ever weighed before and, at 70, I know that’s not good. Being overweight and out-of-shape, I need to go at this with caution.

The apartment complex we just moved into has a fitness center with a treadmill. Since I haven’t yet met my goal of being able to jog 2 miles this year, that’s where I’m starting. I began by just walking the distance. Next I plan on jogging ¼ mile as part of the 2-mile walk, and then raise that to ½ mile when I feel ready…and so on until I’m jogging the whole thing.

Just 5 years ago, a comfortable jog for me was at a 6 mph pace. Now, though, I see that I’ve slowed to 4 mph (15 minutes/mile). Jogging 2 miles will take me 30 minutes. Going 2 miles has me huffing & puffing & sweating, so this workout fits the healthy brain guideline. Now if I can just stay motivated enough to do it 5 days each week…

Post script: On Wednesday I discovered another way I can huff & puff and burn a few extra calories. We live on the 4th floor of our apartment complex. Getting there from the street level takes 3 flights of 19 stairs each. I doubt I’ll ever be able to walk up and down for 30 minutes, but doing it is definitely more heart and brain healthy than taking the elevator.

And then I saw someone much younger than I jogging around the complex. Each lap is probably about ¼ mile.

It’s nice to know I have options!

S1E20. Dear Diary…

Each week I wait for something to happen that will become the focus of my post on Friday. I pass on any number of smaller mistakes while I wait for something ‘big’ to happen. It occurred to me that perhaps those little errors deserve their time on stage, too, and so this week I tried to track the ‘little’ things.

Wednesday

This falls into the “can’t walk and chew gum at the same time” category.

I was on my way out the door to get our morning coffee when Sally handed me a cardboard carrier for the cups. I thanked her but hesitated before going out the back door to the car. I knew it was already warm outside and so I decided to take off my quilted shirt and just wear my t-shirt.

Having left the shirt on the bench next to the back door, I continued to the car, got in, started the engine, and was on my way before I realized that I didn’t have the cardboard carrier with me. I did a u-turn at the stop sign a block from my house and scanned the road as I retraced my route, thinking perhaps I had left it on the roof when I got into the car and it had fallen off.

Nope. And it wasn’t in the driveway, either. I went back into the kitchen and saw it on the counter above the bench where I had left my quilted shirt. Obviously, I had put it there to take off the shirt and forgotten to pick it up again as I left.

Thursday

We are scheduled to move into our new apartment next Wednesday the 26th (see December 12 ‘Happy Box’ here https://tinyurl.com/jwz43sjk) and so I shopped on Amazon to find a non-slip bathtub/shower mat. I found two that Sally might like and emailed her the links so she could pick one. We talked about it for a few minutes and decided on the light gray pebble pattern.

After doing a few other things around the house, I returned to my computer and placed the order. It was less than a minute after I received the confirmation email that I realized I had forgotten to change the item in my cart from ‘dark gray’ to ‘light gray’ as Sally had wanted. Fortunately, I was able to cancel the original order and get it right the second time around.

Friday

I have no sense of direction and I marvel at those who do. The invention of GPS changed my life for the better.

For me, it’s not a question of finding my way out of a paper bag, but more importantly of learning how to get from point A to point B in our new apartment building.

From the main office, you go down a long hall to reach an elevator. Take it to the 4th floor and our apartment is across the hall and a little to the left. Couldn’t be simpler, right?

When I visualize the location of the elevator on the ground level, I see it on the right-hand side because that is how I approached it when I first learned its location. But when I visualize the elevator on the 4th floor, I see it on the left, probably because it is on my left as I exit the elevator to open the door to our apartment on the right. Try as I might, it doesn’t make any sense to me at all when I try to reverse the 4th floor image in my mind. It just feels wrong.

Clearly, north and south have no meaning for me. It’s all about right and left…and that seems to be determined by my first impressions.

If I want to go from our apartment to the mail room, I need to take that elevator (which is easy enough to find!) and walk down the hall towards the office. If I visualize the ground floor elevator on the right, I will turn left when the door opens and reach my destination. If I visualize the elevator on the 4th floor, though, with the elevator on the left, I will turn right when I reach the ground floor and never reach my destination.

Can you guess which way I turned this morning?

Saturday

Sally: “At some point, I want to put these yard signs in my car so I can return them.”

Me (picking up the signs): “Do you have your keys? We can do it now.”

Sally: “Yes…but that’s not my car.”

Sally’s car is a blue. The car parked in front of us was silver. My car is silver but doesn’t look anything like this one.

I have no clue what made me think I was looking at Sally’s car.

Sunday

We’re moving from the house to the new apartment on Wednesday, so I went over today to install the new bidet we ordered. I got a little past the stop sign a block from our house when I realized I had forgotten to bring the screwdriver and pliers I needed, so I turned around and got them.

I took my time with the installation and only made one mistake when I put 2 holding brackets in upside down…but, seriously, you couldn’t tell it was supposed to be that way from the diagram.

I gathered a variety of things I was taking back to the house, went down the elevator, put them in the back seat…and realized I had forgotten my mask. So I went back up, got the mask, and headed home.

Seven miles later and halfway home, I realized I forgot to take the screwdriver and pliers. 😦

Monday

Well, this is embarrassing.

We’re moving in two days and most of our stuff is already packed up or at the new apartment. As a result, I’ve been doing almost no cooking here at the house. We eat out a lot and I warm leftovers in a skillet.

This morning I found half a bagel and egg sandwich in the refrigerator. I thought about warming it up in the skillet, but that didn’t seem like it would work, and so I ate it cold…just before realizing that I could have put it in the toaster oven. DOH!

Tuesday

Tomorrow is moving day. We spent the morning at the apartment then came home for dinner and a high school lacrosse game.

I racked up errors throughout the day, turning the wrong way at the apartment, giving wrong answers to Sally’s questions and then realizing a minute later why they were wrong, and generally being irritable.

Welcome to Wayne’s world!

________________

You can join me on the journey to nowhere by providing your email address below. Once you do, you’ll receive each week’s post in your inbox every Friday morning at no cost or obligation. Thanks for being interested!

—Wayne

S1E19. My Screening Test

In the third episode ‘My Life Is Now An Experiment’ (https://tinyurl.com/3j6vaf7x), I described myself and this blog as an ongoing experiment, recording data that could later be evaluated to determine if my experiences represented normal aging or the path to dementia.

It’s not a ‘real’ experiment, of course, and that made me think that it might be valuable for me to apply to participate in a real clinical trial…and so I did.

My Facebook feed is overrun with invitations to participate in a variety of studies and so I responded to one. I received a telephone call a few days later which was described as a ‘pre-screening interview.’

I was told about the experiment and asked if I was willing to take medication, undergo periodic testing including MRIs and blood samples, and travel to a testing site periodically for ongoing assessments. I was more than happy to do so.

The person on the phone asked what kinds of problems I was having and I related some of the information I’ve posted in this blog. She wanted to know if there was a caregiver available who could accompany me and so I had her talk with Sally.

I was informed that someone would contact me to arrange an in-person appointment for an actual screening.

I was delighted!

