Hyper in the Morning. Mellow in the Afternoon.

Kate’s behavior was been a bit unusual yesterday morning. It started when she got up on the early side again. We even got to Panera in time to see some of our regular friends there. It had been almost two weeks since we had seen them. She was wide awake and seemed almost hyper. She was quite talkative, mostly kidding me about the usual things, my name, my nose, and my graying hair.

It started as we stepped from our laundry room into the garage. I handed her a sweater. As she was about to put it on, I said, “You could put it on before you get in the car.” She said, “Men.” She followed that with something like, “You say the dumbest things.” Once we were in the car, she asked my name. When I told her, she just laughed.

When we walked into Panera, we saw the group from the Catholic Church sitting across from the table where we usually sit. Normally, Kate would walk directly to the drink machine while I greet our friends. This time she said “Good Morning, Everyone” in a loud voice. Then she started talking about me. She was telling them that I am a big talker. They seemed surprised at the bold way in which she spoke since she is normally rather quiet.

Her talkative mood continued during lunch. Soon after we sat down at our table, she looked at me and said, “It’s a good thing you have a good personality.” I interpreted this to mean that I don’t look so good. As she frequently does, she commented on my nose and gray hair. We left the restaurant a little over an hour later. As we walked to the door, something unusual happened. Her mood changed dramatically. She gave me a serious look and said, “Are you going to divorce me?” I told her I love her and would never divorce her. In the car she said, “I want to thank you for your patience. You are very patient with me.” I am sure she had reflected on what she had been saying and was concerned about my feelings. It’s another good illustration of how well her senses are still working. The balance of the day she was in good spirits.

Follow up to Kevin’s Visit

As always, we had a good visit with Kevin. Except for Kate’s minor anxiety attack the other night, she enjoyed herself. She did feel tired, but that was probably related to getting up so early two of the days he was here. On a few occasions, she was more animated than normal. That was good to see except for the times when she was a little grouchy. That was only in the morning before she was fully awake.

That didn’t end when Kevin left. She’s been a little gruff with me this morning. She was in the shower by 9:00 and ready for Panera just after 10:00 and now seems to be all right. The first thing she said to me this morning was “What’s your name?” She followed that with “What’s my name?” Before we left for Panera, she asked my name again. After I told her, she said, “You’re a nice guy.” I think much of her gruffness is an attempt at humor. Mostly, she is trying to tease me, but it doesn’t come off that way. It was this behavior that led me to stop teasing her quite a while ago. There were times that I am sure that I offended her, especially early in the morning before she was wide awake. The change in my behavior worked. It’s only in the past few days that I have seen this emerge again. I unwittingly teased back. That isn’t a good thing. I will need to be more careful in the future.

That leads me to something else. Having read quite a few caregivers’ experiences, I recognize that we all make mistakes we wish we hadn’t made. I did that earlier this week but didn’t realize it until this morning. Among the potential side effects of Aricept (Donepezil) is diarrhea. To counter that I include an antidiarial with her nightly meds. I forgot to do that when I prepared her pills this week. She got by all right until this morning. Fortunately, she hadn’t developed a serious problem, but I am sure that it was unpleasant for her. She never said a word to me. I just found a few traces of the problem around the toilet this morning. She has only two medications that have noticeable effects. The other is Venlafaxine. I like to avoid these problems and feel bad when I don’t make sure she gets these meds. The good news is that missing the antidiarial was a first. There have been several times that she has missed Effexor (venlafaxine), but I have always discovered it the next time she was to take it.

Kate’s Mood and Mine

I recently read an article that encouraged caregivers to be sensitive to their own moods and the impact that can have on those for whom they care. The author stressed how well people with dementia can read moods and feelings long after they have forgotten most people’s names. I have long observed this quality in Kate. In fact, Monday morning while we were in Chapel Hill, she overheard a man talking on his phone. I hadn’t noticed him until she said, “I don’t like him.” As we sat there, she continued to pick up things he was saying. Several more times she repeated that she didn’t like him. I never knew exactly what he was saying, but it seemed to me that what she was not responding to what he said but the emotion with which he was expressing himself. That was far from the first time I have been aware of how much she reads the emotions of others. Almost all of those experiences have been more positive ones.

