Sometimes stepping back, stripping away the labels, and reassessing our thinking can dramatically change our outlook from dreary to hopeful, from hopeless to grateful, from angry to accepting.

This is a very simple lesson indeed, but a powerful one. What wisdom of children!

In a previous post, I wrote about the symptoms of dementia, and the levels of care available to aging family members. In this post, I’ll provide more information about other types of dementia besides Alzheimer’s, and provide tips for interacting with family members who are disoriented.

Alzheimer’s disease is the most common, but not the only kind of dementia that can occur later in life. Dementia is not a distinct disease on its own, but rather a cluster of symptoms that can accompany other illnesses. Dementia usually includes memory loss (especially short-term), disorientation, and diminished ability to complete independent living tasks. Dementia often starts mild and progresses to be more severe over time, and not everyone experiencing memory loss will develop dementia.

Here’s a quick overview of other dementia types most commonly seen in hospice.

Vascular dementia occurs as a result of stroke or other injury to blood vessels in the brain. The first symptom if often diminished ability to organize or plan, rather than the memory loss seen first in Alzheimer’s.

Dementia with lewy bodies will show the same characteristics of memory and cognitive problems of Alzheimer’s but also be accompanied by hallucinations and rigid movement of the body.

Mixed dementia can occur when two or more of these types occur together.

More types of dementia are described at this page of the Alzheimer’s Association, http://www.alz.org/dementia/types-of-dementia.asp.

If you or a loved one is experiencing memory loss, see your physician to determine what treatment can help. Dementia is not curable, but medications can lessen symptoms. Often, managing difficult behavior or symptoms is done without medication, through caregivers’ acknowledgment of the illness, arranging items in the environment to be the least problematic, and meeting basic daily needs.

Some families experience their loved ones with dementia as becoming child-like. Others become uncooperative or aggressive. It is alarming when a family member becomes confused, disoriented, or unable to speak. Some patients lose the ability to articulate clear words, though they continue to try. Others may string words together that don’t make sense, or respond with one word answers. Here are some tips that may help if you interact with a loved one with dementia:

1. Return eye contact. If they make eye contact with you, let them know you are present and attending to them by returning it.

2. Respond to the needs you can fulfill, like providing food, drink, changing clothes, and keeping them physically comfortable.

3. Don’t argue about reality. If they are disoriented or are fixated on something that isn’t real, gently acknowledge any feelings they are having and move on. For instance, your loved one says, “I have to go now to pick up our granddaughter, she is waiting for me”, you could respond with, “You are thinking alot about your granddaughter right now.”  

4. Keep the focus on the present. Because memory is impaired, those with dementia are not experiencing the world in the context of past and future. They are experiencing the world moment by moment.

Often this present-mindedness is difficult for family members because so much of our relationships with loved ones is based on our shared past and future. Caregivers of dementia patients have to make a fundamental shift in thinking about their loved ones as plans for the future change as a result of the illness. They often put aside their expectations to meaningfully share about memories, in an effort to meet the day to day demands of caregiving. Most caregivers do find patients have occasional “flashes” of awareness. These glimpses of the patient’s former self can be both joyous and painful for caregivers, as they appreciate the moments but also realize that they are fleeting.

Click here for a great resource with more coping strategies for behavioral problems. http://www.alz.org/alzheimers_disease_treatments_for_behavior.asp#non-drug

In Part 3 of this series on Dementia and Caregiver Grief, we will explore more about how grieving is different in these circumstances than with other types of loss.

This very catchy slogan is everywhere now. T-shirts, mugs, posters, internet memes...

1. First, recognize what you can and cannot control. There are some things simply out of your reach, and beyond what our actions, thoughts, or feelings will influence. Probably the most common example is mistakenly trying to change other people's behavior, decisions, attitudes, or beliefs when they aren't aligned with your own. Recognize that no matter how much you may want others to change, you simply do not have the power on your own to make that happen. You can be honest about your concerns or express your worries, but that's no guarantee that change in another person will occur. Other examples of things that are out of you control could be work circumstances or immediate financial situations, political dynamics in your community, and historical events. Letting go of worry about things that are out of your control can help loosen the grip of anxiety.

2. Second, learn where stress lodges in your body. Many times it's the neck and shoulders where tension builds up. Sometimes it's in the forehead, abdomen, or hips. It can be anywhere, but be aware that chronic stress and tension does manifest physically. This happens because stress triggers the sympathetic nervous system which kicks in the fight or flight response. This level of hyper-arousal gets stuck in the "ON" position when we don't allow ourselves to learn relaxation techniques and the time to practice them on a regular basis. Scan the body and take note of where you feel constantly tense. 

3. Third, re-learn how to breathe. Yes, breathe. You do it automatically, but try it intentionally. Slowing down and deepening your breathing into the belly area will increase relaxation and a sense of calm. Often as schedules become busier and circumstances more distressing, you may start breathing shallow and high in your chest. You may not even know you're doing this, but your body is stressing and tightening in a natural reaction to what your brain perceives as intense outer demands. The good news is that your circumstances most likely don't require fight or flight mode, and as you change your thinking about your situation, you can adjust your breathing.When you're feeling overwhelmed, find a quiet(er) place to go if you can, close your eyes, and breathe 5 intentional breaths. 

4. Fourth, take inventory. If you have 10 hours worth of things to fit into 8, then something may need to get nixed off the to-do list. If you have more projects than you can juggle at the same time, then you may need to call someone for help share the work. If you have relationships in your life that create more stress than joy, it may be time to think critically about whether they can improve. If you like things in order, or spend inordinate amounts of time cleaning or organizing, you can consider where other aspects of your life may feel out of control. Taking inventory is like holding up a mirror in front of yourself and your daily routine. When you see the big picture, you can tell what's most important and what you can live without.

5. And fifth, accentuate the positive. Find gratitude for all that is good and right in your life. You can find gratitude for daily events like getting a good night's sleep or enjoying a meal, or when you consider your bigger picture, you may find appreciation for aspects of your family, work, or home that might have gone unnoticed. New advances in brain science have discovered a feature called "neuroplasticity", or flexibility in the brain to absorb and assimilate new ways of thinking throughout the lifespan. So in adulthood, we aren't hard-wired to be a certain way. Positive thinking can actually change your brain and reroute old patterns of personality and behavior that you may have felt stuck with. Challenge yourself to make a small list of 3 or 4 things that are positive in your life every week and keep doing it regularly. 

So is there hope to keep calm after all? Yes! It's about managing the chaos, not avoiding it. Managing stress can be hard, and if you need help, support is available. Ask a loved one or professional to help you work through things.