Coping with dementia: Understanding the decision-making process

One of the most predominant aspects of dementia and/or Alzheimer's disease is the decision making process. Family members struggle with understanding that the parts of the brain are literally dying and having a meaningful conversation with the resident is almost impossible. The individual with the disease will struggle to find words or say the wrong word. This is known as "word salad" in the medical community. They simply do not have the capacity to find the word they are looking for so they use whatever word they can find. Doctors and researchers tell us that the Left Inferior Gyrus (LIFG) and the left Temporal Cortex are the responsible parts of the brain. In this section the words get "sorted out" and a person without dementia or Alzheimers is able to sort out cat from dog, black from white, etc. A person with dementia or Alzheimer's is unable to distinguish one word from another.

One of the techniques we use at Mountainside is to provide pictures of simple words and if we are unable to distinguish what word they are trying to say, use the pictures to help the resident. In the early stages of the disease this may be helpful.

One of the other characteristics of the early stages of dementia or Alzheimer's deals with clothing. Many of the people will put on layers and layers of clothing. Sometimes 4 or 5 layers! No one really knows why they do this but to some degree this is frightening to families and loved ones. It also disturbs some people who come for a tour. Obviously it is socially unacceptable to walk around with 4 or 5 different dresses on. But once again, these residents don't think there is anything wrong with what they are doing.

On our Blue Ridge Neighborhood we don't try to take off the layers of clothing that the residents insist on, we again, meet them where they are and allow them the right to look socially unacceptable. If it isn't a safety issue (they're overheated, are a trip hazard, etc) we simply allow them to wear the layers. Some could argue that it's a dignity issue, either way. We've just found that they are happier when they can do what they want, safely. And, it saves the argument, which no one wants! The bottom line? There is no right or wrong here.

I welcome your feedback and thoughts!

As always,
Sharon Britt, Mountainside Administrator