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Thursday, May 27, 2010

My bvFTD Symptoms - Disorders of Affect and Social Comportment

My bvFTD Symptoms - Disorders of Affect (emotions) and Social Comportment (doing the right thing)

Everything here is my account of what happened to me, or my interpretation of stuff. Every case of FTD is different. Keep in mind as you read this that the person who wrote this has dementia.

This is the first in a set of my symptoms which are more behavioral in nature. Up until now I have been dealing with the easy subjects like Memory and Dysexecutive Syndrome.

These behavioral symptoms are difficult for a couple of reasons. First, they are very hard for me to notice anything is wrong. From my perspective whatever I do is normal, or I wouldn't be doing it. Duh! That is the nature of bvFTD as far as I can tell. Second, it is the behavioral symptoms which cause me the most problems, and are the reasons for my disability. It makes it an emotional subject for me, and difficult to write about.

Though Disorders of Affect and Social Comportment sounds complex it is basically about emotions, and not doing bad things in public, and controlling your behavior. Disinhibited Behavior is a huge component of bvFTD. Just a reminder that the "bv" in "bvFTD" stands for "Behavioral Variant", so be sure that behavior is a critical set of symptoms. In the later stages disinhibited behavior may manifest itself as anything inappropriate from rude comments, eating with your hands, stealing shiny stuff from stores, to urinating in front of a restaurant. I hate to even read about those symptoms, and the effects they have on family and friends.

For me, I have thankfully not noticed any behaviors like that, but that does not mean they will not develop over time. Not everyone shows every symptom, and this is one that would be particularly difficult for those around me. I would be very grateful if I skipped this one altogether.

I have always talked to waiters, waitresses, and cashiers in the checkout line. I still do. I do not think this is a symptom at this time, but I also doubt I will notice if it changes. Having conversations, or making rude comments to strangers is a symptom of bvFTD I have read about in several places, including the book, What If It's Not Alzheimer's?

I can see me telling some idiot in in a restaurant to take his frakkin hat off. Since when did your Mother ever tell you it was OK to wear your frakkin hat at the dinner table? I can also see me telling somebody to shove their frakkin cell phone up their... well, you get the idea. I can hope that if I do develop these symptoms over time they will at least be related to some pet peeves of mine so I can get some gratification from them.

(Hmmmm... In rereading this it occurred to me that I am Diabetic, and low blood sugar also affects my emotions. This is something I will bring up when I next see my doctor.)

I do have some disinhibition of my emotional responses.
I have noticed for me it seems to be triggered by frustration. Under normal circumstances frustration can easily be expressed as anger, at least it always has for me. Well, I can now take that to the extreme in no time flat. Stranger or loved one, it makes no matter to me. This is not something that happens all the time, but it has happened. Even once would be too many times.

For me, in each case, the frustration built up slowly over time, and finally something sent it over the top and it resulted in angry rage out of my control. When it happens it is as if I step outside myself and become a spectator. I am swept aside by the pure white hot energy of the raging emotions. It is like a feedback loop, growing bigger and hotter as it feeds on itself. It has resulted in blistering verbal tirades.

When I feel that strong of an emotion, it stays associated with whatever or whoever was the cause. That makes sense because when someone makes you angry, or hurts you, you tend to remember it and associate the feelings with the person or event. I carry it to an extreme. So, even though the response may be out of proportion, I can still carry a coinciding grudge.

Dr. David Banner said it best,
"...don't make me angry. You wouldn't like me when I'm angry..."

Uncontrolled raging anger can have some nasty effects in real life. It has caused me to have a screaming nasty tirade and escort my lady-friend to the door of my house, and unceremoniously throw her out. Literally, physically, push her out the door. As a friend asked, "How does your relationship get over that?" It doesn't!

It has caused me to begin an email to my North American President at work with the word, "Bullshit!", and then I said what I was really thinking! Whew! That was a beaut! It was all true, but the delivery was very inappropriate. The follow-up phone call was even more extreme, and didn't go over so well. That was my boss at the time.

Most of the time my emotional state is pretty stable, maybe more stable than before, and my emotions do not run away with me in tow. Every now and then they are off to the races without warning. On rare occasions my frustration over something like filling out insurance forms has manifested itself as deep sadness. Again it was a subject that had built up over time, and something small sent it over the top. The process feels similar to what happens when I get angry only with deep sadness instead. That is more rare so far.

I may have some other manifestations of this change in emotions, but if so I am unaware of them. That does not mean they are not there, just that I cannot see them.

There is another change I noticed which may or may not be related
. This one is very contradictory because it has to do with Empathy which the lack of is a common bvFTD symptom that I plan to talk about it in a future article.

I love to watch almost all kinds of movies, especially those old romantic comedies. I have noticed I react to them at a more emotional level. In short: happy movies make me feel happy and even laugh out loud, sad movies make me feel sad and even get teary, action movies make me feel the excitement, and horror movies bother me. I seem to over-empathize with the movie. Sometimes that makes them all the more enjoyable.

Those movies made for the Syfy Channel and shown on Saturday nights just suck! I'm just sayin...

Now, I have been a horror, and even slasher, movie fan since forever. I have even written books about them, as well as a magazine review column. Now I find myself avoiding the genre. No feelings of fear, that is silly, but rather an unpleasant feeling of agitation. I guess I may eventually have to say goodbye to Freddie, and Jason, and even little Chucky.

In any case, sometimes my emotional response does not fit the situation. That is an understatement when I have raging anger, or deep sadness over seemingly little things. Though it is episodic, it has had devastating effects on my life from work to personal relationships. It just isn't something that an apology can fix.

That is what I have noticed, or rather has been pointed out to me, about my disinhibited emotions. Socially, I think my manners and behavior are passable so far. I have always pushed the limits of what is acceptable at times, so who would notice until it is extreme?

Your thoughts, suggestions, corrections, and comments are always welcome.

Monday, May 24, 2010

I Have Cotton In My Lime Jell-O

I have good days, and bad days.

Friday, and today, Monday, have been bad days. Really bad days. Saturday and Sunday were good days. Really good days. Pleasant! Highly functional. Friday and Monday - Barely functional. I have no idea why. The best way to describe it is that I had cotton clogging up my Lime Jell-O. I know it is a lousy analogy, but it is the best I can do. It feels like my head is stuffed with cotton, and I just know it came from those frakkin trees.

