Living in the moment with Alzheimer’s

When we are young, the timeline of our lives stretches from our earliest memories to our expectations for the future. As the cognitive impairment of Alzheimer’s disease progresses, that timeline begins to constrict.  Perhaps surprisingly, the first memories that start to go are the most recent – where did I put that (fill in the blank)? The consolidation of new memories in the hippocampus is impaired while our ability to remember events from the distant past is relatively well preserved in a variety of cortical regions of the brain. As time goes on and the amyloid plaques and neurofibrillary tangles spread through the brain, the distant memories start to fade.  The memories most likely to endure are those that were associated with strong emotional content, but eventually even those start to disappear.  At the same time, our abilities to look into the future and make plans become impaired as damage spreads to the prefrontal cortex. Eventually, in the late stages of Alzheimer’s, we are left with life in the present, no past and no future. I’m not there yet, but I can sense the shrinking timeline of memories from the past and plans for the future. For those of us on the Alzheimer’s journey, it is really important to embrace the moment and not dwell on the frustration of trying to remember the past and plan for the future. Others can help us retrieve old memories. Calendars, lists, and post-it notes will help us minimize the chaos of the future. But happiness and peace come from focusing on the moment, whether it is hugging a grandchild, writing in a journal, working in the garden, or listening to great music. As Horace put it, “carpe diem quam minimum credula postero.”