Where are the Words?

Word finding is one of the most frustrating language symptoms of aphasia related to dementia. It comes about early in the process of the disease, and it exacerbates as the dementia progresses.

I could explain and describe, but I think this short video says it all. Link below.
"Forgetting words. I'm trying to think of it..."

So leave space for the person to think.

Provide time as the words may come slowly.

The video's example of a multi-sensory experience is ideal, the senses of touching, feeling, tasting, hearing, seeing, and smelling will work together and help elicit the verbal response.

Ask one question at a time and WAIT. Bombarding the system with information to comprehend without ample time to process and formulate a response will not be the most effective strategy.

Don't forget that words may not be the most important part. While losing language and memory is devastating it is not the only way in which people experience the world.

Moments of Clarity

If you have participated in my presentations/courses you know that I am most often the last to give up hope. I am the one who says over and over again that we need to look for the moments of lucidity, and take full advantage of the times when our patients and loved ones with dementia are a resemblance of their former self. So today I saw it, again, firsthand. A woman who I’d basically written off, told her family she was not going to regain any of her thinking skills, and told all of the staff that the compensation system we had in place was all we could do, proved me wrong.

I saw her spark come back a couple of weeks ago, and to my dismay that light remains consistent even now. A few months ago, when I first met her, she told me that if I just gave her time she would feel better and recover. I persisted with therapy then, and I failed. She was correct. Now, it seems like she has shed about 10 years. Today we had a wonderful conversation. She laughed, smiled, and discussed her life with a precision and simplicity that made me know this was improvement. She also gave me some insight that was very valuable. Listen to your patients. Sometimes even when they seem off base and confused if we can listen to what they are truly saying, and realize that our goals and our time frame is not always what best suits them.

By leaving my preconceived notions behind and remembering that we all know ourselves better than any medical professional could, I am able to see the value in reading beyond the uncertainty of dementia. We have a responsibility to help our people live their best lives for as long as possible. How can we possibly begin to do that if we don’t use what they know to our advantage? Use their moments of clarity, find some resolution for yourself, and consider what we are here for. Reflect on our purpose of helping the elderly exist in a way that makes keeps life normal.

November 16th: National Memory Screening Day

The Alzheimer’s Foundation of America is holding its annual National Memory Screening Day this upcoming Tuesday.

A screening is not a diagnosis, or in-depth testing, but a systematic way to look at areas of concern and determine if you or your loved one is at risk for dementia. It is also a great way to examine memory right now. Even if you are not having trouble the screen is helpful for future comparisons.

More than 2,000 locations nationally will provide the opportunity on Tuesday, November 16th for memory screening. Click on the link below for more detials.

http://nationalmemoryscreening.org/index.php

Take this opportunity and screen your parents’ memory, your grandparents’, and your memory. This valuable service could help for earlier diagnosis of dementia, and guess what…the medical treatment available right now for Alzheimer’s and other types of dementias is MOST EFFECTIVE in early stages. So why wait?

As Memories Slip Away

Just in case you missed NPR's Morning Edition this morning. I thought I'd share a link to the StoryCorps clip aired. This clip was recorded as part of the Memory Loss Initiative.

http://www.npr.org/templates/story/story.php?storyId=129454463

The Patterson's share what they have learned about living with Alzheimer's, and really living in the present moment. They hit on a key point for sure. Like Eleanor Roosevelt said...

Yesterday is history, tomorrow is a mystery, and today is a gift; that's why they call it the present.

Listening and Loving

Many of you may know of the work I am currently doing with StoryCorps. There will be many exciting projects to come, but today something special will happen. NPR will be airing a beautiful clip that was recorded as part of the Memory Loss Initiative.

This morning at 8:20 on NPR's Morning Edition tune in to hear why I think StoryCorps is so wonderful, and its value with those we care for suffering from memory loss or dementia.

I hope you will listen and let me know what you think.

Jan's Story

Last night I check my email to find a note from a person who attended one of my seminars. She referred me to last week's CBS Sunday Morning show, and simply stated that there was a segment I should see that was wonderfully done. I watched this video and was very touched. Barry Petersen when out on a limb, creating a relevant piece that is absolutely worth sharing.

Take a moment, click the link, scroll down, watch the video, and share your thoughts.

