Where are we on the path?

Last week I learned more about why a dementia patient confabulates, and how confabulation usually developes, and then fades. As I’ve shared before, confabulation takes place when the patient remembers only pieces of an event, and then fills in the gaps they don’t recall in order to share a complete story. This is why mom’s retelling of her interaction with her Island doctor (a phone call) has taken on a life of its own. It’s also a view into how poor her memory really is at this point.

It’s my understanding a next step in memory loss, when crossed with anger (at least in my mother’s case), is that when the patient gets angry, their short term memory doesn’t always allow them to remember why they feel the anger (missed the van to the drug store, was unsatisfied with a meal, didn’t get any mail, someone looked at them wrong, etc…), so their memory jumps back to this ‘thing’ they’ve been confabulating about (if they have such a thing!). In mom’s case, now for months, her thing, the root of her ire, and what she retreats to when she’s miffed about almost anything, is her ever evolving tale regarding what started out as a phone call with her Island doctor.

As the patient walks further down the disease path, anger becomes a blip. Rather than retreat to a confabulated story to channel anger, that malcontent can become a fleeting momentary thing, which while being a sign of deeper memory loss, is kinder for the patient. After all, being stuck in a loop of fury over something no one said to you sounds like a wretched purgatory.

I took in the above, focusing on how in the moment a patient must be to live in a space where they no longer know what makes them angry (or happy), and how much of who that patient used to be is simply gone. This lead to thinking about my mother analytically, and realizing how shallow most of our conversations are in every setting. Her only additions to conversation anymore are to complain about the food, occasionally talk about returning to the Island, showing off her great-grandson, and, of course, her ever-changing tale of Dr. G. She enjoys what I have to say, and understands me, but rarely, rarely adds to anything I’m talking about. As I rapidly realized how much of my mom’s forceful personality carries what I take for her full presence, I asked, “Does the family keep seeing their loved one, keep extrapolating their mindful presence and ability far longer than it actually exists due to force of personality, habits of speech, humor….?” The answer was, “Most families do.”

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