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 My wife was diagnosed with early-stage dementia about a year ago. She has trouble with minor things like remembering appointments or where things go, and I have to keep up with the laundry and her checkbook, but otherwise she seems to be doing pretty well. However, the doctor has told us that she shouldn't be driving. She's not having any trouble with that. Why does he want her to give it up?
Here's the short answer: driving and dementia don't mix. That being said, the point at which someone needs to stop driving may be different for one person than for another. Although most people with a diagnosis of mild memory loss (often called MCI, Mild Cognitive Impairment) can still drive for a time, the progression of the disease will ultimately make it unsafe for them to continue. The hard part is knowing just when that will happen. You might want to ask the doctor to explain more about how he reached his recommendation.
In its early stages, dementia's symptoms are subtle and can be easily masked. On the surface it may appear that your wife is handling the majority of her daily tasks like she always has. She needs help with only a few "minor things," but the rest is fine. Or so it seems. In truth, however, there's a lot more going on than you can see. The changes taking place in your wife's brain are making even everyday tasks harder and harder for her to accomplish.
Memory comes in several different types. "Procedural memory" is what your body learns automatically and stores away in its subconscious, like riding a bike or playing the piano. It enables a person to go through the motions of an activity without thinking. This is why your wife doesn't appear to be having any difficulty with driving - what you are observing may only be her muscle memory at work. Procedural memory allows her to cover up the changes to her thinking brain.
But memory impairment affects a lot more than just memory. It also targets "invisible" skills, what we call "executive function." These are skills that are harder to spot than, say, being forgetful about what day it is or remembering when Cousin Josie is coming to visit. Executive function includes:
Initiative - getting started on something, even something as easy and familiar as getting ready for bed or going for a walk;
Sequencing - following a series of steps, like getting dressed or following a recipe;
Judgment - making decisions that could have dangerous consequences, like going outside without a coat or failing to recognize a money scam;
Concentration - paying attention to what she's doing, not being easily distracted;
Comprehension - understanding what's going on around her;
Insight - being aware of what she can and cannot reasonably do;
Problem-solving - recognizing a situation and being able to react appropriately, like knowing to turn off the stove because the pot is burning.
Look over this list and ask yourself which of these skills are used when driving. The answer is: all of them. And that isn't all. Even in its early stages, dementia often affects vision and spatial skills as well as reaction time. Going through the motions of driving isn't enough; a safe driver has to be able to process the myriad of information going on around her and make appropriate, often split-second decisions. It's hard to face, but doesn't it stand to reason that if a person has lost the ability to keep up a checkbook or put things away, she has also lost some ability with regard to driving?
Giving up driving is an extremely difficult and emotional decision for the person with dementia as well as for her family. It's hard to understand why she should have to stop when there's no apparent reason. After all, even people without dementia have fender benders, right? That's true; however, there is more at stake here than just a bent fender. Making the wrong choices about what to wear or where to put the groceries are annoying and inconvenient; making the wrong choices while driving a car can have much more serious consequences.
(for a perspective on driving by someone with Alzheimer's Disease, Click Here to read Dr. David Hilfiker's August 24 entry on his blog, Watching the Lights Go Out)
 My mother has Alzheimer's Disease and has been in a special care facility for nearly two years. When she first went there she still recognized us, but now she doesn't seem to know any of her family. I go see her a couple of times a week, and although she doesn't say much, sometimes I think she knows it's me. But my brothers say visiting her is a waste of time because she doesn't remember us any more.
Which one of us is right?
You are.
Recognition occurs on many levels. It can be in response to a voice, or a face, or a touch. It is more than just calling someone by name. Most of us, however, tend to measure our loved one's memory loss by whether or not that person can remember our name. Frequently the first question a well-meaning friend or family member will ask is, "Does she still know you?"
Sometimes we have to look beyond the surface to find the answer to that question.
None of us can say for sure what a late-stage Alzheimer's patient is able to grasp from her surroundings. Many of them are withdrawn and seemingly non-responsive to those around them. Many talk very little or not at all. They seem completely lost in themselves and unaware of the present. And so because they no longer respond to things the way they used to, because they aren't able to carry on conversations with us, we assume they're "gone," "lost," or "not there any more."
What we do know is that most of these patients can still connect with the world to some degree, even though it may not be on OUR level. Remember that for an Alzheimer's person, their past becomes their present. Your mother may spend most of her time now rooted in her deep past, possibly before she had children and certainly before she had grandchildren. Imagine how confusing it would be for her to try to reconcile that past reality with the present, many years later. Is it any wonder that she can look on a grown woman and not recognize her as the baby she held fifty years ago? Or see a middle-aged man with a beard and not know he's her son?
This is why it is common for people with even milder-stage memory loss to ask about someone who's standing right in front of them. Millie's husband of 60 years looks right at her and says, "Where is Millie?'" A woman looks at her older sister and says, quite pleasantly, "You sound exactly like my sister Caroline!" This is recognition, simply from a different point on the timeline - back when they had just married Millie or when they were sharing a room with Caroline. They know something's familiar about these people now, but they can't quite place them because of the 50-year time difference. They remember them... they just remember them from another time.
So if you think your mother knows it's you, she probably does. If you are expecting her to call you by name, she probably can't. But just because she isn't able to call you by name doesn't make you any less her daughter. We are much more than simply our names. Same goes for your brothers. You might suggest that they visit again, keeping this thought in mind, and see if it makes a difference for them. But if it doesn't, let it go and allow them to love her at a distance.
In the meantime, celebrate your mother's recognition of you in whatever form it takes. And the next time someone asks if she still knows you, you can say what the daughter of another Alzheimer's patient answered: "Yes, she does. She recognizes me with her heart."
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