7 A’s of Dementia: What They Are and How You Can Help

Typically defined as the “5 As of Alzheimer’s Disease,” there are 7 common conditions that come along with dementia. While not all people have these things, and just because someone has a few does not mean they have dementia, it can be incredibly helpful to know how to help before the issue arises.

Agnosia

What is it?

Agnosia is trouble identifying objects and/ or faces, loss of depth perception. Eyes see, ears hear, all senses physically working properly, but the brain misinterprets the information it’s getting- objects and people can “look” different, sounds can sound like something else, even sensations like hunger or a full bladder can be misinterpreted

What can you do to help?

Cue- remind the person what objects are or who people are. Avoid mix-ups by clearly labeling things or removing look-alikes from the same environment. NEVER ask a person if they know who you are or if they remember you. This can cause anxiety and shame if they don’t.

Amnesia

What is it?

Memory loss, the newest memories are forgotten first; amnesia can also affect ability to learn new information- but it is not the same as normal age-related forgetfulness (misplacing car keys or paying a bill a few days late are different than placing keys in fridge or cupboard or repeated late charges and NSF fees). Amnesia causes confusion and anxiety.

What can you do to help?

In the early stages, leave notes, label items, set alarms for bills or medication, help them track the day with a calendar. In the later stages, repetitive questioning becomes common: “when are we going home?”, “what are we doing here?”, “what are we doing next?” They are often trying to find comfort and control. Reassure them and provide tangible reminders (photos, lists or written reminders). Ask them to reminisce about the situation they are wanting. Procedural memories (things a person did over and over), and emotional memories (sights and smells from childhood, events from younger life) last longer than other memories. Songs, chores, and old photos can help a person remember these positive memories

Anomia

What is it?

Anomia is that “tip-of-the-tongue” feeling; people have trouble naming objects and finding the right word.

What can you do to help?

Give the person time; sometimes the right word will come if they aren’t feeling pressure. Give them the right word if it’s obviously not coming or if the person becomes frustrated. Give visual or verbal choices instead of open ended questions.

Anosognosia

What is it?

A form of agnosia, anosognosia is when a person does not recognize their own problems with cognitive function, and therefore they don’t know they have the problems: they don’t know they are sick. This can cause people to hide/ not mention the problems they’re having or not ask for help when they need it. Keep an eye out for missed appointments, not taking medication as needed, burnt or spoiled food, clutter (if the person was previously organized), dents in a vehicle, missed payments, etc.- anything out of the ordinary can be a red flag that the person needs more help than they’re letting on.

What can you do to help?

While blatantly asking a person about a problem you’re seeing can cause someone to become defensive and angry, remaining encouraging and supportive as issues arise can help them trust you when they do need help. Offer help often, and remind them that you are just looking out for their well being.

Aphasia

What is it?

Aphasia presents problems with communication and expression of thoughts/ ideas, or misunderstanding information taken in. Expressive aphasia can have symptoms like hesitation as they search for the right words, word substitution (calling coffee pot and drink machine), using general instead of specific vocabulary (“thing”), swapping word sounds (wish dasher instead of dish washer), and repeating sounds over and over. Receptive aphasia can be seen in misunderstanding or only hearing part of the message, answering incorrectly or responding with an unrelated message, increases anxiety in social situations.

What can you do to help?

With expressive aphasia, pay attention to the person’s expressions and bod language as they are trying to communicate, and give them plenty of time to think. With receptive aphasia, talking louder WILL NOT HELP. This is not caused by them misunderstanding or not hearing you, it is caused by inadequate signals in the brain.

Apraxia

What is it?

Apraxia is a disconnect between brain and body: willingness, strength and sensation are all there, but the signal from the brain on HOW to do the action isn’t received correctly by the body DOING the action. Some common examples of apraxia include using the right motion but not the right object (brushing hair with toothbrush), using the right object but not the right motion (patting head with hairbrush instead of using a combing motion), using the right objects in the wrong order (putting underwear on after pants, attempting to put legs in shirt sleeves), body alignment (can’t turn to sit in a chair properly), and lack of ability to do the action altogether (feels the buttons and knows how to button a shirt, but can’t make fingers move correctly to do the buttoning).

What can you do to help?

Use modeling: show the person how to do it. Use “hand-over-hand”: guide the person’s hands to do the action, allowing them to do most of the work. Set out only what is needed- set out only the toothbrush and toothpaste in the bathroom, only hairbrush on the vanity, place clothing in the order in which it is to be put on, etc.

Anxiety, Agitation, and Aggression

What is it?

Anxiety, agitation, and aggression are all caused by a loss of control, which then causes fear and feeling of helplessness. Always triggered by something: physical discomfort (hunger, need to use bathroom, cold), environmental factors (unfamiliar situation, too noisy, unfamiliar people), or even a simple misunderstanding.

What can you do to help?

Identify cause/ trigger first, and do what you can to fix it. Distract/ divert their attention to something else. Do not argue or force them into anything.

Some important things to remember

Redirect/ Divert/ Distract

Ask them for help with something, ask them to tell you a story, go for a walk or drive. This is where knowing your loved one well comes in handy. Give them something to do that they enjoy doing. If they like to be needed, make them feel that you need them.

Don’t argue

They can’t meet you in your reality; you have to meet them in theirs. Whatever they say is truth, just go with it. Be empathetic about things you know didn’t happen. Imagine someone telling you that what you thought was true suddenly wasn’t true at all. You’d feel crazy or call them a liar! Don’t make your loved one feel that way.

Therapeutic Lying

When someone is insistent on going “home,” even though they are home, there is no harm in saying, “We can’t leave until later because traffic is awful at this time of day.” When someone is asking for their deceased spouse, there is no harm in saying, “They went to the store, they’ll be back soon.” When someone tells you that the housekeeping staff stole their gold watch, and you know that you have it in the safe at your house, there’s no harm in saying, “I’ll have to ask them about it,” or “I’ll talk to security.” Arguing does no good, and chances are, they’ll forget with time anyhow. Do not feel guilty about saying something that makes them feel better and helps the situation.

BE PATIENT

This is the most important tip. Getting frustrated will only escalate the behavior, and will only cause you pain. Remember that you love them and they love you. Remember that they can’t control this and they aren’t who they used to be. Remember that things can be really bad, but other times can be wonderful. And remember that time spent angry is time wasted that you could have spent loving them.

For more information and caregiving tips:

Caregiving Tips

Dementia Dos and Dont’s

The 5 As of Alzheimer’s

Don’t Correct! Redirect!

The Art of Redirection

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