Alzheimer’s DiseaseAlzheimer’s Disease

By: Megan A. HodgeBy: Megan A. Hodge

Getting Familiar Getting Familiar With the Basics of With the Basics of

Alzheimer’s Alzheimer’s DiseaseDisease

Alzheimer’s DiseaseAlzheimer’s Disease

• Approximately four million persons in the U.S. Approximately four million persons in the U.S. have Alzheimer’s disease (AD). Alzheimer’s is a have Alzheimer’s disease (AD). Alzheimer’s is a disease of the brain that causes progressive disease of the brain that causes progressive deterioration of brain cells. This loss of brain cells deterioration of brain cells. This loss of brain cells can result in a gradual loss of memory, confusion, can result in a gradual loss of memory, confusion, difficulties with language, and increasing difficulty difficulties with language, and increasing difficulty with performing everyday tasks like using the with performing everyday tasks like using the telephone or grocery shopping. People with telephone or grocery shopping. People with Alzheimer’s can also experience changes in their Alzheimer’s can also experience changes in their personalities that may cause them to behave in personalities that may cause them to behave in ways that their families may not fully understand. ways that their families may not fully understand.

Is It A Change In Memory or Is It A Change In Memory or Alzheimer’s Disease?Alzheimer’s Disease?

Some change in memory is normal as we grow older, Some change in memory is normal as we grow older, but the symptoms of Alzheimer’s disease are more than but the symptoms of Alzheimer’s disease are more than simple lapses in memory. simple lapses in memory.

People with Alzheimer’s experience difficulties People with Alzheimer’s experience difficulties communicating, learning, thinking and reasoning — communicating, learning, thinking and reasoning — problems severe enough to have an impact on an problems severe enough to have an impact on an individual's work, social activities and family life.individual's work, social activities and family life.

The Alzheimer's Association has developed a The Alzheimer's Association has developed a checklist of common symptoms to help you recognize the checklist of common symptoms to help you recognize the difference between normal age-related memory changes and difference between normal age-related memory changes and possible warning signs of Alzheimer’s disease.possible warning signs of Alzheimer’s disease.

There’s no clear-cut line between normal changes There’s no clear-cut line between normal changes and warning signs. It’s always a good idea to check with a and warning signs. It’s always a good idea to check with a doctor if a person’s level of function seems to be changing. doctor if a person’s level of function seems to be changing. The Alzheimer’s Association believes that it is critical for The Alzheimer’s Association believes that it is critical for people diagnosed with dementia and their families to receive people diagnosed with dementia and their families to receive information, care and support as early as possible. information, care and support as early as possible.

10 Warning Signs of 10 Warning Signs of Alzheimer’s DiseaseAlzheimer’s Disease

1.1. Memory loss.Memory loss. Forgetting recently learned information is one of the most common Forgetting recently learned information is one of the most common early signs of dementia. A person begins to forget more often and is unable to recall early signs of dementia. A person begins to forget more often and is unable to recall the information later.the information later.What's normal?What's normal? Forgetting names or appointments occasionally.Forgetting names or appointments occasionally.

2.2. Difficulty performing familiar tasks.Difficulty performing familiar tasks. People with dementia often find it hard to People with dementia often find it hard to plan or complete everyday tasks. Individuals may lose track of the steps involved in plan or complete everyday tasks. Individuals may lose track of the steps involved in preparing a meal, placing a telephone call or playing a game.preparing a meal, placing a telephone call or playing a game.What's normal?What's normal? Occasionally forgetting why you came into a room or what you Occasionally forgetting why you came into a room or what you planned to say.planned to say.

3.3. Problems with language.Problems with language. People with Alzheimer’s disease often forget simple words People with Alzheimer’s disease often forget simple words or substitute unusual words, making their speech or writing hard to understand. They or substitute unusual words, making their speech or writing hard to understand. They may be unable to find the toothbrush, for example, and instead ask for "that thing for may be unable to find the toothbrush, for example, and instead ask for "that thing for my mouth.”my mouth.”What's normal?What's normal? Sometimes having trouble finding the right word. Sometimes having trouble finding the right word.

4.4. Disorientation to time and place.Disorientation to time and place. People with Alzheimer’s disease can become lost People with Alzheimer’s disease can become lost in their own neighborhood, forget where they are and how they got there, and not in their own neighborhood, forget where they are and how they got there, and not know how to get back home.know how to get back home.What's normal?What's normal? Forgetting the day of the week or where you were going. Forgetting the day of the week or where you were going.