Sometimes, like on Friday, I can tell right away it is going to be a bad day. Confused! As I was making coffee, I had trouble getting all the steps in sequence. This has happened before. I managed to make the coffee as always, but it was not a smooth process. I had to stop, and think, and go through it slowly. Making coffee is about as simple as it gets, so if I have any trouble at all I know it is going to be an uphill battle. The coffee came out just fine.

Friday is mostly a blur. I did go shopping, and that was OK. I made a list, got what I needed, and got home. No problem. It was only about 5 items! The focus of doing some shopping probably helped. The rest of the day can best be described as agitated. I tried to watch some TV, but could not get interested. I found myself pacing, or more precisely wandering, around the house. I do not normally pace. I was agitated and restless all day. I did not want anything to eat. Nothing appealed to me. I accomplished almost nothing. In the evening a great friend, more like family, came to visit. That was comforting. That made me feel more grounded and secure. That helped, but all through the visit it took all my focus and concentration. We went out for dinner, and that was stressful, but manageable. Overall the whole day exhausted me.

The weekend was very low stress, in safe and comfortable surroundings, and among friends. I had a very good and productive 2 days. After my bad day Friday the weekend was a welcome change.

Today, Monday, was less confused than Friday, but more stressful, emotional, and agitated. I have a whole list of things I need to get done. Some are easy, and some are not so easy. I burned through a few of the easy ones before noon. I was on a roll. Easy for me has nothing to do with the normal definition of easy. Sometimes my difficult would be easy for most. Spending an hour on the phone with DTV to straighten out a billing error was easy. Filling out a form is very difficult for me. It has never been pleasant, but now I find it is extremely difficult. Especially when it deals with an emotional component like my disability, insurance, work, and my future. It is stressful because the stakes are high, and mistakes could be devastating. I was feeling the pressure. I was feeling the frustration. I have learned that frustration is a big issue for me.

After a very emotional start, I finally got focused on filling out the insurance form with the timely support of a friend. This single 3 page form would have taken me about 10 minutes in the past. Not so any more. Two-and-a-half hours later I was stumped by a witness requirement on a signature. All I needed was a witness to my signature. I wanted to complete it today, and I was the only one around. I was frustrated. I do not deal well with frustration. I simply did not know what to do next. I eventually figured it out. I had just finally come up with an easy solution, and was trying to get myself motivated to act on it, when the phone rang. Frak!

I was furious! I lashed out!  My reaction to the interruption of the phone call was totally out of proportion. It completely derailed me from concentrating on the form I was filling out. It just blew me away. I was angry! I usually turn my phone off when I need to concentrate on something, but I did not expect anyone would be calling at that time of day, demanding my attention when I needed it all for something else. Maybe it is a task switching problem, maybe emotional, maybe behavioral, probably all 3, but as soon as I answered the frakkin phone, I knew I was not going to be able to get back to that form today. It had taken me almost a week to get it started. It had taken everything I had to start it, and keep at it. It was a long and arduous process, but I was finally doing really well. I would do some, then look up some medical information and dates, or addresses, take a break, and then do some more. It was working. I was getting it done. The phone call broke that rhythm.

Writing something for this blog was on my list of things to do today. At least I can cross something off. Yay! Sometimes it is the little things.

Tomorrow is another day. It will be better.

I think I will turn off my phone tomorrow - at least until the cotton blows away.

Thursday, May 20, 2010

A walk In The Park

Come Along For A walk In The Park

Today I realized another benefit of writing this blog. Today my writing forced me to go out to the park and take some pictures. I got the idea for this post, and the only way to do it right was to take my camera, and actually go out for a walk. It is hard to get moving, even to do things I enjoy. I realized when I was finally at the park 2 hours later than I had expected that I would not have been there at all if it were not for my idea of writing this article.

Come along with me, and look over my shoulder as I explore. It is a beautiful, warm, sunny day. I have no idea what, if anything, we will find this morning.

My first stop is to look for some Yellow Ladies Slipper Orchids. These unique flowers are always a rare treat. They are well worth fighting with the always present mosquito or two.

Next was a Fringed Polygala. This little evergreen beauty is only about 2 inches tall, and easily missed. I am happy to have found it in full bloom.

It looks like this is going to be a great walk for finding some rare and beautiful plants in bloom. Here are some Dwarf Dandelions. These are not like the weeds in my yard which were brought here from Europe to use in salads, and escaped all over the place. No. These tiny yellow flowers are an actual native of the area. They are only a few inches high, with a little rosette of basil leaves around the bottom.

Here is our destination. I came out here to check out the den that something has been digging under this fallen tree. The den appears to be from a common Groundhog, but his back porch is very nicely landscaped with some wild Blue Lupine.

I am going to head over to the pond, and see what we can find. When out for a walk you can never tell if you will see a deer, or a turtle, or just the sunshine and blue sky. If you don't go, you won't know. Hah! Those are words that have on occasion gotten me covered in mud, or worse. I am going to take a picture of the pond, and then walk down by the water to see if anything interesting is there. There should be some more Blue Lupine blooming up on the ridge.

Try to move quietly, even though I am carrying about 15 pounds of camera and tripod, with extra lenses stuffed in every pocket. Not too fast as I move up near the water's edge.

SHHHHH! Did I just hear something? Look how blue it is!

Now, I gotta stop and tell you. Snakes are very silent animals most of the time, but they also make a very distinct sound as they slither though grass or leaves. Once you have heard it a few times, you learn to recognize it. Kind of like gently dragging a small piece of clothesline through the leaves, and being careful that nobody notices.

That was the sound I just heard.

...and then my bvFTD symptoms came into play.

CRAP! I took dozens of pictures of this beautiful Blue Racer, and did I ever get one with his tongue sticking out? NO! This is the closest I got. He looks kinda stoopid, not like the great predator he is testing the air for prey.

In my post about Dysexecutive Syndrome I explained a little about my difficulty with inhibition, and initiating an action. Here is a great way to Frakkin well test it. I was so frustrated I could have just spit. This guy was posing for me, and sticking his tongue out a couple inches, and waving it around testing the air. If I moved my arm, he would stick his tongue out. If I just waited, he did the same every few seconds.  I was too late every time! I tried anticipating him, I even tried some random shots. I could not initiate the action of pressing the shutter button any faster than I could push the space-bar on that stupid computer at the Psychoneurologists Evaluation.

