Why Repetitions: The Brain Mechanisms Explained

The Destroyed Hippocampus: When Immediate Memory Disappears

To understand repetitions, one must first understand what is happening in your loved one's brain. The hippocampus, this brain structure essential for forming new memories, is one of the first victims of Alzheimer's.

The Normal Role of the Hippocampus: Imagine the hippocampus as the recording office of a town hall. Each new piece of information (a conversation, an answer to a question) is processed, recorded, and then stored there. Normally, when you respond "Lunch is at noon," this information is:

1. Captured by the hippocampus
2. Encoded as a new memory
3. Temporarily stored
4. Available for immediate recall

What Happens in Alzheimer's: The hippocampus is gradually destroyed. It's as if the recording office closes its doors. New information arrives but is not processed:

1. You respond "Lunch is at noon"
2. The information reaches the brain
3. BUT it is not encoded (failing hippocampus)
4. It disappears in a few seconds/minutes
5. For your loved one, you never answered

Clear Analogy: It's like writing on water. The information is there for a moment, then disappears without a trace. Your loved one cannot retain your answer any more than you could retain the details of a dream that evaporates upon waking.

The Thought Loop: When the Brain Goes in Circles

Beyond failing memory, repetitions reveal a phenomenon of "cognitive loop" characteristic of Alzheimer's.

The Normal Thought Circuit:

1. A concern arises ("When do we eat?")
2. We seek the information
3. We find it or ask for it
4. The information calms the concern
5. We move on to something else

The Broken Circuit in Alzheimer's:

1. The concern arises
2. The person asks
3. They receive the answer
4. The information is not retained
5. The concern remains intact
6. Back to step 1 → infinite loop

It's like a scratched record that keeps replaying the same passage. The brain is stuck in a loop it cannot break on its own.

Underlying Anxiety: The Real Engine of Repetitions

Neuroscience teaches us that repetitions are not just memory problems. They are often fueled by anxiety, which is omnipresent in Alzheimer's.

Sources of Anxiety in Alzheimer's:

• Confused awareness of one's difficulties
• Temporal-spatial disorientation
• Inability to foresee/control
• Fear of abandonment
• Constant feeling of insecurity

This anxiety activates the amygdala (the fear center), which still functions well in Alzheimer's. The amygdala sends constant alarm signals, generating repetitive questions that are actually requests for reassurance.

Testimony from a Neuropsychologist: "When a patient asks 50 times 'When are we going home?', they are not really looking for the time. They are expressing a deep anxiety: 'Am I safe? Is someone taking care of me? Will I find a familiar place?' The question is the symptom, the anxiety is the cause."

The Need for Routine and Predictability

The Alzheimer's brain, overwhelmed by confusion, desperately seeks stable reference points. Repetitive questions are often linked to this fundamental need for structure.

Typical Reference Questions:

• Questions about time → need for temporal structure
• Questions about meals → need for routine
• Questions about visits → need for social connection
• Questions about place → need for spatial anchoring

These questions keep coming back because they represent the last islands of structure that the person is trying to cling to in a world that has become chaotic.

The Different Types of Repetitions and Their Meaning

Obsessive Practical Questions

"What time is it?" "When are we eating?" "What day is it?"

These repeated practical questions reveal:

• A deep temporal disorientation
• A need for structuring reference points
• Anxiety about the day's progression
• Sometimes, a way to initiate contact

Real Case: "My mother asked for the time every 5 minutes. We realized it was worse in the afternoon. In fact, she was afraid of missing dinner and being alone. Once we reassured her that we would never forget her, the questions decreased by half." - Sophie, caregiver.

Recurring Worries

"Did you pay the bills?" "Is the door locked?" "Did you call the doctor?"

These looping worries express:

• Unresolved past responsibilities
• A residual need for control
• Specific fears (burglary, illness, money)
• The transfer of general anxieties onto concrete points

These questions were probably the person's concerns before the illness. They remain anchored even when the ability to manage them has disappeared.

Stories from the Past on Repeat

The same childhood anecdote, the same war memory, the same wedding story...

These narrative repetitions serve to:

• Affirm one's identity ("This is who I am")
• Cling to intact memories
• Maintain a social connection (telling is existing)
• Relive significant moments

Observation: The repeated stories are rarely trivial. They are often key moments of identity: successes, traumas, moments of pride. Listening to them is honoring the person they were.