5.5. Poor or decreased judgment.Poor or decreased judgment. Those with Alzheimer’s may dress inappropriately, Those with Alzheimer’s may dress inappropriately, wearing several layers on a warm day or little clothing in the cold. They may show wearing several layers on a warm day or little clothing in the cold. They may show poor judgment, like giving away large sums of money to telemarketers.poor judgment, like giving away large sums of money to telemarketers.What's normal?What's normal? Making a questionable or debatable decision from time to time. Making a questionable or debatable decision from time to time.

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6.6. Problems with abstract thinking.Problems with abstract thinking. Someone with Alzheimer’s disease Someone with Alzheimer’s disease may have unusual difficulty performing complex mental tasks, like may have unusual difficulty performing complex mental tasks, like forgetting what numbers are for and how they should be used.forgetting what numbers are for and how they should be used.What's normal?What's normal? Finding it challenging to balance a checkbook. Finding it challenging to balance a checkbook.

7.7. Misplacing things.Misplacing things. A person with Alzheimer’s disease may put things in A person with Alzheimer’s disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl.unusual places: an iron in the freezer or a wristwatch in the sugar bowl.What's normal?What's normal? Misplacing keys or a wallet temporarily. Misplacing keys or a wallet temporarily.

8.8. Changes in mood or behavior.Changes in mood or behavior. Someone with Alzheimer’s disease may Someone with Alzheimer’s disease may show rapid mood swings – from calm to tears to anger – for no apparent show rapid mood swings – from calm to tears to anger – for no apparent reason.reason.

What's normal?What's normal? Occasionally feeling sad or moody. Occasionally feeling sad or moody.9.9. Changes in personality.Changes in personality. The personalities of people with dementia can The personalities of people with dementia can

change dramatically. They may become extremely confused, suspicious, change dramatically. They may become extremely confused, suspicious, fearful or dependent on a family member.fearful or dependent on a family member.What's normal?What's normal? People’s personalities do change somewhat with age. People’s personalities do change somewhat with age.

10.10.Loss of initiative.Loss of initiative. A person with Alzheimer’s disease may become very A person with Alzheimer’s disease may become very passive, sitting in front of the TV for hours, sleeping more than usual or not passive, sitting in front of the TV for hours, sleeping more than usual or not wanting to do usual activities.wanting to do usual activities.What's normal?What's normal? Sometimes feeling weary of work or social obligations. Sometimes feeling weary of work or social obligations.

Communicating Communicating With The Elderly With The Elderly

Affected By Affected By Alzheimer’s Alzheimer’s

DiseaseDisease

Communicating With An Aging Communicating With An Aging ParentParent

Communication is skill and art. Skills are specific types Communication is skill and art. Skills are specific types of verbal and nonverbal actions that help you get the results of verbal and nonverbal actions that help you get the results you want, including cooperation, joint decision making, and you want, including cooperation, joint decision making, and finding solutions to difficult issues. The art part is taking the finding solutions to difficult issues. The art part is taking the skills and figuring out how to apply the skills to a specific skills and figuring out how to apply the skills to a specific situation. Your job as a caregiver is to decide what to use and situation. Your job as a caregiver is to decide what to use and how to use it. how to use it.

When you are talking with aging parents and have When you are talking with aging parents and have some concern about how the communication may go, you are some concern about how the communication may go, you are most likely talking about an important topic or an emotionally most likely talking about an important topic or an emotionally loaded topic. Important topics may be things such as figuring loaded topic. Important topics may be things such as figuring out where older parents should live, what kinds of help (if any) out where older parents should live, what kinds of help (if any) they need, who needs to know about their finances, what they need, who needs to know about their finances, what type(s) of health care services they should have, whether or type(s) of health care services they should have, whether or not they have an up to date will or even whether or not not they have an up to date will or even whether or not someone else should have some legal power to act in their someone else should have some legal power to act in their behalf, such as power of attorney.behalf, such as power of attorney.

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Emotionally loaded topics are almost anything that leads to Emotionally loaded topics are almost anything that leads to strong emotions being experienced and communicated. In any family, strong emotions being experienced and communicated. In any family, there are a specific and unique set of emotionally laden topics, including there are a specific and unique set of emotionally laden topics, including (but not limited to): who spends the holidays with whom, who is the (but not limited to): who spends the holidays with whom, who is the favored child, who should get possession of various personal items in an favored child, who should get possession of various personal items in an estate, who has to take responsibility for care giving, and what is a fair estate, who has to take responsibility for care giving, and what is a fair share to be paid for gifts or care by various members of the family.share to be paid for gifts or care by various members of the family.

