Severe Memory Loss and Confusion
General Suggestions for Communicating with Individuals Who Have Memory Impairments
How to make and use a memory book
Using Environmental and Visual Cues
An estimated 2.4 to 2.8 million people in the United States have Alzheimer's disease. The cause of senile dementia of the Alzheimer's type is unknown. Several theories on the cause of this type of dementia have been suggested, including aluminum intoxication, vital diseases, immunological defects, and genetic factors.
Research has shown that individuals with Alzheimer's disease have a deficiency of choline acetyltransferase, an enzyme that is required in the production of the neurotransmitter acetylcholine. Somatostatin, another neurotransmitter, has also been found to be deficient in individuals with Alzheimer's disease. It appears that cell loss occurs at the site in the brain where acetylcholine originates, the nucleus basalis of Meynert. Brain tissue biopsies have also revealed abnormal quantities of neuritic plaques and neurofibrillary tangles in the brain tissue of patients with Alzheimer's disease (Kra 1986).
A physician makes a diagnosis of Alzheimer's disease after examining symptoms, ruling out other causes for the symptoms, documenting the progression of symptoms over time, and obtaining compatible CT or nuclear magnetic resonance (NMR) imaging test results.
This is a degenerative disease similar to Alzheimer's disease, causing severe cognitive deficits. (Alzheimer's disease occurs 10 to 15 times more frequently than Pick's disease.) Onset usually occurs between 40 and 60 years of age. Pick's disease causes atrophy of the brain, most commonly in the temporal and/or frontal lobes. Patients with this disease develop a ravenous appetite, loss of fear, oral exploratory behavior, and hypersexuality, and tend to demand to explore environmental stimuli as soon as they are perceived. Aphasia usually develops in the early stages of the disease, but memory and visuospatial skills are intact until the middle or later stages. In the end stages of the disease, all cognitive, motor, and visuospatial skills are impaired. Death generally occurs 6 to 12 years after onset; only 20% of the patients live longer than 10 years.
No one structure or location in the brain is responsible for memory. Rather, memory is a complex process. The brain uses different processes to store memories of what you see, hear, feel, smell, and taste.
There appear to be three phases involved in memory. The first phase is sensory memory. In this stage, your senses hold on to information very briefly. This sensory information is then processed by the brain and stored into short-term memory. Short-term memory consists of what you have in mind at the moment.
The amount of information that can be stored in short-term memory is limited. The information can be kept in this storage for only a short period of time (30 seconds or less). Because the amount of information that can be held in short-term memory is limited, much of the information in this storage system is lost, discarded, or ignored. If you are not able to hold on to information for a few seconds, you probably will not be able to remember the information several hours or days later.
Information in short-term memory is then processed and transferred to long-term storage. Long-term memory has the capacity to hold a large amount of information. Information can be stored in long-term memory from 30 seconds to a lifetime. Memories from yesterday and from childhood are stored in long-term memory.
Some degree of memory impairment is present in many people who have experienced brain damage. Damage to the brain can occur from a stroke, head trauma, brain infection, or disease.
Memory affects almost every daily activity. Many times, people with memory difficulties will have problems attending and concentrating. They become easily distracted by noises (such as people talking, children crying, television or radio audio, and so forth). They may also find it difficult to concentrate when visual distractions are present (such as people walking by, children playing, or cars going by the window). It is important to decrease or eliminate these distractions when the person is trying to concentrate on a task.
Severe Memory Loss and Confusion
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Develop a consistent daily routine for bathing, dressing, meals, and so forth. Give the individual as much freedom as possible to allow the person to have a sense of independence, but provide enough structure to help decrease confusion. A written daily schedule will help provide structure. |
| Avoid talking about the individual's problems or impairments in front of the person, and gently remind others to do the same. |
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Try to maintain a relaxed, calm atmosphere. If the individual becomes upset, speak in a soft, calm voice. Sometimes playing soft music will help the person relax. Check to make sure the individual always wears an identification bracelet or necklace with the phone number and the nature of the problem. |
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Avoid too much stimulation. Keep the individual active and provide stimulating activities, but realize that too much activity or stimulation can be upsetting. |
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The person may laugh, cry, or have inappropriate verbal outbursts. The individual may try to strike out physically at people who are assisting with an activity, or refuse to complete daily activities. These reactions are caused by the brain damage. Watch for signs that the individual is becoming upset or overwhelmed. |
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The person may overreact to situations or events, especially if a task is too complicated or if the individual is asked to do more than one thing at a time. Simplify activities, breaking them down into simple steps. |
| Look for activities the individual enjoys and is able to participate in, and make use of those activities. |
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Be a good observer. Look for signs that may indicate that the individual is becoming upset, and try to determine the trigger for the behavior. Try to avoid the activity or event that triggered the behavior and, if possible, simplify or change the activity. |
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If the individual becomes upset or resistant, gently try to remove the person from the environment. Remain calm and move slowly. Do not reason or argue with the individual. Remember, the inappropriate behavior is due to the brain damage, and the person is not behaving this way intentionally. |
| Take time out from being a caregiver. Schedule some time for yourself on a regular basis. |
General Suggestions for Communicating with Individuals Who Have Memory Impairments
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If possible, decrease distractions in the home, school, or work environment when having a conversation or giving instructions, or when the individual is completing a task requiring concentration. |
| Get the individual's attention and face the individual before initiating conversation or giving verbal instructions. |
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Avoid giving lengthy verbal instructions or using complex sentences and vocabulary. Break instructions down into simple step-by-step tasks. Written steps may be helpful for the individual when completing a task. |
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The individual may not remember information discussed in conversation, even immediately after the information has been given. The person may need to have the information repeated several times in several different ways. Avoid making judgmental comments if the individual forgets something you just said. |
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The individual's ability to remember and concentrate may fluctuate over time. You may see the person's skills deteriorate if the individual is tired. |
| Use descriptions to help the individual orient to person, place, and time. |
| If the individual has difficulty remembering names, state your name
instead of asking the person to recall your name.
The information on this and the linked pages comes from: © 1994 by Communication Skill Builders, Inc. 602-323-7500 |