Understanding the Stages of Dementia

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At Assisting Hands of Cincinnati, we’re excited about everything we are learning about the different stages of dementia and Alzheimer’s. Two of our home care professionals are certified trainers in Teepa Snow’s Positive Approach® to Care, and they are in the process of training all our caregivers. By sharing what we are learning with our families, we hope to give them better insight into their loved one’s mindset. While these stages have many facets, here are three fictional stories about the more common experiences of people living with dementia:

1) Judith is in the early stages of dementia. She is fine with small talk, but often misses cues and can’t really follow longer or more complex conversations. Often she forgets details about your last conversation or what you did together. She sometimes seems a little paranoid – she will misplace things and claim someone stole them from her, and sometimes you might wonder if she is lying to you. Her behavior does not always seem rational.

What you can do: Practice patience and understanding. Know that Judith is probably missing one out of every four words in a conversation, so slow down a bit and repeat if necessary. Don’t correct her or argue about what she says, as her mind is moving back and forth to different times, and she is aware of being embarrassed or made to feel incompetent. She may not remember details, but she will remember how your visit made her feel, especially if you seemed angry or impatient. When she seems paranoid about things she has misplaced, reassure her and help her to find what she has lost. It’s important to give her cues for where to leave things so she can find them again – a bowl by the door with a large “KEYS” sign, for example.

2) Charles is still quite mobile, but has a hard time getting comfortable and often complains about bathing, dressing and brushing his teeth. He is very sensitive to the textures of food and will only eat and drink certain things. He has a favorite blanket that he enjoys twisting around his hands. He also will tear up any paper he can get his hands on. He sometimes recognizes you, but often seems to be responding to something else. If you are wearing a strong scent, he may make a face and want to stay away from you. His conversation is fairly limited and often seems to only be about what is making him uncomfortable.

What you can do: Offer games or activities that can be done repeatedly – perhaps a large plastic puzzle or some specialized fidget toys. If he is resistant to an activity, give him a few minutes, don’t force things on him. If he is having difficulty with pills, find another way to give them to him – maybe smashed into applesauce or pudding. Know that his senses of taste, smell and touch are highly reactive, so be gentle, offer familiar foods, and avoid perfumes or strong-smelling soaps and cleansers. Also, know that he has no sense of danger to himself or others, so safeguard his environment and assist when walking or bathing.

3) Carol spends most of her time sitting or lying in bed. She moves her hands quite a bit and enjoys touching soft clothes or blankets. She loves to listen to music, especially music that was popular when she was in her teens and early twenties. She doesn’t respond well to chaos or noise – a lot of movement by others around her makes her feel unsettled. Often she will try to get up and move on her own, but she is very unsteady and really needs help getting from place to place.

What you can do: Make sure the fabric of her clothes is in a texture she enjoys. Play music frequently – you’ll find she even sings along and can often sustain a short conversation after listening to music. She loves to see young children, but only when they are in the mood to be calm around her. It’s important to have a schedule and stick to it as much as possible. Let her know what is coming next. Stay cheerful and, even though she may not communicate much with you, talk to her about everything you are doing. She is hearing you (even if you can’t tell!), and communicating with her calmly will help her transition from one activity to the next.

Providing consistent, loving care for someone struggling with dementia can be overwhelming. Family caregivers often feel guilty about asking someone else to help. They may worry that no one else knows how to “handle” their loved one. Assisting Hands of Cincinnati has fully trained dementia-care specialists – and we are training more and more of our staff every day. We’re here when you need us. Get in touch, we can service everything from a few hours of respite care a week to full-time, 24/7 care. We look forward to meeting you and your loved one.