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Update on Kate’s Changes

Although Kate did not experience any moments of discouragement or sadness, her memory and overall functional ability were no better yesterday. She was in a good mood when I went in to wake her. She smiled and responded to me as though she knew exactly who I am. I told her I loved her, and she said she loved me. As so often happens, she then said, “Who are you?” About forty minutes later we were ready to go to lunch. In the laundry room as we were headed to the car, she said, “I don’t know where I am or where I’ve been or where I’m going.” She said this without any sense of despair or anxiety, but she was perplexed.

We returned home just before the sitter arrived. Given her growing insecurity, I wondered how she would respond when I told her I was leaving for the Y and Mary would be staying with her. It turned out there was no problem. She showed no sign of insecurity at all. I was relieved. Then I wondered what I might encounter when I got home. That was not a problem either. She and Mary were talking when I arrived. Mary told me that Kate had wanted to talk. She said that Kate had told her about some group of which she was a part and that she was trying to decide whether to drop out or not. Kate didn’t seem to remember that at all. I couldn’t imagine what she was talking about either. Mary said goodbye and started to leave when Kate asked her to wait. She got up and walked over to Mary and said, “Let me give you a big hug.” I was very pleased. As I’ve said before, Kate has a kind heart.

At dinner she carefully placed her napkin on the table in front of her as if to use it as a placemat. It wasn’t long before she wanted a different arrangement of her knife and fork and the napkin. She tore the napkin into three pieces, using one part as a coaster for her iced tea, another for her knife and fork, and the third as a smaller placemat. Many times she asks me what to do with her napkin. She almost always gravitates to using it as a placemat. When she asks, I tell her it’s her napkin and that she can put it in her lap to wipe her hands when she needs it. That seems a difficult instruction for her to understand.

It was another day that she was tired and wanted to rest. We stayed in the family room only a short time before she wanted to go back to the bedroom. I brought her nightgown to her. She put it on right away got into bed. She planned to work on her iPad a while but forgot or changed her mind and called it a night. She is tired more often than she has been in the past.

In an email yesterday, my friend Tom Robinson read my post that Kate seemed to be on a more significant decline. He asked if it is possible this decline could be followed by a similar improvement. I told him that it is possible and explained that she regularly has moments when her symptoms are not as obvious as they have been recently. Today could be different than the past few days.

Having reflected on this, I think it is more complicated than any of us fully understands. Periodically over the past eight and a half years, she has exhibited changes in her behavior. I think one of the best examples is forgetting my name. The first time that happened, there was a tendency of me to conclude that she had completely forgotten and would never know it again. That was almost a year ago, and she still knows my name sometimes; however, she calls my name much less frequently now than she did then.

Kate’s behavior in recent days is different than I have seen in the past, but it is not surprising. She is exhibiting the kind of changes that accompany the latter stage(s) of Alzheimer’s. I don’t know that she will be this way today or tomorrow or the day after that, but I do know I will see more things like this in the future. I will continue to cherish the good times, but I will be sad at other times.

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A Day of Sad Moments

I’ve heard other caregivers talk about points on this journey in which their loved ones took a sudden downturn, but Kate’s decline has been very gradual until recently. During the past few weeks, I’ve noticed more changes that occur almost from one day to the next. Yesterday this pattern continued.

It started when I got her up for lunch. She was awake; she just didn’t want to get up. It took the better part of an hour get her to consent. When I walked her to the bathroom, she started shaking. In addition to holding my hand, she grabbed on to my arm with her other hand. She looked frightened just like she did the day before in Nashville. As I did then, I asked if she was afraid. She said she wasn’t. My best guess is that she didn’t know where she was and felt very insecure.

Once she was dressed, I decided to go to a place that is a little farther from home than we usually go. My purpose was to play music she likes in the car and let her begin to feel at ease. That worked, and we had a nice lunch. We had an especially friendly server and joked with him periodically throughout our meal.

When we got home, Kate asked what she could do. I gave the iPad to her and told her she could work her puzzles or look at her photo albums. She chose the iPad. That didn’t last long. She was very tired and asked if she could lie down on the sofa. I told her that would be fine. I let her rest for the next thirty minutes before getting her up for her hair appointment. Unlike the morning, she got up without a problem.

She seemed very needy as we drove away from the house. She said she liked me and liked being with me. She said something similar as we left the hair salon.

