How Does Dementia Influence Awareness Of The Present
Dementia is a condition that affects the brain in ways that go far beyond simple memory loss. One of the most profound impacts of dementia is how it changes a person’s awareness of what is happening right now, in the present moment. Understanding this aspect of dementia is crucial for family members, caregivers, and anyone who wants to better support someone living with this condition.
The Nature of Present Moment Awareness in Dementia
When we talk about awareness of the present, we are referring to a person’s ability to understand what is happening around them at this very moment. This includes knowing where they are, what time it is, who is with them, and what activities they are engaged in. For people without dementia, this awareness is something we take for granted. We automatically know if we are at home or at a doctor’s office. We understand if it is morning or evening. We recognize the people we interact with regularly.
However, dementia disrupts these basic functions of awareness. The condition affects multiple areas of the brain that are responsible for processing current information and maintaining a sense of orientation to time and place. This is not simply about forgetting things that happened in the past. Rather, it is about difficulty processing and understanding what is happening in the immediate present.
Memory Problems and Present Awareness
The most commonly recognized symptom of dementia is memory loss, particularly difficulty remembering recent events and conversations [2]. When someone has dementia, they may struggle to recall what happened just moments ago. This creates a significant problem for present moment awareness because our understanding of the current moment is built upon our ability to remember what just happened seconds or minutes before.
Imagine you are having a conversation with someone who has dementia. You might tell them something important, and they might respond appropriately in that moment. However, just a few minutes later, they may ask you the exact same question again, as if the conversation never happened [1]. This is not because they are being difficult or stubborn. Rather, their brain is not properly storing and retrieving the information from the immediate past, which makes it difficult for them to maintain continuity of awareness in the present.
This repetition of questions is one of the hallmark signs of dementia [1]. It reflects a fundamental disruption in how the brain processes and maintains information about what is currently happening. Each time the person asks the question, from their perspective, it may feel like the first time they are asking it, because they have no memory of asking it before.
Confusion and Disorientation
Beyond memory loss, dementia causes confusion and disorientation that directly impact present moment awareness [6]. A person with dementia may become confused about where they are. They might be sitting in their own living room but believe they are somewhere else entirely. They might think they are at work, or at a place they lived many years ago, or in a completely unfamiliar location.
This confusion extends to time as well. Someone with dementia may not know what day it is, what month it is, or even what year it is [4]. They may think it is morning when it is actually evening. They may believe it is a weekday when it is actually a weekend. This disorientation to time makes it very difficult to maintain a clear awareness of the present moment, because part of understanding the present is knowing where we are in the timeline of our lives.
The confusion can also affect a person’s awareness of who they are with and what is happening around them. They might not recognize family members who are present with them. They might not understand what activity they are supposed to be doing or why they are in a particular location. All of these disruptions to awareness happen because dementia affects the brain’s ability to process and interpret current sensory information and integrate it with stored knowledge.
Changes in Thinking and Problem Solving
Dementia also affects executive function, which includes the ability to think clearly, plan ahead, and solve problems [4]. These cognitive abilities are essential for maintaining awareness of the present because they allow us to understand the context of what is happening and to respond appropriately to our current situation.
When executive function is impaired, a person may struggle to understand what is happening in their immediate environment. They might not be able to figure out how to perform familiar tasks, even though they have done these tasks many times before [4]. For example, someone might not remember how to use the television remote, or how to prepare a simple meal, or how to get dressed. This is not because they have forgotten the steps involved, but because their brain is having difficulty processing the current situation and accessing the knowledge needed to respond to it.
This impairment in thinking and problem solving also affects how a person understands and responds to what is happening in the present moment. If something unexpected occurs, they may not be able to quickly assess the situation and figure out what to do. This can lead to confusion, anxiety, and sometimes agitation.
Agitation and Behavioral Changes
One important aspect of how dementia affects present moment awareness is through behavioral changes and agitation. Research shows that nearly half of people with Alzheimer’s dementia develop agitation symptoms [1]. These symptoms can include restlessness, pacing, wandering, shouting, repetitive questions, and even verbal or physical aggression [1].
Agitation often arises because the person with dementia is confused about what is happening in the present moment. They may not understand where they are or why they are there. They may feel frightened or disoriented. They may be trying to make sense of their current situation but finding it impossible to do so. The agitation is often a response to this confusion and loss of present moment awareness.
Caregivers report that agitation symptoms are often harder to manage than memory loss alone [1]. This is because agitation reflects a deeper disruption in how the person is experiencing and understanding their current reality. When someone is agitated, it is often because they are struggling to make sense of what is happening right now, and this struggle is causing them distress.
Lack of Insight Into Current Difficulties
Another way that dementia affects present moment awareness is through a loss of insight into how the condition is affecting the person’s functioning. Research indicates that people experiencing memory and thinking problems may have less insight into how symptoms are disrupting their everyday life than the people around them [3]. This means that someone with dementia may not fully realize or understand that they are having difficulty with tasks or that their behavior has changed.
This lack of insight can make it even more difficult for the person to maintain awareness of the present moment. If they do not realize that they are having memory problems or difficulty with thinking, they may not understand why they are confused or why others are concerned about them. They may not recognize that something is wrong with their current situation or their current functioning.
This lack of insight also affects how caregivers interact with the person. Caregivers may need to gently help the person understand what is happening in the present moment, even though the person may not initially accept or understand this
