Dementia is a progressive loss of cognitive function, in stages, reversible or irreversible, accompanied by memory, learning and personality disturbances interfering with normal daily living. It’s also a term for numerous symptoms related to 50 different dementia disorders that affect the brain. Moreover , Alzheimer's disease accounts for 75% of all dementias over age 65. This disquisition depicts nonreversible moderate dementia .
Symptoms for irreversible dementia affecting executive ego functions are characterized by different degrees of impairment and can be described as follows: 1. Memory problems for recent events such as not remembering a recent party attendance; going to a particular restaurant or store; a previous conversation; forgetting seeing a particular movie ; and repeating the same question over and over 2. Words recall difficulty , especially nouns, calling a television a radio, a cell phone a camera, remembering a family member's name and song lyrics 3. Mislaying items such as car keys, cell phones, dog leash, articles of clothing and household items 4. Inability to recall content pertaining to reading a novel, TV news broadcast , movie dialog , and conversations. 5. Problems pertaining to recall , personal history , such as names of previous friends and former residences 6. Problems with numbers as in counting backwards from 100 by 7’s, adding , subtracting ,division and multiplication 7. Balancing a checkbook 8. Paying bills 9. Following recipe directions 10. Withdrawing from conversations because of not being able to follow and/ or remembering the right words. On the other hand, procedural memory is relatively intact. Eye - hand and gross motor movement such as with hiking, swimming, tennis, pickleball, fly casting , riding a bicycle, kayaking, and driving a motor vehicle are not impaired .
Memory capacity is a key as far as ego executive functioning is concerned. Memory is a process of acquisition, storage and retrieval of information. It's about the past, the present and the future and helps the individual to learn from successes and mistakes in order to make reasonable predictions. It affects nearly everything that individuals do .
With dementia, there are problems with short-term working memory. In short term memory one has to pay attention to information that is received from perception. Attention serves as a filter, storing only certain stimuli for a given time from 10 to 30 seconds and then forgotten. With dementia, there are severe difficulties with short-term memory. Also, problems in long-term memory occur with declarative memory which is remembering dates, historical facts, telephone numbers, names of people etc. There's episodic and semantic declarative memory . Episodic declarative memory is a memory of last night’s dinner or what happened on a particular birthday. It's time based life events in one’s autobiographical memory. Semantic declarative memory is memory of facts that is not tied to a particular time. Memories include the type of car driven ,phone numbers, arithmetic operations or a general fund of knowledge.
With dementia, learning is severely problematic. Learning is defined as the acquisition of knowledge or skills through experience, study, or by being taught. With ego executive impairment, especially with memory deficits , how can one acquire knowledge or information and retain it for later use? Problems with attention and working memory makes it difficult to take in an idea , store it or encode it , so it becomes a long-term memory. It is sometimes possible, in the short term , to rehearse the information over and over again in order for that memory to be retained. However, the likelihood of it being remembered the next day is problematic. It doesn't seem to matter if that information was positively reinforced . In other words, reinforcement was ineffective. What's more effective is a constant rehearsal of the information daily . As far as developing insight, that is not likely to happen . New learnings are simply not stored and therefore cannot be retrieved. It's like they've been eliminated from the coordination of higher brain regions of the cortex and lower brain regions in the hippocampus. There is little memory bank of stored information
In the beginning, everyone is born helpless, anxious and dependent on survival from others. During time ,the development of trust, self-awareness, autonomy, imagination, initiative, ability to learn ,reason and ability to contemplate the past and visualize the future occurs while acquiring the ability to love and work . Then, with dementia, there is a shock to one's self awareness.
Assuming that the individual went through the developmental stages with an intact identity, was athletic, received a college degree, married, had children and a successful business career. That individual was trusting ,autonomous , with meaning to life , set goals , had expectations ,and achieved success . Then, came dementia. Psychologically, there was a retrogression, in some ways similar to being again a young child. This mature adult is now becoming significantly less autonomous and more dependent. The issue of trust becomes paramount, and because of memory difficulties, the same question is asked over and over again as if doubting. The ability to reason becomes diminished because of the inability to recall and bring up past knowledge and experience. Thus, more anxiety and insecurity surfaces. Expectations , and initiative become compromised as a result of the inability to plan, organize, synthesize and assimilate information for future activities. New learning is minimal with frustration . The Individual's self-awareness is focused on changes and limitations while identity diffusion with low self-esteem surfaces as one begins to believe they are ignorant and dumb.
An insight as to how dementia affects personality , we turn to Freud,Jung and Fromm. Freud postulated primary and secondary narcissism and ;s attitudes of introversion and extroversion . Briefly, introversion is subjective with psychic energy directed toward self while extroversion is objective and has psychic energy directed toward the outer world in man’s interpersonal and interactive tendencies. According to Jung, there is a blend of both attitudes within each individual. Even though one tendency may be exhibited more prominently, the other exists in the unconscious. Specifically, the attitude of introversion, if normal, is revealed by hesitating, reflective ,reticent disposition , and can be a shrinking away from social interactions . The extroversion type is characterized by an accommodating , apparently open ,a ready disposition and at ease in any given social situation. This type forms attachments quickly and easily in a confident manner.
Ericn Fromm , in his interpersonal model of personality, incorporated various external pressures like socioeconomics , politics and culture. Fromm postulated a number of personality types and are related to Freud's secondary narcissism and Jung's extraversion characteristics. Fromm , to illustrate, depicted a marketing personality type or orientation pertinent to our topic . Fromm , takes into account profit, loss ,supply, and demand pertinent to the economic system. In order for material goods , self esteem and identity success, within the culture, the individual has to be able to sell himself on the market. This is especially important in areas related to selling various services to others while relying on the importance not only of talent but of personality variables.
Prior to dementia, the individual interpersonally exhibited trustworthiness, autonomy, initiative, reliability, cooperation ,attractiveness, flexibility, open-mindedness , social proficiency, efficiency, intelligence, adaptability, witty, generosity and being solid. These character tendencies translated into being an excellent salesperson, business owner, and being efficient with subordinates. Within society , the individual was well-liked, popular, economically and socially successful. The onset of dementia resulted in the impairment of executive ego functioning, loss of autonomy , the predominant attitude of extroversion and a marketing personality . There was an absence of growth , optimism as the quality of life began to decline with retrogression , anxiety , fear and dependency .The former identity was being replaced in this final life stage - sad , tragic and depressing without a cure . Moreover, there is an atrophy, in the mind, of generativity which interferes with the active participation to conceive, reciprocate and /or to reproduce.
PS
All we have to decide is what to do with the time that is given to us, said J.R.R. Tolkien.
Reference
Fromm, Erich. Man For Himself An Inquiry Into The Psychology Of Ethics.
Institute For Natural Resources . Understanding Dementia.
Jung, C. G. Psychological Types.
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