I asked DW to look at a power line as I backed up the Trailer. She was not even able to focus on the overhead powerline. I hit it, she said nothing and was not even looking at it. Yet she fills her pill box every week. She does the dishes. Bathes herself.
I feel the same way frequently. DH can do so much and yet there are more and more things he can't do. Also, he can hide that he has any problems from everyone but me.
Bob, I am reading the list of the things that your wife CAN do, and noting that they are mostly long-term psychomotor skills. Asking her to look at something and make a judgment call called upon her to do something new.
I am especially aware of this because my husband's AD is of the posterior cortical type, hence visuo-spatial processing is utter crap relative to general memory. I can tell you sincerely that once the posterior cortical lobe is affected you cannot ask an AD person to look at something. They can't follow the verbal instruction, they can't follow your finger pointing, and they can't take in the parameters of a new task, as simple as it might seem. But, as long as older, entrenched neuronal pathways are functioning they can do a lot of stuff that's "old hat."
This is very interesting. I wonder if that's why DH can't understand maps and make the connection to the real road. And yes, I have noticed that pointing to something I'm trying to explain doesn't work.
Yes, the map thing is a failure of his ability to make sense of something abstract. It was one of the earliest deficits I noticed. To look at a map and recognize it as a representation of something real (the road) is a pretty high-level function, AND a new one, each time, requiring the synthesis of new information. Whereas playing Joplin is probably utilizing long term wired in muscle memory.
It's also why our AD people can seem "normal" in low-key, short duration social interactions. They're using old stuff. "Hi, I'm Jeff. Lousy weather, isn't it? Track meets are fun. I'm from Seneca Falls...yes, that's where Gould's Pumps used to be." And if the conversation goes no farther they'll never know he doesn't know which of his children is running, what grade she's in, what school we're at, and what day this is.
The variations in what DH can and cannot do also depend on what part of the brain has been damaged and how much, is currently being damaged or hasn't been attacked yet. He has VaD, and as the vessels supplying his brain breakdown, we see declines. Some tiny vessels break and we see a symptom show up, but then fade away because the damage was tiny. However, at a later date there will be more until the damage is significant and here to stay. He's no good with names. Currently, the big issue is his lack of ability to pace himself. He wanted to hel;p a volunteer cut back the branches overhanging the driveway. He woudn't take a break. Insisted on getting everything cut. By the time he came in he was walking poorly and leaning a little. Also, sonething new--had a hitch in his gait. He just doen't get the connections anymore.
Looking back I know that being unable to read a map was one of the first symptoms here, too. DH loved maps, collected them, but as far back as 2005 when we rented a camper in the States I was doing all the map-reading and he wouldn't even help. I had no idea then what was going on. He also had trouble judging distances with the camper and damaged it at a gas station. That didn't strike me as extraordinary, he had no experience driving a big vehicle. But then a couple days later, he damaged it again at another gas station in exactly the same way. That did seem strange. It wasn't till about 6 months later that DS convinced me that something was the matter. There were also some behavioural changes, mostly in the form of hesitance and uncertainty. He had always been a very decisive and dominant personality.
Well, as we know, however familiar and similar these symptoms are, each one of our spouses is unique in his/her deficits. But, among the things mine does:
He cannot approach the car correctly when we leave a store. He follows me. When I ask him to go to the other side, he walks around to the other side of THE CAR NEXT TO OURS. Generally then, I lead him to the correct door, and open it. Because when he's bad, he's likely to grab the side view mirror instead of the handle.
Sometimes he cannot quite grasp how to close a door and be on the correct side. If he wants to be outside, he'll shut the door on himself, unable to figure out how to not be in the way.
He cannot follow me if people cross our path. He will become bewildered and take off after the wrong person, or just freeze and not move.
He fixates on, or hovers near people as if he should be speaking to them, and it would be rude not to. This can weird strangers out a little.
He cannot read a page, although he thinks he reads books. He tries to keep his place with an index card, but usually just reads random lines, or the same page over and over.
He can no longer understand an analog clock (which is, of course, a graph,) and will go to the oven to see the digital display, which he can sometimes comprehend.
He cannot follow a direction such as "it's in the bottom drawer." He will begin randomly looking everywhere else because he cannot translate the words into real space.
He cannot hang up pants or shirts on hangers, but just sort of bunches them onto it.
He cannot tie a tie, or usually shoes either. He gets his briefs on backwards and falls over trying to step into them. He buttons his shirts off kilter, and can generally not figure out how to thread or buckle his belt.
most of what you are describing is due to visual perception, which means he doesn't see things as close as they are or as far away as they are. It is "normal" for an AD patient to walk 10-20 feet behind the spouse because they CAN see and know where to go. You are going to have to start treating him as if he can't see well, and maybe, as I did, just look behind you and make certain he is there. After a few months, I started holding hands as if we were teenagers. And still do, but I grip his whole forearm now.