Long before I had been aware of the ability of people with dementia to read emotions, I believed my own emotions could or might influence how Kate is feeling. I thank my background in social psychology for that. One of the first things taught in the introductory course is that all of us influence others as well as being influenced by them. I had observed that in my relationship with Kate years before her diagnosis. Many times in this blog I have commented on how my own mood has been affected by Kate’s behavior. When she is not doing well, I don’t feel so well myself. When she is enjoying herself, I am too.

Over the past few weeks, I have been especially conscious of how she affects me. Even as she has declined, she has given me a boost when she has been cheerful. For a couple of weeks, she was very talkative. She was expressing gratitude and appreciation. At the same time, she was in the process of forgetting my name and her own, something that is certainly depressing; however, I was feeling good because she felt good. During her several anxiety attacks, my mood dropped significantly.

Over the past week or so, especially while on our trip to North Carolina, she has been less upbeat. This wasn’t so when we were with our friends but when we were alone. She rises to the occasion with others. That is definitely true at first. The longer we are together the more withdrawn she becomes. During the trip in the car, she was very quiet. That was also true most of the time we were alone. It was quite a contrast with her talkativeness in recent weeks.

Yesterday her mood was more upbeat. We had an especially good conversation at lunch. It wasn’t because she was any less confused about where she was or because she didn’t have trouble with names. In fact, it was one of those times that is such an interesting blend of her symptoms with her normal personality.

It began with her talking about our marriage and how fortunate we are. As she usually does, she brought up our children and how proud we are of them. Then she said, “What is your name?” I told her, and she asked her name. Then she asked me to tell her about her parents. I told her almost like telling a child a bedtime story. I told her their names and how they had met, about her mother’s moving from Michigan to Texas, and how she had become such a valued member of her father’s family.

Then she wanted to know about our children. Again, I told it like a story. I described our excitement when they were born and how proud we have been of the way each of them has matured. She took great delight in hearing about both her parents and her children. She was very happy. Although asking her questions is a clear expression of her memory loss, there wasn’t the slightest sign that she frustrated, anxious, or fearful. She was simply asking for and receiving information about those who are most precious to her and loving it. I am only sorry there was no way for her to grasp what an impact she had on my mood. I am also hopeful that with her further decline, we will still have moments like this.

After Lunch

Once we were back at the house, I suggested we change clothes and relax a while. She told me she didn’t want to change. I told her that was fine. I got her a Tylenol to help the pain in her knee, and we sat in the family room. I started this post, and she worked on her iPad. We have been here a little more than an hour. She has been working on her iPad steadily and peacefully all this time. I thought all was well. Then she said, “I’m ready when you are.” I asked if she wanted to go to Barnes & Noble. She said, “I’m just tired of the same old thing.” We went to Barnes and Noble and were there about an hour before she was ready to leave. During the time we were there, she seemed fine.

On the way home, I stopped by Walgreens and bought a sleeve for her knee. I had no idea whether or not it would help, but I didn’t think the Tylenol had made a significant difference. I was ready to try anything. When we got home, I put it on for her. She immediately felt better. I should add that she hasn’t given it a real test so far. She has been sitting in bed with her leg stretched out straight. We’ll soon be off to dinner. That will give me a better idea of how well it works.

I just checked to see how Kate is doing and was pleased to see that her mood had changed completely.

Things pick up in the afternoon.

