Gender Differences in Dementia...More Research - More Answers? Part A/B

My post from last Thursday, 06/25/15, left me wanting to find more answers, as nothing had really been resolved; I really wanted to understand why there were dementia differences between males and females, and how this could happen.  After posting, I began digging more.  There were some "Duhr!" moments which had me slapping myself upside the head (sometimes we can be so focused we can't see the apple for the leaf).   And, what I discovered was exactly what I had hoped for for that previous blogpost.

Although men tend to conveniently die before their spouses this doesn't really answer the questions about why more women are more prone to Alzheimer's than men, and why more men develop Parkinson's and Lewy Body Dementia than women.

Did you know it has to do with brain size and sex hormones, perhaps?!  I really want to insert an "Oooo!  La! La!" here, but I won't.  It would seem a little inappropriate - or would it?   It may also have something to do with Education, Smoking, Caffiene Intake, and Depression; or at least that's what one of the studies said.

The Risks for AD and LBD are varied.  For example, Education and Smoking have opposing effects on AD and PD, but aren't neccesarily risks for LBD .  But, Depression and Low-Caffiene intake which are risk factors for both Parkinson's (PD) and Alzheimer's (AD) increase the risk for Lewy Body Dementia (LBD)  (Risk Factors for Dementia with Lewy Bodies: a case-control study, 6/2015).

Also, did you realize that being a caregiver for a patient who suffers from dementia increases your chances of developing the ailment, as well as possibly decreasing your longevity by 6-8 years?  I suppose it's the stress.   This will need to be another focus of a post in the near future.

Anyhow, back to men and women.

It was first thought that men had a highter rate of MCI than women, but further studies conflicted in their reporting, so this is at something of a stalemate. This is a condition that rests between normal aging and dementia.    Approximately 10-20% of the population experience this state after 65 years of age.

Did you also realize that for approximately 12 years your brain begins to shrink?  It does.  And this is one of the problems with aging and dementia.  AS your brain diminishes it can't take "insults" (or attacks) as well as it did while it was still fresh, pliant, and young.

Now, it was thought that women comprised 2/3 of the AD population.  Well, this may be true, despite the numbers in various studies.  You see, since women somehow outlive men, the progression of the disease happens to those who are still standing, while those who die earlier cannot be stricken.  So they say.

Now, men tend to have larger skulls than women, which allows for more brain reserves (the brain's capacity to reslience of damages).  Men do, however, tend to have much faster age-associated volume decline in men for a normal grouping  (Clinical Epidemiology of Alzheimer's Disease: .assessing sex and gender differences.  01/2014.).   However, women who have been diagnosed with MCI or AD tend to have a much more rapid decline in brain size than men.   Women may have more grey matter in specific regions of the brain, as well, whereas men tend to have more white matter in those regions.

What's the difference between white matter and grey matter, you ask?  Well, White Matter has to do with how the brain learns and functions, and transmits that information as a relay to other portions of the brain.  Grey Matter deals with processing and cognition.  This helps understand some of the gender differences in thinking and processing, and while it's understood that there is an interplay of sex hormones and chromosom

Grey matter and White Matter

es, just how they interact with the brain is still not completely understood.

And, to be honest, this seems more than enough for a post.  I will let you off at this corner while I will continue on with more research and look for more ways to comprehend this little conundrum for my sake, as well as yours.

Till then, have a wonderful and fulfilling day.

Next Time:  A continuation of understanding the gender differences with dementia...perhaps more questions answered and more understanding of the process.
See:  Gender Differences in Dementia...Even More Research...Part C/D   07/01/2015

The Week Ending 06/28/2015

A pretty similar week to those in the past.

Mom reads her paper and does her crosswords.  It's still a challenge to get her to bathe, although they were able to manipulate her on Tuesday, so that was dealt with.  Luckily her room is climate controlled (so she doesn't perspire as much - I guess that may be a good thing) as it is so muggy and hot at this writing.  But, to her, it's winter with unusual weather.

She still ventures over to play BINGO! and enjoys the cookies and treats she wins.  She goes on walks with Mo (her physical therapist), and Jean who visited on Wednesday.

When Jean came on Wednesday she found Mom in the Great Room sitting at a table with a glass of water.  She was wearing her beige top and sandals, appropriate for the weather.  They visited with another woman who was there to see her parents.  They all knew one another's families and had a lovely chat.  Mom interjected, at one point, that her mother loved to garden.  This threw off the visitor who was amazed that our grandmother was still living.  Jean cued her in and her confusion ceased.  Whew!

Then they had lunch, which Mom ate sparingly.

Jean had brought Mom some blue hydrangeas and dahlias from her garden.  Later, in Mom's room, Mom admired them against all the other flowers which adorn her sill; the hydrangeas and dahlias being the only real living ones as Jean had purchased the others from the Dollar Tree so Mom would have no need to keep tossing them out when they died (this does keep the cheeriness alive for her).

Jean had arrived in the morning, this time, to avoid the afternoon heat (she hasn't a/c in her car, and it was going to be a scorcher!).  So she thought it might be nice to go outside for a bit.  This led to changing out of the sandals and into socks and shoes.  Her socks were the same ones she wears daily, and the staff hasn't been able to get them into the laundry (Mom is vigilant!).  Then, Mom wanted to wear a jacket (remember, to her it's January).  Jean talked her out of it.

When it was time to venture outside, Mom went into the loo to exit via the door that was in there.  Whoops!  Somehow it had disappeared!   So, they went out the same way as the other residents.  They admired the plants and Jean felt a pang of wistfulness espying the gazebo and recalling the days not long ago when they played Scrabble there.  Perhaps it could still be done, but on another day when Connie was there.

