Cognitive decline

After learning of my just-departed mother’s affliction, visitors at her wake have been sharing stories of their own loved ones’ manifestations of dementia and apparent Alzheimer’s Disease.

Advances in medicine and health care have extended average life spans in much of the world. But more important than plain longevity is enjoying relatively good health in advanced age.

This is something that science can’t guarantee. In fact it seems that for many, the opposite is happening – that as people live longer, cognitive decline is the rule rather than the exception.

I’m no doctor and I’m in no position to offer expert advice. But based on the shared stories, plus those of others from my previous encounters, I can surmise that there are common threads. Sharing these threads might help those who are distressed by unusual, puzzling changes in the personalities and behavior of their loved ones. It might help them cope and prepare for what lies ahead.

Progressive memory loss is a given in cognitive decline. But there are other early signs, whose detection could help preserve the peace in the household and ease the distress of both the afflicted and those around him/her.

There’s a slew of materials online about cognitive decline. For whatever it’s worth, I’m relating my own experience with my mother, plus those of others who have shared their stories with me.

A common early sign is uncharacteristic grumpiness and sensitivity to imagined slights.

This may progress into a propensity for picking up fights for no reason, and extensive cussing that may be laced with obscenities. Some exhibit violent fits at this stage; an octogenarian woman occasionally slapped her husband in their bed as he slept, for no reason.

The person may become indifferent to personal hygiene, not bathing for several days straight. Brushing the teeth becomes irregular, with lower tolerance for wearing dentures. And the person won’t like being told to bathe and practice dental hygiene.

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At some point, the person may need to be given a bath by other people, even by force. Such sessions may turn into violent episodes, with the person screaming at the top of her lungs that those assisting her are trying to kill her, or that the water is too hot or too cold even if the temperature is actually just mild.

Some have extreme weeping fits, breaking into sobs when they think someone has raised a voice at them.

As I have previously written, such behaviors must not be taken personally by those around the afflicted. Don’t argue; the person needs reassurance of being always right.

Hard as it may seem, love is the best response to all these behavioral changes, combined with infinite patience. A cheerful disposition in the presence of the person also helps.

Another common manifestation is constantly clutching a bag or purse containing some cash and important personal items such as bank passbooks, passport and keys. This stems from an irrational fear that the bag will be stolen right under one’s nose even by the person’s loved ones.

Sometimes the person starts putting into this favorite bag items that happen to be lying around, such as other people’s keys, eyeglasses and even stones.

The person will gradually lose interest in activities requiring strong mental engagement, such as reading, watching TV serials or playing games like mahjong or even bingo.

With cognitive decline comes physical and motor skills deterioration. The handwriting becomes erratic and using objects such as cutlery becomes challenging. And the person might reject offers of help, feeling insulted.

Such phases can progress over many years. It’s not unusual for relatives to realize that something is horribly wrong only near the end stage, when the person loses the ability to walk, talk intelligibly and chew normally. The mind and body are shutting down – a process that medical websites say can take from one to three years. Cachexia or severe wasting can set in, leaving the person emaciated despite heavy food intake.

At this point, agonizing remorse could hit those who failed to detect the symptoms early and fought with the afflicted as the behavioral changes emerged.

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Alzheimer’s and other forms of dementia require hands-on caregiving by several people; one person can’t do it alone. It can be harrowing for households without the means to provide such care.

In the US, where stay-in caregivers are ultra-expensive and house helpers are rare, someone I know puts her Alzheimer’s-stricken octogenarian mother in a nursing home for three months – the maximum covered by the government – and then brings the mother back to their own home. As soon as state coverage rules allow it, the mother is returned to the nursing home.

In our country, state-run services and facilities for elderly care are extremely limited. One probable reason is that in the traditional extended Filipino family, the elderly have enough relatives to care for them in a multigenerational household.

Such set-ups, however, are disappearing as family sizes shrink and amid changes in the mindsets of the younger generations.

With resources for public health care woefully inadequate, it’s doubtful that state-run elderly care would be a priority for the government.

For those who worry about the complications of aging, early detection of cognitive decline can at least help in preparing for what might lie ahead.