Posted on: April 10, 2015 | 0 Comments |
Not too long ago, I was leaving Walmart, groceries in hand, when I realized I had no idea where I had parked my car. Doing what I do for a living, I immediately went to, “This is the beginning of memory loss.” However, after taking a deep breath, I remembered that I’d been talking on my phone while parking and entering the store, so I hadn’t been attentive to my environment. I still didn’t know where my car was, but at least I had a decent explanation why not.
So, with the thought that dementia wasn’t imminent, I began going through the parking lot, aiming my clicker at each aisle until I heard the beep of the horn and saw my lights flashing.
We all have moments like this. And really, in such instances, it is not a lack of memory, but a lack of purposeful attention to our environment that causes the inability to recall the needed information.
Your memory doesn’t work in isolation — it’s an intricate process involving multiple parts of the brain working together.
Because of the complicated nature of memory, many caregivers and care workers may think that a person with dementia is “faking” memory loss because sometimes, they remember some things but not others. On certain occasions, the dementia patient may seem to be doing well, but at other times, their memory seems to falter.
But memory loss is not an all-or-nothing phenomenon. You can have issues in one type of memory, but not others. It is also impacted by many things, including hydration level, blood sugar, fatigue, stress, emotion, and environmental distractions to just name a few.
To further complicate matters, there is not just one type of memory, but multiple types.
Short-Term Memory Loss
In most types of dementia, changes occur in the brain and affect the different kinds of memory. Because dementia is a degenerative condition, many different types of memory begin to fail slowly over time. One of the first types of memory affected in Alzheimer’s dementia is short-term memory loss.
The part of the brain that is damaged early in Alzheimer’s disease is the hippocampus, the part of our brain where we store short-term memories, such as where a car is parked. However, unlike the time I found myself wandering through the Walmart parking lot, someone with short-term memory loss may not even remember that they drove a car to the store, or that they were on the phone when parking.
The memory of driving or parking the car was never actually encoded into their memory in the first place, or maybe it was encoded and can no longer be retrieved. In true short-term memory loss, it is not just lack of attention (although that can make memory worse).
Memory retrieval is thought to utilize a separate part of the brain, the frontal lobe. Again, it is more complicated than an all-or-nothing phenomenon.
Episodic memory is often also affected early in Alzheimer’s. Episodic memory is our memory of what is going on around us and our autobiographic memory for events. Things like: did you eat breakfast? Did your daughter visit? Did you already take a shower?
These are things that are considered episodic memories. Again, this type of memory is stored in various brain regions that must work together to come up with what happened earlier in the day, week, or month.
Memory for facts is often not affected as early in most dementias. This is called semantic memory. So, often a person with dementia can no longer remember what they had for breakfast, but they may know that a quarter is twenty-five cents or that a dog has four legs.
In semantic memory, we may not remember actually learning a fact, but we “just know it.” Semantic memory is often maintained until the later stages of dementia. Eventually the loss will be evident when the person no longer remembers what money is used for or how many kids they have.
Often these long-term memories are maintained for a greater period of time due to the stronger neural connection formed in the brain over a person’s lifetime.
Memory can be affected by where in the brain you actually store the memory. For example, some people are just better at remembering faces than names. Some are the opposite. But as the brain connections weaken, a person can have better visual memory than auditory memory. Or maybe they need to both see and hear something to help them better recall it.
Again, memory is complicated and when looking at a person with dementia, you need to consider that the more areas of the brain that can be stimulated, the more likely memory can happen.
Retrospective Memory & Prospective Memory
Often, the cognitive screens that are used for dementia are based on retrospective memory. Can a person remember a list of five words? Do they know what the date is? Can they tell you who the president is?
While this is a good indicator of retrospective memory, many of the problems seen in early dementia deals with prospective memory —
That is, can the person remember to do something at a future time?
We see this in early dementia when someone forgets to pay bills (or pays them twice) or forgets to take medications at a designated time. In these instances, a person would need to have the prospective memory to do something at a future time, then also have the retrospective memory to know that they have already done it.
If one of these isn’t working, the task may not be done correctly.
Finally, it’s good to understand that procedural memory remains intact in most types of dementia. Procedural memory is basically anything that you do that gets better with practice: things such as getting dressed, brushing your teeth, or making your morning coffee. This is why we can tie our shoes while thinking about something else.
When you are first learning to tie your shoes, you really cannot do anything except concentrate fully on each step of the process. But with time, you no longer need to “think” about how to tie shoes; you just do it. It is no longer something that we need to think about and, in fact, if you tried to explain to another person how to tie your shoes, most likely you could not do so without actually going through the process.
We want dementia sufferers to continue to do these kinds of multi-step tasks. It’s important to allow someone with dementia to continue to be as independent as possible. How many times have we seen someone who, because of an illness or injury, stopped performing their own bath or brushing their own teeth?
If someone is in mid-stage dementia or beyond and stops performing these routine tasks, it may be more difficult to reintroduce them later. This is also why we want to allow lots and lots of repetition for the person with dementia, because then the memory becomes a procedural memory. A person with dementia, even fairly late stage, can eventually learn where their room is if caregivers and staff continually take them along the same route and point out the same landmarks. Eventually, it is not in the “thinking” part of the brain that remembers — the action becomes procedural.
Those with dementia often feel much more comfortable and capable when there is a structured and established schedule for processes and routines. If we don’t assist those with dementia in these routines, we are setting them up for failure, because they are then forced to rely on memory and cognition to accomplish tasks.
Memory is complicated and this is just a brief description to the different types and mechanisms involved.
There are also neurotransmitters that are necessary for memory, particularly acetylcholine. Aricept, a medication often prescribed for Alzheimer’s, helps the body have more of this neurotransmitter available in the brain.
But, although the process is much more complicated than outlined briefly here, it is critical that caregivers understand the processes involved so they can reduce frustration and assist in promoting a person’s remaining abilities to ensure a more satisfying and successful day.