She slipped out a little later than anticipated and left Mom in a relaxed and happy mood.

Today, Sunday, Mom walked into Larry's house looking a little tired.  She was wearing her shoes and a light sweater over her shirt.  She didn't look as though she'd exercised much in the past week, but that's tough to tell - it could be the heat.

She wasn't very talkative and it took some time before she began to make some sense.

When she entered she was asked what she would like to drink.  She stated that she didn't want lemonade, as she could do that herself, and she was sketchy on the wine, and she'd had too much water this week, and tea was very much out of the question.  So, my brother poured her a lemoade with some ice.  Later, she was asking why his wine looked different and she was told that hers had ice.  This sufficed.

We ate a goodly meal and then she took her meds as we sat outside on the patio while she enjoyed ice cream and berries.   Then, soon it was time for us to leave.

On the way home she looked at all the lovely gardens in the area and stated, "I think it's wrong that people are oppressed into planting all these bushes and plants."
I asked her what she meant.
"When some people have too much power it forces others to submit, and it's just wrong!"

So much for people enjoying their gardens, I suppose.

"Now, how do you like the...." she asked.
"The what?"
"How do you like the things shouldn't be done in certain ways, but I suppose when we get there we'll see I did some of that this morning."
I didn't ask.  I only signified that I heard her and that was enough.

She did ask if I'd spoken with Tony (myself).  I asked if he had done something wrong, but she informed me that he took care of all her things and she knew she could rely on him.  I replied that I couldn't think of a more honorable man than he.  She agreed.  My heart soared.

Her comments were then toward the skies and the reflections of buildings as we darted through traffic on the freeways.

When we arrived back at St. Anthony's we went to her room.  I had her sign and initial some medical papers necessary to obtain her records, but this meant reading and re-reading several times (each was the first for her so I had to remind myself that frustration made no situation better).  Finally she signed and when I asked her to initial some items we went back through the same routine.  Then she handed it back to me and said, "I'm done."  Oh well, all is good.

There is a significant change in her over the past year and if today is any indication she will decline further than what was expected on our part.  And, yet, she is happily ensconced in her room which she calls home.  A place where it is safe, routine is known, and she knows she'll be taken care of by a staff who obviously cares.  It's all one could ask for.

Why Are More Men Susceptible to Lewy Body Dementia than Women?

Sitting in my support group for Lewy Body Dementia I was a little curious as to why everyone but two of us was  discussing men with LBD.  It just seemed a bit odd.  I asked my question and Lo!  Behold!  everyone there looked at me as though I was a tad off my rocker!  "Lewy Body Dementia affects men more than it does women," stated one woman rather flatly.  "Didn't you know that?!"  Nope.  I didn't.  No one had told me, and I found nothing much in the literature that would suggest such a fact.  So, I began digging.  And more digging.  And even more digging.

I spent a great deal of time Googling the topic, changing search words, looking for anything that would lead me to any statement of fact that supported this notion.  Aside from finding a study that stated that there were approximately 2.9 men for every woman diagnosed, there was not much else.

There was the search for Risk Factors for males.  Nada.  Zilch.  Rien.  Nothing.

I tried Bing and still the same sites came up.  I went pages and pages and pages into each search but found myself empty-handed.   Then I typed in "Research" and I found something useful.  It was a large autopsy study to investigate male gender and Cortical Lewy Body association.

What isare Cortical Lewy Body Dementia?

 Cortical Lewy bodies are a distinguishing feature of dementia with Lewy bodies (DLB), but may occasionally be seen in ballooned neurons characteristic of Pick's disease and corticobasal degeneration,^[1] as well as in patients with other tauopathies.^[2] They are also seen in cases of multiple system atrophy, particularly the Parkinsonian variant.^[3]

In plain English, this means they are more centralized at the base of the brain with symptoms that are similar to Pick's disease, which is a frontal temporal lobe degeneration (associated with the tau proteins more commonly associated with Alzheimer's)  and the basal cerebral cortex.  This type begins with language degeneration and works into movement, as well.

It may not cover everyone diagnosed with Lewy Body Dementia, but it's a start.

The study abstract was published November 2010 by the Journal of Neurology, and I found it as published by the US National Library of Medicine, National Institutes of Health.

To be brief, there was nothing that linked gender to the susceptibility of males more than females with Lewy Body, and to underscore this, more women are diagnosed with Alzheimer's than men (but we don't want to be cheeky and state each sex has their own flag on a different type of dementia, now, do we?")

After embarking on looking for variables and links that could answer the question about why men have LBD and women have Alzheimer's (yes, I do know these are not absolutes, so don't even try!) they were left with environmental factors.  Huh.  Now, doesn't that answer the churning questions in our bellies?!

So, I'll keep digging to see if there is anything more recent, even if I've the need to speak with a neurologist or two, if only to find if anything more recent has uncovered more answers.   But, until then, just keep living healthy as though there is no tomorrow.

For more, please visit:  Gender Differences in Dementia, 06/30/2015.

GPS and Mom

The other day I entered my car, opened my phone and tagged a new GPS program I figured would be an interesting one to try...perhaps it would be better than the one I currently use.  Ooops!  I should have been wary of the 5hours, 19-minute travel time for the 35 - 50-minute drive.  However, I figured it would readjust itself and all would be right with the world.   I tend to use this for the familiar drive to avoid accidents, slow roads, and to find the most efficient route so I could arrive in plenty of time, should she decide to dawdle.

