Q: Lately my conversations with my father are very lopsided. When I call, he quickly starts in on a story I’ve heard dozens of times. He drones on while I can’t wedge in even a word, let alone “You told me already.” The more often this happens, the more I’ve begun to dread calling him.
A: These repetitive reminiscences are usually a sign of dementia. When a loved one tells you the same stories over and over, it can try your patience like a scratched record that creates an endless groove. But when client Lori understands WHY her father does this, it becomes easier to manage.
First, an early sign of dementia is the loss of linguistic skills, making it hard to participate in the verbal volley of an actual conversation. Although her father may hear her words just fine, processing and comprehending them becomes more difficult as dementia progresses. Finding the right words and sequencing them in an appropriate response is also more challenging. Short term memory problems associated with dementia make it difficult for him to remember what was just said and respond in a relevant way. Running sentences together reduces the chances that Lori can comment and possibly derail his chain of thought.
If doing all the talking, a person with dementia can easily “stay on topic”.
Second, as short term memory fades, Lori’s father will have increasing difficultly holding current events (public and personal) in working memory. This makes it hard to carry his half of the conversation using present day topics and events. But dementia typically affects long term memory much later in the disease. So the old memories are loyal companions in social engagement. Frayed but sturdy, they are familiar, trustworthy companions as well.
Humans are world’s greatest subject matter experts on themselves.
Third, what seems most familiar to a person with dementia often relates to the identity they held in their cognitive peak. The identity Lori’s father still knows is the one that lives in his reminiscences. He can speak with confidence and authority about the major events of the “old days” and his associated feelings. As the subject matter expert on his life, Lori’s father is more likely to invite questions of intrigue than challenge.
A person with dementia doesn’t necessarily make these choices consciously. Instead they are slowly honed coping strategies that, although nearly imperceptible at first, become more exaggerated with time. Lori’s father is using the skills he has left to engage with loved ones the simplest way possible.
My advice to Lori was to remember the reasons repetitive reminiscences happen and to not shy away from conversations because of the inevitable redundancy. My challenge to her was to try on an opposite perspective, with the hopes that the truth was somewhere in between.
Instead of resisting the redundant, dig in for new details each time.
I encouraged Lori to create curiosity around her father’s past and to ask for details not yet mentioned. Understanding the details of her father’s momentous memories will help her communicate with him as his dementia progresses, by tapping into the richest elements of his self-identity.
To understand more about how dementia changes a loved one’s abilities and learn how to provide optimum dementia care, check out my new book, The Dementia Field Guide.
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