Easter Sunday

Last Sunday was Easter. It was a different experience for us. We went to church online. We heard familiar voices saying needed words of encouragement and sang along with familiar songs to lift our spirits. We missed the greeting and meeting that goes with church in our minds, but we appreciated the chance to commune with the more than one hundred people who participated online with us. We hope you had similar experiences on this special day.

That service reminds us of how we all must learn new skills and new ways of connecting. We, as humans, need to connect with others and that is more difficult right now. But we can make phone calls and send emails. We can learn to use Zoom for gathering in a group. I'm sure there are other ways too that this once computer savvy but now way behind the times senior doesn't know. Give them all a try and use what works!

LBD care partners have an extra challenge in that their loved one may not understand what is happening. LBD tends to make groups confusing and so your loved one may actually appreciate social distancing and quarantine. Take this as a gift; one less thing to be concerned about!

Another gift for me is the appreciation I have for those I do connect with. I don't take this so casually anymore. Feeling grateful is very healthy and I've had a chance to feel grateful a lot lately. Sad, too, I admit, and concerned for our country as a whole and for individuals who are dealing with much more difficult situations than we are.

By the way, we welcome you to comment. If you add your phone number I will call you, so that you can ask questions, share experiences or just connect with another human. Since I review all comments first before posting them, your number will stay private and your comment will only be posted if you want it to be. Also,  we do not post any message that includes another website link.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
Responsive Dementia Care: Fewer Behaviors Fewer Drugs
Lewy Body Dementia: A Manual for Staff

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Lewy Body Phrase for 10-23: Empathetic Communication

Empathetic communication is a non-drug option for behavior management based on the fact that to a person without abstract thinking, their delusions are true and their hallucinations are real.

1. Accept that your reality is as false to them as theirs is to you.
2. Accept that their beliefs are unchangeable.
3. Accept that explaining, defending or arguing is futile.
4. Use empathy to consider how you'd feel if you were them.
5. Respond in the way you'd want to be responded to.
• Agree, at least by action if not in words, (nod).
• With delusional accusations: Apologize and move on.
• With hallucinations: Check for safety and go with the flow.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Mindful Listening

Our 3 for 2 book special honoring the 2016 World Parkinson's Congress. Good until Nov, 1, 2016.

Buy Now!

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Mindful Listening

We all know that LBD* slows a person’s thinking. We learn quickly to take our time and wait for an answer. Do you get impatient when your loved one takes so long to process thoughts? Do you ever have trouble accepting that your loved one needs so much time? Do you find yourself wanting to roll your eyes or sigh—and sometimes these might even escape? Or do you just look around or close your eyes and wait, PATIENTLY? Everyone does something like this at least once in a while, so it’s OK to say “yes.” It’s boring to just wait and wait and wait.

Try Mindful Listening. That means that instead of just waiting, which is pretty boring, you put your whole mind into respectful listening, while providing encouragement and support. When you do this you will be so busy doing your part of the job that you may forget to be bored! Here are some things that can get you started:

Put yourself in a good listening position:

• Be close enough so you can hear easily. A PlwD* and especially a PlwLBD*, will often have a very low voice. You can ask them to speak up if necessary, but make it as easy for them as possible.

• Try to be face to face. You may have to squat or sit to do this. No one feels comfortable talking to someone who is looming over them. And it will help the PlwD* to be able to see your face so they can read your lips, and even more, your facial expressions.

• Situate yourself a little to the person’s dominant side. We all feel safer that way and for the PlwLBD, this is even stronger because they feel more vulnerable to start with.

• Offer to hold their hand. Start with a handshake if you aren’t the primary care partner. Touch is an important part of communication. You may find that you want to hold the hand with both of yours, and that is fine.

Use good body language. Non-verbal cues are often more important than what you say.

• Smile and be friendly, and be sure you mean it. Don’t fake it.

• Keep your eyes on the person’s face. Don’t go looking around, or down, or close your eyes. The eyes are communicators too. Use yours to show you are interested and really want to hear what the PlwD wants to say.

When a person is having difficulty finding the right word:

• Avoid trying to help. Think of a time when someone did that for you and it was the wrong word.You had to stop searching long enough to reject the one they suggested. For the PlwLBD, it is even more annoying. It stops their thought process and gets them off on a different track. They will probably have to start over—if they can get back to where they were.

• Encourage the person to continue processing without interruption. Squeeze their hand, smile, nod, keep looking at them expectantly and wait. Put your whole effort into doing this supportively.