Last Friday, I drove an hour to the nearest testing site (this is a nationwide study) for my assessment. The office was located on the first floor of an unassuming building. I presented myself to the receptionist and was asked to complete a standard form detailing my medical history. As I did so, I smiled inwardly because the form required me to write the date on each of 8 pages. I chuckled because I knew that one of the standard assessment tests that is frequently used to screen for cognitive impairment asks you to give the current year, month, and date…and here I was practicing the answers to 3 of the questions!

The physician performing the assessment ushered me into his office a few minutes after I turned in my completed forms. He went to great lengths to make me feel comfortable, explaining that this interview would be very informal and not like a normal visit to the doctor. He explained that his practice contracts with drug companies to recruit participants in research projects.

He then asked me if I was having problems with my memory and I told him about my recent experiences. He then explored what kinds of accommodations I was using.

We talked a little about my career as a psychologist and my volunteer political work over the last decade.

At this point, my gut feeling was that I was not sufficiently impaired to be selected for the study, i.e., I had flunked the interview! But he asked if I’d like to go ahead and have him administer the screening test, and I, of course, said ‘Please do.’

As I had guessed, the instrument he used was the Mini-Mental Status Exam (MMSE). I had administered it often in my work, but if you had asked me, I would only have been able to name a few of the items from memory…like the ones asking about today’s date. However, I did recognize each question as he asked it.

(I’d like to pause here for a moment to ask a favor of you. Even though it’s easy to google the MMSE and download all the questions, I’m going to ask you not to do that. If you should ever find yourself being evaluated, you want the testing to be as accurate as possible. Knowing the questions and, far worse, practicing the answers would contaminate the results and contribute to an inaccurate diagnosis. And that is why I am encouraging you to use some constraint here.)

I wanted to do my best (even though that might result in my not meeting the impairment criteria for the study) and so I decided to take my time and double-check my responses before answering.

There are a couple of questions that ask you to perform tasks in your head using working memory. I was a little surprised at the amount of effort it took, even though I got the right answers.

There was one task that I was on the verge of messing up, but I caught myself in time and corrected my mistake.

There was another question I answered correctly, but realized afterwards that I hadn’t considered a critical element of the solution when formulating my response.

Final result: I only made 1 mistake. If I had made 3 mistakes, I would have met the criteria for further testing.

The doctor told me I did not qualify for this study and we chatted a few minutes longer. He offered advice for maintaining cognitive health, including learning new things, eating lots of colorful vegetables and berries, exercising and staying socially engaged.

He thanked me for offering to participate and I thanked him for the work he was doing.

I drove home with mixed emotions. I was disappointed that I hadn’t gotten into the study, but relieved that the errors I was making didn’t yet meet criteria for an impairment.

So far, so good.

________________

If you liked this post, you can follow my blog by providing your email address below. Once you do, you’ll receive each week’s post in your inbox every Friday morning at no cost or obligation. Thanks for being interested! –Wayne

S1E18. 2 Runs, 4 Hits, 1 Error

It was a near-perfect afternoon for baseball at Citizens Bank Park in Philadelphia: temperatures in the mid-60s under a cloudless sky with a steady breeze blowing in from left field rippling the flags and pennants. Due to COVID restrictions, fewer than 11,000 people would attend the game, giving the event the feel of a spring training game with no crowds in the walkways or at the concession stands and a greater sense of intimacy with the players on the field.

Our bleacher seats behind first base were grouped into 2 sets of 4 that were 9 rows apart. Our other friends hadn’t gotten there yet when Sally and I arrived with her sister Lynn and brother-in-law Bill. Having arrived early for the 1pm start, we immediately decided to have lunch.

Since it was a long walk to the concession stands behind the bull pen, Bill and I volunteered to get the food. I told him that Sally wanted a cheesesteak and he told me that Lynn wanted one, too. They were sold at Campo’s where the line was short and fast-moving. I told Bill that I’d like to pay for lunch since he had driven and paid for parking, and he accepted.

When we got to the front of the line, he placed the order for the two cheesesteaks: both with onions and one with ketchup. At first I thought I would share Sally’s, but I saw something on the menu called ‘The Heater’ and decided to get one. I added that to our order along with 2 Diet Cokes.

When our food was ready a few moments later, I put ‘The Heater’ and a cheesesteak in one carry-out box and the second cheesesteak in another. Bill asked me ‘Is that it?’ and I told him it was. We moved forward in the line to pick up our sodas and I placed one in his box and one in mine. The attendant had just refilled a bowl with ketchup packets and Bill took several for Lynn. We each took a short stack of napkins from the dispenser and headed back to our seats.

I had just sat down when Bill asked if I had the right order and I told him I did. Our other friends had arrived while we were gone and it turned out that Lynn and Bill were in the seats 9 rows behind ours. We didn’t talk with them again until it was time to leave.

The game was a pitcher’s duel with the Phillies beating the Milwaukee Brewers 2-0.

I took a nap when we got home, but woke up with a start.

“Oh my god! I cheated Bill out of a cheesesteak!”

I replayed the event over and over in my mind until I fully understood what had happened.

As we walked to the concession stand, I told Bill that Sally wanted a cheesesteak and Bill told me that Lynn wanted one, as well. Neither of us said out loud what we wanted for ourselves. In my mind, then, I fixed our order at 2 cheesesteaks. It was a silly assumption to make.

Bill was ahead of me in line and so he placed the order for two cheesesteaks. I wondered how he knew that Sally wanted onions but no ketchup. In hindsight, it was crystal clear that he didn’t know and he wasn’t ordering for Sally. He was ordering 1 cheesesteak for Lynn and 1 for himself.

Furthermore, even though we were putting this on one tab, he would never have tried to order for both couples. That’s not the norm. Why did that not occur to me?

Having placed his order, Bill turned to me so I could place mine. Believing that the food for our wives had already been ordered, I added my ‘Heater’ order and the two drinks.

When I put two sandwiches in one box, Bill thought it was his order and I thought it was mine. He asked, “Is that it?” because there were four of us and only three sandwiches.

When we got back to the seats, he asked again if I had the right box because he was expecting two cheesesteaks (which were in the box I carried) while his box only had one.

He deferred to the certainty I expressed and assumed that perhaps he had made an error. Without saying anything else, he went back up the steps to his seat and then, unknown to me, made another trip to Campo’s.

There’s absolutely no way to gloss over or rationalize how faulty and flawed my thinking was during this episode. And even though Bill graciously accepted my apology, it had consequences involving others. Not good.

If you’re keeping score of potential symptoms, this episode qualifies as a failure in social cognition.

The final line for the game was 2 runs, 4 hits, 1 error.

The runs and hits belonged to the Phillies. The error was mine alone.

________________

If you liked this post, you can follow my blog by providing your email address below. Once you do, you’ll receive each week’s post in your inbox as soon as it’s published at no cost or obligation. Thanks for being interested! –Wayne

S1E17. Reading Between The Lines

An interesting study was recently published in which writing samples were used to predict with 75% accuracy who would later develop Alzheimer’s Dementia. Here is the take-away finding:

“The researchers examined the subjects’ word usage with an artificial intelligence program that looked for subtle differences in language. It identified one group of subjects who were more repetitive in their word usage at that earlier time when all of them were cognitively normal. These subjects also made errors, such as spelling words wrongly or inappropriately capitalizing them, and they used telegraphic language, meaning language that has a simple grammatical structure and is missing subjects and words like “the,” “is” and “are.” (Read the full article here: rb.gy/q1igg0)

Although the finding was unexpected, with the benefit of hindsight, it makes sense. It seems to be a very early form of word-finding difficulties, loss of word fluency, perseveration and impoverished processing.

