Which other disorders cause dementia?

In addition to Alzheimer’s disease, other brain disorders of aging that affect thinking and memory include vascular dementia, dementia with Lewy bodies, Parkinson’s disease dementia, behavioral variant frontotemporal dementia, primary progressive aphasia that has logpenic, semantic, and non-fluent agrammatic variants, and normal pressure hydrocephalus. Each produces characteristic changes in thinking, memory, language, behavior, and/or movement that allow you and the doctor to know when to consider them as possible causes of your loved one’s dementia. Note that the dementia of every individual is unique, so the symptoms and signs that they will manifest are all different. However, when dementias reach the moderate to severe stage, most dementias looks similar, despite having different causes.

How to manage memory problems

There are many way to help manage your loved one’s memory problems. If their dementia is fairly mild, memory strategies and aids can often help. Using a pillbox or another method to ensure that medications are being taken correctly is critical. Pictures are more easily learned than words. Don’t tell a person with dementia what not to do; tell them what they should do. Habits and routines are generally preserved in dementia, and new ones can be learned. Use methods to make sure the stove is not left on and the water is not left running. Work to eliminate wandering and write a plan in case it occurs. Take advantage of technological solutions to memory problems. Use reminders of the past to make your loved one feel more at home. Don’t fight false memories. Lastly, reminding your loved one that they have memory problems is rarely helpful.

How to manage problems with bodily functions

Although dementia can disrupt many bodily functions, there are ways you can help your loved one and yourself. Determine the cause of any falls and work proactively to prevent future ones. If their walking is impaired, work with a physical therapist to improve it. To reduce incontinence, use a toileting schedule, decrease fluid intake before bed, and plan ahead when you go on outings. Make meals more enticing by increasing the flavor and spice of food. Use heavy silverware and mugs to dampen tremors. Improve swallowing and reduce choking by altering the consistency of solid foods and liquids and consider a swallowing evaluation. Reduce the difficulties inherent in activities requiring skilled or complicated movements to the extent possible. Lessen scratching and picking by treating medical problems and dry skin; cover the arms if needed.

How to manage language problems

Although language may become impaired by dementia, communication with your loved one is still possible. Speak clearly and slowly in a quiet environment. Help them obtain hearing aids, if needed. Reading and writing may be beneficial for those who have hearing or speech problems and mild dementia. Speech therapy may also benefit those with mild dementia and trouble talking. Pictures can often compensate for a variety of comprehension and communication problems. Gestures, body language, facial expression, tone of voice, and other nonlinguistic and nonverbal communication can be useful, both in person and over a video phone. Lastly, remember that emotional communication is often preserved in dementia.

How to approach problems in dementia

There are several general strategies for managing problems in individuals with dementia. The ABCs of Behavior Change method identifies the antecedents and consequences surrounding a behavior, which can help you discover its cause, track it, and try different interventions to change it. The 4Rs—reassure, reconsider, redirect, and relax—provide some rules of thumb that you can use even in middle of a difficult situation. Lastly, the Three Time Principles can help you improve communication by taking your time, asking for only one thing at a time, and offering timely praise. We recommend that you try the 4Rs first, then the Three Time Principles, and finally the ABCs of Behavior Change.

How to plan for the progression of dementia

As your loved one begins to experience more problems with thinking and memory, they will need help managing their health care, finances, and other aspects of daily living. They may need to leave their home in order to receive the amount or type of care they require. Preparing legal documents such as a will, power of attorney, and health care proxy is an important step in planning for the future. Having conversations with your loved one early after a diagnosis ensures that they can participate in future planning as much as possible, easing your burden as increased care is required. Even if they don’t want to participate, you can still explore options so you will be ready when a crisis occurs.

What are some ways to sustain your relationship?

There are many activities that you can enjoy with your loved one. Visiting museums, attending the theater, watching movies, and listening to music are just a few. You may both enjoy having a massage, strolling on a nature walk, or filling in an adult coloring book—even if you never pursued such pastimes before. Exercise is good for everyone and is a wonderful way to spend time with your loved one. Most people enjoy the touch and warmth of human contact and, for couples, sexual intimacy can be an important aspect of your relationship. Lastly, participating in meaningful activities—including research, advocacy, and providing support to others—can provide an important sense of purpose in life for you and your loved one.

How to manage vision problems

Whether caused by dementia or an eye disease, problems with vision can disrupt your loved one’s function, create hallucinations, and even lead them to think you are an imposter. There are, however, many things you can do to help. Start with an eye examination to make sure their eyeglasses prescription is correct and to look for treatable diseases. Ensure adequate lighting in and around their home and increase visual cues in potentially hazardous areas, such as stairs. Adjust for difficulty seeing or paying attention on one side. Increase visual contrast and size of numbers and letters for their daily activities. Use navigation systems with audible directions. Reduce the impact of hallucinations. Lastly, manage difficulties when your loved one does not recognize you, thinks you are someone else, or believes that you have been replaced by an imposter.

Which medications can improve thinking, memory, behavior, or function?

Dementia disrupts a number of brain chemicals, and medications may be helpful to restore the balance of these neurotransmitters. When considering a new medication, it is important to set clear, measurable goals; start with a low dose; and track the effects over time. Cholinesterase inhibitors help with memory, mood, behavioral problems, and hallucinations; memantine helps with attention, alertness, mood, and behavioral problems; selective serotonin reuptake inhibitors (SSRIs) help with mood, anxiety, and behavioral problems; dextromethorphan/quinidine helps with inappropriate laughing or crying as well as behavioral problems; melatonin and acetaminophen help with sleep; atypical neuroleptics help with agitation, aggression, delusions, hallucinations, and picking; carbidopa/levodopa helps with walking, movement, and parkinsonian tremors; and beta blockers help with essential tremor. Clinical trials of new medications being developed may be available for those who are looking for better treatments for their loved one and for the next generation.

Why and how should you care for yourself?

Caregivers experience higher rates of emotional and physical illness. They are often so focused on taking good care of others that they put themselves last. This is particularly true for the sandwich generation caring for aging parents and growing children. Remember, you can’t pour from an empty cup. In order to care for others, you must take care of yourself. This means scheduling time for your physical and emotional health. Exercise regularly. Sleep well. Eat a healthy diet. Limit alcohol intake. Get medical care. Maintain your social connections. Take time for yourself. Learn relaxation techniques. Seek professional help when needed. Look for the joys of caregiving.