As a caregiver, you undoubtedly have a series of specific issues As a caregiver, you undoubtedly have a series of specific issues that you want to communicate about with your older family member. that you want to communicate about with your older family member. Some of these are emotionally laden, some are not. Some are easy to Some of these are emotionally laden, some are not. Some are easy to discuss in your family situation, some are not. Generally, when there is discuss in your family situation, some are not. Generally, when there is an emotionally laden and important issue, the following guidelines can an emotionally laden and important issue, the following guidelines can help you focus your efforts to get the best out of a difficult situation.help you focus your efforts to get the best out of a difficult situation.

The situation changes dramatically when the older adult has The situation changes dramatically when the older adult has limitations, including dementia. A dementia patient would need more limitations, including dementia. A dementia patient would need more specific guidelines and principles, some of which will be addressed in a specific guidelines and principles, some of which will be addressed in a future article in this series. However, many of the principles listed below future article in this series. However, many of the principles listed below hold regardless of the cognitive limitations of your older family member.hold regardless of the cognitive limitations of your older family member.

Do’s and Don’ts When Do’s and Don’ts When CommunicatingCommunicating

Think ahead of what you need to get (vs. what you Think ahead of what you need to get (vs. what you hope to get) from discussions: That is, what is your bottom hope to get) from discussions: That is, what is your bottom line? Do you need to get your parent(s) to tell you line? Do you need to get your parent(s) to tell you EVERYTHING about their possessions or do you really need to EVERYTHING about their possessions or do you really need to get them to confer with a competent attorney? Do you need get them to confer with a competent attorney? Do you need to get your family member into a nursing home or do you to get your family member into a nursing home or do you need them to be evaluated by a competent agency, need them to be evaluated by a competent agency, physician or other provider who may come up with options physician or other provider who may come up with options that may work for your older relative?that may work for your older relative?

Answer the following question (and it’s a very Answer the following question (and it’s a very important one): important one): Are you doing this WITH the older adult or Are you doing this WITH the older adult or FOR them?FOR them? That is, do they have both a say and veto power That is, do they have both a say and veto power in the discussion? If the older relative has veto power, then in the discussion? If the older relative has veto power, then he or she may disagree with you or even do something you he or she may disagree with you or even do something you are very uncomfortable with. At the same time, if it is really are very uncomfortable with. At the same time, if it is really their decision, then you should not try to coerce or their decision, then you should not try to coerce or manipulate them into the decision.manipulate them into the decision.

Do’sDo’s

• Think ahead as to when and where to have the conversation. Pick a Think ahead as to when and where to have the conversation. Pick a place and time when older relatives can hear what you are saying place and time when older relatives can hear what you are saying without family and holiday distractions. I know of individuals who have without family and holiday distractions. I know of individuals who have actually made a special trip to another city to visit their parents just to actually made a special trip to another city to visit their parents just to have an important conversation.have an important conversation.

• Use "I" statements. Literally, this means beginning any declarative Use "I" statements. Literally, this means beginning any declarative sentence with the word "I". This means talking about "My view", "My sentence with the word "I". This means talking about "My view", "My perception", and especially "My feelings" rather than talking as if you perception", and especially "My feelings" rather than talking as if you have a corner on the truth and anything your parents says not only have a corner on the truth and anything your parents says not only contradicts you but is wrong… "I" statements can lead to negotiation contradicts you but is wrong… "I" statements can lead to negotiation and sharing, "You" statements may lead to war.and sharing, "You" statements may lead to war.

• Consider having a mutual ally present when beginning important and Consider having a mutual ally present when beginning important and emotionally laden discussions.- Having someone who is trusted by both emotionally laden discussions.- Having someone who is trusted by both parties may make things easier.parties may make things easier.

• Be clear about the topic of discussion with your family member.Be clear about the topic of discussion with your family member.• Give the others time to process and think about what you are Give the others time to process and think about what you are

presenting. Going too fast can lead to misunderstandings. You may presenting. Going too fast can lead to misunderstandings. You may have to have more than one conversation about an emotionally laden have to have more than one conversation about an emotionally laden topic.topic.

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• Respect the rights of the others to agree and disagree. Respect the rights of the others to agree and disagree. • Stand your own ground. That is, you can be assertive and clear about Stand your own ground. That is, you can be assertive and clear about

your beliefs and your point of view without denying others their rights your beliefs and your point of view without denying others their rights and own perspectives.and own perspectives.

