As my wife’s Alzheimer’s drew toward its inevitable end, I was often asked, “When did it begin?”
It’s a question with no answer.

As my wife’s Alzheimer’s drew toward its inevitable end, I was often asked, “When did it begin?”

It’s a question with no answer.

First, it turns out that Alzheimer’s is only a definite diagnosis when the brain is autopsied, a procedure most families will forego.  It’s enough that their loved one had the symptoms, and was medicated “as if.”  

At the birth end of things, perhaps an analysis of DNA and family history would indicate  genetic origins.  But is that when it begins?

Maybe the question should be when did the dementia or the symptoms of Alzheimer’s first appear.

That too is difficult, if not impossible, to answer.

In my experience, Alzheimer’s and maybe simple dementia first builds on traits we already possess.  

For instance, my wife had a fantastic ability to remember names, faces, and any stories attached to those folks. This ability certainly helped her relate to her students.  On the other hand, due to her corrected eyesight, she was directionally challenged.  She had trouble reading maps and would hesitate before telling me whether to turn right or left when I was driving.

One sign that she was losing certain abilities came when she got confused driving to a friend’s house..  But, at the same time, memories of folks instrumental in her childhood were quite alive.  

As to beginnings, then, are certain traits merely predictive of Alzheimer’s or actually early stages of the disease?  For instance, high stress, smoking, and a sedentary lifestyle seem to make Alzheimer’s more likely.  When do they become signs?

Teaching can be a very stressful occupation, especially if you care for your students, and their future. You try to advise them, provide a bit of nurturing, but often never know whether it helped. You fret over the ones whose future seems set in some hopeless path.  So I didn’t wonder at my wife’s mood swings, nor her occasional comments on how easy I had it in the college classroom.  At the end of the school year, we would always travel back to her home in the mountains of Virginia, and she would grow perceptibly happier the closer we got.

When we returned from longer stays, we would have packs of unopened mail.  In later years, I began to notice that some and then much of that mail remained unopened.  Luckily, most of our bills are “auto-pay,” but I should have taken warning then.

Then there were the Turbo-Tax problems.  She kept having trouble finding files in the computer, and wouldn’t be able to complete a return on time.  That too was probably a sign.

As should be apparent, she was the financial specialist in the family; I used to joke I was happy getting my allowance.  For instance, she decided that we would emerge from graduate school with no debt, which meant she had to teach Junior High to support my studies.  She wouldn’t hear of our taking out a loan so she too could start graduate studies.  

I think she regretted not getting a graduate degree and, as the Alzheimer’s advanced, rather felt she had sacrificed too much.  As I said in the memorial service, she was the one who excelled in undergraduate studies, inducted into Phi Beta Kappa.  But I had a Master’s when we married and she determined to push me through to the doctorate.

She started two graduate programs at OU in the 80s, but her strong moral will led her to drop the programs, inspite of top grades.  In one case, there was a wholesale turnover of  the very faculty that she most respected. It didn’t help when she heard they were released, in part, because students felt they were too hard. In another case, she lost all respect for a  program when she observed widespread cheating during an exam and a professor who didn’t seem to care.

That same will was exercised in ways that became signs of dementia..  At one point, she announced that she was tired of cleaning house--a task we both shared and disliked.  But she went further and simply quit.  So, being retired, I picked up that task, though doing the  job less well.  

Then she quit washing, including her own clothes.  A certain sign, though not really a problem for me.  Ironically, one of the Wake Forest stories she liked to tell was about the rich girl who came to school never having had to wash her clothes.  Her dorm mates became aware that she was throwing away clothes after a few wears, so they took her in hand and taught her how to use the washing machines.

Can I date each of these things?  No, because I didn’t notice them at first.  And, in some cases, she just hadn’t gotten to doing something, she said. I tended to accept such statements since I just haven’t gotten to a number of things.  I’ve put off laying tile on one floor for so long that I’ve begun to like the pattern on the concrete.

And some things you don’t notice for some time.  When did she quit reading books?  She used to be able to tear through one a day, if she liked it.  When were newspaper and magazine articles too much?  When did she just start looking at the pictures?  Can’t say.

Too, when medications started, we were just treating certain memory lapses or something else.  We were not calling it anything at that point.  The doctor was reluctant to use the “A” word.

It became more real when he requested that I accompany my wife during the examinations. I needed to hear what the likelihoods were and what needed to be done.  Only at that point, did I begin to think of stages of Alzheimer’s.  

And even then, I questioned, because it turns out that there is no set order for the progress of the disease.  Different patients will have different symptoms.  In my wife’s case, for instance, until the last couple of weeks, she was communicating with me, though often without understandable words.  Expressions said a lot; sometimes actions. Only a bit of cold coffee in the cup? Turn the cup over to indicate you want more.

So I come full circle: beginnings are very hard to pin down.  Certain personality tendencies may gradually become more pronounced.  When it is noticeable, it has probably been developing for some time.  

I fear if a caregiver is asked too many times when it began, it only increases the burden.  One begins to wonder if the progress of the disease could have been arrested, if only one had been more alert to the early signs.  (I feel the answer is probably No.)

There’s are plenty of opportunities for guilty feelings when one is losing someone, without insistent questions.