We are storytellers, connecting the dots, whether they connect or not, into a narrative. And much the way that optical illusions reveal how our brain processes visual information, narratives at the ends of life can give us insight into how our minds fashion stories. A recent article in PLOS One looks at how patients with Alzeihemer’s Disease verbally “cover over” memory gaps and points the way towards how we construct the tales we tell.
107 Japanese outpatients with varying forms of dementia [1] were given a mini-mental status examination, and their “saving appearance responses/behaviors” (SARs) were recorded. SARs are a variation of what we might call confabulation, glossing over memory gaps with narrative lines, preserving the ability to communicate rather than appear impaired. For example, when asked the name of their physician, they might respond with “I usually call him doctor” rather than admit that they do not remember their name. And while the authors suggest that avoiding public shame is solely a Japanese quality, the truth is that we too have a term for these behaviors, confabulation – “the production of fabricated, distorted, or misinterpreted memories about oneself or the world, without the conscious intention to deceive.”
The researchers found that patients with Alzheimer’s Disease were more likely to utter at least one of these SARs about 3.5 times as often as those with mild cognitive impairment and 4.2 times more likely than those patients with dementia secondary to Lewy bodies. The also characterized the types of SARS patient’s employed:
- Refutation of a sudden question - “I can’t answer a sudden question.”
- Appearing Indifferent - “I don’t care/I am not aware of it.”
- Disclosure of a trait implying a dislike or weakness about something
- Disclosure of experience - “I don’t do/I’ve never done such a thing.”
- Slight hesitation - “I remembered until just a while ago.”
The first two forms of deflection are grounded in social responses, the narrative give and take. The last three are rooted in memory. Alzheimer’s Disease patients have the greatest impairment of memory [2] of the three groups studied and more frequently employed the first two forms of deflection than either of the other groups. And while it is not proof, it is indeed suggestive that empathy and insight, both what we would consider social responses are maintained because while else cover the memory lapses in this particular manner? Other studies have found that as Alzheimer’s Disease progresses and more memory is lost, the use of SARs decreases and then disappears – empathy and insight, our cognitive mills no longer have the grist of memories to draw upon. Memory is one factor in making us social creatures; memories departure leaves us connecting random dots. The stories we tell blend memory and our social “instincts,” meant to explain to ourselves and others, providing a social lubricant. Alzheimer’s Disease highlights how entwined memory is in our sociability; losing our memory robs us of the sociability of our stories of explanation but not the stories themselves.
[1] 55 with mild cognitive impairments, 30 with dementia with Lewy bodies and 16 with a mixed picture of Alzheimer’s Disease
[2] Patients with dementia from Lewy bodies more frequently demonstrate attention deficits as compared to Alzheimer’s which impacts memory.
Source: Are saving appearance responses typical communication patterns in Alzheimer’s Disease? PLOS One DOI: 10.137/journal.pone.0197468
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
