soap opera

I'm beginning to learn more about the new characters in Mum's life.

I was with her on Saturday. I took her for a cosmetics run to a large department store, where we allowed the Clinique girls to go to town on her face and sell her some new playthings. The staff quickly worked out that giving Mum a choice wasn't a great idea and that she takes suggestion well. They cooed over me, saying that she was lucky to have a Son like me to take her out. It made me wonder what normal Sons get away with. I don't feel like that brilliant a Son.

Anyway, back at the Home, the Screaming Lady was mostly asleep at the table and when she was awake she was feeble and whiny and sounded very scared. I did hear her refer to "those bitches" but she was immediately challenged by a staff member, which I found reassuring. I'm a bit sorry for her now, as she sounds very confused and seems to live in a frightening world where everything is being taken away from her. As I keep telling Mum, this is a troubled lady, but Mum no longer has the subtlety of distinction necessary to understand this. Like an child in a playground she categorises people only as 'nice' and 'nasty'. I try to tell her that every drama needs to have some conflict and that she's now living in her own private soap opera with Screaming Lady as her Nemesis.

'The Gentleman', is my new focus of concern. He was constantly wandering off down the corridor, past his own room and disappearing into those of others. I made a point of running after him whenever he was headed for Mum's room, and the staff member on duty caught on and began coming with me. 'The Gentleman' kept insisting that they were all his rooms, which claim we firmly refuted. When the staff member asked him what he wanted in those rooms, he said that he was looking for cash, which pretty much answered for me the question of what happened to the £100 I left in Mum's purse all those weeks ago. At one point, the staff member took him to each one of 'his' rooms and pointed out that they all belonged to different people and each had that person's name on the door. 'The Gentleman' strode back, apologetic and saying "You're quite right", but 2 minutes later he was off down the corridor again. He's too much of a handful when there's only one staff member on duty. I need to speak to the Manager about him.

So we have a Nemesis and we have a Gentleman Thief.

Also in the lounge was a new resident I hadn't met before. At first I wondered why she was in the Home, as she seemed normal enough and made sense in conversation. But after a while I noticed that her conversation was cyclic and came around and around to possessions of hers that had gone missing. Now I knew that she and Mum had clashed over a black coat in Mum's wardrobe to which this woman laid claim. The woman's own coat had then been located in her own wardrobe, but this didn't stop her retelling the story about 5 times while I was present. When I circumvented her on the last occasion to say that I knew all about it and that Mum hadn't taken her coat, her face fell and she asked for the telephone and started weeping, holding it in her hand. We had actually met this woman earlier in the department store, shopping with her daughter, and she was wearing her black coat...

So that's a Nemesis, a Gentleman Thief and an Accuser.

Then I met Mum's Special Friend who, again, seems quite normal, if maybe a little fragile and excitable in temperament. She sat next to Mum gazing adoringly at her, as if Mum was made of diamond, and drinking up anything that Mum said and repeating it back to us both. She seemed positively ecstatic to meet me (so she's definitely nuts). Mum doesn't even remember her name, which is slightly embarrassing. She's told me before how her new friend hugs her and kisses her goodnight, but I was amazed to hear that they've even shared a bed on occasion when Screaming Lady was prowling the corridor.

Oh my, this is a progressive soap opera! It seems we've got a potential Lesbian love interest, too.

I'll be back after these messages from our sponsors....

office

“Ah, he's here... Hello, Greg?”
The call comes around 4:30pm while I'm at work. Mum sounds bright and urgent. I can hear activity in the background.
“Hi Mum. What can I do for you?”
“I’m in the office here and I wanted to talk to you about this….er..... So…. I’ll call you later.”
“Mum… I don’t understand… You’re calling me now to tell me that you’ll call me later?”
“Yes.”
“Is there anything wrong? We can talk now. What did you want to tell me?”
“Well it’s about the money… this money… this 5… er…. To pay for one room here.”

Mum's clutching at straws. She’s desperate to make sense to prove to me that she’s competent, but everything she says betrays her. Behind this conversation, I suspect, is the loss/theft of the five £20 notes I left in her purse 3 weeks ago. At the weekend, we had several discussions about this, where I explained how all her pension was now going towards paying for her stay in the Home.

“Well, so I’m in the office now…”
“Is Christine (the Manager) there?”
“I don’t know… [shouts]… is there a Christine here?…. No…”

I hear a plate go into a washing-up bowl.

“Where are you, Mum?”
“In the OFFICE… I told you! You know… where we have the television and the sofas and they cook things for us in a kitchen.”
“The Lounge?”
“Yes, the Lounge.”