Back at the house, she started working puzzles. Very soon she was frustrated and asked me to help her. She looked depressed and was almost in tears. She had reached a point at which she didn’t know what to do. She wanted me to finish her puzzle for her. She asked me to work another. I explained what I was doing with every piece. Then I asked if she would like to work one. She did but wanted me to help her. We tried, but she seemed too tired to think. I said, “I love you and want you to know that I will always be with you.” She said, “I know that, and I need you.” She said she needed a break. I suggested we go to dinner. As she got up from her chair, she said, “You just tell me everything I should do.” This was a very sad moment. Once again, it reveals an awareness of her difficulties, and that is painful for both of us.

On the way, I played music that I knew she would like. That seemed to lift her spirits. We enjoyed our dinner. Near the end, however, she got very sad about the servers. She said she never had to work like that. That got her thinking more broadly about all the people who struggle to make ends meet. She said she grew up taking her life for granted. It is not unusual for her to express such feelings, but she doesn’t usually seem so depressed.

Typically when we arrive at home after dinner, Kate likes to sit in our family and work on the iPad. Last night, she said she was tired and wanted to go to the bedroom. I asked if she would like to watch our DVD of Les Miserables. I thought it would be a good idea because it is our favorite musical. I neglected to take into account the sadness it portrays. It wasn’t long before I could see that she was sad. I asked if she would like to watch something more upbeat. She did. I pulled up a series of segments from Andre Rieu concerts. In the meantime, she decided to go to bed. Fortunately, she sleeps well at night. It wasn’t a good night for me. I was awake at 1:00 and didn’t get back to sleep until after 3:00. I wonder what today will bring.

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Changing Times

Kate and I were in Nashville this past weekend to visit our friend, Ellen, who now lives in memory care. We stayed in a hotel overnight to have a leisurely morning and lunch before visiting her. For most of the day, Kate was not herself. She slept later than I expected or wanted. When I got her up, we had less than an hour before checking out and our reservations for lunch. I tried not to rush her, but she felt rushed nonetheless. Her response was different than usual. I am always concerned about her having a panic attack, something that hasn’t happened in several years. Instead, she seemed frightened and pulled herself away from me a couple of times as I helped her with her clothes. I asked if I had scared her, and she said no.

When we got to the restaurant, she was friendly with the people she met. That is not unusual, but the way she spoke to people outside and inside the restaurant sounded like someone who might have had a little too much to drink.

She got along well once we were seated at our table, but her eyesight caused a few problems. She didn’t recognize it was bread in the bread basket. I picked out a couple of pieces and put them on her bread plate along with some butter which was already soft. In a few minutes, she picked up the butter with her hand and put it in her mouth. Apparently, she thought it was a piece of bread. She didn’t care for it and put it down, but she had a glob of butter on her fingers. I tried to help her wipe her hands on her napkin. I first explained what I was I was going to do, but she was confused and didn’t understand. That shook her up for a minute or two.

We both went to the restroom before leaving. When she came out, she had a paper towel in her hand and dropped it on the floor of the hallway. She apparently didn’t see where to deposit it in the bathroom. As we left, she told everyone goodbye in much the same manner as she had done when we entered.

The big surprise of the day came after we had arrived at Ellen’s memory care facility. We sat down with her in the activities room which was vacant at the time. This time we found that we could understand even less of what Ellen said than the last time. Very quickly Kate played a role that was very different than on our other visits. She took the role of caregiver. Ellen was the one she was caring for. She spoke to her as though Ellen were a child, and she was her caregiver. The tone of her voice was very much like that of an adult talking to a small child. She held Ellen’s hand and discovered that it was cold. She proceeded to explain how Ellen could rub her hands together to warm them up. It was much more of a leadership role than she would normally take. Although Ellen has great difficulty speaking, she seems to understand us quite well. She looked a little puzzled and almost laughed a few times as Kate took charge.

We tried to converse for over thirty minutes before I decided to pull out my iPad and play a few YouTube videos of Rodgers and Hammerstein musicals from past BBC PROMS concerts. Initially, both Kate and Ellen were interested. Then Kate saw a few small pieces of debris from a plant in the center of the table. This started a re-run of an experience she had the night of our anniversary dinner in Knoxville when she mistook the tiny bread crumbs as insects and took pleasure in trying to catch them moving. She did exactly the same thing at Ellen’s. The difference was that she became much more absorbed than she had on our anniversary. She completely tuned out of the YouTube videos to watch “the insects.” She was fixated on them for the next 10-15 minutes. In the meantime, Ellen went to sleep. That left me as the only one watching the videos.