• Listen for feelings more than words. Sometimes the words just won’t be correct. Don’t try to correct the words but respond to the feelings. You will usually be right.

With this kind of attention and encouragement, you will find that the person is able to talk much more clearly, with fewer problems. AND you will be surprised that how more interesting it will be for you than when you were just waiting. Listening is an art. Practice it. You may find yourself practicing it with others with good success too! It isn’t only the PlwD who wants to be listened to with respect and interest!

* Acronyms:
LBD: Lewy body dementia
PlwD: person living with dementia
PlwLBD: person living with LBD
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors. As informed caregivers, they share the information here foreducational purposes only. It should never be used instead of a physician's advice.

We Are In This Together

As the holidays show up, the losses we as caregivers experience are often brought to the forefront. No longer can we celebrate the way we used to. Everything has to be adjusted to the needs of our loved ones. But we still have the togetherness. It may be different now too, but it is even important.

As dementia develops, it is like going into a long dark tunnel. Think about how it must feel to be heading down this tunnel that gets darker as you travel. Having someone to cling to makes the journey much less scary. You may have had a good relationship before, but your loved one was probably able to envision himself operating on his own as well. Now that may not be possible. This leads to more feelings of helplessness. Now, your presence becomes crucial. And as it does, so does the fear that you will leave. That you will not want to be tied down to the helpless old wreck that they feel they have become. This in turn leads to excessive clinginess and even to delusions of infidelity.

Right from the first, talk about this as a journey you both are on. Talk about how you are in this together, and how you are in this for the long run. Remember to put everything in positive tense. For instance, say, “I’m staying right here” not “I will never leave you.” As dementia advances, the negative adjectives get lost and he may hear, “I will leave you.”

Right from the first, develop routines and rituals. Pat Snyder author of Treasures in the Darkness) tells how when her husband John was diagnosed with LBD, she told him, “We are in this together no matter what. I want you to always remember that you have TWO BRAINS now---yours and mine. I’ll act as your second brain when your first brain is feeling sick in some way. That’s my job. Your job is to trust my brain.” Because she started this early, John was able to accept the idea. Because Pat used it often, as when he saw something scary that wasn’t really there or when he became confused, John remembered and the technique helped him through many rough spots. For example, when he recently became agitated with their paid caregiver, she reminded him that he’d just had a tooth pulled and his medicine was making him cranky. She said, “You need to use my brain right now and trust her to help you. Lewy has made you ornery!" It made him laugh and he was able then to cooperate more with the caregiver.

You can also adapt the rituals and routines you already have. For example, before Morris became ill, he and Judy had the habit of leaving notes to each other. She kept this up even after he couldn’t read. Even early on, it helped. Judy could leave Morris alone while she ran errands but his time sense was going and he’d get anxious and start calling her cell in about a half an hour. She found that if she left him a note, he’d be fine for a couple of hours. She was there, with him, in that note. Later, when he was in a memory care unit, she’s stick a note over his heart before she went home and it had the same effect. He would pat the note, nod and smile. Again, Judy was “there” with him and he was peaceful.

For more about working with dementia, read our books

A Caregivers’ Guide to Lewy Body Dementia

Managing Cognitive Issues in Parkinson’s & Other Lewy Body Disorders

LBD and Communication 3: Methods of Communication

Past blogs have discussed the many communication difficulties a Lewy partner (the person with a Lewy body disorder) faces. As verbal communication becomes less effective, other types of communication take over. We sometimes forget that we use a variety of ways to get our messages across. Most of us think of communication as being mostly verbal. However, as the ability to communicate verbally decreases, other methods become more important.

A few weeks ago Kevin started yelling and trying to fight me. I couldn’t understand why he was so angry. He’s usually so mild-mannered and sweet. I didn’t know what to do, but I remembered that stress can mess with communication. I thought that if Kevin was this angry, then something very serious was going on with him. I thought it might be delusions. I’d heard a lot about how they can make a person act out. But he wasn’t making accusations. It was more like he was trying to fight me off. –Sarah

Although the message may be garbled and inaccurate, something was likely stressing Kevin. Some of his intensity might have come from the frustration that he wasn’t able to communicate well enough for Sarah to understand him. However, Kevin could also be just as angry over a small irritant as over a very painful one.

