Do I know you?


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One very poignant passage in Wong Chai Kee’s memoir of his mother’s descent into dementia sticks in my mind. He writes about visiting her one day, and being greeted and invited in very pleasantly. They sit and chat, and he hands her some money as he usually does. She accepts it and thanks him rather formally. He found the experience rather surreal but they continue chatting, and suddenly she gives a start of recognition and says… “Oh, you’re my son!”

She had not recognised him until then. She knew she had a son, but she was not able to put two and two together that the man at her door who came in and gave her money, was indeed her son, until some time had passed.

Other examples are of women who forget who their husbands are, and insist the man they see in front of them is not their spouse. Perhaps they cannot remember what their husbands look like now, and are recalling instead a younger image in their minds.

I had a similar experience of being temporarily forgotten; mom spoke to me as though I was someone else and announced “My son just went home!” when I walked in the door.

I like to think I was not forgotten. Maybe just for that little while I was not properly recognised for who I was. There is a condition called prosopagnosia, which refers to the impaired ability to recognise faces. Apparently, we all have different facial recognition abilities, and the worst ones amongst us are practically “face blind”. There are online tests to help evaluate this – here’s one. Even without the test, I knew I was not going to be great at it. I never recognised Madonna from one remake to the next when she changed hair color, hairstyle and makeup.

If we think of dementia as the gradual loss of discrete abilities as different parts of the brain is affected, then the loss of facial recognition could be just one amongst many losses. Loss of the names of things apparently happens fairly early. Mom would say “troller” instead of “trolley”. When she forgot the word “thunder”, she said, “that loud noise that hit the ground”, smashing her hand against the other palm.

Accompanying the loss of names of things and people is the loss of meaning. The loss of the connections between things. Failure to understand money, a lack of judgement, choosing inappropriate clothing. Complex ideas are simplified. Disjointed ideas may be connected up in inexplicable ways.

Dementia has been described as brain atrophy where there is loss of brain cells. Such loss may result in “holes in the brain” in areas representing specific brain functions such as the names of things. The holes may also interrupt the connecting neuronal highways that link faces and meaning. The detour past the holes and the potential misconnections mess up messages and create confusion. As mom once said, “I cannot go to the US until the later part of the year because of the Southern Hemisphere winter”.

The physical representation using holes and tangles in the brain does not explain everything we see in dementia though. It cannot explain why there are fluctuations of ability from day to day. Nor can it explain why medications seem to help. There’s probably something going on in the brain chemistry that varies from day to day and can be affected by drugs.

To summarise, the reasons for not remembering people in dementia could be due to:

a) loss of short-term memory and forgetting what the person looks like most recently

b) loss of facial recognition or loss of ability to “see” in 3-D.

c) loss of total memory

I am convinced the cure for Alzheimer’s and most dementias is pretty far away. Until then, I will constantly look for spiritual ways to understand and cope with the changes in mom so that we can all lead as meaningful lifes as possible.

 

Post-script: The portraits above are of Hong Kong actor Chow Yun Fat at different ages and settings. Hope you noticed they are the same person. 

 

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20 thoughts on “Do I know you?”

  1. I have not had to deal with dementia but your explanation makes it as understandable as it’s going to get.
    Yes, I knew the three pictures were of the same person, and he looked familiar but I could not place him until I read your ‘bottom’ line.

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  2. One of the hardest things for us–my family–to deal with is Mother’s inability to comprehend ‘time.’ She no longer knows what Spring or Winter means. She doesn’t understand the concept of “we must go now or we will be late.” She does not know if I am coming in 15 minutes or 2 days if I say “I will be there later this afternoon.” Despite knowing this, we continue to use these terms and phrases because they are so critical to our orientation in the world.

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    1. My mom has this problem too! I keep it simple when I can – and just say, let’s go in 10 minutes or half an hour. Fortunately, she lives with me and loves going out, so she will drop whatever she is doing happily.
      If I give her too much warning, she spends hours waiting anxiously for the time to arrive.

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  3. Another well-throughout post! Regarding prosopagnosia, there is an excellent WordPress blogger who has this condition and writes about it. Here’s a link: http://findingstrengthtostandagain.wordpress.com/.

    Regarding long-term memory, at the University of Kansas (KU) we were taught that there is no evidence that a person ever forgets anything. The problem is one of “retrieval” of memories. If plaque, cell, or other damage blocks the path between the “request” for a memory and where that memory actually resides in the brain, then retrieval of that memory is not going to happen. When something like this occurs—and as you implied—the brain may try to “fill in” with a “next-best-fit” like your troller vs. trolley example. Is KU correct on this? I don’t know for sure, but the idea seems sound.

    Again, you did a VERY good job with this post!

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    1. Thank you! Glad you liked this post.
      I checked out the link you gave and that is indeed a severe case of prosopagnosia. Life must be really hard not to recognise oneself in the mirror.

      I think KU is probably correct in that explanation, except the example does not seem to apply very well to dementia. Typically in early Alzheimer’s, long term memory is excellent, while short term memory (or new memory) is absent.

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  4. “Accompanying the loss of names of things and people is the loss of meaning. The loss of the connections between things.”
    I really appreciated this reminder.
    Thank-you for educating both yourself and others about this tragic disease as you care so tenderly for your dear mother.

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  5. Mom forgot me very shortly after we had to place her in a home. It broke my heart and still makes me get misty eyed. To this day I can still recall the exact place and what she was doing when she said my name to no one in particular (and especially not to me). Wonderful post today I wish things like this were out when I was a caregiver.

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