Anxious Dependence June 22, 2014

In the early stages of Alzheimer's disease the spouse attaches him or herself to the other, tagging along, asking the same questions repeatedly, criticizing the tasks the healthy person has assumed. We label this behavior "dependence" because the person doesn't trust him or herself to perform these tasks adequately or to remember the day's agenda. 

The ability to recall is missing sooner than the ability to recognize, so the person sees what the spouse is doing and can see that it is not accomplished with the precision or expectation he or she still knows how to do.

It is at this beginning stage that the person asks about family members who are no longer here, parents and perhaps siblings who have died or live far away. Long term memory remains intact while short term memory disappears, but the confidence in one's memory is gone and  folks need the reassurance that they do indeed remember long ago events and people.

As time passes, the person really does need help showering, dressing, being driven rather than driving; sometimes these are accepted and sometimes the person fights against his or her recognizable skill diminishment.What is known or felt is not alway discussed- and consequently the spouse who has become the caregiver doesn't talk about it either. It seems easier that way.

So Alzheimer's disease remains "in the closet" and the couple continues to socialize with friends and relatives--until an event occurs that changes the balance. One husband I heard about told his wife he didn't want to be put in the position of having to entertain a friend's husband as he asks too many quesitons repeatedly and could not keep up with the conversation. The couple was not invited again. In other instances an Alzheimer's diseased person took food from a serving plate with his fingers, or used her own fork instead of a serving fork. These friends no longer invited them either, increasing the isolation of the couple and especially of the care provider.

Alzheimer's disease is a form of dementia. The timing and occurrence of symptoms vary. Partners need to be sensitive to the needs of their spouses in the beginning when they are feeling so vulnerable, but need to speak up with family and close friends, to ask for help and even companionship--which occurs when the visitors know what is happening. Just as many Alzheimer's patients can "rally" in social situations for a long time, the rest of us can tolerate difference in behavior when we know what to expect. We all have anxieties, we all have areas where we feel vulnerable; sharing those feelings is human and visiting is kind.