Watching Dementia

I mentioned before that I would visit two friends who lived in elder care facilities.  One of these was a good friend that I'd known for more than 25 years but was in his late 90s.  I would visit him two or three times a week.  In years gone by, he and I would meet for dinner in a diner we liked that seemed to cater to older people.  On those evenings, he would tell me stories about growing up on a dryland wheat farm along the Snake River as one of the younger of 10 children.  He would also tell me about his service in WWII, when he fought in the Battle of the Bulge.  He was born two years before my own father.

More recently I tried to get him to tell me those stories again for my video camera, and he could still remember the earlier ones.  However, he had a hard time recalling later periods, even from the 1960s.  While he had days when he was quite confused, he clearly did not have Alzheimer's disease or any neurodegenerative disease -- he was simply old.  And most days he was quite coherent, even if he had trouble recalling specific memories of events that had been readily available to him a couple of years ago.

A couple of weeks ago, his wife called to tell me that he had fallen and broken his hip.  This was the day after I finished filming his video autobiography, what of it we were going to get.  The next day she called to tell me that he had died.

The other friend is in a memory care facility that is much closer to our home.  I'm able to see him pretty much every day.  He's in his mid-80s and does have significant dementia.  His wife is a friend of my wife's, and I didn't know him before he had dementia.  His cardiologist judges it is vascular dementia, but I don't believe he's ever had any brain imaging to support that. 

While the second friend has serious dementia, he is very pleasant to speak with most days, and is always happy to see me.  Some days he recognizes me as a familiar face, while other days we are introduced to each other as if for the first time.  Some days he knows his name, some days he knows only his first and middle name, and other days he can't recall his name at all.  Unlike my first friend, he (apparently) had no religious background or upbringing, but nevertheless is always happy for me to read to him from the Bible.

What prompted me to write today is that, when I visited him yesterday, he was much more confused than I'd seen him in the past.  He has always been confused to some level, but yesterday he seemed much more uncertain of who he was or where he was.  He spends a lot of time in bed, but he's usually pretty lively when I'm there talking with him.  Yesterday seemed different.

In visiting these facilities, I've come to learn a little about some of the other residents.  If you're sitting in the common area talking, others are likely to come up and start talking with you, usually nonsense.  One theme that came up with both of my friends, and also with other residents, is their fear that they have no money.  They need to find a job so that they can pay their expenses.  I hadn't heard that for a while, but my friend brought it up yesterday.  My sense is that question may signal depression, based on their apparent mood at the time they bring it up.

My friend recently began to hallucinate.  Apparently, he had some kind of issue over a car he owned that he may have given away or sold for less than it was worth.  I don't know if anything like that happened in his life, but he seemed obsessed with it for a couple of days.  I'll have to ask his wife about it.  He once pointed across the room from his bed and was surprised that I didn't see the car there.  Perhaps we were in a garage  The issue of the car seems to have passed, but two days ago he was surprised that I didn't see a couple of other people in the room with us.

What I'm trying to discern in the time I'm spending with my friend are the ways in which his disease progresses.  I'm not always sure if, when I see something I hadn't seen before, whether it is evidence of decline.  I am curious about whether the four syndromes will manifest themselves, although these are largely peculiar to Alzheimer's disease.  I'm also curious about how quickly he is declining and whether there are factors that can be associated with either retarding or accelerating his decline.  For example, sleep and social connection, although I can't measure these objectively.