What is Flat Affect?

Flat affect is a common symptom in dementia such as Alzheimer’s disease or Parkinson’s disease dementia. It can also happen in other diseases such as Schizophrenia and depression.
In today’s video, I share how flat affect looks in dementia and how to NOT let this common symptom make you feel like you aren’t doing a good job at bringing joy to your loved one’s life.
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In case you haven’t met me, my name is Natali Edmonds and I am a board certified geropsychologist. That means that I am a clinical psychologist who specializes in working with older adults. One day, while hiking a trail, I came up with the idea for Careblazers and I decided to see if posting videos online could provide help to the many other Careblazers in the world who don’t get to have help come directly to them in their homes. I hope that this work helps you in some way on your caregiving journey.
#careblazer #dementia #dementiacare

[@odysodys1098]

Being a caregiver is a hero's job. Hats off to them.

[@orthodudeness]

Sometimes, a lot of times now, I am flat affect. I let it go, let so many things go, house cleaning etc. you name it. I still keep up somewhat, I am just flat about it. The routine-nonroutine is emptying of myself. I know this will end; life will come back. Just now really flat and boring and stuck. I will be unstuck someday. Without the support here, I would have no answers, ability, or reason to do this level of care. The foundation here is lifesaving. 💖

[@yvonnekneeshaw2784]

My mom is 10 years into dementia. No longer recognizes me or family. Hymns & Christmas music still reaches her spirit because her toes tap to the music occasionally. I am thankful to this one sign . Dementia = loss & grieving x 2. To all caregivers … may u be given strength for the role you find yourselves in 🇨🇦❤️

[@Grace2010H]

My Mom showed genuine happiness -for the most part - this year at Christmastime. She thanked us for her gifts, she laughed at movies, she enjoyed meals and ate well. We were truly blessed this year. While I know things can change moment to moment…I’m so thankful for these precious moments we’ve had these past few days. 🥰🥰🥰🥰

[@annbancroft2165]

This has literally just started for my mum and I am soo glad to have watched this video. I have spent the last 2 days like a dancing monkey trying to get a response from her as to whether I was making Christmas fun for her as it’s just the two of us together all the timeT. hank you for relieving my stress as I did not know this was a thing with dementia. I have said it before and I will say it again you really are a lifeline to people navigating this seemingly treacherous journey. It becomes so easy to take it all as personal failure. Thank you and happy holidays ❤

[@all4paws508]

I've been following Natalie for years and she is my saviour 🙏 Soooo glad u found her too! Blessings from South Africa 🇿🇦❤

[@stephaniecostello2262]

Natali is a lifesaver. I followed her for several years while caring for my mom. I truly don't know what I would've done without her coaching. God bless you, Natali. 💜💛❤

[@annbevan211]

There are only the two of us too Ann, which can be hard at times.

[@kathyharmon2093]

Look up Dr Ken Berry on KZbin his lifestyle can improve dementia… best wishes

[@Ima523]

Thanks, I so needed this reminder. I'm my dad's primary caregiver and it's hard to not take things personally. At least now it has a name called flat affect. It's nothing personal, it's his Alzheimer's, so I should just carry on and never doubt myself..

[@steviem5279]

my dad passed away in the summer after a battle with frontal lobe dementia. My mom and I were his primary caregivers and while it is tough not to take things personally (you're only human) but try your best to remember that they are suffering with this disease. But keep this in mind, be proud of what you're doing, not many people would take on that kind of responsibility, I have to say, now that my dad is gone, I miss caring for him and there are days I wish I could take care of him for one more day.

[@DementiaCareblazers]

It doesn't mean it's not hard, but at least there is an explanation behind it. I hope that brings you some comfort.

[@wendyharley1132]

Oh my LO shows her emotions, the good and bad

[@annbevan211]

It is heartbreaking and it is difficult not to take it personally. I find the constant tearfulness hard to deal with and constantly saying she is sorry for changes in behaviour she has no control over. It is good to hear that being unable to express the normal emotions is part of the condition. It's something I have realised as time passes. . .

