Caregiver Insights

Understanding Dementia

A Peek Inside the Alzheimer's Brain

Alzheimer’s disease is caused by physiological changes in the brain, including atrophy and a breakdown of communication between neurons. This results in the loss of memories, declining word recall, and confusion.

Our vocabulary provides the structure for us to form, organize and communicate our thoughts. With the loss of words, people with Alzheimer’s slowly lose the scaffolding that enables reasoning. Without language to anchor memories and meaning, the mind begins to drift – first losing nouns, then narratives, then the ability to relate to others and even the sense of self. It is not just the words that are lost. People with Alzheimer’s lose the concepts the words represent. The decline in language mirrors the descent from articulated thought toward our pre-verbal time as infants.

It is hard for us to conceive of life without the ability to process new information and structure our thoughts. But this decline helps explain the reliance our loved ones have on the prevailing emotions of the moment. It also explains why non-verbal activities like art and music provide comfort and relief from more stressful activities that require skills they no longer rely on.

During my journey as a caregiver, I wondered what was going on in Gayla’s mind as she sat and silently stared into space. It was so unlike the vibrant, active person I had known for more than fifty years. My attempt to find the answer through research has only been partially successful. The best answer I found was: “It depends.” Individuals are so different, and moods are volatile. That, however, doesn’t prevent experts from making educated guesses.  Four of their observations:

  • When people with Alzheimer’s are overwhelmed by frustration or activities going on around them, they likely are having difficulty processing their thoughts. This could lead them into a neutral mental state in which their brains disengage with the world around them, and they appear to be content. 

  • Even when they do not feel overwhelmed, Alzheimer’s cognitive decline leads to confusion, disorientation, and difficulty forming coherent thoughts. Jumbled thinking may lead to moments of staring when they seem lost in their own minds.

  • Behavior is affected by the location within the brain in which damage from Alzheimer’s occurs. People who have severe damage in the frontal or temporal lobes that govern impulse control and emotional processing are more inclined to exhibit aggressive behavior. People with less damage in the frontal and temporal lobes tend to be more relaxed and accepting. This dynamic likely plays a role in what people are thinking as they stare into space. 

  • In many cases, staring may simply be a sign that the person is daydreaming or just enjoying a moment of peace.

The commonality of these four observations is that, regardless of the cause, in each instance of staring, the person with Alzheimer’s has become disconnected with their surroundings and has entered a world of their own. I believe that this is something caregivers should appreciate and be sensitive to.

It is not uncommon for caregivers feel that they should keep their loved ones stimulated, active and entertained. While this is a noble belief, sometimes it may be misdirected. When your loved one’s mind is frustrated, overwhelmed, confused, jumbled, or just taking a break, it is quite possible that they will be most at ease if you just let them drift in their own world for a while. This is an opportunity for you to take a break as well.

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