Emotional Requests

"Do you love me?" "You won't abandon me?" "Am I okay?"

These questions reveal:

• A need for emotional reassurance
• The painful awareness of one's vulnerability
• Fear of abandonment
• The need for validation

They are particularly frequent in moments of confusion or in the evening (sundown syndrome).

Motor Perseverations

Constantly tidying and disturbing, checking the same things, making the same gestures...

These behavioral repetitions indicate:

• A need for activity and utility
• Preserved motor patterns that run idle
• A way to manage anxiety through action
• Sometimes, hallucinations or fixed ideas

Example: "My father folded and unfolded the same napkin for hours. It was his job: he was a tailor. These gestures reassured him, connected him to who he was." - Marc, son of a patient.

The Impact of Repetitions on Surrounding People

The Gradual Wear of Caregivers

Repetitions have a devastating cumulative effect on caregivers:

Phase 1 - Patience:

• We respond kindly
• We re-explain
• We tell ourselves it's the disease

Phase 2 - Irritation:

• Patience erodes
• We respond more curtly
• We start avoiding the person

Phase 3 - Exasperation:

• We sometimes explode
• Immediate guilt
• Vicious cycle of stress-guilt

Phase 4 - Exhaustion:

• Resignation
• Emotional detachment
• Risk of unintentional mistreatment

Confession from a caregiver: "I screamed 'NOON! LUNCH IS AT NOON!' after the 30th time. I saw the fear in her eyes. She had forgotten the first 29 times, but my anger stayed. I cried from shame." - Marie, 58 years old.

Family Conflicts

Repetitions often generate family tensions:

• Disagreements on management ("You're not patient enough")
• Mutual reproaches ("It's you who annoys them")
• Withdrawal of some members ("I can't take it anymore")
• Overload on the primary caregiver

Social Isolation

Repetitions contribute to isolation:

• Avoidance of outings (shame of repetitions in public)
• Friends spacing out visits
• Impossible conversations
• Withdrawal of the caregiver-care recipient couple

Concrete Strategies for Managing Repetitions

The Golden Rule: Respond as if it Were the First Time

Why It's Crucial: For your loved one, IT IS the first time. Their brain has no trace of previous times. Getting angry is punishing someone for something they are not aware they did.

How to Achieve This:

1. Conscious Breathing: Before responding, take a deep breath
2. Same Tone: Keep a soft and even voice
3. Short Response: The simpler, the better
4. Eye Contact: Look at the person while responding
5. Reassuring Touch: Hand on the shoulder if appropriate

The Effective Script:

• Question: "When are we eating?"
• Answer: "Soon, at noon" (smile, calm tone)
• Avoid: "I've already told you 10 times!"

Visual Supports: Externalizing Memory

Creating visual supports can significantly reduce questions:

Orientation Board:

• Large visible clock
• Calendar with ONE visible day
• Illustrated daily schedule
• Photos of loved ones with names

Reassurance Signs:

• "Lunch is at 12pm"
• "Marie is coming this afternoon"
• "You are safe here"
• "The bills are paid"

Tested Tip: "I created a 'response board' with mom's 5 favorite questions. When she asks, I say 'Look at your board' while pointing. It works 7 times out of 10." - Paul, caregiver.

The Diversion Technique

Rather than responding endlessly, redirect attention:

How to Do It:

1. Briefly respond to the question
2. Immediately follow up with something else
3. Propose an engaging activity
4. Use a transitional object

Concrete Examples:

• "Lunch is soon. Oh, look at this beautiful photo!"
• "Yes, I paid. Come on, let's water the plants."
• "It's 10am. Can you tell me how you met dad?"

Emotional Validation

Often, you need to respond to the emotion, not the question:

Identify the Underlying Emotion:

• "When are we going home?" → Anxiety, fatigue
• "Where is mom?" → Need for security
• "Did I pay?" → Fear of irresponsibility

Respond to the Emotion:

• "You look tired. Come sit with me."
• "You are safe here with me."
• "Don't worry, everything is in order."

Occupational Activity

Occupied hands and mind repeat less:

Effective Anti-Repetition Activities:

• Folding laundry (repetitive but useful)
• Sorting buttons/beads
• Flipping through a photo album
• Manipulating a sensory blanket
• Listening to engaging music
• Very simple puzzles
• Adult coloring books

Testimony: "When dad starts his looping questions, I bring out the box of screws and nuts. He sorts them by size for an hour, focused and quiet. It was his job, it reconnects him." - Julie, daughter of a patient.