[@brendadickenson6743]

I had to tell mom, listen to me, no sorry is necessary. You took great care raising me for a long time with all 4 it is a wonder you survived. I love you. Remember how she put up with my and siblings crying, had 4 kids in 6 years. I think back and then it is a lot easier let the emotions come, ask if she wants a hug, then move on to hey want a tuna fish sandwich and soup for lunch? The change in what I said and including her in the decision she seems to pick up on like okay and next thing you know she is in the frig for water and her relish for the sandwich, while I get the mayo. My mom never wants hovering over her much. I know she like ice cream late a night..not much. As I have watched out of my eye sneaking some spoonfuls at time throughout the day. She swears I did it, I tell her she wasn’t to notice and I will get more.

[@constance4065]

I agree @Ann Bevan. It is heartbreaking! I sometimes feel like my Mother does not love me like she did before she started having symptoms of Dementia.

[@annbevan211]

It is common for those closest to and the main caregiver to be resented for what they are doing. It took me a while, and many periods of hurting, to figure this out . . and then Natali confirmed it in one of her sanity-saving videos. Sometimes we can over-care to a point where our loved ones feel they are in chains and not allowed to do what they used to do and in the way they are able to do it now, so we try to rescue them when they just want to be left to do it, whether it is safe or risky for them to do it or not. It's a juggling act. Let them feel good they have done something useful or over protect.

[@TitianTopsyTurvy]

@annbevan211 Oh gosh the dilemma of whether to intervene with possibly risky tasks! Wanting to prevent an accident/incident at the cost of undermining Mum's sense of independence. I struggle with this and before I know it I've stomped all over my poor Mum's feelings. I wonder if one of the reasons I struggle is I haven't had children and the whole distraction and moving onto some other task or interest isn't something I learnt to do. I've seen some parents prevent toddler meltdowns with finesse and envied their skills.

[@surfrby8876]

I was caregiver for my mother for a year and a half before she passed last May , my mother had flat affect , I could never get her to smile even for a pic towards the end, Iaccepted it because she used to thank me for taking care of her , she was happy inside , I knew that and she loved my dog Murphy Brown , great pet therapy , thank you for these videos , they helped a lot during that time with my mother

[@rebeccagirson1087]

I just experienced this with my Dad on Christmas. I feel as if I'm constantly striving to find the right gift, the right movie, the right food that will make him happy and it feels like he doesn't care about or appreciate anything. I needed to hear this message.

[@alissagonzales735]

My husband shows very little emotion. He gets upset easy and will not speak for about a month sometimes more. Yet he never was like that before. He just doesn't care shows no emotion what so ever. He got upset the day before Christmas with me. He still has not spoken to me. Yet I have no idea what I said or did. It been just a little over a year he got diagnosed but I am sure it started before then. I had noticed it and finally was able to get him diagnosed.

[@Joe67888]

I am a veteran who has been indoctrinated to keep calm and show no emotions during stressful situations. Now, as a civilian, I find that I don't show emotion either in extremely happy surroundings or in emergency situations. I am totally flat in both cases. It is so ingrained in me that I can't show emotion. My own wife died right in front of my eyes when I was called at work to see her at the hospital, I didn't show one bit of emotion. That hurts me so much, but I cannot show emotion. I love people, and I want to laugh and be happy like others, but I can't. I do not have dementia or anything resembling a loss of cognitive function. I just lack the ability to show emotion. I can't even cry. I am so sad...

[@DementiaCareblazers]

Flat affect can happen in many conditions- including depression. Sending you so much love 💖

[@Claudia-up6hr]

I live in a nursing home. The majority of residents have dementia to varying degrees and also of several types so it gets very confusing to say the least. Those of us without dementia try to help the overworked staff. The question came up this morning of how to know whether or not a resident is truly benefiting from efforts to make them a little happier because it can be exhausting & frustrating-we have our own serious health challenges too. Some who can't express themselves are really pleased by extra attention but we suspect that others with this 'flat affect' are just that--emotionless. Still, we feel guilty when we give up on answering the unending cries of "Please help me/take me back to my room/feed me/tell me what to do, etc". I wish the doctor had talked a little about this but perhaps she has in another video. One thing for sure though: doggos 🐶are the best therapy ever--they come here weekly & put huge smiles on everyone's face😁!!

