My Approach to Dementia Treatment

Many families and professionals believe that once a person is diagnosed with dementia, that's it.  There's nothing that can be done.  "They won't remember"  

That's not entirely true.  Episodic and short term memory are failing, that's true.  One client and I used to say that her "memory was very good...it was just very very short."  Procedural memory, however is still present and can be used to help progress.  That's why techniques such as Spaced Retrieval Training and use of routines work.  When we do the same thing over and over again, our body remembers what to do.   Some people with dementia enjoy writing long after the words are legible. Sometimes a person can feed themselves the entire meal with just a simple hand-under-hand cue to get started.

Research by Bourgeois has shown this to be effective in reducing repetitive questions (among other issues). She uses spaced retrieval training and errorless learning to teach client to refer to wallet, in response to asking their questions.   "Where would you look to find your daily schedule?".  Have them pull out their wallet.  It doesn't take long before they can answer their own question, improve independence and decrease anxiety.

With a little support, extensive caregiver training, and focus on client priorities and quality of life, you can make progress with Dementia.

Want to learn more?  Keep reading...

What is dementia?

Dementia is an umbrella term for cognitive decline.  Dementia is NOT a normal part of aging. 

Forget where your keys are? Normal. Forget what to do with your keys?  Not normal
Forget a name? Normal.  Forget how to ask where the bathroom is?  Not normal

Types of Dementia

There are many types of dementia, with different characteristics and appropriate treatments.  For example, Some medications that are helpful for Alzheimers may be harmful for a person with a Fronto-Temporal Dementia (FTD).  Primary Progressive Aphasia (PPA), for example, is a type of FTD, and is very different that Alzheimers.  With PPA, a person's language declines, but their memory and much of cognition stays intact for much longer.  

The symptoms of dementia can cause many challenging behaviors, including rummaging, wandering, yelling, aggression, and not eating.  Almost all behaviors are due to an unmet need, e.g. looking for a bathroom, hunger, loneliness, boredom, frustration due to communication breakdowns, confusion due to change in routine or anything unexpected.

Anyone can read a book on dementia and behaviors, how to improve quality of life, with a list of things to try.  And there are some great ones published, I highly recommend you check them out (try your local library).  The challenge is implementation.  That's where I come in.

I sort through all the materials and information overload and partner with you to come up with an actionable plan.  

My approach to treating dementia is whole-person.  

I look at the communication style  of the person.  How are they functioning at this moment in time?

I identify communication strengths.  

"I teach caregivers to consistently use the appropriate, effective strategies.  We develop routines.  The more consistency there is, the more effective the strategies will be.  We focus on how to improve communication so that caregivers understand the person, and the person understands the caregivers.  I teach caregivers not only what words to say, but the nonverbal communication, which is so important."  - Beth, www.speechspark.com

For example, reading short phrases is often preserved long after auditory comprehension is gone.  We use those strengths to adapt caregiver's communication style and techniques.  

I teach caregivers to consistently use the appropriate, effective strategies.  We develop routines.  The more consistency there is, the more effective the strategies will be.  We focus on how to improve communication so that caregivers understand the person, and the person understands the caregivers.  I teach caregivers not only what words to say, but the nonverbal communication, which is so important.

This quote by Ralph Waldo Emerson is SO important.  A person with dementia often does not understand fully what a caregiver is saying.  When too complex/long information comes in too quickly, it's confusing. The person often things they should understand, which causes more frustration.  A person with dementia does understands your body language - are you rushed or relaxed?  Are you mad or scared?  Are you calm and smiling?  The person with dementia may mirror your behaviors and emotions.  When we see a person with dementia, we often look at their words or actions, and not their intent, not the cause.  It's vital that caregivers look at the cause and the intention behind the person's words/behavior.  That is the only way to help them.  

Communication to meet basic medical needs (like pain, illness, bathroom), but also for social communication, like simple conversations and asking for another cup of coffee, for quality of life.  

We identify and encourage purpose.  

An often unmet human need is purpose.  Without it, a person, regardless of their cognition, may feel lost.  Everyone needs a purpose.  If you can find something functional the person can do, so they feel like they are helping, that is purpose.  Simple things, like sorting/matching socks, putting away silverware, setting the table, folding towels, watering plants.  All those tasks are cognitively-simple, but functional, familiar tasks the person can do.  

Individualize.  

Not all strategies work with every client.  And they won't work every day.  And that's okay. (we all have 'off' days, right?) We will talk about the person, their past, their interests, current routines, and their priorities.  We'll learn what strategies and activities help.  And implement those strategies for a custom plan to help you and your loved one communicate effectively.