From this article:
In time my better-than-expected (albeit painfully slow) progress on my book about dementia—from which this essay is derived—became its own puzzle. Looking back at the chapters I’ve completed, I ask myself, “How come I can still write? Could I be faking dementia?” Since the indignities accumulating in my ADLs as well as conversation-inhibiting lacunae in my speech are classic markers of early dementia, the discrepancy between those failures and my preserved writing ability must be part of my story too. When I betook myself to my doctors, my friends, and the Internet, I found that I am not the only person who appears to be “faking.” For example, a counselor friend tells of a retired philosophy professor from her alma mater who can no longer bathe, dress, or feed himself, but directs canonical philosophy discussions with visiting former colleagues. A sprinkling of peer-reviewed neurological research, too, reports the “unexpected preservation of a cognitive function in individuals with dementia.”
At the meeting I attended Saturday night in Solvang, the speaker was a long-haired and bushy-bearded older fellow who had gotten sober at 61 years of age. He was a good speaker. His story was entertaining and his message was helpful and on point. But there was no avoiding the fact that this gentleman had eaten a lot of acid in his time. He had that quality about him. There are those in meetings who are more obviously damaged than others. You can sometimes spot the former tweekers, for example, and the former coke addicts as well. They display some of the qualities in sobriety of those still actively involved in their respective addictions. The other night I went to a meeting in Arcadia. A very damaged old homeless fellow was there. Wet brain? I don’t know. I’m not a doctor. Something though.
Yesterday in the car I was telling my wife that I feel lucky in that I don’t display so obviously the damage done. I might display more than I think, of course. It’s hard to gauge objectively the perceptions of others when stuck behind one’s own eyes. But even if I’m right, and I don’t display much obvious damage, it doesn’t mean it isn’t there. As with dementia, the last skill sets affected by long term substance abuse are probably those that are most practiced and central to one’s daily work. For me, that’s written and oral language stuff. But I notice the damage when I lie in bed, and can’t keep thoughts on track. I notice the damage to my short term memory. I notice the trouble sitting still, and the struggles with impulse control, the problems with follow through, the instant overreactions, and the delayed reactions. In short, I notice the brain damage, even if others don’t. I’m like the writer with dementia. The reader may notice nothing wrong, but that doesn’t mean all is well.