Q. I recently went to visit my father, Paul, who has Alzheimer’s. I posted a picture of us on Facebook, which prompted several cousins who lived nearby who I rarely see to visit while I was there. His first cousin, Sophie, came to visit and talked about how she lived next door to my dad growing up, and how she remembers her childhood adventures with him fondly. She spent hours reminiscing about the past with my father, and I was shocked that he remembered a lot of the details she mentioned such as the name of his childhood dog, Buddy, his first motorcycle, and even names of guys who were on his high school football team. Yet, he doesn’t remember anything that happened just a few hours ago. I don’t understand: why do some people with Alzheimer’s remember things from the past so vividly, but completely forget recent events and conversations? And how can I get my dad to reminisce with me more often, since it made him so happy?
A. As you can imagine, the workings of the brain are mysterious in a lot of ways, especially for those with memory impairment. Often recent memories (from a few moments to a few days ago) are mostly lost, while longer-term memories tend to remain strong the longest.
Some people with Alzheimer’s are still engaged with the present, so they may talk about current activities as well as past ones. But often they can’t capture these current activities as memories that will be called up tomorrow or even later that day or that hour. Here are some reasons why:
• For people with Alzheimer’s, a small reminder of something from the past — a smell, a sound, even a certain texture — can sometimes be enough to trigger a memory.
• Alzheimer’s affects recent memories first, i.e, short-term memory, debilitating retention of new information.
• Emotional memories, or those connected to strong emotions, such as joy and grief, can sometimes still be formed, and these long-term emotional memories are remembered longest. Emotional memories tend to be most vivid and detailed for everyone, regardless of memory impairment.
• Memories of childhood or from long ago are well encoded into long-term memory since the person has had longer to process and remember specific events.
• While those with Alzheimer’s can typically remember events in the distant past better than those in the immediate past, they still perform worse than older adults without Alzheimer’s disease in long-term memory retrieval.
• Sadly, Alzheimer’s affects the brain in such a way that even those long-term memories will fade over time as well.
What is Happening in the Brain?
Scientifically speaking, new experiences and new information is first stored in the part of the brain called the hippocampus, which then sends the memory to the brain’s long-term memory “storage bank.” The hippocampus works in concert with numerous sensory processing regions throughout the neocortex (the outermost layer of the brain) to form the new memories. Inside the neocortex, the neurochemical connections that represent an event in our life are distributed across multiple regions of the brain according to the content. For example, visual information is processed by the visual cortex in the occipital lobe in the back of the brain; auditory information is processed in the auditory cortex in the temporal lobes, on the side of the brain.
When Alzheimer’s develops, the hippocampus is one of the first areas to be affected; because the hippocampus can’t process new memories, it has no chance of moving the memory from short-term memory into the long-term storage banks.
What You Can Do
Families and friends of those affected by Alzheimer’s often do not know how to respond when their loved ones can so vividly recognize remote memories and can’t remember recent ones. Here are some suggestions on how to reminisce and recall distant memories with a loved one who has Alzheimer’s:
• Reminiscing is a way to improve mood, well-being, and behavior in those with Alzheimer’s. Initiate a discussion of past activities, events, and experiences (ideally with the with help of photographs, music, or familiar items).
• Memories of children, work, childhood, and other past events tend to be happy ones, so thinking about them can make someone with Alzheimer’s feel content. Perhaps your father can converse with the cousin he grew up with more often, or you can ask her more about memories you can discuss with him.
• If a person with Alzheimer’s acts as if they are back in the past, rather than trying to bring the person with Alzheimer’s back to reality (which is just going to cause your frustration), reflect on the past with them to enhance trust and empathy and reduce anxiety.
• Be patient while listening to repetitive stories. Ask follow-up or leading questions — you might learn something new about your dad!
• When looking through photo albums, it helps if there are names and dates under the photos.
• Don’t quiz the person to see what can be remembered or berate him or her for forgetting something that happened yesterday. Reminiscing with a loved one should be a positive thing.
• Avoid the phrase, “Do you remember . . .?” It can cause anxiety.
• If pictures and reminiscing verbally don’t work, art and music might be an effective way to bring back positive memories for your loved one with Alzheimer’s. Play your dad’s favorite song and perhaps it will help jog some happy memories for your dad.
Planning for a Loved One with Alzheimer’s
While people with Alzheimer’s can stay in the home for some time, the loss of executive function and deterioration of mental faculties can create hardships for caregivers. This is why, for most people with Alzheimer’s or other forms of dementia, there will come a time when assisted living and, eventually, nursing home care is needed.
Planning ahead for long-term care is one of the most important steps you can take. At the Farr Law Firm, we are dedicated to easing the financial and emotional burden on those suffering from Alzheimer’s and their loved ones. Through the process of Life Care Planning and Medicaid Planning (also-called Medicaid asset protection planning), we help protect a family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as and Veterans Aid and Attendance to help pay for assisted living and Medicaid to help pay for nursing home . If your family is facing a diagnosis of Alzheimer’s disease or any other type of dementia, please call us as soon as possible to make an appointment for a consultation:
Medicaid Planning Fairfax, VA: 703-691-1888
Medicaid Planning Fredericksburg, VA: 540-479-1435
Medicaid Planning Rockville, MD: 301-519-8041
Medicaid Planning Washington, DC: 202-587-2797
About Evan H Farr, CELA, CAP
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