In any case he got tired of waiting for me to get the picture of him sticking his tongue out. He had done it now about 30 times, and it was time to move on. So he did. He is FAST! The snake is a Blue Racer. They are rare, and have a very limited range. This one is about 3 1/2 feet long, and in wonderful healthy-looking condition. He raced into the little stand of willow trees, and the next thing I knew he was up a tree. Whodathunkit?!

Well now, it probably seemed like a good idea at the time. Climb the tree growing in the water, and get away from the stupid human creature. Har! Bad plan! Unknown to this poor snake, there is a Redwing Blackbird nest about 3 feet from where he decided to hide in the tree. Redwing Blackbirds do not tolerate snakes coming around their nests to eat their chicks for lunch. This snake was big enough to easily capture and eat an adult bird, but it didn't matter.

The bird, in the upper left of the picture, was flying at the snake, in the lower right, and the snake was striking at the bird, and I was standing less than 10 feet away. It was nature at its best. That Blackbird attacked so furiously that he knocked that Blue Racer right out of the tree!

Again, bvFTD strikes!
The action was way to fast for my impaired initiation of action to push the shutter button fast enough to get the picture of the bird attacking the snake. I have taken pictures of fast action many times in the past with no difficulty, but now I am incapable of it. Funny how bvFTD crops up in the oddest places - even on a walk in the park - but that is what this blog is all about. It is always with me.

I got one last picture of the Blue Racer as he slinked off under the watchful eye of the Redwing Blackbird. He was moving so fast I thought I missed him. This was just a "luck shot".

Whew! That was exciting!

Check out the Birdsfoot Violet, and the Puccoon as we head back to the car.

What a great way to spend a couple of hours.

Thank you for coming along with me. Your comments are welcome.

Wednesday, May 19, 2010

The Book - What if It's Not Alzheimer's?

Product Recommendation - What if It's Not Alzheimer's?

Whodathunkit? A product recommendation right here on my blog.

Buy this book by clicking on the picture above.
I was not going to recommend this book for a few weeks, at least not until I covered my most debilitating symptoms: Emotions, and Behavior; and my Prognosis. I will reference this book heavily when I write about those subjects, and will recommend it again when I do.

Well, so much for my plans. Better sooner than later I suppose. An avid reader of this blog notified me by email that they had gone ahead and already purchased this book because I had referenced it here a few times.

It is easy for me to put things off, and adding the book for sale on my blog was something new to learn. I have been considering it for weeks. Thank you for forcing me to get it done in spite of my bvFTD-driven procrastination.

Anyways, I got more good solid useful information from this book, What If It's Not Alzheimer's?,  than from anywhere else because it gets very specific. It does not sugar coat anything, and is easy to read and understand. It is written for the caregiver of someone with FTD as a resource. As someone with bvFTD, I found it invaluable in helping to understand what is going on with me, and what to expect. The detailed descriptions of the symptoms and what they affected were exactly what I was looking for. I will warn you, some of it is hard to read, but that is the nature of the beast. I highly recommend buying it.

For more general information on FTD, see:
Facts About FTD.

Who should buy this book?
Anyone who has, suspects they have, or knows anyone with dementia. FTD is so difficult to diagnose, and is so often misdiagnosed, this book may help identify symptoms one would miss even if the current diagnosis is Alzheimer's or Depression, or nothing at all.

Anyone who has FTD, or is caring for someone with FTD, or cares about someone with FTD. The more you know and understand, the better.

Why buy it from here?
Because I get a small commission on each copy. I also get a commission on anything else you buy at Amazon when you link through this web site. Your price does not change, so it does not cost you anything extra to buy from here. It isn't going to change my life, but every little bit helps.

I plan to recommend a few other books, and maybe even some music, in the future.

Buy What If It's Not Alzheimer's? now by following the Amazon link below, or at the bottom right of this blog.

Thank you.


Denial - I can't deny what I can't see.

From reading the posts on this site it would appear that all I think about is dementia. It would appear that it effects my every waking moment. That could not be farther from the truth. Most of the time I don't think about it at all, and am completely unaware of any effects from it. I don't notice anything different. I feel completely normal, and I see myself as I have always been.

It just so happens that the part of the brain which keeps track of how you are doing - the part that gives feedback and self assessment - is located in the Frontal Lobes. It is actually a symptom of bvFTD to not notice anything is wrong. From what I have read, as it progresses this gets worse, and contributes to unwanted behaviors because subjectively they seem normal no matter how bizarre they may be.

When I look at myself, and examine my dementia, it is as if I were looking at someone else. I am very detached from my own condition. It is like I am looking at an interesting bug through a magnifying glass. The glass may be clouded or distorted sometimes, but it is the only glass I have. Most of the time, I am not looking, or even aware the bug exists.

What this means is that subjectively I do not feel any different. It is only when some very obvious change comes to my attention, or is pointed out to me, that I notice anything at all. I finally noticed that I could not do mental math, but it was probably going on for months or years before I finally noticed. I just wasn't aware of it and used a calculator for everything. I just automatically adjust and create work-arounds without ever noticing I did it.

It amazes me that I have had a drop of 30 points in my IQ without ever noticing it happened. I still have a huge collection of knowledge, I just can't use it as well as I used to. Subjectively even big changes like that look normal from my perspective because I still see me as I was before - at least most of the time I do.

That is not denial. That is truly the way my brain is telling me I am. That reflects my impaired assessment of ME.

Denial is different. I have that too.

I still sometimes question whether or not I have bvFTD. I still feel normal to me. I think it is just a bad dream, and I will wake up and everything will be back to the way it was.

Most people would never notice anything is wrong with me at all. At least I don't think they would. So, if nobody can see anything wrong, maybe nothing is.

Well, I know different, and the evidence is right there in front of me. I have heard it from my Family Doctor, my Neurologist, and a couple of Neuropsychologists. These little side trips of actual denial do not last long.

Most times I just bounce along through life -  fat, dumb, and happy -  like I always have, completely unaware of any changes.

Tuesday, May 18, 2010

My bvFTD Symptoms - Dysexecutive Syndrome

I have Dysexecutive Syndrome, and it makes it really hard for me to think.

Everything here is my account of what happened to me, or my interpretation of stuff. Every case of FTD is different. Keep in mind as you read this that the person who wrote this has dementia. That would be ME.

 I think this is a very complex symptom for me to understand because it includes so many different brain functions seated in the frontal lobes all working together. The way I understand it is that it is made of of several component parts. Pretty descriptive of what an executive does. You kinda have to describe them one at a time, but they all interact and depend on one another. If one breaks down, it effects the functioning of the entire set.