Nope!  As I drove from my house it was already telling me to take side streets.  I did.  These streets led to the artery I could have made minutes earlier using my natural guidance system.  But, it seemed fine to see if there were any interesting routes I may not have known about.

Around and around I went.  The system took me through neighborhoods I hadn't seen since childhood.  While my inner routing system was nagging at me I continued to see where I would be taken.  More side streets and around areas that flung me further away from those arteries that would be more direct.  Finally, I looked at the clock - I had just spent 30 minutes driving and I wasn't anywhere closer to where I was going than I was when I'd begun.

I took measures into my own hands and the system went nuts.  It began telling me to turn onto streets we'd passed blocks before.  Over and over again it consistently directed me, once it tried to push me into a park where a dead end awaited, but I forged ahead, thinking I would beat this awful thing.

I soon found myself on a street on the other side of the river, where I believed I knew where I was.  I heard that nagging woman's voice, "Turn Right!" but it made no sense.  Something was wrong with the signs.  I felt a few pangs of panic as I was now quite late and I'd no idea where I was headed anymore.

At last I took a turn and found myself going in the correct direction, only a few minutes from Mom's place; but it felt wrong - something wasn't right.   And yet, I arrived, parked, and entered, feeling a bit frizzy and fried from my experience.

Then it dawned on me.  Was this experience similar to that of Mom's?  Was she going about life listening to her GPS and computer systems which nagged at her to do things that made sense, but then frazzled her so much she was lost despite herself?  

Watching and listening to Mom as we drove I noted how she had no clue where we were, most of the time, despite our having lived in some of the areas during my lifetime.  I had to point out some of the locations and she weakly stated she knew but it was obvious she didn't.

How quickly and easily we must forget that the dementia patient  begins to listen to such a system that guides with no apparent reason or rhyme.  They just go.  They know what is familiar but take away those elements and there is nothing but a world of chaos and confusion; they've no idea where to turn or what to do, so they begin to reason with a bad computer and GPS to find anything that  makes sense.

While I'm not going to use that application again, I'm glad I did.  It helped make sense of Mom's world for me.  And, while it didn't take me 5 hours plus to get there, it seemed providential that I had an epiphany to remind me of who I was dealing with and how she was affected.  

Descending a Bit Further...or The Week Ending 06/21/2015

Mom bathed this week!  Yes, she did!  Tuesday.  It had been about a week and a half since she last took a shower.  Her reasons to me were that she didn't approve of people telling her what to do;  and she didn't appreciate the thought of people waiting outside or peeking in to be sure she was doing what should be done in private.

So, how did they do it?  Aha!  I thought her weakness was ice cream.  BAH!  The very thought.  No, she was promised a glass of wine if she did.  And she did and it was a sensation.  I'm not completely sure why she hasn't taken one since, though....something to ponder, isn't it.

And Wednesday came as did Jean.  Jean was bolstered by the thought that Connie would receive a release from the doctor allowing her to venture to see Mom soon, so she whistled as she wound down the streets of Portland on her merry way.

I'm posting a portion (goodly) of her experiences that day (God forbid she kills me for doing this):

Got there at 2 pm to find Norma sitting in her chair, wearing a dark red sweater with some kind of short skirt below it. Shower garb?  Nightgown? She did not answer my question about that.  She had her stockings on and slippers.

I brought out of the closet a hanger holding white shorts and a gray skirt (thought it was slacks at first).

Reaction to the shorts: "I would wear those at the beach."

I told her it was nice and warm, not too warm, outside. "Why don't you take off that warm sweater and wear the nice white shirt and gray skirt outside?"

So--many random sentences later, Norma went into the bathroom and came back wearing the red sweater and gray skirt, carefully folding the white shirt and stuffing it into a dresser drawer. I told her that slippers were fine for outside.

We actually walked a bit in the garden, said Hello to Morena, who was sitting next to Barbara M, who was talking loudly about something. Mo complimented Norma on the gray skirt: "It looks very nice on you."

Another caregiver was sitting in a group with two residents.  Norma always discourages me from greeting or chatting with residents, so I do less than I would do on my own. The red roses are always good for our admiration, and we took the time to look closely at other flowers in the garden. During today's visit, Lucile is very much alive, so I use the present tense every time.

For the first time we entered the other cottage, saw only two ladies there, one a visitor.  A resident came to that table, and we heard someone being a bit rude to someone else, and  a few exchanges of pleasantries, as a caregiver stepped in to distract the rude one.

We sat for close to five minutes, and Herself said we could leave by that other door, and go outside.  As always, I tell her I do not know my way around that building. As she forged ahead along the short corridor to the lobby where we come into the building. I prayed no one left that door open.  Yes, it was locked. She suggested I might work the keypad, but I protested ignorance.  So we went back into the garden.My objective was to keep her walking as much as possible.

Did not see any of The Oregonian; I wonder what happens to it.Wednesday is a delivery day.

We walked the big "circle" around the kitchen in South Cottage.  A little lady came out of her room--Rosemary is her name--and seemed lonesome and confused.  She took my arm, which was fine, kissed Norma and said,"I love you," which went over well, you can imagine.  I was advised to shake her; the three of us walked to the big room, then Rosemary went to speak with someone at a table.  We got out of town.

I asked Josepha, who was in the kitchen, for paper cups to get a drink of water.  She offered orange juice, which was nectar to me then.  Norma took a sip, had more juice in her cup than she wanted, so poured some into my cup.  She is fast! I drank it.

