28- Apr2017

New Ways To Approach Dementia Communication

At a recent support group, an adult daughter asked, “Is there such a thing as too much information?”  She continued to express her concern about how much information she should share with her father when he asks “How did I get here?”

There are new ways to approach Dementia Communication. First lets review some of the old ways we tried to communicate with Dementia patients.

Reality Orientation Is A Thing Of The Past

The first is based on the torturous manner in which we re-oriented dementia residents 20+ years ago.  We gave them so much information, too much information, we created chaos, confusion and a heck of a lot more frustration for both ourselves and the resident.

We would use reality orientation to bring the resident “kicking and screaming” into the here and now.  We felt that more information was better and eventually they would succumb to our reality instead of their own.

Reality orientation has its time and place, but for the most part, it is not in the world of dementia.  This type of intervention created havoc for the resident, often hearing information they had long forgotten, only to be reminded of their age, loss of family, loss of independence and loss of self.

New Methods Of Dementia Communication Cause Less Stress

Today we encourage the idea that “less is more”.  Consider when broaching the subject of sex with your pre-teen. Once they become curious in the concept and begin to ask questions, I doubt most of us would divulge everything all at once.  Not only could this be harmful to a young person’s psyche, but it becomes difficult terrain for us, as parents, to navigate.

The key to sex and the pre-teen is to answer only what is being asked.  Straight forward answers, no euphemisms, no diagrams needed.  Talk plainly, using the proper anatomical descriptions and answer only what is being asked.  Then wait.  Wait for a follow-up question or a query to more detail. Again, answer only what is being asked.  Let them guide you.

I am in no way encouraging a stunted and strained conversation, rather a cautious approach to a sensitive topic.

The same is true for someone suffering from dementia. When a question is asked, answer only that question.  No euphemisms, no diagrams, no over explanation needed.

Be Creative and Probe

So how do you do this?  Be creative.  In the case of the woman at the support group, I encouraged her to use her father’s dementia to her advantage, leverage his short loop and need to find connection.  When he asks “How did I get here?” answer “In my blue Chevy”.  It is a straightforward answer to only the question he asked.

Then if probed further, use the concept of cars as a jumping off point to conversation.  Explain that you drove your blue Chevy here and it is your favorite car.  Then ask what his first car was.  Was that his favorite?  Was his first car blue, red or black?

Imagine how the dialogue would ensue if you started all the way from the beginning to describe how he arrived there.  Would you start by describing the symptoms you noticed, the doctor appointments, the clinical testing, the diagnosis, the selling of his home, the decision for nursing care?

Not only would you exhaust yourself in that lengthy ordeal, only to relive the difficult days, but you would cause him to do the same.  Anger, frustration, and overwhelming emotions would arise taking the two of you farther away from a brief and joyful conversation of reminiscing but rather immerse you in the strain and heartache of watching him feel loss, deprivation, and defeat.

Less is more.  But the right approach to less can create more and more opportunities to connect.

Learn more about new methods of Dementia Communication at the Dementia RAW website.

26- Apr2017

Five Reasons To Get A Diagnosis Beyond Dementia

If you or a loved one is given the diagnosis of dementia from a general practitioner, the very next question you need to ask is:  What kind?

This is critically important in determining which chronic brain condition is causing issues with memory, judgment skills, communication changes and potential behavior transformations.  

It is important to think of the term “dementia” as a grouping of symptoms that is evident in a variety of disease processes.  Like the term “cancer”, the past, present and future is dependant on the type of cancer.  If you or a loved one were given the diagnosis of cancer from a general practitioner, your very next question would be:  What kind? The same holds true for dementia.

The following are 5 main reasons why it is important to distinguish the “type of dementia” you or a loved one is living with:


Based on the type of dementia diagnosis received, specific medications may be recommended to alleviate some symptoms or slow the progression.  For example, not all medications effective for Alzheimer’s type dementia are advantageous with other forms of dementia, such as Frontotemporal Degeneration, where an exacerbation of troublesome symptoms may be apparent.  

Additionally specific medications that have proven effective in alleviating symptoms in such types of dementias such as Lewy Body Dementia (LBD) or Frontotemporal Degeneration (FTD) can create serious side effects if taken with other common medications that treat depression, cold/ allergy symptoms and anticoagulants.

According to the Lewy Body Dementia Association, “While traditional antipsychotic medications (e.g. haloperidol) are commonly prescribed for individuals with Alzheimer’s with disruptive behavior, these medications can affect the brain of an individual with LBD differently, sometimes causing severe side effects” –  source Lewy Body Dementia Association

A Diagnosis of Exclusion

A diagnosis of such chronic brain conditions as Alzheimer’s disease, LBD, FTD, and Vascular dementia should be provided only when all other options have been exhausted.  There are many chemical changes, hormonal imbalances and harmful medication interactions which mimic a type of dementia, but are potentially reversible.  An example of this is Hydrocephalus where surgical treatments can restore and maintain normal cerebrospinal fluid levels in the brain, alleviating symptomatology and progression of the disease.  

Symptoms of depression often mirror those of early stage Alzheimer’s disease.  If the proper information is provided at medical appointments and a thorough exam is performed, including necessary tests, it is possible to rule out a chronic and fatal disease processes.

Non- Medical Treatment Options

Various therapies and interventions are recommended to stave off progression of troublesome symptoms and maintain quality of life for anyone living with a chronic brain condition.  Some therapies target specific symptoms, while others are utilized to stimulate remaining brain health and mood.  Proper diagnosis allows for important early treatment options that may extend quality of life and independence.  

Those living with LBD often suffer from low voice volume and poor enunciation. Speech therapy may improve muscular strength and swallowing difficulties.  Music, dance and aroma therapies have been shown to reduce anxiety and improve the mood of those living with Alzheimer’s disease.

Support Systems

Depending on the type of dementia diagnosis received, families find themselves wrought with guilt, grief and fear of the unknown.  Support groups specific to the disease and one on one therapies can be helpful to make caregivers functional and effective in a time of crisis.  Groups sponsored by local hospitals, spiritual organizations and local municipalities can provide great options for empathy, understanding and service options.  

General groups that support those living with a chronic brain disease should be considered as a “jumping off point”, but if a specialized group is offered, it may be helpful to engage and seek the support from others who know exactly what you are living with.

Future Plans 

Depending on the diagnosis, planning for the future progression of the disease as well as the social well-being, comfort measures and financial needs of the patient and family can very greatly.  A progressive, inoperative brain tumor many indicate that palliative and hospice care may be the best intervention to ensure the patient’s comfort during their final months.

A diagnosis of Alzheimer’s disease many indicate that families need to rally together, assisting the patient to determine what their end of life choices are.  The implementation of financial and legal documents such as power of attorney, guardianship, and living wills will depend on the cognitive and judgment capabilities at time of diagnosis and application.

We all know the importance of receiving a proper diagnosis from our doctors when it comes to chronic illnesses, persistent ailments and even temporary infections.  When we are misdiagnosed, it takes us longer to heal, regain our strength and resume life as normal.  Diseases that plague the aging population are no different.  With the proper diagnosis, treatment and prognosis can enable anyone, at any age, to remain active and independent for as long as possible, enhancing quality of life.