I am going to try to break it down into the individual components, and then explain how they act together to effect me. It is unlikely I will do a great job of it because this is a big topic to cover, and I do not understand it all that well. Apparently nobody else does either as there is no current agreed upon definition. I found this statement about Executive Function on a wiki about selective attention, and it sounds as good as any. "No exact definition has been agreed upon. However, typical descriptions involve maintaining behavioral goals, and using these goals as a basis for choosing what aspects of the environment to attend to and which action to select."

Another wiki defines it as a "loosely defined collection of brain processes which are responsible for planning, cognitive flexibility, abstract thinking, rule acquisition, initiating appropriate actions and inhibiting inappropriate actions, and selecting relevant sensory information"

First, working memory is an Executive Function frequently effected by FTD. It is different than long term memory, but the two interact with one another. I have separated memory problems out into a different post because memory loss is so typical of dementia in general, and such a frequently reported early symptom.

In addition to working memory, the book, What If It's Not Alzheimer's?, lists difficulties with control over selective attention, control over inhibition, task switching, and planning and organizing as contributing to Dysexecutive Syndrome. I will use that list as a guide and outline for this post.

Selective Attention is loosely defined as the cognitive process of selectively concentrating on one aspect or stimuli in the environment while ignoring other things. In short, this is the ability to not let extraneous crud going on around you be a distraction. It is the ability to concentrate on what you are doing.

My psychoneurological evaluation indicates I am profoundly impaired in sustained visual attention, which causes me to rate Marginally Impaired on the Dementia Rating Scale for overall attention. I believe this is where ADHD-like symptoms of my bvFTD originate. I have no idea why it is visually centered, but I have always been particularly visually oriented.

I do not have ADHD in the classic sense, but rather the results of my Psychoneurological Evaluation were more like someone with ADHD than someone who does not have ADHD. That is psychobabble saying I act like I have ADHD a lot of the time.

For me, it appears attention difficulties have had a big effect on learning. That is typical for anyone with ADHD. For example I was unable to learn a highly complex process at work, and had difficulty learning to operate within a new reporting platform. This is a big change as I have never had any problem learning anything before no matter how complex the subject or process. I could do my homework, watch television, and listen to music all at the same time, and do them all passably well. Now I require a quiet environment with limited noise and distractions. There are other factors that effect learning in addition to attention, so I am hesitant to place too much of the blame for my difficulties on attention alone.

Several weeks ago in a noisy restaurant I had difficulty concentrating on the menu to choose what to order. It was obvious even to me that it was the noise and distraction going on around me that was the cause. I just couldn't ignore it. When I read, write, or watch TV I am totally involved. I can concentrate just fine, as long as there is only one thing I have to concentrate on at a time. Unfortunately, in real life outside of my living room that seldom if ever happens.

Control Over Inhibition. This is not at all what I thought it was. In fact, if you have read about my Psychoneurology Evaluation , this is one of the things being tested by those stupid letters and "X"s that caused me so much frustration during my evaluation. In short, I could not inhibit the response to push the frakkin space bar when I saw an "X". This test also contributed to the evaluation of my attention.

As I understand it Control Over Inhibition is the ability to not do something that you don't want to do, or want to stop doing. I didn't want to push the X, I knew not to, but I could not prevent my hand from doing it.

According to my reading this includes repetitive actions and thoughts you are unable to stop.  This is not like a habit, but more like repeatedly washing your hands, or reading the same thing over and over, or saying the same phrase over and over. Those are more advanced manifestations than anything I have at this time. I don't think I have any repetitive actions, but I do sometimes have thoughts that get stuck in my head. I may dwell on a certain thought until I finally have to do something else to force it out of my head. I am not sure this is the same thing at all, so I am not going to dwell on it here.

The antithesis of this is the ability to initiate and sustain actions rather than inhibit them. I do not even know what I would look for to evaluate if I exhibit this or not, so I am not going to initiate a discussion of it here. I think a test of this is to count backwards from 100 by 7's. That is difficult at best. Creating word lists of animals or beginning with a certain letter would also measure this. From that I can guess it is something like staying with something until you complete it.

That naturally leads us to Task Switching. This has to do with being interrupted while performing one task, and switching to another, and then maybe back again. I read an article somewhere that said the average worker switches tasks about once every 3 minutes, and that half the time it was to do something self switched like surf the web, rather than answer the phone or something work-related. All I know about it is that it is an Executive Function. Again, I have no idea how to test it, or what I would look for to determine if I had a problem with it. I do switch tasks frequently, and I may not return to my original task in a timely fashion.

For me Planning and Organizing is the main point of all Executive Functions. The ability to organize things in a meaningful way, and to plan several steps ahead is nearly impossible for me. It takes days, or even weeks, to do what I used to do in minutes. I will address issues I had at work in a future post, but that is where planning and organizing really hit me hard.

When I was tested, it seemed to me that each individual facet of Executive Function was evaluated by itself. That really does not explain how this impairment relates to the real world because all of the parts interact and are dependent on one another. I have problems with attention, working memory, and less seriously with inhibition.

For me I see it as effecting the speed at which I can think in general. I used to be very smart and fast at everything. Now I have to slow down my thought process and concentrate on each and every step to make sure I gather all of the information, then manipulate it the way I need to, and report it in a meaningful matter. I have to concentrate every step of the way. All of the various facets of Executive Function work together to slow me down tremendously.

In my case, with an MRI that shows "Severe General Atrophy" of the brain, I am sure there are also other things going on in other parts of the brain which have an effect on overall thinking, or cognition. I think the effect on the Frontal and Temporal Lobes is greater, so that is where my current symptoms are being generated.

A really common example of Dysexecutive Syndrome for me is when I am in a conversation with more than a single person. I have to separate out what each person is saying, and has said before, to keep it in context. Then I have to keep it in working memory long enough to think about it and decide what if anything I am going to say. Then I have to actually stop thinking about it, and say it. When more than one person is talking, I just plain get lost and can't keep up with the flow of the conversation. I have noticed this is much worse when I am tired, and the number of people increases. This also contributed heavily to me not being able to work. That will be addressed in a future post.

