Stuck on Repeat in Alzheimer’s Disease

People with Alzheimer’s disease often experience conversation loops.

Posted Dec 14, 2017

If you have a relative with Alzheimer’s disease, you’ve probably experienced multiple conversational loops. A topic comes up and is addressed. Within a few minutes, however, your relative is back around to the same topic. Stuck on repeat. Repeating the topic multiple times during the course of a conversation. Maybe even returning to the topic over several days.

I remember, for example, the last time I visited one of my grandmothers. She was experiencing the moderate cognitive declines that accompany Alzheimer’s disease. She was doing pretty well overall. She still recognized me and knew many things about me. In the midst of a conversation with her and my grandfather, she really wanted to take a turn in the conversation. So she asked me how things were going in college. In answering her question, I explained that I had finished college and was now in grad school. She nodded and the conversation moved on. But within a few minutes, she again wanted to participate in the conversation. I could see her thinking about something she wanted to ask me. At the next conversation break, she asked me the exact same question: how things were going in college. I answered her question just as I did the first time, noting I had finished college and was now in grad school. Again, the conversation moved along to other topics, as conversations do. But about 10 minutes later, my grandmother once again asked me how things were going in college. She was stuck on repeat, looping the conversation back around to the same point over and over again.

The conversation loop is a regular feature of interacting with people with mild to moderate Alzheimer’s disease (Cook, Fay, & Rockwood, 2009). You can see this in the course of a single conversation, with the person returning to the same topic repeatedly. You can also see this over the course of days. The person with Alzheimer’s may keep coming back to the same topic or question. The nature of the topic can vary greatly as well. With my grandmother, she was relying on old memories as a way of engaging in a conversation. But I’ve seen other examples. When my mother-in-law lived with us, she would often learn something that concerned her deeply. She would then ask about the topic repetitively, sometimes over several days. But she never remembered the answer or realized that she didn’t need to worry about it any longer. Another family member is frequently reminded of old memories by things around her. She will then tell me the same story that she has told me before. She fails to remember that she has already told me that story. If you are planning an activity or taking someone with Alzheimer’s somewhere, they may ask multiple times about the activity or trip.

Why do people with Alzheimer’s get stuck in conversation loops? To put it simply: they don’t remember that they’ve already had that conversation.

These types of memory failures are typical for people with mild to moderate impairments. People with Alzheimer’s disease experience more difficulties encoding recent experiences. In mild to moderate cases of Alzheimer’s the difficulties with recent memories isn’t a complete block, some things still get into memory. Usually, these are more important and emotional experiences. That’s why they can get stuck on one of these recent experiences as a repetitive topic of conversations.  

They can still remember old memories. Those memories from earlier in their lives remain and are cued by the environment around them. Thus, the same retrieval cue will bring to mind the same memory. And the person will repeat the story for you one more time.

They can track a conversation for a reasonable period of time. For this reason, they don’t repeat the same thing immediately. How long they wait before they repeat tells you something about how many memory difficulties they may be experiencing at the moment. By the way, this isn’t constant. In Alzheimer’s disease, although the trajectory is downward, there are good days and not so good days. But the length of time before the person hits the replay button will probably be anywhere from five to 30 minutes.

I should note that all of us experience these sorts of small everyday memory failures (something I’ve written about before). We tell people the same story we’ve told them before. We ask the same question we asked a few minutes ago. This is normal. We don’t remember every experience. We often have these errors because we weren’t completely focused on the situation. We may also have difficulty remembering who we told a particular story. We may wonder if we actually told them or only meant to tell them. Creating a clear memory of an event require binding the various elements – it involves paying attention. Even in the best cases, we don’t remember everything and experience problems knowing where and when something happened. Or in the case of repeating a conversation, knowing who we told or if we had the conversation. So don’t worry if you have these small memory failures occasionally. That’s normal.

But creating these recent memories becomes more challenging in Alzheimer’s disease. For people with mild to moderate cognitive impairment, the work of binding the elements of an experience into a personal memory is disrupted. With mild impairments, although some things are remembered, more failures start to occur. You may have an older member of your family who is frequently repeating conversations within 15 to 30 minutes or you may have a family member who tells you the same story over and over—maybe within a single visit and maybe across several visits. If you have a relative experiencing frequent conversation loops, then it may be time to check with your primary care physician.

Finally, I’d like to make a suggestion for those of you who are primary care providers. When your family member with Alzheimer’s repeats a story or asks the same question again, simply have the same conversation again. There is no point in telling them that they are repeating themselves. Everyone feels bad when that happens. The person with Alzheimer’s is doing the best he or she can. People with Alzheimer’s are trying to engage in conversation, trying to track things, trying to still be themselves. You only increase their embarrassment and frustration by pointing out the repetition. I’ve found simply having the conversation again leaves everyone happier in the moment. In supporting one family member who has mild cognitive impairments, the conversation loops often replay after 15 minutes. I simply replay the conversation with her. We’re both happy enough in the moment. I don’t make her embarrassed and I feel less frustrated. I save my crying for when I go home.

References

Cook, C., Fay, S., & Rockwood, K. (2009). Verbal repetition in people with mild-to-moderate Alzheimer disease: a descriptive analysis from the VISTA Clinical Trial. Alzheimer Disease & Associated Disorders, 23(2), 146-151.