When Cognitive Loss Impacts a Marriage
During a wedding ceremony, many couples include a vow that references loving and caring for each other through all the ups and downs of life. Optimism and positivity are excited about the marriage and living a full life together. Few are thinking about what happens when major life changes such as chronic illness, mental health challenges, or the onset of cognitive decline and eventual dementia arise.
Even before an official diagnosis, Mild Cognitive Impairment (MCI) can begin to affect the marriage. Symptoms such as short-term memory loss, occasional confusion about time and place, new difficulty in communicating, trouble finding the right words or finishing sentences, as well as irritability or frustration due to the changes, may arise. If the person is experiencing younger-onset MCI, late 40s to early 60s, it can be more confusing as some of these symptoms may mirror those of common relationship issues. This may lead to conflict due to misunderstanding what is occurring. Regardless of when symptoms start all cognitive decline will change a marriage in some way.
Meet George & June
When George and June were married, they were filled with joy and passion for living their lives together, entwined in love and commitment. They had the type of relationship that was based on a deep friendship and every day they were excited to reunite and share the events they had each experienced during their working time apart. It was not unusual for them to just sit and talk for hours about life, philosophy, and the world around them. When you saw them together you could clearly see that they had a special relationship, two of them against the world, always there for each other.
They raised their children with the same love and dedication that they had for each other. After the children were grown and creating their own families, they enjoyed time traveling and pursuing art and hobbies that fed their spirits. They loved each other deeply for over 40 years before things started to change. George would go out to run an errand and would be gone “too long.” He would stand up and walk away during a conversation. He would get frustrated while working on his model airplanes. June asked him questions about what was happening. She even went so far as to wonder and then ask if there was another woman. George became so angry with her because he did not think anything had changed and he did not understand her line of questioning.
This went on for a couple of months until the kids brought their families for a holiday visit and their daughter, Audrey, told her mom that she thought that dad was having memory issues. She shared that she was talking to him on the phone about her son’s birthday party and the model he had sent as a gift. He did not remember that he had sent the gift. Audrey was concerned and asked June if they should make an appointment for him to visit with the doctor to bring this up. They decided to talk with George about what they had been noticing hoping that he would cooperate. They talked to him about it in a non-accusatory, loving, and kind manner and he agreed that he would go to talk to the doctor. He mentioned that he had been feeling quite frustrated with June’s questions lately and he did not want her to be worrying about him or accusing him.
Mild Cognitive Impairment
At the appointment, his doctor asked questions and agreed that there were some concerns, so he made a referral for a geropsychiatric visit. A couple of visits, along with some tests, uncovered the beginning symptoms of MCI. The family was provided with information about MCI and what to expect. The physician set a follow-up plan with them. June was saddened because she knew others who had been down this road and she knew that the man that she had relied on and partnered with was going to need her in a different way. This was just the start of how their life would change as George’s cognitive loss continued.
There is no predetermined set of stages for how cognitive decline progresses. A person may have Mild Cognitive Impairment (MCI) and that is the only type of cognitive loss they experience. In many cases MCI will progress to further loss of cognition. How it progresses and how it affects the marriage depends on the actual diagnosis and the couple. There are several types of dementia related illnesses. The Alzheimer’s Association website lists 11 main types of dementia (https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia). A diagnosis is reached through specialized physician visits, cognitive and neurological testing, laboratory tests, brain scan, psychiatric review, and genetic tests.
Once a diagnosis is reached then there are many options for the holistic care of the couple as they go through the process. Even though they will face challenges and changes going forward, the goal would be that they also find enjoyment in their married life.
Back to George & June
George’s MCI increased over time. It was a constant learning process for both. For a couple of years George was able to be aware of the symptoms and work together with June. The kids were incredibly supportive and would visit to give June a chance to take a break. The cognitive decline continued, and the doctors started the process to find the diagnosis. After testing, scans, and multiple doctors working together, George’s diagnosis was Alzheimer’s Disease. Knowing this helped the rest of the family plan for how best to support June and George.
A New Diagnosis & A Professional Care Manager
One of the first things they did was partnered with a professional care manager. The care manager was not only able to recommend how to best provide care for George but also shared support information for June. The goal was to keep George living at home as long as possible. By sharing resources, the care manager was able to help them bring in a couple of aides from a home care agency who were able to provide hands on care for George. This freed up June to be his wife and spend quality time with him. It was a difficult process to lose that close friendship they had when they first married but she shared that it was a different type of deep love to be able to care for him during this struggle.
George’s Alzheimer’s Disease did not present his best qualities. The care manager gave June information to attend a support group which really helped. As the disease progressed, he became more difficult to care for and he would get very agitated. It became evident that having him in the home was becoming a concern for June’s safety so the difficult decision was made to find him a memory care unit in an assisted living facility that could care for him 24/7 and could handle his outbursts. June was accepting of this decision because George had explained to her when he was still cognitive that it was his wish that she move him if he was becoming physically agitated or was too much work to manage at home. The care manager helped them find an amazing solution where June felt comfortable that he was being cared for in a compassionate manner. She visited him every day and would stay longer on Saturday to watch a movie with him. This continued for a couple of years. When George passed away, it was bittersweet to the family. They missed him and yet knew he was no longer suffering. The whole process was extremely hard on June. She would talk about how much they loved each other in their younger days and how they still loved each other the same amount, just in a different way, at the end. Her eyes would twinkle with stories of their life together. He would be deeply missed.
Cognitive decline will change marriage. There are many resources to alleviate the burden and allow the spouse to focus on loving and supporting the person with the decline. Family support and support groups help the spouse who is caring for them and the rest of the family. Nobody knows when they go into marriage what is going to happen throughout the entire marriage but one thing that many aging couple deal with is cognitive impairment and diseases. Being informed and working with a care manager helps alleviate the stress and worry. Ultimately, the goal is to help the couple maintain their love despite the struggles they face!