08 Mar The A’s of Dementia: Care Tips

Knowing the A’s of Dementia is useful for carers, because this provides good insight into how people with dementia experience the world.  The ‘A’s’ set out the losses linked to particular damages to the brain, and understanding them helps carers put in place proper support strategies.

We can’t MAKE the person with dementia remember or undo the damage to the brain.  But we can properly support them to cope with their issues and reduce situations where they may feel anxious or fearful.

Amnesia

Memory loss (Amnesia) touches every aspect of life for people with dementia from learning new information to remembering past familiar information.  Our brain is like a filing cabinet storing information on everything we do and experience. Each thing saved in a separate file – even file’s within files.  Diseases such as Alzheimer’s erases memories in reverse order – last in first out.  Symptoms appear when the brain has lost 1/3 of volume so before this it can seem to others that the behaviour is intentional.  However the fact is the brain is being damaged  – the people just cannot experience memory.

Short-term memory (minutes-days) includes remembering where I parked the car, what I had for lunch yesterday, what’s going on in my TV show.  It is connected to Working memory – comprehending something as you read or how to appropriately react to conversations.

Problems with short-term memory loss include classic features of dementia:

• Repeating the same questions over and over
• Forgetting where things have been put
• Information overload
• Trouble planning or organizing things
• Withdrawal from interactions

Long-term memory (months-years-decades)  These memories last far longer for a person. This includes personal events, skills learned and general facts about life.  When dementia affects the long-term memory people have difficulties with:

• Mixing up words
• Taking longer with daily activities of living
• Forgetting names of familiar people such as family and friends
• Mixing up stories

Atypical depression

Normally depression makes people withdrawn.  Atypical depression is different in that symptoms can be overeating, oversleeping, heaviness in arms and legs, irritability, agitation and aggression.  It is often treated with strong medications (antipsychotics) because of behavioural issues.  Medicines can be problematic for older people as they could act on blood pressure or cause confusion if they are sedating.  People with atypical depression can temporarily cheer up in response to positive events.  Visits with family and good news will give them a lift.

Aphasia

This brain damage causes difficulty with language or speech making it hard for people to express themselves or understand what they read or hear.  It affects everyday tasks – using the phone, email – even speaking with others.  You will recognize it by a person’s slow interrupted speech, struggles to get words out or errors in word choice.  You can help people with communication if you:

• Make sure you have their full attention
• Make eye contact with them
• Reduce background noise and distractions (radio, TV or other noises)
• Give the person plenty of time to talk
• Avoid using open-ended questions
• Ask them to explain it in a different way
• Use other ways of communication such as drawing, gesturing or pointing.

Agnosia

This damage to the brain causes the loss of sensory ability to recognize objects, faces, voices or places.   It can be more prominent on some days more than others.  It is often linked with Apraxia.  We can support people by:

• being organized for tasks in advance
• providing cues by demonstration e.g. using the fork, you brushing your teeth
• using labelled photographs of people and everyday things like kitchen presses

Apraxia

This neurological disorder shows as inability to perform learned movements i.e inability to make correct movements.  Causes problems for people with dementia such as:

• using wrong side of an object,
• mistaking one object for another e.g fork for a spoon
• mixing up sequences such as getting dresses, eating
• facial movement problems such as coughing or opening mouth to spoon or moving food within the mouth
• leads to swallowing difficulties.

If someone is struggling with a task it can be better to set it aside to return to, because without positive success, distress and frustration will result in emotional reactions.

TIP: Touch is the last sense to go, so people can still use their comforters which can greatly reduce anxiety for them.

Altered perception

This is difficulty with vision processing which results in problems perceiving the world around them.  The person sees one thing as something else,  they can lose depth perception, have reduced peripheral vision or have reduced ability to see colour.  Please note:

• Patterns are over-stimulation and confusing ( meal-times and food placement on plate)
• People in mirrors or on TV can seem to be real in the room (bathrooms/dining rooms)
• Judging stairs can be a problem – fall hazard
• Shiny surfaces may seem wet – fear factor
• Water may seem to be deeper than it is- fear of drowning = refusal to bathe
• People can bump into things so ensure place is obstacle and clutter-free

Apathy

It is often caused by frontal lobe damage to the brain.  This is challenging for carers to cope with because the person lacks motivation to do anything or to care about what’s going on around them.  It can worsen if the person loses confidence because they can become withdrawn.

Carers need to work to help prevent apathy from settling in by building up confidence and participation.  Creative activities even if difficult can help just with feeling involved.

TIP: Try music, art, reminiscence as therapies for this.

Caring for people with dementia

Key responses for carer to help support people with dementia include –

1. Patience: Repeat information as if it’s the first time asked, speak slow and clear
2. Active listening and physical cues are important
3. Setting systems in place where glasses always kept in same place
4. Written aides and notes
5. Breaking down information to one step at a time
6. Use reminiscing to settle anxiety for the person

Always focus on encouragement and positivity around their achievements.  Carers need patience and to remember that the person with dementia is not choosing this – there is a medical reason for the mood and behaviour.  Here for more about Dementia or Alzheimer’s progression, or here for information compiled by the Alzheimer’s Association.

Phone us direct on 499 2201 f you are considering getting additional support for your loved one at home and speak to our Dementia care specialist.