Most of the time here at home in a controlled familiar location, I have no problems at all. I can do all of the simple stuff I need to do to take care of myself. When I go out it is different. All of a sudden it is no longer a controlled environment. There are many new and competing stimuli vying for my attention. There are other people, sometimes many of them. I have to process stuff, and make decisions based on the information I sense. I have to figure out what I am going to do, and in what order, and that is a dynamic process as I move along. Everything has to be processed, and I have to... THINK!

And that is what all of this Dysexecutive Syndrome crap boils down to. It is now more difficult for me to THINK.

Does this make sense? Comments welcome.

Monday, May 17, 2010

I count frogs

I count frogs... Really!

No, I am not hallucinating, and I am not talking about lime Jell-O jigglers. I really do count frogs. The live hoppy kind. I have counted frogs for a long time. There are many of us frog counters out there. If you have doubts, check out the USGS Amphibian Monitoring web site.

Amphibian populations worldwide are declining, and this is one of many programs monitoring populations over time to try to help figure out why. So far there are several theories, but nothing conclusive.

A friend and I have been counting frogs along the same mile long stretch of ditches and vernal pools almost every Friday night for about 10 years. There is no better way to spend an evening than out for a walk in a secluded park after dark. That is nature at its best.

Now before you get a picture of me with a big pile of frogs, sitting there in a swamp, swatting bugs and counting... one... two... three... as I toss each frog back into the muck, I better explain. We do not count the frogs we see or catch, we count the frogs we hear. The males of each frog species have a distinctive call. As we walk along the path shortly after the sun goes down, the frogs start calling, and we count the individual calls as we walk along. We record how many we hear of each different species.

I noticed the past few Fridays it is slightly more difficult to discern the different frog calls. I can still hear them all just fine, but when there is a series of 10 or more different individuals calling, I have trouble keeping track of them. I never noticed that I had any difficulty before. This is something new, and I suspect related to my bvFTD. (Maybe it is more accurate to say it is newly noticed rather than just new.) My guess is that this is another artifact of difficulties with working memory. You have to store the first frog's calls and locations as you go. Even in the quiet, dark, and secluded environment of the outdoors at night, it is more difficult to do.

The work around is naturally to go slower, and count the individual frogs in smaller bunches. I now top out at around six. After that I get all mixed up. I also have to start over a few times, but that is not really a problem when the frogs are calling every few seconds, and I am only counting them to six.

To keep a running count, we record hash marks by fives on the count sheet and total them up later. I am sure everyone knows IIII would be 4, and to make it 5 you make a diagonal hash across them. Simple. I noticed last Friday that I could easily count them up and add them by the groups of 5, but when there were a few extra ones left over I had difficulty. This is similar to the difficulty I described with mental arithmetic and working memory. I have trouble remembering the five count long enough to count up and add the single ones left over.

Again, I think this is an artifact of working memory. I have to remember the result of counting by fives, and then add the few extra hash marks. I could do it without too much difficulty, but I am sure my friend holding the flashlight noticed me hesitating as I totaled up the counts on the sheet. It took me by surprise, and was a little embarrassing. It has been going on for a long time, but I never noticed it before. I seem to be able to count by 5's just fine. Apparently counting and adding are different..

On Saturday I was taken out to lunch by a loving friend. The first thing I had to do was ask the waitress to lower the blind on the window because the bright sunlight glaring in was hugely annoying. I should have had her lower it all the way because the traffic I could still see moving by was a constant distraction, and I kept looking out the window and drifting away a few seconds as we were talking. I kept catching myself doing it, and hoped it wasn't noticed and taken as me being bored by the conversation.

We were seated in a corner of an empty room so it was otherwise quiet with very few distractions. I enjoyed the lunch immensely, and we had a very nice long conversation. I was instantly ready to leave when a group was seated at a nearby table with several loud and ill-behaved children. It sounded like there were about 30 of them, but I think it was only about 5 or so. They were behind me so I could not see them, but I sure could hear them.

Now, I understand kids will be kids, but there is no excuse for taking children out to eat when they have no idea how to behave in a restaurant. There is no place for screaming and yelling little brats. They were so distracting that they are all I can remember from the time we were seated until we moved. If my children ever behaved like that in a restaurant... well, they never did, at least not for long.

Once we moved to a quieter location in the restaurant, I was fine again. I was really tempted to unload on the adults for disrupting our lunch, but I was able to refrain. I am thinking in the future I will be unable to stop myself from giving them a small piece of what little mind I may have left. I shall have no guilt when it happens, and I hope I really let whoever it is have it. I just hope I really have a reason.

Now, I have never liked children in a restaurant who are disruptive and do not know how to behave. In the past they were an annoyance. On Saturday they were a total distraction, and a bigger annoyance.

I believe this slight change is a manifestation of some of the complex of symptoms associated with Dysexecutive Syndrome. Maybe the escalation of the level of annoyance is tied to emotions, but the inability to concentrate when there are a lot of distractions to me seems to fit changes to my executive functions.

The irony is not lost lost on me that eventually I myself may be the annoying distraction to someone else in a restaurant. By that time, I doubt I will be frequenting many restaurants.

On Sunday I decided not to mow the lawn, or do anything else constructive. This is always an easy decision for me to make - especially now. I did force myself to get out for a walk in the park to enjoy the beautiful weather. I ran into an old friend from work with his grandson, and we poked around together for a couple hours. After they left I continued my meanderings until I was getting very tired.

As I was leaving I remembered that a group of volunteers would be arriving to monitor the critters living in a nearby vernal pool. I decided to wait the few minutes more, and stop by to say hello before leaving the park.

I met up with the group, and made my greetings, though by that time I was exceedingly tired. There was someone there who I had not seen in over a year, and we stood aside for a awhile catching up. I noticed when talking that at times my speech was hesitant, and I frequently paused to search for a word. I think he noticed it a couple times as we spoke, but I am not sure. I certainly noticed. This is unusual for me, and except for searching for a word occasionally is not a daily occurrence. Usually my speech sounds pretty normal, at least it does to me. I have noticed on other occasions that my speech gets hesitant when I am very tired.

At the end of the day I can still count frogs, go out to lunch, and visit with friends. The differences in me caused by my bvFTD are so subtle under these circumstances a stranger would never have noticed, and even people who know me might not see them. The reason I am writing about them is because I noticed. I could see and feel the change in myself. I could tell something was just slightly changed.

That is how my bvFTD works. It has been a progression of ever so slight changes. It has been subtle. I never noticed a thing. Now that I have been made aware of it, I can see some of the changes. I do not think I would notice anything even now if I were not specifically attuned to try to document any changes. Some of the changes are apparent to others who know me. Most would go completely unnoticed by a casual acquaintance.

