I’ve often wondered about the cognitive awareness of patients with differing forms of dementia. My most intimate knowledge of dementia lies in Lewy Body Dementia with a slight knowledge of Vascular Dementia. I have had little if any true contact with anyone suffering from Alzheimer’s Disease.
The question that has been and remains on my mind is do all dementia patients realize the degree of cognitive decline they have suffered. This question comes to my mind because of the differences in the types of dementias.
For example, as I understand it, in Alzheimer’s and, to a lesser extent, Vascular dementia, cognitive decline is constant and permanent without periods of remission. Therefore, in my mind, these patients gradually fade into a mental grayness, a world of their own understanding from which they rarely return. Do they remember their former cognitive abilities, do they realize they’re declining each and every day. Is this loss a source of pain for them or is it something the are unaware of. Is each day just their new norm with yesterday’s norm lost to the ages. I know for the caregiver the answer to the questions is most likely a resounding NO, but what is the patient’s perspective.
From the LBD point of view, I may be quite aware now and capable of dealing with my surroundings but within an hour I might not be able to add 2+2 or remember how to find my way to the bathroom in my own home. And the thing is, I know it’s coming. I know I’m going to become a potted plant. And I know in all likelihood I will eventually regain some mental clarity. I also realize that eventually, in the severe stages, this cycle will most likely stop. I will become a perpetual doorstop with no hope of an up cycle. But for now I know what I’m missing and what I become in my down phases. It’s something that I dread in the back of my mind. I don’t consciously dwell on it but it’s always just below the surface, a nagging feeling of when the next downturn will occur, how long will it last and could it possibly be the “one” that I don’t come back from. I, and I believe most LBD patients, are very aware of my condition.
Another question I have seems almost bigoted or prejudiced or... I don’t know, just wrong, but it’s there and I’ve got to put it out there. Do people of differing educational levels and cognitive abilities suffer differently from dementia? For example, my mother had LBD and my brother had Vascular Dementia. My mother did not finish elementary school and struggled with many of life’s more challenging tasks such as contracts, complicated readings, higher math, etc.. This not to say she was unintelligent. Far from it. She just never had the opportunity to develop those cognitive skills in a formal way. My brother, on the other hand, would have been a professional student if it had been possible. He graduated secondary school, went immediately to college, was accepted to one of the naton’s premier pharmacy schools before graduating college and graduated pharmacy school suma cum laude. He excelled at all things educational and loved it. His mind was razor sharp. My question is, was there any difference in how they perceived their walk into darkness? Did the one with so much more education realize what he was losing to a greater extent than the one with the less formal education? Or is the realization of a mental loss just that, a loss. No matter the ability prior to the loss.
And, does it really make a difference? So, that’s what’s on my little twisted mind this morning. It really doesn’t make a lot of difference but it is a moment of pause for me.
Until next time.