I told Norma, as we strolled, that I had been trying to think of a word to describe a person who takes the place of an actor when the actor is sick. Right away: "Stand-in."  Some of those brain cells are just fine, thank you.  "Understudy" is the word I wanted, but she was correct, with  no hesitation.

When we returned to her room, she was looking for something, used words to tell me what she wanted, but none of it made sense.  She looked thru things in the cabinet behind the toilet. Never did find what it was, but I mentioned the two liquid soaps smelled good.  Back to her room.  She folded up the nightgown--never did agree that's what it was.  Into a dresser drawer it went.

I had seen a letter from Nadya on the dresser, so asked if she had a letter from Nadya recently.  Yes, she had. I handed her the letter, ready to make my getaway as she read.  Told her I would be back in a few minutes, and she asked, "Where are we going to eat tonight?"  I said I would let her know in a few minute when I got back.  "Don't take too long!"

There is a good picture of your mom sitting on the deck of your beach house.  We talked about the house, location, as I asked questions to keep on that subject.

One good laugh today:  A big smile and a chuckle when I entered the bathroom and asked Norma to "Hold my calls!"   It was a pleasant time; we chat like old friends about real and imagined times, people alive and passed on.  I  left at 4 pm.

Thank you, Jean.

Today, when I came in she was drinking a soda wearing a soiled blouse.  Well, not much I could do about that.  She saw no issues or dirt on the shirt, so I let it be.  

I told her we were leaving for Jean's, and she decided to wear a jacket despite my cautioning of 80-degree weather.  "You're full of prunes.  It's raining outside - Look!"  There was no rain, only slightly grey skies.  

"Fine.  You want to wear a jacket, then that's good.  I'll go out and get your meds.  When I return let's go."

"Okay," she replied.  

I got the meds, did a quick check-in with Ledi, and then came back.  She was seated in her recliner with the jacket on while sipping her soda.  "Okay.  Let's get going!  It's getting late and Jean is expecting us!"

"Hold on.  I need to find that ------"  the words were lost to me as they had been to Jean in her post.  I never did understand what she was looking for (later, someone told me to tell her it was in the car so she'd be quicker to leave -- Duh!).  Then, she decided the jacket wasn't going to be warm enough so she needed something heavier, such as her wool coat.  Ah Me!  

We finally were able to set off to our destination.  She was full of pep looking out the windows at everything we saw.  She kept trying to drive my attention to whatever she saw but alas I needed to pay attention to the road.  

We had a good lunch at Jean's.  Mom discussed how her grandmother didn't live with her grandfather, at the house a block away, as there were the wars and conflicts, she stated.  And, by the time she did arrive, there were just too many families living in the house for there to be room for her.   Goodness sakes!  The family history we'd never learned - because it didn't happen!  Good Golly! 

As we drove home, Mom was happy to espy Mount Hood.  This truly gave her joy.  She was also quite tired and wanted a nap, but this seemed to enervate her.  Then, she turned to me.

"Have you called your mother today?"

"I'm looking right at her.  Why would I phone you."

"You're acting like a fool!"  she was enraged. 

"Who do you think I am?"

"You know who you are.  Stop playing these stupid games with me."

"Sorry.  Yes, I did call her.  I'll stop by to see her later and I'll give her your greetings, as well."

"Where is she?"

"She's in a nice apartment she found."

"Why isn't she living with you?"

"She craves her independence."

"You're a selfish, rotten, no-good person.  You aren't nice to her at all."

"I'll be sure to remind her of that, as well.  Hey!  Look how clear Mount Hood is!"

And the conversation turned to happier thoughts.  

They were able to wash her clothes, but they discovered she had hidden most of her <ahem> private things, and they were very soiled.  They requested I buy another set or two, or three....

So, time marches on, despite her sinking into the LBD mire.  Her physical activity is much smoother, and she moves more quickly and adeptly.  However, there is a bit of the balance problem that is becoming a bit more pronounced.  But that will be  something to deal with in the future. 

REM Sleep Behavior Disorder (RBD) and Lewy Body Dementia/Parkinsons

There is nothing like a good, fitful, uninterrupted sleep without the use of any sleeping aid to ensure it.

But, what if that wasn't possible?  What if you had a condition that didn't allow for the conditions that would lead to a peaceful night and a bright, shiny morning?

Two of the symptoms for Lewy Body Dementia can be (not always)  Restless Leg Syndrome (RLS) or REM Sleep Behavior Disorder (RBD).    These occur earlier than the onset of the disease but can be seen as possible precursors.

During a regular night's sleep, the average person will fall into two distinct states:  Non-Rapid Eye Movement (NREM) sleep, and Rapid Eye Movement (REM) sleep.

In order to fully understand the impact of the RLS and RBD, one must also be able to understand how sleep works.  The following is an abbreviated primer:

NREM sleep has three stages:
1)  Beginning of the sleep stage with slow eye movement.  This is sometimes referred to as "Relaxed Wakefulness".  This stage lasts for up to 10 minutes, and also includes hypnic jerks in which the person may awaken and have no idea they had even fallen asleep.  This stage accounts for approximately 5% of the sleep time.
2)  No eye movement and dreaming is quite rare. Any consciousness of the environs decreases as do the muscular activities of the body.    There are bursts of activity from the brain, but there is no realization of the surrounding environs.   This stage is passed through several times during the sleeping process and accounts for about 45-50% of the sleep time.
3)  This stage has a longer duration during the first part of the night and comes in stages.  During this phase, the sleeper is more prone to dreaming than the other two, although it is not REM sleep stage.  This is the phase in which the sleeper is more prone to parasomnias such as Sleep Walking, Bed Wetting, Sleep Talking, and Night Terrors.   One must also note that the breathing and blood pressure have also slowed greatly, and the body is now coming into a stage of full paralysis for the normal sleeper.