Kevin has a history of ulcers and so I asked him if his stomach hurt. He became very excited and tried to hit me. I almost called 911. This was getting dangerous. Then I remembered reading that sometimes touch will work when words won’t. And so I gently touched his stomach and asked him if it hurt there. He collapsed into a chair and nodded. I gave him some mild pain medication and he quieted down. In fact, he went to sleep. I called the doctor and got an emergency appointment for the same day. Kevin is now on medication for ulcers. –Sarah

Intensity, words, touch, tone of voice, body language and facial expressions all convey messages. Recognizing Kevin’s angry behavior as communication, Sarah tried to understand what his behavior meant. Before resorting to a medical solution, she thought it through and checked her conclusions by using touch instead of words.

Intensity. This reflects the amount of tension involved. The mode of communication may change but the intensity of the message may remain. It affects expressions, actions and voice tone. A low softly voiced “I love you” accompanied by a gentle touch and a loud “I love you” accompanied by a frown have totally different meanings. As a general rule, the louder, more energetic or negative an interaction, the more stress it suggests.

Intensity is not a constant for the Lewy partner. Without an ability to judge the severity, a Lewy partner either hurts or he doesn’t. He is either scared or he isn’t He is either angry or he isn’t. Although he will usually respond better to a low intensity communication, he may not be able to adjust his own intensity appropriately.

Verbal communication. Lewy symptoms impair verbal skills more than any other type of communication. Words are symbols we use to express our feelings and thoughts. We hear words and use our past knowledge to interpret what they mean. We respond internally with a feeling or thought, interpret that feeling into words, and reply.

When LBD damages a person’s thinking abilities, the interpretation steps often get missed or garbled. Words become either misunderstood or unavailable. Then when muscle problems make talking harder to do and understand, many Lewy partners choose to talk very little.

Next week’s blog will be about communicating via the senses.

Find more about LBD in The Caregiver's Guide to Lewy Body Dementia available on LBDtools.com in the LBD Book Corner.

LBD and Communication 2: Problems Not Related To Language

A couple of weeks ago, the blog was about language-related problems for the Lewy partner (the person with a Lewy body disorder). Communication is a huge issue for the Lewy partner. Without good verbal skills, they often find it difficult to be understood. This week is about some of the Lewy-related problems with communication that aren’t directly connected to language.

Thinking errors. Lewy causes a variety of thinking errors. Some result in delusions as described previous blogs. Others are less obvious.

I had to be careful how I told Quentin to do something. He’d go when I said, “Don’t go…” or sit when I said, “Don’t sit.” I guess he didn’t hear the negatives. –Beth

The subconscious brain, even when healthy, tends to ignore the negative prefix to a directive—hypnotists learn that “sit” and “don’t sit” often generate the same sitting response. It is the thinking part of our brain that recognizes the negative prefix. Quentin’s weakened ability to discriminate caused him to ignore the negative parts of Beth’s directives and do the opposite of what she wanted him to do.

Muscle rigidity. Quentin may actually hear what Beth wants but his body isn't complying.

Sometimes I'll tell Quentin to lean forward and stand up. Instead he pushes back and appears to resist me.   --Beth 
Lewy bodies can cause muscles to become rigid, so that when requested to do something, a Lewy partner appears to be resisting. This is unconscious. In fact, the more the person tries to follow directions, the more rigid the muscles will get. This is also temporary, so that once the pressure is off, Quentin may do the same thing easily, as though he had simply been being difficult or contrary.

Slow thought processing. As Lewy advances, thinking gets bogged down more and more. The Lewy partner processes everything very slowly—for others, that is. For them, their mind is racing a mile a minute trying to wade through everything that’s going on. It’s like your car when it is in mud and the motor is racing but you are hardly moving.

One evening, before we knew there was anything wrong with Bill, we took my dad out to dinner. I asked Bill if I could have his butter if he didn’t want it. He ignored me, and just sat there looking at his plate. I’m easygoing and so I didn’t push; I just went on eating and visiting with my dad. Five minutes later, Bill picked up his butter and put it on my plate. Years later, after his diagnosis, I remembered that and understood that he’d been processing my question that whole time. –Marla

Marla asked a compound question; one with more than a single idea to be processed: a) Did he want it and b) Could she have it. Such questions take more time to process because each component must be considered individually. Also, Marla’s conversation with her father may have been distracting, making processing the request harder. Bill would likely have had to start over if Marla had repeated her request or asked if he had heard her.

Attention deficit. A Lewy partner gradually gets to where they cannot focus on more than one two things at a time.

