When the memory of a loved one with Alzheimer's disease (AD) begins to fade, family and friends may question what's really left of the person they used to know.
If mom cannot remember who you are, is your connection with her completely severed? Does it even matter to your husband that you visit the nursing home every day when he cannot even speak anymore?
While dementia undoubtedly alters relationships, it can't completely erase them, according to heartening research that uncovers a truth many caregivers have always known: just because a person cannot remember does not meant they cannot feel.
Patients are "profoundly impacted emotionally by events they cannot recall," according to researchers from the University of Iowa Carver College of Medicine. They found that the more impaired a person's memory of a specific event is, the stronger their feelings—both positive and negative—about that experience will be.
A progressive brain disorder, Alzheimer’s Disease (AD) destroys brain cells and leads to memory loss and significant changes in thought processes and brain function. Normally, it involves a slow and gradual development characterized by distinct stages of declining functional ability. Unfortunately, the disease is fatal and currently there is no cure.
It is the most common type of dementia, which is a general term used to describe many conditions and diseases that damage the brain. AD was discovered in 1906 and it accounts for 50 to 80 percent of reported dementia cases. It currently deprives more than 5 million Americans their memories and cognitive abilities. Researchers are constantly studying and developing possible treatments and better ways of providing care.
A rush of emotion
Caring for a loved one and watching this disease rob them of a lifetime of memories is extremely difficult for family members and friends. This research concerning patients' emotional states has been comforting for many families.
To unravel the connection between memories and emotions in AD patients, the study authors based their methodology on previous investigations into the "feelings without memory" phenomenon sometimes seen in people who've damaged their hippocampus (the part of the brain that processes memory and is often one of the first areas affected by Alzheimer's).
Video and television clips meant to provoke feelings of happiness and sadness were shown to a group of older adults, some of whom had been diagnosed with AD and some of whom were cognitively healthy.
After seeing Sophie Zawistowski choose between her children in a Nazi concentration camp in "Sophie's Choice," witnessing an Alzheimer's-stricken Allie Hamilton forget her longtime husband in "The Notebook," listening to Bill Cosby perform stand-up, and viewing highlight reels from "America's Funniest Home Videos," participants were given memory tests and asked to report on their emotional state.
Thirty minutes after the videos ended, the men and women with AD (predictably) had difficulty recalling important details about the clips. However, their emotional response to the clips still lingered, leaving many in a state of bewilderment as to why they were experiencing such strong feelings for no apparent reason. "I feel like all my emotions and feelings are rushing in on me," one AD patient remarked. "It's extremely confusing and I do not like the feelings."
The participants' discomfort is important to highlight, researchers claim, because it provides insight into the distress that a so called "free-floating" state of emotion can have on individuals with memory impairment. When a person with the disease cannot remember what is making them sad, it can cause their feelings of agitation to become magnified and last longer.
They can exhibit strong emotional responses to minor problems as well. Catastrophic type reactions can involve crying, shouting, swearing, agitation, pacing and even striking out at another person. These can be random, but typically result from triggers such as fatigue, stress, discomfort or failing to understand a situation. It is a natural, but heightened response to being overwhelmed or frightened. This behavioral response is caused by a brain dysfunction and is not within the person's control.
The power of positive encounters
Longtime family and professional caregivers (and anyone who's seen this amazing video) are unlikely to be surprised by these findings, but the conclusion is encouraging, nonetheless.
"Actions toward patients with AD have consequences, even when the patients do not appear to remember the actions," say study authors. "Our findings should empower caregivers by showing them that their actions towards patients really do matter and can significantly influence a patient's quality of life and subjective well-being."
These life-affirming activities do not have to be over-the-top: bringing your mom her favorite cookies and telling her your love her; reading your wife's favorite gossip magazines to her; watching a funny movie with your dad. Big or small, science proves that positive experiences can enhance your loved one's life in a major way.
Similarly, music evokes reactions and emotions you may not expect if you haven’t had the cause to explore. Many times a person losing the ability to speak can sing the words. There are many methodologies that successfully implement music therapy for a variety of reasons and results.
The Alzheimer’s Association recommends a best practice of Habilitation Therapy (HT), which is a comprehensive behavioral approach to caring for AD patients. One of the primary goals of the therapy is to create positive emotional states for the entire day. This is accomplished by thoughtfully engaging a patient's independence and morale to produce a positive state of well-being.
This is not rehabilitation therapy, so the emphasis is not on memory and reasoning. Instead, it focuses on harnessing the power of emotions. HT assists the patient in using the functions they still have, and using them at an optimized level. Patients still have the ability to experience emotions and perceive the emotions of others. It is a common belief that this remains intact until the end stages of the disease. This method can reduce difficult behaviors and encourage enjoyment (or at minimum, better toleration) of unwanted care tasks. It can also trigger emotional states of calmness, self-esteem and happiness.
Experienced care providers know to "spend 5 to save 20." In other words, preemptively take five minutes to initiate a social interaction that will create enjoyable moments and positive emotions. The effects are lasting and worthwhile. Keep in mind that it can take a minimum of 20 minutes to calm a frustrated outburst. An irritated caregiver produces a very agitated patient. Take a little time to share a positive moment and both of you will reap the benefits.