What's Happening in the Brain
It is common for people with Alzheimer's disease to withdraw somewhat, and many stop interacting with friends. Why this happens is complex, and many factors are in play. Some friends sense that there is something wrong, and while some come forward to do what they can, other people withdraw, for reasons of their own - such as fear of the disease, or fear of facing someone who has a problem that they themselves fear.
But an important cause of withdrawal is the diminished ability to interact with friends in the usual way. This ability is a complex one. It requires an established sense of self, the ability to understand the motivations of other people and to react to them in a way that is socially appropriate. Each of these are functions that require intact circuitry going through the brain's prefrontal cortex .
In addition to these important functions (collectively sometimes referred to as 'social conduct'), interaction with friends requires intact language abilities , as well as enough memory to get by. Each of these functions (social conduct, language and memory) is affected in Alzheimer's disease, and to varying extents, in other dementias too.
As far as we can tell, there are real brain benefits for people with Alzheimer's disease to continue to interact with friends and family. In fact, people who have higher levels of social interaction seem to be at a lower risk of developing the disease.
Interacting with friends is a two-way street, so it is important to help friends and family understand what they can do by way of continuing to interact with the person who has dementia. First, it is important to help friends and family members get to grips with what they know about the illness, whether they fear it, and whether this fear - which is quite natural - is inhibiting them from interacting with the person you care for. As you are identified as knowing something about the illness, people often will want to ask you. We hope that you can use this resource to help them answer some of their questions. One thing that you will likely have noticed is how helpful it is just to listen to what the person you care for wants to say. This will be the same for that person's family and friends - and that is a point you can make to them. They can ask the person you care for how that person feels, and they can listen to the answer. This in itself can be very therapeutic for everybody - for the person you care for, it is validating. For the person now engaging in a new role - listening to someone with Alzheimer's disease - it can show them how useful that role is. (If all this seems like common sense to you, you can be reassured that it is done much less commonly than you might think.)
Here are some specific things that are reasonable to do:
- Stay in touch. Being there for the other person is important; especially include them in regular activities. And remind them gently not to forget including you and other caregivers.
- Visit. Don't just stay in touch by phone or in writing - although that is very helpful. Come by. Visit. Help. Take the person out.
- Talk - and include the person in the conversation. A good way of doing this is to share some memories together. Special times can be remembered together. That is one of the most pleasant ways to spend time with someone who has a memory problem, by helping them remember.
It is common for people with Alzheimer's disease to withdraw somewhat, and so many stop interacting even with friends. Interacting with strangers can be even more difficult. Why this happens is complex, and many factors are in play. While many people never recognize mild dementia in others, some people have a highly attuned sense that there is something wrong with others. Commonly, they will end the encounter with the person with dementia - i.e., it is the unimpaired person who withdraws from the encounter.
Further reading for what is happening in the brain:
Fratiglioni L, Paillard-Borg S, Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol. 2004;3:343-53.