• Be aware of your own feelings and reactions to the situation and the Be aware of your own feelings and reactions to the situation and the others involved. Sometimes, this may mean taking time to go over others involved. Sometimes, this may mean taking time to go over your likely reactions and figuring out how to enhance reactions that your likely reactions and figuring out how to enhance reactions that might help the conversation move along and, at the same time, find might help the conversation move along and, at the same time, find ways to keep inflammatory reactions in check.ways to keep inflammatory reactions in check.

• Practice the conversation with a "coach", someone who can listen to Practice the conversation with a "coach", someone who can listen to you and let you know how you are coming across. A coach can be a you and let you know how you are coming across. A coach can be a spouse, significant other, family member or friend. If you practice, be spouse, significant other, family member or friend. If you practice, be sure to ask your coach what behaviors or actions you have that might sure to ask your coach what behaviors or actions you have that might give the wrong message to your older relative.give the wrong message to your older relative.

• Be prepared for the discussion to end before you want it to. Make Be prepared for the discussion to end before you want it to. Make every attempt to treat the discussion as a door opener, that is, an every attempt to treat the discussion as a door opener, that is, an opportunity to get the ball rolling, rather than the time everything has opportunity to get the ball rolling, rather than the time everything has to be decided upon.to be decided upon.

Don’tsDon’ts

• Don’t blame others in either word or tone of voice. We often Don’t blame others in either word or tone of voice. We often forget that our internal tension or concern may come across as forget that our internal tension or concern may come across as judging others or being defensive, which in turn leads to their judging others or being defensive, which in turn leads to their not paying attention to our care and thoughts about them.not paying attention to our care and thoughts about them.

• Don’t do all the talking. A rule of thumb is to do occupy no Don’t do all the talking. A rule of thumb is to do occupy no more than ½ of the airtime. It is important to listen and more than ½ of the airtime. It is important to listen and acknowledge the others’ concerns and questions. You don’t acknowledge the others’ concerns and questions. You don’t have to answer each and every point when it is made.have to answer each and every point when it is made.

• Don’t go in with a fearful attitude, it will become your Don’t go in with a fearful attitude, it will become your message. Being clear about your goals and having practiced message. Being clear about your goals and having practiced what you want to say can help decrease anxiety.what you want to say can help decrease anxiety.

• Don’t overload the table with old issues and hurts. A major Don’t overload the table with old issues and hurts. A major mistake made in these conversations is that once the initial mistake made in these conversations is that once the initial point is agreed upon, too much is attempted too quickly. It point is agreed upon, too much is attempted too quickly. It helps some people to think of their old history as a museum, helps some people to think of their old history as a museum, don’t show all of the items at once, limit your exhibits.don’t show all of the items at once, limit your exhibits.

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• Don’t believe that disagreement means someone does not love Don’t believe that disagreement means someone does not love someone else. I would even go so far as to suggest that a someone else. I would even go so far as to suggest that a parent’s defensiveness (or our own) also does NOT mean that parent’s defensiveness (or our own) also does NOT mean that someone does not love someone else. Too often, people someone does not love someone else. Too often, people mistake defensiveness as a lack of love.mistake defensiveness as a lack of love.

• Don’t believe that a quick agreement means the others will Don’t believe that a quick agreement means the others will agree with you after reflection. People may go away from an agree with you after reflection. People may go away from an involved encounter and think things over again, be prepared to involved encounter and think things over again, be prepared to revisit tough issues several times.revisit tough issues several times.

• Don’t go in with a "someone has to win" attitude, you are Don’t go in with a "someone has to win" attitude, you are usually working together. People who are naturally competitive usually working together. People who are naturally competitive may find themselves competing with their aging parents rather may find themselves competing with their aging parents rather than working together even with the best of intentions. One than working together even with the best of intentions. One way around this is to be clear that the goal is for the "team" of way around this is to be clear that the goal is for the "team" of both of you to figure out what is best for the ENTIRE familyboth of you to figure out what is best for the ENTIRE family

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While this is hardly a complete list of all While this is hardly a complete list of all nuances of family communication, these guidelines nuances of family communication, these guidelines may help you evaluate how you want to have may help you evaluate how you want to have discussions as well as be an informal checklist to discussions as well as be an informal checklist to evaluate how you did after a discussion about an evaluate how you did after a discussion about an emotionally laden topic. Let’s take a look at an emotionally laden topic. Let’s take a look at an imaginary conversation (with some comments in imaginary conversation (with some comments in parentheses about the dos and don’ts). Remember, parentheses about the dos and don’ts). Remember, these guidelines have to be applied by you in your these guidelines have to be applied by you in your situation. They will potentially take many forms, situation. They will potentially take many forms, you have to be the final judge on how to apply you have to be the final judge on how to apply these principles and ideas. these principles and ideas.