Now, we enter the REM zone.

Mind you, during the NREM phases the body has relaxed as has the breathing.  But during REM the body enters complete paralysis as a sort of insurance against self-harm in acting out the dreams.  The breathing becomes irregular and the heart rate also increases.  The brain activity begins to soar, as well.   This phase lasts approximately 20-25% of the sleep duration and lasts from 90 - 120 minutes for each cycle.   This decreases with age, as infants tend to have dreams for 80% of the sleep duration so these numbers reflect those of an adult.

With  RBD, the paralysis that should occur during REM sleep is either absent or incomplete due to some neurological disorder.   Sometimes it could be the person is in withdrawal from alcohol, or sedative-hypnotic drugs.  The actions that characterize the behaviors can be vivid, intense, and violent.   Actions that a person with the disorder may demonstrate are:

  Punching, Yelling, Kicking, Grabbing, Jumping, Sitting, Walking, and others.

This is one of the symptoms that can lead to a diagnosis of LBD.

If it were present, you would most likely know.

With RLS, the person feels the impulse to keep their legs moving.  It's as though there is energy that is locked up and is attempting to burst out.    This occurs at regular intervals and can keep the person from falling into deep REM sleep, and wakes them up during Stage 3 NREM.  The consequences are fatigue and impaired daytime function.

While there are treatments, if you believe you have this condition, you should pay a visit to your doctor to ensure it isn't linked to another condition such as kidney failure, diabetes, or peripheral neuropathy.  It is not directly linked to Parkinson's (PD), but can be a precursor, just the same.

Also, they have discovered genetic markers for these conditions, as well.  However, these conditions usually present during middle-age or later.  Despite their presence, too, they don't always lead to a debilitating condition, such as LBD or PD, but they could also indicate some other problem, as stated earlier, so you should troop yourself into the doc and get the 411, just for peace of mind.

For more information on this topic, below are some links to information that was used to write this article:

Restless Leg Syndrome - National Institute of Neurological Disorders and Stroke

Sleep Behavior Disorder - Web MD

Non-Rem Sleep Stages - How Sleep Works

REM Sleep   - How Sleep Works 

A Trip to the Neurologist...and a milkshake

Lively.  She was lively today.

The staff tried, again, to have her bathe, but her stubborn nature refused.  This makes it over a week.  When I arrived I tried, telling her it would be rude to be quite so fragrant for the good doctor.  She scoffed.
"I'll not have people guarding me and watching me in the shower!" she exclaimed.  "I deserve some sense of privacy!"  The truth is that no one is even about when she bathes.  They just check the shower and towels to ensure she has used them.  But then, paranoia is a symptom...

So, withholding ice cream and trying just about every sneaky device they could have yielded nothing.  Nada.  Rien.

She was looking quite charming, though, in her vivid blue tee.  This was quite the change.  She was waiting for lunch to be served when I arrived, and the aide hurried out to fetch it so we could leave on time.   Mom ate and took her medications very nicely.  

As we were preparing to depart, Mom wondered if she should bring a jacket.  She was told it was quite warm out and that we needed to go.  She quickly followed me out of the building without question.  I'm finding that lingering and waiting for her to make a decision doesn't work.  If there's a way for her to go out "The Doors" then she's more than willing to go.

As we drove she asked about my nephew, Damian, and whether or not he'd left for Seattle yet.  I asked for more information.  She stated that he and his mother were there for a visit yesterday and she would be surprised if he had already left.  I assured her he had.  She mulled this over as we drove.

We came to a 4-way stop.  I stopped.  The other cars went through from the sides.  Mom decided it was a good time to chastise me for stopping at all.  Reason and rationality had no effect.  Thank God she doesn't drive!

At the doctor's she sat quietly reading (she appears to be the only one at St A's who does read) as I filled out the paperwork.

We went in and the doctor came in for his visit.

He asked Mom the date.  She told him it was sometime in January, year one.  She stated it was Winter.  He smiled and told her the correct answers.  Mom gave him a look of cynicism.   He then asked her if she knew what this was (as he pointed at his watch).  Mom told him it was a time thing.  She knew the strap and buckle, and the face she knew, but she didn't know the word 'watch'.  She gave him another look when he named it for her.

Next, he ran her through some exercises which she did with more difficulty than the times before.  She was slower, and she had great troubles closing her eyes and keeping them closed as she performed the activities per his instructions.

She walked well for him, except that she didn't stop when he told her to; rather, she began opening doors to rooms that held other patients.  Whoops!  A good thing he has a sense of humor.

He and I spoke in private for a minute or two (I can't tell, but Mom appeared outside the doorway window somewhat rapidly.  We went over some issues I see coming up for her and he stated that she's doing pretty well, and we've got a great team working with her.  This was wonderful.  There really wasn't much significant change he saw, but he did review the DNR and I stopped him from speaking with Mom about bathing (I didn't want to hear her rant about the embarrassment in the car on the way home.  He did ask me questions in her presence, but she kept interrupting telling me I was wrong and I had bad information, so I requested the private chat without interference).

We left and headed for Mickey D's for her milkshake (strawberry).  I dropped her off in her room and headed to the store to buy some supplies for her.

Upon my return, I bumped into Mo (Morena) the woman who does Mom's physical therapy.

She told me Mom has not been doing the bike very often.  She finds it difficult to get the rhythm and power for the pedals.  But, they've been walking.  That's good news.  She stated that it's been tough to convince Mom to get up out of her chair, but when she does she's hardly resistant.  More good news.

