Memories in Alzheimer’s: Gone or Not Accessible?
“Will my mother forget who I am?” I receive this question, or variations of it, daily in my work with Alzheimer’s patients. It is a hard question to answer. Some memories do become “erased” when nerve cells die. Other memories become hard to reach. Memories are like a washed-out road. I can see the road, and my destination, on the other side of the gaping, giant hole. I may see a detour. Awesome, I can get to my destination, but the detour may take hours and add miles to the trip.
In a healthy brain, pieces of a memory are stored in different places in the brain. Let’s say I am enjoying a family dinner with my kids. I am making memories of this fun family dinner. The visual pieces are stored in the back of my brain, the conversation is stored in the temple area, and the delicious smells go into their special compartment. The overall emotions of love and happiness thread this memory pieces together, like beads or pearls on a string. Several weeks later, I smell roasted chicken while walking through the deli section of the grocery store and BAM! The aroma is identical to the roasted chicken I made. The recall of that aroma “tugs” on the aroma already stored in my brain and associated with the happy family dinner, and the whole memory “string” gets pulled out so that I can enjoy this happy memory.
If I develop dementia, a piece of the memory string may be cut off. The pieces of the memory are there, I just cannot get to them. When I try to recall the happy family dinner, I may only be able to get to one small piece of the memory: I remember my son being there, but not my daughter. Should I share this altered memory with my adult children and omit Sara, she may think that I have “forgotten” her. Nope. My memory of her is still in my brain, but the road getting me to my memory of Sara has been washed out.
Getting Around the “Washed Out” Road
Family members often try to “help” the person with dementia by telling them, reasoning with them, or even arguing with them about the correctness of a memory. If Sara were to argue with me and tell me she was present at the family dinner, this will only get me very upset. I would not forget my own daughter!! How silly! But I don’t realize that my memory road is disconnected. That my memory string has been cut. Well-meaning family members and friends who try to convince the person with dementia about a specific memory are basically trying to get to the other side of the damaged road by driving into the hole. Nobody wins, nothing gets accomplished, and someone gets (emotionally) hurt.
This is where the detour comes in. Using the same scenario, my son decides to reminisce with me. Mark shares that he remembers a song on the radio that was playing while we were eating dinner. He hums a few bars of the song. That song tugs a different memory, and as I follow the string, I wind up getting to the cut-off memories of that memorable dinner. Suddenly, I recall that Sara was singing along with the song as she and Mark cleaned up. Mark helped me to find a detour and get to another memory.
More Connections Equal More Detour Routes
What helps us to recall memories? Connections. Another way to think of connections is layers. One flimsy plastic grocery bag will rip if I put a 10-lb bag of sugar in it. But if I use 3, 4, or even 5 plastic bags, all layered one inside the other, I can easily carry a 10-lb bag of sugar to the car without the bags ripping apart. The more nerve connections that are involved with the making of a memory, the more detour options I have to get to these important memories if I have a cluster of dead nerve cells (or neurons) in parts of my brain.
When I lived in central Pennsylvania, I had one option to get to work: Route 322. There were other routes but they did not intersect, or connect with, route 322 for miles. A major truck accident would result in being stuck on route 322 for hours, something that occurred with annoying frequency during winter snow storms. In contrast, when I lived in Philadelphia, I had several alternate choices because of the busy grid of roads, highways, and interstates. Some of the detours took longer and were less convenient and direct, but I had options to arrive at my destination in spite of accidents or closed sections of highway.
Physical exercise, sufficient sleep, healthy eating, minimal alcohol consumption, and mentally-stimulating activities promote plentiful nerve connections. This is something we can all do now to help support our brain health and memories as we age. These same things can help maintain the connections already present in the brain of a person with dementia.
“Will my mother forget who I am?” I hope not. There may be times when she is not sure who you are, because of the road block between memories of you. Help her find the detour through favorite sounds and scents, pictures and foods. There will be times when she gets around the road block; cherish those moments. For times when the road remains impassable, know that she wants to get to other side but is happy to be with someone who loves her. Even if she is not quite sure who that person is, today.