So we know we have dementia.
Let's talk about what's happening,
what's going on in the brain when someone is living with these changes.
And it's important to understand what's up there.
What do you have in your brain and what's going on?
Well, let's talk first about the job of the brain.
The brain runs everything.
It's really the guiding system, the maintenance system, the managing system.
So in your brain,
you have two major groupings, deep in your brain.
The limbic system.
It's the first system to develop.
It's the part of your brain that says [revving engine]. Infants have it.
It's the thrive to survive.
It's where all the core stuff is
hunger, thirst, elimination, wakes,
sleep, temperature control, regulation,
the ability to know whether or not you like something, don't like something.
Emotions, impulses, including the amygdala, which is part of this system.
And it's a really important part because it's the part
that allows you to recognize threats and that you need to do something.
And it's flight, fright, fight
fright is oh, the scary part.
Flight is the get away from this,
this is dangerous part.
And fight is I want what I want and the drive towards something.
So that's the core of your brain
that's preserved longest because it's developed first.
And in most dementias, that's going to be the last thing to go
they'll be damaged before there's destruction in that area.
But this part of the brain,
the surface of your brain called the cortex, it's the newer part.
It's the part that develops later.
And we're going to start off by talking about the part
that really controls some of this and runs this, the front part.
Now, the interesting thing is it's the last part of your brain to develop
the front part of your brain called the frontal prefrontal.
Doesn't reach full maturity in males a little later than females.
But until the late twenties, early thirties, mid-twenties to late twenties.
And what happens here is this drive, the center thing starts to be controlled
and the front part of your brain does three major things.
Number one, it says, whoa, no, no, no, no, don't do that.
That's going to get you in trouble.
Or you know what?
The long range positive outweighs the temporary.
So it causes you to be able
to delay gratification, to wait on something, to decide.
Okay, well, you know, I'll wait instead of, that's what I'm going to do.
And it also gets you to pay attention to
is this going to get me what I want in the long run?
So don't say that.
That's mean.
Don't do that. You'll lose your job.
The second thing that the front part of your brain does and is really good at
is getting you to think things through and make choices and decisions.
And and you can consider among all your options
which one you're going to pick.
Then the third thing it does, and this is the one
that's last to develop and to be honest, not everybody gets really good at it.
It's this one seeing things from another person's point of view,
being able to actually not consider it just from where you're standing,
but from where they're standing.
So when you have dementia, the parts you tend to keep really well.
Is this part, that core part, that--that flight, fight, fright
part that I want what I want and the emotions
not always like they were, though, and not like you knew the person
because this part is the first part to be damaged in many, many types
So it means I'm having trouble with controlling my impulses.
I'm doing things that don't seem right.
I'm very impulsive, so I don't like what you're doing.
And I let you know that in a nasty way.
And I've never done that.
Or the second thing I have trouble making decisions, or I make a decision,
then I go back and I'm not being logical and reasonable
and then it comes to seeing it from your point of view.
And I simply can't.
I don't understand even what you're talking about.
It can be extreme in some dementias.
And minor in others.
But ultimately, that part of your brain, this part, is much more impaired
than this part, for a good part of the disease.
And from the very beginning.
So now let's talk about the rest of this brain.
And what's interesting
is the whole rest of this brain is really based on getting information in
so you can use it. So the rest of your brain is a sensory processing system.
And in order to get the sensation in, you've got to pick it up
So we have five ways that you get information in your brain,
what you see, what you hear, what you feel and do.
Now, that's a complicated one because there's a 2--2 pieces to it,
what you smell and what you taste.
Now, the smell and the taste are actually primitive.
They're pretty basic.
They're not really high tech and so where they go first is into this limbic system.
But if you think about it, that's sort of important
because if something is not tasting good, you wouldn’t eat it.
And if it doesn't smell good, you want to get away from it.
So it's interesting that, that really is a part of the brain,
believe it or not, safety awareness in that area,
is dropping down from the very beginning, even though the rest of that
is still working.
So I want what I want, but I don't recognize danger anymore,
even with these basics of smell and taste.
So you might have noticed more interest in sugar
and salt, less in nutritional.
You might also notice that I love smells that I love,
but I don't notice smells that bother you, like...
elimination smells and
like urine and feces and body odor and spoiled food.
I'm just not aware of that.
So although this part is working, it's not right.
And I don't use this to make it work right.
The wiring is not right.
Now, these three, what you see, what you hear
and what you feel and do, that's taking up a lot of brain space.
So let's--let's figure that out.
Vision, back here in the back of your brain.
And this thing called dementia really does mess with that.
It changes it.
You have two major kinds of vision, center field and edge vision.
The center field vision is where you have curiosity and interest,
where you figure things out. That tends to be pretty well preserved.
But the edge vision, paying attention to the edges,
safety awareness, it’s just not there.
So what does that mean?
What it means is I become less
and less able to pick up on the edges of my visual field.
I become more and more focused, my world is getting smaller and smaller and smaller.
And even in the early stages of the disease,
I can go from a visual field like this, to a visual field like this.
