Dementia and history of trauma

Regarding the CMAJ Salon article, “What my 5-year-old son taught me about medicine,”1 I commend Dodek’s sensitivity to his son’s visit with Anni at the nursing home. I wonder however, if there weren’t more to their gentle interaction than met the eye. While studying for my master’s degree in counselling, I completed two practicums concurrently, one in a trauma therapy certification program and the other as a counselling assistant at a residence for patients with Alzheimer disease or other types of dementia.

One resident with advanced dementia was generally unapproachable, withdrawn and uncommunicative. During the Christmas season, a group of children arrived to sing carols at the facility. She became very agitated and tried, quite violently, to push the children out of the room. The assumption by staff was that, in her dementia and old age, she did not like children. Upon reading the social history of the patient, I discovered that as a young woman she had lived in a war-torn country. One day while walking in her village, she saw a class of children out with their teacher on a field trip. They began to cross the bridge that she herself had just traversed. Suddenly, there was a huge explosion behind her. When she looked back, the bridge had been bombed; the children and their teacher all died in the event.

This story led me to more and more research of the trauma history of many of the residents and, almost without exception, I came to the conclusion that much of their repetitive, often violent behaviour was the result of previously experienced traumatic events. In their dementia they continued to act out, appearing to attempt to resolve and heal the emotional scars of these earlier experiences. This woman, I believe, was still desperately trying to keep the children safe. To my knowledge, little research has yet to be done on the possibility that dementia, in particular Alzheimer disease, can be the result of long-term dysregulation of nervous system biochemistry in the body and the resulting neurological deficits. Dodek’s story, I am certain, reflects the history of his patient Anni. Did Anni see something in Max that no one else could see — perhaps her past as a tender and loving mother who had lost her child many years before? Further research leading to a deeper understanding of the connection between unresolved life trauma and some types of dementia would perhaps lead to more compassionate therapeutic care for patients with dementia.