Sep 18, 2017

Dementia: “It’s ok, they won’t remember anyway”

There is often a misconception that people with dementia or Alzheimer’s disease have memory loss, and that they are unable to create new memories.

But at a lecture from Alzheimer’s Australia last week, Professor Steven Sabat told the crowd that “thinking that people diagnosed with dementia have something called “memory loss” is harmful for a number of reasons”.

People with dementia are able to create new memories, and those memories are able to affect their actions and behaviours – even if they can’t remember why.

This is called implicit memory, which is defined as “a change in the way a person behaves that is due to an experience that the person does not recall having had”.

And in Prof. Sabat’s career, he’s witnessed many examples of this in people living with dementia – showing that dementia doesn’t mean memory loss. 

Here are three example of people with dementia who were able to still create implicit memories.

mowing-the-lawn

Mr D and the Lawn Mower

Mr D was an avid gardener. One of his regular chores was mowing the lawn.

When he was diagnosed with dementia, his wife became worried that he would hurt himself mowing the lawn.

So she decided to put a lock on the shed. But when it came time for him to mow the lawn, he took a brick, he threw it at the window and took his mower.

Mrs D, desperate to stop her husband from mowing, asked her oldest son to keep the mower at his place. Nobody told Mr D.

When it comes time to mow the lawn again, he sees that his lawn mower is gone. And when he tells Mrs D she calmly explains that their eldest son has it.

A few days later, there is a family dinner. When the younger two children arrive, Mr D greets them with hugs and kisses. When the eldest son arrives, Mr D doesn’t even look at him or talk to him.

When Mrs D asks, “are you angry with him?”

Mr D replies, “yes.”

“Why?” Mrs D enquires.

“I don’t know,” says Mr D.

Mr D was able to make a memory about being disrespected, disenfranchised, and left out of a family conversation. The eldest son, having his mower, is the perpetrator and therefore Mr D is most disappointed with him.  

Yet Mr D, who cannot recall the details, does remember that his son was involved in something that angered him.

1-3

Muslim Woman in Nursing Home

There was a Muslim woman in a nursing home. She was widowed 10 years earlier, and during those 10 years she developed Alzheimer’s and eventually placed in a nursing home.  

After her husband passed, she never saw another man – not even for a date. Because she didn’t feel the need to remarry or find a man other than her late husband.

During the night, at the nursing home, she would get up and walk around which some people would consider “wandering”.  

One day she accidently walked into the room of another resident, one who had a history of sexual aggression. And he raped her.

When he son was informed, he sued the facility for negligence.

The attorneys for the nursing home said the lawsuit should be dismissed because the woman had Alzheimer’s – and therefore she would not remember and no long term harm would be suffered.

However, contrary to this, every now and then the woman would start crying. Something she never did before her rape.

Though she may not remember the incident, deep down her implicit memory still remembered the rape and felt sadness.

8

Mrs E and the Adult Day Centre

Mrs E was a regular at the Adult Day Centre. She had dementia, and as a part of that she wasn’t able to complete a three stage command.

In the mini mental state exam, a three stage command is usually;

  1. Take a piece of paper in your right hand
  2. Fold it in half
  3. Put it on the floor

Mrs E couldn’t do that.

During lunch one day, Prof. Sabat asked Mrs E, “could you do me a favour?”

She beamed, “sure”, having rarely been asked to do something for someone else.

Prof. Sabat instructed her, “could you go over to Frank, pick up his tray and empty it in the bin please?” – his own tailored variation of the three stage command.

And she did it – a three stage command, within a context that had meaning to her.

Two days later, Prof. Sabat returned to the Adult Day Centre.

And when it came to the end of the lunch time there, Mrs E went over to the Professor and out of nowhere asked “do you have something for me to do?”

“Like what?” asked Prof. Sabat.

“I don’t know,” replied Mrs E.

She couldn’t recall the explicit detail but she knew that he would. She mad a memory of  Prof. Sabat asking her to do him a favour.

These three cases are proof that believing people with dementia have “memory loss” is damaging. 

Because if people with dementia or Alzheimer’s disease have “memory loss”, then they supposedly cannot make new memories and if they cannot make new memories, they cannot be affected for very long by what happens to them hear and now. 

And if they cannot be affected by recent events, then there is this idea that “it doesn’t matter how we treat them” – which is not true.

What do you have to say? Comment, share and like below.

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  1. Excellent article, and yes I notice this with my mother all the time. I am able to create new memories with her, or at least facilitate her ability to do so. She is 92 and has had Alzheimer’s for at least 10 years, but still is able to live well and with a little help enjoy the things she used to like painting

  2. My mother, when in high level care, would look away from my brother & his wife when they visited her each week. He decided that she didn’t even recognise them & this was the reason she did so.
    I live interstate & was only able to visit mum once or twice a year but usually rang to speak to her weekly. The care staff would hold the phone to her ear & would always comment that her face lit up like a Christmas tree whenever she heard my voice. She even tried very hard to speak to me, although she was unable to. I maintain that my brother & wife had probably been talking about her whilst being with her & she had decided she didn’t like them & that is why she ignored them. My brother kept telling me mum didn’t even know them & couldn’t understand anything they were saying. I disagree wth him.

    1. I agree with you Margaret. When your brother says that your mum doesn’t know you, it depends what you mean by ‘know’. Perhaps she cant remember your name, or even how you are placed in her family but perhaps she remembers that you are a person who is significant in her life, and she recognises that when she sees you she feels happy or relaxed or comforted. Perhaps she feels joy at hearing your voice, but does not know why she does and perhaps she could not say ‘that is my daughter’ but she connects to the love she has for you and that you have for her. ‘Knowing’ another person is a much more deeper experience than simply being able to identify them.

  3. I look after my Mum-in law with Alzheimer’s…i believe even with the condition there is new learning …as she has learing…her English has improved so much (which is not her first language). Also her emotional memory is intact as she may not remember the details of an event she has attended but woould express it by beeing happy or sad …

  4. To treat anybody by using the excuse ‘they won’t remember’ is so disrespectful and a very sad comment on our society.

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