An elderly woman with dementia leans quietly on a cane. Her outline seems to be submerged into water.

Alzheimer's Progression: Coping with Changes in Language

They say it's best to start at the beginning. That's what Glinda the good witch said anyway. My first experience with being aware of dementia was when I, along with my family, witnessed my grandmother's mental and physical decline.

It probably happened over time, but it felt like some sea witch came up from the depths and stole my grandmother's voice overnight. It felt like 1 day she was having normal conversations, and the next day getting her to talk was like pulling teeth.

A brilliant woman

My grandmother was a brilliant woman. She often bragged to me about how she graduated in the top of her nursing class, earning herself a trip out west to places like Pikes Peak and other sites in Colorado. That was a big deal for a girl who grew up in a farming community and rarely left its borders.

Her success in nursing led to her overseeing a ward for a local mental institution here in West Tennessee. She worked there for more than 20 years before retiring.

Was my grandmother dropping hints?

Looking back, maybe she was dropping hints when she reminisced about her trip past the exotic west side of the Mississippi River.

When I was a teenager, I often visited my grandparents on the weekends to help clean the house. Sometimes, she had me dig out all of her photographs from the back bedroom. She pored over them, telling me about each picture. She had me label the backs of ones that were blank. We ran through her memories leaving proof in ink.

I wonder now if there was more of an urgency in our labeling system than I grasped at the time. I think she felt the need to get everything down in print, and I wish now that I'd taken better notes and paid more attention.

A mix of medications

She was smart and proud... And stubborn. She often visited a doctor who apparently thought there was a pill-fix for every ailment, and in her eyes, that doctor could do no wrong. She had grown to trust him, and there was no questioning him in her presence. Not without a fight.

He had her on a mix and number of medications that we suspect were more detrimental than beneficial to her overall health.

I remember when my aunt, who was a registered nurse, looked appalled at the list of medicine she was taking once she got her hands on it. I knew little about the subject at the time, and really didn't understand what was happening, but I remember her tone and the look on her face when she learned. It wasn't good. The damage was likely done.

Transition to transition

Over time, her physical state began to decline, and her mind soon followed suit. She spent more time on the couch and less and less time up and about. Her spoken words dwindled along with her physical activity. My grandfather cared for her as she spiraled until it became too much of a toll on him.

She was eventually placed into a nursing facility, and Granddaddy drove to see her everyday for a long time. He eventually joined her in the nursing home, still doting on her as much as possible. My family also visited her often. My mother recalls that Grandmommie would often ask, "How are the kids?," but she wouldn't call us by name. She didn't say much inherently "wrong," but she spoke in generalizations.

My family and I came to the general consensus that rather than say anything wrong or illogical, she preferred to shut down verbally. She was too proud to ever let anyone see her "mess up." So, she found a way not to.

As Grandmommie grows quiet and still

Grandmommie's breathing eventually slowed as an encore to her silenced voice and stilled movements. She passed away surrounded by people who still loved her, even though the articulate, proud, stubborn woman we knew had grown quiet and still.

Grandmommie worked for 20 years caring for those who were mentally fragile. I have to wonder if she started recognizing the beginning signs of her own decline. Maybe she noticed the sharp corners of her mind beginning to dull from wear.

She was far too proud and stubborn to ever be seen as rambling or irrational or admit any deficit. So, she learned to cut her sentences short. She kept exchanges general and simple. She hid the cracks in the facade by building a wall across her lips.

Observed language changes with Alzheimer's

She was still in there, but she had company. She didn't dare open up for fear of us seeing the dementia that had taken up residence there as her constant roommate.

Dementia isn't always forgetting your address or the day of the week. It’s not always mixing up words or stringing together incoherent semblances of sentences. Sometimes it's stoic silence. That was the case with Freddie, and that was my first glimpse at dementia.

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