Simple Scenario and Simple Scenario and DialogueDialogue

ScenarioScenario: An imaginary conversation : An imaginary conversation about where mother is gong to live. about where mother is gong to live. Mother is 78, in fairly good health, but Mother is 78, in fairly good health, but has had a few falls and has high blood has had a few falls and has high blood pressure. She lives alone in the family pressure. She lives alone in the family home, a two story dwelling with all the home, a two story dwelling with all the bedrooms and the bathroom upstairs. bedrooms and the bathroom upstairs. The conversation is between daughter, The conversation is between daughter, age 45 (with grown children and a age 45 (with grown children and a husband) and her mother.husband) and her mother.

DialogueDialogue::• Daughter: Mom, there’s something we need to talk about.Daughter: Mom, there’s something we need to talk about.• Mother: What is it dear?Mother: What is it dear?• Daughter: Well, I’ve been thinking about your house.Daughter: Well, I’ve been thinking about your house.• Mother: Oh?Mother: Oh?• Daughter: Well, the house is where we grew up and everything, but I was Daughter: Well, the house is where we grew up and everything, but I was

hoping we could sell it some time. (Not clear about the topic of discussion)hoping we could sell it some time. (Not clear about the topic of discussion)• Mother: What? Sell the house? Why would I do that? Where could I live?Mother: What? Sell the house? Why would I do that? Where could I live?• Daughter: (becoming a little nervous): Mom, you need to think about this Daughter: (becoming a little nervous): Mom, you need to think about this

before you say that. (blaming)before you say that. (blaming)• Mother: What do you mean, I don’t think?Mother: What do you mean, I don’t think?• Daughter: No, mom, it’s just that we want you to have what is best for you, Daughter: No, mom, it’s just that we want you to have what is best for you,

you know. (defensive)you know. (defensive)• Mother: Have you talked to your brother about this?Mother: Have you talked to your brother about this?• Daughter: Of course not, I mean I should of, I hope he doesn’t get too mad Daughter: Of course not, I mean I should of, I hope he doesn’t get too mad

about this. (includes old issues)about this. (includes old issues)• Mother: Now, now, dear, you two shouldn’t fight.Mother: Now, now, dear, you two shouldn’t fight.

• Daughter: We don’t fight, we don’t even talk. (brings up old topics)Daughter: We don’t fight, we don’t even talk. (brings up old topics)• Mother: Well, I certainly won’t sell the house if it makes you all upset.Mother: Well, I certainly won’t sell the house if it makes you all upset.• Daughter: Mom, I am not upset, it’s just that I find it hard to talk with Daughter: Mom, I am not upset, it’s just that I find it hard to talk with

you about this. (is assertive)you about this. (is assertive)• Mother: Why, what do you mean? Are you saying I am difficult? Can’t I Mother: Why, what do you mean? Are you saying I am difficult? Can’t I

have my way?have my way?• Daughter: I’d like to have my way, just for once. (blaming)Daughter: I’d like to have my way, just for once. (blaming)• Mother: You can, but not with my house.Mother: You can, but not with my house.• Daughter (takes a breath): Mom, I’m sorry, but I really want to talk with Daughter (takes a breath): Mom, I’m sorry, but I really want to talk with

you about your home and where you live while things are going OK for you about your home and where you live while things are going OK for you. I care for you, I do not want to fight with you or my brother, I want you. I care for you, I do not want to fight with you or my brother, I want us to talk together about how you can handle yourself. (assertive, clear us to talk together about how you can handle yourself. (assertive, clear about topic)about topic)

• Mother: (reconsiders): OK, I believe you, what do you want to talk Mother: (reconsiders): OK, I believe you, what do you want to talk about?about?

• Daughter: I am concerned about what may happen to you in the future Daughter: I am concerned about what may happen to you in the future if you stay in the house. (shares real concerns)if you stay in the house. (shares real concerns)

• Mother: What do you mean?Mother: What do you mean?

• Daughter: I mean that the house is designed for younger people, with Daughter: I mean that the house is designed for younger people, with the bedrooms and bathroom upstairs. If you fell and had to walk with the bedrooms and bathroom upstairs. If you fell and had to walk with assistance for any period of time, the house would not be a good place assistance for any period of time, the house would not be a good place to rehabilitate.(Gives good reasons, is calm)to rehabilitate.(Gives good reasons, is calm)

• Mother: And, I think, if I had to go into a nursing home, the house Mother: And, I think, if I had to go into a nursing home, the house might have to go to pay for my care.might have to go to pay for my care.

