1.  Memory Loss That Disrupts Life- One of the most common signs of Alzheimer’s is memory loss.  Asking for the same information over and over and relying on memory aids like keeping constant notes are a common signs of Alzheimer’s.

2.  Challenges in Planning or Solving Problems- They often have trouble following a familiar recipe or keeping track of monthly bills.

3.  Difficulty Completing Familiar Tasks at Home at Work or at Leisure- They will have trouble driving to a familiar location or remembering the rules to a familiar game.

4.  Confusion with Time or Place- They may forget where they are or how they got there.

5.  Trouble Understanding Visual Images- They may pass a mirror and think someone else is in the room or they may not realize that it’s them in the mirror. 

6.  Problems with Words in Speaking or Writing- They may have trouble following a conversation as well as finding the right word.

7.  Misplacing Things- They may put things in unusual places and they may accuse others of stealing.

8.  Decreased or Poor Judgment- May use bad judgment when dealing with money and they may pay less attention to grooming.

9.  Withdrawal from Work or Social Activities- They may remove themselves from social activities or projects.

10.  Changes in Mood and Personality- They may become fearful, suspicious, depressed or confused.  They may become easily upset in places where they are out of their comfort zone.

1. Being Reasonable, Rational and Logical will Just Get You in Trouble. When someone is acting in ways that don’t make sense, we tend to carefully explain the situation, calling on their sense of appropriateness to get compliance. However the person with dementia doesn’t have a “Boss” in his brain any more, so they don’t respond to our arguments, no matter how logical. Straightforward, simple sentences about what is going to happen are usually the best.

2. People with Dementia Do Not Need To Be Grounded in Reality. When someone has memory loss they sometimes forget important things e.g. that their mother is deceased. When we remind them of this loss, we remind them of the pain of that loss. If someone wants to “go home” reminding them that they are home is only going to lead to an argument. Redirecting them by asking them to tell you about their home and talking about your home is a better way to keep things calm.

3. You Cannot Be a Perfect Care Giver. Just as there is no such thing as a perfect parent, there is no such thing as a perfect caregiver. You have a right to your emotions and you are going to have days when you are impatient or frustrated. Learn to forgive yourself and your loved one.

4. Therapeutic Fibbing Reduces Stress. We tend to be meticulously honest with people. However when someone has dementia, honesty can lead to distress for you and your loved one. Does it really matter if your loved one thinks she a young mother of an infant? It’s OK to tell your loved one that you’re going out to lunch and coincidentally stop off at the Doctors office while you’re out.

5. Making Agreements Doesn’t Work. If you ask your loved one never to do something again or to remember to do something, it will soon be forgotten.  In early stages of dementia leaving notes may help but as the disease progresses this will become ineffective.  Change the environment if necessary to keep them safe. For example, shut the power to the stove off at the master breaker to keep them from playing with the stove.

6. Doctors Often Need to Be Educated By You. Telling the Doctor what you see at home is important. The Doctor can’t tell from an exam if they have been up all night pacing. Doctors can also benefit from therapeutic fibbing by telling your loved one that an anti-depressant is a vitamin to keep them feeling well. 

7. You Can’t Do It All. It’s OK To Accept Help. When people ask if they can help, the answer should always be yes! Put together a list of things people can do to help. Maybe it’s picking up a prescription or staying with your loved one while you run an errand. Doing this will reinforce others to help and besides, it’s always harder to ask for help than it is to accept it.

8. Don’t Overestimate or Underestimate What Your Loved One Can Do. Sometimes it’s easier if “we just do it.” Just make sure that you are not taking away their ability to be independent in that skill. On the other hand make sure that your not asking too much of them which can lead to frustration and agitation. It can be hard to find the balance and remember that it can change from day to day.

9. Tell, Don’t Ask. Rather than ask the sometimes-challenging question of what do you want for dinner; simply remind them it’s time for dinner. This will encourage them to eat and avoids the burdensome chore of trying to process in their minds what they would like to eat.

10.  It’s Normal to Question the Diagnosis When Your Loved One Has Moments of Lucidity. Remember that you are responding to a disease and not the person. Everyone with dementia has those moments when they make perfect sense and can respond appropriately. You’re not imaging things but rather than second-guess the diagnosis, enjoy those moments when they occur.

Caring for people with dementia can bring out the best and the worst in the human personality. Compassion, concern and loyalty are just a few of the characteristics of those who are caregivers. At the same time, caregivers often experience great frustration, anger, depression and guilt in response to the stress of caring for those with this chronic illness. Guilt or self-reproach seems to stand out as the feeling experienced most frequently.

Although countless situations can induce guilt, a few examples show common dilemmas:

• A daughter of someone with Alzheimer’s disease works a full time job in addition to caring for her spouse and three children. She spends Saturdays helping her parents. When leaving she is distraught as her parents want her to spend even more time with them.
• The husband of a woman with Alzheimer’s disease arranges for her to attend adult day care a few times a week. In her absence he is unable to relax or enjoy himself.
• The wife of a man with dementia had promised her husband and herself that she would never place him in a nursing home. After several exhausting years of home care, she places him in a long-term care facility.

Persistent guilt can become a crippling problem for caregivers. It usually stems from unrealistic expectations of oneself. Despite unbearable conditions, some caregivers expect that they can handle any problem that comes their way. Instead of freely choosing such challenges, they become caught in a trap of thinking they should be able to meet all of the needs all of the time.

When guilt becomes a dominant motive in care giving, help is clearly indicated.

It is possible to move beyond feeling guilty. Here are some recommended Guilt Busters.

1. Acknowledge that you are in a no win situation; the disease will worsen despite your best efforts.
2. Set realistic goals; take pride in offering care and comfort when you cannot offer a cure.
3. Accept your shortcomings; perfectionists are bound to be disappointed.
4. Find your sense of humor and hang on to it; laughter is good medicine.
5. Get some physical exercise; it’s proven to reduce stress.
6. Share your thoughts and feelings with a friend; don’t go it alone.
7. Take a break and enlist someone to assist you on a routine basis.
8. Remember that persons with dementia need an emotionally healthy caregiver so take care of yourself as well as you can.

Adapted from an Article by Dan Kuhn, ACSW