Kate has never been a morning person, but I think her cold has made it especially difficult to get going. She didn’t get up until shortly after 10:00 today after going to bed close to 9:30 last night. When we got to Panera at 11:20, she was still not fully awake and not very jovial. She didn’t recover during lunch. After getting home, she went directly to bed where she rested about 45 minutes. When she got up, she joined me in the family room where she worked on her iPad for another hour. We didn’t talk during that time, but she seemed to be more alert. Finally, she indicated, though not in words, that she was ready. She just closed her iPad and said, “Well.” I said, “I guess you are ready to go.” She said, “Whenever you are.”

As we drove to Barnes & Noble, she was quite cheerful and talkative. I was playing a CD of the musical Cats. When she heard “Memory,” she said, “I love that song.” I said, “It is interesting that it is probably the best known song from the musical, and it’s the only one not based on one of T. S. Eliot’s poems.” She hadn’t remembered that the musical is based on his book, An Old Possum’s Book Of Practical Cats. She said, “That’s got to go in the album.”

She was talking about her photo album of our family. She hasn’t worked on it in at least two years, but she still occasionally mentions things that she wants me to remember to put in the album. I could tell she would never finish the album more than two years before she stopped working on it. The only thing she has ever done to create the album is to select some family photos for inclusion and edit them. She has never put anything into the software that she would use to make the albums. She did edit and edit and edit the photos. That was the first of her activities to go. That left her with the yard and jigsaw puzzles on her iPad. Now it’s looking like the yard may become a thing of the past as well.

Speaking of the yard, spring is on the way. We see various trees and shrubs beginning to bud and flower. I have been watching to see if we might get any new leaves on the shrubs around the house. I am glad to see that at least some of them are coming back. I haven’t seen any indication that others have any new growth. They are completely bare. I’m not going to give up hope just yet, but it’s not looking good.

The short rest that Kate had gotten after lunch must have done the trick. She has been just fine since she got up. Once we were at Barnes & Noble, she got rather chatty. She started reminiscing about her mother and father as well as our marriage and how good she felt about our children and grandchildren. These are things she says quite often. She and I talk about how fortunate we are. Periodically, she would say, “Okay, I’m going to stop now.” She would look down at her iPad. Then she would start talking again. She must have done this at least four or five times before she really stopped. At that point, she said, “Now, I think I’m going to play.” Then as though she had to justify that to me, she added, “You know, you can’t do serious things all the time.” I am glad to see I’ve got the “real” Kate back now, and I am grateful that we always seem to have good afternoons and evenings.

Still Recovering from the Flu

We continue to make incremental steps forward in our recovery; however that isn’t the most important thing about which I’d like to comment. That relates to her mood today. She has been a little depressed, something that I don’t see that often. Part of the reason it made an impression on me is that she had a very good night’s sleep. She got up close to noon on Saturday and 11:00 yesterday. Today, I finally woke her up at 12:20. I didn’t rush her. She got up slowly, and we didn’t get to Panera until 2:00. Earlier this morning, I decided not to go to Rotary and to cancel the sitter. I think I did the right thing.

When she was ready, she was not cheerful. I didn’t think much about that at first. She is often not ready to engage in conversation when she gets up. She needs a little time. We were at Panera about an hour before I looked across the table and noticed that she was looking bored. I knew she was ready to go home. I asked to make sure, and she confirmed my suspicions.

It was about 3:15 when we arrived home. Recognizing that she was a little depressed, I asked if she would like to work in the yard. It’s not a beautiful day, but the temperature is warmer than we have had in a while. She indicated that she did not. I suggested that we might find a movie on TV or Netflix and watch it. She said okay without any enthusiasm. While she went to the bathroom to brush her teeth, I explored movies. I suggested an old Cary Grant and Audrey Hepburn movie. She indicated she didn’t want to watch a movie. I asked if she would like to look at some of our old photos from or past travels. She didn’t want that either. Then I gave her the iPad and told her to work on it in the family room, and I would find something. I found some old family photos her father had taken along with a couple of albums of our own and took them to the family room.