When Repetitions Hide Something Else

Unexpressed Pain

Sometimes, repetitions increase when the person is suffering physically but cannot express it:

Warning Signs:

• Sudden increase in repetitions
• More anxious questions
• Associated agitation
• Behavior changes

Points to Check:

• Constipation (very common)
• Urinary infection
• Dental pain
• Discomfort (too hot/cold)
• Tight clothing
• Uncomfortable position

Clinical Case: "Mrs. Dubois repeated 'I want to go home' 200 times a day. After investigation: painful urinary infection. Under antibiotics, the repetitions dropped by 80%." - Dr. Martin, geriatrician.

Medication Effects

Some medications can worsen repetitions:

• Benzodiazepines (confusion)
• Anticholinergics (memory)
• Certain antidepressants
• Drug interactions

Regular review of treatment is essential.

Environmental Factors

The environment strongly influences repetitions:

Aggravating Factors:

• Too much stimulation (TV, noise)
• Frequent changes
• Unknown people
• Inadequate lighting
• Uncomfortable temperature

Soothing Factors:

• Calm and familiar environment
• Stable routine
• Familiar faces
• Soft lighting
• Familiar soft music

Advanced Strategies for Difficult Cases

The Gradual Extinction Technique

For truly incessant questions:

1. Phase 1: Respond normally 5 times
2. Phase 2: Response + diversion for the next 5
3. Phase 3: Simple acknowledgment + activity
4. Phase 4: Reassuring presence without verbal response

This technique should be applied gently and consistently.

The Communication Notebook

Creating a Personal Notebook:

• Frequently asked questions pre-written with answers
• Photos of family with names and relationships
• Weekly schedule
• Reassuring messages from family
• Illustrated happy memories

The person can consult their notebook, even if they forget they did.

Audio Recording

For some, hearing a recorded response works:

• Record answers to frequently asked questions
• Voice of the primary caregiver (reassuring)
• Messages of love from loved ones
• Soothing readings
• Music interspersed with messages

Innovation: "I recorded 'Mom, lunch is at noon, I love you' on a talking button. She presses it instead of asking me. It gives her control." - Innovation from a creative caregiver.

Structured Reminiscence Therapy

Channeling repetitions towards constructive memories:

How to Do It:

• Identify recurring themes
• Create a "life book" on these themes
• Encourage elaboration rather than repetition
• Ask open-ended questions about the details
• Value each "new" version

This transforms sterile repetition into valuable storytelling.

Taking Care of Yourself in the Face of Repetitions

Recognizing Your Limits

Alarm Signals:

• Rising anger at the first question
• Avoidance of the person
• Overwhelming negative thoughts
• Sleep disturbances related to stress
• Physical symptoms (headaches, tension)

These signals indicate that action is needed BEFORE you break down.

Preservation Strategies

Micro-Pauses:

• 5 minutes in the bathroom to breathe
• Going out for a walk in the garden
• Quick call to a friend
• Heart coherence exercise
• Music in headphones

Organized Respite:

• Regular day care
• Home help for difficult moments
• Family/friend relief
• Support group
• Psychological consultation

Liberating Testimony: "I put on noise-canceling headphones when mom repeats. I stay present, I smile, but I preserve my mental health. It's not abandonment, it's survival." - Anonymous testimony.

The Personal Mantra Technique

Create your own mantra for difficult moments:

• "It's not her, it's the disease"
• "She's not doing it on purpose"
• "My patience is an act of love"
• "This phase will pass"
• "I'm doing my best"

Mentally repeating these phrases helps maintain calm and perspective.

The Support Network

Don't Stay Alone in the Face of Repetitions:

• Support group for caregivers
• Online forum (France Alzheimer)
• Listening hotline
• Understanding friends
• Individual or family therapy

Sharing the experience of repetitions alleviates guilt and brings solutions.