Needless to say, I’ve been monitoring myself ever since I first read about this in early February. After all, I am writing a weekly blog about looking for early warning signs of dementia!

Because I edit my drafts and polish them before posting, and because Sally proofreads them, and because I write with my spellcheck and grammar check turned on, I would be surprised if you found much evidence of these kinds of problems in my writing. For example, in a recent post, my final draft had this sentence: “If that be wisdom, then so be it.” Sally spotted the repetition of the word ‘be’ and so the published version became: “If that passes for wisdom, then so be it.”

When I look at all of my written communications (blog, email, tweets, Facebook posts), though, there is one change that stands out. It seems I avoid using the word ‘I.’ So instead of writing, “I was wondering if…’, what comes out is, “Wondering if…’ Or if someone asks me what I think about something, my response is more likely to be, “Nope” or “Not interested” instead of ‘I don’t think so.”

Let’s not make too much out of this. There are many factors influencing my writing style. Writing a blog about one’s experiences is narcissistic by nature and so I consciously try to minimize the expression of my egotism by editing out “I” references.

The unusual punctuation you sometimes see is more likely intentional literary license than it is unintentional grammatical error.

Two weeks agi, I misspelled the word ‘pejorative’ because I’ve always thought the word was ‘perjorative.’

Twitter and Facebook are inherently telegraphic media where one must capture the reader’s attention with very few words. They are their own literary art form and so it is not surprising that their influence spills over into my blog writing.

Bottom line: it doesn’t appear that we can attribute my current writing style to a subtle prodromal indication of a looming dementia.

But the idea of the loss of the ‘I’ does intrigue me when discussing dementia.

To what extent is it fair to describe dementia as losing the ‘I’ in oneself?

Descartes famously said, “I think, therefore I am.” Who I am is the sum of my experiences, how I react to my world and how I think about it. Should I lose my memories in the coming years, should my personality change and become irritable and unforgiving, should my thoughts become dramatically altered…will I still be me? Or will my ‘I’ have been deleted from my existence during the final days of my journey to nowhere?

_________________

If you liked this post, you can follow my blog by providing your email address below. Once you do, you’ll receive each week’s post in your inbox as soon as it’s published. Thanks! –Wayne

S1E16. The Name Game

No…not the Shirley Ellis 1964 version (“Nick, Nick, bo-Bick, bo-na-na fanna fo Fick…).

I created a new version after noticing I was blocking on names in everyday conversation. Although I clearly knew who I was talking about, when it came time to say their name, I would blank out and it would take me 5-10 seconds to retrieve it.

That got me thinking about remembering names in general. There are plenty of articles on the web about how to better remember names when you are first introduced, but I couldn’t find anything about how to recall names of people who were well known to you.

So I decided to test myself by trying to remember names of people who I hadn’t seen in years.

I started in 1972 (the year I graduated from Brown) and tried to recall names up to about 2011 when I left North Carolina to move to Pennsylvania to be with Sally.

I had no trouble at all conjuring up mental images of their faces. After all, these were people with whom I had long-term relationships, like professors, co-workers and neighbors.

A few names appeared right away. For the most part, though, I had to work hard to find them. I would often get the first name fairly quickly, but it might take me 15 minutes or more to find their last name. Having done this for a week, I’ve successfully recalled dozens of names from my past, with only 2 remaining unidentified.

All of which got me wondering about what was going on in my brain.

Memories of faces and memories of names are stored in different places in our brains. Designing and implementing a strategy for finding both and linking them takes place in another area altogether. And then there are the pathways that connect all three regions.

So what did I learn about myself by playing the game? First, I can recall a lot of faces. More accurately, I can recall important faces. There are hundreds of patients I saw as a psychologist and guests I hosted at our B&B who didn’t leave retrievable memory traces.

Second, although they are hard to find, my memory for names is pretty good, too. The memory of the name is intact as is the pathway connecting it to its face.

Third, my ability to create a task, develop a strategy and implement it is also working well. I tried multiple approaches when my initial search failed: going through the alphabet to test first letters (similar to how knowing the first letter of an answer in a crossword puzzle makes it easier to solve), trying to recall how many syllables were in the last name, replaying memories of my interactions with the person instead of just viewing their face in my mind’s eye. And then there were the times when I just gave up…and the name popped into my head ten minutes later!

But it wasn’t like I could go straight to the file folder where I knew the answer was. Most of the time I was staring into empty space, knowing that the answer was not where I was looking. I could feel when I was wrong and also when I was on the right path. When I did unearth the correct name, it was as if all the associated circuits lit up simultaneously and I instantly knew for certain that I was right.

So if I had to guess, I would say that my weakest link might be the pathways connecting the involved modules. It would make sense (to me, anyway) that they had atrophied over the years for lack of use.

But is this normal aging? I have no clue! In my brief web search, I couldn’t find any published research about this subject. The failure to connect faces with names and identities is well-documented in Alzheimer’s Dementia, but I couldn’t find anything about difficulty making those connections earlier in life being a risk factor.

So if you decide to play the game, please let me know how you make out. I’d love to hear about your experience.

In the meantime, feel free to reminisce a bit with Shirley Ellis’ memorable lyrics:

The name game. Shirley! Shirley, Shirley

Bo-ber-ley, bo-na-na fanna

Fo-fer-ley. fee fi mo-mer-ley, Shirley!

Lincoln! Lincoln, Lincoln. bo-bin-coln

Bo-na-na fanna, fo-fin-coln

Fee fi mo-min-coln, Lincoln!

Come on ev’rybody, I say now let’s play a game

I betcha I can make a rhyme out of anybody’s name

The first letter of the name

I treat it like it wasn’t there

But a “B” or an “F” or an “M” will appear

And then I say “Bo” add a “B” then I say the name

Then “Bo-na-na fanna” and “fo”

And then I say the name again with an “”f” very plain

Then “fee fi” and a “mo”

And then I say the name again with an “M” this time

And there isn’t any name that I can’t rhyme

Arnold! Arnold, Arnold bo-bar-nold

Bo-na-na, fanna fo-far-nold

Fee fi mo-mar-nold. Arnold!

But if the first two letters are ever the same

Crop them both, then say the name

Like Bob, Bob, drop the “B’s”, Bo-ob

Or Fred, Fred, drop the “F’s”, Fo-red

Or Mary, Mary, drop the “M’s”, Mo-ary

That’s the only rule that is contrary

And then I say “Bo” add a “B” then I say the name

Then “Bo-na-na fanna” and “fo”

And then I say the name again with an “”f” very plain

Then “fee fi” and a “mo”

And then I say the name again with an “M” this time

And there isn’t any name that I can’t rhyme!

