Dementia Time

Due to the relentless advancing of my age, I often contemplate time and question how much is left. When I was a child, it took forever for my next birthday to come around. Now on each birthday, I’m dismayed at how quickly the year passed.

Einstein said time is relevant to the one perceiving it. “Put your hand on a hot stove for a minute, and it seems like an hour. Sit with a pretty girl for an hour, and it seems like a minute. That’s relativity.”

Time slows when we are young because what we are experiencing is new; we pay more attention to what happens. With age, our past experiences, knowledge, and tendency to follow routines and habits make for fewer new experiences. Because it’s all “old hat,” and we commonly don’t pay as much attention. Thus, time seems to race.

We lose track of time when we are older because we don’t focus our attention as in earlier years when our lives began to unfold. Basically, time awareness depends on the intensity of our concentrated attention.

With dementia, it’s difficult to understand time because the ability to concentrate deteriorates to a minimal attention span.

PAST

The brain can mentally fabricate what seems like an actual experience. When we become immersed in a daydream, we lose track of time, and the present fades as we lose ourselves in fantasy; then, something or someone jolts us back.

During a dementia episode, the individual is unaware this experience is just in their mind. These states of mind happen more frequently in the advanced stages when the defined boundary between the inner and outer world breaks down. They may outwardly appear “gone,” staring blankly into space, or seem to be napping while, in reality, they are emersed in a mind-fabricated reality.

EMMET’S JOURNEY (fiction)

Emmet’s eyes were blankly fixed on the blaring television, playing a sitcom with loud canned laughter. The residents of the “Happy Trails Old Folks Home” were aimlessly milling around the poorly lit sitting room.

A bird singing in a tree outside the window caught his attention. The Florida sun was beautiful and the garden inviting, but for some reason, he felt afraid of the door leading to the outside.

Floating particles of sparkling dust reflected in a sunbeam, and as he watched their movement, he thought how they looked like dancing snowflakes. He always liked the snow and the winter.

Emmet’s eyes gradually took on a blank, faraway stare as he slipped away in time.

The wind blew billows of snow over the dunes surrounding the frozen lake and the white-capped North Carolina Mountains created a picture-postcard vision. Snowflakes were falling, and no footprints marred the pristine white surface of the hill leading from the house down to the dock.

Emmet had just received a brand-new sled and was about to take his maiden voyage. He tightened his cap and knotted his scarf. Then, belly to sled, Emmett launched his red rocket down the hill. He felt the sharp sting of the cold wind on his face and the exhilaration and excited fear at the increasing speed.

At the shore of the lake, the momentum shot him out onto the ice, traveling at the speed of light. The wind became silent, and his screams of eight-year-old delight echoed in the stillness of the air.

Suddenly a deafening alarm sounded, bringing Emmet abruptly back to the reality of his wheelchair. He noticed a woman had attempted to go out the garden door. She looked confused as an aide reset the alarm and then led her away.

Emmet vaguely remembered something about a bird as he returned to staring at the tree with the now-empty branch.

Emmet traveled back in time; he became a child again. He experienced the cold and snow and felt his excitement as though it was happening in the present. To Emmet, the experience was real.

PRESENT

What is it like living constantly in the present, without past memory or awareness of the future?

Every time a person finishes saying something, it immediately becomes the past, and the listener has to remember what they said to answer. Whether it was said a minute ago or an hour. If memory deteriorates, one wouldn’t know how to answer.

Memory is part of the past. Memory is information on how to do things, recognize people, and places, label objects and recall words. When memory is lost, so are significant parts of our lives.

The past and future don’t exist; all that is real happens now. When we are mindful of the moment, we grow consciously and spiritually. Many new spiritual leaders like Eckhart Tolle, Deepak Chopra, or Bruce Lipton expound on the benefits of living in the now.

We usually live our lives pretty oblivious of the moment. Most of our thoughts are on the past or what we plan to do later. We automatically go about our “moments” unaware of the present. It takes a conscious effort to pull it all back and be focused and aware of whatever you are doing in the present moment.

We prepare meals, read books, exercise, build things, and even walk with our minds wandering elsewhere. Try to keep your focus only on your movements while walking. You might be able to for a while, but your attention will eventually wander. I practice mindfulness quite often while driving long distances to keep alert. I consciously focus my attention on the road ahead. However, invariably my mind wanders. Driving doesn’t require 100% of my attention; it’s an automatic function. Sometimes I arrive home and can’t remember the last mile; I was thinking about dinner. Who was driving!

Keeping your conscious attention focused is called mindfulness. You become a watcher, mindfully aware of whatever is happening at the moment.

Most times, the person with dementia is also aware of what’s happening at this moment, but the difference is they usually can’t mindfully follow what’s happening; they simply experience it. They can’t create a watcher that observes themselves doing.

Caregivers can utilize their LOs living in the present to their advantage. Do those constantly repeated questions drive you up a wall? The simple solution is to find a short reply and automatically reply with the same answer every time.

How about the questions about where their long-dead mother is? The easy reply is, “She’s at the store getting food for lunch.”

“I want to go home!” Just reply, “The taxi is on its way,” or “Let’s visit a while longer and then go home.” Find an easy reply and use it every time. Get creative.

When trying to find something to talk about, it isn’t easy to keep the individual engaged in conversation. But if they have memory loss, you can repeat the same stories; for them, it’s new every time. It can be for you too.

FUTURE

How does a person with dementia understand the future? They don’t.

You might say, “Lunch will be ready soon,” but soon is pretty abstract; how soon is soon? Time is conceptual, and the person can’t understand what the length of time, “soon” means. If hungry, give them a snack and let them know when lunch is finally ready.

Reminding them that they have a doctor’s appointment tomorrow is also not a good idea. When is tomorrow? They often get apprehensive and stressed about the impending excursion, which can last from your first reminder until you return from the doctor. It can also trigger those repeated questions. “When are we going, what day do we go, do we have an appointment, etc.”

My policy is not to mention any future activities or appointments until close to the designated time to get ready.

When the brain gradually loses past information, it can’t formulate the future. We create our future using elements from what we’ve learned and experienced in our earlier lives. Imagination deteriorates with memory loss, and the ability to envision the future in our minds and how to create it vanishes. We can’t build our future if we lose what we have learned in the past.

When the ability to visualize is gone, they can’t create a picture of something in their head. So, when you ask your LO what they would like to do, they usually reply, “Nothing.”