I am often asked, “Is the dementia real or do people just remember what they want to remember?” Dementia can by puzzling to caregivers. Some short-term memories go “poof” while others stick around. Today, Mom cannot remember whether or not she took her medications, but she can tell you that YES SHE FED THE CAT! Sure enough, the medications are sitting in the little box but the cat is finishing up his breakfast. No, the person is not faking or being difficult.
Memory and Emotion
When the memory starts to go, problems are first seen in the short-term arena. The person forgets some conversations as soon as they happen. This is the “shrinking box” phenomenon. What confuses a lot of caregivers is that some short-term memories seem to stick around, while others fade away like candle smoke. The anchor that keeps some short-term memories alive while others literally go “poof” is EMOTION. What I just ate for breakfast, or the boring conversation I just had with my adult daughter, evaporates like a drop of water on a hot parking lot. But something with a lot of emotional voltage, like the damn doctor telling me I can’t drive anymore, is going to anchor that new short-term memory in my brain. If this event upsets me enough, I am going to bring up the topic repeatedly…causing my family to wonder, “I thought she had trouble with her short-term memory?? When is she going to forget about driving???”
This is why a person with dementia may go on and on (ruminate) about something that just happened but still be unable to tell you if they ate something for breakfast. The recent event is linked to a strong emotion, either positive or negative.
Making Emotion and Memory Work for You: Schedules & Structure
The linkage between memory and emotion is important. Caregivers and care partners cannot start early enough in the disease to make the emotional connection to memory work to everyone’s advantage. The first way is to get the person with dementia on a schedule. With very small children, schedules help the brain to develop and create safety through routines. With persons with dementia, schedules are keeping the brain networks functioning (and hopefully slowing the breakdown).
The daily schedule must incorporate pleasurable activity or activities. And by that I mean pleasurable for the person with dementia. In the early stages of dementia, the pleasurable activity can serve as a reward. The reward will help to link the memory to emotions of happiness. People with dementia often start to self-isolate because social interactions can be so very draining. The carer can help by tweaking the events. Perhaps lunch with another couple instead of a large group gathering at a noisy restaurant. Or going to a local neighborhood bar for pub-grub (aka finger food) instead of an uptight restaurant with 14 forks and 12 knives.
Incorporating daily physical activity is also a must. If the physical activity has a social aspect, even better. Many of my patients and clients go to the local gym or Y. Water aerobics is a favorite. Caregivers start to become concerned about the gender-separated locker rooms, especially when a spouse or parent needs help. Start talking to your gym or Y about family changing rooms. All of these places should have family restrooms, too.
Sunshine and Fresh Air
Outside activities are important to incorporate as well. Most people feel better if they have had a chance to walk on fresh grass or sit outside and feel the breeze and sunshine. If going outside is not an option, have the person with dementia sit or stand in front of a window. Or use a porch or deck. I personally love porches and decks and patios, especially if there are planters with flowers and herbs nearby.
Caution: Negative Emotions
Unfortunately, negative emotions can also create and anchor memories. I have learned this the hard way. When I first began practicing as a nurse practitioner, I thought I had to administer a memory test at every appointment or I was not doing a good job. One lady in particular became extremely anxious and tried to leave the examination room. Her family shared that it was becoming more difficult to get her to the appointments because of “the questions.” I had inadvertently created a negative memory. The good news is that I changed my approach and avoided triggering her anxiety. She still was not happy about the appointments with me but she stayed in the room and seemed calmer.
Family members share with me their concerns that some day, mom or dad or spouse may not know who I am. While there are no guarantees, I have observed a connection between quantity and quality of interaction and recall. One family discovered that the person with dementia first recognized the family dog, then recognized the family members! The son who sees mom once a week but brings her favorite pastry may be recognized even in the severest stages of the dementia. The spouse who shows up every couple of days but spends the time “quizzing” her husband may find herself being forgotten. Or being greeted with a frown and silence. The nursing assistant who sings “You are my sunshine” to one of her residents may notice less resistance to care than others who simply try to complete a task.
Remember the shrinking box ? Emotions can be thought of as “pushing” a new memory into the crowded box, much like I shove clothing into my already bursting suitcase. The trick is to figure out how to keep the positives outweighing the yucky.
Want more information? I provide monthly webinars and individual coaching for caregivers who would like to learn more about dementia, and how to successfully deal with frustrating or scary behaviors. Click here!
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.