I sat down beside her and told her I wanted to show her something. I gave her the album with her father’s photos and let her look through them while I watched along with her. She enjoyed seeing them and took her time moving from one page to another. I was feeling good.

When she finished, I said, “Now let me show you something else.” I reached for a box of photos of our own and was going to show them to her. She said, “Do we have to do this now?” I told her no. I had already put on some music that I thought she would like and said we could enjoy the music while she worked on her iPad. She got up and went to the kitchen. In a minute, she had gone outside. I thought that might be a good thing. She hasn’t worked in the yard for more than a week. I think that is mostly because of the weather week before last. Last week, it was the flu.

She was outside for about twenty minutes before coming back inside. She asked if I were ready to go. I told her to give me a minute, and we would go. So here we are back at Panera where we are likely to stay for another 20-30 minutes before we head to Chalupas for dinner. I surely hope she feels better before bedtime tonight.

Good Moods Make for Good Days

In my previous post I failed to note that Kate was in an especially good mood yesterday. I am sure that played a significant role in my own sense that we had had such a nice day. It is not that she is usually irritable. She does continue to show more irritability than before her Alzheimer’s, but those moments don’t last long, and, fortunately, at those times she is not difficult to get along with. That said, sometimes she is especially happy and cooperative. That is the way she was yesterday.

She also continues to be reflecting or thinking a lot. Over the course of her illness she has occasionally said something that sounds like we had just been talking about something and expects me to know what she is talking about. There were a couple of those experiences yesterday. She said, “I’m going to be very careful.” Instead of acting puzzled and asking what she was talking about, I said, “That’s a good idea.” She said, “I’m going to stick close to you whenever we are in public.” I told her I would watch out for her. She said, “I know you will. I feel safe when I am with you.”

When she says things like this, as she has done in recent weeks, I tend to impute more to her actions than may be justified. In this case (as in others recently), I believe that she is grappling with a sense that she is less and less in touch with her environment and the people around her. It may be her way of expressing her own insecurity. Overall, she seems not to associate her challenges with her diagnosis, but she still knows she is not normal.

More Confusion and Recognition of It

It has been another nice day with our son’s family. It is Sunday, so they went to church this morning. I chose not to go thinking it would be good to let Kate get up leisurely and have a relaxing morning. Kevin called us after church, and we met him and his family at a local hamburger place for lunch. Then we came back to the house for the afternoon. We watched a couple of football games. Kate worked puzzles on her iPad. She did rather well, but I could tell she would have liked a change of scenery. When I asked if she would like to go back to the hotel, she said no. Thus we stayed at the house until time to leave for their annual Christmas Eve church service. We attended with them as we have done in the past. We came back to the house and had chili that Rachel had made. Then we came back to the hotel where Kate quickly got ready for bed. She didn’t even work on her iPad and was asleep in no time.

Despite having a nice day, Kate continued to be confused about where we are. I know she must have asked me almost ten times. That began this morning when we went to the car to go to Panera. She asked, “Where are we?” She asked again as we were leaving and also as we were leaving lunch. When we got back to Kevin’s house after lunch, she got out of the car and started pulling leaves from a shrub in front of the house. She had pulled only a few when I told her I thought we should go inside. Yesterday afternoon at Kevin’s she had said, “I can pull a few leaves.” It was a statement but really a question. I told her this was Kevin’s house and that might not be a good idea. She accepted that without a problem.

Tonight when we got out of the car at the church, she pulled me aside and asked, “Where are we?” I told her we were in Lubbock. She said something about knowing that. I told her she could ask me as many times as she wanted. She said, “And you don’t even make fun of me.”

Apart from the confusion, Kate has seemed melancholy. I noticed the first signs during the church service after we had sung “The First Noel.” After that it appeared that she wiped a tear from her eye. I asked if she were all right. Of course, she said she was. She enjoyed the service. It involved a lot of music. She especially liked a quartet’s version of “O Holy Night.”

