Reflections on Alzheimers Disease
George Bunn
August 4, 2002
Palo Alto, CA

At our 11 AM Sunday service on February 17, I rose during "Caring and Sharing" and said I had been diagnosed by a neurologist at the Palo Alto Medical Foundation as likely to have an early stage of Alzheimer's Disease. There was an outpouring of warmth and concern from members of this community. One of them told me about a Stanford-VA Alzheimer's Research Center, and I volunteered to participate in that research.

After rigorous written examinations, long interviews about symptoms and family history, brain x-rays and other tests, a committee of researchers at the Stanford-VA Research Center concluded that I had impaired memory of recent events and reduced speed of information processing beyond what is normal for someone with my age of 77 and my education and experience. The most likely causes, according to their diagnosis, are early stages of Alzheimer's and depression -- depression which could be caused by the diagnosis of probable Alzheimers,' by other problems, or by both.

Mayo Clinic research on cases like mine has produced a new name for a diagnosis such as mine, a name the Stanford-VA Center is beginning to use. The new name is "mild cognitive impairment" meaning impairment of memory of recent events beyond what is normal for the patient's age and education but not yet enough impairment to diagnose as full Alzheimer's. Mayo says that "research has shown that 80 per cent of people with mild cognitive impairment will develop Alzheimer's within 10 years of the diagnosis."

The Stanford-VA committee recommended treatment for depression, and the neurologist at Palo Alto Medical Foundation then put me on Prozac. As a result I have been more cheerful. But the significant problems of memory loss of recent events and slower information processing seem to have continued. The Stanford-VA Research Center will probably test me again in six months or so and compare those results with the earlier tests.

I dread the future. My mother had Alzheimer's toward the end of her life, as did her brother. The family history is another factor in my diagnosis of mild cognitive impairment, and it places me in a family-history category for future research at the Stanford-VA Research Center. Having watched my mother fade, I am particularly apprehensive. She really lost her grasp on reality sometimes by the time she was 77, my age now. Luckily, I managed to get her into a nursing home before we knew that much worse symptoms were coming. In her last years there, when she was 86 to 88, she was without words or recognition of anyone, strapped into a wheel chair and in diapers because she was incontinent. She said nothing and recognized no one so far as we could tell. My most moving experience with her then I described here at a service last Christmas. It was this: I played Christmas carols on my flute by her side on Christmas eve when she was 87. Suddenly she was singing the words. They were the first words I had heard from her in more than a year and the last words I ever heard from her. My music had brought her back to life momentarily.

My diagnosis has forced me to think about what I want to do with my future life while I can still make choices – before I get as far gone as my mother was. The Serenity Prayer has been important to me in thinking about my future.

First, I must have the serenity to accept what I cannot change – the diagnosis. Thich Nhat Hanh advises us to enjoy the present moment rather than putting off that enjoyment because we hope for a better future. He says "Western civilization places so much emphasis on the idea of hope that we sacrifice the present moment. … Hope cannot help us discover joy, peace or enlightenment in the present moment." If I accept the diagnosis, I know that my memory and information processing are not going to improve. I should not put off enjoyment of life today in the hope that the diagnosis will turn out to be wrong or that suddenly a new cure for Alzheimers' will come along.

My description of the diagnosis at "Caring and Sharing" in February and the outpouring of warmth that came from my church community helped a lot toward my acceptance of the diagnosis. So has talk about it to members of a church Covenant group and a 12-step support group; to fellow residents of Webster House, a retirement home where I live; to colleagues at the office at Stanford where I work; to those with whom I play music in a wind band and in chamber music groups. My ability to read and play difficult fast music has degenerated somewhat in the last couple of years. One of my symptoms besides memory loss of recent learning is reduced speed of information processing. I need to accept that I have these limitations. I have talked a lot about these symptoms to friends and family outside the UUCPA community as well as to this community. I think this has helped my acceptance of the reality.

Second, I must have the courage to change what I can. What should I do in light of the diagnosis? I have revised my will, reviewed my power of attorney for health care, and joined the Funeral Consumers Alliance which I learned about from Jean McFadden after my February statement. As indicated, I am participating in the Stanford-VA Alzheimer's research. I have just come back from a long vacation trip to visit two sons in New Hampshire and Wisconsin, and to play music at a music camp in Quebec.

And I certainly don't want to stop participation in the communities I described. I don't want to stop the work on arms control I do at Stanford. I find that facing irrelevance soon takes more courage than facing death later. I have been involved in a career of nuclear arms control analysis, policy, negotiations and writing that, I think, have helped a little to prevent the spread of nuclear weapons to many additional countries, and I am still working at means to prevent terrorists from acquiring nuclear weapons. This career became more important to me than anything else in my life, as my three kids and my ex-wife would probably tell you. My kids tell me not to stop now because they think I will no longer have good reason to live if I can't continue this kind of work. My associates at work tell me not to stop now because I am still making a contribution – even though I learn more slowly, may forget the project I was working on last week, or forget the status of an important report that is due.

Research on Alzheimer's shows that continuing significant mental exercise slows the rate of Alzheimer's degradation to dementia – just as physical exercise does. That is another reason for continuing at my job. But I know that I must stop before I do damage or make a fool of myself. When will that be? What will I do then? Again, facing irrelevance soon is harder than facing death later.

I ask for first, the serenity to accept that I cannot change the diagnosis; second, the courage to stop -- when I should -- my arms control efforts and trying to play fast, difficult music; and, third, the wisdom to know when to make those decisions.

I am learning that other things in life besides career have great relevance. I think I do not face irrelevance in this church community. It is very meaningful to me. Is that part of what "community" is all about? Clearly the warmth of the response to me from members has meant a lot. This response from the heart is more meaningful than denial from the brain. For me, that is what community in this church is about.

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© 2002 George Bunn
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