I’ve now gone through stacks of information that has either been given to me, or that I’ve discovered. I haven’t written any of this; I just want to pass along pertinent Alzheimer’s information that may help you understand it more. Let’s learn together…
What causes dementia?
There are many different diseases that cause dementia. In most cases, why people develop these diseases is unknown. One of the most common form of dementia is:
Alzheimer’s disease is the most common form of dementia, accounting for around two-thirds of cases. It causes a gradual decline in cognitive abilities, often beginning with memory loss.
Alzheimer’s disease is characterised by two abnormalities in the brain – amyloid plaques and neurofibrillary tangles. The plaques are abnormal clumps of a protein called beta amyloid. The tangles are bundles of twisted filaments made up of a protein called tau. Plaques and tangles stop communication between nerve cells and cause them to die.
It has been noted widely that non-verbal communication, such as body language, voice tone and facial expressions relay great amounts of information to the cognitively impaired adult. As their ability to process verbal information is impaired, the way in which we use language is extremely important when working with cognitively impaired adults.
Clear communication, verbal and non-verbal alike, is the essence of any quality interaction. The following suggestions will enhance your effectiveness with your family member or patients.
1. In your interaction with the patient, try to:
• Be calm and reassuring
• Speak slowly and distinctly
• Use simple words
2. Remember that the patient is dealing with:
• Loss of self-esteem
• Feeling of depression (when he/she is aware enough)
3. Before asking the individual to do something, address him/her by name to get their attention. While you are speaking, maintain eye contact to help maintain attention. Non-verbal gestures help in communicating to the individual what you want him/her to do.
4. Ask only one question at a time and give the individual time to respond. If they do not seem to understand, repeat the question using the same wording. If this does not work, after a few minutes try to rephrase your question. (This will require that the patient process new information).
5. Approach the individual from the front. It may startle and upset someone if you touch them unexpectedly or approach from behind
6. Allow the individual adequate time to respond in conversation, or when performing an activity. Rushing the individual will increase confusion.
7. Use humour whenever possible though not at the individual’s expense.
8. Always remember the importance of love and affection. Sometimes holding hands, touching, hugging and praise will get your loved one to respond when all else failed.
9. The feelings expressed in your voice when speaking to the confused individual are as important as the words you say.
10. Try to maintain a regular daily routine. An individual with Alzheimer’s has difficulty coping with change. A structured routine will help them maintain their abilities. It may also save you time and energy.
11. Involvement with daily tasks will help to maintain their self-esteem. Also, disruption in the individual’s usual habits may result in them no longer being able to perform that activity. For example, if you begin dressing the patient, they may soon forget how to perform this function.
12. Keep your expectations of what the patient can do realistic given their degree of impairment. There will be les frustration on both your parts if expectations are realistic
13. Break down all tasks into simple steps. Tell the individual one step at a time what to do. Giving too many directions at one time, or giving them too quickly, will increase confusion. If the individual gets upset and becomes uncooperative, stop and try again later
14. When the individual wakes up from a nap or a night’s sleep, they may be more disoriented than usual. Expect this and be prepared to orient them through general conversation.
15. Do not disagree with made up stories. Instead, gently correct the individual to avoid increasing their anxiety. If the individual mumbles incoherently or rambles, attempt to reduce this by directing them with an activity.
16. Be consistent. If you say that you are going to do something, follow through with it.
17. If the individual repeatedly asks a question, remember that they cannot remember the answer you have just given them. Instead of continuously answering the question, reassure the individual that everything is fine and that you will be with them to help them.
18. Repeating the same act may be meaningful for the individual and provide them with tension relief. For example, the individual may spend 20 minutes contentedly wiping the kitchen counter. If the activity does not seem upsetting to the individual, let them continue. If it upsets you, try to gently redirect the activity by giving them something else to do.
