Cognitive decline and forgiveness

 Our Sunday school class has been going through a series on forgiveness. This week’s class focused on forgiveness and cognitive decline. (The majority of class members are over 60.) I found it enlightening. The teacher, Pat Stone, retired psychologist, gave me permission to share some of his material.

At the beginning of the class, Pat gave us a list of five words to remember, just like the nurse does in my annual wellness exam. The words were grass, computer, atom, lumber, fly. I can’t remember words or numbers out of context so I quickly made up a story I could visualize; I saw Adam (how I misheard atom) at his computer which was sitting on a piece of lumber out in the grass (the Garden of Eden), but he couldn’t get any work done because of a pesky fly. I managed to remember, but I couldn’t say the words without describing the picture. What does that say about my aging brain?

Pat told us that fluid intelligence is the ability to think, solve problems, and identify complex relationships. As our brain physically shrinks with age, this kind of intelligence decreases. This is true of everyone, whether or not they have dementia. The good news is that crystallized intelligence, the accumulation of a life-time of learning and experience, seems to become stronger with age. Wisdom can enter the picture. That’s hopeful.

Forgiveness, our teacher informed us, is a complex cognitive activity which is, of course, affected by age. Our ability to recognize we’ve hurt or have offended someone and therefore need to ask forgiveness can grow dim, as can our ability to remember that we have been forgiven. Along with that, the ability to forgive others gets more difficult as we tend to re-live old hurts.

Pat shared some characteristics of the aging brain, all of which affect our ability to forgive or to know that we need to be forgiven. These characteristics can increase as we grow older.

Perseveration is the retelling of the same thoughts and events that triggered negative emotions in the past. If it results in an endless mental/emotional loop, that makes forgiveness very difficult.

Confabulation is mixing the stories, putting together different unrelated events and thoughts from the past, resulting in a kind of personal mythology. How can one even know what to forgive?

Anxiety and depression can accompany the grieving process as the person faces what she’s lost. The inward focus precludes an attitude of forgiveness.

Disinhibition is the loss of ability to screen thoughts and emotions. The person can sound abrupt and insensitive. This characteristic goes along with impulsivity. Rather than Feel, Stop, Think, and then Act, the person is reduced to Feel, then Act. Family members need to understand and forgive.

Aphasia refers to the loss of ability to find the right word, or to have the word in the mind but not be able to say it. Years ago, I experienced this when I got soroche, or altitude sickness, in Bolivia. I knew what I wanted to say, but only nonsense came out my mouth. I was young at the time. Now I’m not, but I increasingly know the frustration of not being able to bring the right word to mind in a conversation. This may not be a full-blown case of aphasia, but it seems to be a common part of aging. How would that affect forgiveness?

Loss of executive functioning, of being able to think clearly, solve problems, or “put it all together,” also makes it difficult to seek or give forgiveness.

Other characteristics include putting on a social façade because the person doesn’t quite understand what’s going on, so chooses to pretend. Or he chooses withdrawal into silence. Both indicate a separation from the surrounding reality. A person who can’t respond can’t forgive or receive forgiveness.

And then there’s the need of the caregiver of the elderly. Compassion fatigue may make it hard to keep on an even emotional level. Patience and continual forgiveness can get difficult, especially if behavior triggers past hurts and emotions. That’s why it isn’t always a good idea for family members to be the caretakers.

As I read all this back, it seems so dark and negative, like a worse-cast-scenario. I think these characteristics describe tendencies some of which we’re all beginning to exhibit, but that they refer more to people at the end of life. The very old.  And not all of the very old exhibit all these characteristics. I think of friends and family members who lived into their eighties and nineties (and even beyond) who, while forgetful and a little distanced from reality, managed to keep the same sweet disposition they carried all their lives.

One thing the study highlights for me is the need to keep up-to-date on forgiving and asking for forgiveness—while we still have our wits about us. We may need to forgive people who have harmed us in the past, pardoning in our hearts if a face-to-face encounter is not possible. Or we may need to ask someone to forgive us. Now may be the right time.

I think of a very short poem by Canadian poet Suzanne Buffam:

On Forgiveness

It is best to forgive all sins in advance
Because afterward can be hard.

In this case in advance means “before we get too old.”

Even with the difficult connections between growing older and forgiveness, we do have the presence of the Holy Spirit who lives within us and changes seeming impossibilities into realities. And a God who understands us and loves us as much when we’re old as he ever did.

Pat ended the class with a wonderful teaching from the Apostol Paul:

“Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal.” 2 Corinthians 4:16-18

The dark path in the forest

 The three words were picture, captain, and garden. I was instructed to remember these words as the nurse would ask me to repeat them again in a few minutes. So I formed a mental image of a framed picture where a sea-captain was walking in a garden. I know my limitations. If I can’t picture it, I forget it.