I get agitated when someone tries to talk to me when there is loud music in the background. I am also beginning to notice that I hate it when there’s more than one person with me in a conversation. And don’t go talking about too many things at once. –Joel

Joel’s brain can handle only a limited amount of input at any one time. It works hard to process that. Any more just doesn’t compute.

Light sensitivity. Lewy partners aren’t just sensitive to drugs. They are often also sensitive to light. They may frown or squint. They may also simply close their eyes and appear to be bored or asleep.

LBD is not necessarily the only thing causing communication problems. If you suspect that the Lewy partner has any of these or some other similar problem, have them checked.

Poor hearing can decrease and/or distort the sound of voices, making them difficult to understand. Even a healthy person can become isolated by deafness.

Poor vision can hide and/or distort visual information. Add LBD’s visual problems such as hallucinations and partial blindness can be very distracting.

Depression and apathy may make the effort to communicate seem too much to deal with.

Pain, infections and other illnesses will take priority and remove focus away from communication. They also add stress which increases any LBD symptoms already present.
Next week, the blog will discuss the non-verbal ways that a Lewy partner communicates. And the week after that, we will finally get down to how to use this knowledge to communicate better with our loved ones. Better communication goes a long ways towards decreasing stress and the accompanying Lewy symptoms.

Find more about LBD in The Caregiver's Guide to Lewy Body Dementia available on LBDtools.com in the LBD Book Corner.

LBD and Stress 6: Stress Management Tools

Oops! Got ahead of myself and didn't post this last week. Rather than get too far ahead. I'm going back and publishing it this week. Next week, we'll go back to talking about communication. Like the information in the 2/7/14 blog, these tools also send calming directives to the brain. However, they usually take more training. For best effectiveness, choose one or more and make it a part of your weekly, if not daily, routine. Both caregiver and loved one can do these exercises, especially if you begin early in the journey.

The goal of these tools is to send oxygen to your brain and give you some space from what's going on in your head and in your world. Some add exercise which increases oxygen intake and provides a temporary mental escape as well. You will find that you can think more clearly and deal with issues more objectively after a session of any of these stress management tools.

Whole books are written about stress management tools. Colleges and community centers offer classes. Magazines and the internet have countless articles. Here are some suggestions to get you started. Choose one or two to learn more about. Then make them yours by using them regularly.

Muscle relaxation. Tensing and then relaxing muscles one set at a time from toes to head helps to consciously relax tense muscles. It releases the oxygen and energy held there and allows it to travel to places that need it more—like the brain. This is most easily done using an audio tape with guided muscle relaxations.

Self-guided relaxation: Think of a favorite restful place and put yourself there. Mine is sitting with my back against a shady tree near a babbling stream on a warm sunny day. Someone else might imagine they were lying on a beach near the ocean, or relaxing against a rock on top of a mountain with a gorgeous view. Combine this with some deep breathing for best effect. Guided recordings are also available for this type of relaxation.

Meditation: Sit in a comfortable position, close your eyes, breathe deeply and silently repeat a calming word or phrase like Oommm or Let it go. This prevents distracting thoughts while you relax the mind.

Yoga: Perform a series of postures and controlled breathing exercises to promote a more flexible body and a calm mind. While often strenuous, yoga can be adapted to fit the needs of a person with limited physical abilities.

Tai chi: Perform a series of slow graceful movements while practicing deep breathing. Tai chi is recommended for the elderly because the gentle movements are done standing instead of down on the floor.

With any of the above methods, also consider the following:
Be consistent. These tools need to be used regularly. If you don’t like one, try something else until you find one you enjoy. This makes it more likely that you will practice enough to make it a useful tool.
Avoid excitement. An exciting activity may be distracting, but remember that a LBD-compromised ANS may recognize excitement as danger, which will increase not decrease stress.
Practice, practice, practice. First response people like firemen or EMTs practice until their actions in a crisis are second nature. They don’t have to think about them, they just do what they’ve learned to do. Athletes do the same. They don’t become proficient swimmers or ball players or dancers without hours and hours of practice. They too need to train their muscles to act automatically. Practice your chosen stress management method every day so that when a crisis comes, you will be prepared. Practice so that you react with calming behaviors automatically.

Find more about LBD in The Caregiver's Guide to Lewy Body Dementia available on LBDtools.com in the LBD Book Corner.

LBD and Communication 1: Language-Related Symptoms

The symptoms that affect communication are seldom obvious at first. They show up slowly, insidiously moving in and gradually changing the way a Lewy team communicates. At first, most problems occur during times of stress. Thus, when the Lewy partner (the person with the Lewy disorder) most needs to communicate well will be when it is hardest to do.

