On April 18th, 2005, Judy and I moved into our retirement home in Regency at Dominion Valley in Northern Virginia and in September of that same year, I retired and started playing golf.
During the ensuing years, Judy experienced multiple memory issues. First, it was her purse; we’d be ready to go out, and she couldn’t find it. We’d search the house and retrace her itinerary for the day to see if she had left it somewhere outside the home; invariably, we found her purse in the house where she had put it but forgot where. Then it was putting forks in the kitchen drawer where knives go, spoons where forks go, and cups where glasses go; these memory lapses weren’t serious but differed from losing track of her purse. She was now forgetting placements that hadn’t changed in years more associated with long-term memory than with short-term memory. Then, a progressive string of events showed that things were getting worse.
During our Air Force stint in Japan from 1972 to 1976, Judy took multiple-levels of Chinese cooking lessons from the proprietress and owner of a five-star Chinese restaurant near Tokyo. She once impressed my boss, his wife, and six other dinner guests in Japan serving a six-course Chinese meal which included what she called a bird’s nest desert—meringue in a crystal bowl carved-out and filled with lemon custard frozen lightly that went well with the Chinese seasoning. She was a self-styled gourmet cook. Give Judy a recipe, and there wasn’t anything she couldn’t make.
She often made Cajun gumbo, one of her specialties, for our retirement friends in Dominion Vallen. Toward the end of 2012, we invited our neighbors over for a shrimp-gumbo dinner. As she prepared to make the gumbo, Judy approached me as I was watching a Washington Redskins football game.
“Will you help me make the gumbo? she asked. “I tend to forget which ingredients I’ve used.”
This surprised me. My help in the kitchen usually included setting the table, washing the dishes, reaching for something on a top shelf, or just lifting something heavy. On this occasion, I went and stood next to Judy and placed the open recipe book on the counter; when Judy put an ingredient in the gumbo, I moved its container to the side. I found it interesting that she could remember the most nuanced changes to the gumbo recipe she had made over the years but remembering what ingredient she had just put into the pot escaped her.
It was understood between us that memory issues would crop up as we grew older, so we didn’t discuss this as an indicator of a more serious condition. I now realize that Judy’s working (short-term) memory was the issue. I didn’t understand then that the hippocampus acts as the switchboard for memory, allocating characteristics of one memory item (e.g., color, smell, taste, shape) to different segments of the brain and when called upon, it retrieves these characteristics from storage to reconstitutes the memory being called forth. In this case, not remembering which ingredients she had just used was more a short-term memory.
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Towards the end of October 2012, Judy’s thirteen-year-old SUV stalled at Quantico Marine Corps commissary thirty-seven miles from our home with a full load of groceries. We traded her vehicle in for a new metallic copper-colored SUV. Judy chose the color—“It matches the color of my hair,” she said.
This new vehicle differed from her old one in two ways. First, its shift extended from the upper center console, instead of connecting to the steering column. Second, this vehicle had a starter button in lieu of an ignition key. As far as I could see, the speedometer, the tachometer, the fuel gauge, the temperature gauge, and engine warning light were the same as those in her old vehicle. Judy asked me to do the test driving at the dealership, but she drove her new vehicle home.
The next day, I joined Judy for a ride in her new car. She got into the driver’s seat, fastened her seatbelt, and stared at the instrument panel as if expecting me to tell her what to do next; I didn’t take the bait. She opened the center console and took out an index card.
“What’s that?” I asked.
She looked at me as if I should know. “My start-up checklist.”
Judy had borrowed the term from my flying days. She placed the index card on the center console and peered at the instrument panel. Bending her head slightly, she stared at the starter button. Slowly, she brought her index finger up to the starter button and depressed it. Nothing happened. She faced me with a puzzled look.
“Do you have your foot on the brake?” I asked.
“Oh, no! I forgot,” she said.
The checklist lying on the center console didn’t list “press the brake pedal before starting,” since it was the first step to starting her old vehicle.
With her foot on the brake, Judy again pressed the starter button; the engine revved up. Looking furtively at the shift lever, she meticulously maneuvered it into reverse position and slowly backed the car out of the garage. Once she had the car moving down the street, it drove the same as her old vehicle.
Relying on a checklist for starting her car reminded me of her long to-do lists she made for planning large parties during my Air Force career. She would time-sequence shopping and preparations and have everything prepared and ready early to prevent a last-minute rush. Five minutes before our guests were to arrive, Judy and I would be sitting in our den sipping wine.
Judy’s sharp memory made her the family go-to person for remembering things. Looking back, I realize that Judy’s inability to recall how to start her new vehicle indicated a procedural memory issue. Things were getting worse, but I didn’t see it at the time.
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I loved barbecuing. I barbecued a turkey in a hibachi pot on our concrete slab outside our back door in base housing at Yokota Air Base near Tokyo during a snowstorm in the early 1970s. When I retired from Raytheon in 2005, I began barbecuing every evening on our patio grill. If I had a late tee time, when I got home, Judy would point to the platter on the kitchen counter.
“The meat’s ready for the grill,” she’d say.
When I came home one day in March of 2013, Judy told me, “The chicken platter is ready for the grill.”
I put the chicken thighs on the grille, then helped Judy make the salad and set the table. As I removed the chicken from the grill, the warm aroma from the barbecue chicken wafted me in the face, reminding me of Judy’s Mexican cooking. I couldn’t recall the last time Judy had cooked a Mexican meal, or any complete meal for that matter.
I carried the platter into the house and placed it on the table. “How come you don’t cook tacos anymore?” I asked. I loved her tacos.
Judy turned a soon-to-become all-too-familiar blank expression at me. “Did I use to cook tacos?”
I stared at my Judy. It didn’t occur to me at the time that, not only had she forgotten how to cook tacos, but she seemed to have forgotten that she had ever cooked a whole meal! When I grilled, Judy quick-cooked potatoes in the microwave, prepared a sauce from a packet, and warmed up vegetables; occasionally she made chili, but she never deviated. This didn’t come close to meeting her former gourmet standards. She seemed to have lost her creativity in the kitchen.
This memory issue differed from anything we had experienced in the past. This was something habitual, something routine and recurrent, that seemed lost to her memory. At the time, I still thought of this as related to aging, but was beginning to suspect something more serious.
People I’ve spoken to traveling this same journey with a loved one have told me, “I remember many incidents that pointed to cognitive impairment, but it didn’t occur to me at the time.”
It seems that everyone who has gone through this pre-diagnostic phase has experienced this same phenomenon.