Friday, November 04, 2005

Obsession

When Mom is all dressed up with her hair freshly coiffed, her nails done, wearing earrings and jewelry, she is elegant.
But lately she's been looking a bit battered: there are two red scabby patches on her chin and several other small red spots elsewhere on her chin and forehead.
These began when she kept insisting that the three or four hairs on her chin needed to be shaved. Never mind that these hairs weren't there--they were being shaved several times a day by whichever caregiver she could get to do it, once again.
To Mom, however, the hairs were there and they were bothering her. She started rubbing her chin to get them off. Then she had to rub to get the rough skin off, the patches irritated by her scratching and rubbing. She scratched spots on her forehead too.
For the last week the caregivers and I have been pulling her hand away from her face and nagging her.
If I say "No! Don't rub your chin" and remove her hand, she starts again twenty seconds later.
"I'm just trying to clean it," she says.
"It's already clean!" I say. "Your face is washed every day."
"But this part needs to be cleaned off."
"No, that's a scab. If you rub it off, it will bleed."
We get into a game where she rubs again, and I catch her in the act, and she laughs.
But she can't help it. Her mind is in a groove that it can't get out of.
Part of Lewy Body Dementia is obsessiveness.
The first obsessions I noticed had to do with toileting. She was worried about losing her continence and wanted to use the toilet many times per day, even though she was wearing Depends. I would limit her to one bathroom trip per hour, but she wanted to use the toilet every ten minutes or so.
While at the toilet, she had to have the water running "for inspiration." If it was just a trickle, that wasn't enough. She had to hear it loudly. Then it had to be hot water.
Then she got into counting and folding the squares of toilet paper as she sat on the toilet.
Later her obsessive-compulsive behavior turned to coughing and spitting into a tissue. She went through two boxes of tissue per day while her doctor changed her medications to try to get rid of the nasal drip and phlegm that was causing the cough.
The next issue was rubbing her crotch with her hand inside her Depend.
In each of these phases, redirecting her to some other activity was the only solution. Scolding and arguing did not work. Her mind would return to the activity like a phonograph record with its needle stuck in one place.
The only good news is that so far each obsession has faded, to be replaced by something else.
It's sad to watch her mind deteriorate, to see her brain losing its connections to the frontal temporal lobe that produces intelligent, logical thought.

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