[@Paul12345671]

I've noticed that in my father, except for when he was angry. Flat affect seems to effect every emotion except anger.

[@TitianTopsyTurvy]

Thank you Natali, the things you have taught me helped save our Christmas. It nearly ended with my brother storming off on bad terms with our Mum. It's hard, they were so close, she was always his confidante. Now that is gone and he's finding it really tough to take. He just wanted some reassurance from our Mum about difficult things happening in his life, but Mum isn't able to do that for him anymore and he took her reaction as rejection. Dementia can be so emotionally painful for loved ones 💔.

[@annbevan211]

My brother finds it difficult to deal with too . .

[@thatinspiredme1073]

Thank you so much for doing this video! My husband and I have noticed a dramatic decline in my MIL’s reactions and now things make sense. Thank you for educating caregivers. This would be so much more difficult without these insights.

[@elainesullivan5484]

My mom just started the flat affect stage in the last 6-8 months. Although I'm not her full-time caregiver (I live in a different state), I stay with her for a week, sometimes a month or more throughout the year. I've found myself feeling guilty if I can't get a reaction from her. Because it's, for the most part, a one-sided conversation now I started facetiming with her and it goes better when she can see me. I can get her to smile if I ask her to but she only smiles with her mouth, not her eyes. It's so hard to put on a happy face when I'm crying inside at what I see but I realized that singing brings her out of her shell, if even for a moment. At Christmas I facetimed with her and we sang her favorite Christmas song. She knew all the words. Her face was emotionless but I smiled for both of us. It was a beautiful moment to cherish. Thank you for sharing your knowledge with this community of careblazers & teaching us how to navigate this disease. Your videos have been so helpful & reassuring. We are not alone. God bless❣

[@mytinyretirement]

I would very much appreciate your take in a video on dealing with a dementia loved one who has mental health issues that have seriously worsened with the onset of dementia. My mother has always been extremely manipulative, controlling, negative, and filled with rage my entire life. Now, with dementia being clinically addressed, her behavior toward me has become so violent that I'm afraid for my own safety when in her company. Thank goodness for my (large) husband who has stepped in to do things like transport her, check her meds, check her blood pressure, etc. Even with him she pivots between from extreme euphoria, down to utter sadness where she can barely speak, to violent rage, theres never any stability...one end of the emotion spectrum or the other. I barely see her anymore and never without my husband for fear of being physically attacked. I have NO idea how to handle this and no one seems to want talk about it...only how to be the best caregiver you can be. But what if by doing so, you're putting yourself at risk? I have multiple recent new loose teeth because I can't raise my hand against my own mother. I'm in several support groups, but they all seem to be the same.

[@yvonnereeves4968]

I feel your pain. I am going through the same situation. The good news is this too will pass. My mom's aggressiveness has declined and now she is just sad and pitiful - but not combative. It is hurt breaking to be the dart board sort of speak. I start everyday with a good attitude and hope not to lose my S*@t. Sometimes God gives me the patience and grace I need, but none-the-less the dementia symptoms keep changing. Hang in there.

[@7hilladelphia]

A "combative" dementia sufferer is above our pay grade to work with. Simple isnt it? Loved ones inadvertently triggering the worst so, maybe its best to not be there at all. Nuetral ever changing rostered staff less likely to trigger rage (?)

[@Danette1959]

I've been noticing this for a while with my ex boyfriend whom I am helping to caregive. I have a BA in Behavioral science I actually have not taken any of this 'flat affect' personally. I understand it is part of dementia before seeing this info. Thank you because all this info helps me really understand. I went thru some with my mom going into dementia late 70s, then my older sister took mom to live with her for awhile.

