Insights into a Mind Damaged by Alzheimer's

Coffee stained section from Mom's journal.

Yesterday I was shocked when I read Mom's journal entries for the day. I felt appalled by the complete disconnect with reality; the brokenness of expression revealed the extent of the brain damage she's suffered. There was an almost frightening singsong, sometimes rhyming but nonsensical pattern to some of the words she'd written.  I suppose the brain shrinkage from Alzheimer's along with the plaques and tangles that destroy neural connections can cause symptoms similar to those suffered by the mentally ill. After several pages of disjointed, sometimes illegible entries, Mom ended with these heartrending words:

Where is she? Her ticket say MO
That is where her farm home is. (Mom grew up on a farm in Missouri)

I realized that I've underestimated the degree to which Mom's thinking processes have been compromised, and because of this I've been unkind when I have only intended to spur her to do for herself what I thought she was still able to do. 

Because my mother has a pre-Alzeheimer's established habit of recording her thoughts in spiral notebooks, her journaling has helped me make a list of reminders for myself that may help other caregivers as well: 

1) Don't assume that our patients understand more than they do. Pay close attention to their responses, even (especially) those that seem at first to make no sense.   

2) Do respond with love and acceptance to irregular behaviors.

3) Don't respond according to the past rules of our relationships with our patients.  In the past it might have been appropriate to respond to our loved ones' seemingly unjustified hostility with self defense or logical argument, but now such responses are ineffective and even cruel in light of the patients' compromised ability to think clearly. 

4) Be willing to try one strategy after another until we find ways to communicate effectively. 

5) Don't assume too much.  Arm ourselves with knowledge about the brain damage of dementia and how it impacts behavior. 

6) Remember that although the mind is damaged, the heart remains intact. Our loved ones still need  kindness, expressions of love, hugs, and approval.  Our disapproval still has the power to hurt.