Presented by Sunday Care Therapy
Understanding the nuances of memory and attention is fundamental to providing compassionate dementia care. This guide explores the different types of memory, the critical role of attention, and practical sensory strategies—such as the C-Tactile system and priming—to reduce stress and enhance quality of life.
Part 1: Memory vs. Cognition
A common question in dementia care is: “Why can they remember events from 50 years ago but can’t remember what they had for breakfast?” The answer lies in understanding that memory is not a single system.
The Different Types of Memory
We categorize memory into several distinct systems, which are affected differently by dementia.
| Type | Description | Examples |
|---|---|---|
| Sensory Memory | Short-duration storage tied to senses. | Iconic (visual), Echoic (auditory), Haptic (touch). |
| Short-Term / Working Memory | Temporary storage and manipulation (seconds). Essential for reasoning. | Doing mental arithmetic; remembering a phone number long enough to dial it. |
| Long-Term: Explicit (Declarative) | Memory you can consciously recall. | Episodic: Personal events (wedding day). Semantic: Facts and knowledge (Paris is in France). |
| Long-Term: Implicit (Non-Declarative) | Memory that influences behavior without conscious awareness. | Procedural: Skills/habits (riding a bike). Priming: Exposure to a stimulus influences response. |
Part 2: The Critical Role of Attention
Attention is the gateway to memory. In simple terms: Attention selects what enters memory; memory stores what attention captures.
The Process of Memory Formation
- Selection (Attention): The brain filters sensory input. If attention is weak or split, information never enters the system.
- Encoding (Working Memory): Active information is processed. Deep processing strengthens encoding.
- Consolidation (Long-Term): The memory is stabilized (often during sleep).
The Myth of Multitasking
Divided attention, or multitasking, is the enemy of memory. When attention is split, the brain cannot form memories effectively.
- Tip: Eliminate background distractions (TV, radio) when communicating important information.
Part 3: Sundown Syndrome & Stress Management
Understanding Sundowning
Sundown Syndrome refers to increased confusion, anxiety, agitation, and pacing that typically begins at dusk. Up to 1 in 5 people with Alzheimer’s experience this.
Common Triggers:
- Fatigue (end-of-day exhaustion).
- Hunger or thirst.
- Pain or physical discomfort.
- Depression or boredom.
- Disrupted sleep patterns.
Interventions:
- Light: Use bright light in the morning and adequate lighting in the evening to reduce shadows.
- Routine: Adhere to a structured daily schedule.
- Physical Needs: Address pain, hunger, and toileting needs proactively.
Domain 5: Stress Management
Chronic stress is the antithesis of care. High cortisol levels (the stress hormone) can be toxic to the hippocampus, accelerating cognitive decline.
Why Manage Stress?
- Reduce “Excess Disability”: High anxiety makes a person more confused than their dementia alone would cause.
- Manage Behavior: Agitation is often an expression of an overwhelmed nervous system.
- Preserve Personhood: Calmness allows access to remaining skills and personality.
Part 4: The C-Tactile System (The Power of Touch)
The C-Tactile (CT) system consists of specialized nerve fibers in the skin that are optimally responsive to slow, gentle touch. Unlike fast nerves that signal pain or texture, CT fibers send signals directly to the brain’s emotional centers.
Benefits of CT Touch
- Autonomic Regulation: Shifts the nervous system from “Fight or Flight” (Sympathetic) to “Rest and Digest” (Parasympathetic).
- Chemical Release: Increases Oxytocin (bonding) and decreases Cortisol (stress).
- Connection: Provides a feeling of safety without words.
How to Apply “CT-Optimal” Touch
- Speed: Slow (3–5 cm per second).
- Pressure: Light but firm enough to make contact.
- Location: Most effective on hairy skin (forearms, back, shoulders). Avoid palms/soles.
- Context: Always approach from the front and announce your presence.
Part 5: Harnessing Implicit Memory
Even as explicit memory fails, implicit networks often remain intact. We can leverage this through Priming and Procedural Memory.
1. Priming
Priming involves using cues to prepare the brain for an activity, reducing cognitive load and resistance.
Practical Examples:
- Olfactory (Smell): The smell of toast or coffee primes the brain for “breakfast.”
- Visual: Placing a towel and washcloth on the bed primes the “bathing” routine.
- Verbal: Instead of “Get dressed,” say, “I was looking at this lovely blue shirt. It brings out your eyes.” (Primes the concept of the shirt before the task).
2. Procedural Memory (“Muscle Memory”)
This is the memory of how to do things (e.g., brushing teeth, folding laundry). It bypasses cognitive deficits.
Strategies:
- Hand-over-Hand: Gently place your hand over theirs to guide the first few motions of a task (like brushing teeth). Once the motor program starts, their body often takes over.
- Chaining: Break complex tasks into single steps. Hand them a shirt -> wait for them to put it on -> hand them trousers.
- Music: Music is deeply tied to procedural memory. A familiar song can trigger movement, humming, or dancing automatically.
Part 6: Communication Guide – What Not To Say
| Instead of saying… | Try this… |
|---|---|
| “You are wrong.” | Change the subject or validate the emotion behind the statement. |
| “I have already told you!” | Imagine it is the first time you are telling them. Remain calm. |
| “Remember when…?” | Avoid the word “remember.” Say: “I was thinking about the time we went to…” |
| “What do you want?” | Offer limited choices. “Would you like tea or coffee?” |
| “They are dead / passed away.” | Gently distract or change the subject if they ask about a deceased relative, or acknowledge the missing feeling. |
Part 7: Recommended Activities
To maintain cognitive health and quality of life, we recommend engaging clients in:
- Orientation: Gentle reminders of time, date, and place.
- Initiation Tasks: Participation in cooking, cleaning, or personal care.
- Physical Exercise: Activities that increase heart rate and cross the mid-line.
- Scanning Tasks: Puzzles or sorting activities.
- Social Interaction: Essential for brain health; isolation is a silent killer.
Sunday Care Therapy – Occupational Therapy-led Home Care Provider