________________

–Wayne

S1E15. Vivid Memories That Aren’t

“I’m at Mom’s condo. The police are here. They won’t commit her. Can you please talk to them?”

It was a frantic call from my sister Lorna in Florida. My 83 year-old mother had assaulted her aide and the police had been called. We knew she was dementing, but she refused to move into assisted living. It was only a matter of time before something like this happened.

I vividly recall talking to the officer from the dining room of our B&B, holding the phone to my ear and pacing back and forth only as far as the cord would allow me. Fortunately, we had no guests at the time.

I told him that I was a licensed clinical psychologist and explained why she needed to be committed. He replied that she did not currently appear to be a danger to herself or others and he could not commit her under Florida’s Baker Act. He told me I was a terrible son for not taking better care of her and that if I didn’t make arrangements for her, he would have no alternative but to handcuff her and arrest her for assault.

I told him to go ahead and arrest her. When he tried to do that, she did exactly what I knew she would do: she punched him. At that point, the police restrained her, brought her to a hospital psychiatric unit and had her committed. She got the help she needed.

Nearly all of what I just recounted is true, all except my vivid memory of having the conversation in the dining room of our B&B. You see, I didn’t become a clinical psychologist until 5 years after we sold the B&B.

Yet I can see this scene in my mind’s eye as clear as day. I see myself holding the phone…and that should have tipped me off that my memory was faulty, because I could not possibly have seen myself at that moment. I might have seen the table, the door out to the side porch, or my wife, but I would not have seen myself. The perspective of my memory was all wrong.

As memory expert Dr. Elizabeth Loftus tells us, “…once you have an experience and you record it in memory, it doesn’t just stick there in some pristine form you know waiting to be played back like a recording device. But rather, new information, new ideas, new thoughts, suggestive information, misinformation can enter people’s conscious awareness and cause a contamination, a distortion, an alteration in memory…”

So mis-remembering is a fairly common occurrence, but I suspect it can become more of a concern as we age, not because we are subject to new information being received, but because our memories become more fluid and permeable, that is to say, more at risk for being contaminated by a nearby memory.

In the case I just described, I tried hard to recall some other important conversation I might have been remembering that had occurred in that location, but I couldn’t. Then I tried to imagine having the conversation in the house were I actually was living in 2003 when this happened…and I couldn’t. So the mystery of this faulty recollection remains unsolved.

But it does bring to mind a similar, more recent experience. Once again, my memory is distinct and clear. We had just moved to Kennett Square and we went to the grand opening of the local Democratic Party campaign headquarters. It was 2012 and we were eager to work for Obama’s re-election.

No sooner had we stepped inside the door than the party chair walked up to us, introduced himself, and asked where we lived. When I told him, he immediately invited me to join the organization as a committee person for our precinct.

Although I don’t see my wife who is standing beside me in this memory, I feel her presence. The problem is that it’s not Sally. It’s my first wife who had passed away two years earlier.

That’s the kind of porous, mix-and-match memory recall that concerns me. I have no clue if this is meaningful or not in terms of distinguishing normal aging from the alternatives, but I’ll keep an eye on it. One thing is for certain: it’s definitely a mistake on the journey.

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S1E14. That Was Then. This Is Now.

I wrote this about my parents when I was 22:

‘They’ve been grandparents almost two years now. Grandparents twice over, that is, and a third expected momentarily. As I stepped through the doorway I was met by a heavy-sweet menagerie of home-cooked aromas. Outside, it was a crisp spring afternoon. Inside, it was a trifle too warm. They had both mellowed in recent years, but just now, for the first time, I felt as though I were entering a grandparents’ home. They’re growing old.’

When I wrote that closing line, I meant ‘old’ as a pejorative, not as a compliment.

My father was 52 at the time. He died at 60. My mother lived to be 85, developing dementia a few years before she died.

Paul Simon wrote this lyric into the song ‘Old Friends’ when he was 27 years old:

“Can you imagine us

Years from today

Sharing a park bench quietly?

How terribly strange

To be seventy”

Sally and I are 70. We quietly share park benches. It’s not strange at all.

On the other hand, Paul Simon will be 80 in October.

Our view of aging is curious, isn’t it? How must today’s 20-somethings view us? If we asked Paul McCartney today, would he say that 84 is the new 64?

In any event, heading toward our ninth decade, the goal is to be active, engaged, wise and interesting…a group of adjectives we don’t normally associate with the degenerative effects of dementia. The good news is that there appear to be things we can do to increase our chances of achieving those goals and of sidestepping our worst nightmare. In fact, we can now reduce our risk of dementia by some 40% by adopting a brain-healthy lifestyle. We can fight back against the prejudices and preconceptions of our younger selves!

Spoiler alert: I’m not one for miracle cures or for buying into ‘secret information that you can’t find anywhere else.’ As a former psychologist and researcher, I trust the science and want to see multiple studies heading in the same direction before I accept a conclusion as valid. So here are 4 recommendations for which there is a body of evidence supporting their efficacy:

Take care of your heart. Your brain depends upon blood flow to provide nutrients and remove debris. There are 400 miles of blood vessels in your brain. You want every inch of them pumping at peak efficiency to prevent neuron damage and maintain synaptic connections. Adopt a heart-healthy diet; keep your stress levels in-bounds; keep your blood pressure and cholesterol levels in check.

Exercise. The current guideline is about 150 minutes of ‘huffing & puffing’ each week (e.g., 30 minutes/day x 5 days). Walking is fine, but you need to work up a sweat and breathe hard. Obviously, this is good for your heart, but I also suspect that its moderating effect on cognitive function is also related to the fact that it engages so many areas of your brain.

Challenge yourself cognitively. Read books. Learn new skills. Change your routine. Solve puzzles. Take on-line courses or, better yet, once we are COVID-clear, take courses in person. There seems to be a ‘use-it-or-lose-it’ aspect to how well our brains age, so try to be open to new experiences and challenges.

Socialize. We are social animals and engaging with others engages our brain in ways well beyond any other activity. Just take a moment to think about all the ways you use your brain when sitting down for a meal with a group of friends. The complexity of negotiating a social context is stunning, invigorating, challenging…and fun!

That’s roughly where the research stands today. You can reduce your risk of developing dementia by about 40% if you adopt a lifestyle that also happens to be associated with increased longevity. You get double the bang for the buck: more years and better years.

Bottom line: We don’t have to accept the dire predictions of our younger selves. We can marshal the resources that got us this far to get us through the final years of our journey in good stead. It’s definitely worth a shot.

All of which gives a brand new meaning to Bob Dylan’s 1964 lyric:

“…I was so much older then

I’m younger than that now.”

__________________

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S1E13. A Baby Boomer’s Worst Nightmare

“Don’t ever let me get like that.”

Sally’s 7-word reaction to the movie said it all.

We had just watched ‘The Father’ starring Anthony Hopkins. It’s the story of an 80-something year-old man in London struggling with dementia. The movie is filmed in a way that forces you to not just observe him, but to experience his confusion for yourself, to get a brief glimpse of what it might be like to have dementia.

It’s masterful. The performances are superb. It’s painfully important for you to see it.

