Kate was up a little earlier yesterday. That gave us time to spend an hour at Panera before leaving for lunch at Andriana’s. Other than the time she got up, Kate seemed pretty much the way she usually is, perhaps a little less groggy. After we took our seats at Panera, I discovered something that established a pattern for the rest of the day. Here’s an excerpt of our conversation.
Kate: “What’s my name?
Richard: “Katherine Franklin Creighton.”
Kate: (Looks puzzled) “Creighton? Where did I get that?”
Richard: “From me.”
Kate: “Are you my father?”
Kate: “Who is my father?”
Richard: “Charles Franklin.”
Kate: “Charles Franklin. Who is he?”
Richard: “He’s your father.”
Kate: “Is he married?”
Richard: “Yes. He married Virginia Franklin.”
Kate: “Wait. Tell me that again.
Richard: Your parents are Virginia and Charles Franklin.”
Kate: “Do they have any children besides me?”
Richard: “Yes. You have a brother.”
Kate: “What’s his name?
Richard: “Ken Franklin.”
Kate: (Now on overload) “Stop. You’ll have to tell me again, but later.”
In some ways this conversation was no different than others we have all the time. What struck me about this one was that nothing I said appeared to spark the least sign of recognition. Normally, upon hearing her father’s name, she might say something like “He was a nice man.” In this conversation she was always searching for something that sounded familiar and not finding anything. She just kept asking questions until she couldn’t process any more.
From Panera we went directly to lunch at Andriana’s. She continued to have memory problems. The big surprise was the first time (of many) that she pointed to the mug shot of Frank Sinatra and asked me who he was. I fully expected her to say, “I don’t like him.” She has been saying that or some variation the past few years we have eaten there. This time she didn’t say anything. It was about the third time she asked that she said, “Is he a nice guy?” I tried to get around this by saying that he was very popular. She pushed a little harder, and I told her that his ex-wives and girl friends might not think so. She didn’t pick up on that. Subsequently, she just asked his name, and I told her without her expressing any evaluation. That is a big change from the past.
Before we got our food, she asked about her name and mine. That led to asking about our relationship. When I told her I was her husband, she was surprised. She couldn’t understand how that could be, but she did believe me. It was one of those times when she was glad to know we were married. Despite her confusion, we had a very nice lunch and conversation.
As soon as we got home, she wanted to take a nap. She rested about an hour. Then she came to the family room and started work on her iPad. It wasn’t long before she saw the “Big Sister” album on the coffee table. She picked it up and started to go through it. I was seated across from her with my laptop. She spent about twenty minutes before asking if I could help her. I took a seat beside her on the sofa. She asked me to tell her all the names of the people in the photos. She didn’t mean on a single page or several pages. She meant all the people in all the photos in the book. Most of them are of her, her brother, her mother and father, and occasionally other extended family members. She never appeared to recognize them from one photo to another. Each time I said, “This is your Daddy” she said, “What’s his name?” The same was true for her mother. Frequently, one photo was beside the other. I still needed to tell her their names. We hadn’t gone through more than four or five pages before her brain was on overload. That’s when she said, “I think we should stop. This is not my best day.” Once again, I was struck by how well she understood that she was not having a good day. I should add that she didn’t display any sense of frustration, confusion, or anxiety. She simply recognized her brain was not working as well as it should. She was right.
I suggested we leave for dinner. She said, “Maybe that would help.” She sometimes says the same thing before taking a nap. On the way to the restaurant, she asked, “Are we in Texas?” I told her we were in Tennessee. She said, “Where is TCU?” I said, “In Texas.” She said, “I know that, but where is it around here?” She hadn’t remembered I had just told her we were in Tennessee.
We had a nice time at dinner. We didn’t talk a lot, but we did converse off and on throughout the meal. She had salmon and talked about how good it was. When she had almost finished, she said she was getting full and wanted to know if I wanted the rest. I took a small piece, and she said, “It’s all right but not really that good.” This change in evaluations is not unusual. This happens frequently and makes it difficult to know if she really likes or dislikes things.
