Rallying the Forces

Max Wallack writes on the tendency for Alzheimer’s patients to present a overtly “normal” social image towards those in contact with them. Often, patients work very hard to maintain a certain image, to hide the symptoms of the disease. Alzheimer’s is a memory problem, not necessarily a social problem until late stages, patients often realize that they are having serious problems, and put up a social front to hide this fact. This can be quite exhausting, and takes it’s toll.

Great Grams would be extremely paranoid when she knew she was going to her doctor. Of course, she was afraid we were going to "put her away" (nursing home), so her behavior would be horrible. Once at the doctor's office, she could hold an intelligent conversation. She appeared pleasant. If he asked questions she didn't know, she could even make excuses. For example, "I never really paid attention to the name of this hospital". Great Grams even tried to change the subject, like pointing out the doctor's pictures of his family and telling him how cute his kids were.

When my aunt and uncle called on the phone, Great Grams talked completely normally. Anyone who didn't understand her condition could easily conclude there was nothing wrong with her. Sometimes they assume all is going very well based on these conversations.

Often when we went to visit someone, Great Grams held normal conversations, way into her illness. I remember, on one of her later hospitalizations, hearing her tell an aide how beautiful she was and how pretty her sweater was -- then telling us that the aide was a horrible person plotting against her.

For much of her time in Alzheimer's, Great Grams could travel and be fine on a trip. However, total breakdowns seemed to happen when we returned home. You would think that returning to the familiar would have made things better, but they always made things worse. Understanding and accepting Alzheimer's behavior is very difficult. Even when you see it over and over.

I asked a doctor about this once, and he answered that sometimes Alzheimer's patients can "rally the forces", meaning they can work exhaustively at trying to "keep up" and interact. This can continue until late stages of the disease. Alzheimer's patients are somehow successful at continuing to do this. HOWEVER, this exertion of attention is SO EXHAUSTING to Alzheimer’s patients, that they basically are having a breakdown afterwards.

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