But if you don't know that as somebody who's in my life, you touch me
on the shoulder and lean around and suddenly I think you're attacking me.
And I react strongly to that.
As the disease moves into the mid stages, which is approximate
when most people recognize it as what it is,
my visual field is closing down into binoculars.
I have about this much of the world I can see at a time.
And what that means is I miss lots of detail,
particularly, I can look out or I can look down
and pay attention here, but I can't do both at the same time
because you as my care person may not know that
you might really surprise me.
And that's not necessarily a good thing.
I surprise myself sometimes by missing details
because I also can't scan in an organized fashion.
I can't remember where I last looked to know where to look next.
And so I lose things.
And then I think people have moved things, and it's really distressing for
me to figure this out.
Then as the disease moves further, I can't take an image through
each eye, flip them around, line them up in the back of my brain.
So I can see in 3D.
So my brain has to decide double vision
or just use one but lose depth.
And when you lose depth suddenly, simple
things become very difficult because I can't judge distance to objects.
I can't tell whether it's 2D or 3D.
Is that an apple or a picture of an apple?
And so you might see me do what seem to be very odd things
where I'm trying to pick patterns off of the carpet or I'm running my hands
along the edge, or I miss the whole table when I set something down.
It's not I'm not trying.
It's that I'm not getting data and in processing it like I should.
And then we get to this one, auditory processing
now I hear things and you hear with your ears,
but you process right above that, the temporal lobes.
The interesting thing in the human brain is one side is not the same as the other.
So for 98% of human beings, the left side of your brain is where you
have formal language skills, vocabulary, comprehension, speech production,
the right is where you have basic rhythm type skills,
plus one.
Most dementias attack asymmetrically, and what they do
is they attack the left more than the right
so you lose on the left, but you maintain or keep or retain on the right.
What that means is you're losing your vocabulary, and it starts with nouns, comprehension,
early on, you may be losing one out of four words in a sentence,
and the ability to actually produce the speech and the words
in the particular format that you meant to deliver them
what you're keeping, automatic social chit chat,
which makes it seem like you're much more processing than you are,
you're actually getting more than you are
because you chit chat with people back and forth.
The second thing is you can both deliver
and get the rhythm of speech.
Third thing is that you have music, poetry and prayer.
Now, that's a gift because you can do those things.
You can sing when you can't talk anymore very frequently because that's preserved
and you learn the music as a song and it's--it's there.
You can also move rhythmically.
That means you can dance and clap
and you can move automatically better than you can plan a movement out.
Because that requires thinking skills
that just won't come together for you.
Now, the last skill you keep on this side are your forbidden words,
they're stored over there from a very young age
and they are swear words, sex talk, racial slurs and ugly words.
And suddenly you're saying things you shouldn't to people
you shouldn't say them to and you never did stuff like that before.
Don't blame the person.
They're doing the best they can when you're the care partner.
The challenge is letting that go because it just happens
to be a preserved skill, something they're good at.
Sorry, it's how it is.
Now, let's go to this
last part, and this takes up a huge amount of real estate up here.
What this is, is your ability to feel things all over your body
and then do something about it
to do something and then to realize what it feels like
and just keeping in mind that safety awareness versus skill and curiosity.
I keep curiosity, but I'm not as--I'm not as safety aware.
So temperatures
textures, I might touch something and be curious,
but I'm not as good at picking up on things.
So my safety becomes an issue fairly quickly.
And I don't necessarily know that.
So you have a map of your entire body up here
for sensation in, movement out
and this disease, even though that isn't necessarily
where it starts with many dementias, will eventually involve these areas.
It's estimated with most dementias you're going to go from a full sized
brain to one that is one-third its original size.
So you go from this to this
and quite frankly,
it's amazing that the person with dementia can do what they do do.
But the other piece of the puzzle
is to realize it's not just about the structural changes.
Your brain has chemistry and the chemistry changes second to second,
even shorter times than that, sending impulses in your brain.
But the problem is the chemistry is changing, too.
So what I could do 5 minutes ago I may not be able to do right now
because I just don't have the chemistry.
So brain changes and dementia,
does it matter?
Do you need to know this stuff?
You better believe it.
And the problem is when you hear the word dementia,
typically you're still just thinking about memory problems.
Well, working memory involves all of this stuff.
And so you can imagine it's changing.
But when we talk about long term memory
and emotional memory that is actually stored in your brain.
Tip it up, drive it in to the hippocampal area,
new learning, holding on to new things and remembering old stuff.
It's all in there.
The problem is with some dementias, you lose one and not the other.
So I'm very good at old stuff, but not new stuff.
And in other cases, I have trouble with both.
But what I tend to keep is emotional memory.
Now, that's a bit of a problem because I remember that I'm mad at you,
but I don't know why.
So chemically and structurally, the person is changing.
You can choose what you do
they don't get a choice.
It's happening.
So once you understand that about brain change, about dementia,
suddenly aha, the front of your brain activates
you have choices, decisions to make, things to do differently.
And when you do that, you make choices that change everything for both of you.