It is a funny thing about Alzheimer’s that memories are lost in reverse order; memories formed recently are more fleeting than those from many years ago. Alzheimer’s disease starts in the hippocampus, the region of the brain responsible for putting experiences into memory. When the hippocampus is damaged, recent experiences never have a chance to become memories. Not until much later in the disease’s progression does it affect the regions in the brain in which older memories are stored, and so those memories are available even into later stages of the disease. This phenomenon is responsible for much of the behavior and the symptoms commonly associated with Alzheimer’s, and we need to consider its effects when communicating with and selecting activities for people affected by the disease.
Make Yesteryear, not Yesterday, the Focus of Conversation
As caregivers, we need to learn new communication skills; otherwise our attempts at conversation might be the cause of frustration rather than comfort. Steer clear of talking about recent events, those things that rely on short-term memory. (Read more about communicating with people affected by dementia.)
Memory, Reminiscence and Alzheimer’s Disease
Many people with progressive memory disorders are much more comfortable talking about earlier memories. Because the area of the brain that stores memories long term is affected later in the disease’s progression, the affected person will know more about her life when she was 40 years younger than she knows about what has happened this week. A person with Alzheimer’s disease, for example, might have a detailed and lucid conversation about something that happened after the war (World War II or the Korean War) than what he or she had for breakfast, or experienced at the theater the night before.
Reminiscing and reminiscence therapy involve reaching the memories that reside in these still viable regions of the brain. There are many ways to encourage these memories, and you should. They can be comforting, even therapeutic. A study published in the June 2007 issue of Geriatrics and Gerontology International concluded that a reminiscence group program was an effective way to enhance the cognitive capacity of people with Alzheimer’s disease and vascular dementia as well as their ability to participate in normal activities of daily living. A summary of existing data, including studies published in professional journals, and interviews with specialists concluded that the general mood and cognition improved in subjects with dementia who participated in some form of reminiscence therapy.
~ Helen Keller
In a strict sense, reminiscence therapy involves discussing and sharing memories, reviewing and evaluating those memories, and re-capturing the emotions and feelings that are an integral part of those memories. This process can be done one-to-one or in groups. However, when reminiscing with someone with dementia it is often better to take a less formal approach, and one-to-one can be preferable to group reminiscence, especially for people in more advanced stages. You may want to eliminate the evaluation and review part and focus on the emotions inherent in the memories. The activity should be enjoyable and nonthreatening, and talking and sharing is not even a strict requirement. Never try to force the conversation, but you may have to lead it by making suggestions, like, “Do you remember what you were doing when Neil Armstrong landed on the moon?” Props or aids are also a good way to initiate and sustain the process.
Prompts and Aids for Reminiscing
Music (music therapy) is one of the most popular and effective ways to stimulate reminiscing. A song might trigger memories of things a person was doing forty, fifty, or even sixty years ago. He might re-live a date that he was having with the girl that would later become his wife, or remember high school days and school dances. That is the essence of reminiscing. It not only exercises the brain’s memory mechanism, reminiscing also provides positive emotional feedback, which improves the quality of life. Petr Janata at the University of California has found a direct neurological connection between music and the memories that the music triggers. Music causes activity in the same part of the brain in which the corresponding memory is processed.
The HBO documentary The Alzheimer’s Project, quite literally follows Woody as he wanders from place to place around the community in which he lives. Never content to stay put, he finds a place to sit, and before he has had a chance to settle in is wondering where he should go next. Told the basic rules of baseball, Woody cannot name the game, yet he whistles and sings incessantly. In fact, he occasionally sings with an acapella group, The Grunyons, that he belonged to for many years, and will even sing fairly complicated solos. He never flubs the lyric, and it is quite obvious that he is enjoying himself immensely while performing.
A clip from HBO’s The Alzheimer’s Project showing Woody singing with his old acapella group, The Grunyons.
