Before I began this blog, I contributed to Bob DeMarco’s blog, The Alzheimer’s Reading Room. Bob often wrote about “tall tales,” or some of the mixed-up memories that showed up in conversations with persons with dementia. This blog helps explain what is happening in the brains of persons with dementia. Future blogs will provide ways to handle this behavior.
One way to think of the brain is that it functions like a well-organized closet. You take apart an outfit and hang the shirt in one place, the pants or skirt in other section, and the shoes are organized in another section. When you need to put together an outfit, no big deal. You simply reach in and find the pieces that you want and put those pieces together. The pieces closest to the door are the easiest to get to, but you recall that nice wool jacket way in the back and you know to reach back and find it.
Your brain does a similar thing with memories. Each memory is like an outfit. Think of a good memory, perhaps a family vacation or an important event. The images that are part of your memory go in one section of your brain. The sounds that make up that same memory are filed in the sides of your brain. Any sensations or tastes or smells that make up this memory you are having, those are all separated and filed in specific brain compartments. Your brain works similarly to a neat and orderly walk-in closet.
As cells die in the brain of a person with dementia, several things happen. First, the most recent memories are lost. Using the closet example, notice the empty hangers in the left side of the picture. They represent the lost memories. The items deeper in the closet, however, remain accessible. This is why persons with dementia may forget what you just told them or what they had for breakfast (or even if they have eaten), but they can tell you in detail something that happened in 1972. The memories that remain also get mixed up inside the persons brain. Notice that in the closet pictured here, there is a red pair of men’s shorts and a solitary men’s shoe mixed in with women’s blouses; a white lab coat has also appeared in the shirt/blouse section.
Remember how organized the shoes were? Now, some of the shoes are sitting next to the wrong mate, while a woman’s pink blouse, a pair of silver heels, and some NYY baseball caps are residing where the shoes had been.
How difficult do you think it would be to put together an outfit from this disorganized and chaotic outfit? How frustrated would you be if you went looking for your favorite black shoes and a pink shirt was sitting there instead? Or worse, what if you were unable to tell that the closet was all mixed up? What if you simply put together outfits based on what was available in the closet? You may wind up trying to use red gym shorts as a nice shirt (to be fair, it was in the blouse/shirt section) or using a baseball cap as a shoe (hey, it was there in the shoe section).
This “mixing up of memories” inside the brain of a person with dementia may explain why your family member might have trouble getting dressed in order, or may wear the same outfit repeatedly, or may argue with you that his or her outfit is appropriate. He or she is using available memories to function and to make sense of what is going on around him or her.
Some caregivers think they are helping their loved ones by “quizzing” them almost constantly and asking them to remember. There is a difference between helping someone with dementia process information with cues and hints, and treating them like they are a game show contestant. I will talk about ways to support a person’s memory in other videos here. At the same time, presenting logic and arguing does not work. It would be like me pointing to the empty hanger and telling you to put on the bright blue shirt—if your memory is like that second closet, you don’t have a bright blue shirt and no amount of arguing will convince you otherwise.