Prairie View

Monday, April 05, 2010

A Little Mental Vacation

Several times over the past three or four years, my father has had an episode of extreme forgetfulness lasting several hours or more. Twice we took him to a doctor, fearing a stroke or some other serious malady. This happened again last week. This time he saw a neurologist who did extensive testing. He stayed in the hospital overnight.

So now we know a number of things he does not have. No stroke, no brain tumor, no cardiac problems, no lung problems, no infections, no seizures--generally in good shape. That's what his family doctor had said after the first event. He had also assured us that this is not characteristic of impending dementia. This doctor asked him to come back in two weeks.

Earlier I had searched the internet for clues to the strange manifestations of amnesia. Transient Global Amnesia (TGA) seemed to fit. Since it is a diagnosis of exclusion (meaning it is usually not considered till a number of other things have been ruled out), it's perhaps not surprising that no doctor has ever mentioned this possibility to Dad. But I still wonder why not. Maybe a TGA diagnosis would seem too much like a cop-out, since the cause is unknown, and there is no treatment known to be helpful.

Such events are largely unpredictable, but they nearly always follow some event or circumstance that is emotionally or physically exhausting. They usually happen to people older than 65, but some people in their 30's have experienced them. Some people can feel them coming on, and have time to tell someone they feel strange. That's usually the last thing they remember till things are back to normal. Sometimes the incidents are associated with migraines.

For my dad, the first incident came at the end of a week when he had taken three out of state road trips--to Illinois, Colorado, and Oklahoma, driving several thousand miles, part of it alone and at night--a schedule that would exhaust anyone one-fourth his age. No wonder it was too much for an 80-year old. (He's going on 83 now.)

The single most defining characteristic of TGA is an inability to form new memories. For that reason, everything that happened during the episode is a complete blank to the person it happened to. Only a portion of old memories can be accessed. A person experiencing TGA will not usually act totally out of character, and will not endanger himself or others, even while driving. He might get hopelessly lost, and not know how it happened, but he will usually observe normal traffic laws--at least if that has been his habit otherwise. The person usually recognizes people who are familiar, but may not be able to say any names. Afterward, extreme fatigue is usually in evidence. No permanent loss of memory occurs, and the ability to form new memories comes back promptly.

In extreme cases, TGA can be very frightening to those looking on. Some people repeat the same questions incessantly. Sometimes they say the same little jokes over and over, always with the same voice inflections, and laughing in the same way at the same place in the story each time. My dad's symptoms seem fairly mild. At these times, he can't track what is happening around him, he repeats himself more than usual, and he has no memory of any of it afterward.

The very first incident was a little different than subsequent incidents in that he was more self-aware than in recent times. He was leading in a public prayer, and suddenly he heard himself talking without making any sense at all. His listeners realized it too. My brother Lowell was there and stepped up to help him off the stage. He was back to normal very quickly that time.

The other day after Dad was home from the hospital, I stopped in and chatted with him and Mom for a while. I asked him if the doctor had suggested the possibility of his amnesia being TGA. Dad was very interested in learning about this condition, and seemed quite relieved to have a name to use when thinking and speaking of his recent episode--whatever it was. I think it was a very helpful conversation in terms of making good plans for the future. It's possible, for example, to decide together now what Dad wants us to do if it happens again.

This week Dad and Mom had planned to drive to Indiana for minister's meetings. The doctor's orders not to drive for two weeks put a speedy end to those plans. Fortunately they were able to ride with others who were also going. Dad knows now that, while he might be able to drive safely, even if he suffered from amnesia, it would be very stressful for Mom if the two of them were alone, far from home, if such a thing were to happen. Everyone understands that they should probably not plan long trips by themselves.

Dad has had a very public role for many years. He has laid aside some of his responsibilities, but really enjoys some of the remaining ones. He does still have much to offer that is of value. So we will need to determine together how best to accommodate his needs, treat him with respect, and allow him to make a contribution while maintaining his dignity.

Our church has a lot of old people--more than 20 of them over 80, as I recall. Some of them are the parents of my friends and age mates. I see what some of them are dealing with, and wonder if our family will face similar challenges in the future. I feel good though when I think how gladly I make whatever allowances are necessary to accommodate the needs of the aged, and hope for the same kind of willingness on the part of others if patience from everyone is required as my parents age.

When we visited Dad in the hospital, his good humor was obviously still intact. "I guess my mind went on a little vacation," he informed us cheerfully. That's essentially what I think the doctor will conclude, only his assessment will likely not be offered so cheerfully, and it will come with a price tag attached.

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