Two steps forward, one step back

I will be seeing my neurologist in Seattle on July 1 for my annual evaluation.  This year she had me skip the annual psychometric testing, because I was doing so very well.  My scores have risen gradually but steadily since 2015, so giving it a rest might tell us something.  In 2017 and 2018 I was tested exhaustively by Harborview and a couple of different studies, so I had been getting pretty good at their tests which can distort results.  But I knew from my own subjective experience that I was holding my own or continuing to improve regardless of test results.

Ahead of the visit, I have been preparing a short account of what has occurred over the past year.  This has gotten me thinking about a number of things.

At last year's evaluation I told her that sometimes it seemed like something would break in my brain, and I would have a sudden apparant loss of cognitive ability.  However, these episodes seemed to pass, perhaps because my brain was adapting to whatever went bad.

At the end of April of this year, I was confident that, were I tested, I would score just as well as I had last summer.  By mid-May that had all changed.  I had another episode of losing ground, but this one was deeper, and I thought I might not recover.

There are two tests that I have been giving myself daily since 2016.  One is, do I remember to lock my car when I go into the gym?  The other is, can I recall that I checked for pedestrians and cars going straight after I turned left at the tricky intersection by the gym?  This had been the site of a couple of close calls in 2015 that led me to quit driving for 6 months.

During the second week in May, when I left the gym and got to my car the doors were always unlocked.  This occurred even when I had been reminding myself to lock up just as I pulled into the parking space.  I could also not recall having been cautious after leaving the intersection.

In 2015, I had mood swings/depressive episodes four or five times a week, but these receded in 2016-2018.  I had one about six months ago, and probably not another one for six months before that.  But I had a couple of them in mid-May.  Not very deep, but enough to make me worry that I was going back to 2015.  This was deeply worrying.

I devised a new test for myself.  I found a "random noun generator" on the internet that would give me five random nouns I could use for testing my memory.  In the Mini-Mental State Exam used for screening people for cognitive impairment, they give you a list of three words to remember, and then ask you to recall the words five minutes later.  (In 2015 I could only recall one of the words.)  In the Montreal Cognitive Assessment they ask you to recall five words.

So every second day, I order up five new nouns and have Amy write them on 3X5 cards without me seeing them.  I review the cards two times and then distract myself for five minutes, usually be reading a magazine article.  How many of the words can I recall?  Usually 3.  Once all five, once only one.

This is really, really unscientific, and it doesn't tell me where I'm at.  I do hope that it will show trends, but I probably don't self-administer in a way that ensures consistency.  So I'm not even sure about the trends.

But I have gained confidence that I am still doing better now than in 2015.  I locked the car door every day this week, and I'm confident that I have been safely turning left at all intersections.  I don't think my card trick is pointing to any nasty trend, and the time of the mood swings seems to have passed.

Life is good.