When someone in the later stages of dementia has a traumatic or upsetting experience, perhaps a particularly nasty fall or even a fright or an assault from another resident, it is easy to think that it is a blessing that they probably won’t remember it anyway. We may even console their loved ones with this thought. But the likelihood is that they probably will remember and may still be affected emotionally by their experiences even though they can’t tell us.
Our brains have two ways of storing, encoding and retrieving long term memories. Explicit memories are based on words, we can talk about them and they become part of our history. These memories fade in someone with dementia. However, Implicit memories are stored as bodily sensations or images and this system is preserved in people with dementia. Although they may not be able to verbalise their thoughts and feelings, there is growing evidence that people with dementia are still able to create new memories. These “implicit” memories can evoke an emotional response that can affect a person’s actions and behaviour even if they can’t remember why.
Here is an example:
Lily is a frail 87-year-old with severe dementia. She is a real sweetie, usually quite passive, sociable and easy to manage.
Unfortunately, one evening she was attacked in her bedroom by another resident who had become aggressive, mistaking her for someone else and she was bruised and upset. Staff were able to act quickly to calm the situation down with reassurance and distraction and Lily seemed to quickly recover. However, soon after this she started to become increasingly agitated at bedtime, frightened to be in her room and not wanting to go to bed. This was not usual behaviour for her. She was unable to explain what the problem was and didn’t respond to usual reassurance.
Lily’s implicit memories of the trauma were causing her emotional distress and affecting her behaviour. She was associating her bedroom with sensations and images of the traumatic event. She couldn’t tell anyone how she felt but her behaviour alerted staff that something was wrong, and they were able to work out that her reactions were associated with her environment.
On the other side of the coin environments can have a very positive impact on someone’s wellbeing. In Lily’s case, moving her to another bedroom, completely different to her usual one may do the trick. Families often get upset that their loved ones seem flat and don’t recognise them anymore. A change of environment to somewhere familiar such as a Park they used to visit or even a local pub can trigger those illicit memories and facilitate a positive change, including increased conversation, sharing of old memories and displays of affection and emotions previously buried. That’s why it is important when using reminiscence techniques to not just talk about old times but try to experience them using whatever media you can including a change of scenery to tap into both explicit and implicit memories.
Remember these wise words from Maya Angelou:
“…people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”