Dementia Demensions

I’ve noticed that one of the things that is difficult for my mother, who has dementia, to do is to hold a representation of something we are talking about in her mind. Anything we attempt to converse about requires her to reference an abstract representation in her brain. (This is true for anyone.) It doesn’t matter if we are talking about a person, a place, or a thing. She is unable to hold onto these representations. They slip quickly from her mental grasp. I noticed that during those times when her dementia is heightened by tiredness or illness, she anchors herself by describing what she sees around her. Not only is this something her brain can still do successfully, it also makes her feel more in control. My mother lives in a memory care facility a couple of plane rides away from me. We video chat to keep in touch. I’ve started planning our encounters by selecting concrete objects I can show to her as I talk about them. Recently I used holiday ornaments as the focus of our chat. We were able to talk about each ornament and notice what it looked like. I then could tell her how it was acquired and relate any memories associated with that particular ornament. Many had direct or indirect ties to my mother. These stories sparked comments from my mom, which sometimes wandered but the ornament we were talking about was always there to bring us back to the moment and to clarity. In short, people with decreased mental ability can benefit from using a concrete representation to do the work of the abstract representations many of use so automatically. We forget or are unaware that the elderly with dementia, and others impaired in similar ways, struggle to generate and hold onto these representations. Most of us realize that children often need a concrete representation to make sense of language. Those of us with brains still working well sometimes do too, especially when we are having difficulty grasping a concept that is new to us. We often use metaphors as what I used to describe to me students as “abstract concretes”, but only metaphors that are instantly recognizable and comfortably familiar will work with someone like my mother. Less indeed becomes more. Simpler and more concrete conversation aids her ability to make small mental connections. These small and successful connections create a net of trust and a lack of urgency that also promote understanding. The richness of what came up during our recent holiday ornament perusal was delightfully surprising. Many of us have been acculturated to becoming quickly angered when we encounter frustration. A little planning can lessen the struggle on both sides of a conversation between two brains that don’t work in the same way.