I was also given a copy of the sleep monitoring for Mom from a couple of months ago.  I wasn't all that surprised, to be honest, until I  crunched the numbers:

There are 168 hours in a week.
If one were to sleep 8 hours a day one would sleep about 34% of the week.
That means that 66% of the week is wakefulness for the majority of the population.
However, Mom is awake 35% of the week.
That means she is asleep 65% of the week - the complete opposite of what we might consider the norm.
Surprised?
Her sleepiest day she slept 20 hours.
Her most active day she was awake for 13.

Could it have been the weather?  From my understanding not much has changed.  This is pretty typical for her.  And, knowing that LBD causes great tiredness and feelings of somnulence this brought no shock.

A day of some revelations and solidifications.  

The Week Ending 06/14/2015

A mild week.  Yes, that's the word.  Mild.  Interesting in some aspects, quiet in others.

This week Mom took part in her regular regimen of physical therapy and BINGO!  She continually wore clothes with stains, refusing to change out of them or allowing them to be laundered.

Most Saturdays Mom spends in her room.  She has no interest in joining the others for meals, which is a concern; so, the staff refuses to bring her meals into her room as this sets a precedent for her to isolate.  Her meals are still held for her so she won't go without.

On Wednesday, Jean came from the hospital where her brother was undergoing a procedure.   She found Mother reading the paper in the great room.  They discussed a couple of articles that Mom had read.  Jean found her articulate on the subjects from the readings (later, Mom would have no idea of any of them).  They also managed a bit of the crossword, and Mom showed no interest in the jumble.

Jean suggested that Mom change out of the sweater shirt she was wearing and put on something lighter, as the temperatures were not those of a frosty day.  Mom obliged and went in and came out wearing a shirt with some noticeable dirt on them.  Jean then suggested she put that one in the hamper for laundry and find another.  Out came Mom wearing the original sweater shirt.  Oh well!

Jean also looked for the ribbon she had brought the last week to tie the curtains, so Mom wasn't tying them together in a pseudoknot.  This had obviously been something Mom had forgotten.  Jean found the ribbon in a drawer and re-tied them.    To be honest, this lasted until that evening when Mom untied them and hid the ribbon, again.

There was the suggestion they go outdoors and Mom began the search in the bathroom for the door that led to the garden.  Nope.  No such luck - it didn't exist.  So, she stated she had the key and they could go out the regular way.  So, they went down the corridor to the locked door that led to the front of the building.  Mom showed her the keypad and then they (with an aide right behind them) turned and went back into the great room.

Back in her room, Mom read from one of Nadya's letters and finished by stating that her friend, Nancy, was dead.  So, Jean turned her attention to the pictures surrounding her mirror.  This led to a discussion of their mothers.  "My mother IS a good cook," stated Mom.  "How often do you see your mother?" asked Mom.
    "Oh, once or twice a week, as they live next door,"  Jean retorted, keeping up the delusion for Mom.
This talk continued with them discussing the doings of their mothers who were very close and quite busy of late with each other, apparently.

Jean finally took her leave knowing Mom was doing well and in good spirits.

Saturday arrived and try as they could, the staff couldn't steer Mom into the shower or even consider bathing.  Not only that, but they couldn't get her to eat her breakfast, even though she was up quite early.  They were able to get her into a lighter shirt, though, and out of the sweater shirt she was demanding to wear every day.

And then she had surprise visitors:  her grandson, Tim, and his fiancee, Becky.   Mom had trouble recalling exactly who Tim was, let alone Becky (as they'd never met, before).  Tim stated it was a little awkward at first, but Mom was in a convivial mood and truly enjoyed their company.  After a bit Mom began to think Becky (who is of Chinese descent) was her niece, Kim (who is of Japanese and American descent).  They played along brilliantly, for when I arrived they were laughing and truly enjoying themselves.

Finally, Mom remarked that she was quite hungry (it was after 1 pm and she'd still not come out of her room for anything to eat).  I told her I'd arranged for them to hold her lunch, and while she was eating I'd give them a tour of the facility (a plot devised with the staff so we could easily escape).  She loved the idea, but then decided to follow us...ooops!  So, I escorted her back and kissed her forehead, reminding her of our doctor's (neurologist) appointment on Monday.  She sat ready for her meal as we headed out.

Of late, with the exercise and good weather, Mom has been much brighter and adept in her moving.  Her delusions are increasing a bit, but seeing her smile and be in such good spirits brings calm to my heart.

Tomorrow we see the neurologist, and we'll see what further information he has to impart.  

When the Child Becomes Parent of the Parent

You read about these things.  It's always someone else and in the back of your mind you shudder to imagine it happening to you.  But, then, you also feel a tinge of momentary glee when you realize there might be some opportunity involved - but that's when you understand that it's really not something you could pull off.

Then it happens.  You're left holding the world, decisions, and fate of the one who raised you, for better or worse.  For the majority, I would hope, there's a sense that dignity must be maintained.  I have met others for whom this is incidental and they simply want to wash their hands of their parent.   What leads to the latter is beyond me, as they seem empathetic, normal, and good hearted people.

When the determination is made you're left with a pit in your stomach not knowing what to do and where to turn.   You have a life relying on you.  It's not a newborn but your parent or spouse.  They've been diagnosed with dementia and you are in the center of a tornado trying to keep your grip on the ground before you spiral away.