• Daughter: Unless you made plans in advance.Daughter: Unless you made plans in advance.• Mother: Which I haven’t done.Mother: Which I haven’t done.• Daughter: So, where should we go from here? (Includes mother in Daughter: So, where should we go from here? (Includes mother in

decision)decision)• Mother: Well, we should talk to your brother. Maybe I can talk to him Mother: Well, we should talk to your brother. Maybe I can talk to him

first. Then we should talk to someone who knows about these things.first. Then we should talk to someone who knows about these things.• Daughter: Thanks, mom, I love you.Daughter: Thanks, mom, I love you.• Mother: I hope so (laughs).Mother: I hope so (laughs).

I hope you can see how the dos and don’ts of communication can I hope you can see how the dos and don’ts of communication can influence how a discussion goes.influence how a discussion goes.

More Tips for More Tips for CommunicationCommunication

• Always approach the person from the front, or within his/her line of vision – no Always approach the person from the front, or within his/her line of vision – no surprise appearancessurprise appearances

• Speak in a normal tone of voice and greet the person as you would anyone elseSpeak in a normal tone of voice and greet the person as you would anyone else• Face the person as you talk to him/herFace the person as you talk to him/her• Minimize hand movements that approach the other personMinimize hand movements that approach the other person• Avoid a setting with a lot of sensory stimulation, like a big room where many Avoid a setting with a lot of sensory stimulation, like a big room where many

people may be sitting or talking, a high-traffic area or a very noisy placepeople may be sitting or talking, a high-traffic area or a very noisy place• Maintain eye contact and smile. A frown will convey negative feeling s to a Maintain eye contact and smile. A frown will convey negative feeling s to a

personperson• Be respectful of the person’s personal space and observant of his/her reaction Be respectful of the person’s personal space and observant of his/her reaction

as you move closer. Maintain a distance of one to one and a half feet initiallyas you move closer. Maintain a distance of one to one and a half feet initially• If a person is a pacer, walk with him/her, in step with him/her while you talkIf a person is a pacer, walk with him/her, in step with him/her while you talk• Use distraction if a situation looks like it may get out of hand. A couple of Use distraction if a situation looks like it may get out of hand. A couple of

examples are: if the person is about to hit someone of if he/she is trying to examples are: if the person is about to hit someone of if he/she is trying to leave the home/facilityleave the home/facility

• Use a low-pitched, slow speaking voice which older adults hear bestUse a low-pitched, slow speaking voice which older adults hear best• Ask only one question at a time. More than one question will increase confusionAsk only one question at a time. More than one question will increase confusion• Repeat key words if the person does not understand the first time aroundRepeat key words if the person does not understand the first time around• Nod and smile only if what the person said is understoodNod and smile only if what the person said is understood

Discourse Analysis Discourse Analysis Experiments That Experiments That Were Observed Were Observed

Among Alzheimer’s Among Alzheimer’s Patients Before and Patients Before and After InterventionAfter Intervention

Stevens, King, and CampStevens, King, and Camp

Used script and structured question Used script and structured question and answer exercises in a group and answer exercises in a group activity increased the amount of activity increased the amount of verbal interaction among an verbal interaction among an Alzheimer’s group.Alzheimer’s group.

Camp, Foss, O’Hanlon, and Camp, Foss, O’Hanlon, and StevensStevens

Reported how space retrieval can be used Reported how space retrieval can be used to decrease repetitive questioning and to decrease repetitive questioning and trigger verbal responses that lead to desire trigger verbal responses that lead to desire future actions. Spaced retrieval is a process future actions. Spaced retrieval is a process and teaching method that requires learners and teaching method that requires learners to answer questions about recently to answer questions about recently presented facts at gradually increasing time presented facts at gradually increasing time intervals. This is believed to engage implict intervals. This is believed to engage implict or unconcious memory processes thought or unconcious memory processes thought to be realitively preserved in Alzheimer’s to be realitively preserved in Alzheimer’s patients.patients.

Hopper, Bayles, and Hopper, Bayles, and TomoedaTomoeda

Measured discourse production in for Measured discourse production in for AD patients before and after an AD patients before and after an intervention that used toys (dolls and intervention that used toys (dolls and stuffed dogs) as stimuli. Found that stuffed dogs) as stimuli. Found that there was an increase in the number there was an increase in the number of information units produced in the of information units produced in the presence of the specific stimuli used.presence of the specific stimuli used.

