This Ain’t Just About Memory: Dementia and Impulse Control

To function as a member of society, it’s necessary to have the ability to sometimes stop yourself from doing what you really want to do.

You had an urge to call your co-worker a jerk, but you stopped yourself. (If you work with me at the university, this is totally hypothetical. It’s not like I’ve ever experienced the urge to call you a jerk…just an innocent example…you believe me, right?)

For a fleeting moment, it occurred to you that you get away with stealing something from Target. Of course, you paid for it. You’d never steal it, obviously; it was just a thought that crossed your mind.

You liked what your friend ordered for dinner more than your own meal. You wanted to grab her plate. But you didn’t.

Let’s be honest…sometimes we get frustrated and we want to punch someone. I’ve only punched someone once in my life. (It was at a water park and he totally deserved it; feel free to ask me about it sometime.)

And that’s the only time I’ve ever had the urge to punch someone.

Okay. That’s a lie. I’ve had that urge plenty of times. I’ve only acted on it once.

To say that impulse control is important is an understatement.

There’s a part of your brain that’s responsible for impulse control. It’s called your frontal lobe.

I’d like to thank my frontal lobe. Without it, I’d have no job, no marriage, and no friends. I would have eaten myself to death on frosted sugar cookies with sprinkles, and I’d probably have adopted 19 dogs.

The frontal lobe is impacted by various types of dementia. It is often the first part of the brain that shows damage in frontotemporal dementia, which is why uncharacteristic behavior (e.g., physical and verbal assault, sexual comments, stealing) is many times the first symptom that families notice. However, lack of impulse control is a symptom in other types of dementia as well.

I was visiting a memory care community recently when a man living with dementia started making a high-pitched screeching noise. I was trying to have a conversation with another resident, and I’ll admit the noise was distracting. I was trying to block it out and focus on my conversation.

The guy I was talking to told me to hang on a second. He got up and walked over to the man making the noise.

He bent down and got in his face. Then he said in a very stern voice, “YOU. NEED. TO. SHUT. THE. HECK. UP.”

Except he didn’t say heck. He didn’t even say hell.

I’ll let you take a guess.

I hate to say this–because I’m not going to make myself sound like much of a caring professional–but I wanted to walk over to the man and say the same thing. I knew it wasn’t his fault he was making this noise. I wanted to be patient.

But it was hurting my ears.

My frontal lobe stopped me from doing that.

Again, thank you, frontal lobe.

Residents who take food off other residents’ plates at nursing homes? Those guys at the nursing home who make inappropriate comments to me about my body? People with dementia who shout out whatever comment crosses their mind–whether nice or not so nice?

It’s likely their frontal lobe is damaged.

I’ll tell you another secret about the frontal lobe. It doesn’t function as well when your brain is tired.

That’s true for me. It’s true for people living with dementia. And it’s true for care partners.

If your loved one has dementia, you might be able to cope with being asked the same question dozens of times–when you’re well-rested. But after a long day of stress, you might snap. I know it’s not always possible to take a break, but you need one.

As I’ve said before in my blog, we don’t talk enough about mental fatigue when it comes to dementia. A tired brain doesn’t work as well. That’s a truth we all know…we’re not at our sharpest when we’re exhausted.

If someone with dementia is tired, they may struggle with impulse control more than typical. And then we often respond with frustration and anger, which is about as effective as getting upset with someone who has lung cancer for coughing.

We tend to think dementia is just about memory loss.

It’s not.

 

 

 

6 thoughts on “This Ain’t Just About Memory: Dementia and Impulse Control

  1. Neither I nor wife have dementia, as far as we know, but she does have a little brain damage from a cardiac arrest. What you wrote still applies to us. We get aggravated with each other and must exercise control of our impulses. But we don’t always do so. I can better appreciate the importance of impulse control thanks to your blog post today. Thank you.

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  2. Elaine, thank you once again for an excellent article. I not only learn about dementia (my husband has bvFTD and Parkinson’s) but how to relate better to him, others, and myself.

    Like

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