Changes to information processing and emotional responses
You may recall from Chapter 2 of workbook 2 where the different lobes of the cortex were described. (If necessary please revisit this section of workbook 2.)
Elizabeth Millwain (2010) described how important it is to have an understanding of different structures within the brain in order to develop an insight into the world of people with dementia.
Emotional responses come from the inner part of the brain which is more instinctive than the thinking (cortex) part of the brain. (The cortex of the brain was discussed in workbook 2). Primary emotions such as anger and fear are co-ordinated by a structure called the amygdala which is in this inner part of the brain and connected to the cortex.
When there is a situation that is threatening, the amygdala responds by sending messages to the body to react. This normal reaction is the body’s mechanism for survival and is sometimes referred to as the ‘fight or flight’ response.
A person with dementia can sometimes experience a misperception of what is being seen when responding to an environment that can be difficult to interpret. At these times the ‘flight or flight’ response may be activated.
Misperception of information
Powell, J. (2007) Difficulties in understanding
The amygdala is ‘kept in check’ by the cortex of the brain in particular the frontal lobe. For example, when we may feel like striking out at a person who has annoyed us, the frontal lobe helps to regulate the triggered feelings and decide on a more thought out way of responding..
The above could be represented by the following equations:
Feeling + Thinking = Behaviour
Or
Amygdala + Frontal Lobe = Behaviour
When a person has dementia, they continue to experience life with associated feelings and emotions. Evidence for this can be seen in the range of emotional responses expressed both verbally and non-verbally even when they may not be able to communicate them clearly.
The person with dementia will experience emotions but the person may have less ability to regulate an appropriate response.
This could be represented by the following equation:
Feelings + difficulties with cognition = difficulty to self regulate behaviour
For example, when being supported during intimate care tasks the person with dementia may be unable to recognise why the help is needed or who is providing the help.
- Feelings: Extreme embarrassment / frustration / distress
- Cognitive difficulties: Difficulty to self regulate feelings
- Behaviour: shouting / hitting out at those people who are trying to be supportive
- Feeling frustrated at being unable to work out how to get dressed.
- Feeling embarrassed should a ‘stranger’ need to help you with intimate tasks.
- Feeling lonely, cold, tired, or hungry and not knowing how to get support to feel comfortable.
These feelings can be heightened when a person has dementia, and it can become increasingly difficult for them to regulate their expression.
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