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Losing Confidence

A young couple from our church visited yesterday for an extended conversation. I enjoyed talking with them. At one point I mentioned that when Marja was away, I sometimes watched movies that she didn't care for.

"So what doesn't Marja like," they asked.

"You know," I said," action movies, sex, violence … no, that's wrong; she likes sex, but not the violence."

It was my little attempt at humor. In the conversation it was inconsequential; I'm not sure my friends even noticed it

After they left, however, I wondered whether I had been too flippant. Did I reveal a beginning lack of judgment, a common symptom in Alzheimer's?

I've always been pretty loose in my conversation, often saying things that others might not say, that are personally revealing, or that are just non-sequiturs meant to be funny. Sometimes they're inappropriate, but usually they're fine, showing a lighter part of myself that doesn't get much expression, otherwise.

It's a part of my personality that I like, actually, and that others (well, some others) appreciate.

But I skate a thin line between appropriate and inappropriate, between intimate and offensive. While I occasionally skate over it, I can usually trust myself to stay in bounds. I have confidence that my intuitive judgment is pretty good, and I don't need to be particularly careful or to censor.

But if I'm beginning to lose my judgment—even just a little bit—then I will begin censoring, being much less spontaneous in conversation.

That would be a great loss, an important piece of myself crumbling away. Several times in these posts I've mused about what happens to the "self" as such pieces fall away.

Does my sense of self change as my capacities decline?

I'm still very early into the disease, but despite my recognition that some of my cognitive ability has declined, I feel no different as a person.

Some of my conversations with others who have loved ones with Alzheimer's indicate that the ability to relate person-to-person is maintained until late in the disease. So I'm wondering if perhaps the sense of self remains constant, but that the person with Alzheimer's isn't always conscious of it.

Perhaps it's simply forgotten for increasingly long and increasingly frequent intervals.

And finally it's simply gone … no, not really gone but forgotten.

My former therapist told of her husband who was late in his Alzheimer's, actually shortly before his death. He had been quite out of it for years. But suddenly one morning "he" was back, and they had a short but intimate conversation together. And then, just as quickly, "he" was gone. So during that period of return, did he then remember himself only to forget a while later?

This is all my speculation, of course, but that's what much of my mental life is these days, wondering what impact this disease will have on my very experience of "self."

Editor's note: David's journey with Mild Cognitive Impairment was chronicled in "Fade to Blank: Life Inside Alzheimer's" an in-depth look at the real lives of families impacted by the Alzheimer's epidemic. His story continues on his personal blog on

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An author and former physician, Dr. David Hilfiker was diagnosed in 2012 with a progressive mild cognitive impairment. His doctor thought it was Alzheimer's but additional testing proved this initial diagnosis to be wrong. Now David must learn how to come to terms with the reality of worsening cognitive issues that appear to have no cause.

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