Language difficulties and weak facial muscles may make verbal communication frustrating and sometimes so exhausting that it isn’t worth the effort. The symptoms are not always obvious. Slowing thought processes, growing attention deficits and apathy may be seen as boredom. Light sensitivities show up as sleepiness. Misinterpretations and inappropriate responses due to failed thinking filters become identified as character defects.

Word recall difficulty. We all have this “it’s on the tip of my tongue” experience at times, but it can be one of the first symptoms of LBD. People often have a feeling they know the first letter of the word or even how many syllables it has, but the word just isn’t there.

We loved to go on picnics as a family. My dad and I still do, although we usually just stay home and eat in the backyard. Recently Dad suggested, “Let’s go on a, uh…Let’s take our food outside and eat on that table out there.” “Oh,” I said. “You want to go out back and eat on the picnic table?” Dad responded, “Yeah, let’s sit at the picnic table.” --Deborah

Deborah’s dad knew he didn’t have the right word and was able to talk around it to get his message across. Once he heard the word, he could use it with understanding.
Word substitution. Sometimes people use the wrong word and don’t even realize it.

We used to laugh when Quentin said green when he meant blue or things like that. Sometimes it wasn’t so funny. He once asked me for a chair and was mad when I brought him one. He’d wanted a step-stool. That was even before we knew he had MCI. –Beth

Quentin didn’t recognize he’d used the wrong word. Usually, the substituted word or phrase will be similar in some way to the intended word. It might:

• Have a similar function or meaning: chair vs. step-stool.
• Be in the same group: green vs. blue.
• Start with the same letter, or sound: computer vs. counter.
• Rhyme: washing fishes vs. washing dishes.

It may not have any apparent connection at all. The further into the LB journey a person is—or the more stressed—the more garbled the words are likely to be.

Weakened facial muscles. Even when Parkinson’s is not involved, Lewy tends to weaken the muscles around the face and throat. At first, it tends to attack and weaken those muscles that control the voice.

Quentin’s voice got so soft I could hardly hear him but when I asked him to speak up he’d tell me he was already shouting. –Beth

Quentin was making the effort to speak loudly; it just wasn’t coming out that way. Beth may also be hard of hearing--a common problem with aging caregivers. That makes Quentin's efforts even more ineffective.

As these symptoms add up, a person will become less able to communicate verbally and start communicating with their behavior—which we all do anyway, far more than we realize.

Next week, the blog will be about Lewy-related communication roadblocks other than language.

Find more about LBD in The Caregiver's Guide to Lewy Body Dementia available on LBDtools.com in the LBD Book Corner.

Just Telling Isn't Enough

“Don’t rush into a room with little more than a greeting and start working with a dementia patient,” the CNA (Certified Nursing Assistant) trainer told Janie’s class. “They function at a slow pace. Too much speed and not enough information confuses them, which slows down their thought processes even more. This adds stress, which increases symptoms like delusions. So walk in the room and, with a pleasantly calm voice, let your patient know what you want to do. Ask their permission. Include them in the task. Otherwise, someone who is already delusional may feel attacked and that’s when you are likely to get hit.”

Janie remembered what her instructor said. She was late—as usual, but she walked into Ed’s room instead of rushing in the way she wanted to. She took the time to ask him if he would like to have a shower instead of just telling him it was time for a shower while getting him ready. “OK,” Ed responded with a smile. Janie smiled back, glad that her instructor’s advice was working. Ed was being more agreeable than he usually was.
Information given and permission received, Janie bent over to take Ed’s shirt off—and he slugged her in the jaw. To Janie, “have a shower” meant a whole string of events, from removing Ed’s clothing to toweling him dry. To Ed, whose LBD type of dementia made sequential thinking difficult if not impossible, “shower” had nothing to do with taking his clothes off. He perceived Janie’s bending down into his personal space as an attack.

For the overworked and rushed CNA, or for that matter, the stressed out family caregiver, taking time to explain every little thing can seem like a burden. But in the long run, it saves time, because their patients will be much more cooperative—and less combative. But as Janie learned, it’s not enough to simply explain the concept—the big picture. They need to explain each step as they go along. Let’s replay the above scene:

“Hi Ed, would you like to have a shower?” Janie says as she enters the room. With a smile on her face she waits for Ed to think a minute before he nods and says, “OK.”

