Wednesday, January 2, 2013

Why Doesn't Mom Recognize Herself?

It can be confusing to caregivers when their loved one no longer seems to be able to recognize his or her own face. That thing we would think could never be lost, even in the depths of dementia. Yet there is is, an inability to know the features that define each of us, eyes, nose, smile, hair, that tiny scar on the chin. The ability to know one's own self in the mirror. And it can seem so confusing to the caregiver as well as making certain tasks more difficult to complete.
Like needing your loved one to go into the bathroom and trying to reason with his or her refusal because some older person is already in there. Or trying to explain to your mom why that old lady , her own reflection, won't wave back at her from the window.
But if you understand what dementia is doing to the brain, the confusion suddenly makes sense.
Imagine the brain and its memories are like a filing cabinet, full of files. There are files with information about your mother and father, files containing your social skills, files that tell you how to sit up straight, hold your head erect, files for the people you know and love. There are literally files for all of our memories, whether those memories are how to walk or chew food or knit a sweater. The files exist for everything around us, everything in our world. And there are files for us at each age. How else would we recognize that photo from the sixth grade or our first dance?
Dementia, whether it is Alzheimer's or Vascular or Lewy Body, is destroying those files. Often, the files are being removed from the brain in a reverse order of how they were learned. For example, your loved one can't recall information from 2005, but can remember the family/holiday vacation from 1990. The files from 1990 are still intact, the newer files are corrupted and damaged by the dementia. Because of dementia, the brain is not only destroying files, but it is also unable to make new files, to take in new information.
So if my brain contains files only from when I was 30, I can no longer recognize myself at 70. My brain simply doesn't contain those files anymore, so when I see that 70 year old in the mirror, I believe that must be another person. It can't be me, after all I'm in my thirties.

The corruption and destruction of the files each of us hold in our brains, those files of memory/information that make each of us unique, drastically changes the experience of care for families amd professionals as well as the person with the disease. The loss of files can be painful for families to experience as their loved one forgets who they are. For some families this loss of information results in a general confusion about who you are, for others it is a total loss of any memory of you at all.
It is key to remember that during the dementia process, dead brain tissue is being removed from the brain. As individual cells are killed off, the body's systems remove those dead cells as part of waste. It is the normal system for how our bodies replace and repair cells throughout our lifetimes.
But in the process of dementia, these cells are not replaced and eventually the removal takes its toll. The brain, which weighed three pounds during adulthood, ends up weighing only one pound, because of this process. This drastic loss of tissue means the body runs less efficiently, and the memories held in the brain are damaged and destroyed and finally lost.
So mom doesn't recognize herself at her current age, means she also may not recognize you at yours.
But because each of us carries that familial link, that physical link that makes us resemble someone in our family, your mom may be convinced you are her sister or brother or mother or father. Is because those files still function. They are longer term memory, older files more deeply imbedded, therefore, still functioning as her current memory.

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