“Why don’t I get any appreciation from Jack now that he has Alzheimer’s?” I overheard a caretaker say recently.  “I do so much for my husband, and he used to be so gracious.  Now he just snaps at me all the time.”

A very basic explanation of how this disease process works is that the Alzheimer’s sufferer is unable to keep track of the most recent events that occur in his life.  Unfortunately, everything you do for your loved one is in the here-and-now, and he cannot show appreciation for something he cannot even remember occurred.  But why does he expect more and more from you? It’s quite impossible to do enough.  The answer to this is actually the same: he can’t recall what you have done.

I have my own little trick for explaining how this works: with Alzheimer’s,  the brain-gizmo that gathers new information starts to malfunction first, meaning that it either doesn’t store new information, or can’t retrieve it when it is needed - even if it did get stored.  This malfunction continues to get worse and worse, and only when it adversely affects the person’s ability to function normally in their daily life can it be considered a diagnosis of dementia.

Don’t forget that dementia is the symptom, and what is causing the dementia is what the doctor will establish upon examination.  There are three causes:

1) Alzheimer’s Disease,
2) Vascular Dementia, and
3) NOS (meaning “Not Otherwise Specified,” which refers to some other disease process).

For the dementia to be considered Alzheimer’s, the patient will also have at least one of the 4 following afflictions:

1) Aphasia,
2) Apraxia,
3) Agnosia, or
4) Executive Functioning Difficulties.

To expect someone with Alzheimer’s or a related dementia to show appreciation would equate to a diabetic not having a reaction to the birthday cake you made them, just because they liked the taste of it.  Your husband’s reaction is because of the disease; it is not a choice he has made, or something over which he has any control.  When we as caregivers become aware of this, we can focus our anger on the disease and its symptoms instead of our loved one.  Then, and only then, can we move forward and work with the person for whom we truly care.

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