Sunday, November 24, 2013

Dementia -some thoughts of a GPS trying to reset

I took the picture that fell out of the book and turned it over. Out side the wind blew in cold air from the north. I had been quietly  remenescing as I sorted through the childrens books, some to give away and yet others to keep.Some faint memories without a time stamp hung in the air , 'of reading to my children at bed time' and then the picture fell out.
It must have sat there for over a decade.There sat my parents, in their active life , involved, energised by life, smiling back at me...I do not recall taking that photo, but the energy that was them still enliven the picture.
The years in between has aged them,-- cells that broke down,  acting out , coursing through time as their improper repairs gatherd into clumps of waywardness, all slowly, quietly as all cells age.The biggest change had been that they lost  themselves too- slowly , quietly. I want to forget the present but keep the memories of the past alive , but how can I when the present is the reality.
Hence, despite the present reality I delve into the past and wonder what had been different, what changes over the years got us to  here.There are many  questions in my mind,but  most though evade any  answers.
        Why my grandparents and great grandparents seemed to have an easier course in their old age? Are my memories fixed in some skewed perception of the past that is causing the recall of the past to be faulty?Why do my parents' generation seem to have more debility? Answers to these questions are all too elusive.
Yet as I delve into  my memories, what do I have the easiest recall for, ...not my high school or middle school years, but they are of  my childhood, my early years, then some for my pre-adult and early adult years. The rest all stay mixed in with a lot of fluff..There are bits of my own children's early years that stand clear as well. I am glad that most of the fluff stay as fluff....
As I ponder over this, it does make sense-- these are survival sensitive periods and carry emotion charged memories, hence are  easily laid down.  There are also  hormonal shifts that ease the storage and retrival of these memories, probably triggered by emotion driven cues, that set the whole recall process in motion.(this then  may also  explain how some PTSD circuits are set to a constant cycling set of cues and can't re-set itself )
      In a far away past during my grand parents' time and generations prior to that , families grouped together into small communities.... small villages, stayed small, with a static rythmicity to life.Children grew up , settled near-by , change being almost imperceptable... when you look further back in time the community was further condensed, with groups of extended families under one roof, additions added to the family home . Lives stayed almost set in one place, with its set pace. Changes were only those of time marked by seasons . An assigned child , usually a son and his family cared for their parents in the same home that many generations had passed through.
The way to the church/temple/mosque remained the same, the foot-paths long worn too remained unchanged,except may be, widening with time, as generations  trekked through...all neighbors were known--so and so's child or someone related , hence almost unchanged. Thus communities thrived on the known.
Unknowns by  itself  produce stress, and stress is not conducive to well being.Where change becomes  synonimous with progress, one forgets what this causes to an aging brain and body. The youth progresses into that  range of aging/ages and in that span they forget the cost.They see possibilities in change and charges ahead until they too progress into time...
The memories that settles into time stay and these may be what were stored. I picture them being sorted tagged and settled  into boxes , scattered there with  emotions, mostly pleasent ones that come along as one grows.May be that is why I can recall to the smallest detail where I have wandered at ages three and four; may be these memories, they store well .
What the past generations embellished through-out their lives , being in the same community, interacting with the same group of people, their three and four year old memories maintained with additions(almost as add ons to the same strand)may have helped them.No new damaging  stresses, no severe changes requiring  shut down of the systems all the way  from brain to the periphery.
I realized how disorganising change can be for one, as I drove up the path to my grand parent's home, on my last visit to India.I searched for landmarks... the giant jack-fruit tree,the sound of the brook, the big boulder by the side of the road, the glint of the evening light through the trees. At some point I too realized the simple fact- I was lost. The script that my brain had safely stored away was not compatable with what was there in front of me. Yet it was just only minor changes to my known path, just a new  path few hundred feet away from what I had known and saved into memory.
Even though at five or six yearsof age  I could trace my paths , eg to the mainroad, to aunts house, to church and back , from my grandparent's home( about 5 miles) I felt utterly lost this last time right in front of the house.The changes that came with time confused me and distressed me. Like all stressed plants and animals,  that may fail to thrive, or even fail to survive in a new locale I see how distressing and disorienting  the repeated stress tend to be.
          Imagine how shocking it would be for an older person, to be re-planted thus and expected to adapt ...
Let's take my father for example, who preferred to walk when-ever he could, yes with his charecterestic long stride..he-a social being , now living in a newer house, where everything is suddenly different. To him all that surrounds him is changed,and his internal construct now just causes dismay in the face of these  acute changes . The stress of change causes distress and furthers his confusion.. These stresses further compounds his memory impairments ,all stress being neuro-toxic. The lacunae in his memory in turn furthers his stress, and he enters a vicious cycle of loosing memory and function
In the progress modelled after presumed  modern societies, there is a dismay at aging, a lessened regard for aging as an asset.In a past where age was venerated for wisdom and the care of the aged was a required social norm,it may not have been a burden as it is today just because the societal construct of that period was more forgiving to the process of aging itself. It was probably more supportive just by reducing the destructive stress of change..

At times I wonder how if we projected the progress of changing societies, eg in India  into the future, what will be the result. I have no answers, just more questions.In India we have a population that is migrating even when it is static, migrating because of changes that occur all around.One cannot ascribe an economic cost to it, because stress cannot be measured in straight forward economic cost.The cost is going to be multiplied and multi-layered.-regrets for some, the disregard that results to mitigate those regrets, the growing  frustration for children, neglect for some, all in all a vicious cycle that ends with suffering all around, especially as the Indian society moves forward with lesser self reflection or any tangible long term planning for the care of its aging population.It can only further lead to fractures to the society at many levels.
Hence the question is what can we do to this growing  tide of distress?

The distress for the child in me is two fold,one I can not ease my parent's distress and then, - how will I manage when my memory starts fading.
          Yet I try to remenesce with them, hoping that a spark will catch sometime to spark a little bit of memory and hence some comfort. Mostly for my dad his memory is set at his childhood now as he has progressed further into his dementia.It helps me to use my imagination to describe his own home and its surroundings,because I too remember it as it used to be, before those distressing changes all around. I try to ask some questions, and sometimes a spark catches and I see him smile and engage.I am so glad for skype and he seems to wait for my calls. Some times it is only dis-interest that I face on these calls. If only I could set time back to a place before everything started shorting-out at the neural-circuits and spinning out error messages in the memory codes in his brain, if only....