It is well known that people with advanced dementia often struggle to recognize faces—even those of their nearest and dearest loved ones. Fortunately, my mother, who was diagnosed with Alzheimer’s disease a number of years ago, still has no problem recognizing me or others who are close to her. However, I do notice that when I say someone’s name, especially someone she hasn’t known very well or for very long, Mum struggles to “picture” the person in her head.
The other day, I attempted to talk to Mum about her friend Penny, who visits every Wednesday.
“Penny?” Mum questions. “I know the name, but I just can’t bring her to mind.”
It used to be that I could get Mum to remember her new friend if I provided a simple description.
“Penny,” I’d remind her gently. “Masses of curls, smiley with very brown eyes.”
But as Mum’s condition progressed, these strategies stopped working. What I find interesting is that as soon as I present her with a photo of Penny, Mum knows exactly who I’m talking about.
It seems to me this is more than just a memory problem. Penny isn’t really “forgotten” because Mum recognizes her immediately in the photo. Somehow the name Penny and my descriptions fail to form a connection and trigger recognition in Mum’s brain.
Understanding How Dementia Affects Facial Recognition and Name Recall
All this leads me to think that some sort of breakdown in abstract thinking abilities might be to blame. I’ve been hunting for a good description of this phenomenon, and I stumbled upon some information on symbolic thinking from Marcus Geduld, a teacher, writer, computer programmer and lifetime psychology student. According to Geduld, abstract thinking is really just symbolic thinking or the ability to manipulate symbols in your head. Some symbols are more abstract than others, which makes it harder for our brains to make sense of them.
Geduld uses art as an example. The Mona Lisa is the artistic representation of a person—a symbol. Picasso’s portraits are also symbols, but most of them are far more abstract than the famous picture of the woman with the smile.
So, what does this tell us about what is happening in the brains of people living with dementia? When Penny arrives each Wednesday, she is right there and Mum recognizes her immediately. When Mum is shown a symbol of Penny (a photo), Mum can still recognize her friend. The photo is an abstraction, but an extremely close representation of the real thing. Symbols that are more abstract, such as words, don’t work nearly as well. When I talk to Mum about Penny, using her name and nothing more than generalized verbal descriptions, Mum’s brain can’t make the connection.
One study published in Geriatric Nursing addresses this complicated neurological process in dementia patients: “Alzheimer’s disease (AD) affects face-name memory, the ability to recognize faces and recall names. Remembering face and name requires a sophisticated cognitive process because of the complexity and similarity among faces and also because of their arbitrary association with names.” While dementia can affect how patients perceive and process stimuli, another study has found that memory deficits are the main culprit in poor facial recognition and name association. In fact, multiple areas of the brain are involved in these cognitive processes and neural degeneration in these regions is what results in impairment.
This can be frustrating and confusing for dementia patients, especially those who receive services at home from relatively new caregivers and those who reside in senior living facilities, such as assisted living communities, memory care units or nursing homes. Staff turnover complicates this problem even further. For example, my mother lives in a rest home. She has known most of the long-term staff for years. When she’s telling me about them, though, she often has trouble recalling their names and describing them to me. (To be honest, I have a hard time remembering their names sometimes, too!) Between this disconnect in names and accurate physical descriptions, it can be challenging to work out which caregiver Mum is referring to.
Sadly, dementia can pose a number of different issues with memory and facial recognition that are more complicated than my mother’s, such as the total inability to recognize loved ones or the belief that they have been replaced by imposters (Capgras syndrome). In these more complex instances, there is not much that family members can do to “jog” their loved one’s memory or snap them out of their delusions. However, for patients like Mum who are in the middle stages of Alzheimer’s, there are some visual aids that may help them more easily identify and communicate with the people around them.
Using Visual Aids for Dementia Patients
I have been thinking that a staff photo board might help Mum. It doesn’t need to be anything fancy—just a poster of photos, first names and titles/relations that residents and their families can refer to. It serves as a sort of visual suggestion tool for guiding dementia patients through the cognitive processes of facial recognition and name recall. A number of local rest homes have begun using these boards already, and I know several home-based caregivers who also use them. They create a simple bulletin board with photographs of family members, medical staff, friends, professional caregivers and volunteer helpers and post it somewhere convenient.
Dementia patients often enjoy looking at old family photos and picture albums, so expanding this visual activity to include others they interact with on a regular basis can’t hurt. As their cognitive impairment progresses, this may become less effective, but the board or photo album might still be useful as a reference material for communication purposes.
I’ve sown the seed with the manager at Mum’s rest home, and I understand he’s looking into creating one of these displays. If that doesn’t work out, Mum and I might break out the camera and make one of our own to hang in her room. It’ll include her favorite caregivers, the manager, the receptionist and, of course, Penny.
Sources: Face-Name Memory in Alzheimer's Disease (https://doi.org/10.1016/j.gerinurse.2014.03.004); Are Faces Special in Alzheimer's Disease? Cognitive Conceptualisation, Neural Correlates, and Diagnostic Relevance of Impaired Memory for Faces and Names (https://doi.org/10.1016/S0010-9452(08)70689-0)