Part 14 of The Mental Health Workers' Guide looks at orientation and memory in dementia. Don't forget you can download the video clips supporting this series here.

Buy the entire series as an Ebook here

Orientation and memory

Orientation is the term given to the process of ‘understanding’. There are many ways to think about orientation but as a rule we focus upon only three.

These are Time, Place and Person.

Most people have no problem knowing what day it is or whether it is morning or evening, they know where they are and they can recognise others without problem. However in the dementias these things become progressively more difficult.

Interestingly, people tend to lose orientation of these three areas more or less in order. So the Alzheimer’s sufferer might begin by not being able to keep track of time before becoming confused about where they are or perhaps how to find their way home. Finally they might fail to recognise others or mistake strangers for long dead relatives such as parents.

Although this is far from reliable it can provide a useful ‘rule of thumb’ when tracking the changes in people we work with. If a resident who previously had no trouble knowing where they are suddenly becomes unable to find their bedroom we should use that as a sign to assess further. It may be that we will need to update their risk assessment for example or their consultant might want to review the use of cholinesterase inhibitors as a result.

Memory

In very general terms memory can be divided into ‘long term’ and ‘short term’. Long term memory is where we store information that we want to remember for a long time. For example things that happened to us a long time ago or facts we need to recall at a later date.

Short term memory is different. This is the kind of memory we don’t need to keep for very long. For example an interesting study was done in an American diner where the waitress was expected to remember complicated orders for customers.

The researchers watched her flawlessly ‘fill’ customers’ orders without writing a single thing down and even correctly calculating their bill at the end of their meal. She did all this from memory. The researchers then asked her to recall what people who had just settled up and left had ordered and she could not. The information was no longer needed and so she had ‘wiped’ it from her short term memory.

People with dementias often have no problem at all remembering long term information but short term memory is poor or effectively absent. This is why they often ask the same question time and again and can express surprise at the answer no matter how often it is given.

Sometimes carers can become frustrated at this but it is just a function of dementia.

There is no point in becoming frustrated when people with dementia behave like people with dementia.