Why this blog?
TO point to: Caregiving – An Over-the-Shoulder View of Caring for a Loved on Through the Seven Stages of Alzheimer’s – A Love Story
By Paul J. Bourgeois
STAGE I:
BEFORE SYMPTOMS APPEAR
Preclinical Alzheimer’s begins when
early indicators appear ten to fifteen
years before symptoms that lead to a
diagnosis are noticeable. Close
relatives, friends, and even medical
professionals usually misinterpret or
miss these early indicators.
At the time of this writing, researchers
consider slowing the disease’s advance
or curing it to be unlikely once neurons
in the brain are destroyed. Future
medications to prevent Alzheimer’s or
slow its progress will be most effective
in this first stage.1
For Judy, pre-diagnosis dates back to
2004, nine years prior to real
symptoms.
———————————————————-
1 The definitions for each stage of Alzheimer’s in this memoir are edited versions from the Alz.com web page.
1. The Early Signs
Judy experienced early memory issues nine years prior
to her Alzheimer’s diagnosis, but they seemed trivial at
the time.
I had just passed my sixty-fourth birthday and was
planning to retire in a year; looking ahead, Judy and I
visited several over-fifty-five communities in Northern
Virginia as a first step toward retirement, but when we
didn’t find anything that pleased us, we stopped
looking. Then, Judy saw an ad in the Washington Post
Sunday real estate section for a new development at
Regency at Dominion Valley in Northern Virginia that
she liked, and she wanted to take a look. As we neared
the subdivision entrance, road construction told us that
the Dominion Vallen community was expanding.
The entrance to Regency dead-ended into the
number-one golf course’s tee box. Tall trees skirted the
fairway’s left edge, and verdant lawns and brightcolored
pansies adorned empty spaces along the
entrance road and around the model homes. We drove
along the few roads that were open to look at houses.
“Now, this is more like it,” Judy said.
3.
In the Regency sales office, a three-dimensional
area mockup on a large table highlighted lots available
and those about to become available.
“Let’s pick a lot that will have minimum traffic as
the subdivision grows,” Judy said.
We had owned five houses over the years, and we
both had a good idea about what we wanted in our
retirement home. The road she pointed to looped
around to parallel the main drag, which promised that
the only car traffic on our street would be limited to
those who lived there.
“We’ll take this one,” I said to the real estate agent,
pointing to the middle lot in the group.
We had four different floor plans to choose from;
we selected the model home with a master suite, a large
den, separate living and dining rooms, a kitchen, a bath
on the first level with two large bedrooms, a private
bath, and a sitting room in the loft. The upstairs living
space would accommodate family members and friends
we expected to visit during our retirement. We signed
the contract in June 2004 for our new home, which
would be completed in April 2005.
#
Three weeks after we signed the contract for our new
home, we drove out for a looksee at our lot. As we
drove along the dirt path that was euphemistical
4.
called a road, I checked the stakes marking the lots and
found ours. We both stared at what had been a bare
piece of land; we were looking at a concrete slab,
freshly poured, with two piles of prefab home
construction components stacked behind it. This house
could be delivered early, I thought. I needed to get our
Centreville home on the market for a quick sale so we
could move into our retirement house.
At home that evening, I drew up an action-item list
of what I needed to do before putting our house on the
market and decided to start the repairs the next evening.
I left the list of supplies I needed for the evening’s work
on the kitchen table so Judy could do the shopping,
which she usually did while I was at work.
When I got home from work the next evening, Judy
was sitting in her den chair watching TV, and my list
stared back at me from where I had put it on the kitchen
table. Judy had not touched it. In prepping our four
previous houses for the market, Judy had been an equal
partner. She shopped for paint, brushes, rollers,
turpentine, and anything we needed for that evening’s
tasks while I was at work. In the evening, we worked
side by side on the project for the day, and sometimes
she took the initiative to do a task while I was at work.
I thought something must be wrong.
“Are you okay?” I asked.
“I’m fine,” she said, and continued watching TV.
5.
I changed clothes, went to Lowe’s to pick up
supplies for the evening, and worked alone. In the days
that followed, Judy didn’t shop or help with the repair
work in Centreville, a clear deviation from how we had
worked together in the past. Judy had symptoms of
arthritis, so I chalked it up to aging.
