Alzheimer Disease, dementia & cognitive impairment are in the news with the FDA approving Aducanumab, a new drug to help people with mild cognitive impairment. Lots of controversy surrounding the drug including its effectiveness and costs but the news gives hope to the families that are living with mild cognitive impairment.
GenXers should be familiar with this area of medicine to prepare not only for their later years but also to recognize what may be happening to a parent or a loved one suffering from Mild Cognitive Impairment.
First a #genx #moviememory – On Golden Pond. Then what to expect with your parents and memory loss and finally what are the practical, legal and financial implications when we spot memory loss in our parents?
On Golden Pond
Do you remember going to a movie in 1981? In Dallas Texas, going to the movies meant the $1 movie theater at Northwest 6, located at Webb Chapel and LBJ. The listings were located in the Dallas Morning News in the Entertainment section. In those days, buying a movie ticket involved going to the theater, standing in line & buying a ticket. Sometimes the lines to buy the ticket were long and sometimes the lines to get into the actual movies were long. At the Northwest 6, the ticket taker window shot out this amazingly beautiful cold air – a hint at our next two hours of delicious freezing cold. Once entering, it was so dark and fancy. Red carpets and drapes and the turnstiles that were also covered in rich-looking material. Maybe once in a great while were we allowed to visit the concession stand. Snacks were usually in Mom’s purse – four separate plastic bags of Cheez-Its or Shoestring Potatoes. As you walked into the theater, the crunch of popcorn on your shoes along with the stickiness of spilled soda. The seats were crunchy-feeling and uncomfortable. The lights dimmed and Mom would lean down and say “the previews are my favorite part.” And they were mine too! My mom was a kindergarten teacher so summers were spent frolicking in the pool, her working on the garden, General Hospital and every once in a while a trip to the $1 movie theater. Mom always picked the movies.
Katherine Hepburn, Peter and Jane Fonda starred in Mark Rydell’s “On Golden Pond.” released in December of 1981 – two days after Britney Spears was born, the same month Mohamed Ali lost his last fight AND the same month as America’s first test-tube baby. The movie was the second highest grossing movie of 1981 sandwiched in between Raiders of the Lost Ark and Superman II
My mom, of the Silent Generation, did not have nice things to say about Jane Fonda. Fonda’s anti-war activism offended many. She overlooked that and fell in love with the cottage and the people and the story of On Golden Pond.
The story is of Ethel & Norman Thayer (Hepburn and Peter Fonda), a long-married couple who own a cottage home on Golden Pond. The retired professors use the cottage as their summer home and have for many years. Ethel and Norman have one daughter – Chelsea (played by Jane Fonda). Norman’s memory loss makes an early appearance in the movie as he is sent out to pick berries and gets lost – not able to remember how to get home. Norman admits this to Ethel who consoles him and agrees to go with him to get the berries next time.
Chelsea arrives with her boyfriend and his son, Billy. Chelsea’s old clashes with her dad begin anew. She never felt like she was enough for the “old coot” and he didn’t do enough to dissuade that notion. Billy stays on for the summer as Chelesa and the boyfriend leave for a trip. Billy witnesses some of Norman’s memory loss as they fish and grow closer over the summer.
Chelsea eventually returns and makes peace with her dad, culminating in Norman recognizing Chelsea’s swimming talents and Norman accepting Chelesa where she was at the moment.
The character of Chelsea is returning to Los Angeles with her new family but that about her parents? What is she thinking about Norman’s memory loss? What should she be thinking about doing to help? What are her next moves? She sees a decline in her dad; she feels like her mother has a good handle on it. As an only child, she must rely on her parents to be honest about the situation.
What Should You Expect When Your Parent is in Decline?
First let’s get into what you should be expecting from your parents after age 60 & their memory. For an in-depth and excellent course about memory, check out John Seamon, Professor of Psychology Emeritus, Wesleyan University Memory and Movies FREE course on Coursera. We reference Dr. Seamon’s work throughout the article.
Five Things to Know About Your Parent IN Regards to Age & Memory:
- Brain shrinkage is normal in adults over 60.
- They will have cognition slowing mainly resulting in their inability to make new memories (like the layout of a new city)
- It will be difficult for them to handle distractions. (get off my lawn! How am I supposed to hear anything with all that racket?).
- They can be affected by negative stereotypes of the elderly.
- DESPITE 2-4, brain systems are not uniformly impaired in people over 60.
When should we be concerned about the memory loss of our parents?
Episodic memory is how we remember where we put our keys, when to pay the bills and when the refrigerator needs restocking. We use these past experiences to guide our future experiences. So when those tasks are becoming more difficult, this is where you would want to intervene and have your parents tested for Mild Cognitive Impairment.
Dr. Seamon suggests that forgetfulness is the first sign of abnormal memory. This is when a PATHOLOGICAL CHANGE has affected the brain. The Pathological change (a stroke or some other event) has changed the brain, NOT OLD AGE.
