If and Alzheimer's patient can't answer simple questions, are they just having a bad day?

5 answers | Last updated: Oct 04, 2016
Anniegirl asked...

If and Alzheimer's patient cannot answer the questions, What day is it? What year is it? And what is the name of the President of the United States? About how far along are they and could they just be having a bad day?

Expert Answers

Joanne Koenig Coste is a nationally recognized expert on Alzheimer's care and an outspoken advocate for patient and family care. She is the author of Learning to Speak Alzheimer's. Also, she currently is in private practice as an Alzheimer's family therapist. Ms. Koenig Coste also serves as President of Alzheimer Consulting Associates, implementing state-of-the-art Alzheimer care throughout the United States.

This is an interesting question AnnieGirl and it sounds a bit as if you are hoping it is just a 'bad day'. Most likely it is a combination of the loss of short term memory and either the time of day or, like all of us, simply not being in 'a good place' at the time of the questioning. It is always fascinating to engage an Alzheimer (AD) patient in deep conversation about things they did as teenagers and yet not recalling what they had for breakfast this morning. This is short-term-memory vs. long-term-memory and the latter is preserved for most of the AD journey. The ability to store new information however, is slowly eroding and when new info has not found a place to be kept in the injured brain then it is not possible to recall that material. This is why your mom is not able to answer these seemingly simple questions - the infrmation hasn't been stored. You will find that mom may have more accurate responses on another day or earlier in the day when AD folks seem to be at their best.
It is difficult to determine what 'stage' she is in without more behavioral and cognitive information but if the doctor is asking these questions, I suspect she is most likely in the late part of the early stage. A rule of thumb for caregivers is to try to eliminate questions from your conversation. A beloved AD patient told me once: "Asking me questions doesn't make me better, it makes me sadder". When we question cognitively-impaired adults, we make them more aware of their losses; they feel as if we are testing them and they are already pretty sure they'll flunk the test. Try to interact with mom without asking her to remember something that just may not be possible for her to recall. Do remember to take care of you.

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Community Answers

Anniegirl answered...

Thank you so much for your prompt response to my question. I have to agree that I'm hopeful that she was just having a bad day. It does however make a lot of sense that current information has less of a chance to be stored in the memory than events that happened many years ago. The quote "Asking me questions doesn't make me better, it makes me sadder", really hit home. Understanding this is very helpful. Would you recommend that her care givers leave a calendar out for her to see? Also, do you recommend that her caregivers wear name tags?

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Joanne koenig coste answered...

I don't really like the idea of a full month calendar - I have found that too much info can easily overwhelm the AD person whose brain is already being assaulted. I do recommend a calendar that is a-day-at-a-time and reflects ONLY the month, day, and the actual date. In simple large clear print, it would read "Today is Saturday April 2". Displaying the year can truly confound the person who believes it to be 1968! I love the homemade versions of this simple calendar. By all means, have her caregivers wear SIMPLE white name tags with bold black letters showing only their first name; Hurrah for you for figuring this out! Be well.

Anniegirl answered...

Thank you again for answering so quickly! The calendar and the name tags can be taken care of in a flash! I know it embarasses my Mom when she cannot remember someones name, so this is a great remedy. I think it will take a bit of stress off her too. Thank you again.

Silverlight answered...

This information is very salient and very personal as I watch my Mom go through the stages of Alzheimer's disease. I have periodically "played" a memory game that involves her and me. It allows me to assess her through the stages of AD. There are no winners or losers, and she has the sense that we are solving something together. I am in Northern California and developing a new Home Care business. This information is very valuable as my focus will be on the Geriatric Dementia patient and the broader aspect as it pertains to family, friends, and healthcare providers. This will lend itself to choosing and guiding everyone in appropriate directions as the process of AD continues. I will combine my efforts with a colleague and a specialist with the same goals. He is a geropsychiatrist (a new designation for a medical specialty). Name tags, a one day calendar, rather than her weekly desk calendar will help her understand and reduce the stress that she already experiences. Thank you very much for your very helpful information.