by Peggy Noel, Angie's List contributor

I listen to the patient's story. I hear the family's story. And in the difference between, I start my work.

Jack and Bunny Boulton have been coming to MemoryCare, which helps those with memory loss and their families, since 2006. At a recent appointment, I asked Bunny if she had family in for Thanksgiving. Instantly, her smile changed to a look of bewilderment and she glanced toward her husband, Jack, who sat expressionless. She smiled again and said, no, they'd been alone. After the care manager took Bunny for cognitive testing, I got to speak to Jack alone.

"You know, Dr. Noel, all six kids and the grandkids were home," Jack said. He'd tried to keep family in the workshop so Bunny wouldn't get agitated by all the activity. "I went in the kitchen and found her pacing and staring out the window [into the workshop]. 'Who is that man?' She demanded to know."

Jack had learned people with Alzheimer's may have hallucinations and thought he'd triggered one. He then asked her to point out the man. "By God, she pointed right at our son Dennis," Jack said. "I felt bad telling him his own Mama didn't recognize him, but he just hugged me, laughed and said, 'It's her world, and we live in it.'"

Some caregivers intuitively grasp this concept, but most want to pull their loved ones back to their world. A critical part of my job is helping caregivers cross that bridge of understanding. I've learned it's impossible to care effectively for our patients without the education, counseling and support of caregivers like Jack.

Of those living to the average life expectancy of 78, about one in eight will suffer from cognitive decline that makes them dependent on others for daily function. By age 85, those with dementia increases to about half. Sadly, there are no proven strategies for recovering memory in a person with dementia. But regular physical activity, a healthy diet and lifelong cognitive engagement have shown some promise in smaller studies, and we stress these concepts when we teach family caregivers about memory preservation.

Bunny is 77 and in great physical health. Ironically, it was her inability to prepare the traditional Thanksgiving meal at age 71 that first tipped off her family to her cognitive decline.

Over the years, we've navigated through myriad challenges, from surrendering Bunny's role in managing family finances (she was a loan officer) to finding respite for her husband. Dementia is a terrible, relentless thief. Bunny's family, like most we endeavor to help, doesn't shrink from needed sacrifices. They don't just survive, they lift each other up, wipe away the tears and even laugh.

I concluded my time with Jack and went to examine Bunny. When I walked into the room, she smiled and hugged me as though it was our first greeting of the day. Always gracious, she asked, "How are your children?"



Dr. Margaret "Peggy" Noel, a fellowship-trained geriatrician, takes a holistic approach to caring for patients with dementia. She founded highly rated MemoryCare, an Asheville, N.C.,-based non-profit, in 2000 to deliver specialized medical care to older adults with memory loss, support caregivers and provide community education. To learn more, visit memorycare.org.