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Advanced Dementia: Why Some Skills Remain

- Monday, April 02, 2012

A subscriber to the Johns Hopkins Memory Disorders Bulletin asked: “I recently read a newspaper interview with a famous neurologist who described the case of a musician who had completely lost his memory to dementia, yet was capable of playing piano concertos -- from memory at a professional level. Having cared for my mother, who died from Alzheimer's, I do not see how this is humanly possible. Can you please explain?”

Dr. Peter Rabins answers:  “I have also observed individuals who have advanced Alzheimer's disease but can still play bridge or music. There are several plausible explanations. Most likely, the retained ability is "highly developed," that is, something the person was especially good at. Usually, there is some deterioration from the very high level at which the person could once perform, but the remaining skills are still far above average. Often, what is retained is something learned a long time ago.

In Alzheimer's disease and most dementia, new information is lost first and information that was learned long ago is retained for a much longer period. As a result, the person with dementia can play a piece of music learned many years ago, but not learn a new piece of music. In vascular dementia, the deficits are described as "patchy" because some abilities are intact and others are impaired -- the difference depends on whether a particular area of the brain has been injured or not.”

Johns Hopkins Health Alert