My grandmother, Nehama Shepps, passed away about four years ago but really hardly a day goes by when I don’t think of her. Her and my grandfather, Baruch, were always a pretty big part of my life. I visited and stayed with them quite often when I was young. My grandpa grew what he called Clementina trees, maintained the pool, and was always cooking fabulous meals with his shirt off in the kitchen while my grandma taught me how to play Jin and needle-point while watching game shows. I spent a lot of time with them while my parents were at work and the routine became fairly familiar to me.
Then years later, after my brother was born and my grandpa was diagnosed with throat cancer, they moved even closer to us and I was again there a lot helping out. The dynamics had changed though by this point and it was a challenge to us all.
Then quite a few more years after that, my grandma finally just moved in with my parents. My grandpa had passed after many painful years and so she lived with them for several more until she could join him. In those final years my grandma, along with other symptoms of old age and chronic chain smoking, suffered from Alzheimer’s and mild dementia. This is how I learned how important memories truly are, and also how convoluted and distorted memories become over time. Only one memory was ever truly safe with my grandma and that was her family. She had so many great stories, some tragic and some magnificent but always hopeful.
Ever since seeing this strong and resilient woman have to fight such a slow and uphill battle I have looked at mental health differently. I studied dementia and also the mind in college, and there is a good chance that it left me with more questions than it did answers but I still find the mind fascinating. I want to try and relay what I may, hopefully it will find it’s way to somebody who is in need of it. Looking back it is clear that my grandma was most likely suffering from Alzheimer’s years before anyone thought about it. It is no one’s fault, between her being very secretive about her personal life and all the attention being put on my very ill grandfather it makes perfect sense. It’s important that we keep our eyes open though for our older and often overlooked friends and relatives.
First of all, the mind and the brain are separate entities. The way I think of it the mind is another way to describe the soul. I don’t know that I really believe in the soul, not in the traditional way anyway. I don’t think that when we die our soul takes the form of a ghost or anything like that, but I do subscribe to the “mind theory.” That is, we are our minds. So in this way “loosing our minds” is really loosing ourselves because we loose the way we think, we loose our memories. If the past along with our rationality makes us who we are but we forget it all anyway then it goes on to mean that we forget who we are, and if you are one to subscribe to Rene Descartes’ “I think therefore I am” then it also means that without thought you yourself are nothing, and if it’s so easy to become nothing then what is the point of anything? I suppose that is also why happiness is so important to us, because attaining happiness doesn’t depend fully on the mind. Although it has been debated that the happiness of a rational being is more valid than the happiness of say a single cellular organism. All of this is to do with the philosophical mind though, let’s bring it back to the scientific brain.
Alzheimer’s disease accounts for 60-70% of dementia cases. It is also a chronic neuro-degenerative disease that usually starts slowly and gets worse over time. Although little is known about the onset of this disease it is thought to be mostly genetic and of higher risk to people with head injuries, depression, or hypertension. There are no cures for it although treatments can be done to lesson the symptoms. German psychiatrist and pathologist Alois Alzheimer discovered the disease in 1906, and it continues to plague about six percent of people 65 years or older today.
Their are seven known stages of Alzheimer’s, first is the stage known as normal outward behavior. This can only be spotted by a PET scan as there are no real symptoms yet. The scan will show grey areas from things like oxygen deprivation and tissue death.
The second stage is known by very mild changes; you still might not notice very many changes in your loved one but they might start to be frustrated by small memory lapses although it will not affect the person’s ability to work or live independently.
The third stage is mild decline, when others around the person in question begin to notice changes in thinking and reasoning. They might forgets something they just read, ask the same question over and over, have more and more trouble making plans or organizing, and have serious trouble remembering names when meeting new people.
Stage four which is known as moderate decline is when things start to get more intense. This is when the person will most likely start forgetting details about themselves that they should remember and thank goodness my grandmother was living with my parents at this point. My grandmother could not recall what country she lived in or that her son (my father) had been a pilot in the air force. She use to tell me the same four or five stories over and over having no idea that she had told me before. I use to remind her when it first started but after a while of seeing how much she loved to relive her past I would just listen. It’s interesting too how depending on the day small details would get told differently.
Stage five is moderately severe. By this time she wouldn’t know what time of day it was unless the window was open and she had to smoke outside as to not fall asleep with a cigarette in hand. I would often find her roaming about the house looking for items she hadn’t had in years. It is important to make sure the person feels safe and taken care of at this point, you can help by laying out clothes for them or helping them to make decisions about meals or gifts. My grandma use to love to go and get her nails done so she could pick her own colors and have contact with new people. I also believe that the physical contact was good for her.
Stage six set in pretty quickly, this is when the person in question starts forgetting names and becomes delusional about their own limitations. This is when she started needing help in the bathroom. As much as she resented it she really did appreciate my mother helping her. She liked to listen to her game-show network from the comfort of her bed although she didn’t actually watch it anymore. She would also love to have people show her pictures and any kind of meaningful memorabilia.
The seventh stage is the final and most severe stage. Many basic abilities in a person with Alzheimer’s such as; eating, walking, and sitting up fade during this period. My grandmother started to have medical issues and had to be hospitalized during her final week. Luckily all four of her children were able to come from all over to be by her side, in the end though she wasn’t interested in being on life support. She managed to remember how much her husband had suffered on it and so rather all she wanted was a cigarette. She had lived a long and exciting life that was chalk full of love and I’m happy for her that she could recognize the end when she saw it. May we all be so fortunate.