(I took the photos used above. The top is me and a Fowler's Toad. The middle is a Spring Peeper. The lower is a Grey Tree Frog.)

Friday, May 14, 2010

My bvFTD Symptoms - Memory Loss

My bvFTD Symptoms - Memory Loss

Everything here is my account of what happened to me, or my interpretation of stuff. Every case of FTD is different. Keep in mind as you read this that the person who wrote this has dementia. That would be ME.

Though I have a whole range of symptoms, I am going to start with memory loss. It was the first thing I noticed, and the easiest symptom of mine to write about. It is also the one most people seem to associate with dementia. I know I did. I am going to try to describe how my memory loss is now. It will inevitably get progressively worse over time. At this time, being newly diagnosed with bvFTD,  it is one of my more manageable symptoms.

If you have done any research at all on the web it will probably be apparent that the main difference in Alzheimer's Dementia, and bvFTD is that the primary symptom of Alzheimer's is memory loss, and the prime symptoms of FTD are behavioral. Some of the best web sites I have seen make it sound like memory loss is not at all a part of FTD. That is what initially caused me to question my diagnosis of bvFTD.

For me, the symptom which I noticed first was memory loss. Note that I had a bunch of other symptoms, but as is the case with most people with FTD I was totally unaware of them. All I noticed at first was that I had some problems with memory.

It turns out that memory problems are not uncommon in people with bvFTD, but they are very different from the memory problems associated with Alzheimer's. I think that as the damage to the brain advances, it is more difficult to differentiate between the two, so this is probably more descriptive of the earlier stages of the disease.

It is my understanding that with Alzheimer's you forget the most recent stuff first, and then older stuff. Once something is forgotten, it is gone for good, or soon will be. This loss of memory occurs deep in the memory centers of the brain where long term memories are stored and processed. This progression is well documented on the web.

What I finally found was a short description of memory loss symptoms specific to FTD in the book: What If It's Not Alzheimer's?

According to the book, FTD memory loss is a symptom of Dysexecutive Syndrome. Dysexecutive Syndrome covers a whole bunch of different symptoms, and is going to be the subject of a future post because I have it in spades. In any case, it is comprised of a whole set of higher brain functions controlled by the anterior parts of the Frontal Lobes of the brain, and working memory is one of those functions. Aha!

"Working memory involves the ability to manipulate a relatively small amount of information held in short term memory over a brief period of time. Working memory is involved in a large number of ongoing cognitive activities such as the comprehension of a conversation, or a movie."
That is right from the book. I copied this 2 or 3 words at a time, referring back to the book at least a couple times for every few words. I missed a whole clause. It was very difficult because the process relies on working memory to store what I read in the book long enough to type it here. 

ADHD-like symptoms are sometimes associated with bvFTD, and also effect working memory. Of course, I also have ADHD-like symptoms. My psychoneurologist, and my Neurologist, both thought it likely my memory loss problems were actually related to my profoundly impaired attention instead.

Information comes at me, I miss it because my brain is not focused on it at that millisecond, and it is not stored in my working memory, and is not stored anywhere else either. I simply saw or heard it, and it didn't register with me at all cuz in that instant my brain was visiting Jupiter. My brain spends a lot of time on Jupiter.

So, I really have two things going on. I have an attention problem, and a working memory problem. The attention problem makes it seem like I forgot something when I never really remembered it, and the working memory problem effects very short term storage while thinking complex thoughts, or multitasking.

Shortly after I first noticed the memory problems, I was describing them on the phone to my ex-wife. She works in long term care, and has seen many people in all stages of Alzheimer's. She said immediately that I should see a doctor, and that what I described did not sound to her like Alzheimer's. She made a simple analogy. Everyone forgets where they put the car keys now and then. A person with Alzheimer's forgets what car keys are for. Neither case fits my symptoms. I know what car keys are for, and I most always know where they are. But, when I am getting ready to go somewhere I may look for the keys I just had in my hand a few seconds ago, and not remember setting them down, or where I set them. I immediately start searching, and usually find them a few seconds later. I know I put them there, but I have no memory of doing it, even though it was only 30 seconds ago. An imperfect analogy at best, but it gets the idea across. If you were observing me, you would see me set the keys down, search for them, and pick them up again. I might look a little disorganized, but you probably could not tell that I had no idea why the keys were not still in my hand to begin with.

For me almost all of the problems I first noticed with memory loss occurred at work. I could not remember job numbers. I did not remember what databases I had completed last quarter. New product codes became a mystery to me. I did not remember half of the steps I performed to produce the databases I was currently working on. I could not remember half of what went on at meetings, or what was said in a phone call. Copying updates from paper and typing them into the computer was downright painful.

I covered for this loss of memory at work by creating work-arounds. I was smart, and very good at my job, which helped. Creating work-arounds was not something I consciously did. I see them now in retrospect, but I was totally unaware of doing it at the time. It seemed completely normal. If I didn't remember something, I just looked it up again... and again. I started making notes to myself. I had lists of job numbers posted on my wall. I had post-it notes stuck everywhere. I would work at home to minimize distractions. I got by this way for a long time. Eventually I just couldn't keep up. I had no idea why. I did not even realize I had changed the way I did things.

The big scary memory issue that prompted me to make an appointment to see a Neurologist was forgetting a couple of important meetings. I had a personal meeting with my boss for my mid-year review last summer. I had a telephone meeting with my boss to plan out and redefine my objectives last fall.

I remember having the personal meeting. I remember what the meeting was for. I remember exactly what my boss was wearing, and how she was sitting. I remember where we were, and even where we sat at the table.  I remember the time, and that the meeting lasted over an hour. I can describe the whole boardroom in detail. I do not remember a single thing she said, or anything we talked about. Nothing! This was brought to my attention in the telephone meeting last fall, but I covered for my total lack of recall as best I could. I was just a tad behind on my objectives because I did not remember what they were, and didn't even realize at the time that I didn't remember until it was pointed out to me by someone else. I was clueless as to what was going on, and chalked it up to stress, or some odd complication of Diabetes.

So, of course, I didn't remember anything about the telephone meeting either until right before my year-end review when I was reminded of it, and I realized I was still just a tad behind on meeting my objectives.

That is when I went to see the Neurologist. By that time I had also noticed some other symptoms.