It immediately forces us to address our worst nightmare: What if we get like that?

Our parents’ worst nightmare was becoming a burden to their children. Themselves children of The Great Depression, they feared financial insecurity that would deny them their independence as they aged. They didn’t want to add the weight of caring for them to their children who would be simultaneously carrying the burden of raising their own families.

But that generation didn’t expect to live long enough to dement. Seventy was considered a ‘ripe old age.’ The prevalence of dementia wasn’t what it is now.

More than half of us baby boomers will live into our eighties…and the incidence of dementia will increase. It’s our worst nightmare.

If dementia is the path before me, is it possible to prepare for it like I did with retirement? What happens when I stop being me? When is being alive not the same as living? Where are the inflection points?

I’m wrestling with all of those questions.

There is one school of thought that says we are constantly changing throughout our lives and that dementia is just another aspect of that change. You might become different as you dement, but you are still you.

I don’t think I agree with that.

Our life changes are forged from our experiences that shape how we relate to the world: how we think, feel and act. In normal aging, we continue to grow and adapt to our changing bodies and environment until we die.

The dynamic is quite the opposite in dementia. There is a physical process that is attacking our capacities, our stored memories and our adaptations. It is fundamentally changing how we think, feel and act–not in the furtherance of our ability to survive and cope with our world–but in direct conflict with it.

That’s not living. That’s dying.

Hospice and palliative medicine physician B.J. Miller, In a recent New York Times opinion piece titled ‘What Is Death?’ wrote:

“For some of us, death is reached when all other loved ones have perished, or when we can no longer think straight, or go to the bathroom by ourselves, or have some kind of sex; when we can no longer read a book, or eat pizza; when our body can no longer live without the assistance of a machine; when there is absolutely nothing left to try…If I had to answer the question today I would say that, for me, death is when I can no longer engage with the world around me. When I can no longer take anything in and, therefore, can no longer connect.“

I agree with Sally: ‘Don’t let me get like that.’

In the 2014 film ‘Still Alice,’ Columbia University cognitive psychologist Alice Howland (played by Julianne Moore) develops a suicide plan after receiving a diagnosis of early onset Alzheimer’s Dementia. She designs it to be implemented at the inflection point when she loses full agency over her life. Spoiler alert: Her plan doesn’t work.

In ‘One Flew Over The Cuckoo’s Nest (1975),’ after witnessing the life-altering effects of a lobotomy on Jack Nicholson’s character, Chief holds a pillow over McMurphy’s head and smothers him to death. He knew that Mac was no longer Mac and that his life had already been stolen from him.

So it appears that there are a few questions that need to be asked and answered. First, is there a point when dementia meets Miller’s definition of death? And, if so, is there anything we can do about it?

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S1E12. I Got Scammed!

It’s the 3rd quarter of the University of Connecticut vs. Baylor NCAA Women’s Basketball playoff game. My Lady Huskies are struggling against the Bears with the score seesawing back and forth.

That’s when I receive an email saying my Facebook account was going to be deleted due to copyright infringements. I have 48 hours to appeal the decision.

I freak out!

Facebook advertising is how I introduce my blog to new readers. In fact, I’m not 100% focussed on the game because I’m monitoring the performance of a new ad campaign during the timeouts, and that is how I happen to see the email.

Splitting my attention between the game and my Facebook panic attack, I do what I usually do to see if I am being scammed: I check the email address of the sender. Usually it’s bogus and I can spot a phony quickly.

It looks fine. It’s from a facebook.com address and the extension looks like a tracking code that Facebook uses.

Baylor 45

UConn 44

5:08 to go in the 3rd quarter

Grammar. Just about every phishing email I’ve ever seen has at least one grammatical error. This one does not. No spelling errors, either.

I realize I’m being distracted from the game. I know I can respond after the game is over, but this is bothering me.

Baylor 55

UConn 53

End of the 3rd quarter

So I click on the ‘Appeal’ button. It takes me to a new page where I enter my name, email address and birthday. I explain why I believe an error has been made and click ‘Submit.’

Then it asks me to log in to Facebook. Since I don’t know it offhand, I have to look up my password.

While doing so, it occurs to me that it’s strange to first submit information and then log in. I look at the page again. It’s no longer a Facebook ID. Something isn’t right.

I check my Facebook page. There is no similar warning there. My ad is still running. I can post to it, even though the warning email says my access is blocked.

BINGO…It’s a phishing scam after all!

I assess the damage and decide I haven’t revealed any information that someone could not easily get elsewhere, so I don’t bother to change my Facebook password. I block the original sender from my email account.

Thinking about it, I’m disappointed in my reaction to what just happened. I consider myself pretty savvy when it comes to spotting internet scams, yet I fell for this one. I did my standard due diligence, but I didn’t think it through before I reacted. That’s a pretty big mistake.

It was a failure of executive functioning: the ability to organize and sequence your thoughts, to look at things from different perspectives, and to consider the pros and cons of a situation and give them appropriate weights in order to make a judgement. It involves not only searching for evidence that confirms your belief, but looking for and considering contradictory evidence. I didn’t do that.

I didn’t consider the fact that if Facebook had spotted a copyright infringement or some other violation of their policies, they would have taken down the post, not the entire page, especially on a first offense. And they would have notified me on Facebook, not via email. But in the moment, I was swept up in the fear of losing my account, and my emotions hijacked my thinking, resulting in a first-class error.

So I’ve added ‘judgement’ to my list of things to keep an eye on as I dribble down the road to nowhere.

The good news? UConn won, 69-67, and advanced to the Final Four!

_______________

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S1E11. The Wisdom Paradox

“There is nothing which for my part I like better, Cephalus, than conversing with aged men; for I regard them as travellers who have gone a journey which I too may have to go, and of whom I ought to inquire, whether the way is smooth and easy, or rugged and difficult.”

— from Plato’s The Republic

__________

The notion that we may achieve wisdom as we age is comforting. Throughout history, many cultures have revered the elderly for this very quality: wisdom born of experience. It’s nice work, if you can get it!

In the 1940’s, psychologist Erik Erikson described the period from about age 65 to death as the time we negotiate our path through the conflict between integrity and despair. We reflect back on our lives and begin to confront our mortality. He defined success as reaching the conclusion that your life was meaningful, and then facing death with wisdom and integrity.

But there has also been recognition through the ages of the other path we might follow.

In the 6th century BC, Pythagoras posited that the decay of the mind and body began in one’s 60s and in one’s 80s the tendency was to revert to the mental capacity of a child.

The physician Galen, in the 2nd century, attributed dementia to the presence of too much black bile.

Quite the choice: being revered vs. being diapered; wisdom vs. black bile.

It’s quite the paradox: just as our lifetime of experiences grants us wisdom, aging can rob us of the memories and faculties upon which it is built.

When I was in my 20s (long before I learned about Erikson’s work), I set a standard for myself that was similar to his criterion. I decided that when I was on my deathbed, I wanted to be able to look back on my life and say, “I dug what I did while I was doing it.”

I’m not yet on my deathbed, but I think I’ve done a pretty good job. I’m pleased with my performance so far. I have very few regrets.