I used to tell Mom that the time was coming where I was going to have to be the parent and she the child.  She guffawed at this and said, "That'll be the day!  Hell will freeze over first!"  But it did appear that she was slowly losing her grip on reality which we were attributing to senility (after all, she was over 80).  And then came the phone calls - not only from her but her friends, doctor, and other people associated with her.  She was in her own world while the others were concerned about her welfare.  Demands were made that I couldn't possibly make while working 250 miles away.

Finally, as I drove to visit her for several days I received the blow from her doctor - "Your mother can no longer live on her own.  I need to send her to Seattle to the geri-psych ward for observation, and then you and your brothers can begin making preparations for the next step."

I suppose I'd been waiting for something like this.  I called my brother who lived the closest to her and told him about the call.  I told him I'd asked the doctor to fill out the paperwork but to wait until we had our consult the following Monday.  He understood.

Heartbreaking is too mild a term to use in spending those last days with Mom in the house and town she loved so much.  It was as though she knew and kept rubbing salt in the wound every evening when she stated, "I just love this view and this house."  She'd be sitting in the front picture windows gazing over the Straits of Juan de Fuca gazing at Vancouver Island, the San Juan's, and Mount Baker.

It was beautiful but, sadly, too far away for anyone in the family to care for her in any way.   We spent our days traveling to the spots she loved so much in Victoria, and around the Olympic Penninsula.   Of course no mention was made about any of the plans that were being set forth, which made it all the more agonizing (but had she known the fight would have been bloody and the results would have been terrible).

Placing her, finally, into a residence that made sense was surreal.  I knew I needed to be there to help her begin to feel wanted and at home - but what she needed was just the opposite.  She needed her independence and to begin acclimating on her own time.  So, I let it go - seeing her once a week rather than three or four times.  It helped with the physical, mental, and psychic exhaustion I was experiencing.  It also helped with her easing into the daily life of the facility.

Now, Mom always had a propensity for arguing with some people and using the logic of a 10-year-old if she wanted something and had to reason it out.  It was quite annoying; however, now it seemed perfectly legitimate, except her logic had become that of a 4-6-year-old.  Her reactions, too, had also gone to kindergarten, pushing, shoving, hitting.  She was angry with me when I tried to explain to her to "use her words and not her fists".

While maintaining the dignity and respect due to my parent I also find myself leading her around and taking care of her needs.  In may ways, (I hope this doesn't come out wrong), my dogs are much better with doing what needs be done.    But, then, they have always had me to care for them - she used to be independent and by God she won't let that go!

There are elements of the situation which help create a stronger bond between us, but they need to be tempered as in her mind these are obliterated within minutes if not seconds.

While there are components of the relationship that are that of parent and child, it's more complicated.  She's too smart and too set in her ways to be treated as an inferior, but her needs are those of a tot.  

It's a conundrum that will repeat itself for time to come and with so many others.  Another circle of life.

Taking Away Driving Priviledges

"Old age is no place for sissies!" - Bette Davis

I can remember the angst of sitting in the passenger seat watching Mom do the driving.  If you told her to "Watch Out!" or made any sound that indicated an imminent impact there would be "Stop making me nervous!  Do you want to get us into an accident?!"  There was no logic in attempting to explain that one had narrowly been avoided - she'd call it "Bosh!" and carry on her merry way.

There is the story of my brother and his wife coming back from dinner with Mom.  Mom had insisted on driving.  As they went up the hill from the main street to her home she pulled into the wrong lane and proceeded uphill at the regular rate.  My brother strongly cautioned her there was another car coming.
"The sun's in my eyes.  Stop making me nervous!" she spat back.  My brother gripped the door handle tightly while his wife went down onto the floor of the back seat bracing themselves for impact.  Fortunately, nothing happened, and somehow this amazed us all.

Mom's driving had been a bone of contention all our lives.  It was something out of an amusement park.  As one friend stated, "I didn't know if we were in the Indy 500 or a stunt show.  She'd speed up and then she'd go to the shoulder and I braced for impact after going off the road and over the cliff!"  Such was our experience growing up with Mom driving.

There did come a time when I realized that as she drove she'd opine and opine and opine, chastising for any interruption, including attempts to tell her to turn, or to stop at a stop sign;  I'd just hold my tongue and my breath praying we'd make our destination.    So, I realized, and I explained to her that for this reason, and this reason only, I would drive so she could opine and speak without the distraction of the road.  She actually agreed and thought it a marvelous idea.  So, from that day forward I always drove when I was with Mother.
However, Mom lived 250 miles away.  None of us had any control over her driving from afar.  We knew that even if we had taken away the keys she'd figure out how to get them made and then plot a serious revenge.  It just wasn't worth it.  We all are in agreement with this.

When her license expired we all knew they'd never renew it without a test that she'd fail.  Washington was known to have these rules.  HA!  They bloody well just issued her a new one, according to her and sent her on her way.  Her doctor was absolutely amazed.   Mom had just had an accident and she was the only one who knew.  The insurance paid, finding fault with the other driver, so she obviously had an evil guardian angel.

The doctor brought up her driving and Mom fired her.  Most grievous mortal sin with Mom.  You dared not criticize or question her driving.   I counseled the doctor on how to get back onto Mom's good side, but it was too late.

So many people came to me telling me we needed to get those keys and her driving rights taken away.  Easier said than done.  We knew that Mom would march down and purchase a new vehicle no matter what - even if her insurance was expired (which it had a month before she was committed, but due to non-payment).

So, all that aside, and skipping the articles that are full of smarminess  and idealism about "Having The Talk", How does one take away driving privileges without falling into the "Pit of the Unforgiven"?