[@marianamanzana8016]

It definitely was difficult to experience this during Christmas for the first time. My mom used to love decorating and cooking but showed nothing when I mentioned it to her. I want to believe she had a good time and that she enjoyed eating her favorite recipes ❤️ tysm for all the info

[@adeodata6364]

Thank you very much 😅 => It doesn't mean they don't enjoy "it“, but how do we know if they DO enjoy "it" still? If not, what's the point in still doing this or that activity? My father doesn't manifest flat affect yet, but he seldom likes (at the same level) to do what he used to enjoy, and he SAYS it (as and while he still can say it). For instance he used to listen to music a lot, and now he listens to one or two songs and suggests I can turn it off if I want (which seems to mean he prefers silence, music now tires him)... I know that NOW because he can still explain it (he says he doesn't need music), but if I start doing another activity with him when he starts manifesting flat affect, how will I know it's not bothering him the way music tires him now (rather than "he's probably enjoying it but can't show it“) ? In this case why not just BE with the person, and leave him/her alone (I mean not bother him /her with “activities“? I'm not talking about birthdays or such that are social gatherings in which we'd like our loved ones to participate... But even birthdays... It reminds that me & my dad, we celebrated this Christmas with my son and his family, as we thought it might be my father's last Christmas. He was a bit lost but tried to participate by asking a few questions and talking to some people but pretty soon he got tired and I suggested that he be alone for a while in another room-which he gladly accepted. We took turns to go see if he was alright. He wouldn't have been able to manifest his desires if he had had flat affect and it could have been an unending torture if we weren't careful. He was exhausted when we got home, anyway (although we made the party short) ... My point is: wouldn't it have been better if he had stayed home, peacefully, with someone, without doing anything special, rather than joining with us, which made US (selfishly?) happy (and probably him too, but just a little while, as he forgot about it immediately after anyway- what he remembered for much longer, on the way home, was his frustration). Again, my point is... If a person has flat affect, isn't it more prudent and caring to let her/him BE, and assume that she/he is fine like that, without doing anything special to entertain or please her/him? I'm noticing that what my dad most needs these days is just a presence near him, but maybe that's just him...

[@pattitibble]

Wow. I really really needed this! Thank you so much!

[@ritadose4357]

This video has just restored me. Thank you for this wonderful video and advice. Your videos are priceless ❤️

[@lindagraham8884]

This sympton is what In noticed about my mother well before her Alzeheimer's dementia major incident, it was about 2 years prior. Thans for the explanation.

[@markchin8256]

Merry Christmas, Dr. Natali. Thanks for all your videos from 🇸🇬 Singapore.

[@donnaingle1359]

Great information

[@jandecourtney4638]

Thank you, this was very helpful.

[@nerissathieler7780]

Thanks so very much for all your information to help us!🙏

[@tstader1]

Your Hair is FAB here! Very flattering on you. Love you and your insights…lost Mom a few months ago but you made it easier (can I say that).

[@brendadickenson6743]

Diffidently keep this mind. Thanks so much! I am over 70 and this can certainly apply even for our age group of family and friends. 😃😃😊

[@carolejackson8357]

When Mom had dementia relates to brain cancer, she lost her ability to smile. But I could discern her smiles even when others couldn't. Pay attention to the small things. Yes, it's nothing to tale personally. We grew closer than ever when I became her voice.

[@elainemedley8638]

Doing what you would like to do to bring joy to my love one I’d perfect. I have gone up and down with should I or should I not 😅 I had the the 2nd. Totally off the chart reaction from my sweet guy after a family get together. He made up a story, which of course seemed true to him. I helped him get thru that, thank you Lord. And the next event still went and he enjoyed himself. It’s just good for us to get together with others no matter. ❤

[@melstjohn3766]

Thank you 🎄

[@DementiaCareblazers]

You're welcome!

[@zoeiiseda246]

Thanks for this. And you look GREAT, btw.

[@larryschoonover7913]

thank you Natalie

[@DementiaCareblazers]

you are so welcome 💖

[@dianethompson6980]

Happy Holidays ❤️🇨🇦

[@DementiaCareblazers]

Happy Holidays!