I have noticed several other effects of my impaired working memory since then of which I was totally unaware... of. You are actually seeing one right now. I have just repeated the content of the last paragraph, but I think I said it better the second time.

I cannot do even simple mental arithmetic. When I try, I can't store the number from the first part long enough to complete the next step, and then come back to it. That probably makes no sense, but when I add the ones column, I forget the answer to that step by the time I add the tens column, so I can't put it together to get an answer. I was totally unaware of this. I have no idea how this could have crept up on me without me noticing.

The severity of this inability to do mental math due to impaired working memory surfaced after I met with my HR department, and had already undergone some preliminary testing. I was driving home, and struggled for almost a half hour to answer the question: How many months are there in 180 days? I finally came up with the answer. I was so happy, I mentioned it in a phone call with someone later that evening. There was a long silence when she said, "Six!" Up till that moment I was so sure it was 9. Not only did I work out in my head that 18/3 was 9 - I had actually checked it by 3 x 9 = 18. I was never great at arithmetic, but this was ridiculous even for me.

This effects my day-to-day activities. Imagine taking that impairment and balancing a checkbook. Estimating an arrival time. Gas mileage. Making a schedule. Shopping. Converting a recipe. The list goes on. I use a calculator whenever I can.

It is extra confusing because I can still understand calculus, advanced predictive statistics, and other math theory. Imagine. I could be in a conversation about statistics, and can't add 12 + 16. I was actually in a conversation similar to that a couple weeks ago discussing the probabilities of repetitive sampling from a population.

It seems really weird to me that I can write a sentence, or a paragraph, or a whole post (though it takes a long time), but I can't add 12 + 16 in my head. You probably guessed it. Language and working memory are located in different parts of the brain. Mathematics and working memory are also in different parts of the brain.

Another thing I sometimes notice is that when I am doing things that take several steps, and get interrupted, I have to go back and retrace my steps to know for sure if I completed the last step. This is not that different than being stopped in the middle of saying the alphabet, and having to start all over again from the beginning - and sing it. The interruption may be something very minor for me, or even a random thought breaking my concentration, so it happens more often. I have to be very careful taking medication if I don't use the daily pill dispenser because there are several, and when you are swallowing the 5th pill, you had better remember if you took the first one. Everybody asks me about cooking, but I do not seem to have a problem with that yet.

So, the way I interpret my memory loss is that it is not really memory loss at all. It just seems like it. When I was confronted with evidence of something that happened, and I did not remember it, I naturally thought I had forgotten it. What really happened is that I never remembered it in the first place. The result is the same. Subjectively it looks the same to me either way, but the mechanism is different. I do believe that forgetting something you knew is more Alzheimer's-like, and not ever remembering it to begin with is more bvFTD-like. That may, or may not, actually be the case.

There are a couple things that I thought were memory related symptoms, but are probably not. I use my DVR to repeat stuff I am watching on TV cuz I get lost in the plot. I also have a difficult time getting through a novel. I have been reading 3 books off and on over the past year. It isn't a memory issue as I first thought, but more of an attention problem that makes me re-read or repeat the same stuff over again so often it becomes frustrating. My mind just wanders off. I think everyone finds themselves reading a paragraph, and having to reread it because you were thinking of something else and missed the content. Well, I may do that 5 or 6 times for every page, especially if there are distractions. When I read, or watch TV, I am totally absorbed in concentration, or I miss it.

I got lost a couple times in the past year going to a familiar place. This is a classic memory problem associated with Alzheimer's. In my case I eventually remembered how to get where I was going. I knew, I just didn't know the next step in the trip right then. The memory was in there - intact. I think it was not an issue with memory, but rather with another Executive Function: Sequencing.

For me, I prefer it when people correct me, or remind me. At least that is how I feel about it now. If I am talking, and forget we talked about the same thing yesterday, just remind me. If I start telling you something that I have already told you, just remind me. Sometimes I may remember, sometimes not. When I do remember it might actually help me to remember other things associated with the event. Maybe not. In any case as long as it is more helpful than annoying I would rather be reminded. Besides, it is better than you hearing that stupid story a second time.

Though this is very simplified, it is how I remember and interpret it.

Comments, suggestions, corrections and questions are encouraged.

Thursday, May 13, 2010

There Is Still Humor With My Dementia

Lime Jell-O - There Is Still Humor With My Dementia, even when I am the only one who sees it

Don't misunderstand - There is no upside to having dementia. It isn't at all funny, but...

Years ago a friend was taking Fen-Phen, a weight control drug. It turned out this medication was associated with heart valve damage. We used to joke his heart muscle was being turned into Lime Jell-O. I am not sure why we chose Lime Jell-O, except maybe that it is nobody's favorite - especially not mine.

In speaking to my friends over the past weeks I have often referred to my brain as turning into Lime Jell-O to help explain what is going on. That carried over to here.

So, last Monday was my first day of not working for a living. I have been on FMLA leave while going through all of the steps and tests resulting in a final diagnosis of bvFTD. It wasn't so different on Monday since I have not been at work for 3 months, but it still felt odd. For the first time I did not have the hope of a goal of returning to work on Monday May 10th.

I wasn't depressed exactly, but I certainly wasn't celebrating. At times I was not at all happy about my situation.  I just puttered around the house, watching some TV, and doing nothing in particular. Well, there is nothing new lately in that.

Then the mail arrived. There was a small package addressed to me in a uniquely annoying way that told me instantly who had sent it - a friend in Upper New York State. Way better than getting a load of bills.

I opened it to find a carefully chosen funny Birthday card. My Birthday is in January, and this is May. Usually if I get a card at all it comes in around August. This was a record! The chuckle was appreciated.

I opened the package, and then fought my way through 2 Tyvek envelopes. I hardly had to use my teeth at all. (Curse the man who invented Tyvek - and Snap Rings - prolly the same guy.)

I laughed long and hard when I found a couple boxes of Lime Jell-O inside. I set them on the dining room table, and chuckled every time I walked by. Walking around in a big empty house laughing out loud may sound crazy to some. Go figure!
I got another laugh today. I went to take a quick picture of the Jell-O for this post. I picked up the box, and laughed out loud all over again. It wasn't even Jell-O! It is an off brand of "Lime Gelatin". I wonder just what the price difference really was?!

So, to paraphrase another common saying about lemons:

When life hands you a couple boxes of Lime Jell-O... Make green Jell-O shots!

