I am running late, and therefore rushing when I arrive at the retirement home for my first appointment of the day. As I step into the building, I automatically slow down in response to the atmosphere.
I work in Alzheimer’s and dementia research, and travel around town visiting seniors in their homes. We are into year two of a three-year study, so I’ve had several visits with each of my subjects. I have grown quite fond of and somewhat attached to them. Many of them have very full lives, juggle numerous activities, and have good to excellent memories.

But the man I’m seeing this morning has experienced rapid cognitive decline in the past year. His impaired judgment and altered behavior has been devastating for his family. He recently moved into assisted living. He sometimes understands why he had to move, but often does not.
The nurse takes me to his room where he sits, as dignified and well dressed as always, looking quite young for his age. She introduces me and explains that I am there to do some memory testing.
“I saw you last week and we made this appointment,” I remind him, shaking his hand. “We’ll be doing the same tests that we did last year.”
His smile tells me I look somewhat familiar though he can’t quite place me, but that he is happy to have a visitor regardless. The nurse shows us to the small meditation room that doubles as a meeting room. We sit down at a folding card table.
“How old am I?” he asks casually as I flip through his file to find the necessary forms.
“How old are you? Do you not remember?”
“No.”
“Well, you are one hundred years old!”
“One hundred?” He smiles. “How is that? Why?”
“Because you are a very lucky man,” I say. “Most people don’t get to live that long.”
He nods, looking pleased.
Once a year I administer an hour-and-a-half long battery of neuropsychological tests to each of my subjects. I’ve done it so many times that the words come out of my mouth automatically. It’s easy to stay present before and after the tests, when we chat informally. I look forward to those times. We talk about current events, or books we are reading, or life in general. Sometimes I get knitting help. Sometimes I get taken to lunch.
But during the testing I feel somewhat like a robot and frequently find that although I’m looking directly at them, speaking, and writing, my mind is far away, and I have to keep bringing it back over and over again. I confess that some days I don’t even try to bring my mind back.
Those who are categorized as ‘impaired’ require so much attention and focus and care that it is impossible not to be present.
I begin today’s session with the MMSE, the Mini Mental Status Exam. His score on that determines which tests I administer next.
“Can you tell me, what is the year?
“’09.”
“The full four digit year?”
“1907… I mean ’07… I mean ’09… I mean 1998.”
“Okay. What is the day of the week?”
“This is Sunday.” It is Thursday.
“Can you tell me the name of this building?”
“I don’t understand.”
“What is the name of this building?”
“I don’t know. I wasn’t looking when we came in here.”
“No, I don’t mean this room. I mean this building,” I say, gesturing to indicate the whole thing. “What is the name of this place where you live?”
“Well, it must be a public building of some kind,” he speculates confidently.
Last year when I arrived for the testing he was on the balcony of his apartment watering flowers, and he proudly went from planter to planter telling me the names of each. He definitely had memory trouble then, but the change is considerable.
“No chocolate this time, huh?”
He remembers now that I am the person who came to visit last week, bringing him a certificate of appreciation for his participation in the study, and a chocolate truffle.
I laugh. “No. I’m sorry. I don’t have any chocolate this time.”
He scores a 13 out of 30 on the MMSE. A score between 10 and 19 indicates moderate dementia. I administer several more tests involving memorizing words, naming objects, repeating number sequences, categorizing things, and using logic.
After we complete the testing he asks, “Did I do okay?”
“Yes, you did fine.” I specify a test on which he did in fact do quite well.
“So you don’t see too much of a decline from last year?”
I hesitate as I continue gathering my paperwork and testing materials.
“Well, yes, I do see a change from last year.”
As we are leaving the meditation room, he gets up from the table and ignores his walker so that he can open the door for me. I am nervous about this, because if he fell and broke a bone it would be life threatening. But he’s very determined, so I thank him, push my bag out into the hall, and immediately come back to grab his walker and bring it to him.
As we head back towards his room he tells me, “That was interesting. That was fun. It was a nice change from the usual.”
“Good. I sure appreciate you taking the time to do these tests.”
“I want to show you something,” he says.
On the wall next to his bed, along with family photos, hangs the certificate of appreciation. He points to it proudly.
“Yes,” I smile, “I brought you that last week.”
“I got one.”
“Yes, you got one. We’re very grateful for your help with our research.”
I ask him about the photographs. He doesn’t remember the children’s names, though he knows whose children they are. He describes to me in detail his daughter’s work in public interest law.
As I am leaving, he again opens the door for me. Looking at the suitcase on wheels that serves as my mobile office he asks, “Do you need any help?”
“No, thank you. I’m good.”
“Okay. Well then, have a nice day. Are you sure you don’t need any help?”
“Yes, I’m sure. Thank you again.”
I shake his hand. It is a little longer than a typical handshake. I tell him that I will be in touch. As I drive away, I’m not thinking about the busy day ahead. I’m thinking about impermanence.