The more familiar the music is, the stronger the emotional response, but even unfamiliar music seems to aid reminiscence. As reported in The Epoch Times; Mar 19, 2008 Singer-songwriter Jason Soudah was asked to provide music to accompany personal films made specifically to trigger reminiscences. He played music to fit the scenes on the film, music that was “soothing and dreamy”. The combination of music with the personal memorabilia increases the effectiveness of the visual reminders. This is part of the reason that our nature and ambient DVDs are so effective and well liked. Most are accompanied by music similar to what Soudah composes for the films and we offer a broad variety: there is a setting or a subject that almost everyone will find memorable including forests, oceans, flowers, butterflies, beaches, and many more.
Pictures that bring back memories are another excellent aid to the reminiscence process. Photographs of family and friends and anything else in one’s personal history are obvious choices, but any picture that elicits a memory of something in the past is beneficial. The picture at the top of this page shows Bernice
enjoying a photo album of our family, which is her family, for all intents and purposes. She recognizes and loves asking questions about our children. “How’s Jackie?” she’ll ask, taking them in chronological order. “She’s fine,” Holly will answer. “And she is expecting a baby,” she’ll add. “She IS?!” is always her response to that. Then, “Is she old enough?” “Yes, Holly will tell her. “She’s 27.” “She IS?!” once again. After her surprise settles down she will ask about Abby and Christy, and we’ll get her up to date on them. Invariably she will then ask, “And how’s Jackie?” and the whole conversation will be repeated, almost verbatim.
Photographs are not the only pictures that interest Bernice. She loves to look at her reprints of old Sears Roebuck Catalogs. Bernice worked for Sears when she was younger, teaching women all over the country to sew. She loves to point out the dresses and suits that she designed. We, of course, don’t challenge that. It doesn’t hurt her to think so (and who knows, maybe she did design those dresses). She also loves her picture books of babies and animals. Rachael Hale has several very fun books that show animals in different poses and settings, and Ann Geddes has become somewhat famous posing babies in colorful and interesting clothes. Some of the coffee table books have beautiful pictures of things past: old cars or airplanes, art and architecture, nature and geography, cities and countries, and countless other subjects. You can sometimes find these books deeply discounted at the larger bookstores.
All sorts of sensory stimulation can prompt reminiscences. Familiar smells are particularly good at eliciting memories. We have all been transported to a time in our past by the smell of a favorite food wafting from the kitchen, or the scent of a certain flower. The fact that smells have a particular ability to transport us into our past is well known by literary figures such as Poe and Hesse, as seen in their respective works Marginalia and The Glass Bead Game. If your mother was a cook or baker, use spices to inspire memories. If your dad enjoyed woodworking, the smell of different woods will remind him of that, though these smells might be more difficult to collect.
A memory book is simply a way to organize memories and mementos — photographs, stories, genealogy, significant documents, etc. Creating and completing such a book can be an invaluable life review, especially as an activity for people in earlier stages of any progressive cognitive disorder. Later it can be used over and over again to stimulate reminiscences. There are several good books that have been designed to prompt and contain memories of one’s life. They have questions about genealogy, friends, marriage and all of those things that make up personal history, and provide space to write answers as well as post photographs and other memorabilia.
Blank journal books come with a large variety of decorative covers and are available at most book stores. Use one of these to create your own memory book, or use a loose-leaf binder that will allow you to add and re-arrange pages. Connie Lucas, Program Specialist at the Alzheimer’s Association, Greater Iowa Chapter, offers guidelines for creating such a book. Use Connie’s suggestions, then follow your own creativity and intuition to create a truly unique and personalized book of memories that will be enjoyed by the entire family.
More Aids for Reminiscing
Shake Loose A Memory is an easy to play game designed especially for elderly people who are memory impaired. All five games in this series contain memory-stimulating cards that will inspire hours of reminiscing, conversation, and socialization. Game play can even produce ideas to include in a memory book.
Music from the past is one of the most powerful ways to stimulate reminiscing. Even people in the most advanced stages of progressive cognitive disorders will visibly enjoy listening to familiar music. Non-communicative individuals will sometimes sing along with music that they recognize, or move in time with the tempo. Our music collection contains recordings and artists that the person or people in your care will remember fondly.
Our reminiscence DVDs include subjects ranging from America’s heritage to its national parks and railroad history to sing-a-longs of familiar songs.