Carol Mae Maphet:  My Mother-in-Law

Vascular Dementia-Multi-Infarct Dementia / Uncontrolled Diabetes

I met Carol at New Jerusalem’s Catholic Charismatic Prayer group facilitated by Richard Rohr, OFM and John Quigley, OFM.  Her daughters Mary Carol and my wife Cynthia attended with her.  I was a member of the music ministry and lived in a household as part of New Jerusalem’s Community in Cincinnati, OH.  Carol was an RN and worked for the State Of Ohio inspecting nursing homes.  When I met the Heiselmans, Carol and Leonard were in the midst of a divorce.  Cynthia’s younger brother Doug was a brittle hemophiliac and we spent many hours at Children’s Hospital for Doug to receive Clotting Factor VIII to replace the missing blood clotting factor inherent to the disease.

Carol, like her Mom was an insulin dependent diabetic.  She maintained a relatively healthy lifestyle except for the stress from selling their farm and raising three teenage children on her own. Fast forward to 1990 when Doug received a tainted blood transfusion resulting in the diagnosis of HIV (the virus that results in AIDS).  He died four years later (1994) at the age of 30 from HIV/AIDS.  The subsequent wrongful death lawsuit against Bayer Pharmaceuticals took its toll on Carol’s health.  In addition the untimely and unknown cause of Mary Carol’s (Cynthia's older sister) death in her sleep on February 16,1995 threw Carol and Cynthia into a deep state of sadness and depression.

Cynthia and I were living in Pasadena at the time and Carol would fly out to visit or we would meet in Williamsburg or go to Santa Fe for Christmas.  In 2002 Cynthia called her Mom who did not sound like herself when she answered the phone, her speech was slurred, she was confused.  We thought she had severe hypoglycemia (low blood sugar) so Cynthia asked her Mom to take her blood sugar.  She said she didn’t know where her blood sugar meter was. I reminded Cynthia that her slurred speech, her confusion and disorientation could have also been attributed to a mini-stroke. Cynthia called one of Carol’s friends who was a nurse and she went to see Carol.  The nurse called Cynthia and told her that the house was a mess, the dog had not been walked for days and Carol needed immediate help.  Cynthia flew to Ohio and it was apparent that Carol probably had a stroke and possibly a number of mini-strokes or TIAs (Transient Ischemic Attacks).  Over the course of a week Carol reported that she had fallen down the basement stairs and could not get up for a number of hours.  That incident explained why she was bruised black and blue. 

Carol agreed to come to Pasadena.  When she arrived we had her evaluated by one of the leading researchers in dementia, Michael Harrington, M.D. at the Huntington Medical Research Institute. We had her start seeing a psychologist on a weekly basis and connected her with one of the best Internal Medicine physicians in Pasadena. 

Dr. Harrington’s evaluation included an MRI, a complete battery of neuropsychological tests, physical examination, and extensive blood-work. The aforementioned battery of tests should be completed for the definitive diagnosis of any type of dementia. Dr. Harrington concluded that Carol had had a stroke in left temporal lobe and there was evidence of Vascular Dementia and Multi-Infarct Dementia a specific type of Vascular Dementia.  He told her that she could not live alone and that she should not even consider returning to Cincinnati.  He advised her to start physical therapy and Occupational Therapy.  In addition, he referred her to Dr. Chrisitian Rutland one of the best psychiatrists in Pasadena.

We noticed that Carol became more depressed, and less compliant with her diabetic diet.  We hired a companion to take her to her doctors’ appointments, and to help her with bathing, and grooming until she could complete these tasks by herself.  Her companion spent eight hours a day with her.  Dr. Rutland put her on an antidepressant to help with her mood swings and major depression.  On the weekend she would spend most of her time in bed and would only get up to fix something to eat and walk her dog.  

We noticed the step-wise decline that is associated with Multi-Infarct Dementia.  Unlike Alzheimer’s disease which is a slow insidious onset, Vascular Dementia more specifically Multi-Infarct Dementia progresses in steps.  You may see the patient at one level for many months and their dementia suddenly takes a step for the worse.  The change in sensorium is often attributed to small strokes.  Even if the individual is on medications to help prevent strokes and atherosclerosis the strokes can still occur.  Structural damage to the brain tissue, either by blocked arteries, blood clots, or bleeding (hemorrhage) causes symptoms of vascular dementia.  Hypertension (high blood pressure) and diabetes are major contributors to vascular dementia.

When Carol came to live with us we were in a two-bedroom apartment.  We needed more room and at her suggestion she wanted us to buy a house.  She knew that she was not going to return to Cincinnati and suggested that she and Cynthia take two weeks and return to Cincinnati to sell her house and she would help us with the down payment to purchase a home in Pasadena.  The two weeks to sell her house turned into a month.  She sold her home and upon her insistence we purchased a home together with a mother-in-law suite and a large back where her dog could run.

After the purchase of our home in Pasadena, Carol became more depressed and angry.  Martha, her attendant, would come every day, but often Carol would not get out of bed until noon.  She refused to eat with us and stopped spending time with us.  When we tried to help her with her meals or invite her to spend time with us she was curt and angry.  We also noticed that she was becoming more distrustful and paranoid.  She paid for Martha, but we made all of the house payments, paid for all of the utilities and taxes, and most of the groceries.  After a number of years cohabitating with us the tension became so bad that we were in therapy because we could not tolerate her abusive behavior.  Living with a parent with dementia who is also agitated and paranoid effects the lives of couples who are Adult Children Caregivers. I have seen this as a common issue in the 25 years of facilitating Adult Children Support Groups.  She decided to move to an Extended Care Facility into its Assisted Living where she had her own one bedroom apartment that included animals.  She lived at Westminster Gardens for two months and then announced to us that she was moving back to Ohio.

Carol had called a moving company and found an Assisted Living apartment in one of the nursing home she used to inspect.  Two months later we received a letter from her attorney suing us for the down payment on the house with attorney fees.  She changed her will and left everything to her only Grandson who visited her twice during her move back to Ohio.  She had become paranoid, but able to convince an attorney who took thousands of dollars from her and us because she claimed that we had coerced her to buy the Pasadena home for us with the plan of putting her in nursing home.

We had to hire an attorney and had to take out a Jumbo Loan to pay off her attorney who ignored the reports from Dr. Harrington, her psychiatrist and therapist who reported her multi-infarct dementia and her delusional behavior.  Cynthia was with her when she passed away February 25, 1993.