I looked at my watch and saw that it was close to the time for a guest to lead the residents at their Sunday afternoon music time. I suggested we join the crowd. What happened then was my biggest surprise of the day. As we walked in, the woman in charge of the program was playing the piano while the residents and a few staff sang. Kate very quickly joined in. She not only sang; she also danced. The leader played a series of very upbeat and familiar tunes to a group our age. Most of them, however, were further along in their dementia than Kate who became the most active participant. Periodically during the songs and at the end of a song, she said in a very loud voice “Woooooe.” It was loud enough that no one could miss it. A mother and her two teenage daughters were standing near us and got a kick out of Kate’s participation. I am sure the leader was pleased. She probably would have liked everyone to respond in a similar way.

So how did I feel about this? I was pleased. It was good to see her enjoy herself so much. As I have mentioned before, she and I often sing in the car. Sometimes I can push her into dancing a little at home, but she was completely unleashed at Ellen’s. Her filter was off. She responded the way she felt. I liked that, and in this situation it was perfectly acceptable. I would have felt very differently if this happened at one of our music nights at Casa Bella. In Ellen’s memory care facility it was one of our joyful moments.

At the same time, I was sad because this was the first time in a public situation that Kate behaved so much like a person with dementia. Until recently, she has gotten along well. In casual contacts, most people would never suspect that she has Alzheimer’s. That is changing now. She seemed a little like the residents around her. Kate is not at their stage yet, but all the signs suggest she is not far away.

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Joy and Sadness Intertwined

The other day I mentioned that I experience more sad moments now, but that does not mean that we don’t experience many joyful ones as well. Our Saturday meeting with Joan, my Twitter friend, is a good example of that. Even in our daily lives we have such moments. There are also times when I experience both joy and sadness at the same time.

As we arrived home from lunch the other day, Kate asked me her mother’s name. When I told her, she said, “I wish I could have known her.” I said, “Let’s go inside, and I’ll show you some pictures and tell you about her.” Once inside, I took her to the hallway where there are several family photos. I pointed out one of her mother that is a favorite of mine. It must have been taken when she was about twenty. Kate has always liked it as well. She asked me who it was. For several minutes, she looked at it and commented on her mother’s eyes and how beautiful she was. She was deeply touched. Then I showed her pictures of her father. She asked his name and said, “He looks like a good man.” I told her he was “a very good man.” I followed that by showing her a photo of her grandmother. Kate was excited to learn that she had been the first member of the family to attend TCU.

After looking at these pictures, we went back to the family room where I showed her an album she and her brother had made of her mother’s family. It was just like the first time she had ever seen it. She was excited.

After dinner that night, she worked on her iPad for a while. I noticed that she had put it down and was just sitting in the chair looking bored. I brought in the “Big Sister” album that her brother Ken had given her a year ago. We went through a few pages together before I took my shower. She continued to look through it until she was tired, but she had had a day of pleasure looking at her family photos.

They were moments of joy for me as well, but that joy was accompanied by a measure of sadness as I perceived that the pictures did not bring back memories in the way they had done in the past. They only served as brief moments during which I told her about her family. The memory was gone just as fast as I gave her their names. Her interest in the photos struck me as a vain effort to reclaim her memories of family. We’re in a different place now.

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Another Social Experience

Kate and I are in Nashville today where we plan to meet our friend, Ellen, who is in a memory facility here. Because Kate sleeps so late in the morning, we came yesterday afternoon to have dinner and spend the night before our visit this afternoon. I have found that works better than rushing her in the morning so that we can make it a day trip.

For the second time in two weeks, I had arranged to meet another Twitter friend, Joan, who lives on the east side of Nashville. We met at a Cracker Barrel about 3:15 and chatted for a little over an hour before going to our hotel. I am glad to say this was another social situation in which Kate was quite at ease and talkative. It was as though she had been yearning to talk with someone and found a good listener. Once she started, it was hard for her to stop. It was good to see her so engaged in conversation.