Have my various careers elevated me to the ranks of those with wisdom? I don’t know. By virtue of having lived this long, I have a lot of stuff stored in my head. Am I able to integrate it, manipulate it, and present polished pearls of wisdom on demand? That’s a pretty tall order. I’d like to think, though, that I have a unique and helpful perspective to offer. If that passes for wisdom, then so be it.

When Erikson penned his theory, we retired at 65 and our life expectancy was in the early 70s. Today, many of us are working well past 65, and even if we have retired, our lives are full and enriched by our volunteer engagements, travel, family and community involvements. Life expectancy in the United States is now 79. It’s becoming more common to read obituaries of centenarians. When I read about someone who passed while in their 70s, I hear myself lamenting, “So young!”

So now I’m 70 and not yet focusing on end-of-life issues. Instead, I’m embarking on a new career as a blogger. I can still express myself pretty well…and people still laugh at most of my jokes!

But how long will I occupy this state of grace? With aging–whether normal or pathological–I’m losing access to my database. My abilities to think things through and connect previously unconnected dots are slowing down. How long before listeners stop listening with interest and start finishing my sentences for me? How long before the black bile makes its presence felt? How long before Plato would not consider me a worthy traveller?

________________

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S1E10. How It All Fell Apart

In March of 2019, I was on track to be the next chair of the Chester County (PA) Democratic Committee. Two years later, I’m not even a member of the organization. How did that happen?

More importantly: Why did it happen? The answer to that question makes a big difference.

Up until now, I’ve explored specific mistakes related to specific brain networks such as memory and language. But there are also global effects related to an oncoming dementia that can generate errors on a grander scale.

As our processing speed slows or as specific deficits develop, it takes more effort to attend to business as usual. The effects can be very subtle. We might get frustrated more easily, or feel more fatigued more often. Some of us will lose interest in things we’ve long enjoyed, while others will start to withdraw from social activities.

Now let’s take a look at what happened to me over the course of the past two years.

In March of 2019, I had a falling out with the Chair of the County Democratic Committee and resigned my position on the executive board. This was not planned and it immediately ended any chance I had to be elected County Chair.

Surprisingly, however, I felt relieved. I realized that–for the first time in my life–I had taken on more than I could comfortably handle. In retirement, I was feeling more stressed by my volunteering obligations than I ever had as a full-time employee or business owner!

Two months later, I resigned my seat on the Kennett Square Borough Council. The reason was pretty straight-forward: Sally and I were planning to travel a lot in the second half of the year and I wouldn’t be around to do my job. I thought it only fair to resign so that my fellow Council members could appoint someone to complete the 8 months remaining in my term who would take over my workload.

Again, I felt immediate relief after my resignation, even though relief was not my goal.

(By the way, Sally and I thoroughly enjoyed our trips in the second half of the year!)

At this point, having resigned two positions, I was still Chair of our local Democratic committee, the Kennett Area Democrats, and I was still a committee person responsible for my precinct.

In January of 2020, instead of further lightening the load, I took on a new assignment when I became the campaign chair for our candidate for State Representative. Once again, I was a full-time volunteer.

I thoroughly enjoyed the work, embraced it and learned a great deal from the experience. I was busier than ever, but not feeling the pressure.

My job as campaign chair ended on election day in November.

In December, I resigned my position as the Chair of the Kennett Area Democrats. It had been my intention ever since I was first elected three years earlier to guide the organization through the 2020 election and then step down. And so I did.

Let me pause here for a moment to provide some important context. As I’ve explained in earlier posts, cognitive impairments are defined as declines from previous levels of functioning, so it’s important to know a little something about my history.

Interestingly–or maybe ‘strangely’ is a better word–my life pattern has been to change my career (not just my job) every ten years. It seems my interest and enjoyment have an expiration date assigned to them. My careers as the manager of a performing arts center, as a B&B owner, and as a clinical psychologist all lasted just about 10 years, more or less.

Each time I shifted, I embraced my new life with all my heart and soul and never looked back, never regretted the change, and lost interest in the old job. Now it appears to be happening again as I transition out of my career as a political activist, which began in October of 2010, a month after the death of my first wife.

The final separation came this past week when I resigned as the committee person for my precinct. During recent Kennett Area Democrats’ monthly ZOOM meetings, I realized I was losing interest in the organization. And then when a motion I offered was defeated, I thought: ‘I don’t need this aggravation and I don’t have the fire in my belly anymore to fight for this stuff. I’m done.’

Other than Sally, writing this blog is now my only passion.

So…what do you think? Does what I’ve described sound reasonable? Or is it a series of rationalizations to mask what’s really happening to me? Am I experiencing signs of cognitive decline on the journey to dementia? Or am I just beginning my 5th career?

Time will tell.

________________

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S1E9. When Words Hide

I was 45 and they were 22 the first time I met informally with my 6 new classmates in the clinical psychology Ph.D. program at the University of Connecticut. They were all incredibly bright and I couldn’t help but marvel at how fast they talked. For the first time in my life, I had to concentrate to follow the conversation…and I frequently discovered that they had moved on to a new topic by the time I had formed a thought I wanted to express.

It was my first encounter with the normal decline in brain processing speed as one ages. I, of course, attributed it to my having so many more experiences and neural connections than they did so that it took my brain longer to sort through all the information I had stored up before responding.

That was a soothing theory to which I clung, but the fact is that our processing speed slows down as we age.

Fast forward 25 years. I no longer have to compete with 22 year olds in the classroom, but I’m sure my processing speed has continued to slow. There are some television shows where the rapid-fire dialogue is a challenge. I’m convinced they are written for a younger demographic.

Even among my peers, there are times when I listen and follow the conversation, but nothing witty or relevant occurs to me that is worth sharing.

On the road to nowhere, this subject is known as ‘verbal fluency’ and it is one of the abilities that is measured to test for problems with language, 1 of the 6 domains in which impairment may be the basis for a diagnosis of mild neurocognitive disorder or dementia.

We all know its most common symptom: difficulty with word-finding. You know what you want to say, you can see it in your mind’s eye, you can recall any number of facts about it, but the word eludes you.

If you pause in mid-sentence while you search (which is uncomfortable for everyone), someone invariably tries to fill in the blank. Or worse yet, a guessing game erupts!

Or you don’t pause and instead try to work your way around it: ‘You know, that thing you hit with a stick at a party and candy comes pouring out.’

Worst of all, though, is when you just try to muscle your way through and the wrong word comes out: pinball; pintail; pintata.

There are simple tests that have been developed to detect problems with verbal fluency. In general, you are given a short period of time (e.g., 1 minute) to come up with as many words as possible that meet a certain criteria, such as names of animals or words that start with the letter ‘y.’

I just gave myself 1 minute to list words that begin with ‘y.’ Here’s what I came up with:

Yacht, yen, yin, yang, yank, yankee, yawl, yam, yak, young, youth, yap, yahoo, yard, yardarm, yikes, yipes, yarmulka.

As I took this make-believe test, I noticed that I began quickly with several words at the ready, but then my production tapered off. By the end of the minute, I was staring at an empty room in my brain.

It’s now several minutes later and a few additional words have come out of hiding: yarrow, yes, yell, yellow, year, yearling, yield.

