One thing that is hard to grasp when trying to understand people who have Alzheimer’s is that their decline in cognition goes hand in glove with physical changes in the brain. Besides plaques and tangles that can interfere with neurotransmission, the brain actually atrophies and develops big empty spaces, especially in the temporal regions of the brain. That is the area that is most responsible for memory.

So imagine a thought, firing along the neuro pathways toward the area in the brain that fills in the pieces that provide a memory, only to arrive at a hole. Does the brain redirect and look for another way to the places that are still available to give that thought substance? What about when those memories are now forever lost in the hole? What information does the thought then choose to latch on to make it complete? Now realize that this all happens in nanoseconds, the part where the brain picks different pieces of information to fill in the blanks to create a memory, ask a question or create conversation. To complete a thought.

That is the life of a person with Alzheimer’s. Working with a brain filled with blocked pathways and holes so they are unconsciously recreating their reality every time they try to retrieve information. The brain fits together the pieces of memories like a puzzle. To you and I the picture they are presenting is a jumbled mess, but to them it often seems to make perfect sense. Not only does what they pieced together make sense, but most importantly to them, they need you to understand it to be real.

In the spirit of full disclosure it is more experience than science that brings me to the conclusions of why and how Alzheimer’s suffers communicate. It is the countless hours of spending time with my mother and her deteriorating brain and her efforts to make sense of the world that has given me a hint of how and where the puzzle pieces, that don’t seem a fit to me, look and feel good to her. Memories lost necessitating new ones created, give her a reality that enables her to still coexist, find a place to fit in and still be relevant. It happens unconsciously I am sure, but it speaks to the dignity that we all strive to maintain as sentient beings.

To take off the heavy edge, my reality is that some of the new and jumbled pieces my mother creates can make a brighter place than the memories and habits of old. For example, every time she has a Haagen-Dazs chocolate covered ice cream bar she exclaims that it is the best thing she has ever eaten. When I walk out of the bathroom after a shower she will point to my head and say “Oh look, your hair is smiling!” Everyday I come home from work she greets me like I just came back from a lengthy absence and is so excited to see me. Any bright colored clothing I wear is the most beautiful thing she has ever seen. Trees blowing in the wind are talking and that makes her happy. She smiles and waves at almost everyone at a restaurant like she knows them. Paper plates are to be washed and put out in the sun to dry. Sometimes they are to be displayed on her dresser because the flowered patten is so pretty. Dogs and cats can eat, sleep and behave however, and where ever they want. The only down side to that new reality is it has to have limitations and THAT makes me the perpetual bad guy, but the animals all adore my mother!

All the new is not fun, but conversely some that was lost is not necessarily missed. I have a choice in what to enjoy, I try to embrace the inevitable change and give myself permission to be upset when this new reality is not easy. But in the end, because my mother no longer has a choice in how her thoughts are constructed and her memories created, it is my greatest hope to help to maintain her dignity. Regardless of how a person with Alzheimer’s pieces and puzzles together their new reality, the parts of who we know them to be are still in the mosaic they are creating. It’s our job to remember for them, and love them just the same.