Dementia affects everyone differently

Dementia is a group of symptoms caused by a disease such as Alzheimer's disease. Alzheimer's disease is the leading cause of dementia resulting in a decline in cognitive abilities.Other causes of dementia is vascular dementia, Lewy body dementia and frontotemporal dementia.

Dementia is caused by a disease, and Alzheimer's Disease is the leading cause of a dementia.

"A dementia" acknowledges the person has one specific types of dementia. Using "dementia" only describes a collection of symptoms, just as you would say "a cancer," and specify the type.

Research shows amyloid changes in the biomarkers of Alzheimer's disease have been found as early as 15 years prior to noticeable change.

This is a very important question. In a nut shell, no. Understanding early symptoms can result in early treatment and better outcomes. Early symptoms that could indicate cognitive changes may include loss of smell, difficulty with vision and depth perception, falling victim to a scam due to problems with judgement, and decision making. Other symptoms can be changes in mood, increased anxiety, social withdrawal, loss of interest in hobbies and difficulty finding words. OBSERVE and keep notes of changes you see can help recognize when more support is needed.

People with dementia have difficulty storing new information. The person repeats the question because they can not recall the answer to the question, even if you continue to repeat the answer. This is very stressful and frustrating to you, but learning to LISTEN to the emotion and feeling behind the repetitive question (is the person repeated asking for breakfast after just eating, my still be hungry, and sitting down and having a snack together may solve the issue. It is very important to show dignity and respect to the person, and a reasonable question always deserves a reasonable answer. 

During the progression of cognitive decline, details in long- term memories made fade. But  these memories have been stored for 60 or 70 years and many of these earliest memories  often relate the good times in life such as childhood memories. Because the person has difficulty following conversations, repeating their stories help them to feel connected to others. It is important to LISTEN to the feelings of the story, but most importantly, LISTEN to how you respond.

Often, parts of the story may be missing in their memory, and they are simply filling in the blanks so the story flows. These are not lies, and correcting the person in the middle of the story brings shame and embarrassment. Avoiding being a constant corrector and VALIDATING the feelings rather than the facts, helps to maintain a trusting relationship. 

People with dementia often sleep more due to disruptions in their circadian rhythm, brain damage, medication side effects, and psychological factors. These factors can cause daytime drowsiness, Excessive napping can also be a result of lack of stimulation and boredom. Daytime napping can disrupt nighttime sleep, so it is important to keep the person engaged throughout the day. ENGAGEMENT is key!

This of course is not the case with all persons with a dementia. However, some people living with a dementia may resist showering due to cognitive decline and lacks the understanding of the need to shower,  sensory sensitivities, and emotional factors. The person might have a fear falling, fear of being cold, feeling embarrassed about needing assistance, or is sensation to the water hitting their body.  Addressing these concerns by OBSERVING and approach the person with patience, compassion, and empathy, and adapting care routines to meet the person's needs can help make showering a more positive experience.

When a person with a dementia "refuses" a request, we often call this a "challenging behavior." However, when we shift our perceptions and recognize this is an attempt for the person to communicate an unmet need, we can better understand the feelings behind their hesitation. People with a dementia may resist changing clothes due to various factors including an increase in cognitive decline and not recognized clean clothes are needed, sensitive changes to fabrics and emotional distress. The person may struggle with the physical act of changing, or find comfort in familiar clothing. VALIDATING emotional responses such as embarrassment or anxiety can be helpful, and giving choices of when to change can help maintain the person's dignity and personhood.

People with dementia may stop eating due to a combination of physical, cognitive, and environmental factors. These can include changes in taste and smell, difficulty swallowing, cognitive decline affecting the recognition of food, medication side effects, and even environmental factors like a stressful mealtime environment. If the person stops during a meal, simply hand them the eating utensil without any words. This physical prompt may be needed several times during a meal. Having a routine for meals, and sitting and eating together and ENGAGE, can help minimize any hesitation. Research shows listening to soothing background music (only instrumental as the person may start singing lyrics and choke) can decrease agitation and improve nutritional intake. 