We left Kevin’s right after dinner. After we got in the car, she asked if we were in Fort Worth. I told her we were in Lubbock. Then before I got out of the drive, she asked again. When I told her Lubbock, she said, “I don’t know why I keep forgetting that.”

In the car on the way back to the hotel, she said, “I know one thing; I am glad I married you.” I told her I was glad to have married her. I told her I wanted her to know she could count on me. She said, “I know that.” Back at the hotel, she seemed very dependent and appreciative of the ways in which I help her. Before getting into bed, she gave me a hug and said, “I don’t know what I would do without you.” I said, “Well, you don’t have to worry about that. I will always be with you.” She said, “I know.”

Her mood makes me think that she is recognizing her loss of memory. I doubt that she is associating it with her Alzheimer’s, but I believe she knows something is wrong. She is feeling more dependent on me. I think traveling brings this out because she has no idea where we are or where things are around the hotel room. Several times she has asked me where the bathroom is. Since I have packed her clothes, she has no idea what things I have brought for her, or where they are. There is good reason she is confused. My deeper concern is that this confusion is not just a result of being in strange places but that it represents a sign of further decline. I fear what things will be like in the next few months. I hope my fears are unfounded.

Another Mood Change

I have mentioned before that Kate is particularly sensitive to lots of things like temperature, noise, music, etc. It seems to me that this sensitivity is even more noticeable now than in the past. It doesn’t take much to startle her. She often responds audibly to someone’s sneezing or coughing. I have to believe the people around us sometimes hear her reaction. She is frequently hot in the house and likes to have the overhead fans turned on regardless of the temperature. I compensate by wearing a sweater.

This morning she wasn’t in a particularly good mood when we went to Panera. It wasn’t long before she complained about a particular rendition of a favorite Christmas carol that was playing. After forty-five minutes, she asked when we could go home. She said it was too hot there. We left to come home. Since it was a little before 10:00 and too cold to work in the yard, I told her I would build a fire and put on some Christmas music. She seemed to like the idea but didn’t express great enthusiasm.

When we got home, and I had the fire going, I turned on the music, Handel’s Messiah. I had the volume too loud for her. It startled her. I turned it down to a more acceptable level. She came into the room and has been working on her iPad for almost an hour. She has enjoyed both the fire and the music. We are back on track now. I think we have averted any further problems, at least for a while. We will go to lunch in another thirty minutes or so. This afternoon we are going to the Bijou where they are putting on a production of Miracle on 34th Street. I expect that will provide another good experience.

Mood Changes

The answer is (Do you remember the question? ) “yes.” Kate remembered and came out from her room dressed for dinner. She continued to seem very normal. In fact, I would say her mood was better than normal. She was nothing like she was when I first saw her this morning. She had her top on inside out, something that is very common. I told her about it, and she thanked me. We made our way to Chalupas, our favorite Mexican restaurant, where we sat quietly, enjoyed our meal and just being together. I treasure moments like these and wish they could occur more often. I know that is not possible; so I take special pleasure in each of these experiences and feel grateful that they continue to occur.

On the way home from the restaurant, Kate mentioned that she felt sleepy but didn’t want to go to sleep too early. Once arriving at home, she commented again about being sleepy. I took this immediately as a sign that the symptoms of whatever illness she has had the past few days might be returning. Fortunately, no other symptoms materialized

I suggested that I turn on the “PBS Newshour” in the bedroom while she got ready for bed and worked on her iPad. She mentioned that she would like to stay awake until 8:30. I don’t ever recall her being concerned about going to bed too early. I don’t think I have suggested it. I’m wondering what might have prompted this. At any rate, she put on a night gown and came into the bedroom to work on her iPad in her chair, not in bed. A little later, she indicated she was ready for bed. I pointed out that it was 8:28. She had made it to her own appointed bedtime. We ended the day on a high note.