[@shelbymorris8088]

Thanks!

[@DementiaCareblazers]

You are so welcome. Thank you for your kind donation.💖

[@lindagraham8884]

Watched your vide yesterday 12/26. My mother and I were at a family gathring 3 years ago, she is usually somewhat talkative and friendly, she sat in a chair the entire time and said next to nothing to no one, and seemed sullen. This was so unlike her, that was first time I noticed there was something wrong, totally wrong with her mentally.

[@andrewblake2254]

Based on that one limited piece of information it could also be depression.

[@OldSchool1947]

The “flat affect” you talked about is true of depression too…maybe they can be misdiagnosed.

[@sylviebigger4939]

Thankyou for your insight yes we are at the flat stage. The video back and forth app is annoying a bit. I loke the old versions of conversation.

[@tbunnyshy1]

I am here because my family brought symptoms to my attention. My voice has been very weak the past couple of years. It takes a lot of effort to show expressions. I use muscle memory to force my face into a look when I can. It feels like I can no longer connect with people. I don’t know what to do right now as I’m in a bit of shock.

[@dollyindixie1411]

My mother 85 years old recently diagnosed with mid stage Alzheimer’s by her primary care Dr. Appointment with neurologist in February .. I knew for the last 2-3 years she was showing progressively worse signs of cognitive function.. finally convinced her to have testing ..We bought her a very nice new home next door to me (in the country) and sold her home in a small over 55 gated neighborhood in town.. she has now decided she hates being so far from town (20min) and wants to move back.. there’s no convincing her she is where she needs to be .. she repeats or asks the same exact thing 5-6 times with a short conversation.. misplaced items daily like her purse her box of checks her rings etc that I have to go help her find .. yet she thinks she’s perfectly capable of living in town by herself.. any advice on how to handle this is much appreciated 😢

[@sandrapride1046]

I just tell my mother, “Not today.” Make excuses not an argument.

[@michelebond264]

Can you tell about what stage they are in when you notice this change?

[@melanieopperman6688]

❤❤❤

[@davidschroeder3397]

Is the flat affect something you can see early on, before a diagnosis of dementia? Or is it only in later stages?

[@carolgose3985]

I feel this way at Christmas…but my HWD passed away Dec 3…how can one differentiate between grief and pre symptoms of dementia?

[@lisaharvey5418]

I tried to use the link to provide my email for the free class, the link is not highlighted, so I cannot get signed up for notification on when the class is.

[@Guide504]

In FTD this is primary

[@Auggies1956]

I'm a big kidder, when I stop that will tell the family and friends that something is drastically wrong.

[@robertdesantis6205]

You might appreciate the movie, "Do You Remember Love," with Richard Kiley.

[@oksanaml9279]

Your link to sign up for the webinar doesn't work.

[@mollymalone5307]

My dementia patient constantly HIDES every day items, ie. toilet paper, cutlery, bread, any colorful or shiny objects. I keep my jewelry under lock and key. I call it "the squirreling phase.

[@laundrygoddess4]

My lo goes between underreacting and over reacting. I have no idea what he feels based on his face

[@emilykrahn3185]

Yes I have the same problem or same experience with my partner. It's like they're either on really high volume or completely off and flat affect. There'll be a lot of anxiety or anger, I guess and then just nothing. And it's unexpected, you never know what it's going to be...

[@Guide504]

By the way, your camera lens is dirty and splitting the light!

[@alexmorgan3435]

