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Two to Tango: Using Positive Communication When Someone has Dementia (Part I)

There is a hands-on educational workshop facilitated by dementia care expert Teepa Snow.

The seminar is full of valuable insights and advice on effectively communicating with individuals who have dementia, with special emphasis on fostering a positive relationship that reduces stress on both the impaired individual and the caregiver. (For the purposes of this discussion, dementia will include all forms of dementia, including Alzheimer's disease.) The information is so useful that we would like to share it with our readers in a two-part series in order to help others navigate the waters of managing a relationship with a loved one who has dementia.

First, Ms. Snow stresses the need for caregivers to recognize dementia as a form of brain failure and not simply a "memory problem." The brains of individuals with dementia are undergoing progressive deterioration which eventually affects nearly all areas of functioning −from the ability to recall events, exercise judgment, and control impulses, to the loss of language and field of vision. Taken together, these physiological changes impose significant limitations on the ways in which an individual with dementia is able to relate to the world. Generally speaking, the brains of individuals with dementia "lose left and retain right," where the left brain controls language and speech and the right brain controls the rhythm of speech, music, prayer and song, as well as, ahh, well, expletives. (More about this later.)

For example, an individual with dementia will, on average, miss one of every four words spoken to him. It's not that the individual can't hear what is being said: Auditory perception is one of the few brain functions to remain intact in the individual with dementia; however, the ability to comprehend language (a left side function) is gradually lost. Interestingly, the part of the brain that controls the rhythm of speech (a right side function) remains intact. This is why the sometimes nonsensical speech of a person with dementia maintains the hallmarks of conversational tone. It's also why our loved ones with dementia may shout expletives when frustrated: As their range of vocabulary diminishes in the left brain, they rely more on the use of the right brain, which, as previously mentioned, stores all of those colorful words we try so hard not to let slip. According to Ms. Snow, some other functional and behavioral changes that can occur as a result of dementia include:

--Confabulation, or the act of making up facts to replace lost memories. This is the brain's way of compensating for a lack of information that can leave the individual with dementia feeling frustrated and confused. Confabulation helps to fill in the gaps. Interestingly, the individual with dementia can remember the emotional tone of a past interaction, even if this individual cannot recall the actual facts surrounding the encounter. For example, if a past interaction with a caregiver felt unpleasant or upsetting to the individual with dementia, then this individual may react to a future interaction with the caregiver with resentment, fear, or guarded suspicion−perhaps "recalling" (confabulating) untrue events that are leading this individual to approach the caregiver in a cautious manner.

--Peripheral Inattention, or the loss of field of vision. Imagine you are looking through binoculars. (With each hand, curl your thumb and index fingers to create a circular "binocular" effect and hold them to your eyes.) Now, determine whether your shirt is soiled. That's right; you can't see it to know. This is essentially what happens to individuals with dementia: As the part of the brain controlling peripheral vision continues to deteriorate, they increasingly experience the world through "binocular" vision. Combine this organic change with normal, age-related visual decline and the mental confusion of dementia, and you're left with a recipe for disaster. Grimace in frustration at the person with the soiled shirt, and you've set yourself up to endure another bout of confabulation.

So, what to do? Stay tuned for specific tips next week in Part II of Two to Tango.

To learn more about the work of Teepa Snow, visit www.teepasnow.com.

The attorneys at The Estate Planning & Elder Law Firm can assist families with their estate, financial, insurance, long-term care, veterans' benefits, and special needs planning issues.

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The Estate Planning & Elder Law Firm, P.C. is an elder law firm. We represent older persons, disabled persons, their families, and their advocates. The practice of elder law includes estate planning, estate and trust administration, powers of attorney, advance medical directives, titling of assets and designations of beneficiaries, guardianships, conservatorships, and public entitlements such as Medicaid, Medicare, Social Security, and SSI, disability planning, income tax planning and preparation, care management, and fiduciary services. For more information about The Estate Planning & Elder Law Firm, P.C., please visit our website at http://www.chroniccareadvocacy.com.

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