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If you're new to this blog and want some context for it, read this post from the day I announced my Alzheimer's disease and this post about the day I announced I had lost it. For more info, visit my website with my autobiography and all blog entries in chronological order for easier reading to catch up. There's also a sermon on the spiritual lessons I've learned through this journey through my damaged mind.

Sunday, September 07, 2014


Amtrak, Iowa
Written: August 27, 2014

Marja and I are on the train home from visiting our children and grandchildren on the West Coast.  While in Napa playing with my grandchildren, I got addicted to the puzzle game Sudoku, downloaded it to my computer and have playing it on the train-ride home

Without going into the intricacies of Sudoku, I need to copy an 81-cell grid that’s on my computer screen righin front of me onto a piece of paper also in front of me.  The grid is divided up into nine squares of 9 cells each, and I need to mark with an X the cells I’ve completed and leave the others blank.  It’s a simple task: copy a design that is right in front of me. 

I just can’t do it; not even close; I become repeatedly confused.  I’ve posted about other experiences of getting confused; for example, here, here, and here, although in those situations I was confused about much more complicated matters.  But this is straightforward copying, and I can’t do it.

Immediately afterwards, I was editing an essay I’m writing and I got confused again, too confused to continue.  Then I tried reading a simple novel and got mixed up there, too.

  Have I suddenly gotten worse?  What can have caused it?  If the cause of my cognitive decline is vascular (little strokes), have I just had another shower of the tiny clots?  It seems that my life has turned again.
Written: Sunday, September 7, 2014
Several hours after the episode above, however, I came back to my reading and then to editing, and I was able to do both without difficulty.  Just yesterday, a week after the events above, I had no difficulty in copying a similar pattern from a Sudoku game.

So it was a temporary event.  It could have been something akin to a transient ischemic attack (TIA), but I doubt it.  I suspect it was something much simpler.  I don’t sleep well on the train (to say the least) and was extremely tired.  I was also wired on caffeine, which I ordinarily don’t drink much.  I’m beginning to think that the physical stress I was under from the tiredness and from the caffeine significantly exacerbated my cognitive decline. 

Come to think of it, my trouble calculating the speed of the tips of the wind generators occurred on the train out West, when I’d also been short of sleep (and probably wired on caffeine, too).

Hard as it may be to believe, I’ve never thought of this possibility.  Could other exacerbations of my underlying cognitive decline have been similarly affected by physical distress?

If physical stress is a major contributor to my episodes of worsening confusion, then I need to think seriously about decreasing that stress.  It’s the lack of sleep that is the most likely culprit.  I’ve never slept well and can say that I’ve been chronically tired a great deal of my life (except during certain vacations).  Part of it is anxiety, part of it is my history of depression, but much of it, I suspect, is that I just enjoy the late night so much and can’t discipline myself to go to bed.  This kind of change could be very problematic.

In certain ways I’ve taken good care of my body throughout my life: lots of exercise, reasonably good diet, normal weight, and so on.  I have not, however, ever given much thought to my chronic tiredness.  It’s time to re-examine things.


  1. Hi David,
    Often times it is just the simple things (and afterwards so obvious) that do mess with our abilities.
    I don't have cognitive decline that I am aware of and know that my cognitive abilities are compromised when I am tired or very stressed.
    About ten years ago I also discovered I have sleep apnea. I'm not overweight or have any of the typical criteria. But since wearing the CPAP mask I do feel there has been an improvement in my waking hours. I still like to take naps and still have the midday crash and still love to stay up late --- but now know that if I need to be clear and think at my best I have to be conscious of how I feel and plan accordingly.
    You might want to think about getting checked for sleep apnea - I never would have except my husband said I stopped breathing a lot. My sister got checked out as well and she has it too.
    All the best, Carrie Fradkin

  2. Anonymous9/08/2014

    The sleep and stress combination is certainly worth looking into. Also consider if you were hydrated enough towards the end of your holiday?

    For me, travelling to a different place often means going to a warmer climate, a change in the usual balance of drinks and foods I have (e.g. less water during travelling that I would normally have at home, extra coffees, a few more wines, saltier foods, walking in the sun, etc) and unless I remember to drink more water (even though I don't feel thirsty!) over time my thinking becomes less clear, but gets better when I return to my usual routine at home.

  3. Anonymous9/08/2014

    I too had trouble with cognitive functions, though I've not been diagnosed with cognitive decline. I couldn't do simple math in my head, nor even on paper. I kept forgetting what I'd said and what I hadn't said. I was even getting lost while running errands, ending up on the wrong bus several times. I was so worried that I even got a brain MRI, which was negative. I finally convinced a doctor to let me get a sleep test. I had 40 apneas per hour, or roughly every 1.5 minutes I stopped breathing. And just like Carrie, I don't fit the sleep apnea profile (I'm female, physically active, not overweight, don't smoke). Cpap has changed my life.

    I'm now convinced my mother had sleep apnea all her adult life. My earliest memories are of her not sleeping well. She passed on last summer, with advanced dementia, may she rest in peace. I'm certain that my sisters have sleep apnea too. I've tried to convince them to get tested but they won't even think about it. There are many studies linking cognitive impairment and dementia with sleep apnea. It's worth it to investigate it.

  4. Liz Rolle9/09/2014

    Sleep apnea is certainly a very real issue for many. But if that is not your issue, then what? This may seem a bit lightweight... My ADHD son insisted for a long time that he had to sleep from 3am til noon. If we don't have job to be at or a train to catch, who says we have to get up early? I, too, hate to give up and go to sleep at night. Of course, you can try forcing yourself to go to bed (I generally lie awake when I do that!). Or, you could consider getting up later and rearranging your life away from mornings. After all, it's not WHICH hours we sleep, it's that we sleep enough of them!

  5. Anonymous9/10/2014

    Sorry, forgot my name: Roel

  6. I do it the easy way. There is an app on my phone for soduku. And a couple of game sites have it too.

    I think too that when we get frustrated or expect something to be harder than it is, we get flustered and then its next to impossible to do it right.

  7. Thanks for this post. As a geriatrician, I think you are getting at something very important.

    I've found that patients and families are often focused on medications or treatments for cognitive impairments. But optimizing the body and brain's overall health -- through sleep, exercise, nutrition, minimizing stress -- is very very important. As healthcare professionals, we should probably do a better job of helping people with this...


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