Coping with Alzheimer's

Alzheimer's disease is a progressive degenerative brain disorder that gradually diminishes a person's memory and ability to learn, reason, make judgments, carry out daily activities, and even communicate. People with Alzheimer's or related dementias have more difficulty expressing emotions, and can also have trouble understanding others.

The ability to exchange our ideas, wishes, and feelings with other people is a basic need for all of us. Communication is an important part of our relationships, a way to express who we are and is more than talking and listening. Communication is also about attitude, tone of voice, facial expressions, and body language.

Signs of Alzheimer's

Changes in the ability to communicate are unique for each person. A caregiver may notice or recognize differences in the person with dementia, such as difficulty finding the right words, using familiar words repeatedly, inventing new words to describe familiar things, or even reverting to speaking in a native language. These changes can make communicating somewhat difficult and can require a great deal of patience and understanding.

Tips when communication is difficult:

Avoid criticizing or correcting. If the person with dementia says a word or phrase incorrectly, don't say she is wrong. Instead, listen and try to figure out what the person is trying to say. It may seem natural to want to correct her, however, doing so can cause frustration, anger and/or embarrassment. To avoid this, it may help to repeat what was said to help clarify the thought.

Avoid arguing. If the person says something you disagree with, let it be -- arguing usually only makes things worse. Don't disagree with made-up or inaccurate stories. Rather, respond with affection and assurance to the feelings he is demonstrating and avoid trying to convince him that he is wrong. The story may be incorrect, but he is showing that he really wants to communicate with you.

Enjoy the conversation, not the content.

Focus on the feelings, not the facts. Sometimes the emotions being expressed are more important than the words being used. Look for the feelings behind the words, the tone of voice, and other actions that may help to provide clues.

For example, if the person with dementia is trying to tell you something and she is very excited and happy, but can't find the words, smile with her. Tell her you can see she's happy and excited and explain that you're excited and happy, too. This situation may not lead to a fruitful conversation and you may not fully understand what she's happy about, but it will allow you to have a moment together where you are both smiling and conversing with non-verbal communication.

Encouraging unspoken communication can assist the person with dementia, but can also help you, the caregiver to communicate, as well.

Adjust your communication

It's often difficult to change the ways you communicate with a family member or close friend, but when that person has Alzheimer's disease or a related dementia, it is imperative to take a good look at how you as a caregiver communicate. As dementia progresses, communication can become more and more challenging.

Using sensitive, compassionate and ongoing communication is important, no matter how difficult it may become or how confused the person may appear. While the person may not always respond, he or she still requires and benefits from continued communication.

Tips when communicating with a memory-impaired person:

  • Approach the person from the front and identify yourself first.
  • Call the person by name. This not only helps to orient the person, but also gets his attention.
  • While you identify yourself, establish and maintain eye contact to help get his attention. Nonverbal gestures help in communicating to the person what you want to say to him, or what you want him to do.
  • Use short, simple sentences and words, and give one-step directions. Certain common tasks may become progressively overwhelming. For example, brushing his teeth requires a sequence of steps that may be confusing and difficult.
  • Give short, one-sentence explanations and use gestures to aid in the explanation, such as standing in front of the mirror with him and making brushing movements with your hands.

Specific communication techniques

Speak slowly and clearly while asking one question at a time. Allow time for the person to respond to one question before asking another. If she doesn't seem to understand, repeat the question using the same wording. It may take a few extra moments for her to comprehend what you're asking.

If this doesn't work, try rephrasing your question after a few minutes. For example, you may say, "I like your hair today." If she does not respond or appears to be confused by your comment, you may need to repeat it, "I like your hair today." If she still appears to be having difficulty comprehending your statement, it may help to rephrase by saying, "You hair looks nice" while slightly touching her hair.

Turn questions into answers. Try providing the solution rather than the question. For example, say "The bathroom is here," instead of asking, "Do you need to use the bathroom?" Don't use confusing expressions, such as "Let's run to the store really quick," which he may take literally and think you're going for a run. Describe the action directly to prevent confusion, "Let's go buy milk at the store."

Be aware of your tone of voice and the feelings expressed in your voice. Use a gentle and relaxed tone of voice and convey an easy-going, non-demanding manner of speaking. Be aware that your feelings and attitude are often communicated through your tone and body language.

For instance, you may be having a bad day and need the person with dementia to get dressed and say, "Frank, get dressed" with your hands on your hips and a scowled look on your face. Frank will feel as if he is in trouble and may be confused as to what made you angry. This confusion can potentially make him angry and agitated simply because he's confused.

Instead you might say, "Frank, let's get ready for church, please" with a smile on your face and rubbing his hand. This tone and expression tells Frank that you're a cheerful and reassuring person and that he can trust you.

In a situation like this, I recommend that people think of a duck. When we see a duck swimming along the surface of the water, we see a smooth, calm, beautiful duck However, under the water, that same duck is kicking and moving as fast as he can. Try to be like that duck -- you may be kicking and moving quickly under the surface, but appear to be cool, calm, and collected above the surface.

Facing the challenge

Alzheimer's disease and related dementias can be difficult, especially when it's your own loved one that simply can't recognize familiar faces or places.

Here are some important aspects to remember:

  • Some days the person might seem normal or better, but isn't. Her reality is now different than yours and you can't change that. You can't control the disease. You can only control your reaction to it.
  • Alzheimer's or dementia patients don't intend to hide things; they protect objects by putting them in a safe place and then forget they've done so. Don't take "stealing" accusations personally. It isn't that they don't trust you, but that they can't find an object and you're often the first person they see.
  • Be patient, cheerful, and reassuring. Go with the flow. And most of all, elevate your level of generosity and graciousness. The person with dementia may not thank you with words, but it will mean the world to them.
    Always remember, someone with Alzheimer's disease is a person first and foremost. Like you, he or she needs a lot of love, dignity, and respect.