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We're waiting for Gabe to finish a math placement test. Jeff's about out of brain for the day.

Posted on July 11, 2011 by

Apraxalexiagnosi-what?

Have you ever seen one of those “novels” which are written for high-school students with the aim of prepping them for their verbal SATs? I’ve seen them, but I would avoid them assiduously on the (possibly misguided) assumption that any work of fiction designed to weave in a pre-determined unrelated collection of 1000 or so words is bound to be stilted and awkward.

Nonetheless, here and now I propose to perform an equally contrived service. I will, in the context of describing this weekend’s trip for my son Gabe’s college orientation, incorporate on-the-spot examples of some of that medical jargon you run into when you delve into the world of technical journals for the purpose of trying to comprehend your loved one’s illness.

Heck, maybe it’ll work. Maybe next time we hear someone say “prosopagnosia,” we’ll grasp their meaning right off the bat! Or maybe this will just be boring, as I expect novels clunkily studded with words like “brogan” and “refragable” would be.

Keep in mind that I am describing the adventures of a main character with posterior cortical atrophy, which tends to cause more visuospatial stumbling than textbook Alzheimer’s. Then again, I bet you’ve seen plenty of this stuff anyway.

As a springboard, let’s hear it for bringing optic ataxia along on a road trip. (Optic ataxia: an inability to guide the hand toward an object using visual information.) That plus a dash of agnosia (loss of ability to recognize objects) makes for an interesting step-wise process every time a bathroom, gas, or Starbucks break occurs. (And they do occur several times between Annapolis and Greensboro, North Carolina, particularly when there’s only one driver.)

In general, I lead Jeff from the latte counter to the Subaru, then turn him over to Gabe. Without help, Jeff will jab fruitlessly at the side of the car, then make a grab for the side view mirror. Gabe opens the car door (using the handle, which works best,) and points inside. Jeff gets in. Lather, rinse, repeat.

These two failings, optic ataxia and agnosia, also make pumping gas an adventure. Jeff still views this as “his” job. I maneuver him through it, placing his hand on the pump handle, and making sure he squeezes. I usually say “don’t pull back!” I say this because of the time I got a lapful of gas.

Here’s a good one: Ideational apraxia. Apraxia as a general term refers to inability to perform meaningful movements. Tack “ideational” on the front and we’re talking about loss of ability to carry out learned tasks in the proper order. This means that after a quick morning trip to the black and white tiled hotel bathroom I will come out to find Jeff wearing shoes and socks, but no pants.

“No buddy,” I say. “The pants are going to have to go on first.” We remove the shoes and I don’t quite stop him from yanking off a sock as well. Oops. Now a shoe tries to climb back on an un-socked foot, and the pants still aren’t on yet. You can bet a dozen mini-bottles of ginger-mint shampoo that when the pants do go on, they’ll be backwards.

We do get this sorted out. But then Jeff has to just wait, while I get dressed and I rouse Gabe into the shower. We did not bring a book for Jeff this time. His alexia is pretty complete. Alexia: The inability to understand written or printed material. To be fair, Jeff can read a little. In fact, just this morning he picked up a newspaper insert and told me that Pat Boone wants us to eliminate bugs. I looked at it. Indeed, it was an ad having to do with pest eradication, but Pat Boone was nowhere to be found. I can only assume he appeared somewhere else in the paper and was applied, out of context, to this snippet about insect control.

Books no longer make sense to Jeff. In the hotel room, Gabe hands Jeff volume #1 of Scott Pilgrim, the graphic novel, which Gabe has stowed in his duffel. Remarkably, Jeff peruses this for a good 10 minutes. I am sure he cannot read the panels in logical order, or apply dialog in the correct spaces, but nevermind…it seems to keep him busy for a few minutes.

In our hotel there is a daily breakfast buffet. I could probably take any term pertinent to PCA and use it to explain why I manage breakfast by sitting Jeff down and bringing his food to him. But today we’ll use this one: Simultanagnosia. With simultanagnosia, the affected person can distinguish some individual details from a complex visual array, but cannot make sense of the display as a whole. You might think this means he should be able to zero in on a hard-boiled egg and snag it. In fact, this is not true. The visual cacophony of the buffet table will have so muddled his processor that he’s apt to return to the table with a plate containing one napkin ring and a single-serve packet of mixed-fruit jelly. I don’t consider this an adequate breakfast, so I do it for him.

I made a mistake in the last paragraph. He wouldn’t return to the table with mixed-fruit jelly, because he wouldn’t return to the table at all. Here is one of the roadblocks to returning to a table: Hemineglect. This is sometimes known as hemispatial neglect. When parietal lobes get good and damaged it is not unusual to see one side or the other of the person’s visual field get short shrift, attention-wise. In Jeff’s case, this sometimes means that, as far as he’s concerned, stuff to his left is often just not there.

There is a special way this manifests as we stroll across the brick pathway through the sylvan quad of Guilford College. If I let go of Jeff’s arm, he drifts to the right. He is like a shopping cart with one annoying, listing wheel. So usually I don’t let go.

It was a steamy day of orientation, and we were all ready for a good night’s sleep when it was all over. I can’t think of a good medically-technical term for “wilting in the heat,” or “ready for a beer,” but you can bet we were there.

COMMENTS

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Donna

July 11, 2011 at 7:58 pm

Emily, for the past four or so months i have been reading your posts and waiting for the next one to come out. I had to comment to this one as your visit was so near our town on your trip to Greensboro. I want to thank you for your writings, my husband is 56 yrs old and was diagnoised at 52 with EO alz. I tell myself so often that it is not alz. because he does not fit the cookie cutter mold of it. All i have ever known is the dementia end of this horrible condition. i was not aware of the physical disablities that would come also. i see us so much in your writings and realize we are not alone. the support groups i have attended i leave generally feeling more left out of then good. no one has a 56 yr old husband and they all say” are the drs sure it is alz”. Thank you again for blogging to all of us out here that are just getting by day to day !

Emily Clement

July 15, 2011 at 2:57 pm

Thanks Donna…what is it we say in Alz-world? Right: If you’ve seen one Alzheimer’s patient, you’ve seen one Alzheimer’s patient!

There are many similarities on which we compare notes, but there always seem to be just as many differences in how different affected people manifest the illness.

Linda Janes

July 19, 2011 at 7:35 pm

Emily,
Oh THANK YOU again for your wonderful blog. I look forward to each writing and am amazed that you can say ‘spot on’ for “life with Alzheimers” and always throwing in a giggle too! Thanks!
Linda

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