As I reflect, I think there were several things that made our meeting such a success. First, there was just one other person with us. That meant there was no distracting conversation that can occur when there are four or more people. Second, the way we were seated lent itself to more conversation between Kate and my friend. When we took our seats, I deliberately put Kate directly across the table from Joan. I sat beside Kate. Third, Joan is a very warm, friendly person. She immediately gave her attention to Kate who became a key person in the conversation. Fourth, one of the good things about initial meetings like this one is that people discover things they have in common. It wasn’t long before we learned that Joan had been a librarian. That opened the door for Kate to talk about her own experience in the field.

Since Joan and I have been Twitter friends, I would have enjoyed talking more with her about her own experience as a caregiver as well as her blog. I was glad, however, to let that go in order for Kate to have such a good experience.

There were a couple of other things worth noting. One is how well Kate was able to communicate without having a memory to draw on. Of course, that means that some of the things she said weren’t really true. For the most part, Joan probably didn’t notice though I did. Much of the conversation didn’t require much in the way facts. Kate could talk about her feelings for her work and her family.

The other thing is that Kate’s Texas pride has increased substantially in the past few years. As we were walking out, someone overhead Joan’s voice and asked where she was from. When she said, “Nashville,” the man told her she didn’t sound like it. Then she said she was originally from Long Island. That began a somewhat more extended conversation between the two of them. While they were talking, Kate tried to interrupt them to ask the man to guess where she was from. It was very much like what a child might do. I got her to hold back for a minute. When she finally asked her question, he said, “Where?” She couldn’t remember. I was standing behind her and whispered, “Fort Worth, Texas.” She repeated it in perfect timing. He might not have noticed her slip.

I was very glad that we stopped to meet Joan. My own purpose was to meet face to face with a woman I had known only through brief tweets. The bonus, like our meeting two weeks ago, was seeing how much Kate enjoyed herself.

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Social Situations

Yesterday we were in two different social situations. The first was at lunch. The other at dinner. Kate responded to the two of them quite differently. Coincidentally, both occurred at Casa Bella.

We had lunch with a friend, Lillian, who is with the health foundation on whose board I served for nine years. Kate has met her on several occasions but can’t remember her. That didn’t matter. She got along quite well. We got off to a good start when we went inside the office to meet Lillian. We were warmly greeted by the receptionist whom I hadn’t seen in quite a while. That was followed by another staff member who passed through the reception area. We chatted briefly before Lillian came out. I should add that most of the staff is aware of Kate’s Alzheimer’s and have always been attentive and kind to her. When Lillian walked out, she was carrying a small basket of flowers for Kate who was thrilled to have them.

Although our lunchtime conversation involved a good bit of talk about the foundation, Lillian was good about speaking directly to Kate. That was especially true at the outset. That enabled Kate to feel she was an integral part of the conversation. I asked Lillian to tell us about her recent experience with neck surgery. One might think that it would have been difficult for Kate to follow and understand. I am sure that it was; however, she did grasp that Lillian was out of the office a while and that the recovery was not easy. Her eyes filled with tears as she reached out to take Lillian’s hand. Kate was touched.

A little later, Lillian invited us to an open house at a camp for deaf children supported by the foundation. She explained to Kate that we had paid for a number of children to attend. Kate was touched by that and wants to go.

Except for the few times she picked up or pointed to her glass of tea and asked if it was hers, an observer might not have recognized that she has Alzheimer’s. Lunch was a good experience for her.

Dinner was quite different. I think she was confused from the start. Although we sat with the same couple we always sit with, we were joined by three other people. At first, I was seated diagonally across from Kate. That meant that she forgot where I was several times. I moved to be next to her. She forgot that I always order for her and was nervous about ordering herself. I told her I would take care of it, but she couldn’t remember. She repeatedly picked up a separate bar menu and tried to read it. One time she asked the woman next to her to read it for her. Each time I explained that it was the bar menu and that I was taking care of or had ordered her meal. Once we had ordered and the menus were removed, she didn’t have to worry about that anymore.

Then we faced two additional problems. First, the noise was so great before the music started that it was hard to hear what others at the table were saying. In addition, Kate was in the middle seat of the three seats on our side of the table. No one was seated across from her. The noise was the greater problem, but I am sure she felt alone because of the seating arrangement.

The second problem of the evening was the music. It was jazz night. The musicians were outstanding, perhaps the best we have heard there. Typically, however, the program includes a predominance of old standards with the vocalist playing a central role. Last night, it was almost entirely instrumental. I think there were only three standards. Kate didn’t seem unhappy, but she didn’t express any of the enthusiasm that she normally does.