Mahendra, Bayles, and Mahendra, Bayles, and TomoedaTomoeda

Measured discourse production in four Measured discourse production in four AD subjects before and after an AD subjects before and after an individualized music intervention. Found individualized music intervention. Found that there was an increase in the that there was an increase in the number of information units produced in number of information units produced in the presence of the specific stimuli used. the presence of the specific stimuli used. Also investigated and found an increase Also investigated and found an increase in the ratio of different nouns to total in the ratio of different nouns to total nouns.nouns.

Brownell and JoanetteBrownell and Joanette

Discourse analysis is described as Discourse analysis is described as “The basic unit of social “The basic unit of social communication” says Brownell and communication” says Brownell and JoanetteJoanette

..

Psychosocial and Psychosocial and Behavioral Behavioral

Interventions for Interventions for Alzheimer's Alzheimer's

Disease PatientsDisease Patients

BenderBender

Through cognitive intervention he found that in Through cognitive intervention he found that in early dementia, patients may initiate their own early dementia, patients may initiate their own reality orientation by using lists and calendars. reality orientation by using lists and calendars. In later stages, reality orientation is rarely In later stages, reality orientation is rarely recommended or used since studies have recommended or used since studies have shown that it increases the patients' frustration. shown that it increases the patients' frustration. Bender described a variant of reality orientation Bender described a variant of reality orientation in which he oriented patients to the season of in which he oriented patients to the season of the year rather than to the day of the week by the year rather than to the day of the week by celebrating one event for each season. He celebrating one event for each season. He reported increased alertness and energy in reported increased alertness and energy in patients. patients.

Camp, Foss, and StevensCamp, Foss, and Stevens

Through cognitive intervention they Through cognitive intervention they used techniques borrowed from used techniques borrowed from Montessori schools, such as color Montessori schools, such as color coding external memory devices. They coding external memory devices. They used nine different colored coupons to used nine different colored coupons to teach prospective memory skills to four teach prospective memory skills to four patients with dementia. This area holds patients with dementia. This area holds promise for developing interventions promise for developing interventions that minimize patients' frustration. that minimize patients' frustration.

Beck, Heacock, Souder, Beck, Heacock, Souder, Baldwin and MercerBaldwin and Mercer

Through functional performance Through functional performance intervention they tested independence-intervention they tested independence-promoting strategies that supported promoting strategies that supported retained cognitive and physical abilities retained cognitive and physical abilities and compensated for deficits during and compensated for deficits during hygiene, dressing, grooming, and hygiene, dressing, grooming, and eating. These strategies include eating. These strategies include stimulus control, verbal and physical stimulus control, verbal and physical prompting, and physical guidance. prompting, and physical guidance.

Bonder, Bonnel, Coyne, Rader, Bonder, Bonnel, Coyne, Rader, Barrick, Sloane, Yankou, Black, Barrick, Sloane, Yankou, Black,

Whall, Schnelle, Newman, Fogerty, Whall, Schnelle, Newman, Fogerty, Jirovec, and JarvisJirovec, and Jarvis

All helped with the improvement of All helped with the improvement of patients' dressing, eating, bathing, patients' dressing, eating, bathing, and toileting behaviors. Prompted and toileting behaviors. Prompted voiding and scheduled voiding help voiding and scheduled voiding help maintain dryness in selected maintain dryness in selected patients. Prompted voiding involves patients. Prompted voiding involves assessing the patient's dryness and assessing the patient's dryness and need to void, while scheduled voiding need to void, while scheduled voiding establishes set intervals for trips to establishes set intervals for trips to the bathroom.the bathroom.

Beck, Modlin, Heithoff, Beck, Modlin, Heithoff, Friedmon, Tappen, Namazi, Friedmon, Tappen, Namazi, Gwinupp, and Zadorozny Gwinupp, and Zadorozny

Through functional performance Through functional performance intervention they found that various intervention they found that various exercise regimens ranging from simple exercise regimens ranging from simple stretches to scheduled walking and use stretches to scheduled walking and use of stationary bicycles have helped of stationary bicycles have helped decrease agitation and improve sleep decrease agitation and improve sleep rhythms in patients with mild to rhythms in patients with mild to moderate dementia. moderate dementia.

BuettnerBuettner

Through functional performance Through functional performance interventions he tailored exercise interventions he tailored exercise programs to the patients' programs to the patients' neurodevelopment level and neurodevelopment level and reported improved physical strength, reported improved physical strength, alertness, and sociability. alertness, and sociability.

