Dementia is a condition that affects the brain and changes the way a person thinks, remembers, and behaves. One of the most common and confusing things that happens to people with dementia is that they start to mix up the past and the present. This means they might talk about events from long ago as if they just happened, or they might believe they are living in a different time than they actually are. This can be very hard for both the person with dementia and for their family and caregivers to understand and deal with.
When someone has dementia, the brain is not working the way it used to. The parts of the brain that help with memory, thinking, and understanding time are damaged. This damage makes it hard for the person to keep track of what is happening now and what happened in the past. For example, a person might think they are still at their old job, or they might believe their children are still young, even though they are grown adults. Sometimes, they might even forget that a loved one has passed away and ask about them as if they are still alive [1].
This confusion between past and present is not something the person is doing on purpose. It is a direct result of the changes happening in their brain. The brain uses memories to help make sense of the world. When those memories are damaged or lost, the brain tries to fill in the gaps with whatever information it can find, which often comes from the past. This is why people with dementia might repeat stories from their childhood or talk about events that happened decades ago as if they are happening right now [2].
One of the reasons this happens is because dementia affects the way the brain stores and retrieves memories. In a healthy brain, memories are stored in a way that makes it easy to tell when something happened. But in a brain affected by dementia, those memories can become jumbled. The brain might not be able to tell the difference between a memory from last week and one from fifty years ago. This is especially true for people with Alzheimer’s disease, which is the most common type of dementia. Alzheimer’s causes the buildup of abnormal proteins in the brain that damage the cells responsible for memory and thinking [4].
Another factor that can make this confusion worse is something called disorientation. Disorientation means losing track of time, place, or who you are with. People with dementia often become disoriented, especially as the disease gets worse. They might not know what day it is, where they are, or even who the people around them are. This can make it even harder for them to keep the past and present separate. For example, a person might think they are at their childhood home when they are actually in a care facility, or they might believe they are waiting for their parents to come home when their parents have been gone for many years [1].
Sundowning is another issue that can make this confusion worse. Sundowning is a term used to describe when people with dementia become more confused, agitated, or restless in the late afternoon or evening. This is thought to happen because the brain’s internal clock, which helps us know when to sleep and when to be awake, is not working properly. When the light starts to fade and the environment changes, it can trigger more confusion and make it harder for the person to tell what is real and what is not. This can lead to them mixing up the past and present even more during these times [1].
It is also important to understand that this confusion is not just about memory. It can affect the way a person understands language, solves problems, and makes decisions. For example, a person with dementia might not be able to follow a conversation or understand what is being said to them. They might also have trouble with simple tasks like dressing or eating, because they cannot remember the steps or understand what they are supposed to do. This can make it seem like they are living in the past, because they are not able to keep up with what is happening in the present [4].
Sometimes, people with dementia might also have hallucinations or delusions. Hallucinations are when a person sees, hears, or feels something that is not really there. Delusions are when a person believes something that is not true, such as thinking someone is trying to harm them or that they are somewhere they are not. These experiences can make it even harder for the person to tell the difference between the past and the present, because their brain is creating its own reality based on damaged or missing information [2].
It is also worth noting that this confusion between past and present can happen at any stage of dementia, but it tends to get worse as the disease progresses. In the early stages, a person might just have trouble remembering recent events or getting confused about what day it is. But as the disease gets worse, they might start to lose track of who they are, where they are, and what time it is. This can make it very difficult for them to live independently and can require more support from caregivers [4].
There are things that can be done to help reduce this confusion. Keeping a regular routine, making sure the environment is well-lit, and providing clear and simple information can all help. It is also important to be patient and understanding, and to avoid arguing with the person about what is real or not. Instead, it can be helpful to gently redirect their attention or provide reassurance [1].
In some cases, medication or other treatments might be needed to help manage the symptoms of dementia, including the confusion between past and present. It is important to talk to a doctor or healthcare professional if you are concerned about someone’s memory or behavior, as they can provide advice and support [3].
Overall, the confusion between past and present is a common and challenging symptom of dementia. It is caused by changes in the brain that affect memory, thinking, and understanding. While it can be difficult to deal with, there are ways to help manage it and support the person with dementia.
Sources
[1] https://www.dementiacarecentral.com/caregiverinfo/coping-with-disorientation/
[2] https://www.womenshealthmag.com/health/a69544406/sundowning-dementia-early-warning-sign/
[3] https://www.alzheimers.org.uk/about-dementia/stages-and-symptoms/dementia-symptoms/restlessness
[4] https://blog.bonsecours.com/healthy/alzheimers-dementia-early-warning-signs/