On the way home, she was fine. The contrast in the two situations was striking and illustrates the kind of situations that are easier for her than others. I may need to be more sensitive to this in the future. It is also possible that we might drop the jazz night before I feel the need to do that for the opera and Broadway nights. Coincidentally, I spoke with a church friend yesterday morning. She had mentioned our getting together for lunch. She said something about inviting a couple of other people. I told her that Kate does best with just one or two people besides us. I’m glad I said that.

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How I’m Feeling

Considering Kate’s recent changes, it’s fair to ask how I’m doing. Let me try to answer that. By now, you know that I am bound to say, “remarkably well,” but it’s more complicated than that. Like Kate’s spirits, mine go up and down in about the same proportion as hers. As I have said before, “When she’s happy, I’m happy.” That implies there are times when she is not happy. That is true for both of us.

After Kate’s unusually happy day a couple of days ago, yesterday and the day before have been a little different. It’s not that she was sad or depressed. She wasn’t. It was that the symptoms of her Alzheimer’s seemed to be more evident. There wasn’t anything new. She just seemed more like she was drifting away, somewhat distant. That was particularly true last night.

At dinner, she asked my name several times and asked what I like people to call me. I said, “Richard.” She asked if that is what she should call me. I told her that would be fine. When she asked, she did so in the very natural way she usually does. What was different was that my name didn’t seem to register with her at all. It didn’t seem any more familiar than the name of the restaurant at which we were eating.

Our evening after dinner was also a little different. She was very tired and wanted to rest about 7:30. I suggested she could get ready for bed. At first, she just wanted to rest on the sofa. I told her it was getting close to bedtime, and it might be better to get ready. After getting into bed, she asked my name in much the same way she had done at dinner. After two or three times, I asked if she knew how we were related. She didn’t. When I told her we were married, she couldn’t believe it. I gave her a little information about our courtship and our wedding. That seemed to ring a bell, but she soon asked my name again. I told her and didn’t say anything more.

She has been gradually drifting way over the past few weeks. That means more moments of sadness for me. Like all things, I knew this would happen eventually, but it is the reality that has the greatest impact. I know that Kate’s condition will only get worse.

The good news is that I have a lot of things to keep me occupied. This blog is one of them. I am editing a book of emails I wrote under my dad’s name the last few years of his life. I am also writing an article for someone else’s blog. I am active on Twitter and with the United Way, Rotary, and the health foundation on whose board I served for nine years. In addition, I donate platelets every 3-4 weeks.

Of course, my primary role is that of Kate’s care partner. While that involves stress, it also incorporates a considerable amount of pleasure. I am thinking specifically of all the social contacts we have in connection with our meals and the many ways in which music plays a role in our lives. Beyond that, I derive satisfaction from helping Kate get through each day. She can’t do it on her own. I am glad to be here for her.

On balance, I believe that I am doing “remarkably well,” but there is no question that there is more sadness in my life as I watch her decline. I can work to minimize it, but I can’t escape it.

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Morning Incident

I continue to celebrate the fact that Kate and I have gotten along so well, but that is not to say everything is all right. As she sinks further into the depths of Alzheimer’s, she has become much more insecure and dependent on me. I have mentioned several times when she has experienced attacks of anxiety or panic. Something similar, though less intense, occurred yesterday morning.

Watching the video cam, I noticed her turning over in bed. I thought she might want to get up for the bathroom. For a short time thereafter, she didn’t move or make a sound. Then she said something that sounded like “Hey.” I headed to the bedroom. From the door, I saw that she was awake and looked relaxed. She didn’t say anything. I walked over and sat down on the bed. She looked uneasy. I said, “You didn’t know where I was.” She nodded, and tears welled up in her eyes as though she was about to cry. I said, “You probably didn’t know what to do.” She nodded again, and I said, “You don’t have to worry. I am always here. I would never leave you alone.” I talked with her a few minutes. She felt secure again. Then I asked if she would like to get up or rest a little longer. She wanted to rest. I asked if she would like me to bring my computer into the bedroom and stay with her. She did. In a few minutes, she was sound asleep.

This was a little problem. It was not intense, and it lasted only a short time. Had I not gone in when I did, she might have become more worried, at least for a longer time. It’s a good reminder of how important it is to be with her and to be observant. It is also a sign of her insecurity. I don’t find that surprising. If I didn’t have any memory, I would be frightened as well.