I first noticed Mum’s word-substitutions at Christmas. They're cropping up more and more frequently.

scrabble

I’m sitting playing Scrabble with two relatives of another resident in the communal lounge/diner, wondering if the presence of a Scrabble board here is therapeutic or a cruel joke, given the level of Aphasia in this room.

The staff member is having trouble getting Mum to the table for her meal. The food keeps going back in the oven because Mum has wandered off down the corridor to her room. She’ll go and fetch her but the moment she turns her back to plate the meal, Mum has risen because she’s just remembered something or she needs the toilet. For someone who has such trouble walking, Mum certainly puts in some good mileage.

Eventually, she is sitting and eating.
“I must show you the pool,” she says to me, standing up suddenly.
“Pool? I didn’t think this place had a swimming pool.”
“Oh yes, a large one. It’s over that way. They use a chair to lift you in and…”

Mum’s talking about the bath.

what I have learned in 2007: different types of dementia

2007 has been an education for me in lots of ways. Finally getting my Mum's problems investigated has meant that I've learned some distinctions between various types of dementia. I thought I'd share these here, for anyone reading who's going through a similar process.

'Senile Dementia' is a general term which groups all the different types of dementia experienced by the elderly into one category. Of course, the most common form of dementia is Alzheimer's Disease, accounting for roughly two thirds of cases in the over-65s. Alzheimer's Disease is a degeneration of nerve cells and their connections. Protein deposits tend to accumulate in the brains of Alzheimer's sufferers, but it hasn't yet been determined if this is a cause or effect of the problem. Progression of the disease can be gradual. I'm not going to write any more about this form of dementia, because there is so much information about it elsewhere.

However, there are several other types of dementia. Another form is Vascular Dementia. Vascular Dementia describes a number of conditions linked by a vascular cause (e.g. Hypertension, Stroke, Atrial Fibrillation). Often caused by a series of mini-strokes in the brain (Multi-infarct dementia), the disease tends to progress in a series of steps depending on the severity of each progressive stroke. Small steps leave the symptoms looking much like Alzheimer's, but it's equally possible for a major stroke to cause significant sudden loss of abilities. Each stoke cuts off or blocks blood flow to part of the brain, depriving it of oxygen and nutrients, leading to the death of that section. These dead areas, or lesions, are what a CT scan picks up.

Then there is Lewy Body Disease (Dementia with Lewy Bodies), in which small deposits of protein accumulate in the nerve cells of the cerebral cortex. The sufferer experiences persistent hallucinations, perhaps seeing a person in the same chair over and over. Here, the confusion can fluctuate such that a Carer might believe that the sufferer is 'pretending'. Parkinson-type symptoms like tremors or rigidity are associated with this type of dementia. As the disease progresses over several years, the sufferer experiences memory loss and his or her language skills will deteriorate.

Fronto-Temporal Dementia (grouped with Pick's Disease and Primary Progressive Aphasia) is a rare and slowly-progressing condition where the sufferer's personality changes, perhaps resulting in a loss of inhibition or sudden inappropriate rudeness or maybe a loss of emotional warmth and empathy. Over-eating or a craving for sweet foods is an indicator here (maybe I should get myself diagnosed?), as is a change in sexual behaviour. In this group, memory loss is not usual in the early stages, but a decline in ability to communicate sometimes gives the impression that memory problems exist. As the disease progresses, reading and writing skills deteriorate along with numerical skills. The sufferer will likely develop problems handling money. Some sufferers develop obsessive behaviours, with repeated hand-washing or similar activities. This group of diseases is characterised by more localised damage in the frontal or temporal lobes. Primary Progressive Aphasia attacks cells in areas of the frontal lobe particularly associated with speech. Pick's Disease is caused by abnormal or swollen cells or abnormal protein deposits within cells in the fronto-temporal areas.

In Mum's case, she has what's known as a 'mixed pathology', with the problem chiefly being Vascular Dementia but with some other damage present that could be due to one or several of the other forms listed above. I've certainly noticed a marked loss of empathy, her increased selfishness, and her preferred diet of sweet foods. This and her deterioration of abilities to deal with money give me reason to suspect that there's a fronto-temporal aspect to her condition, too. Then again, I have observed Mum having Lewy-Body hallucinations on many occasions over the past 5 or 6 years. She sees someone standing in a street and is convinced that she saw them standing in exactly that spot yesterday, and will not budge from the assertion, even if I tell her we were 300 miles away yesterday.