A primary function of the brain is to maintain a representation of the state of the body in its physical and social environment and project that representation forward into the future, both short term and longer-term. These processes depend on both long-term and short-term memory as well as current information from the senses, both external and internal. They also depend on a story-telling capability, probably the same or closely connected with the more or less constant emergence of thoughts, including daydreams, that are often disconnected from whatever topic is the current focus of attention. Most of us have a background knowledge of what we are likely to be doing both over the next few hours (short-term projection) as well as over a longer future time-span (long-term projection). All of this is part of the cognitive context, background knowledge that contributes to how we understand relevant events, including communication. We ordinarily pay attention only to what is relevant to current concerns and otherwise give little thought to this background mental “chatter” – until it stops.
In healthy young people the body usually repairs itself – and even the brain is able to repair minor damage, sometimes growing new neurons when needed. As we age, this self-repair ability weakens, just as damage becomes more common. Unfortunately, the brain seems especially susceptible to enduring damage. Physical injuries, including concussions and penetration wounds, can destroy brain tissue. Strokes are a common cause of damage, and they become increasingly common with advanced age. Diseases, including Alzheimer’s, often cause a progressive damage to various brain tissues. Any of these factors can result in loss of memory (short term, long-term, or both), impairment of language skills, partial or complete impairment of one or more perceptual senses, balance, social skills, reasoning, and so on.
Patients whose short-term memory is impaired can have difficulty engaging in a coherent conversation, even when their language skills have not been impaired, because they can’t clearly recall what has already been said. This can lead to repeatedly asking the same question or series of questions, in what becomes and endless loop (frustrating to family members and care-givers).
The loss of short-term memory is also sometimes associated with inability to make or recall plans, even plans based on ordinary routine (for example, lunch and socializing, followed by afternoon snack, followed by socializing, followed by dinner, followed by going to bed). This suggests that the ability to project forward in time is related to memory or possibly part of memory. Daily routine, and forward projection based on daily routines, appear to be closely related to short-term memory, and longer-term plans to long-term memory. Cycles of the same question or comments like “I don’t understand” could be evidence of an impairment to reasoning functions, but they could also indicate a loss of the contextual knowledge in short-term memory.
I’ve yet to find anything in the neurological literature that addresses this possibility, so it remains just an interesting speculation.