If I were being evaluated, the psychologist would compare the 18 words I found with the number found by 70 year old men with more than 16 years of education. If my score was below the average range, I would be on my way to meeting one of the criteria for a diagnosis.

But I’m not ready to take the test just yet.

Post script:

I went for a walk and came up with: you, your, yourself, yeti, yoga, yogi, yogurt, yew, yenta, yearly, yearn, yearning, yore, yurt… Where were all of these words when I needed them? Where were they hiding?

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S1E8. Splotchy Thinking

I look at the back of my hand and I see veins running under a splotchy, thin skin. It is the hand of an old man.

I know I am 70. I know this is normal, just as I know that a decline in brain function is normal. Yet I want my brain to look and act the same as it has for the past 50 years. I reject splotchy thinking. I bristle at the errors I am noticing with increasing frequency. Even though this might be normal, I don’t like it.

It happened for the first time the other day. I was putting things away after dinner and I put the butter on the upper shelf of the refrigerator. Only problem is that we keep it in a covered compartment on the refrigerator door. I caught the mistake as soon as I made it, but something tells me that this wasn’t the last time that this will happen.

We don’t have a regular set of dinner dishes. Instead we have an eclectic collection of dinner plates. I was looking for the ones with the colored dots design and couldn’t find them. Did the housecleaners move them? They have their own sense of fengshui and we find all sorts of things have been re-purposed after their visits. Instead of going down that path, though, I asked Sally if she knew where they were. As we talked, I recalled that some plates had chips in them. Did we throw them out? Sally remembered our conversation about throwing them out, but neither of us could say for certain that we did. I’m going with the ‘we threw them out’ theory.

At Sally’s request, I haven’t cut my hair since COVID hit a year ago. It’s now ponytail length and so she gave me one of her hair ties. I used it the other day when I went out and took it off when I returned. Later, when I had to go out again, I couldn’t find it. I looked all over. Sally gave me another one. Later that night, when I undressed for bed, I found the original one. It was on my wrist, hidden by my long-sleeved shirt.

I was walking on the track at the YMCA and I got to thinking about impressionist art. I set about trying to remember who it was that painted scenes of Tahiti. It didn’t come to me easily. I knew it wasn’t Van Gogh, Mary Cassatt or my favorite, Renoir. Not Seurat, Monet or Manet. Not Pissarro. I went through the alphabet to see if that would trigger a name, but that didn’t help. I visualized one of his paintings. I recalled a scene from the movie ‘Goodbye, Columbus’ where Richard Benjamin gives the name to a young black boy in the stacks of the Newark Public Library. It took about 10 laps around the track, but it finally hit me: Gauguin.

When I got home, I googled ‘major impressionist artists’ to see how many artists I knew whose names did not occur to me: Matisse, Cezanne, Degas, Toulouse-Lautrec. That means I was able to conjure up 8 out of 12. I think that’s a pretty good percentage. Ask me again a year from now.

When I drive somewhere, I take a moment and look around to lock in my location after I park. So far, I haven’t lost the car once!

I turned on the tap in the upstairs bathroom sink, reached into the medicine chest and took out my toothbrush and toothpaste. There was nothing wrong with that…except my intent was to shave, not brush my teeth.

And that, my friends, is what a splotchy brain looks like.

Post script: I think I really dodged a bullet in the tale of the missing dishes. In dementia, it’s very common to fabricate explanations when your memory fails in order to fill in the gaps. A brain, like nature, abhors a vacuum.

Paranoid explanations are quite common. Instead of concluding that I must have thrown them out because they were chipped–even though I don’t recall doing so–I could have decided that the housecleaners stole them. Or that a thief or neighbor had come into the house at night and taken them. If you told me that didn’t make any sense because no one would steal 2 chipped plates when there are plenty of better ones right there for the taking, I would argue with you, confabulate another rationalization, stick to my guns…and wonder why you were being so difficult.

If/when I start doing that, I will have traveled well beyond splotchy on the road to nowhere.

_________________

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S1E7. A False Sense of Security

It’s both gratifying and reassuring when readers leave comments reporting that they, too, are making errors similar to the ones I describe in a post. If you are of a certain age, you worry about these things. It’s nice for all of us to know that there is a community out there that embraces us.

But I don’t want to mislead anyone. Just because I am making mistakes that I can write about doesn’t necessarily mean that they are not a problem…for me or for you. You see, I don’t know whether what I’m describing is normal aging, a mild neurocognitive disorder or early signs of dementia. I don’t want to scare you with this blog, but neither do I want to give you a false sense of security.

So now would be a good time to talk about what it takes to determine where one actually stands. In other words, to make a diagnosis.

A diagnosis is a traffic light on the journey to nowhere. Normal aging is green: full speed ahead. A mild neurocognitive disorder is yellow: proceed with caution. Dementia is red: stop and revise your travel plans.

The first criterion for earning a diagnosis is that the mistakes are disrupting your life in a meaningful way. If they are occasional and only mildly irritating, then it’s probably normal aging. If they are more frequent, have actual negative but minor consequences, and you have difficulty compensating for them, then it might be a mild neurocognitive disorder. If the errors are significant, disrupt your daily activities, place you in danger, or you are unaware of them, then they might reflect the onset of a dementia.

Unfortunately, the above paragraph isn’t really all that helpful. There are too many squishy, undefined adjectives like ‘meaningful,’ ‘mildly,’ and ‘significant.’ We need to drill down.

The second criterion is that the changes you are noticing in your thinking and behavior represent declines from your normal or prior levels of performance. I’ve never been good at remembering faces or last names, so not being able to do so now doesn’t necessarily tell me anything about my status today. It’s new problems that we’re looking for.

But satisfying these first two criteria alone won’t earn you a diagnosis. Your performance should also fall below what is considered average among your peers. ‘Peers’ are often defined as those of the same age, gender and educational background. ‘Average’ is defined as scoring between the 16th and 84th percentiles on standardized cognitive tests. If you score between the 2.5 and 16th percentiles, you will meet the criteria for a mild neurocognitive disorder. If you fall below that level, it is most likely indicative of a dementia.

Finally, this isn’t just about memory. There are 6 broad areas of brain functioning that need to be evaluated. Significant problems in any one of them are sufficient to earn the diagnosis of mild neurocognitive disorder. Significant problems with memory and in at least one other domain are required for a diagnosis of dementia:

Complex attention
Executive function
Learning and memory
Language
Perceptual-motor
Social cognition

I hope to discuss them all in future posts. Meanwhile, here’s a link where you can learn a little more about these categories: https://rb.gy/xdhwnu.

Bottom line: The only way to know where you stand is to be tested. I have not yet been evaluated, so I don’t know where I stand. I can have no sense of security.

_______________

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S1E6. Did I Do That?

Instead of electric blankets, we have electric sheets. If you’ve never tried them, please do! One of the highlights of our day is getting in bed at night, just to feel that head-to-toe warmth. Sally and I both squeal with pleasure!

But in order to make sure our bed is toasty warm at 11pm, I go upstairs and turn on both sides of the dual-controlled sheets at 6pm.