People with dementia may not want to leave the house due to a combination of factors including confusion, anxiety, fear of falling, fear of getting lost, and fear they will not be close to a bathroom in time.  The person may struggle with disorientation, memory loss, and communication difficulties, making unfamiliar environments overwhelming and anxiety-provoking. VALIDATING these concerns will build a more trusting relationship. Additionally, physical changes like mobility issues can make outings more tiring. Short car rides or outings to enjoy ice cream together, can help keep the person feel safe when leaving the house and more comfortable away from home.

At times, a person living with a dementia may gradually stop participating in hobbies, activities or conversation as much as they used to, or not at all. These can be an early symptom often gone unnoticed and occurs when the person is aware they are finding certain things more difficult to do. They may not enjoy socializing because of difficulties following conversations or have trouble expressing themselves.

The person may also find too much stimulation is distressing, such as being in a noisy room with lots of people. People with dementia may also become more withdrawn over time as they  communicate less. Learning to OBSERVE changes and ENGAGE with the person helps maintain well-being with a significant impact of quality of life.

People with confusion often lose or misplace common items, such as glasses, the TV remote, or a cell phone. The person may place an item for safekeeping, but not recall where the item is. The person may also leave items in unusual places – for example, putting the dog's bowl in the refrigerator, or in the closet with their shoes. To the person, these incidents make sense to them, but not to us. You may discover a muffin under the pillow, because the person thought they might want a midnight snack and forgets about the treat.

Avoid shaming or scolding and OBSERVE any pattern, or similarity with objects that go missing. An office worker may collect pens. staplers, envelopes, bills, or other office supplies in an attempt to make sense of their world.

Keeping valuable locked away can prevent the loss of important items.

Loss of inhibitions is more common in certain types of dementia, such as Frontotemporal Dementia (FTD) which causes damage to the frontal lobes resulting in poor impulse control and the ability to filter comments.

The memory of the loss of the person''s parents may have faded and thus they do not recall their deaths and thinks parents are still alive. You may try gently reminding the person that his/her parent had died to see if that jogs their memory and they can affirm the death. If the person seems shocked and agues the parent is alive, avoid giving the sad news over and over.  

The person will be hearing the news as if for the first time and not helpful. Often, the person may be thinking of a childhood memory and just wants to talk about their mother or father.  VALIDATING with a simple response  "Your mother was such a great cook and the smell of her cookies baking always made me hungry. Let's go sit on the porch and have a cookie together." Sharing memories of childhood, cousins, and grandparents can create many joyful moments!

Lack of stimulation creates boredom and people living with a dementia may become apathetic and unmotivated to do things they once enjoyed. Because thinking and reasoning skills are affected by the changes in the brain, the person maybe unable to recall hobbies they once enjoyed. Offering opportunities to ENGAGE in a familiar hobby by adapting the activity to meet the person's ability can become meaningful again. Muscle memory will often kick in and if given the opportunity, a pianist may begin playing again, a knitter may knit again (let the person just knit with no expectations) and an artist may paint again!

A person with dementia may frequently follow a person around the house seeking reassurance or support. This can feel intrusive and frustrating, and giving yourself a break can help you. Rather than telling him what to do (Please stop following me!), try telling him what you will do. "I'm going to sit outside for a few minutes and I will be right back." Finding small moments of respite can make such a difference in your day. 

Adult children can often be confused with an older family member.  For example, a father with a dementia thinks his adult daughter is his wife, and not recognize his wife. Struggling to understand the passage of time, the father may be experiencing "time-shifting" where he feels he is living in a different era. The father may see himself as a thirty-year old husband and the adult daughter may look like her mother during that time period. He has no memory of how his wife looks as an 80 year old like himself, and mistakes the daughter for his wife, and does recognize his older wife. VALIDATING the similarity you look like your mom when she was younger may help recalling memories during the happy times they enjoyed when young.

Dementia significantly impacts a person sense of time, leading to disorientation and confusion. The need for safety is important for well-being, and not understanding you will return, the person may feel abandoned. Dementia can impact the person's ability to show empathy, and can not relate to errands you must run. Leaving for short periods of time and quickly returning may help to establish a feeling of trust you will return as you promised. VALIDATING feelings of any expressed fears is key.