I recall Mom telling me about one of her friends doing just that when it seemed her father was terminal.  She sold his car.  When he made a miraculous recovery he discovered what she'd done and he disinherited her - giving all his fortune to her children.  Her response was to bypass her children and give her lot to charities.

With Mom, it would have been worse.  But - - It's also a grave necessity.

But why is it so difficult?

The Parent is Now the Child.  This transition is extremely difficult for most, including those involved.  Not everyone has a parent that will graciously accede his/her independence, and taking it away is rife with guilt and knowing the end may not be so far in the future.

Fear of Doing it Wrong.   Not knowing how that parent will react, especially if they are prone to dramatics and plotting against any perceived wrongs.

Responsibility.  Now, there is an added responsibility in transport for that parent.  This means finding methods and modes of getting them to their doctors, stores, and events.   For many this means finding more time out of their day to make this happen successfully.

Now, how to do it is truthfully beyond me, if you're going to have a happy compromise.  One friend moved his mother in with him and he simply took her where she wanted to go.  But she was demure, sweet, and very passive without the aggression.  I believe she was an anomaly.

I have been given pointers - such as:
1)  make the vehicle inoperable and state the parts are hard to find, but you may be able to order them...then bide your time.
2)  Hide the keys.  Put them out when they aren't in the mood to go anywhere, and then keep hiding them.
3)  "Take the car into the shop" and put it into storage...depending on where they are mentally, they may give up.

Yes, these may seem mean, but they have worked for a few people I know.

So, I toss it to you.  How did you, or will you, or have you dealt with this issue?  It's critical, and the more people can share the better off more will be when the time comes.

A Day of Delusional Construction ... OR The Week Ending 06/07/2015

What a glorious day!

The sun is out and the temperatures soared into the low 90's.  The morning air was fresh and full of promise. It must have touched Mom, as well, as she was moving better than I've seen in some time.

This week she's been doing her physical therapy - upper body and recumbent bike, taking small walks, going to BINGO, and spending quite some time in bed.

On Wednesday, Jean came for a visit.  She brought a ribbon to help tie Mom's curtains together (as Mom ties them together like a sweater around the shoulders) and Mom gave her direction on just how to perform the task.

Later, they went outside with Mom wearing a light jacket (even though it was close to 80!).  They brought tangerines with them and a plate for the peels.  They walked along the path admiring the roses and other blooms showing their fertile colors at this time of year.  Then they sat on the wooden bench so they could admire the entire garden and chat.

Barbara, the hairdresser, entered the garden and they chatted with her for a short time and then went back into Mom's quarters.   Here they chatted about activities and things done with Mom's mother and my father.  Jean thought it wonderful that Mom is acquiring new memories of her past loved ones, and I must agree.

It was a lovely visit and lasted a little under 2 hours.  Mom was ready for a rest.

Today, Mom refused to shower but was ready for me, wearing her sweater shirt and peddle pushers.   She was reading the paper and thought it best to bring along the adverts to Jean's house, just in case.  I asked if there was anything she needed to do before we left and she considered this for a moment then said, "I would really like to look around for things that other people have left here.  Maybe then we could go to their houses and drop them off."  I agreed, then asked if she was ready.  She was.  

I then stated that she might want to reconsider her shirt as it was supposed to be quite hot today.  She looked at me as though I was nuts and replied, "Why would I?  This is nice and I wouldn't want to wear anything conspicuous."  A sweater in summer - inconspicuous.  Hmmmmm.

So, she arose quite quickly and with little effort.   I alerted Jean we were on our way (it was a total of 10 minutes at most, this time.  A new record!).

We took a scenic route through the Clinton and Hawthorne areas.  As we drove through the Clinton neighborhood I remarked that it was quite pretty.  "What are you talking about?" asked Mom.  "The neighborhood or the music (I had on classical)?"
   "Both," I responded.
    "You know, if you are going to be rude, people are going to stop speaking to you," was her response.  It took me a few seconds to think about her answer, then realized something wasn't sparking quite right.

We made it to Jean's, where we were joined by her son, Tim.  Mom was quite anxious to go within minutes, as her mother was going to be going back to do some things with Mom.  This was a theme for about 30 minutes until Tim left, I began fixing lunch, and Jean took Mom into the front parlor to show her the new car seat she'd bought for her granddaughter.

We had a healthy lunch, then Mom had some ice cream and cookies.  It was pretty low-key, and she seemed to comprehend most of what was happening, even though there were times when Jean and I looked at each other wondering where some of Mom's statements were coming from.

Then, Mom stated that I needed to call my grandmother and get the door out of the car to help her.  Apparently my grandmother had so many things on her shoulders (Mom's words) that my bringing the door would help.    I'm clueless here.

We left for home, but before we did there was the entering the car bit.

I opened the door for Mom.  She thought it too hot so she demanded I get in on my side first so she could see how hot it was.  Apparently it was a normal thing for a son to do for his mother.  I helped her in and scurried around to my side.  I then opened all the windows to let the heat out and cranked up the A/C.  She was fine.

As we drove through Irvington she commented on a few homes telling me who lived there.  I'm not sure it was fact, but it was interesting, nonetheless.

We passed by the house where I was born and she told me my oldest brother was born there, as well (we were really birthed at hospital, but ... well, you get the idea).  The latter part of that was untrue.

When I returned her she was spent.  She just wanted to lie down and nap.  I took a gander for the ribbon Jean had brought, but nary a sign of it existed.  I inquired, but Mom told me there never was a ribbon.  <sigh>


So, she had a bright and sunny week.    This week  promises more warm temperatures and a busy three days beginning on Saturday - but more of that next week.