Laurie said she gets into a panic when I forget something she’s told me just a few minutes earlier. That is, she fears my cognitive functions are failing. We talked about this a day of so after my 75th Birthday, which wasn’t so great as we had a falling out that marred the day for both of us. I think she thinks I’m in denial. I think we think a lot about what the other one is thinking. I think we are usually wrong.
Not that I was into celebrating my birthday. I wasn’t. Now, we’re back in a good place. This is the place I like to live in. I have to admit I do forget things quite a bit. I fear that the things Laurie tells me might not be forgotten, but not absorbed in the first place. Maybe thinking this is part of my defense. Let’s assume, for the sake of argument, Laurie is right. Let’s assume this, even though I don’t want an argument.
What’s her panic about? Maybe that she’ll have to look after me as the “cogs” decline more. “Cogs” is the term we use for declining memory and general mental malfunctioning, which could apply to both of us, but actually only applies to me. I think every couple creates a personal language. At least I have done so in every longterm relationship I’ve been in, and there have been quite a few. Unfortunately for me, Laurie’s cogs are razor sharp and turn with precision.
Am I in denial about my decline? How would I know something like this? To be meaningful, a proposition must be theoretically true or theoretically false. If you’re not allowed to deny you’re in denial, then you are faced with a contradiction. Laurie stopped listening to this reasoning as soon as I said, “I’m not in denial.”
Still, for whatever reasons, I’ve lost some confidence in my cognitive competence. We have lived in our house for over five years, and I still don’t know which light switch to turn on among the three choices in the kitchen. Also, Laurie does have to remind me repeatedly of upcoming events. I have started leaving myself notes about what I need to do in the coming days, in anticipation of not remembering them. Doesn’t everyone? Well, not Laurie, although, not long ago, we both forgot to go to a friend’s house for a meal and had to rush over an hour late.
When my mother was in serious “cog” decline, my dad refused the help offered by their doctor’s staff. For example, he wouldn’t put labels on the kitchen cabinets so my mother would know where the tea was. Yes, a bad move as far as my mother was concerned. He didn’t want to be reminded of the gravity of their situation. For him, it was as if acknowledging the need for help would speed her decline. Am I, like my father, showing signs of similar denial? It’s hard to know. I’m not aware of the cog problem in myself unless Laurie points it out. Maybe it’s like the brain not registering the blindspot in the visual field.
I did wonder if my apparent—or at least possible—decline was a function of my type 1 diabetes, so I looked it up. A recent study reported that the signs of cognitive dysfunction in patients with type 1 diabetes are “a slowing of mental speed and a diminished mental flexibility, whereas “learning and memory are spared.” Laurie said that sounded vague. It’s true. The authors didn’t say what counted as “mental speed” or “mental flexibility,” but I took comfort in knowing that learning and memory were “spared.” These are two of my favorite mental capacities.
I was also pleased to learn some of the article’s findings were from the very study I’d volunteered for: the Diabetic Control and Complications Trial (DCCT). I remember taking all sorts of mental tests, including long math problems, sorting different series of cartoon images into coherent stories, coming up with as many animals I could remember starting with the letter J, organizing tiles into specific shapes, being told a story and later being asked to repeat it, counting backwards by 7s starting with 99. You get the idea. I actually enjoyed taking these tests.
When the study finished in 1993, and the new study I’m in now hadn’t yet started, I went over my DCCT results with one of the study’s staff in New York City. She said I’d done very well in abstract reasoning and poorly in the test of sorting cartoon images into a story. In fact, the poorest of those in the study group I was in.
I remember one set of images I was supposed to make a story about that I must have sorted “wrong.” There was man, driven to a pier by a chauffeur. There was a fish caught on a line. And there was a fishing line dipped in a river. It makes perfect sense to me now, laying out these “plot” elements: man drives to pier, dips line in river, and catches fish. At the time, it seemed to me there were at least three other possible orders of events that made sense—including the man having second thoughts about catching the fish and returning it to the river. I kept finding story variants with other sets of cards. Maybe back then, my “mental flexibility” was too flexible.
The article also said cognitive decline among type 1 diabetics, if it existed, was generally “mild to moderate.” That made me feel a little better. For a second. Because, according to their next opaque finding, even a small amount of decline was enough to affect everyday activities, particularly in “demanding situations.” What the hell did they have in mind? Again, no examples. A car wreck? Getting caught in an avalanche? Or, closer to home, applying for US citizenship, as I did last year, or getting married, as I did last December?
What I did find demanding was reading a journal article with vague pronouncements, ambiguous findings, use of abstract language, and use of the passive voice. Demandingly annoying, that is, and proof if anything that my cogs were sharp enough to weigh these deficits.
I went on to read several more articles on my condition, which I’ll spare you. Generally, no one knows very much about what happens to type-1 diabetics as they age because until recently, not many of us lived to reach old age. I’m still in the study. My data points will add to medical knowledge. From my point of view, the challenge in collating data will be to figure out if poor diabetic control produces cognitive deficits or if having cognitive deficits produces poor diabetic control. The second challenge is knowing whether deficits are simply a result of aging or a consequence of being diabetic—these studies have rarely matched control samples to compare outcomes.
I’m assuming I will live long enough to find this out. Why do I care? I care about everything concerning my condition, and I care about how it affects others. And just like everyone else, I’m making the effort to live well for as long as possible. I think I can remember that.
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This is post number 18. I love writing these posts for you, and I’m grateful to everyone who’s supporting my Substack, EVERY TWENTY MINUTES. For those who are joining, in each post, I will be writing through the experience of chronic illness and type-1 diabetes, although not always directly about these topics. When I started this project, I thought my focus would be on the many selves I have been as a person with a chronic illness. As I continue, the stack has a mind of its own about what it wants to talk to you about. And who am I to stand in its way?
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I’ve always been forgetful terrible with names etc. now that I’m 71 I worry about it. When I was young I just said. I’m forgetful or I’m terrible at names and moved on
I sometimes wonder if fear of cognitive decline is worse than cognitive decline.
Their anxiety leads some people to search for articles on this subject, to only eat certain foods, to take many supplements, and to criticize those who are forgetful, or even be accusatory about something that is happening pretty naturally.
In any case, it is a brave thing to write about and an interesting thing to read about. Win-win!