I think I will make mine look like little green frogs ; )

Har! This gets even better. I go to use the Jello, and actually make some Jell-O jiggler frogs for a final picture, and the packet inside the box is about the size of a little tiny tea bag. It actually takes 3 boxes or so of this stuff to equal a single box of real Jell-O.

BTW - They taste DREADFUL!!!!

I hope my dear friend way up there in New York State got a great price on this Lime stuff, but in any case the effect on me has been great. I am still laughin... This has kept me in good spirits and busy most of the day today. I actually added this to my "To-Do" list so I could cross it off, and pretend I accomplished something useful today. Everything takes me a little longer, these posts included. I must have looked up how to post a picture elevnty-seven times.

What a hoot! Anybody know if you can mail toxic Jello jigglers?


Wednesday, May 12, 2010

bvFTD defines Me

Lime Jell-O - Who am I?

I was on the phone with a friend last night. She is going through some family issues, and needed some cheering up. There is an irony there somewhere since I have not been the cheeriest person on the block lately. In any case, we got to talking about this blog, and why I use the term "Lime Jell-O" to describe what is going on inside my brain.

She said that I am letting my dementia define me, and that I am still me.

I disagreed. Here is why.

First I guess I have to explain that I think I am defined mostly by my personality. That is what makes me... ME.

My bvFTD has changed my personality. I am no longer the self-starting powerhouse who could tackle anything. I am more tentative, and lack the overbearing confidence I had before. Some have said I am actually easier to get along with. Hmmmm... anyway, I occasionally have some pretty radical emotional swings. Luckily not too often, but often enough to have effected a few important relationships in some very negative ways. I am no longer capable of working. I still know a lot of stuff, but I can't always remember it at the time I want it, and I also sometimes search for words to describe it. I have always been opinionated, and set in my ways. I am becoming even more so. Glenn Beck is starting to make sense! I am no longer in any way shape or form a self-starter. I like sitting and watching the grass grow. I cannot do simple mental arithmetic.

What I am getting at is that I think with a physical disability your sense of self can remain unchanged, or at least within some control. I still have some control over my Diabetes. With mental illness, and especially dementia, the control of your actions, behavior, attitude, knowledge, and even your basic thoughts and opinions are taken away from you or modified by the disease itself. I am lost somewhere within my bvFTD. I am not the same me as I would be without the dementia. I am my dementia.

I am, of course, the me I am today, but the me I am today is governed in every aspect by bvFTD, not by me.

Does this make any sense? My friend didn't think so ; )

Tuesday, May 11, 2010

Lexapro and Ritalin - Part 2

Lime Jell-O - Lexapro and Ritalin - Part two

Lexapro has got to go!

Actually it has already gone. It has been 11 days since I took the last pill. I seem to have totally misplaced the whole week I was taking it, and it took another full week before I was feeling back to normal. What finally did it was Thursday. After having a fair day on Wednesday mowing the lawn Thursday was a disaster. I spent 2 1/2 hours sitting on the deck watching the grass grow. That tired me out so much I decided to take a nap. I laid in bed staring at the darkness for about 4 hours - wide awake. It was all like a free association meditation. I was thinking all these thoughts, but I can only remember that I mowed the lawn. Actually I do not remember mowing the lawn, but it was mowed and I am the only one here, so I must have. I really have no memory whatsoever of Monday through Thursday. Oh yeah! One more thing. The sexual side-effects of Lexapro - No frakkin way!

I did not take any Lexapro on Friday, and will not take them again.

Oh yeah - I do not really remember fixing the lawnmower.

That said. In the event that I start to exhibit bizarre behavior because the my FTD, I am sure that Lexapro will help because when taking it I really had no behavior at all. Just stick me in a rocking chair, and point me so I can see the grass.

Other than being a little jittery once in a while I seem to have no side effects from the Ritalin. It may be helping with my memory a little bit by increasing my focus so I remember more stuff. It may also be helping me to start things and get stuff done. If it is helping the effect is subtle. I am going to give it a chance.

Lexapro and Ritalin - Part 1

Lime Jell-O Lexapro and Ritalin

Whoa Jittery, and high. I guess I can really focus on being high. Worked on the lawnmower for about 4 hours. I got the front axle removed, and am having a devil of a time getting the snap rings back on the shaft to mount the bushings to the deck. Very frustrating. I covered it all up with a tarp when it started raining. Tomorrow is another day. I think I need a bunch more clamps to hold everything together so the ring will slide into the channel. Curse the man who invented these stupid snap ring retaining washer thingies.

It rained all weekend, so I did not work on the lawnmower until Monday. I did not need more clamps. The snap rings were bent, and needed to be replaced. A quick trip to the hardware store for some new rings, and the proper tool to install them, fixed the problem. It only cost $82 in parts, $10 for a tool, and about 6 hours labor to get the lawnmower working again. I am quite proud of the accomplishment.

As for the drugs. I started them on Saturday, and saw no real effects at all the first day. Sunday was a mess. I had nausea, reflux, nap attacks, tremors, and a general feeling of jitteriness. I had no appetite at all, and did not sleep well if at all. Other than that it went just fine. According to what I read on the net these side effects are pretty typical of the Lexapro. By Monday I was just tired, and that lasted through Tuesday. Today is Wednesday, and I am feeling better. I mowed the lawn, and did some gardening. I did not have the nap attacks I had over the past couple of days, though I did sleep in an extra hour this morning.

Diagnosis - Thyroid

I was thinking that things have moved very slowly. It has been 3 months, and I still do not have a definitive diagnosis from the doctors. The best they can do so far is “suspect” a diagnosis of BVFTD. This is very frustrating. Then I did a little research and learned of others who went through 9 doctors, and a year or more of agony trying to get someone to finally believe they had something wrong and were not just slackers or depressed. So, what was different for me? My doctors are good, but they are just doctors like all the rest. I do not really think they are better, but they certainly are not the worst out there. Maybe it is because of an accident. Pure happenstance. When I got my blood tests from the neurologist it turned out that I had Hypothyroidism. One of the symptoms of that is problems with memory. I think my low thyroid caused some memory issues that were already present to get worse. Of course this is just a thought from a broken mind. I am now taking medication for my Thyroid, and it has not seemed to have any effect on my memory so far. I had a few seconds of hope when I first heard the news about my thyroid because it is generally reversible. Those hopes were dashed when my neurologist pointed out that low thyroid does not cause “sever general brain atrophy” as shown on my MRI.