Listening to the long good-bye

Add that to where are my keys, can't find the glasses on top of my head, and why did I come into this room to do what, and we all think perhaps it's the early signs of dementia.

One of my good friends said it's not when you forget someone's telephone number, or after dialing, forgetting who you called … that's merely getting older. Alzheimer's she said, is when you look at a telephone and can't for the life of you figure out what the hell it is. Or as Babs joked, "Who are you and why do you keep emailing me?"

We kid about Old Timer's Disease because we are all afraid of Alzheimer's and dementia, not just in ourselves but in those we love. Because when someone develops these conditions for real, we spend a long time saying Good Bye. It's like trying to listen to a favorite song or show while the volume is being slowly, gradually, but irretrievably lowered…and it's never going to get louder.

The heartbreak is watching someone we love slip away from us incrementally; the body is there but the spouse or parent disappears before our very eyes.

Although Americans rail against Big Pharma for every ill in the healthcare sector, we hope and pray that they'll soon come up with the Magic Pill that prevents cognitive deterioration or stops it once it begins.

It was reported last week that Dimebon, also known as latrepirdine, which supposedly had great promise to improve cognitive function or slow down decline, failed to show any difference from a placebo. We hope and pray that diet, exercise, and a healthy lifestyle will likely give us some advantage, but we don't know how much. Besides, most of us eat and sit around way too much.

In the lovely Canadian movie, "Away From Her," (made in 2006) Fiona, a woman married 44 years, realizes that her difficulty in finding her way home is a sign of early Alzheimer's. She lives in a remote area, and she and her husband are realistically concerned that she'll get lost and perhaps injured. Together they decide to place her in a residential care center, where she soon forgets who her husband is but becomes very attached to a fellow patient.

This is a very real and common occurrence; it's what happened to the husband of former Supreme Court Justice Sandra Day O'Connor, among others.

The film's producer, Simone Urdl said, "The role of Alzheimer's in the film is a metaphor for how memory plays out in a long-term relationship: what we chose to remember, what we choose to forget."

And, if memory is selective during our most vibrant years, it should not be a surprise that it's even more so in decline. In the early stages, people use strategies to disguise their frailties.

I asked my father about five years ago what the name was of our dog, a pet we had for only a few months when I was 3.

"We had a dog?" he asked. Yes, I said, what was his name? To cover his memory gap, my father who had a brilliant mind and a world-class memory, said, "Why should I bother remembering that? I have enough trouble remembering the names of my children and grandchildren."

A few years later, I asked him about a significant medical condition he and my older brother both had and he said he never knew my brother was sick because "he'd been busy at work."

When my 90-year-old Nana began to fail, she initially thought I was my deceased mother. Soon she got me confused with my cousins; she called any of the five of us by any of our five names. Later, she greeted me warmly as someone familiar but whom? Then she had no idea who I was and, for the last year of her life, was mute to the world.

The scientific explanation for the trajectory of the brain's deterioration is that we lose function from the front of the cerebral cortex, the site of the highest-level cognitive functions, first. Eventually, we will lose the ability to speak, to swallow, and to breathe.

When the person finally dies, it's not a tragedy but still a loss. A loss that although we thought we were prepared for, we never are.

Ann Rosen Spector is a clinical psychologist in Philadelphia and an Adjunct member of the Department of Psychology at Rutgers-Camden.