EAST GRAND FORKS, Minn. — For some people, it can start slowly. They misplace valuable objects, start to forget important information like appointments, conversations or recent events, or their ability to make sound decisions starts to fade. For others, it can come on a little more quickly.
For Dale Rivard, it started with a fall.
"Back in 2016, I had fallen outside my home and I was knocked out," Rivard says while sitting in his East Grand Forks home in early February. "They took me by ambulance to Altru in Grand Forks. I was very dizzy and disorientated, just in a very bad fog."
After tests and lab work, cognitive and neurological issues were not what the medical staff was thinking about. Instead, they focused on ruling out cardiac disease or diabetes.
Shortly after his first visit to the hospital, Rivard met with a neurologist who wrote his issues off as stress, something the 58-year-old says could have made sense.
"I was at the prime of my legal career," he says. "They thought I was carrying on too hard too long and carrying too big of a caseload. I was the deputy state's attorney for Grand Forks County at the time."
In March 2017, Rivard noticed his issues were getting worse.
"I thought it would get better, but it never did," Rivard says. "I was hospitalized again and this time another neurologist came up and gave me a workup and suggested we make the trip to Mayo (Clinic)."
After three weeks of extensive tests — including pulmonary and cardiac testing and everything in between — Rivard met with the neurologist.
"The neurologist sat me down and diagnosed me with mild cognitive impairment," he says.
A new diagnosis
According to the Alzheimer's Association, mild cognitive impairment, or MCI, causes cognitive changes that are serious enough to be noticed by the individuals experiencing them or to other people, but the changes are not severe enough to interfere with daily life or independent function. About 15 to 20 percent of people 65 and older have MCI, and they are more likely to develop Alzheimer's disease or other dementia than people without MCI.
"It's not to the stage yet where it's classified as Alzheimer's," Rivard says. "But it will probably get there. It's progressing."
MCI is classified based on the thinking skills that are affected in each case, with two types being recognized: amnestic MCI and nonamnestic MCI.
In amnestic MCI, a person may start to forget important information that they would usually remember easily, like appointments, conversations or recent events. Nonamnestic MCI affects thinking skills other than memory, including the ability to make sound decisions, judge the time or how to complete steps in a complex task or visual perception.
For Rivard, his inability to recall stories and perform math tests while at Mayo were the first signs that something bigger was happening.
"They give you simple math tests, and I was having problems," he says. "It was awful, I was getting so frustrated. I knew something was bad. Then they did a PET (positron emission tomography) and, of course, it lit up. That was kind of the definitive."
Rivard was diagnosed Aug. 23, 2017. By Aug. 25, he resigned from the state's attorney's office at 59 years old.
Thriving, despite setbacks
Since his diagnosis, Rivard has made many trips to Rochester, Minn., to follow up with doctors at Mayo. As his condition has progressed, he has developed aphasia — or issues understanding and expressing words — and gait issues, all of which are related to his disease. Medications can lessen some of the symptoms, but there is no cure for the disease.
But Rivard has found a way to raise awareness about early-onset MCI and dementia using his disease.
"When they gave me that diagnosis, I contacted the Alzheimer's Association and I guess you could say they basically saved my life," he says.
Rivard got information from the group and soon joined the national association's Early-Stage Advisory Group.
"There's about nine of us who get together in Chicago, and that was the first time I actually saw people my age with the disease. And it wasn't just us, there were caregivers as well. It was wonderful!" he says. "There isn't very many of us, but we are all going through the same problems, so when they develop policies, they ask our group about how it affects us and if we have any input. They have been just such a blessing."
In addition to his role on the advisory group, Rivard's involvement in the community ensures he enjoys retirement, even though it came earlier than he would have expected.
"Just because that door closes on you, and it does and it's completely devastating, it doesn't mean you give up. You don't," he says. "There are things you can do. I was a lectern at my church, but naturally I can't do that anymore, but I can still give. I read books on the dial-a-story for the local library. I am involved in the Unforgettables Choir for people with dementia here in Grand Forks. One thing about the choir that is so fantastic is that we meet from 10 to 11:30 a.m., every Wednesday, but from 10 to 10:30 you get the chance to meet and talk to people who share the disease."
Rivard also attends and speaks at Alzheimer's Association conferences around the country, including serving on a panel in Wichita, Kan., last November. He'll soon speak at the Meeting of the Minds Conference in St. Paul, Minn., set for Saturday, March 2, to talk about his experience living with MCI.
His wife, Marianne, travels with him and offers her take on being a caregiver.
"We had about 200 people come up to us and talk to us and ask questions (in Kansas)," she says. "It was very interesting I thought because everyone there was in the same boat."
"There is a lot of information for people with the disease and caregivers, so (the conferences) are something they should attend," Rivard says. "Being in a rural area, we don't have all the connections to the drug trials and activities they do in bigger cities. But it's nice to know that if there is something people want to get involved in, they have the opportunity to."