And IF he needs a tie, you will have to do it. I buttoned the top button for him and he buttoned the others. I sat him down and put his feet in his underwear and let him pull them up. I talked about where we were going, the kids, the weather, but not what we were doing. Don't expect him to take care of his clothes any more. As more time passes, you will find you have to do EVERYTHING they used to do....and it's the pits!!!
And then will come the time to do away with belts and get pants with elastic waists. MUCH easier. And you will have to fasten his seat belt too.
Understand that each day they grow younger. You don't. And you have to continue to talk to them as you would a friend, not talk in anger and stress, because if you do, you will get it back.
These stages are really harder to learn and make peace with yourself and this disease than the one my husband is in now. You get through it by coming here, asking questions, learning and VENTING and GETTING HUGS!!!!
I think the answer is that both our spouses fall into the posterior cortical atrophy (PCA) sub-category of Alzheimer's, so the particular set of deficits we're seeing are somewhat specialized. (although pretty much all AD people will lose these abilities eventually.)
But a big difference will be that our visual processing impaired spouses will NOT be the ones who have no idea where home is, or who their family members are, but who can still unlock the front door and escape. Possibly ours will still know who we are but be utterly unable to stick a spoon in their mouths. I don't know.
I'm just thinking of my husband this morning, standing in front of the toaster, trying to butter his english muffin. He slices a bit of butter off, and hovers, unsure whether to put it on the half which is already overly slathered, put it on the empty half, or just wipe it off on the countertop. The visual clutter created by more than one choice is beyond what a PCA brain can deal with.
Mary--quite right. I am doing more things that he used to do every week. My tie tying is improving, but not by much.
Emily--fortunately, ties aren't required very often these days! I've never tried to learn--there's always someone around at functions that require a tie who can help.
They make pre-tied ties that are clip-on for those of us who are tie-tying impaired. <grin>
I finally gave up trying to make sense of what he could do and couldn't do...it got to where it was all that I could do to make certain he was safe; that he wasn't creating a BIGGER mess for me to clean up; to try to maintain his dignity and also allow him to do what he could as long as he could. That was and is a BIG CHALLENGE.
Ann and Emily it seems like you are talking about my dh also. We are having some strange things going on over the course of the last three days. My dh has been sleeping more and complaining of things being more confusing for him. He is also complaining of being dizzy even when being still. Concentration is almost none, and attention span is 0. He is staying in bed more and doing much of nothing except sleeping. This is scareing me and I don't know what to do. Please send words of wisdom.......soon....... could this be the disease getting into the central nervous system?
Have any of your spouses required extensive eye exams? Most of the articles suggest that, but if it is the brain, I don't understand the reasoning.....
In the case of a PCA presentation of AD (PCA can have other causes too, namely Mad Cow/Creutzfeldt-Jakob,) it isn't uncommon for patients to seek eye doctor help first. Mine went, and nothing much was diagnosed except for slight presbyopia for which glasses were prescribed. Which didn't help and he never wore. But eye docs aren't typically geared toward diagnosing dementia, so usually all it does is rule out mechanical eye problems. For this reason, and also because most PCA sufferers seek eye help early in the process when they're otherwise relatively functional, cognitively, seeking ophthalmic help is usually a dead end.
The reason it's a dead end is, as you say, because it's a brain problem. But the patient doesn't know that. He thinks it's his eyes. Really, it's the brain which is losing its ability to interpret the data the eyes are sending.
So usually, even though they may seek eye doctor help early on, the diagnosis doesn't come until later, when other symptoms that are clearly cognitive become more apparent.
In regard to seeing an Eye Specialist mid or even late stage Dementia. I took Paul every 6 to 12 months as the Doctor suggested. At one point he was watching a narrowing of a certain vessel in the eye becoming closed. If it closed Paul would immediately and irreversably become blind in that eye. When the time became right Lazier surgery was performed in office and stopped him from being blind in that eye. For that reason I think it is important to go once a year.
Visual Spatial orientation was an issue for DH as well. He had previously had cataract removal surgery..then after all the rehab and recovery from bypass surgery, we went back to the opthomologist and were told that DH's VISION was good but that it was a matter of 'visual integration'. The brain correctly letting him know what he was seeing. (?) Thats the way I understood it and this was before AD diagnosis. I thought it was a result of the bypass surgery..BUT map reading skills were gone much earlier and I didn't catch on either. Yes, sounds like an echo of some of the very same things.. DH can still tie a tie too. amazes me.