After Ed answers (giving him time to process), Janie continues, “Well then, we need to get your shirt off.” (Telling him the first step of what she wants to do.) Janie waits until she is sure Ed understands what she said. (Letting him know about the shirt is a 'step.') Then she continues, “Which arm do you want to take out first?” (Including him in the task.)

Now that Ed knows why Janie is reaching for his shirt, he cooperates, holding out his left arm. As they go along, Janie tells Ed each step before she does it and includes him when she can. She never moves to the next step until she can see that Ed is with her—that his processing is “up-to-date.” Ed is less confused because he isn’t being rushed. He has a better idea of what Janie wants this time, and so instead of fighting her, he helps. Ed gets his shower and enjoys the experience. Janie is done in record time and moves on to her next patient with a feeling of success.

The first scenario is most likely to happen in a care facility where staff members are less familiar to their patients than family caregivers are and therefore can more likely be seen as attackers. However, if you are a family caregiver, you need to use these skills too. It may also fall upon you to be the “instructor” who explains these skills and the reasons for them to the well-intentioned, but not always Lewy-savvy Janies in your loved one’s care facility.

Improving Communication

LBD can play havoc with verbal communication and yet the ability to communicate is important for our well being  with our without dementia.

• Language difficulties include the inability to find the right word or using the wrong word, often without even being aware of the substitution.
  
• Weakened facial muscles can cause a low, soft voice, even when the speaker believes he is almost shouting.
• Poor thinking skills. Slower thinking can take as long as 30 seconds to process a question and come up with an answer. Although this may seem like forever to you, your loved one is very busy processing and it does not seem long to them. Inaccurate interpretations are common and negatives may be missed, with directives such as “Don’t sit” seeming the same as “Sit.”
• Other issues may impede good communication: Poor hearing or vision, and depression or apathy decrease anyone’s ability to communicate well. Pain, infections or other illnesses all increase LBD symptoms and decrease language abilities.

Negative feelings, like frustration, confusion, low self-esteem, discouragement or inadequacy, are generated by poor communication. This adds stress, which increases LBD symptoms and makes communication even poorer, with social isolation a very real risk. Here are some ways you can improve communication and help your loved one stay socially connected, healthier and happier:

• Believe. If you believe that your loved one can still communicate, you will likely be successful—if you don’t, you probably won’t be. In support of belief, researchers have long said that comprehension is among the last abilities to go.
• Make the goal about being together, not about understanding or being right. If your loved one calls you Mary and your name is Janice, don’t correct the mistake. It will probably only embarrass or confuse which adds stress—and still poorer functioning.
• Eliminate distractions. Your loved one can focus on only one thing at a time. For a successful conversation, make sure their focus is on you.
• Listen carefully. Sit or stand closely and pay attention so that you can hear their soft voice. Make sure nothing is distracting you either.
• Be alert for non-verbal cues, often much more accurate than words. Check to see if you’ve guessed right: “Do you mean….?”  You can use visual cues too—pointing, touching, smiling, etc. can help your loved one to understand you better.
• Take your time. It takes at least 30 seconds for a person with dementia to process a response. That can seem very long but if you are patient, you may be surprised at what your loved one is able to give back to you.
• Talk normally, but slowly and distinctly. Don’t shout; dementia doesn’t cause deafness. (Shouting also makes you more difficult to understand.) Do talk slowly; remember the processing time issue. Also, talk clearly. Most of us are able to make educated guesses about words that are unclear. Your loved one may not be able to do that. Use positive directives: “Stand” not “Don’t sit.”  These are easier for your loved one to follow.
• Don’t interrupt. Let your loved one complete their response. Interrupting confuses. This includes finishing their sentences or trying to provide the right word. Only do this if asked, or if they have obviously come to a stopping point.
• Limit choices and ideas: Yes or no? This one or that one? Give only one instruction at a time and don’t change subjects.  To many choices or ideas at once overloads their processing ability, resulting in negative feelings, stress and increased symptoms.
• Use humor. This is relaxing and defuses negative feelings—for both of you. Laugh at your mistakes and help your loved one laugh at theirs.
• Check for other issues. How is your loved one’s hearing? Vision? Are they depressed? Apathetic? Are they ill in some other way? Maybe some of the problem isn’t dementia?
• Use touch and affection. When all else fails, this remains. Even when your loved one doesn’t know who you are, a loving touch, a gentle tone of voice and a caring smile are still communication they can understand.