Innovations and Technological Aids

Applications and Digital Tools

Useful Applications:

• Scheduled voice reminders
• Talking clock
• Simplified calendar with alerts
• Video messages from loved ones
• Soothing cognitive games

Specialized Devices:

• Clocks with date and time of day
• Digital photo frames with messages
• Simplified voice assistants
• Recording buttons
• Motion sensors with messages

Companion Robots

Therapeutic robots can reduce repetitions:

• Infinitely patient responses
• 24/7 availability
• Interactive stimulation
• No judgment or fatigue
• Effective distraction

Feedback: "The PARO seal robot has transformed our days. Mom asks her repetitive questions, pets it, calms down. It gives me respite without guilt." - Experience in a nursing home.

When Repetitions Evolve

Natural Evolution

Repetitions change with the progression of the disease:

Mild Stage:

• Questions about upcoming activities
• Spaced repetitions (every hour)
• Partial awareness of repetitions
• Frequent excuses

Moderate Stage:

• More frequent questions (every minute)
• Loss of awareness of repetitions
• More anxious themes
• Stories from the past on repeat

Advanced Stage:

• Repetitive sounds or words
• Repetitive gestures
• Gradual decrease with aphasia
• Final silence

Adapting to Evolution

Each stage requires a different approach:

• Beginning: Written supports still effective
• Middle: Emotional validation is a priority
• End: Reassuring presence and touch

Complete Testimony: Learning to Live with Repetitions

Sylvie's Journal, caregiver for her husband Pierre for 7 years:

"The repetitions started subtly. 'Did you close the garage?' two or three times in the evening. We laughed: 'You're repeating yourself, my dear!' We didn't know.

The first months after the diagnosis: Pierre was mortified by his repetitions. He apologized: 'I already asked that, didn't I?' This painful awareness was almost worse than the repetitions themselves. I learned to respond: 'No problem, I'll tell you again.'

The Escalation (Year 2-3): From 3 times a day, it went to 30, then 300. 'Where are we going?' was his favorite. In the car, it was every 30 seconds. I cracked several times. Once, I stopped the car and cried. Pierre said: 'Why are you crying?' then 'Where are we going?' I laughed through my tears.

The Strategies That Worked:

• Sign in the car: 'We are going to [destination]'
• Playlist of his favorite songs (distraction)
• Sung response (it relaxed me)
• Timer: I really responded every 10 minutes, in between I just smiled

The Strategies That Failed:

• Telling him he was repeating (anxiety ++)
• Ignoring (agitation ++)
• Sarcastic responses (my shame...)
• Post-it notes everywhere (he didn't see them anymore)

The Turning Point (Year 4): I accepted. The repetitions ARE our new normal. I stopped fighting against them, I surfed with them. His questions became the background noise of our life, like the ticking of a clock.

The Magical Moments Despite Everything: Sometimes, in the middle of 50 'What time is it?', Pierre would say: 'I love you.' It might have been a repetition too, but it carried me through the day.

Professional Help (Year 5): Daycare saved our couple. Pierre asked his questions there. I recharged my patience batteries. In the evening, I was capable of true affection, not forced patience.

The End of Words (Year 6-7): The questions gradually fell silent. 'Where are we going?' became 'We are going...', then 'We...', then silence. Strangely, silence was worse. The repetitions were still communication.

What I Learned:

1. Repetitions are not personal
2. My patience has limits, and that's OK
3. External help is not a failure
4. Humor (dark) helps a lot
5. Each phase has its hidden beauty
6. Love survives repeated words
7. One day, I will miss these repetitions

My Ultimate Advice: Don't aim for perfection. Aim for kindness - towards your loved one AND towards yourself. If you respond with love 7 times out of 10, that's a victory. For the other 3 times, forgive yourself. You are human in the face of a superhuman situation."

Repetitions and the Extended Family

Educating Family and Friends

Occasional visitors are often taken aback by the repetitions:

What to Explain to Them:

• It's neurological, not behavioral
• For the person, it's always the first time
• Getting angry never helps
• Respond simply, without apparent weariness
• It's exhausting for the primary caregiver

Script for Visitors: "Mom is going to ask you the same question several times. Respond naturally each time, as if it were new. It's the disease, she no longer retains. Your patience is a gift."

Children Facing Repetitions

Grandchildren may be disturbed or amused:

How to Explain to Them:

• "Grandpa's brain is like a magic board that erases itself"
• "Grandma forgets very quickly, so she asks again"
• "It's her disease that repeats, not her"
• "You can respond or just smile"

Involve Them Positively:

• Create the response board together
• Draw the answers
• Invent a song-response
• Praise them for their patience

Touching Moment: "My 7-year-old son created a game: for every repetition from Grandpa, he puts a marble in a jar. When it's full, we make a cake. He turned frustration into joyful anticipation." - Creative mom.

