The 7 A’s of dementia: amnesia

The 7A’s tool was developed to help understand the way a person living with dementia is experiencing their world and how we can learn to support that person. Each of the 7A’s represents damage to a particular part of the brain associated with cognitive losses. It is worth noting that each of the “A” words are stand alone medical terms often relating to other brain disorders.

Here are the 7A’s:

1. Anosognosia                           loss insight
2. Amnesia                                  loss of memory
3. Aphasia                                   loss of language
4. Agnosia                                   loss of recognition
5. Apraxia                                   loss of purposeful movement
6. Altered perception               loss of perceptual acuity
7. Apathy                                     loss of initiation

As a caregiver, keep in mind a person diagnosed with a form with dementia may not experience all of the A’s. The A’s can affect several different areas of the brain, but not always at the same time. The A’s can also appear in a combination with each other such as amnesia and agnosia.

Amnesia

Amnesia results in loss of memory and is often seen as the “classic” symptom of dementia. The two main features of amnesia that are prevalent in dementia are:

• Difficulty learning new information following the onset of amnesia (anterograde amnesia)
• Difficulty remembering past events and previously familiar information (retrograde amnesia)

In some types of dementia, you may notice other symptoms first, like personality or mood changes long before memory loss occurs. This means that amnesia is not necessarily the earliest symptom. However, as dementia symptoms progress to later stages, memory will eventually be impacted with a wide range of cognitive abilities being affected.

Common types of memory

Memory is the mental function that enables you to acquire, consolidate, convert, retain, recall, or store information. Memories can manifest as facts, experiences, events, skills, people, emotions, identity, impressions, sensations, instructions, or general knowledge. Different types of memory are stored in different areas of the brain .

Let’s look at the different kinds of memory and what distinguishes them from one another:

• short term memory
• working memory
• long term memory

Short term memory

Short term memory is usually measured in minutes-to-days and mainly relates to recent memories.  Short term memory is a brief storage of information; it is the short period of time that you can recall information that you were recently exposed to. Examples of short-term memory include where you parked your car this morning, what you ate for dinner last night, or remembering details from a TV show that you watched a few days ago.

Working memory

Working memory is connected to short term memory in that not only do you have the ability to retain information for a short period of time, but the brain uses, works, and processes the information to then apply it. Working memory is vital for many day-to-day tasks like following instructions and carrying them out, responding in conversations, listening and reading comprehension, and organization.

When short term and working memory are affected by dementia it can lead to:

1. asking the same question over and over again
2. forgetting where they just put something
3. forgetting recent events, having trouble to plan and organize
4. not being able to follow instructions or being overwhelmed by too much information
5. withdrawing from conversation

Responding to short term memory loss in dementia

1. Repeat information without pointing out the fact that the information has already been provided. Treat the repetitions as though the person was actually asking the question for the first time.
2. Validate the person’s concern over the missing item and search for it together. Try to keep items in the same place, where they are used to them being, for example keys on a hook or glasses in a drawer.
3. Use memory aides or reminders like keeping a diary, a calendar, or other visible written schedules to organize day to day activities-shopping, appointments, bath days, banking.
4. Give one piece of information at a time, whenever possible demonstrate the task. Write out the steps in short simple sentences in a large font. Structure is important-try doing the same task, in the same order, each day to develop a routine.
5. In conversation, speak slowly and clearly with the person.

(Check out this memory handbook -tips by persons living with early stage dementia)

 Long term memory

Long term memory is the information stored in the brain for a long time that can be recalled with ease. Long term memory relates to more distant memories, usually measured in months-to-years-to-decades. Long term memories last far longer than short term memories with a greater storage capacity of holding information the length of a person’s lifetime. Examples of long term memory include recollection of an important personal event like your wedding day (episodic memory), general facts like “the sky is blue” (semantic memory) or skills you learned early on like riding a bike, or tying a shoe even work tasks from a previous job (procedural memory).

When long term memory is affected by dementia it can lead to:

1. advancing word problems (mixing up words or forgetting common words)
2. taking longer to do familiar tasks such as getting dressed
3. family members appearing familiar, yet the person may be unable to recall their name or association
4. confabulation-fabricating stories due to a disruption in the long-term memory retrieval process. The person becomes unable to differentiate between what really happened, what didn’t, and when or where it happened.

Responding to long-term memory loss in dementia

1. Be patient. Allow the person plenty of time to respond – it may take them longer to process their words and work out their response. Avoid interrupting the person as it can break the pattern of communication. Look and listen for clues when there is difficulty with words:
   • Are they saying one word as a substitute for another?
   • Are they describing the word? (a chair becomes “you know… that thing you sit on”)
   • Are they pointing to something?
   • What else is their body language telling you?

2. Consider Montessori-based activities for dementia. With the Montessori method, you can incorporate familiar life skills tasks and activities into their day. The person with dementia may enjoy the process of participating in something they used to do regularly, and also come away with a sense of accomplishment and purpose.
3. Before starting a conversation, introduce yourself. Tell the person your name and your relation to them, e.g., “My name is Brenda. I’m your daughter. I am here to visit with you today Mom.” Displaying and labelling pictures of family and friends helps to cue the person without having to guess. Reminiscing can also help trigger memories by using recordings of special family events or videos of meaningful people from their life.
4. Confabulation is not lying but rather the person’s way to cope with memory changes. Avoid challenging or correcting the person on their story. One suggested approach is to “go with the flow” and meet the person where they are at in their memory.

Watching the person you’re caring for go through Amnesia can be tough. Trying some of the suggestions to support the short term and long term memory losses may make things less stressful for the both of you.

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