When we stood up to leave the restaurant, she said, “I want you to know I’ve enjoyed being with you. You’re a nice guy.” It sounded like I was her boyfriend, and she was about to dump me. I said, “Thank you, I enjoy being with you too.” In the car I mentioned something about our son and his family’s being in town next weekend. She said, “What do you mean our son?” I explained that we are married. She gave one of her most common responses, “How did that happen?” I told her and said, “Are you unhappy about that?” She said, “No, I’m glad. You’re a nice guy.”
Back at the house she picked up her iPad and worked puzzles for the balance of the evening. That is not to say it was easy. She ran into problems working puzzles all day. At one point last night, she closed the iPad and put it down. I could tell she was a bit frustrated and asked if she would like to look at one of her photo albums. She said she would. I brought her the “Big Sister” Album. She expressed only mild interest in the cover photo that she loves so much. In a few minutes, she said, “What do I do now?” She had never opened the album. I went over to her and opened to the first page of photos. She didn’t express much interest. I couldn’t believe it. I told her who the people were, but that didn’t make any difference in her response. She said, “What do I do now?” I told her she should just look at the pictures. I started to step away when I noticed that she was pressing a photo. She was treating the album as though it was her iPad with jigsaw puzzles. She thought when she pressed a photo, it would scatter the pieces so that she could put them back together. She was confused when nothing happened. I told her they weren’t puzzles but pictures. She was disappointed and said, “Then what do I do with it (the album)?” I told her she could just look at the pictures and enjoy seeing her and her family. She must have had it so deeply imprinted on her mind that it was an iPad with puzzles that she couldn’t relate to it as a photo album. I said, “It sounds like you would rather work puzzles now.” She nodded. I picked up her iPad and gave it to her.
While she was working on her iPad, I played a variety of YouTube videos starting with Tony Bennett and Diana Krall. She expressed only modest interest until I pulled up a Julie Andrews concert. She enjoyed that so much that she put her iPad down and watched. That led automatically to a portion of a BBC PROMS concert from 2010. It featured the music of Rogers and Hammerstein. She was fully engaged. Once again, music made a difference.
She was so engaged that she didn’t want to go to bed. She finally did and slept until 1:45 this morning. She sat up in bed. I asked if she wanted to go to the bathroom. She said yes and asked, “Should I go to my bathroom?” and pointed to our bathroom. She seemed rather alert and got up on her own and walked to the bathroom. I was afraid I might go back to sleep before she returned to bed, so I got up. After using the toilet, she spent about ten minutes brushing her teeth and cleaning her face.
I walked her back to the bedroom. As she was getting into bed, she said, “Well, we did it. <pause> Once again.” I didn’t ask what she was talking about. I just agreed that we had done it again. Once we were in bed, she laughed and said, “If we told our friends about this, they wouldn’t believe it. <pause> I almost don’t believe it myself.” She repeated this several times before we went to sleep. She is still sleeping. I wish I knew what she was talking about.
Given all these things, how do I assess the day? Clearly her memory was worse than any other day I can recall. In that respect, it was a bad day. To make matters worse, I know that this is part of a transition to even greater memory loss. I don’t like that. For the most part, Kate’s decline has been very gradual. The most striking changes have been since last spring. I know from others that people with dementia sometimes have sudden changes. Should I expect to see more of this in the next few days? Weeks?
On the other hand, she was happy all day except for a little frustration with her puzzles last night. We had a good time together. For that reason, I think of it as a good day. I really mean that. It reminds me of a professional and Facebook friend whose child has Down’s Syndrome. I know she is troubled by her daughter’s diagnosis and wishes she weren’t disabled in this way; however, she relates to her daughter as she would do with a normal child and enjoys her immensely. It’s much the same with Kate and me. Having Alzheimer’s is the worst thing that has ever happened in either of our lives. I find it especially difficult to watch her lose more and more of her abilities, but I try to look on the positive side (what she can do and what we can do together) and be grateful for those special moments we experience together.