What if Jan's story was your family's?

http://www.cbsnews.com/stories/2010/06/20/sunday/main6600364.shtml?tag=cbsnewsTwoColUpperPromoArea

Reminisce Resurrect

Easter Sunday, brings us to see our elders, a family dinner, baskets, eggs, church, a new dress or a nice suit. Easter sparks many memories for the neurotypical person like one of us. For instance, I can recall the exact shade of pink in the stripes on my dress one Easter, the scratchy knee socks, and the bright sun shining on my face while I posed for Easter photos in the nicely manicured lawn with my cousins. The patient with dementia will not have these memorable details easily accessible. So asking the person with memory and cognitive impairment about their favorite Easter, or what their Easter traditions are may be a great way to begin a conversation, without very fruitful discussion.

What we know about memory is that short term recall is the first to disappear, and then long term recall slips away more slowly. It manifests like this in the early stages…The person with dementia gets up and dressed in their Sunday’s best, the family leaves for church and no slip up yet. They go to service, sing the songs, read the scripture, and then time for family dinner. But this year family dinner is at the granddaughter’s home, and the driver is relying on the one with dementia to give directions, as he is in from another town. Travel there is not so easy, despite many visits prior to this one, wrong turns are made, even pulling into the wrong home, but thankfully noticing another family in the drive. Talking about the sermon this date is impossible, even though the person with dementia was present and participated during the service, no recollection of information so new exists. So, with a lack of interaction regarding current happenings, the family begins to dig back into days past. Reminiscing about the year that one lost egg from the hunt wasn’t found for a week, and only did the stench of the decorated egg lead them to find it. The person with dementia may remember this humorous event. Perhaps they break out the photo album. The senior with memory loss sees a photo of their children 20 years ago, outside the church after Easter, and with a quick comment from the daughter regarding the fun had that day, comments flow easily and memories though long lost begin surfacing.
Now how can we make this Easter, and everyday special? How do we help preserve memories and interactions in life while dementia is trying to take those skills away? Stick with tradition, and keep the events of the holiday as recognizable as possible. People with dementia will remember the familiar, and function optimally when provided with stimulation that is not constantly changing. Memory loss will often not attack the prayers that were repeated throughout life, the common routine of cooking the same recipe for the Easter ham will be intact, and even knowledge of the normal attire, or typical events of the day are tools to use to help the person with dementia live life as normally as possible. When it comes to remembering and conversing, use items and pictures from the past to elicit recall, and keep the demand simple. Allow the senior to recall what they easily can and keep the conversation flowing by feeding in missing details. Familiar smells, tastes, places, routines, and providing stimulus with emotional content will retrieve memories from places hidden.

Not only this Easter, or on special holidays, but everyday, we can draw from this knowledge to help those we love with memory loss have meaningful interactions. Keep routine intact, use familiar ritual, and pull in concrete items to stimulate memories and conversation. Fill the day with success driven interactions. We can tap into emotions, feelings of love, joy, and peace to promote pleasant contact with the senior suffering from dementia, and through these moments preserve quality of life in the face of a terrible disease.

Happy Easter!

Meds and Memory Improvement

A body of evidence exists discussing a positive secondary effect of antidepressant use. Hippocampus cell growth is the result which comes as a byproduct. The hippocampus is a structure within the brain which stores memories systematically. Typically examined in those with long term depression, studies show that with use of antidepressants over extended periods of time, hippocampus cells proliferate and increase in plasticity. If the hippocampus cells are generating, or even if the plasticity is allowing new information to be stored and retrieved, then implications could be profound.

The use of antidepressants can be very beneficial for the elderly and those with dementia, for decreasing depression, but perhaps there is an additional benefit. Wouldn’t it be amazing if we could kills two birds with one stone, or at least slow down the migrating flight of memory loss throughout the fragile brains of those with dementia, Alzheimer’s, or normal age related memory impairment.

Now I have to say that doctors do not prescribe antidepressants for this purpose, and research is virtually nonexistent in hippocampus volume increase with the population whose diagnosis is that of a memory disease such as Alzheimer’s. What’s available is the promise of clinical trials related to this concept. Here is a link to one such trial, and this site will provide a tool to find other trials as well that may benefit our patients and loved ones with dementia.
http://clinicaltrials.gov/ct2/show/NCT00702780?term=Alzheimer%27s+and+antidepressant&rank=12

More than a clinical trial, the promise or hope that perhaps a treatment we use for one symptom, depression, will change the brain with memory loss in a positive way may provide solace in the face of a very challenging disease.

Photo By: Tom Varco