As our mother aged and Alzheimer’s disease ravaged her mind, she seemed to have fewer asthma attacks.  She had suffered for years with serious asthma, but as subjective awareness diminished, so did the frequency of her breathing crises.  But on this particular evening just before dinner, the asthma attack onset was quick and frightening.  I knew she needed emergency intervention; on the way out the door I supported her with one hand and grabbed a granola bar with the other.  When her breathing normalized, she would need food. 

In the emergency room she was triaged; and as we waited for further attention, her breathing improved.  Now was the time to offer her the granola bar.  She looked around the room and spotted a young child; then she said to me “What about her?”  I responded, “What about her.”  Mother insisted that if I had no food for the child, she would eat nothing.  I explained that the child’s mother was caring for her and probably would prefer we not intrude. Then I went through the drill about how much energy she herself had used, how long the evening would be, and that I would worry if she had not eaten.  Nothing doing; if I did not feed the child, she herself would not eat.

This incident and countless others are examples of mother’s declining judgment.  She was such a caring soul, but also a logical thinker.  But now the billions of neurons in her brain could not bring reasoned judgment to this simple challenge.  This experience was inconsequential and produced no serious result, only a fleeting reminder.  However, in the months and years ahead, the loss of judgment became a “crossover point” in the progression of her Alzheimer’s disease.  The question had now become not only “What do I call this object?”, but also “What do I do with it?”   

In “How Long Will the Suffering Last?”* I wrote about the progressive nature of Alzheimer’s and its discernible, predictable losses: memory, judgment, understanding (comprehension), and control of bodily functions.  It is important to note that these losses have uneven and porous borders. 

The disease does not progress in a straight line, neatly and definitively from “stage to stage.”  In fact, the losses involve a process, with its advances, regressions, and zig-zags across the life and time that’s left.  The loss of judgment, likewise, is not sudden.  But when it begins to manifest itself in behavior it moves the loved one to a new place.  I sensed that Mother, my siblings, and I all experienced elevated anxiety.  For us, distrust grew about her ability to manage the simplest activity.  For her, she now was the victim of the competing claims of personal safety and independence. 

Judgment is a mysterious activity of our magnificent brains.  The integration of experiences, values, rational thought, culture, and presenting circumstances enables us to make congruent judgments consistent with who we are.  When the brain is disturbed the process falters.  For example, when plaques and tangles disrupt the flow of neurological activity the reel of life pictures is disconnected or broken.  When memories have faded, some of the material needed to integrate into the decision-making process is missing. Without the memory of past experience, the anchor component of judgment is mute. 

I am not qualified to explain what happens in the brain of an Alzheimer’s patient to rob her of sound judgment.  In fact scientists themselves can’t fully explain how the mind and the brain are bound together.  But what we do know about our loved one with Alzheimer’s is that sooner or later her/his judgment will silently slip away.  And as it does we will grieve yet another loss. 

We can, however, do something constructive:

·         Keep the loved one safe and comfortable; 

·         Refrain from showing alarm or embarrassment, or from trying to correct a flawed idea; 

·         Speak calmly and lovingly, and let the incident go;

·         Recognize the changes taking place and inform other caregivers or family members as appropriate; and 

·         Continue to engage the loved one in conversation and activities as long as he/she is responsive. 

*This website, “Symptoms” category