Understanding dementia

Dementia is a general term which describes a wide range of symptoms associated with deterioration of memory and other thinking skills. It eventually reduces a person’s ability to perform daily activities. Dementia is a neurodegenerative condition, meaning that the symptoms slowly get worse over many years because of a progressive damage of the nerve cells in the brain.

Early symptoms of dementia usually include:

• Memory loss
• Language and communication issues
• Difficulty in performing familiar tasks
• Difficulty with images and spatial relationships
• Disorientation in time and place
• Difficulty planning and organising
• Decreased judgement
• Changes in mood or behaviour

Dementia comes in several main types, with Alzheimer’s disease being the most common. Each type presents unique early symptoms, affecting individuals differently. Some people even experience mixed dementia, showing signs of multiple types. All dementias are characterized by the alteration of cognitive functions and behaviour, producing loss of autonomy. However, depending on the cause and the affected brain areas, some symptoms will predominate and the evolution will be different.

Alzheimer’s Disease: This is the most common form of dementia, which affects between 60% and 80% of people with dementia. It destroys brain cells and nerves, disrupting the transmitters which carry messages in the brain, in particular those responsible for storing memories.The early symptoms often include memory, thinking, language, or perception issues. Alzheimer’s disease tends to get worse over time, leading to a total loss of autonomy.

Vascular Dementia: This is the second in prevalence. It’s caused by problems in the supply of blood to the brain, commonly due to strokes or ‘mini strokes’. The symptoms of vascular dementia are often similar to Alzheimer’s disease, such as memory problems, disorientation and difficulty with communication, difficulties in planning and in making decisions.

Dementia with Lewy Bodies (DLB): Linked to Lewy body disease, DLB leads to focus problems, delusions, movement and sleep issues. People with DLB can have trouble swallowing, be prone to fall or have temblors. It’s closely related to Parkinson’s disease. Memory is often less affected than with other types of dementia.

Frontotemporal Dementia (FTD): Less common, FTD can mostly alter personality, mood and behavior, emotions, and more. Frontotemporal dementia can be difficult to diagnose. It’s sometimes confused with depression, stress, anxiety, psychosis or obsessive compulsive disorder (OCD). Frontotemporal dementia can cause inappropriate social behaviour and a lack of inhibitions.

Is is currently no cure for dementia. Since it comes from various diseases, it’s unlikely there will be one fix for it all. But there are medicines that can help with some dementia symptoms. These medicines are mainly for Alzheimer’s disease, which is the most common kind of dementia. They can help reduce the symptoms for a while and improve the quality of life. Before taking any medication, remember you need to consult with a specialist.

Planning for the different stages of dementia and adjusting your caregiving style can make a big difference.

Early stage:

• Encourage Engagement: Encourage the person to engage in activities they enjoy, such as hobbies, gardening, or crafts. This keeps their mind active and spirits up.
• Promote Social Interaction: Arrange social gatherings with friends and family to prevent isolation. Socializing helps maintain cognitive function and emotional well-being.
• Advance Planning: Begin discussions about future care preferences, legal matters, and financial decisions while the person can still actively participate.

Middle Stage:

• Simplify Tasks: Break down tasks into smaller steps and guide the person through them. Simplifying activities like dressing or eating can make them more manageable.
• Use Visual Aids: Utilize visual cues like labels, pictures, or color coding to assist with recognizing objects and locations around the house.
• Practice Patience: Stay patient and calm when facing challenges. Use gentle communication, and provide choices when possible to help them feel more involved.

Late Stage:

• Focus on Comfort: Prioritize their comfort and well-being. Ensure they are in a comfortable position, have proper bedding, and are dressed appropriately for the weather.
• Provide Sensory Stimulation: Engage their senses with familiar scents, soothing music, or textured objects. Sensory experiences can evoke positive emotions and memories.
• Stay Present: Spend time with them, even if communication is limited. Hold their hand, maintain eye contact, and provide reassurance through your presence.

Communication with a person living with dementia can be challenging, as one of the more common symptom is the loss of language ability. While communicating with a person living with dementia, the key is to be patient, adaptable, and compassionate in your communication approach!

