Aug 26, 2013

The Logic behind Alzheimer's Fear and Emotion

Understanding the logic underneath the illogic is one of the keys to more successful communication between persons living with Alzheimer's and those who care for them.

By Carole Larkin
+Alzheimer's Reading Room

The Logic behind Alzheimer's Illogic

For caregivers, Alzheimer’s seems to be the most illogical disease ever -- right?

Well, today I want to give you the logical reason for the illogical, and sometimes counterproductive, behavior that emanates from Alzheimer’s disease.

First, we need to review our biology of the human brain. This information is from The Evolutionary Layers of the Human Brain.

Carole Larkin MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related dementia care. She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related issues. Carole can consults with families via telephone nationwide on problems related to the dementia. Her company, ThirdAge Services LLC, is located in Dallas, TX.

Subscribe to the Alzheimer's Reading Room

Neuroscientist and physician Paul D. MacLean in the 1960’s developed the “Triune” model of the human brain that had become the standard explanation of how the human brain developed.

Portions of this model have since been discarded but this much remains as accepted.

“First, we can accept a few general ideas—for example, that some structures in our brains are older than others, from an evolutionary standpoint, and that our emotions involve some relatively primitive brain circuits that have been preserved over the course of mammalian evolution.

The fear circuit and the pleasure circuit, for instance, are specific neuronal circuits that form what might best be called not our “emotional brain” but rather our “emotional neural networks.

The switches in these circuits consist of structures such as the amygdala, the nucleus accumbens, the hippocampus, the hypothalamus, the thalamus, and certain areas of the prefrontal cortex and the temporal cortex. And no doubt other structures are involved that remain to be discovered.”

In short, our emotions preceded our logic -- our emotions come first. That explains why sometimes we do the things that our emotions demand us to do, instead of what our logic asks us to do. But because our logic has been strengthened by many generations of existence, at times our logic does overcome our emotions.

But with Alzheimer’s and some of the other diseases, the portions of our brains that are involved in logic can and do become more damaged than the portions of our brains involved in emotions.

In addition, the “filter” in our brains, (the part that allows you to think one thing, but say something else that is softer, gentler, and more socially acceptable), gets damaged pretty early in Alzheimer’s. Comments and behaviors that persons with Alzheimer’s show to us all the time confirm this idea.


Related Content

So knowing that we humans are prone to choose emotions over reason as a first response and that Alzheimer’s affects our filter first, would it not be logical to conclude that this is precisely what one is dealing with in a person who has Alzheimer’s disease?

Well, it is.

In spite of the fact that the person is standing in front of you and is apparently arguing with you on a logical basis, in actuality she is really arguing with you on an emotional basis instead. Your error is not recognizing that fact. When you respond on a logical basis, you are doomed to “lose” the argument. First, you are arguing logic to a person whose ability to follow logic is impaired. Second, emotions trump logic in an impaired mind more often than in an unimpaired mind.

What can you do to “win the argument? Obviously, quit trying to use logic and start talking to the person’s emotions.

If the two “base” emotions (meaning the emotions that are triggered first in humans) are fear and pleasure, it stands to reason that those two and iterations of each, such as anger, and depression for fear and joy and comfort for pleasure, should be the emotions that you should be speaking to instead of logic.

So instead of pointing out the facts or “reality” maybe you should be asking questions like:
  • What’s wrong?
  • You look like you are worried about this. What about it is worrying you?
  • Is this scary for you? What is scary about it?
  • Is this making you angry? What about it makes you angry?


Mull over in your mind what they answered, because chances are they are telling you the truth as they see it, think it and feel it.

Remember, their filter is gone, and generally by a certain point in the disease, it’s just too complicated for them to make up a lie. They are just NOT capable of doing it.

So give yourself a few seconds to formulate your answer. Because they process words more slowly than we do, they’ll never notice the time gap!

When you do speak, speak only to the emotions you are hearing out of them. That’s what they REALLY care about.

If its fear, you comfort and soothe them, telling them that they are alright, that they are safe, that you are there to make sure nothing bad happens to them.

If they are angry, you validate their anger saying that you see why they are angry. You don’t tell them to not be angry, but instead that you understand why they are angry and that they are not alone in their anger.

If it is pleasure you say that you understand that they like it and want it. If what they like or want is really something that is not beneficial to them, and may actually do them harm, then you can offer something similar but not as harmful in its place, or perhaps postpone the fulfillment of their pleasure, for a little while or distract them with something else, in hope that they will forget this desire at least for a while.

For example, you both are away from home, and the person gets agitated saying “I want to go home. I need to go home right now. NOW!!!”

Your question may be “What do you need to do at home now?” Maybe the answer is, “The children are coming home from school and I need to be there.” Then you would speak to their fear that the children are not being taken care of by saying, “Well, you know your sister said that she was going to be at your house with them until you came home” or some other plausible statement relating to that time in their life.

The important thing is your response quells their FEAR or lifts their burden of responsibility from their shoulders.

If they are wanting to go home due to the pleasure emotion of feeling safe and secure at home, your response may be, “Yes, Home is a wonderful place to be, and we will be going home shortly. But right now, you and I are going to have a quick snack before we go home. I’ve got a chocolate chip cookie just waiting for you. How about having a nice glass of iced tea and that cookie, and then we’ll go home.” the offer of the chocolate chip cookie is a substitute pleasure and a distraction all at the same time.

If you can look beneath their words to see the emotion they are trying to express to you, and address that emotion in a positive way instead of responding to their words, you will have a far better outcome, more often than not.

Try it 30 or 40 times not once or twice, because once or twice is not enough times to judge whether it is working or not.

Understanding the logic underneath the illogic is one of the keys to more successful interactions between you.

Original content Alzheimer's Reading Room.