Developing Dementia Competence

Focus on what Remains, not what is Missing

Some see their glass as half empty; others see their glass as half full.  So, which is it?  Well, it all depends on where you choose to focus your thoughts.  When we focus on negative things, we seem to see more negative things all around us. Living with dementia is not easy, and caring for someone with dementia is even harder; no disease is easy to live through.  If you know someone who has dementia, then you have watched what happens when he or she gets lost, forgets someone’s name, or can’t communicate an important piece of information.  It’s often humiliating for the person and it’s heartbreaking for family members to see this occurring.  These instances of memory loss tend to become our focus.  We notice every time our loved one forgets something.  But sometimes, we just need someone to point out the positives to us; to steer us in the right direction.

I would like to tell you a bit about a type of memory that isn't lost and point out some preserved abilities of people with dementia. Although the ability to learn and recall information is impaired by Alzheimer's disease, not all aspects of memory and learning are equally affected. Memory is not one thing, but a number of complex systems. As information enters through our five senses, It is translated into sensory memory and then stored in our working memory. Working memory involves short-term use of memory and attention. It holds sensory information temporarily until it is either used at that moment or processed into long-term storage for later access. 

Long-term memory has two components: nondeclarative and declarative, which are often used together.  Nondeclarative memory is knowing how or knowledge of skills and is reflected in how we do something. Once a skill is learned, it is recalled automatically. This type of memory is called procedural memory. Procedural or nondeclarative memory involves motor and perceptual skills and habits, such as brushing teeth, dressing, singing, reading, etc.

Much of procedural memory is a spared ability in dementia. For example, most people with dementia can read well into the stages of the illness, although type and size of font may need to be adjusted.

Declarative memory is knowing or knowledge of facts. This is the autobiographical memory of the events of our life, and our world knowledge. This type of memory is the first to be impaired in dementia. People with dementia become disoriented to time, forget people’s names, cannot retain information in conversation, and repeat stories or questions. A person with declarative memory impairment may forget the steps in a task or ask you to repeat the directions you just explained.

STRENGTH’S PEOPLE WITH DEMENTIA MAY RETAIN

·       Completing familiar tasks such as cooking or doing household chores

·       Using one’s imagination

·       Socializing with friends and family, helping others

·       Identifying numbers, shapes, colors

·       Reading

·       Appreciating or playing music

·       Engaging in artistic expression

·       Emotional connection

·       Knitting, sewing, painting, playing familiar games such as cards or dominoes

·       Understanding body language

·       Following directions with verbal or written cues

So, what does this mean for people with dementia?  It means that if we can help them to fill their day with all of the things they CAN do, such as familiar skills and hobbies, we will all be focusing our attention on the positive aspects of our lives.   When we have success, we feel good.  So, don’t ask someone with dementia to recall what they had for lunch or if they took their medicine, instead, read a book, play a card game, take a walk, paint a picture, listen to music, weed the garden, or just have fun spending time together.