As I’ve observed my mother’s responses to the cognitive changes caused by her Alzheimer’s disease, I’ve become convinced that dementia patients are often treated unfairly for behaviors that are disease related; in other words, they are blamed for stuff they can’t help. I believe this is true.
A car ride with my mother is an exercise in patience for me. She thinks the tones that chime to tell us to fasten our seat belts sound like they are saying “dang me dang me dang me,” and when she hears these tones she sings the chorus to what is surely one of the most annoying songs ever written, Roger William's rendition of “Dang Me.” She does this every single time. And if I don’t laugh at her little song, she gets a long-suffering look on her face and feels as though she is not loved and appreciated as she ought to be.
After a few minutes she typically begins to sing snippets of hymns or 1940's popular songs to herself and if am distracted and miss an approximately five second window of opportunity to compliment her singing or sing along with her, she talks to herself, saying, “Just shut up Anna Ruth. No one wants to hear you sing.” She then stares out the window, offended and hurt. Soon she doesn't remember why she is angry but she does remember that she's mad.
Today when I took Mom to the beauty shop I weathered this pattern of behavior with an admirable lack of daughterly annoyance, and with caregiverly wisdom I drew Mom's attention away from singing by telling her a funny story about her great grandson, Daniel. "He has a box turtle, and it is the best fed turtle in town," I said. "Daniel feeds it strawberries, bananas, and crickets. The only thing it has ever refused to eat are grapes."
"Bring the grapes to me then," said Mom.
When we pulled into the beauty shop, Mom noticed the unmown yard next door. "Hmmm. I hope they don't think I'm going to go over there and mow that lawn for them," said Mom. "If they do they've got another think coming because I'm not doing it!"
These two comments triggered a memory for me from a long ago psychology course. "Egocentrism," I thought. "She's relating everything back to herself."
When we returned home I did some internet searches and though I didn't find much about egocentric behavior in Alzheimer's disease, I did find a relatively new study that said not to blame young children for egocentric behavior. It seems that an immature prefrontal cortex in the brain renders a child incapable of empathy and selfless behavior. Here's the summary of the study from sciencedaily.com: Self-Centered Kids? Blame Their Immature Brains.
Now. Isn't it reasonable to think that the plaques and tangles of Alzheimer's, which cause brain damage and shrinkage in the size of the brain, could have a similar effect? After all, many caregivers refer to Alzheimer's disease as "aging in reverse."
When children are selfish we discipline them and attempt to teach them differently. Disciplining a dementia patient would be a stunningly inappropriate response. Teaching something new is ineffective, because dementia patients are slow to learn new behaviors. Thus, the strategies we use to deal with egocentric behaviors in children certainly cannot and should not be utilized with our dementia patients.
Instead, we must adopt caregiving strategies that honor the dementia patient's integrity and yet keep the caregiver from going
Easier said than done.
Distraction is my number one caregiving strategy when my mother is engaged in a negative behavior. I bring her a snack, or tell her a funny story, or show her something beautiful. A new book to read is always a successful distraction strategy for Mom. Car rides are difficult because I'm unable to give Mom my full attention as I'm preoccupied with driving. Only as I write these words has it come to me to hand her a bag of crunchy snacks as soon as we are settled in the car. She can't sing "Dang Me" through a mouthful of Fritos!
I don't think.