Earlier this month, I had an opportunity to spend some time with Belva, a 90-year old elder who is living with dementia, and her family. Towards the end of the afternoon, her adult granddaughter stopped by to visit. The granddaughter made sure to spend some quiet, one-on-one time with her grandmother so they could have fun together. They sat down and looked at FIT’s “Wonders of Sports” book that is part of the SPORTS FIT KIT. As they were looking at the pictures and laughing, Belva read aloud the few words that accompanied the pictures. Afterwards, the granddaughter asked me why her grandmother could still read words yet not be able to do other things such as remember what day it is. Being able to do some things and not other things is a common dynamic for people who have dementia, but one that is not always understood.
Positron emission tomography (PET) scan imaging is a helpful way to explain why this dynamic exists for people who are living with dementia. Different parts of the brain control different functions. The PET scan images below show typical patterns of brain activity for four different cognitive functions:
- Reading words (top left image)
- Hearing words (top right image)
- Thinking about words (lower left image)
- Saying words (lower right image)
The red color indicates brain areas where activity is the highest. Yellow represents a decrease of brain activity, then green, and then to blue-violet that indicates the lowest level of activity. As you can see, reading words uses a different part of the brain than thinking about words such as what day it is. With Alzheimer’s disease, the most common form of dementia, parts of the brain experience death of clusters of brain cells which translates to a loss of ability to do some of the things controlled by that part of the brain. The part of the brain used for reading words may not be affected as the part that controls thinking about words which explains why someone who has dementia can do some things but not others.
The ability for the brain to ‘read’ and ‘hear’ words continues to function much longer in Alzheimer’s than does the ability to ‘say’ or ‘think about’ words. Knowing that the person who has dementia will have difficulty finding words to express what they are thinking helps care partners realize what they need to adjust in their communication skills.
Using questions that offer only two options, known as closed ended questions, is helpful and can reduce frustrations. An example of a closed ended question is “would you like a sandwich for lunch or soup?” You are providing the words for the two options. This type of question is more manageable for someone who has dementia to answer instead of “what do you want for lunch?” As you communicate, thinking about the PET scan images can help you be more successful as you navigate life with someone you care about who has dementia.
As I reflected on the afternoon with Belva and her loving family, I was struck by how wonderful and skilled they were in supporting Belva’s abilities and strengths. Rather than assume that because Belva has fairly advanced dementia she would not be able to do or enjoy much, they engaged Belva gently in all kinds of activities such as cutting flowers for a table arrangement, throwing a squeaky ball to the puppy, going for a walk around the backyard to see how it looked in the fall, and some one-on-one quiet time with family members. It was obvious by the laughter and joy on Belva’s face that she was having a good time. As she said goodbye to everyone to return to her assisted living home nearby, Belva put her hand on each family’s members’ cheek and said “I love you.” The joy on everyone’s faces was precious. While Belva couldn’t return to her assisted living and describe what a wonderful afternoon she had and what she did, that she had fun would be evident from the happiness radiating from her.
Belva’s family was not left thinking, “How sad she has dementia,” but rather were left with warm memories of her enjoyment at squeaking the puppy’s ball, pride at cutting the flower stems just so, laughing at the pictures in the sports book, and being told she loved them. Positive and happy engagement is good medicine for all!
Karen Love is a former speech therapist and long-term care administrator with more than 30 years of experience advancing person-centered practices in long-term service and support settings. She has been a co-investigator of numerous research projects funded by the National Institute on Aging and the U.S. Administration on Aging. She is the Co-Founder of FIT Interactive, which researched and developed FIT Kits. FIT Kits are engagement kits that help family and care partners improve the quality of life of people living with dementia. For more information please go to their website www.fitkits.org
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