Presented by: Judith L. London, PhD
Licensed Clinical Psychologist
Author, Connecting the Dots
February 24, 2010
More than 5 million Americans are living with Alzheimer’s disease (AD), a long-term progressive disease that affects memory, intellectual ability, judgment, and behavior, depriving people of their independence and ability to communicate. Alzheimer’s accounts for 70 percent of all types of dementia, and more than half of these cases are in the middle to late stages, when individuals require extensive help with daily activities and lose the ability to respond to their environment.
There’s no known cause of AD, a slow but irreversible mental decline that lasts an average of seven years but that can linger for as long as 20. People in mid- to late-stage Alzheimer’s can no longer survive in society without an extensive support system.
“So many people mistakenly assume that there’s nothing left as the disease advances, and don’t bother trying to connect and communicate on a meaningful level,” said Judith London, PhD, a clinical psychologist specializing in dementia, who spoke at a presentation sponsored by the Stanford Health Library. “But when you focus on what’s still there rather than what’s gone and reach out, you discover the part that’s still there and very much alive.”
London, who worked extensively in public long-term health facilities, described how Alzheimer’s precipitates damage to the neurons in the brain, preventing cells from communicating with each other.
“You can help ‘connect the dots’ of scattered information and memories in a meaningful way. You become the connector, and help the person express him or herself,” she said.
Because Alzheimer’s patients often feel isolated, it’s up to the visitor or caregiver to initiate interactions. The easiest first step, London advised, is to make eye contact: Get into their field of vision and say who you are. “Start with a smile,” London advised, “and approach the person as you would want to be treated-with respect, kindness, and dignity.”
Make sure you can be seen and heard: Speak slowly and clearly, and use gestures, she said, and use anything you know about the person’s interest or background as a basis to communicate. Use the person’s name, not a nickname or term of endearment, to help validate their identity.
“They also often have poor vision and hearing, which adds to their sense of isolation,” said London. “Don’t assume they are no longer interested in engaging.”
She also suggested that instead of using distraction when people are repeating themselves to try to help them express what’s on their mind. “They are reacting to something that is emotionally important to them,” she said. “Be positive about their efforts to make a connection and communicate.”
London suggested that visitors carefully observe the immediate circumstances to find possible triggers for episodes of depression, paranoia, or anger. If you can identify a pattern by examining what happened right before, during, and after an incident, the time it occurred, and who else was involved, you may be able to alter the circumstances to head off an outburst. She advised caregivers to not take accusations personally.
In group therapy with dementia patients, London found that that people responded to personal questions and empathy even when they seldom initiated a dialog.
“Unconscious memory is still present in those with Alzheimer’s and is the last part of memory to go. People with late-stage Alzheimer’s can understand even when they cannot let you know in a direct way,” London said. “When you reach out to connect and communicate, the person will connect back with you.”
About the Speaker
Judith London, PhD, is a clinical psychologist licensed in New York and California who has worked with patients with Alzheimer’s and other forms of dementia for more than 20 years. A former adjunct professor at New York University, she now conducts seminars on Alzheimer’s, dementia, and maintaining brain health. She is the author of Connecting the Dots: Breakthroughs in Communication as Alzheimer’s Advances.
For More Information:
Stanford Aging Adult Services
National Institutes of Health