cognitive decline

In my geriatric practice one of the complaints of families is how often their loved one tells them the same thing over and over.

They use that symptom as evidence of cognitive decline – the inability to recall what was said previously. This symptom, although common and often indicative of cognitive functional decline, is also a manifestation of the common human propensity to focus on the narrative of one’s life and to recount it as part of one’s process of self-identity and validation. But, what is the separation between the normal attribute of recounting the narrative of one’s life and the pathology of cognitive impairment that fails to recognize the recent repetition of that story to a loved one?

The importance of stories

The telling of stories is important. In normal relationships and conversations, we spend much effort recounting life events to others. The tendency to be repetitive is universal, as anyone in a long-standing relationship will admit. If the topics of conversation between spouses are tracked over time, we would probably find the same topics repeated in one form or another repeatedly.

For instance, one partner in a marriage usually knows the political views of the other. When the topic comes up in a social setting, they often patiently listen to their partner express their views to presumably a new audience (although this is not always the case) with rare rude interruptions such as: “We’ve heard your views before. If you don’t have a new one, just stop talking.”

The challenge for those facing the extremes of repetition by a loved one who is experiencing cognitive impairment is knowing what to do. Family members usually learn to avoid interrupting the recounting of an event with “You told me already” or “I know,” as this may cause conflict with a denial that the conversation has taken place.

In the context of normal aging, family members may find that the retelling of one’s life narrative frequently occurs. This is one way we validate our lives, which is important as the past becomes increasingly important compared to the limited options for the future. This human need to tell our narratives is reflected in the interest by many in writing autobiographies and memoirs and in reading them. Being patient with our narrative-telling loved ones is important to them and ultimately to us.

Be patient and listen

The best recommendation I can make about this inevitable process is to find ways to be patient with your loved one and accept that even though you have heard the story before, acknowledging it and expressing an interest in it is helpful and even therapeutic to both of you, but especially to that aging loved one.

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Dr. Michael Gordon MD, MSc, FRCPC
Dr. Michael Gordon, MD, MSc, FRCPC and FRCP(Edin) is medical program director of Palliative Care at Toronto's Baycrest Geriatric Health Care System and professor of Medicine at the University of Toronto. He an educator and author and is involved professional and public education. An American by birth, he is a graduate of the University of St. Andrews Medical School in Scotland. His pre-specialty training included Internal Medicine, Obstetrics and Gynecology and Nuclear Medicine. He came into geriatrics in Canada where he settled after much world-wide travelling for his medical training in 1973. He came into geriatrics by a confluence of unpredictable events prior to it being recognized as a medical specialty in 1981 at which time Dr. Gordon received the first certificate in Geriatric Medicine awarded by the Royal College of Physicians and Surgeons of Canada. His career has included a wide range of clinical activities in eldercare, which for years included responsibilities at Toronto’s Mt. Sinai Hospital. His main commitment has been to the Baycrest Geriatric Centre where he served for many years as its Vice President of Medical Services and Head of the Department of Geriatrics and Internal Medicine. He currently devotes his clinic and administrative and educational activities to Geriatric out-patient care, in-patient palliative care, medical ethics and end-of-life planning, communication and care and writing for the lay and professional press. His books include his first book Old Enough to Feel Better: A Medical Guide for Seniors which went through three editions; An Ounce of Prevention: A medical guide for a healthy and successful retirement; The Encyclopedia of Health and Aging; Parenting your Parents (two Canadian and one American edition); Brooklyn Beginnings: A Geriatrician’s Odyssey; Moments that Matter: Cases in Ethical Eldercare; and most recently Late-Stage Dementia: Promoting Comfort Compassion and Care and now the revised third edition of Parenting your Parents: Straight Talk about Aging in the Family. For more information see drmichaelgordon.com

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