Dr Natalie, I noticed in this video that quite frequently you were looking around to the sides off camera while you were talking and animating your hands. I've not noticed you do this so obviously before I was waiting for you to say it was a sign of dementia where perhaps a LO is not concentrating. I found it quite disconcerting. Regarding my mother she comes alive when my sister is around, but me she shows little emotion, well little happy positive emotion to me. It's always a hostile looking face and arguing with what I am saying. Two days ago she had a big fall banged her head badly on the right side of her cranium. Has a huge bump and haematoma with an adjacent black eye and bruised adjacent right cheek. My sister had taken her away against my wishes to a holiday cottage. On Christmas Day my mother fell on a set of stairs leading up or down to a toilet which were uneven. I have not seen it. My sister never told me until this afternoon some 48 hours after my mother's fall by which time my mother had been admitted to hospital had CT scans and blood tests. She has a huge bump on the right side of her head and the hospital are keeping her in for observation and results of blood tests tomorrow. The thing is this happened fairly locally to me about 80km away on the coast, whereas my sister lives over seas and had taken my mother there without my approval from her retirement accommodation without even asking me, even giving me the address of this cottage they were staying at. I have not seen it but it does not sound very friendly for an elderly infirm person who struggles with balance. This the third time my mother has fallen in 3 years and by far the most serious. The previous one back in May she fell flat on her face in a gas station sustaining a black eye and cuts to her brow and nose, but she made a full recovery. This time is a lot more serious. My question is can dementia cause issues with some one's balance and increase the risk of some one falling? If so does this indicate that some one is not safe to live independently? I feel this may now the time that we or I, as it is me that has to care for my mother, considers a residential care home where if she does fall she would have staff close at hand to assist her 24/7? Even in the hospital this afternoon when the nurse was with us at my mother's bed with my sister, her husband and myself, I was asking the nurse what injuries they believe my mother has sustained and what the prognosis is and what happens next? The nurse briefly explained and I told her that my mother had fallen before earlier in the year. The nurse said she was being kept in for observations. After the nurse had gone my mother nastily said to me in front of my sister, who should have taken more care with our mother, "I know what you were trying to do, get me taken away some where!" If my mother had been in my care she would not have been taken 200 miles to a remote cottage on the coast in winter and certainly not to a property that what not suitable for her! I think tomorrow my sister and I are going to have words. In one weeks time my sister returns home back over seas to Asia. She wants to hand our mother back to me in two days time so she can make the most of her remaining time here in UK and then continue her high powered corporate job back in Asia leaving me with our Mum. I am not working. I feel like I am going to crumble under all the stress as I have been looking after our mother pretty much on my own for three years now. I worogked so hard with my mother to try to get her some suitable retirement accommodation to buy but residents have to be suitable for independent living. This purchase has almost reached completion ready to sign contracts and pay the monies. Some who is at risk of falling or who has a history of falling may not be suitable for independent living. Am I correct? If my mother shows off a shining massive ugly black eye pushing a zimmer frame when she arrives for her first day it is not going to look good. I am so worried. She could be asked to leave even before the end of her first day! Should I ask the place where she is buying the flat before she signs the contract to purchase the flat and pays any money? Time is so short now. I just wish my sister hadn't taken our mother away to a silly cottage for Christmas and excluded me. I work so hard to keep my mother safe. Never in three years have I ever let her injure herself or come close. I am always looking out for hazards even if my mother is resisting at the time eg crossing a road where getting run over is a risk. She cannot really appreciate risk any longer.

[@21972012145525]

I would relax and enjoy your temporary time away from your mom. Your sister wants to “care” for her but she doesn’t know how obviously and your mom doesn’t care. Just tell your sister that your mom needs an easy walking environment and leave it at that. They both might’ve learned their lesson. Also, I personally wouldn’t interfere in the move. If she’s incapable of being independent, they will note that and ask her to relocate. If it’s coming from them you will avoid being the “bad guy.” Sometimes you have to play mind games with people if they fail to recognize correct decisions for their own well being without becoming the scapegoat or bad guy

[@utubestalker.dotcom]

Nikko's belly must be sore and your arm must be tired. 100k+ belly rubs is a lot, or did u mean new subscribers only lol

[@towzone]

Triggering filter.

[@pamp7076]

Hi Natali, Thank you so much for your informative videos, my Mum was diagnosed with late stage Alzheimer's beginning of this year and has been declining rapidly, my father has severe health issues and he is in denial and will not accept my mum's situation. I find it a constant battle with my father, to give mum the care she needs. Thank you again for the brilliant advice you give and I now know I am not on my own giving this support. 💖😢🫶