Follow-up

I remained in the room with her until it was time for me to get her up for lunch. She took a shower and then got back in bed. It took me three tries over thirty minutes to get her up again. I was careful not to push her. When she finally got up, she wasn’t smiling. I asked if she were upset with me. She indicated that she was. When I asked why, she said, “I don’t know.”

I helped her get dressed, and she seemed fine when we left for lunch. She was definitely not as cheerful as she was yesterday, but we had a nice time.

The rest of the day went well. We relaxed at home until time for dinner. She did not nap at all. That is very unusual. She worked on her iPad. After dinner, we watched our granddaughter’s high school graduation online from Texas. She received her diploma early. Then I took my shower and prepared for bed. To my amazement, Kate continued to watch for another hour even though she didn’t know anyone. I went in to bring her to bed. She said she wanted to sleep on the sofa where she was sitting watching the graduation. I encouraged her to come to bed, and she finally consented.

I don’t know what was going on in her brain, but she wasn’t as happy as she was the day before. Once in bed, she was very relaxed and seemed fine. I can’t help wondering what she will be like this morning.

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Kate was in an especially good mood yesterday.

Most of the time Kate is good-natured. That is one of the reasons life has gone so well for us. There are times when she is low. Those are usually times when she is more mindful of lack of memory and inability to function the way she should. There are other times when she is unusually upbeat. Most of the time, she is somewhere in between the two extremes.

Yesterday she was in an especially good mood, and it lasted the entire day. I’m having difficulty thinking of a word that captures it. There are two things that were different. The first is that she smiled a lot. The second is that she was very agreeable and easily “rolled with the punches” when things didn’t go her way. Yesterday was the first time she has had a sitter in three weeks. I wondered if she would feel uncomfortable when the sitter arrived and I left. That was no problem at all. She seemed happy to see the sitter and not bothered in the least when I left. The same was true when I got home. She was glad to see me, there was no sign of relief as sometimes happens. She just seemed happy and nothing could change that. Above all, I didn’t see any sign of concern over Alzheimer’s symptoms.

This is not to say that her memory was any better. In fact, she seemed so happy that I found myself thinking of her the way she was before Alzheimer’s. That was quickly erased when she would ask me something like “Where is the bathroom?” in our house. I did, however, get the impression that she remembered I was her husband all day or close to it. As we neared time for bed, she said, “I want to thank you for your patience with me.” I think that was prompted by my helping a number of times with her puzzles. Shortly after that she said something that clearly acknowledged that we were married. Just as quickly that was followed by her asking my name and hers. I was just grateful to see her so at ease and happy all day.

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Another Bedtime Conversation: An Example of Kate’s Intuitive Thought/Ability

In yesterday’s post, I talked about the challenges that Kate faces in some types of conversations. I also noted that we converse about as much as we did before Alzheimer’s. I failed to say that until I took her off of Trazadone a year ago, she didn’t talk much. Most mealtimes we hardly spoke at all. Looking back, I think she may have been taking a higher dose than she needed. She was very sleepy. I am glad to say that is no longer an issue. We do have conversations, and some of those are unlike anything I could have imagined. Night before last we had one of those.

As usual, Kate was still awake when I got into bed. I moved over close to her and commented on what a nice day it had been. I told her I loved her. She said, “I like you. I even think I love you.” She went on to say that she was not ready to marry me. From there, she took us in a very different direction.

She talked about a “project” that she was thinking about. She never got specific, but she wanted to do something for people who have chronic financial problems. She expressed a desire to recruit a large number of people who could join together to address these issues. She wanted me to work with her. I told her I would. As with other conversations, she was very repetitive. She would circle back around and say the same things she had said earlier. She was confident with the two of us working together we could make a difference in people’s lives.

This conversation was another good illustration that her feelings are working. She can’t remember any facts, but she retains a sense that there are people with many needs. Her heart goes out to them. This particular idea about initiating a project to help people in need is just one example of that. It is also apparent when she talks about her mother, she invariably talks about her mother’s kindness to others and her desire to “help people.” Her mother was indeed kind, but I view this mostly as an expression of Kate’s personal feelings about relating to other people. It is also evident in the way she interacts with strangers. She is a caring person. This is not something new, but it is more pronounced now than in the past. It is certainly a more positive symptom of Alzheimer’s than one usually imagines.