Medical and Therapeutic Aspects

When to Consult

Signals Requiring Medical Advice:

• Sudden increase in repetitions
• Change in the nature of questions (more anxious)
• Nocturnal repetitions disrupting sleep
• Association with agitation/aggressiveness
• Major impact on the caregiver

Medication Approaches

Possible Options (with medical advice):

• Cholinesterase inhibitors (modest effect)
• Mild anxiolytics if major anxiety
• Antidepressants if associated depression
• Melatonin for nocturnal repetitions
• Avoid neuroleptics unless in exceptional cases

Attention: Medications do not eliminate repetitions but may alleviate them.

Non-Medication Therapies

Validated Approaches:

• Music therapy (reduces anxiety)
• Aromatherapy (soothing lavender)
• Multisensory stimulation
• Validation therapy
• Animal presence
• Art therapy
• EDITH program (adapted cognitive stimulation)

These approaches address underlying anxiety, indirectly reducing repetitions.

Key Messages to Remember

For Caregivers

1. Repetitions are involuntary: Your loved one cannot control them any more than you can control your heartbeat.
2. Anxiety is speaking: Behind each repeated question, there is often a worry to soothe.
3. Your patience has limits: It's normal and human. Organize yourself to preserve it.
4. Creativity helps: Find YOUR strategies, those that work for YOUR situation.
5. Help exists: Professionals, associations, support groups... Don't stay alone.

For the Sick Person

Even if they cannot consciously understand:

• Their questions are legitimate in THEIR reality
• Their anxiety is real and deserves compassion
• Their dignity remains intact despite the repetitions
• They are doing their best with a sick brain
• The love we have for them transcends repeated words

Conclusion: Transforming the Trial into Learning

The incessant repetitions in Alzheimer's disease are one of the most challenging trials for families. They test our patience, our love, our very humanity. They confront us with our limits and force us to develop unsuspected resources.

But understanding why your mother, father, or partner keeps repeating the same questions radically transforms your ability to manage this situation. It's not stubbornness, it's not to annoy you, it's not a test. It's a sick brain doing its best to navigate a world that has become incomprehensible.

The destroyed hippocampus can no longer form new memories. The omnipresent anxiety generates constant needs for reassurance. The need for structure in chaos produces these reference questions. Understanding these mechanisms replaces frustration with compassion, misunderstanding with empathy.

The strategies we have shared - emotional validation, visual supports, gentle diversion, engaging hands and mind - are not miracle recipes. They are tools to adapt, personalize, and reinvent according to your unique situation. Some days, they will work wonderfully. Other days, nothing will work. That's normal.

What matters is to remember that behind the repetitions, there is a person suffering from disorientation, seeking reference points, needing love and security. Responding with patience, even imperfectly, even 7 times out of 10, is offering what they need most: the reassuring presence of a caring loved one.

Never forget: you are not required to be perfect. Your patience is not infinite. Your limits are legitimate. Taking care of yourself, asking for help, taking a break, is not abandonment, it's wisdom. An exhausted caregiver cannot help with love.

Repetitions may be the aspect of the disease that wears you down the most daily, but they can also strangely become a space for profound learning. They teach us patience beyond what we thought possible. They teach us to be present in the moment, as it is the only one that exists for our loved one. They show us that love can transcend annoyance, that tenderness can coexist with frustration.

One day, when the words have fallen silent, when the questions have ceased, you might find yourself surprised to miss those repetitions that exasperated you so much. Because they were still communication, connection, life. So today, even if it's difficult, try to see each repeated question not as a burden, but as an attempt to connect from a brain struggling to stay linked with you.

Our training "Understanding Alzheimer's Disease and Finding Solutions for Daily Life" delves into these strategies for managing repetitions and all other behavioral symptoms. We provide you with concrete tools, proven techniques, and above all, the support you need to go through this trial with more serenity and less exhaustion.

Because understanding repetitions means being able to manage them. And being able to manage them means preserving quality of life - yours and your loved one's.

[Learn to Transform Repetitions into Manageable Moments →]