What is time-shift?
In some types of dementia, particularly Alzheimer’s disease, the first part of the brain to be affected is the hippocampus, which plays a role in the formation of new memories. Although the hippocampus is required to retrieve newer memories, it isn’t relied on so heavily to retrieve memories from longer ago. The amygdala, responsible for emotional memories, is also less affected in the earlier stages. This means that someone with Alzheimer’s will struggle to remember what happened earlier that day but will be able to remember things that happened in their childhood and will be able to remember the emotional aspects of certain memories.
When a person’s short term memory is affected, they are more likely to interpret things in the present, based on memories of the past, as they are the memories that are most vivid. This is known as ‘time-shift’ and can result in them living in a different reality to yours. For example, Mum often believed she was of working age and would talk and act as though she was at school.
As the disease progresses further, they are more likely to regress back to their teenage years and early adulthood, as these memories often remain most vivid until the advanced stages of dementia. This is known as the reminiscence bump (possibly due to the fact that a person’s ability to remember new information peaks in our 20s).
As Mum’s illness progressed she seemed to regress further back to the time when her parents were alive and she would often ask after her Dad. Handling questions like “have you seen my Dad?” when he has been dead for 30 years is a difficult one and is one reason why ‘therapeutic lying’ is commonplace in dementia care.
Reminiscence therapy is defined by the American Psychological Association (APA) as “the use of life histories – written, oral, or both – to improve psychological well-being” and is often used with older people. Reminiscence therapy is an effective way to help positively engage with people who have ‘time-shifted’ and can help to manage some of the changes in behaviour that often occur in people living with dementia (see behavioural changes).
How does it work?
Reminiscence therapy can be done with a professional, friend or relative either in groups or on a one to one basis. It can be done with prompts, such as music, objects or photos which can be general, designed to trigger memories such as a piece of music from the 60’s or specific to the person concerned such as a photo of their wedding day.
In essence reminiscence therapy is simply acknowledging that someone has ‘time-shifted’ and is effectively living in the past. Past memories are the only ones that remain. So rather than constantly correcting them or engaging in conversations about things they know nothing about, because they occurred after the brain was damaged, you find things to talk about that they can remember, where they can contribute.
What are the benefits to the person living with dementia?
- Allows them to engage in conversation and recount happy memories.
- Improves mood.
- Increases confidence.
- Reminds them of their identity.
- Greater feeling of self-worth.
Note: Reminiscence therapy is less effective in the more advanced stages of dementia as the part of the brain which deals with longer term memories also becomes affected. I have also read that it is less effective for people living with frontotemporal dementia, possibly because memory loss isn’t the main symptom.
Mum & time-shift
I always tried to join Mum in her reality. I tried to talk about things in the past or kept the conversation very general and if she asked me where her Dad was I always lied and told her he had nipped to the shops.
Having said that I do remember one conversation where I managed to upset Mum as I didn’t acknowledge she had time-shifted.
Mum – “Sorry what’s your name again?”
Me – “Emma, I’m your eldest daughter”
Mum – “How old are you?”
Me – “45”
Mum – “Right, well how old am I?”
Me – “72”
Mum – “72, 72 that can’t be right!”
A moment silence occurred while I tried to think of a suitable reply, when Mum suddenly said with a hint of emotion “Bloody Hell, how did that happen!!”
I quickly changed the subject and avoided talking about age ever again!!!