By: Beth Hutchason, MN, ARNP

Did you know that short-term memory lasts less than 30 seconds and can only hold about seven items? On the other hand, long-term memory can last for days to years. Some long-term memories are conscious (specific knowledge and events), and some are unconscious (knowing how to do things like tying your shoes). As a palliative care nurse practitioner, I met many people living with Alzheimer’s disease at various points along their journey. Keep in mind that not everybody with the disease is the same, but here are some generalities about Alzheimer’s disease progression.

Early Stages

Since long-term memories remain intact, you can switch the conversation to those. For example, when the questions are about when breakfast is or what they ate for breakfast, ask them to tell you all about their favorite breakfast foods, where the best breakfast they ever had was, etc. Suddenly, they are telling you detailed stories from their intact long-term memories.

Middle to Late Stages

As the disease progresses, the person’s age “walks backward” in their own mind. At first, this is not noticeable. As this process continues, they may become confused about their daughter, who looks older than the age to which they have regressed. “That would make no sense! How can this 60-year-old woman be my daughter? I am only 40 (in my mind)!” At this time, I would recommend not using your familial terms (son, daughter, granddaughter, etc.), but just use your name and continue your warm, loving relationship. They can still understand that Julie comes to see them, helps them and spends enjoyable time with them. The confusing aspect is time, not the person.

This process continues, and the person with dementia begins worrying about caring for their young children, then maybe events of their wartime service, and next, whether they missed the school bus themselves. 

Late Stages

When I first saw people with advanced dementia holding baby dolls or stuffed animals, I was a bit perplexed; I did not understand this process. Once I did, the dolls and stuffed animals made complete sense. Dolls provide structure and security as they do for a young child. I have seen people with very advanced dementia, lovingly caring for these dolls, dressing them, holding them endlessly and putting them to bed. Stuffed animals provide security and a device to help manage agitation and fidgeting, which is much better than trying to use medications.

Language

Language is another area impacted by disease progression. Suppose that a person spoke a different language in their younger years. In that case, they might well return to speaking that language, at least intermittently. Initially, you could gently remind them to speak English, assuming that this is what you speak. You may wish to consider using a translation app or a web-based translation program to learn some words of their native language so that you can communicate better. If you consider moving the person with dementia to a residential care facility, ask whether they have staff members that speak your loved one’s native language. I guarantee that this will be helpful.

Time’s a thief; he steals away
Many blossoms of to-day.
Joy he steals and also tears.
Pilfers hopes and filches fears.
May the rascal steal from you
Only what you want him to!

– Amos Russel

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Beth has been a registered nurse for 33 years and a nurse practitioner for 25 of those years. She has spent the past 14 years doing palliative care, a branch of medicine focused on improvement in quality of life and relief of suffering. During these years, she has had the opportunity to interact with many hundreds of patients with dementia and their families. They have taught her a great deal, which she hopes to share. She lives with her husband David, dogs Katya and Benson, and about 60,000 largely unnamed bees in Poulsbo, WA.

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