AD is plaque buildup and tangles in the brain. The brain builds memories and associations by creating synapses and dendrites etc in the brain. My topic isn't how it works exactly - it's that the brain literally creates 'electric' circuits in the brain which are the memories and associations. That is where what the mind does becomes a physical reality. Those circuits which are the memories are now physically real inside the body.

When we go to Conneticut and are suprised that our friend owns a horse now - the brain creates new electric circuits that connect horse to Connecticut to our friend. There was unusued brain area, we found this out, there are now physical circuits connecting these things. Whether by creation or nature, this is how it works just as we could believe many different philosophies; but, they better include that human beings have two arms because that's pretty clearly true.

This mechanism is not turned off or destroyed by any of the dementias. Our spouses are forming new memories and new associations just like anybody else and those do NOT have plaque or tangles because they were made very recently just as when I now say the word Racoon - you are going to build a new circuit that connects the little furry critter to the AS board and someone named Wolf. That's how it works in simple terms.

Just as with us, the brain is the busiest with the most recent memories. That's because it continues to form more circuits as we consider what we have recently seen and experienced. We peek into part of this process when we remember our dreams, but it goes on during the day as well.

I consider why my lifelong friends have become baboons and have conflicting feelings and thoughts that have now gone on for months unresolved (and therefore still on the 'to do' list of the mind) while I meander around hate and forgiveness and hurt and resolution.

Our spouses are going through the same thing. And they still dream. But their cognitive abilities and higher reasoning functions are likely partially or greatly damaged and so their experience of the same new memories is different from ours.

The pooper and the poopee are both recording the pooping experience from their own perspective equally well. The poopee (us) come away with reactions and try to start assimilating the experience. The pooper (them) may not have functioning assimilation capabilities or more likely some but damaged and only God would know what goes on in their mind when they have as good a memory of the incident but damaged ability on what to do with the information.

All of these mechanisms of the mind reinforce and develop our concious and unconcious perception of who and what we are. That pretty much drives everything we do and the thoughts we have. That stuff gets pretty tangled because life as a human gets complicated. Having random damage to these functions means that the patient's experiences are just as vivid as ours - but reactions to them and behaviour changes from them are virtually alien.

When we have an experience that is alien to us we have a strong reaction. The brain is on high alert because something new is happening and that may be a serious threat. We stay very aware until we either resolve it or block it off (as too weird to deal with for example). The AD patient doesn't have those abilities that are so finely tuned that we know very quickly if we're 'off' today. Imagine if powerful things are happening to you and while for most of us that would be experience enough - they have much more powerful experiences inside because they next realize (less so as the disease progress and more stuff is damaged), that they don't know the answer, or that their own mind is offering progressively weirder interpretations of what's going on.

I believe I touch the nightmare of AD when I realize that I have been talking out loud for the last 15 minutes about a situation that doesn't make sense and have been doing both parts. I stopped suddenly and in the silence realized horrified that I really was doing that. The hairs stood up on the back of my neck because that's bizarre behaviour and I was doing it and didn't know it until I suddenly saw it.

Try to imagine what goes on when you have the toothbrush in your hand and don't know what it is and someone is telling you and they expect you to do something but you don't know what and then it suddenly comes back and you start brushing your teeth. Whatever your thoughts or ability to use the thought part of your damaged brain - the stress is real and at least as powerful as when I realized I was acting crazy.

I have heard it explained this way, The connection between short term memory and long term memory gets destroyed by the disease. That means that they can no longer learn. They have noway to move the data into long term storage. The disease also attacks long term memory and it destroys the most recent data put into long term memory. That is why they regress into child hood memory and the think you are their mother of father, because the most recent memory of you is gone.

Wolf, you have explained very clearly what AD does to the victim. By destroying the existing neural connections--the wiring--portions of the functions are lost. When that ha[p[pens their ability to recognize, understand, and utilize the new information coming at them each waking hour, is it any wonder that from the first development of the disease, they are frustreated, may become angry, are scared, etc. When we as Caregivers can get our heads around that, perhaps we can then realize and accept, sooner, that their behavior is not deliberately out of the "norm" and is not aimed at us or anyone else. I imagine it would be like waking each morning finding yourself in a new foreign country, where the language is different, things may look the same , or not, but the rules are different, and only somethings remain sufficiently familiar for us to cling to.

moorsb put forth another angle to the picture, on the way the memory areas are affected. New memories are made but the storage function's been destroyed, plus, as the disease progresses, the long term memory is demolished on a last -in-first-gone schedule. And so they regress into childhood.

I have another perspectmive. My DH has VaD. The results are basically the same, but the progression is slightly different. The damage from VaD comes from the deterioration of the nourishing blood supply to the brain. Microscopic vessels break or block and cells die. Same with larger vessels. The is no rhyme nor reason to where this may happen in the brain at any given time. Unless there is a large event, the damage may at first be undetectable. But with repeated events in the same area, symptoms appear for short spates which eventually grow until the skill is permanently affected, and then proceeds to continue worsening. He is well into Stage 6, but some might say I'm wrong because he is only sporadically incontinent, and is still totally ambulatory. For him this ois not a downhill slide as much as an elongated stairway with every step of a diffrent width and height, and which shifts, like walking on a squashy mattress. The result is like falling o0ff a series of cliffs--some just a small bump, some really steep. From one event to tghe next we have no clue what will be lost next, nor how much.

I'm sure others, dealing with the other Dementias can tell us how the damage happens for them.

The main thing I think that has helped me deal, accept, and continue the changing role I have as his Spouse--now his Caregiver, is that this is not his choice and his behavior is a combination of the damage being done to him and his reactions to that--fear, frustration, anger, etc.