She then gave me the clock-test, a blank sheet of paper with instructions to draw the face of a clock and mark 10 minutes after 11. I had no problem drawing the clock with evenly spaced numbers. But it took me a few seconds to get the hands to the right time. The little hand on eleven. Right. But 10 after? Using my logic I counted ten digits after the 11, which actually set the clock for 11:05. I handed in the paper. She quietly walked out the room.

In a few minutes The Nurse came in and asked me the three words. I had to first bring up the image, see the captain smelling the roses; then I gave the Right Answer. The Nurse smiled. Then she frowned. She told me I had messed up the clock test and she showed me my drawing. I instantly recognized what I had gotten wrong and proceeded to explain my logic, flawed as it was. I suppose I was a bit defensive. But The Nurse was definitely defensive and cut me off by stating, “No! You failed the test! This is a strong indication of cognitive impairment.”

Well. That shut me up. For a few seconds. Then I protested. How could such a flimsy silly little test lead to such a serious diagnosis? She wasn’t even a doctor! Fortunately, I had the sense not to spout my academic degrees, professional accomplishments, and other such nonsense. But I did protest and she came back insisting I go to a specialist for further testing. All on the basis of the clock test.

That was my annual wellness exam, just a few days ago. I left the clinic less well than when I went in.

I’ve been stewing about it ever since. Hal assures me, “No, Nancy. You are not cognitively impaired.” But off and on, those nasty words, cognitive impairment,­ run through my brain, turning somersaults around my common sense, ricocheting off the walls of reason.

In short, I’m mad. And when I get mad, it’s not pretty. I’m mad at The Nurse. I resent the presumption and the stereotyping. I hate the memory of the pity in her eyes as this demented old lady left her office. I hate it when medical professionals see bodies and cases, not people.

Reflecting on the incident in a calmer frame of mind, three things are coming clear. The first is my need to forgive The Nurse. That doesn’t mean excusing her behavior. Less presumption and defensiveness, more sensitivity and a bit of common sense are good qualities in nurses and doctors. But she’s only human. Like me. So I’m saying the words of forgiveness and trusting that eventually the emotions will follow.

The second thing I’m realizing is that of course I’m cognitively impaired. I’ve been cognitively impaired all my life, and it has little to do with growing older. Some people call the condition dyslexia. And while I have only a mild case, it’s always made it difficult for me to do certain things. The alphabet, for instance. I can’t for the life of me get the letters in the right order unless I sing the silly little ABC song I learned as a child. I have to do that when filing documents, which can be embarrassing if other people are around.

I have trouble telling right from left. When asked to turn to the right, I have to literally focus on my writing hand and make the translation from write to right. (Fortunately, I’m right-handed.) The other thing I have trouble with is telling time. I have little exercises that compensate and get me to appointments on time. The before and after parts always confuse me (e.g., “10 after 11”). The Nurse didn’t know that. Would it have made a difference? Possibly not.

The other thing I’m realizing is that all this anger is really a cover-up for fear. The real emotion.

Cognitive impairment, memory loss, Alzheimer’s, dementia—all of this is the dark path in the forest of growing older. Will it happen to me? Will it happen to Hal? Will it be gradual? Will I know it’s happening? How old will I be? What will I be like? Will I be a burden, or worse, an embarrassment to my family? Is the clock test really a sign on the trail?

Or maybe it won’t happen to me. After all, it’s not inevitable.

I can’t picture myself as demented, but I have to ask, “Why not me?” It has happened to many of my friends and loved ones. Intelligent people. Strong people who made significant contributions. People who had adopted admirable life-styles, ate nutritious food, exercised their brains as well as their bodies, and enjoyed reasonable good health. “Why them?” is a question without an answer. As is, “Why not me?”

I had the blessing of not seen my parents go through any kind of cognitive impairment. That would have been an agony to witness. But the blessing is mixed. They missed this experience because they both died young. On the other hand, both Hal and I suffered alongside his parents as they lived into their 90s and had a very difficult last few years. We trust they are whole now, enjoying all their God-given capacities.

But we’re still here, facing an uncertain future. So, we juggle fear and faith. Even as we trust God, we face the nagging possibilities that loom in front of us on the path.

I’m not certain how to handle all this. I will affirm the Scriptures that talk about the righteous living long and fruitful lives. I will remind myself to make the most of the present time, to love my family well, to read good books, to pray, to attend to the needs of others as I am able. And to have fun. Fun is good and laughter heals the body as well as the mind.

As someone has said, “Wherever you are, be there.” I try to do that.

Plus, it really helps to hear Hal say, “Nancy! You are not cognitively impaired!”