“She sang every word of that song yesterday. How can she not remember what I told her ten minutes ago?”
If you've asked something like that, I understand why. It can be confusing to hear a detailed story from years ago and then answer the same question about today's appointment again.
You might even wonder whether the person is choosing what to remember.
That difference can happen with Alzheimer's disease. Understanding it can help us respond with support that makes more sense for the person and takes some pressure out of the moment for both of you.
Why can someone with Alzheimer's remember old memories?
Memory involves several systems working together. Learning something new asks different things of the brain than singing a song practiced for decades.
Alzheimer's commonly affects the ability to learn and remember new information early in the disease. Familiar songs, prayers, and some older memories may remain accessible longer. That doesn't mean every old memory stays intact or that every person follows the same pattern.
But remembering a childhood story doesn't prove that the person can reliably remember what you said this morning.
“I already told you” can't make information available if the brain didn't hold onto it in the first place.
A more useful question is: How can I give this person the information they need right now?
Alzheimer's affects more than memory
Think about making coffee. It feels like one task, especially after doing it every morning for years.
But the brain has to identify the supplies, understand what they're for, put the steps in order, maintain attention, and notice when something goes wrong.
If grounds end up in the water reservoir, memory may be part of the problem. So might difficulty with sequencing, recognition, attention, or judgment.
The same is true of getting dressed. “Go get ready” includes choosing clothes, figuring out their orientation, putting them on in order, and staying with the task.
Looking at those demands gives us more ways to help. We can lay out the clothes in order, offer one step at a time, or demonstrate the next action while leaving room for the person to do what they can.
Put less pressure on remembering
Notice how often daily life depends on remembering something someone said earlier.
“Remember, Susan is coming later.”
“Remember, we have an appointment.”
Sometimes, we can move that information into a form the person can use now. A simple note saying “Susan will be here after dinner” may help someone who can still read and understand it. A clear calendar may help another person.
Watch what happens. If the reminder adds confusion, it isn't the right support for that person at that moment.
And if repeated announcements about a future appointment create fresh worry each time, consider sharing the details closer to when the person needs them, while including them in decisions as much as they can participate.
Make conversation easier to enter
We sometimes ask memory questions without realizing it.
“Do you remember who this is?”
“What did you do today?”
You may simply be trying to connect. But if finding the answer is difficult, the person may feel put on the spot.
Try offering a starting point: “Maria's here. She came to have lunch with us.”
Or share something yourself: “These flowers remind me of your garden.”
There is still room for stories, opinions, humor, and connection. The person doesn't have to recall a recent event to belong in the conversation.
Sudden confusion needs medical attention
Alzheimer's generally develops gradually. A sudden change in confusion or alertness needs immediate medical attention. It may be delirium or another urgent condition. Don't assume it is simply the dementia progressing.
An Alzheimer's diagnosis also doesn't explain every difficult moment. Pain, poor sleep, hunger, hearing problems, and other health concerns can still affect the person's day.
Know the diagnosis, and keep seeing the person
In The Signal Guide Navigation System™, Know the Waters means knowing the diagnosis, knowing the person, and noticing the moment.
The diagnosis gives us clues. The person's response helps us decide whether our support fits.
This week, choose one moment that regularly gets difficult and ask:
How can I make this easier with the abilities available right now?
Maybe that means fewer words, a quieter room, or showing the next step. You don't have to change the whole day at once.
In Episode 11 of Navigating Dementia, we explore these Alzheimer's changes and what they can mean in everyday care.
Notes
- Alzheimer's Association. (n.d.). Communication. https://www.alz.org/help-support/caregiving/daily-care/communications
- Alzheimer's Association. (n.d.). Memory loss and confusion. https://www.alz.org/help-support/caregiving/stages-behaviors/memory-loss-confusion
- National Institute on Aging. (n.d.). What are the signs of Alzheimer's disease? https://www.nia.nih.gov/health/alzheimers-symptoms-and-diagnosis/what-are-signs-alzheimers-disease
- National Health Service. (2024, May 28). Sudden confusion (delirium). https://www.nhs.uk/symptoms/confusion/
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ABOUT THE AUTHOR
Carlyn Lenfestey, PT, MPT, CDP, CADDCT, is a licensed physical therapist with 25 years of clinical experience and 15 years specializing in dementia care. She is the founder of A Better Way: Dementia Care Solutions, LLC, the creator of the Wheel of Function Framework™, and the host of the podcast, Navigating Dementia.
DISCLAIMER
The information provided in this blog is for educational purposes only and should not be considered medical advice. Always consult with a doctor or a licensed physical therapist before starting any new exercise routine, using assistive devices, or following the recommendations mentioned. Every individual's needs are different, and professional guidance is essential to ensure safety and appropriateness of care.
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