Me an' Algernon – grappling with (temporary) cognitive decline

> When I re-read Flowers for Algernon recently I was just sad. The second half of the story, where his mind is going away, is just brutal, especially when he can remember how smart he was but knows it's gone for good.

https://news.ycombinator.com/item?id=21544149

"Von Neumann would carry on a conversation with my 3-year-old son, and the two of them would talk as equals, and I sometimes wondered if he used the same principle when he talked to the rest of us." - Edward Teller

I watched a documentary from the 80ies a long time ago. A mathematician (can't remember his name) who worked with von Neumann in Los Alamanos was interviewed. He described von Neumann's last weeks in the hospital - the cancer had already metastasized into his brain. The mathematician said something along this lines (I am citing from memory): "von Neumann was constantly visited by colleagues, who wanted to discuss their latest work with him. He tried to keep up, struggling, like in old times. But he couldn't. Try to imagine having one of the greatest minds maybe in the history of mankind. And then try to imagine losing this gift. I was terrible. I have never seen a man experience greater suffering."

Marina von Neumann (his daughter) later wrote this about his final weeks:

"After only a few minutes, my father made what seemed to be a very peculiar and frightening request from a man who was widely regarded as one of the greatest - if not the greatest - mathematician of the 20th century. He wanted me to give him two numbers, like 7 and 6 or 10 and 3, and ask him to tell me their sum. For as long as I can remember, I had always known that my father's major source of self-regard, what he felt to be the very essence of his being, was his incredible mental capacity. In this late stage of his illness, he must have been aware that this capacity was deteriorating rapidly, and the panic that caused was worse than any physical pain. In demanding that I test him on these elementary sums, he was seeking reassurance that at least a small fragment of this intellectual powers remained."

I've had cognitive decline over the past 6 years. I turn 41 this year. It's strongly (maybe solely) due to stress, anxiety, depression, migraines, and insomnia. This entire clusterfuck started 6 years ago because, while I had the skills to excel in school and career, I was sorely lacking in the skills to be a father, husband, and homeowner. When I got married and we began having children, my decline began. But it was slow enough and normal enough at first (new parents often don't get enough sleep, they often have extra stress and anxiety, etc) that I did nothing to combat it. It wasn't until 2021 with all the added awfulness of 18 months of a global pandemic that it become obvious things were unsustainable. I was barely able to function at work, I was being put on a PIP, and I was almost completely absent from my family. When I was with my family I was irritable, angry, constantly complaining.

I got on antidepressants and that helped, though it came with it's own set of problems. I started seeing counselors, reading self-help books, I went through 6 months of cognitive behavioral therapy for insomnia (CBTi), working with a neurologist to get migraines under control, seeking help wherever I could. It has been a slow process but I'm doing a lot better. I'm still nowhere near where I was cognitively. In fact I don't know that has improved much at all. And it's only been in the past year that I've began to understand my decline as a result of jumping into marriage, fatherhood, and home ownership without the necessary skills to handle them. I'm hopeful things will continue to improve, I've learned an enormous amount about life, fatherhood, marriage, love, forgiveness, hope, and priorities.

If you are a young parent, or considering being a parent soon, work on yourself. Ensure you have the skills you need or your life (and the lives of those near to you) will become a bag of utter despair filled with shit.

I used to get this pretty regularly, I thought I just keep burning out. I have an unusually high IQ and noticed that my symptoms were very similar to the string of condensed matter physicists that committed suicide. Their descriptions of their health issues before they killed themselves mirrored my own and I too used the Flowers from Algernon to describe my difficulties to others. I shared other weird stuff like extreme sleep difficulty and extreme noise intolerance. I found out only relatively recently it was due to ME/CFS which was from undiagnosed hEDS, a condition nowhere near as rare as it’s thought to be. I had been to see a huge amount of doctors and none of them diagnosed me with this despite being a walking bag of symptoms and having extreme hyper-mobility. Anyway, I think tech, like physics, has a fairly strong IQ selection criteria bias so I’ve noticed a concentration of the same health issues here on HN.

The characteristic brain fog seems to be tied to dysautonomia and excess IL-1B pro-inflammatory cytokines. I treat the latter with a strict no sugar diet, and high doses of D3, TUDCA, and DIM. I treat the dysautonomia with LDN, modafinil, amitryptiline, and a low dose of semaglutide (ozempic).

> I’ve always identified with my thinking—I have value because I’m smart. Turns out, as with all attachment, this is a mistake.

I experienced a period of severe cognitive deficit while recovering from a medical episode. We didn't know whether it would be permanent or not. I also discovered - as a fellow my-IQ-is-my-identity person - that it didn't matter anywhere near as much as I'd have expected it would. I was still able to experience love, and joy, and humour. Some things sucked, and were frustrating, like not being able to retain enough information to read a moderately-complex piece of prose, but the point is that I still felt like myself, even at a very low cognitive level. I'm immensely comforted. I expect I'll experience that again, as I (hopefully!) age, but it holds no particular terror anymore.

I was in a car crash and spent a month in the hospital where they gave me heavy-duty pain killers. I could tell I was having cognitive issues because I couldn't remember words that I knew I used before, but I wasn't curious about it.

After a while they halved the prescription and after a few hours I could feel my words returning. It was terrifying to feel my IQ rise substantially. Before I left eh hospital they gave me various cognitive and mental tests and it was reassuring to be told that I was in the 96 percentile of my peer group (college educated, engineers)

We deal with a parent with dementia and another with a stroke. The difficult part with all of these are not really seeing the decline from the inside, sometimes there are the acknowledgment of hints of decline but mostly you don't want to think about it and compensate as best as you can.

What is “the genie” that is referred to a few times? An AI coding copilot?

If you experience temporary cognitive decline like this definitely pay attention to it, it can indicate serious stressors in your life that need to be dealt with immediately. It can get worse steadily if you ignore it!

I have a fairly unusual genetic disorder, and quite rare to boot in this particular variant. The gold standard cocktail contains a medication which, while effective in dealing with one facet of the pain, absolutely turns down the dimmer switch on my mind in fairly particular ways. Gait is affected the next day, along with a mild aphasia. During the peak, however, I am dumb as a box of rocks. Math and spatial business seem fine. I can still program, however. Just do not talk to me, as communication is ... troublesome.

I usually skip this portion of the cocktail unless things are particularly bad. The disorder is progressive, so when it comes for my brain, well, that's when things are over. I do not have much going on for me in terms of personal value except for, well, solving problems.

A very close friend of mine has had two hospitalizations for gangrene, and the second one absolutely devastated his cognitive abilities. He has leveled off at about eighty-five percent of where he was before. If he is tired or feeling unwell, verbal perseveration begins.

My mother is fairly well-on in her years. She used to have a tremendous vocabulary, despite her very limited education. Now, she has begun to lose words and I end up "translating" for her because I know what she is getting at. She could do crosswords but refuses to, even the Monday selections, which are typically the easiest. Very recently, she has begun misplacing things. I had my suspicions, and during a routine head, neck, and brain imaging for something else, I checked out the results and, sure enough, some loss of volume in the right hippocampus.