Dementia can be thought of as a progressive disability of, or as injuries affecting the brain. Different parts of the brain are affected in different types of dementia, and at different times as the dementia progresses. Understanding how the brain is impacted,and knowing the type of dementia that someone has can help family members, professionals, and caregivers communicate effectively with the individual.
Understanding that dementia attacks different parts of the brain also explains why people retain some functions and abilities, and not others. In some spheres they can appear quite normal and family members will not even notice that something may be wrong. This situation is often confusing to those trying to help them.
For instance, the dementia may impact the emotional centers of the brain. This may mean that someone has less control over their emotions, or that you will see a personality change. Caregivers need to recognize that their loved one is not trying to be stubborn, willful, or difficult. If they are crying, they may not be sad or depressed. The behaviour is due to brain deterioration or injury; it is neither intentional nor controllable. At the same time, however, the individual’s memory may be less affected, or affected later. They can continue to reason and remember.
Dementia may affect the frontal lobe area of the brain.This may show as decreased “executive functioning.” This means someone’s ability to reason, make adequate judgments, and to plan or carry out tasks becomes increasingly impaired. So, it may not help to try to reason something out with them, as their ability to follow the reasoning is impaired. At some point, it becomes difficult to discuss with someone what care they may need, as they do not have the capacity to assess themselves.It also means that you may not be able to give them a series of things to do, or a task that includes a series of sub-tasks, such as “getting dressed.” Dressing actually includes many smaller tasks–choosing clothes, putting several pieces on in a correct order, buttoning or zipping up, and maybe putting on and tying shoes.
With a frontal lobe impairment, even though the executive functioning is impaired, other parts of the brain may not be. So the individual may still have the same personality, and may still seem to function quite normally in other areas such as in some social situations. When talking to them, stay at a conversational level, and there will be no, or less problems.
As dementia increases,their ability to interpret social cues may become impaired and they often lose problem solving ability. Whereas they used to be able to manage and interpret difficult relations, they may come to strike out at someone, withdraw, or get anxious. They may not be able to ask for something, as they either cannot express what they need, or because they simply can’t find the word for it. This means that someone may have to ask them a simple, direct question, or supply the word for them.
A sense of time may also become distorted as a dementia progresses. It may not help to tell someone that something is going to happen in a week or even a day, or even an hour–but it might help to write it down on a calendar. On the other hand, something that may bring joy, is something you can tell them about every day, and the joy will be like the first time they have heard it.
The memory loss that is typically thought of as dementia is due primarily to damage to the temporal lobe. Often short term memory is affected first while longer term memory is maintained. People may also seem to start living in, or regressing to their past. When this occurs, follow their lead and talk to them about their past. It is where and how they will feel most comfortable and competent. At the same time, In this situation, their reasoning and judgment may remain intact for a longer time.
Many people make the mistake of trying to re-orient someone to the present. They will correct the person as to their age, where they are, or whether their husband/father/mother has died. This may not accomplish anything more than to make the person sad. Ask yourself why you need to correct someone, before doing it.
In the earlier stages of dementia, people often know that something is wrong. They may not know why, or what it is, but they know. This can cause embarrassment and fear. It can feel like they are losing control of themselves and their world. This can lead to their covering up the losses and denying it to other people. It may be expressed as withdrawal, depression, or anger. Family or loved ones may have to bring it up with them. They may benefit from a support groups, such as the ones for people with Alzheimer’s Disease at the Alzheimer’s Society.
It is important to recognize that although someone may not be able to express themselves in later stages of dementia, it does not mean that they cannot understand what is being said to them. It also does not mean that they will stop trying to express themselves.
If memory is impaired, someone still is still often capable of expressing what they wish or how they feel about something even if they do not remember they have said it. It is not until the later stages of dementia that all areas of the brain are significantly impacted: a loved one is still a human being, albeit with diminished capacity. It is important to remember to include them and treat them with respect, and to try to interpret what they are trying to say.
As the disabilities from dementia increase, people continue to have feelings, and continue to be able to respond to emotions. They will feel lonely, happy, frightened. They will sense warmth, compassion, and acceptance. They will respond to a warm embrace, holding hands, a gentle massage.They will be frightened of rough or abrupt treatment. Reassurance may have to come from a non verbal cue, as opposed to a verbal cue.
- Make sure that the person can hear and see you as you are talking. Make sure glasses are on, hearing aid batteries are functioning, and that wax is removed from ears from time to time.
- Give someone a choice between two things, (tea or coffee) as opposed to asking open ended questions (what do you want to drink?)
- Acknowledge the frustration, fear, embarrassment, or anger that they might be feeling.
- Talk to someone’s strengths–what they can still do or talk about.
- Do non-verbal activities or sing, because although speech and conversation may be impaired, other skills are not.
- Use touch appropriately to convey something.
- Approach someone slowly, and get their attention.
- Explain what is going on, or what is going to happen.
- Try low stimulation environments; avoid noisy high stimulation ones (such as noisy restaurants).
- Give simple, one step instructions.
- Although it may frighten some people, there are some for whom an explanation that they have an impairment or illness that is affecting their brain is helpful.
- Instead of asking questions such as “do you remember me?” or “do you remember that we did this yesterday?”, remind someone of who you are, and say something like, ” That was so much fun at the park yesterday.”
- Be patient, try different ways to explain something and try at different times.
- If someone is very repetitive and anxious, try distracting them with an activity, or changing the subject, having a tea, changing rooms,etc.
- Caregivers should monitor their own feelings and frustration levels.Rather than getting angry, withdraw from the subject or situation or get some help.
- Remind yourself that it is a physical problem in the brain that is making things difficult, not a willful act, and remember that the situation may be difficult for both of you.
Resources on Dementia
- www.alz.org U.S. national organization.
- www.alzheimers.ca Canadian national organization.