November 11, 2014
People with Alzheimer’s disease may not recall a visit from a loved one. But feelings from the visit may linger long after the person has gone, a new study has found.
The study, from researchers at the University of Iowa, looked at the emotional lives of people with Alzheimer’s. The results may have implications for caregivers and others who care for someone with dementia, since positive or negative experiences can have long-lasting effects that impact mood and behavior.
“This confirms that the emotional life of an Alzheimer’s patient is alive and well,” said lead author Edmarie Guzmán-Vélez, a doctoral student in clinical psychology at the University of Iowa and the lead author of the study. “Our findings should empower caregivers by showing them that their actions toward patients really do matter.”
“Frequent visits and social interactions, exercise, music, dance, jokes, and serving patients their favorite foods are all simple things that can have a lasting emotional impact on a patient’s quality of life and subjective well-being,” the authors note.
For the study, she and her colleagues enrolled 17 men and women in the early stages of Alzheimer’s disease and 17 of their cognitively healthy peers. Each participant watched a series of eight movie clips, some happy and some sad, for a total of 18 minutes each. The clips were chosen to induce feelings of either sadness, by showing scenes of loss or death, or happiness, by showing jokes and other funny scenarios. During the screenings, the films elicited expected emotional responses, with volunteers growing teary at sad movies and laughing or smiling during happy and funny ones.
About five minute after watching the films, participants were given a brief memory test to assess whether they remember what they’d seen. Those with Alzheimer’s recalled far less from the films than their healthy peers, and some were unable to recall anything about the movie. One man could not even remember seeing a movie at all.
Participants also answered questions to gauge their feelings 30 minutes before and after watching the films. Those with Alzheimer’s had feelings of sadness or happiness after watching a sad or happy movie, even if they couldn’t remember having watched the film or much about it.
For example, one woman with Alzheimer’s who had no recollections of any of the sad films stated, “I feel like all my emotions and feelings are rushing in on me. It’s extremely confusing, and I do not like that feeling.” Her reactions captures the bewilderment that a patient with Alzheimer’s may experience in the face of an apparently inexplicable feeling.
Other patients reported remembering that something sad had happened but could not recall details about the source of their sadness. One patient said, “They showed so much heartache. I don’t recall seeing joy, just pain and heartache.” The researchers also cite another paper describing Mr. A., a man with Alzheimer’s who displayed persistent dislike for a doctor after having a negative experience at an appointment, even though he could not recall specifically what had happened there.
The results, published in the journal Cognitive and Behavioral Neurology, underscore how emotional processing may be preserved even as memory fails in those with Alzheimer’s, particularly in the early stages of the disease. Several earlier studies have likewise shown that people with Alzheimer’s continue to recognize and express emotions.
The findings highlight the need to develop new caregiving techniques aimed at improving the well being and minimizing the suffering for the millions of individuals afflicted with Alzheimer’s. They illustrate how even forgotten events can continue to influence a person’s mood and highlight the need for caregivers and family members to avoid causing negative feelings and should work to produce positive ones.
It’s important that nursing homes and assisted living facilities likewise take into account a patient’s emotional life, the authors note. They also note that some experts advise that caregivers should not try to make patients conform to our version of “reality,” because such efforts can leave patients feeling upset and confused. Instead, caregivers should try to view reality from the patient’s perspective and approach the patient with empathy.
“By adopting an attitude of acceptance and giving patients constant reassurance and positive affirmation, caregivers can potentially induce prolonged states of positive emotion while minimizing negative emotion and instances of noncompliant and aggressive behavior. Similarly, because positive feelings can persist, caregivers should be encouraged to continue interventions such as social dancing and therapeutic games,” the authors write.
Guzmán-Vélez, Edmarie; Feinstein, Justin S.; Tranel, Daniel: “Feelings Without Memory in Alzheimer Disease.” Cognitive and Behavioral Neurology, Vol. 27, Issue 3, Sept. 2014