Feb 11, 2013

The Only Predictable Aspect of Alzheimer’s Is Its Baffling Unpredictability!

Two weeks after her fall, she was lucid enough to realize her wandering didn’t make sense, but not aware enough to know she didn’t have a car.

Elaine Pereira
Alzheimer's Reading Room

The Only Predictable Aspect of Alzheimer’s Is Its Baffling Unpredictability
My professional background is as an Occupational Therapist specializing in pediatrics, primarily special needs children, to improve their self-care, fine motor and perceptual skills. Although geriatrics may not be my specialty service, I did work ten years in adult home care.

From my perspective as a therapist, adults often can be a little easier to work with than kids.

They don’t cry when they are having a bad day; well usually they don’t. They don’t require a juggling act of creative motivation in order to get them to do something they really don’t want to do. They follow directions faster and are generally more compliant than the “kids.”

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Having said that though, adult home care was also my first exposure to patients who also demonstrated a compromised mental status. Not knowing these individuals before their recent hospitalization, it was difficult to determine the cause of their confusion or inconsistent level of alertness. Sometimes the family was spot-on accurate and forthcoming, “My aunt’s memory hasn’t been good for some time.”

But some patients lived alone – although maybe shouldn’t have – and didn’t have the family or friend resources on which for me to draw helpful information. The diagnosis for which I was treating them might not provide even a clue as to their whole picture.

What I couldn’t appreciate at the time, but have come to learn from accompanying my mom down her journey with Alzheimer’s, is that dementia is predictably unpredictable!

Look What the Cat Dragged In

Looking back, my first experience with an adult home care patient with memory issues and paranoia, possibly dementia, was an elderly woman – we’ll call her Mary - referred to me for “Deconditioning.” Gotta love that term.

I was returning for my second visit on a blustery, cold, rainy afternoon. I had my purse and paperwork case on one arm and on the other I schlepped a huge, heavy bag of therapy materials. Obviously I couldn’t also carry an umbrella.

When I got inside Mary said, “Wow! Look what the cat dragged in. You’re a mess! Take a few minutes honey and fix yourself up.” I caught my image in her foyer mirror, ran my fingers through my sopping wet hair and put on some lipstick.

A few days later I received a call from my home health supervisor. She said “Mary” had contacted the office to register a complaint that I “had spent the entire therapy time” combing my hair and “putting makeup on.” I was baffled!

I detailed my version of the conversation with “Mary,” which I still remember well. To my surprise, at the time anyway, the supervisor reassured me “not to worry about it at all.” And absolutely nothing came of it.

In retrospect, “Mary” was probably experiencing mental status changes manifested in her twisted perception of our conversation.

Checks and Envelopes

My mother also demonstrated a cornucopia of dementia related behavioral changes, all ugly. But of all of the goofy, bizarre events and personality quirks which Mom exhibited, the most baffling was the car insurance check debacle.

A few months before Mom willingly gave up driving, she had elected to renew her car insurance. Because I lived two hours from her and she was very hearing impaired, we communicated almost exclusively via email. I knew her insurance was going to expire October 30, 2009, so I reminded her to pay it. By email she assured me that she had. But on my next visit to her place I learned the baffling truth!

“Did you get your proof of insurance certificate yet?” I asked.

“I don’t think so?”

“Really? It should be here by now.”

“I don’t know.” Now that was an understatement.

“I’ll call them next week and check on it.”

I contacted (her) insurance company … and learned that she had written several … checks, but the amounts weren’t always correct or even the same and none of them had the account number written on them. Sandy, at the local office … knew my mom (well)…

“Actually, Elaine,” Sandy said, “your mom has written nine checks.”

“Nine! Nine? Really! She wrote nine checks? Oh, my goodness.” I was stunned ... She had literally written nine checks over a two-week period, totaling an overpayment of nearly $2,400. Five of the checks were written on consecutive days.

I was still baffled about how my mom could have written nine checks to the insurance company. I responded, “If you could you give me the check numbers, then can you just shred them, please. What a mess.”

“Yes. Your mom is such a nice person,” Sandy replied. “I’m sorry she’s having some trouble.”

Some trouble? More like an avalanche of trouble, I thought.

What really baffled me wasn’t that Mom had written multiple checks, forgetting that she had written any. But how did she address all of those envelopes correctly! How could she remember the sequential steps of looking up the address, writing it out on the envelope, putting a stamp on it and dropping the envelope in the mail slot and not be able to remember that she had already done that! And not just twice, but nine times, five of which were on consecutive days!!!

From my advanced degree in OT, I have an excellent understanding of neurological impairments as they relate to disorders in people, everything except for the bewildering inconsistencies common to Alzheimer’s.

During lucid moments Mom told me she needed more Snicker’s bars, followed by telling me she had seen (my deceased) “Dad in the parking lot” and would I let him in.

Mom fell on the sidewalk in the parking lot one very early morning – 3am – and was found a few hours later unconscious. After being stabilized and treated, with astonishing clarity she accurately described how she went to her car to empty the groceries from the trunk, but had slipped on the sidewalk. 

There was no car or any groceries, she was right about the fall.

Two weeks after her fall, she was lucid enough to realize her wandering didn’t make sense, but not aware enough to know she didn’t have a car.

“I don’t know,” (Mom) answered when I inquired what had happened that night.

“I thought I had to get groceries out of the trunk, but that doesn’t make any sense, does it?”

No, it didn’t make any sense. Not much did anymore.

Elaine C. Pereira is the author of I Will Never Forget - A Daughter's Story of Her Mother's Arduous and Humorous Journey Through Dementia, and a finalist for the Best New Non-Fiction USA Book Awards & The Hollywood Book Festival.

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