• Use Simple Language: Speak in clear and simple sentences, avoiding complex vocabulary.
• Speak Slowly: Give them time to process and respond to what you’re saying.
• Maintain Eye Contact: This helps them feel connected and engaged in the conversation.
• Be Patient: Give them time to express themselves. Avoid rushing or interrupting.
• Listen Actively: Pay attention to their non-verbal cues and emotions. Listen beyond just the words they’re saying.
• Avoid Arguing: If they say something that doesn’t match reality, don’t correct them. Instead, focus on their emotions and feelings.
• Give One Instruction at a Time: Break down tasks into smaller steps and give instructions one at a time.
• Use Visual Aids: Show pictures or gestures to help convey your message and enhance understanding.
• Use Positive Tone: Use a calm and friendly tone to convey warmth and reassurance.
• Stay Present: Minimize distractions and give them your full attention during conversations.
• Be Empathetic: Understand and acknowledge their emotions, even if their words are unclear.
• Redirect Instead of Correct: If they become agitated or stuck on a topic, gently steer the conversation in a different direction.

Dealing with challenging behaviors requires understanding and thoughtful approaches. Here are some strategies you can consider:

• Stay Calm: Maintain your composure, as your calm behaviour can help diffuse tense situations.
• Identify Triggers: Observe what might be causing the behaviour and try to avoid or modify those triggers.
• Redirect Attention: Gently shift the person’s focus to a different activity or topic to divert their attention from the behaviour.
• Offer Distractions: Introduce calming activities or objects to redirect their energy.
• Validate Emotions: Acknowledge the feelings of the person you’re taking care of even if you can’t change the situation. Validation can help reduce frustration.
• Create Routine: Consistent routines can provide a sense of security and reduce confusion.
• Use Simple Language: Communicate clearly with simple words and short sentences to avoid confusion.
• Provide Choices: Offer options to empower the person living with dementia and give a sense of control.
• Ensure Comfort: Check for physical discomfort like hunger, thirst, or pain that might be contributing to the behavior.
• Limit Noise and Stimulation: Reduce overwhelming stimuli in the environment that might trigger agitation.
• Involve the person living with dementia: Engage them in decision-making when possible to foster a sense of involvement.

Remember, each person is unique, and what works might vary. Patience and flexibility are key as you discover which strategies work best for the person you’re taking care of.

Ensuring personal care while respecting a person’s dignity is crucial. Here are strategies to help maintain their sense of self-worth:

• Privacy and Respect: Always knock and wait for permission before entering their space. Close doors and curtains for privacy during personal care tasks.
• Explain the Process: Communicate each step of the care routine in simple terms, explaining what you’re doing and why.
• Offer Choices: When possible, provide choices that give them a sense of control. For instance, “Would you like to wear the blue shirt or the red one?”
• Use Positive Language: Frame requests positively to avoid making them feel helpless. Instead of saying “Let me do that,” say “Can I help you with this?”
• Respect Timing: Whenever possible, work around their preferences and routines for tasks like bathing and dressing.
• Encourage Independence: Allow them to do as much as they can on their own. Assist only when needed.
• Maintain Eye Contact: Maintain eye contact and engage in friendly conversation to put them at ease.
• Slow and Gentle: Perform tasks at a slow and relaxed pace, using gentle touches.
• Distract When Necessary: If a task is uncomfortable, use distraction techniques like talking about pleasant topics or playing soothing music.
• Adapt the Environment: Make sure the room is warm, well-lit, and free of clutter to create a comfortable atmosphere.
• Offer Reassurance: Affirm their worth throughout the process, acknowledging their cooperation and thanking them for allowing you to assist.

Making enjoyable activities with the person living with dementia allows to create meaningful experiences that keep them engaged and connected. Make sure to choose activities that align with their interest and abilities. Here is a list of activities that you can do with a person with dementia:

• Memory Games: Play memory games like matching cards, reminiscing about past experiences, or looking through old photo albums.
• Art and Crafts: Engage in simple art projects like coloring, painting, or crafting, tailored to their abilities.
• Gardening: Tend to indoor plants or a small garden, allowing them to connect with nature and enjoy a hands-on activity.
• Music Therapy: Listen to familiar music or play instruments together. Music can evoke memories and emotions.
• Puzzles: Choose puzzles with large pieces and simple designs to stimulate cognitive skills and problem-solving.
• Cooking or Baking: Prepare simple recipes together, involving them in measuring, stirring, or decorating.
• Nature Walks: Take leisurely walks outdoors, exploring parks or gardens to enjoy fresh air, sights, and sounds.
• Pet Therapy: Spend time with gentle pets or therapy animals, which can provide comfort and companionship.
• Reading and Storytelling: Read aloud their favourite stories or reminisce about shared memories and experiences.
• Sensory Activities: Create sensory experiences with textured materials, scents, and tactile objects to engage their senses.