What is the test for Mild Cognitive Impairment?
The crazy part about this? There is no standardized test for Mild Cognitive Impairment – the whole thing is subjective to the doctor! WTF? The doc will make a clinical judgement based on a number of tests. This is where you need to step up and make sure your parent is seen by a Memory Doctor or in a Memory Unit. These professionals are trained in the science of the brain particularly for people of advanced age.
- Extensive questioning of your mom and her medical history.
- Questions around her memory loss asked to her and to you and to other close friends around her (your mom’s bestie). “Is there a decline in her ability to do Activities of Daily Living*** (more on that term)?
- Blood tests (to see if there has been a stroke or another patholicial event)
- MRI’s of the brain and spine.
- Short mental tests to test for awareness, short-memory recall and memory. The doc uses the results of the mental tests to compare them to younger people’s responses and response times.
What can you Expect After the Test is Completed?
Unfortunately it is likely that another CIT test (although a bit abbreviated) will have to occur before there is a true diagnosis. This is because the doc needs to see the progression. Many times after the second test, it will have shown little to no change. But obviously the doc could find the beginning of Cognitive Impairment or even an advancement to dementia – all leading to a possible Alzheimer’s diagnosis. All of that is a LOT.
Mild cognitive impairment now has this new drug to treat it but anything beyond that (dimentia & Alzheimer’s) IS IRREVERSIBLE because there is no treatment that can reverse the course. UGH.
Still, others show little change if, for example, their memory problems are the result of a minor stroke. But for many seniors, their memory problems will only get worse, eventually leading to dementia. Their mild cognitive impairment is commonly thought to be a pre-dementia phase of Alzheimer’s disease. For these people, their growing forgetfulness cannot be reduced by drugs or medical treatments because no known treatment can reverse the pathological changes attacking the brain,
Let’s talk about some practical advice with a little legal
Okay you are Chelsea Thayer coming back from the lake. Your heart is full with your new family and a better and more loving relationship with your dad. But the more obvious memory loss is nagging. Billy tells Chelesea about the night with the boat and getting lost and stuck. Chelsea lives 2000 miles away from Norman & Ethel. What should she be doing?
The sooner she starts planning and learning about this, the “easier” it’s going to be. You may be able to make decisions with your mom and dad about how they would like to live their ideal life in the next, 5, 10, 20 years. If they want to maintain freedom and autonomy, let’s start planning it now.
So Chelsea has some options. She could contact an Elder Law attorney or a Geriatric Care Manager. This area of the law is mainly state specific so you would contact the professional in Norman and Ethel’s town.
Also where are is Chelsea on the scale of being able to discuss this with your parents? Are you in the red zone of not being able to discuss, the purple zone of knowing and discussing some or the blue zone of complete disclosure?
What do you know about your parent’s “documents”? Their “Estate Plan”? Their “Power of Attorneys” What property they own? These are not comfortable topics. Make sure to include your siblings or other family members or interested parties in the room. I would advise Chelsea and Bill to get the advice of an Elder Law attorney right away.
Ethel and Norman may object to contacting an attorney. “We have been getting along just fine for 60 years, we don’t know your help.”
Some quick advice about this conversation – this conversation needs to be scheduled and put on a calendar. This is not something casually mentioned on the phone. If you are going for a visit, have this talk be one of the first priorities so you can take it easy the rest of the trip. Talking in a low voice makes it more likely they will listen to you. Pretend you are Casey Kasson and speak in his tone and cadence. Try to make the conversation about you and your needs. Give your parents the chance to jump into parenting mode and take some of the burdens away from you. Ask them to game out their lives for the next year or five or ten years. What would be an ideal life for Norman, for Ethel and for them as a married couple?
We have the opportunity to change the way the elderly and aging are treated. More selfishly it will change the way we are treated as we age. We have an opportunity to develop the model for which we wish to “wrap it all up.”
Chelsea needs to be examining her own health and how she treats her body (and let’s face it, plastic surgery or not, Jane Fonda looks amazing.) GenX must be caring for themselves on the basic level (annual physical, moderate exercise, fruits & vegetables). We are growing older.
What would the Elder Care Law Attorney be able to do?
Talk about what care facilities are available in the area? Talk about what powers of attorney should have & who should have it. Talk about the costs. Talk about longevity. Talk about the options available financially and legally.
And while we are at it, what have you done to help protect your loved ones, your children from making difficult decisions? When was the last time your “stuff” was done? If at all?
Prepare for this conversation and it will turn out at least as good or better than you expect. Hold off having this conversation? Then it is likely you will be having it when some dramatic medical event (stroke, heart attack, fall or worse yet – they can’t find Norman) has already occurred. So you are dealing with the major medical event and now you need to backtrack to have this conversation and what they want to see done. And then you are in a position to have less choices. Is there a memory unit available? Is there some place close where Ethel can visit?
Be smart, do it now ya old poop!