EILEEN ADLER

September is Alzheimer’s Awareness Month focusing on this debilitating brain disease that causes a slow decline in memory, thinking, and reasoning skills. This picture of my mother was taken a few years before her symptoms set in with abandon. In the beginning, Mom would explain that her “brain cells” were dying when she couldn’t remember things, trying to explain her gaffe, but she was acutely aware that something was terribly wrong. How she struggled to share a story, one she had told so many times, but simply couldn’t find the right words and finally got mired in the sequence. I filled in the missing links, but it was difficult for both of us. This picture was taken when she was eighty years old at the beginning of her disease progression; she passed away nine years later. 

            What is the difference between normal age-related changes and Alzheimer’s or generically, dementia?

1. We can admit that we have made a bad decision, but when we use poor judgment, that’s something to take note of. My mother was having a terrible time cutting a cucumber for the salad she was preparing because she was using a spoon instead of a knife. She knew something was amiss, but she couldn’t figure what was wrong. When I told her, she replied, “of course,” but I’m not sure she really understood her misstep. 
2. We can admit that we’ve missed a bill payment and suffered a late fee, that happens, but being unable to manage the finances is problematic.
3. “The word is on the tip of my tongue” is an expression we’ve all used now and then. My mother became very quiet which was so unlike her, withdrawing from conversation. In trying to explain how someone she knew had gained weight, she used her hands to demonstrate a large circle that we understood but no words were forthcoming. 
4. “Where are my keys?” or a question like this can come up, again infrequently, but when it’s a constant, we know things are changing.
5. My mother had difficulty understanding her surroundings, when one evening, while watching The Lawrence Welk Show, she turned to her grandson and asked, “Do you know these people?” Reality with a disconnect with one’s surrounds is a symptom as well.

The truth is this:  a cure for Alzheimer’s hasn’t been uncovered yet, but there is so much research and available therapies that ease the journey for the patient and their care partners. A wonderful art program, Memories in the Making, enables patients to share thoughts and feelings with the stroke of a paint brush. It is easier to activate our minds and memories through our eyes and hands. When I was an elementary school teacher, to begin a story writing lesson, I would provide four by six-inch pieces of paper and invite my students to sketch a picture about the story they wanted to share. Next, two children paired up and talked about their pictures sharing details, thereby instilling vocabulary that might be included. By the time the children had their pencils sharpened, they knew exactly what they were going to write about. Upon completion, the children would read their stories to their partners. Eliciting the words related to the initial drawing connected the dots in the brains of my students, recalling memories. This same approach is applicable to those with dementia. From sketch to story, the transition, was a wonderful experience for each person. You may be wondering why I provided such a small piece of paper - it limited the scope of their story forcing them to focus on the salient parts to include.

Self-care Ritual: Establish routine habits that close the door to frustration. 

• Place things in the same place all the time so time isn’t wasted looking for things. 
• Keep medications in the same place and keep a checklist for dosing correctly.
• Arrange for automatic bill payments.
• A calendar or chart that records the day’s, week’s, or month’s activities is a visual reminder.
• Clear the clutter – remove anything that could be a tripping hazard.
• Install grab bars in the bathrooms and bannisters on staircases.
• Provide correct shoes or slippers that do not slip off feet or slip on floors.
• Mirrors can cause confusion, thinking the reflection they are seeing is someone else; it's best to remove them.
• Wearing an identification bracelet indicating their diagnosis is important if they tend to wander. 
• Keep photographs and other meaningful treasures nearby. Not only do they provide comfort, they may provide a springboard for conversation.