19. Use gestures when appropriate. Point to objects or demonstrate an action, such as brushing your teeth.
20. Do not argue over the correct answer. Relatives are often confused. They may call you mother and mean wife. Also remember your loved one may be speaking in their own reality. If they say it is winter, even though it is in the middle of July, it may feel, look like and be what “winter” is for them.
21. If you do get angry use “I “statements as opposed to “you” statements. Example: “I’m feeling angry, I need to rest now”; instead of “you make me so angry, I can’t stand to be here.” Accusing your loved one of causing your bad feelings is fruitless. They cannot change their behaviour for you. Also, they may be frightened to see you angry at them, when they feel so helpless. Talk to a friend when you need to blow off steam. Support groups are a great place for this. You will be relieved you did not yell after things have settled down.
22. When your loved one is no longer able to communicate verbally, keep talking to them about things that were important to them. Speak clearly, say names of people they loved touch and massage arms, feet, head and back. Touching is the greatest communicator of love.
The 7 A’s of Dementia
Understanding the losses associated with Alzheimer Disease leads to a greater awareness of challenges faced by a person with the diagnosis. One way to appreciate the losses experienced by the person is to understand what has been described as the “7 A’s of Dementia”. The list of 7 A’s include:
• Altered Perception
… My mom has experienced all of these.
Anosognosia: means the loss of ability to realize there is anything wrong. The person with Anosognosia is not pretending and is not in “denial”. They honestly do not realize there is a problem because the part of the brain that allows one to reason is now damaged. This can cause challenges when the person resents being told what to do or what not to do.
Amnesia: means the loss of memory. At first, short-term memory will be lost, but eventually long term memory will also be affected. A person with short-term memory loss may not remember what was just said, and this is why we will often hear repetitive questions or statements. Since people with Alzheimer Disease may only have access to long-term memories, they may talk about things from long ago. It is important to realize the person with dementia may forget what they are doing from one step to the next in an activity and may need simple directions to stay on track
Agnosia: means a loss of recognition of sensory information and includes all senses – sight, sound, taste, touch, and smell. People with Agnosia are not able to sort out what they see, hear, etc. The person may not recognize family members or friends, or even themselves in the mirror. Safety can be compromised if the person with Alzheimer Disease confuses objects and their use. For example, the person may confuse a toothbrush and a razor side-by-side on the bathroom countertop.
Aphasia: means the loss of language, and can include both speaking and understanding others. The person may have trouble thinking of the word they would like to use or may “mix-up” words. Difficulty understanding what other people are saying may lead to misunderstandings. The person with Alzheimer Disease may not take part in social interactions if they feel insecure about their abilities to express themselves and understand others.
Apraxia: means loss of ability to initiate purposeful movements and patterns of movement. People with apraxia may have trouble understanding directions – back, front, left, right, up, down, etc. The person may have difficulty controlling their body parts to do familiar tasks, such as making a pot of coffee or brushing one’s teeth. They know what they want to do, but for some reason, this message does not get to the part of the brain that tells the muscles what to do. Since the message does not get from the brain to the body parts, people with Apraxia often do not know how to start a movement or what order to follow.
Apathy: is when an individual appears to be depressed or simply uninterested in activities. The person with apathy experiences a loss of drive or initiative. The part of the brain that controls initiation of activity is damaged to the point where it may not occur to the person to do anything at all. If someone else encourages the person with Alzheimer Disease to begin an activity, the person may be able to stay involved in that activity.
Altered Perception: means misinterpretation of sensory information, which may lead to illusions and/or delusions. This can be upsetting for both the person and their care partners. Another perceptual loss is loss of depth perception – the ability to see in three dimensions. It becomes difficult for the person to judge how high, deep, long, wide, near or how far things are. For example, if the floor and furniture are the same colour, it may be difficult to judge when one is close enough to try to sit. Visual perception is complex, the brain will always try to interpret and understand what has been ‘seen’. If what we perceive seems real to us, it can directly affect our behaviour.