Taken in isolation, not helping with repairs was a
behavioral change that didn’t cause me concern. I later
realized Judy had forgotten that she had ever helped
with work to prepare our earlier homes for market. I
now see this behavior change as her first early indicator
of Alzheimer’s.
#
By December, I had finished projects inside the house
and was about to move outside into the yard, but I took
a break to attend a Christmas party at my boss’s house.
Judy and I enjoyed some heavy hors d’oeuvres and then
made our rounds talking to other couples. Tired from
standing, Judy found a sofa in the den at the back of the
house where her friendly face invited conversation.
“Boy, do my feet hurt,” the woman sitting next to
Judy said. “We spent the whole day house hunting—my
husband and me.”
“And where are you looking?” Judy asked.
6.
“Today, Great Falls. Tomorrow, we’re gonna try
Centreville. It’s further out, but more affordable.”
Judy gave the woman a wan smile. “We’re about to
put our house in Centreville on the market,” she said.
“Would you like to come by for a walkthrough? You
could get some idea of what’s available in the
Centreville area. No strings attached.”
“Why are you selling?”
Judy nodded in my direction. “My husband, Paul.
He’s retiring next year. We’ll be moving into our
retirement home in April.”
The next day, the couple visited our house and
spent considerable time in the master bedroom
discussing furniture placement. On the sidewalk in
front of the house on their way out, they both
commented on how beautiful the place looked. (He
later commented to my boss that “the house was
impeccably clean,” a testament to Judy’s
housekeeping.)
“How much are you asking?” the husband asked.
I mentioned the price Judy and I had discussed. The
couple huddled together for a moment and made an
offer on th
e spot close to the price I had quoted. We
accepted.
Judy sold our house before we put it on the market
and saved the realty fee in the process. She then
7.
orchestrated the sale herself. That closing went
smoother than any of the four homes we had previously
sold. How could someone who had succeeded in
pulling off what Judy had done be suffering cognitive
impairment? One thing I learned early on about
Alzheimer’s: On any particular day, things appear
perfectly normal, and then, out of the blue, comes the
unexpected.
We scheduled the closing on our new home for
April 15, 2005, and began planning for the move. To
decorate our earlier five homes, Judy had taken
advantage of sales and produced impressive interiors
on a tight budget. This time, we had money in our
account from stock options I had cashed in prior to
retirement, which gave us a comfortable margin to
spend on the interior décor without using savings.
Days before closing, Judy told me, “I signed a
contract with Next Day Blinds to make window
coverings for the master bedroom and the living and
dining rooms. I’m having wooden shutters installed in
the den and the breakfast nook, and on the sliding door
to the patio.”
“Shouldn’t you have waited until after we closed to
sign that contract?” I asked. “What if there’s an issue
that delays closing?”
8.
“Installation is set for Saturday, the day after we
sign the papers,” Judy said.
The closing went on schedule, and everything was
finalized.
In the living and dining rooms, Judy had put a skyblue
two-inch strip across the beige curtain valence that
matched the color of the walls. In the master bedroom,
a detailed floral design in the queen-sized bedspread
and pillow coverings was repeated in the custom
curtain set across the triple window. Judy had
decorated our previous homes beautifully, but what she
accomplished in our new home reflected superb taste.
And then, the bills for the decorations came in, and
I was shocked. Judy had gone first class all the way.
Neither of us ever made such large purchases without
consulting the other. That was out of character for Judy,
but I didn’t see a connection between that and
dementia. Much later, I decided that she had forgotten
the process that had been acceptable to both of us over
the years.
That deviation from our norm was another early
indicator of her disease that, in a future scenario, might
call for follow-up action. At some point, these early
indicators will justify early treatment considered
necessary for new medicines under development to
work. Researchers seeking cures for Alzheimer’s, or to
slow its progress, believe that once neurons are
9.
destroyed that enable communication between
elements of the brain and the rest of the body, they
cannot be repaired. Thus, recognizing these early
indicators and reacting to them will be critical to early
diagnostic testing for new medications to be effective.
On April 18, 2005, we moved into our retirement
home in Regency at Dominion Valley in Northern
Virginia, and in September of that same year, I retired
and took to playing golf.
I recommend the book Mayo Clinic on Alzheimer’s
and Other Forms of Dementia to enable recognizing
the early symptoms of Alzheimer’s. Brain changes
associated with Alzheimer’s disease can lead to early
indicators, which will be critical for early diagnosis,
justifying treatment with new drugs that cure or slow
the progression of the disease.