{"id":135,"date":"2008-06-05T17:42:35","date_gmt":"2008-06-05T17:42:35","guid":{"rendered":"http:\/\/blog.beliefnet.com\/onecity\/2008\/06\/repetition-and-change.html"},"modified":"2008-06-05T17:42:35","modified_gmt":"2008-06-05T17:42:35","slug":"repetition-and-change","status":"publish","type":"post","link":"https:\/\/www.beliefnet.com\/columnists\/onecity\/2008\/06\/repetition-and-change.html","title":{"rendered":"repetition and change"},"content":{"rendered":"

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.
\nI work in Alzheimer\u2019s and dementia research, and travel around town visiting seniors in their homes. We are into year two of a three-year study, so I\u2019ve 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.
\nBut 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.
\nThe 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.
\n\u201cI saw you last week and we made this appointment,\u201d I remind him, shaking his hand. \u201cWe\u2019ll be doing the same tests that we did last year.\u201d
\nHis smile tells me I look somewhat familiar though he can\u2019t 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.
\n\u201cHow old am I?\u201d he asks casually as I flip through his file to find the necessary forms.
\n\u201cHow old are you? Do you not remember?\u201d
\n\u201cNo.\u201d
\n\u201cWell, you are one hundred years old!\u201d
\n\u201cOne hundred?\u201d He smiles. \u201cHow is that? Why?\u201d
\n\u201cBecause you are a very lucky man,\u201d I say. \u201cMost people don\u2019t get to live that long.\u201d
\nHe nods, looking pleased.
\nOnce a year I administer an hour-and-a-half long battery of neuropsychological tests to each of my subjects. I\u2019ve done it so many times that the words come out of my mouth automatically. It\u2019s 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.
\nBut during the testing I feel somewhat like a robot and frequently find that although I\u2019m 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\u2019t even try to bring my mind back.
\nThose who are categorized as \u2018impaired\u2019 require so much attention and focus and care that it is impossible not to be present.
\nI begin today’s session with the MMSE, the Mini Mental Status Exam<\/a>. His score on that determines which tests I administer next.
\n\u201cCan you tell me, what is the year?
\n\u201c\u201909.\u201d
\n\u201cThe full four digit year?\u201d
\n\u201c1907\u2026 I mean \u201907… I mean \u201909\u2026 I mean 1998.\u201d
\n\u201cOkay. What is the day of the week?\u201d
\n\u201cThis is Sunday.\u201d It is Thursday.
\n\u201cCan you tell me the name of this building?\u201d
\n\u201cI don\u2019t understand.\u201d
\n“What is the name of this building?”
\n“I don’t know. I wasn’t looking when we came in here.”
\n\u201cNo, 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?\u201d
\n\u201cWell, it must be a public building of some kind,\u201d he speculates confidently.
\nLast 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.
\n\u201cNo chocolate this time, huh?\u201d
\nHe 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.
\nI laugh. \u201cNo. I\u2019m sorry. I don\u2019t have any chocolate this time.\u201d
\nHe 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.
\nAfter we complete the testing he asks, \u201cDid I do okay?\u201d
\n\u201cYes, you did fine.\u201d I specify a test on which he did in fact do quite well.
\n\u201cSo you don\u2019t see too much of a decline from last year?\u201d
\nI hesitate as I continue gathering my paperwork and testing materials.
\n\u201cWell, yes, I do see a change from last year.\u201d
\nAs 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\u2019s 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.
\nAs we head back towards his room he tells me, \u201cThat was interesting. That was fun. It was a nice change from the usual.\u201d
\n\u201cGood. I sure appreciate you taking the time to do these tests.\u201d
\n\u201cI want to show you something,\u201d he says.
\nOn the wall next to his bed, along with family photos, hangs the certificate of appreciation. He points to it proudly.
\n\u201cYes,\u201d I smile, \u201cI brought you that last week.\u201d
\n\u201cI got one.\u201d
\n\u201cYes, you got one. We\u2019re very grateful for your help with our research.\u201d
\nI ask him about the photographs. He doesn\u2019t remember the children\u2019s names, though he knows whose children they are. He describes to me in detail his daughter’s work in public interest law.
\nAs I am leaving, he again opens the door for me. Looking at the suitcase on wheels that serves as my mobile office he asks, \u201cDo you need any help?\u201d
\n\u201cNo, thank you. I\u2019m good.\u201d
\n\u201cOkay. Well then, have a nice day. Are you sure you don\u2019t need any help?\u201d
\n\u201cYes, I\u2019m sure. Thank you again.\u201d
\nI 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\u2019m not thinking about the busy day ahead. I\u2019m thinking about impermanence.<\/p>\n","protected":false},"excerpt":{"rendered":"

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\u2019s and dementia research, and travel around town visiting seniors in their homes. We are into…<\/p>\n","protected":false},"author":337,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-135","post","type-post","status-publish","format-standard","hentry","category-arts-and-media"],"yoast_head":"\nrepetition and change - One City<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.beliefnet.com\/columnists\/onecity\/2008\/06\/repetition-and-change.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"repetition and change - One City\" \/>\n<meta property=\"og:description\" content=\"I am running late, and therefore rushing when I arrive at the retirement home for my first appointment of the day. 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