“After the stroke, her personality became completely different.” “She just gets so angry over the tiniest things!”
The brain is a lot like a business or company. Every brain cell is a worker and the parts of the brain are the different departments of a company. All of the departments must be staffed properly.
Using this example, imagine that the company decides to lay off a good chunk of the employees. Let’s say 30 out of the 100 people who work for this company. The layoffs do not all happen at once; they happen over a span of a couple of years. As the first wave of layoffs occurs, nothing seems to change. The remaining workers can easily absorb the work of the laid-off works. But once the full 30 are gone, problems start. Some days, the work gets done because all 70 are willing and able to work harder. But there are some bad days. Some of the 70 workers do not get enough sleep or eat poorly or have health problems, so the healthier workers have to shoulder even more of the burden. During these times, there are more arguments, more blaming, more harsh words. Mistakes happen more frequently. A couple of customers notice that things aren’t going as smoothly as possible, and a few comment that it is taking longer to get their orders done. There are more good days than bad days, especially when all 70 eat properly and get enough sleep.
A couple of months later, management lays off 20 more people, but like before, not all at once. However, this time, whenever 2 or 3 people leave, the work quality is noticeably worse. When there are only 50 people doing the work of 100, work quantity and quality drop. There is daily fighting, hourly disagreements, and continuous arguing. Fewer tasks are being completed correctly. Orders are wrong, projects are half-completed. Everything is a mess.
What I’ve just described happens in the brains of people with dementia. Sometimes, the loss of nerve cells is sudden, like in a stroke. The majority of times, the loss of brain cells happens quietly over time, just like the gradual layoffs in the example above.
A person with dementia has fewer brain cells trying to do the work of many brain cells. This explains why they are exhausted by the end of the day. This explains the frequent bouts of irritability or crankiness.
Stay tuned for upcoming posts that provide ways to prevent and handle irritability or crankiness!
Dr. Rita Jablonski
Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.