January 5, 2023

This morning we had a zoom appointment with John's neurologist. These appointments occur every 6 months, but because the disease is in a more rapid progression, our next appointment will be in 4 months. Once I brought the doctor up to date on what's been happening, she gave John the MMSE exam. That's the 30 point test that gives a general idea of his cognitive status. 6 months ago John scored an 8. Today he scored a 4. That is an extremely low score. Any score less than 10 indicates severe cognitive impairment. He was unable to tell the Dr what state he is in, what the month and year is, or where he was at the time of the exam (in our house, in our bedroom). He was unable to repeat 3 words in succession (apple, table, yellow) - but he got the first 2, and was unable to follow verbal directions (pick up a sheet of paper, fold it in half and pass it to me). However, he was able to read a simple direction and complete it (touch his nose). However, the doctor said John's low score isn't completely tied to his cognitive ability because the results showed that he's affected by a receptive language deficit. That means he has trouble understanding what is said to him, and that he has more Aphasia than he did before. He has difficulty understanding verbal instructions, especially compared to written instructions. She said it's better to use visual aids and cues when asking him to do something. So rather than directly asking him to do something, I need to show him how to do a task. I realized that I've been doing this to some degree. When I need him to brush his teeth, I brush mine too. I do have to prompt him to do most everything now. I hear myself instructing him in all ADLs (activities of daily living - activites related to personal care like bathing, showering, dressing, eating, etc.) I feel like I'm barking instructions all the time. Now I'll make a point to provide cues whenever I can - hopefully barking less and showing more. We also discussed the MRI results again from last summer. The Dr showed me the loss of brain volume in the hippocampus and the language center, as well as other parts of the brain. With Alzheimer's the brain shrinks and the ameloid plaques and tau tangles increase, effectively gumming up the brain. So not only does the brain shrink, but the ameloid plaques clump together and collect between the neurons and disrupt cell function. Then the tau protein stick together and form tangles that block the neuron's transport system cutting off the communication between neurons. So it's a big ugly mess in the brain. That's my scholarly conclusion anyway;)