Dear Greg,

You could explain it to her or show her a video or give her a book, but none
of that will do any good if she cannot remember what she was told or what
she saw or read.

I explained her situation to my mother in law kindly and gently every day.
She still doesn't know what is going on.   Did you read the posted analogy a
few days ago about the train journey?

It is so sad, but you cannot impart much to them but for just a moment.   If
it helps, then try, but if the person is sick enough to have been diagnosed
with this illness, then their memory is impaired enough that they won't be
able to retain the explanation.

I'm posing a question to you, that was posed to me last summer when our journey
began ... *and you are wanting to do this for your mom or for you?*  That simple
little question had made me do some soul searching in many different scenarios,
most usually the answer is *for me*. <sigh>  Truth be told, mom doesn't care and
the answers aren't gonna mean a hill of beans to her nor change what we all are
dealing with.  Myself and each of my siblings are asked frequently, *what is wrong
with me*.  Yes, it's frustrating to repeatedly be asked the same things over and
over again.  I'm willing to bet it's even more frustrating to mom.  She's the one
who has to live in this new world.  She's still well enough to know something is
wrong, yet not well enough to remember what we have told her.  By showing her a
video over and over, I think it just goes to show my mom that we probably don't
want to be bothered answering her question verbally anymore ... yet that really is
all she wants.  Someone to spend time with her, someone to talk to her.
Soooooooo, I continue to answer her questions ... your memory is broken mom. Sorry
I can't be more specific since the only diagnosis can be made by autopsy and we
just aren't ready to go there yet (this always gets a laugh out of her ...
laughing is good).   Nope, it's probably not going to get better mom.  Sorry mom,
the doctors don't know how this happened.  No mom, we aren't going to clean your
closet out today - you NEED what clothing you have left. <g>  

Now my younger brother has taken things even farther in his explanations, he has
the quick sense of humor in the family ... as well as is the baby (if you can be
considered a baby at the age of 45).  He tells mom she is somewhat like a
computer,  just needs more RAM ... her hard drive is working just fine, but there
isn't enough functional RAM left.  She always laughs at this, yet I'm sure she
doesn't understand.  And really, any deeper explanations only upset and sadden her
... so who is that video really going to HELP?  <grin>

Keep this question in the back of your mind, I have a feeling you could refer to
it often as your journey continues.  I know I have.  The one I am currently
applying it to, along with the aid of a opthamolgist, is whether or not she should
undergo cataract surgery.  We definitely will go for the eye exam, but the jury is
out on anything further because of the followup treatments, anesthetics, etc.  

Joyce

Hi Greg,

Have you spoken with anyone regarding your feelings?  

No matter what the stage, your Mom is gradually losing her cognitive
abilities.  She could watch the video 10x, 100x, a 1000 times and
while she may grasp the idea within the first minutes, hours, maybe
even a day or so, you will more frequently have to return to the
video.  This won't necessarily be a problem for her because she either
doesn't understand or doesn't remember.  

It will become a problem for you if it hasn't already.  

You have spelled out denial, something that most of us have gone
through and have retained the ability to recognize.  You may even
recognize it yourself; however, for your sake and your Mom's you must
find a way to come to terms with the fact that things are going to get
much worse (yes, you cannot imagine).  Read the 36-hour day, find a
local AD support group, even talk to your doctor (believe it or not,
he/she most likely had psychiatric rotations during residency).

You must take care of yourself first in order to care for your Mom.

Darryl.

Remove my socks for email address

No point, she'll forget.

Hi Greg,
I'm not sure what you will accomplish by reminding your Mom about
her condition thru a video tape. Except to maybe get her anxious
and upset. I've found that people with AD remember the emotions
of a situation far longer than they remember what is actually
happening. So every time she watches the tape she will probably
get anxious and later on that feeling will just keep building but
she won't remember why she is upset. I think Joyce was right on
target. You unfortunately just don't know yet what is in the
future but you sure do seem to be more on top of things than I
was when I started this journey. I kept trying to "fix" things
to, until I had that aha moment that most things were way down
there on the scale of importance in making my Mom happy, trustful
and not in danger of hurting herself.

Greg, if your mother was like my husband, telling her she had Alzheimers
would mean nothing at all.  He was never concerned with medical stuff.
However, he did have a stroke, so I would remind him that he had a stroke
and that left some damage to his brain.  That he could understand.
However, he soon forgot and still didn't understand what was happening to
him.  I don't think trying to get her to understand would really do any
good, except maybe for 10 minutes.  Then she would forget--again and again.
Sorry I can't really be any help to you.
Gwen

Greg, I hate to tell you this, but having heard a number of your
descriptions of your mother's behaviour and issues, she is most
assuredly NOT in Stage 1 but at least Stage 3 and perhaps into early
into Stage 4. All the your logical explanations of what her problem is
are not going to get her to understand what is happening to her.

See below definitions of the stages.

Mary G.

Stages of Alzheimers

In 1982 Dr. Barry Reisberg published what was to become the best and
most widely accepted
description of the stages of Alzheimer's disease. Even today,  when
experts referto a person being in stage 5 or stage 6, they are
referring to Dr. Reisberg's scale of seven stages.

Adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The
global deterioration scale for the assessment of primary degenerative
dementia. American Journal of Psychiatry, 1982

Level 1

No cognitive decline - (or Normal Adult). No subjective complaints of
memory deficit. No memory deficit evident on clinical interviews.

Level 2
Very mild cognitive decline (forgetfulness or normal older adult).
Subjective complaints of memory deficit, most frequently in the
following area:
(a) forgetting where one has placed familiar objects;
(b) forgetting names on formerly knew well. No objective evidence of
memory deficit on clinical interview. No objective deficits in
employment or social situations. Appropriate concern regarding
symptoms.

Level 3
Mild cognitive decline (early confusional or Early AD). Earliest
clear-cut deficits. Manifestations in more than one of the following
areas:
(a) patient may have gotten lost when traveling to an unfamiliar
location;
(b) co-workers become aware of patient's relatively low performance;
(c) word and name finding deficit becomes evident to intimates;
(d) patient may read a passage of a book and retain relatively little
material;
(e) patient may demonstrate decreased facility in remembering names
upon introduction to new people;
(f) patient may have lost or misplaced an object of value;
(g) concentration deficit may be evident on clinical testing.
Objective evidence of memory deficit obtained only
with an intensive interview. Denial begins to become manifest in
patient. Mild to moderate anxiety accompanies symptoms.Deficits
noticed in demanding employment situations.

Level 4
Moderate cognitive decline (Late Confusional or Mild AD). Clear-cut
deficit on careful clinical interview. Deficit manifest in following
areas:
(a) decreased knowledge of current and recent events; (b) may exhibit
some deficit in memory of one's personal history;
(c) concentration deficit elicited on serial subtractions; (d)
decreased ability to travel, handle finances, etc.

Frequently no deficit in the following areas:
(a) orientation to time and person;
(b) recognition of familiar persons and faces;
(c) ability to travel to familiar locations. Inability to perform
complex tasks. Denial is dominant defense mechanism. Flattening of
affect and withdrawl from challenging situations occur.

Level 5
Moderately severe cognitive decline (Early Dementia or moderate AD).
Patient can no longer survive without some assistance. Patient is
unable during interview to recall a major relevant aspect of their
current lives, e.g., an address or telephone number of many years, the
names of close family members (such as grandchildren), the name of the
high school or college from which they graduated. Frequently some
disorientation to time (date, day of week, season, etc.) or to place.
An educated person may have difficulty counting back from 40 by 4s or
from 20 by 2s. Persons at this stage retain knowledge of many major
facts regarding themselves and others. They invariably know
their own names and generally know their spouse's and children's
names. They require no assistance with toileting and eating, but may
have some difficulty choosing the proper clothing to wear.

Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD).
May occasionally forget the name of the spouse upon whom they are
entirely dependent for survival. Will be largely unaware of all recent
events and experiences in their lives. Retain some knowledge of their
past lives but this is very sketchy. Generally unaware of their
surroundings, the year, the season, etc. May have difficulty counting
from 10, both backward and sometimes forward. Will require some
assistance with activities of daily living, e.g., may become
incontinent, will require travel assistance but occasionally will
display ability to familiar locations. Diurnal rhythm frequently
disturbed. Almost always recall
their own name. Frequently continue to be able to distinguish familiar
from unfamiliar persons in their environment. Personality and
emotional changes occur. These are quite variable and include
(a) delusional behavior, e.g., paatients may accuse their spouse of
being an impostor, may talk to imaginary figures in the environment,
or to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may
continually repeat simple cleaning activities;
(c) anxiety symptoms, agitation, and even previously nonexistent
violent behavior may occur;
(d) cognitive abulla, i.e., loss of willpower because an individual
cannot carry a thought long enough to determine a purposeful course of
action.

6a - Requires Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence

Level 7
Very severe cognitive decline (Late Dementia or Severe AD). All verbal
abilities are lost. Frequently there is no speech at all - only
grunting. Incontinent of urine, requires assistance toileting and
feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting
and head control.
The brain appears to no longer be able to tell the body what to do.
Generalized and cortical neurologic signs and symptoms are frequently
present.

Hi Greg-  I am Greg too.
I fully understand why you want your mother to understand her situation.  It
would make it so much easier to care for them if they could cooperate with
that care.

With my Mom it really upsets her to be reminded of her affliction.  She
tries to live a normal life but normal is not the same.  She simply can't
stand for anyone to mention that she has Alzheimer's.  We went to the Dr.
this week and he said the "A" word and she flipped out on him too.   Mom has
been diagnosed for over 3 years now.  I would rather her be calm and happy
even if I have to trick her to care for her.  For example, she has this
thing about washing her clothes by hand.  She only wets dirty, sweaty
clothes and hangs them up and it smells bad.  I have to let her finish and
leave then gather them all up and wash them in the washer.  She will
sometimes do her washing and then put them dripping into the electric dryer,
so I turned the dryer off at the electric panel and turn it on when I use it
and then turn it off again.

My Mom is very hard to care for because she refuses to believe that she
needs care.  When I do something for her it makes her mad, no matter what it
is.  And, it seems to get worse as she declines.  She stands her ground and
defends it with everything, no matter what it is about.

I am sure though that a time will come when I will pray for her to argue
with me some.