(No…that is NOT where I’m going with this. I NEVER forget to turn on the sheets and I don’t need any reminders or accommodations to make certain I do. Clearly, memory is fine when one is highly motivated!)

So each night at 6pm, I walk up the stairs to our bedroom, turn on the sheets on her side of the bed, place her nightshirt under the covers so it will be toasty warm when she puts it on, and then place 2 pillows on top of the covers to weigh them down so they have contact with the sheets.

Then I walk around to my side of the bed and do the same (except I don’t have a nightshirt).

I am about to leave the bedroom when I stop in my tracks. Did I turn on the sheets on my side? I can see the pillows on top of the bed, but from where I stand, I can’t see the control. I have no memory of turning the sheet on. So I go back and check.

It’s on.

I check the control on Sally’s side–just to make sure–and it’s on, as well.

I wouldn’t be writing about this event now if it were not for the fact that the same thing happened the next night, and the night after, too. With the same result each night: I had turned my sheet on, but had no clear memory of it.

This was very different from the experience I described in my second blog entry (https://mistakesonthejourneytonowhere.com/2020/12/12/peek-a-boo/) where I forgot what I intended to do on the way to doing it. Forgetting that I did something after I had already done it, though, was an error of a different magnitude.

There are many aspects of daily life for which we don’t create episodic memories. Things that are rote, routine, automatic, done without thinking and/or repetitive are not worthy of space in our memory bank. Memory is for experiences that are unique, special, emotional, important and/or worthy in one way or another.

I decided to make this activity important to see if that would make a difference. Instead of automatically going through my routine (and allowing my mind to wander where it would while I turned on the sheets), I made a special effort to stay in the moment. When I clicked on the sheet on my side of the bed, I looked at the control. It registered an ‘8’ on its digital display. There was one red light to the left and 3 red lights to the right.

When I walked out of the room, there was no doubt in my mind that I had turned on the sheet. The image of the digital display was clear and vivid.

So, too, the next night and the night after and the night after that.

. . .

A week later, I had cataract surgery which requires using eyedrops for several days during the recovery period. Sally was my nurse, administering the drops 3 times daily. But one day, she wasn’t available and so I did it myself.

And an hour later, I wasn’t sure that I had…

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S1E5. Testy & Edgy

“Do you remember that I have a ZOOM session with my sisters this afternoon?”

It was a simple question and a fair one that Sally asked. She uses my ZOOM account and I have to start the session before making her the host. I do it all the time. So why did I resent her question?

“Noooo,” I replied with attitude, “I haven’t checked today’s calendar yet.”

She picked up on my tone and shot back, “Aren’t we testy and edgy today!’

Why did I snap at her like that? The therapist in me knows that emotions are triggered by underlying beliefs, so I knew I needed to think through what it was about her question that triggered me.

As I explored my thoughts, I realized that I felt as if I was under attack, as if Sally was questioning my ability to remember and not just my memory of this one specific event. Was she keeping an eye on me? testing me for signs of decline?

Sally has volunteered with hospice since her 20s and she truly is a comfort to those with whom she works and their families. She’s familiar with reminiscence therapy and she knows how to help dementia patients stay in touch with their memories, even as they fade.

Is that what she was doing with me? She loves to ask me about my life before we got back together 9 years ago after not seeing each other for 41 years. She is fascinated by the details…most of which I can’t remember. I often get frustrated when I can’t answer her questions.

The more I reflected, the more I came to wonder if her questions were also part of her concern for my mental status…and the more I resented her for it.

So after apologizing for my testy & edgy retort, I told her what was going through my mind. She reassured me that I couldn’t be more wrong and I immediately felt silly for thinking those things of her. But since I knew it was still a trigger, I asked her to try not to start conversations with: “Do you remember…” She was more than happy to do that for me. I felt a lot better.

This conversation unfolded several weeks before I made the decision to start this blog. I was already monitoring myself and thinking about writing it all down, so I was sensitive to the topic of dementia. I hadn’t yet told Sally about it, so she didn’t have a clue when she inadvertently stumbled across it.

So, as usual, there’s good news and bad news here.

The good news is that I was aware of my feelings, was able to think it through, and then talk with Sally about it to allay my fears and work up an accommodation. That was nice work for me as an individual and for us as a couple.

The bad news is that my mind wandered down this dark path. There is a word for when you suspect people of having ill intentions towards you when they, in fact, do not: paranoia.

It pains me to admit that paranoia describes what happened. After all, I’m probably the #1 fan (with Sally a close #2) for #TeamNormalAging. The episode was brief and easily resolved, but an episode nonetheless. I’ll have to keep an eye out going forward.

Sorry to leave you on a down note, but I promised to follow the road wherever it leads…

S1E4. Mistakes on the Journey

Making morning love. Delightful. Surprising. With a different kind of awe and sense of discovery we experience now as lovers pushing 70 than we would have felt at 17, but awe and discovery, just the same.

A beautiful way to begin the day, yes? Making mistakes was the furthest thing from my mind, but it wouldn’t be long before I committed my first.

I got out of bed and went downstairs to the kitchen to take my medicine. I had the two pills in my hand en route to getting water when I picked up a scrap of plastic left overnight on the counter. I pulled out the garbage can to deposit the scrap and dropped the pills in, too.

See what I mean?

Or the check I put in an envelope without signing it first. Fortunately, I caught it before I sealed, stamped and mailed it. No harm; no foul. But the fact remains, I did it.

I was looking for the keys to Sally’s car on our key hook near the kitchen door. The keys to my car were on top, and so I removed them. When I lifted her keys off the hook, I saw that there was yet a third set of keys that remained. I asked her if that was also for her car. She correctly identified them as the 2nd set of keys for my car. When I looked a second time, I saw she was right.

Sally corrects me as I am telling a story because I said ‘wedding’ when I mean to say ‘funeral.’

And here’s one that we all know all too well: the word you want is on the tip of your tongue, but you can’t find it. Your listener is kind enough to provide it for you.

The mistakes are becoming more frequent. I monitor them.

The good news is that I catch a lot of my mistakes as soon as they happen…or, at least, I catch the ones I catch. (Obviously, I can’t catch the errors I don’t know I make–unless Sally flags them for me–and there is no way to tell how many of them there are.)

Making errors, though, is not really a problem. When they happen more frequently, it is a sign of subtle changes in mental status, but that might very well be normal aging.

It’s only a problem when the errors become so severe that they get in the way of your successfully completing your daily activities. Or when you become so upset about the errors (or being corrected by friends and loved ones) that you lash out at them. Or when you start to make up stories to convince yourself and others that you didn’t really make the error, or that it was someone else’s fault.

In clinical terms, mental mistakes are diagnostic of dementia if (1) they represent a substantial decline in your previous level of functioning, (2) what you are experiencing places you significantly below average for your age and education level, and (3) the mistakes are causing problems in your life.

So here I am, 17 days short of my 70th birthday. I’m still hitting pretty much on all cylinders. After all, I’m writing this and making edits as I go. And I’m paying bills. And I’m taking my medicine. And I make love in the morning. And I’m aware of errors I’m making and correct them when I can.

In the great scheme of things, I’ll take that as a win.