Bliwise, Carroll, Lee, Hoch, Bliwise, Carroll, Lee, Hoch, Reynolds, Houck, van Sormeren, Reynolds, Houck, van Sormeren,

Mirmiran, Swaab, Mishima, Mirmiran, Swaab, Mishima, Okawa, and HishikawaOkawa, and Hishikawa

Sleep disturbances in dementia contribute Sleep disturbances in dementia contribute significantly to caregiver fatigue, and several significantly to caregiver fatigue, and several interventions have been found to enhance sleep. In interventions have been found to enhance sleep. In an extensive review of the literature, van Someren et an extensive review of the literature, van Someren et al. summarized non-pharmacological treatments for al. summarized non-pharmacological treatments for sleep disturbances. Two hours of bright light have sleep disturbances. Two hours of bright light have decreased agitation and improved sleep patterns, but decreased agitation and improved sleep patterns, but studies differed on the optimum timing for the studies differed on the optimum timing for the increased lighting. They also suggest that increased lighting. They also suggest that maintaining a dark environment at night is essential maintaining a dark environment at night is essential for optimal sleep but found less evidence that for optimal sleep but found less evidence that exercise is helpful. An early evening warm bath and exercise is helpful. An early evening warm bath and limited daytime napping may also enhance nighttime limited daytime napping may also enhance nighttime sleep.sleep.

Burgio, Scilley, and Hardin Burgio, Scilley, and Hardin

Through environmental interventions found Through environmental interventions found that white noise has modestly decreased that white noise has modestly decreased verbal agitation in some patients. White verbal agitation in some patients. White noise is a continuous, monotonous, soft noise is a continuous, monotonous, soft background noise, such as the sound of a background noise, such as the sound of a flowing stream, ocean waves, or a hair flowing stream, ocean waves, or a hair dryer. They reported a significant decrease dryer. They reported a significant decrease in noisiness when nursing home patients in noisiness when nursing home patients listened to nature sounds from a portable listened to nature sounds from a portable tape player and earphones. tape player and earphones.

Ford, Fox, Fitch, Beck, and Ford, Fox, Fitch, Beck, and Heacock Heacock

Through environmental interventions they found Through environmental interventions they found that lighting intensity apparently affects the that lighting intensity apparently affects the dementia patient in several ways. Demonstrated dementia patient in several ways. Demonstrated decreased mealtime agitation and increased food decreased mealtime agitation and increased food consumption when lights in the dining room were consumption when lights in the dining room were dimmed at mealtime. Also, patients with dimmed at mealtime. Also, patients with dementia often lose the ability to differentiate dementia often lose the ability to differentiate similar colors and might not see dark colored food similar colors and might not see dark colored food served on a dark plate or a black sock lying on a served on a dark plate or a black sock lying on a navy blue bedspread. Thus, colors become navy blue bedspread. Thus, colors become successful visual cues when objects and successful visual cues when objects and background colors contrast sharply.background colors contrast sharply.

Kongable, Buckwalter, and Kongable, Buckwalter, and Stolley Stolley

Through pleasure-inducing interventions Through pleasure-inducing interventions they identified 53 events that might induce they identified 53 events that might induce pleasure in patients with dementia. This list pleasure in patients with dementia. This list helps guide professionals as they assist helps guide professionals as they assist families to plan care for their patient. Pet families to plan care for their patient. Pet therapy is one example of a pleasure-therapy is one example of a pleasure-inducing intervention. Small studies and inducing intervention. Small studies and clinical anecdotes describe the beneficial clinical anecdotes describe the beneficial effects of petting or watching small animals effects of petting or watching small animals such as dogs and cats. Animals can be part such as dogs and cats. Animals can be part of group or individual sessions. of group or individual sessions.

Casby, Holm, Bright, Gerdner, Casby, Holm, Bright, Gerdner, Swanson, and Aldridge Swanson, and Aldridge

Through pleasure-inducing interventions they Through pleasure-inducing interventions they found that many therapies should include music found that many therapies should include music to promote acceptance and a sense of to promote acceptance and a sense of belonging. Playing favorite songs and melodies belonging. Playing favorite songs and melodies often quiets agitated patients. Studies and often quiets agitated patients. Studies and anecdotes report that even aphasic dementia anecdotes report that even aphasic dementia patients may be able to sing old songs and patients may be able to sing old songs and dance to past tunes. Additional benefits may dance to past tunes. Additional benefits may include psychological mood improvement, include psychological mood improvement, intellectual stimulation of speech and mental intellectual stimulation of speech and mental processes, physical sensory stimulation, and processes, physical sensory stimulation, and motor integration. motor integration.

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