Like a Child--but Not

Yes, dementia makes our loved ones similar to a child in so many ways. But there are several big differences.

Learning. Children can learn. Your loved one has lost much of that capability. Parents use various forms of discipline to teach children how to act. A child learns that if they do x, then y happens. Your loved one has lost the ability to understand cause and effect. Punishment simply feels like an attack. Praise feels good but your loved one probably can’t connect it with future behavior. For your loved one, prevention, bribes and distraction work better. Of course, there’s no learning going on and so you have to deal with each incident individually.

Using examples. Children often learn quickly by watching others and copying. Your loved one may be able to learn this way too—if you model the activity for them enough times. It takes an normal adult about six repetitions to learn something like a phone number. It takes a person with LBD many, many more repetitions, but it can sometimes be done. This is one big difference between LBD and other dementias. A person with Alzheimer’s loses the ability to learn at all. A vestige of that ability remains with LBD, but it is very limited. For example, eating can often become an issue. Reteach your loved one to eat by sitting across from him and with a smile, and slowing taking bite after bite. The smile is very important. Don’t talk—that’s distracting. Expect this to take far more than one meal to be effective. (See the 11/22/13 blog)

Perceptions of danger. People with dementia have often lost the ability to have a clear perception of danger. These skills are gone along with the ability to learn. What your loved one cannot do, he simply can’t do. Not now and probably not later either. Don’t expect it of him or castigate him because of his failures.

Instead, set up precautions: locks that he can’t unlock; alarms that tell you he has entered an unsafe area. Black paint or carpets in front of doors may appear as a chasm and be as good as a lock—unless this is a place where you want him to pass through at times, like the front door. Use baby monitors and surveillance cameras when you can’t be in the room with him.

When precautions don’t work—and they won’t all the time, use bribes to distract. Bribes are not a healthy way to deal with children. They teach manipulation. With your loved one, they don’t teach anything—they simply distract. The offer of a favorite treat works much better to get your loved one out of the street than yelling will.

Social rules. The ability to understand and follow social rules and niceties goes the way of being able to understand danger. Lower your expectations. Shrug, smile and move on. Others will follow your example. Apologize if necessary. Judy Scarff, in her book, The Journey Ahead: A Practical Guide for In-Home Caregivers, suggests a "Yikes" card to hand out to people who may not otherwise understand. This is a business-sized card that says something like, "Please excuse my loved one. He has a brain-damaging illness."

Size. Your loved one may be bigger and stronger than you are. Unlike a parent with a small child, you can’t use your size to intimidate or your strength to protect. You can’t just pick him up and carry him out of danger. If he becomes frightened or feels attacked, adrenalin kicks in and adds to his strength. You have to use your ingenuity to entice him away from danger or damage. Remember that he will mirror the intensity of your feelings and so try to stay calm. If you act angry or frightened, his behavior—and strength—will escalate. Bribes work well. Smile, offer an alternative activity and be patient. Your serenity will help him to calm down.

Adult concept. Your loved one has been an adult for many years. He may be acting like a child, but he doesn’t feel like one. You may have to set similar limits and safeguards that you’d set for a child, but if you treat him like a child, his behavior will likely increase due to frustration. Treat him with dignity and respect and you both will feel better.

For more, read A Caregiver's Guide to Lewy Body Dementia, available on LBDtools.com.