In Alzheimer’s disease, which I know very well at every stage, I have experienced not only being a physician but also being a relative of a patient. Despite my nearly 25 years of neurology expertise, there were times when I struggled a lot as a caregiver. No matter the type of dementia, taking care of a patient who gradually ceases to be the person you once knew is difficult. Some of these difficulties stem from the disease and the dementia patient, while others are emotional and physical challenges for the caregiver.
Photo: Dilek Necioğlu Örken
In this article, you will find some principles on non-medicated treatments for memory loss and psychological symptoms that I believe will be useful for relatives of dementia patients.
Our first principle is to provide a sense of security. Ensure that the patient feels confident they will be well cared for and that their needs will be met.
Our second principle is to reassess. Try to think about and imagine how everything looks from the patient’s perspective.
Our third principle is to redirect. When the patient makes a mistake, behaves frustratingly, or experiences hallucinations, do not confront them harshly. Instead, distract them by directing their attention to another activity or topic.
General Behavioral Strategies for Managing Memory Loss and Psychological Symptoms
Managing the Environment:
As forgetfulness progresses, dementia patients become more confused and disoriented. A well-structured and stable environment can help in many ways.
- Keep daily routines as consistent as possible.
- Place a whiteboard and a calendar in a location where the patient can frequently check daily events.
- Avoid changing the locations of items inside cabinets and drawers, or even the furniture.
- Use signs and pictures to direct and identify rooms. For example, place a picture indicating the bathroom on the bathroom door.
- Prefer pictures over words in written communication and signage.
- Use nightlights and additional lighting at night.
Ensuring the Patient’s Safety:
- If the patient goes outside alone, consider using a GPS tracking system, which can be attached to a watch or a car.
- Lock doors and garden gates if the patient is prone to wandering.
- Cut off gas and electricity connections to the stove.
- Use child locks on cabinets containing knives and toxic chemicals.
- Remove or securely store firearms and potentially dangerous household tools.
Redirecting the Patient:
- Change the topic of conversation.
- Listen to old music.
- Watch familiar and classic movies.
- Look through family photo albums and talk about past events.
- Take a walk or go for a drive with the patient.
- Engage in safe and routine activities such as folding laundry.
Caregiver’s Self-Care:
- Seek therapy.
- Participate in educational activities.
Coping with Specific Behavioral and Psychological Symptoms of Memory Loss
Apathy:
- Involve the patient in preferred activities.
- Simplify activities if necessary.
- Do not confuse apathy with agitation.
Depression:
- Avoid telling the patient to "snap out of it" or to stop acting that way.
- Encourage socialization.
- Seek therapy or counseling.
Psychiatric Disorders in Dementia Patients:
Delusions and Hallucinations
Delusions are common. The most frequently seen ones include accusations of theft, suspicion of infidelity, refusal to accept their home as their own, asking to be taken home, and denial that their spouse is actually their spouse.
Hallucinations emerge in the middle and late stages of dementia. Some hallucinations may require medical evaluation, so be sure to consult a doctor.
What should behavioral interventions be? Respond calmly. Help the caregiver understand the patient's condition. Explain that the patient is not doing these things intentionally or to be difficult—it is part of the disease. Avoid denying the patient's experience or confronting them harshly.
Non-Medicated Treatments for Memory Loss in Dementia Patients
- Non-medicated treatments can help improve memory.
- Memory aids such as calendars, lists, and whiteboards help dementia patients maintain functionality. A calendar can be placed on a large table or hung on a wall. Marking off the previous day can help the patient understand what day it is today. A whiteboard or bulletin board can inform the patient about daily activities. Visual aids, such as pictures of places to go and people to meet, can be added. This way, instead of constantly asking, the patient can check the board whenever they forget.
- Keeping memory aids in the same place is essential. Just as having a fixed calendar location makes things easier, placing daily clothing in a specific order the night before can also help (e.g., underwear on top, followed by pants, etc.). Also, avoid rearranging cabinets, drawers, or furniture unless absolutely necessary.
- Learning habits can influence the course of the disease.
- Alzheimer’s patients remember pictures more easily. For example, you can label kitchen cabinets with pictures of their contents.
- Although its effects are uncertain, a Mediterranean diet is thought to reduce memory loss.
- Socialization activities have been observed to influence the course of the disease. Do not hide your loved one's dementia from friends and neighbors. Instead, explain that despite their unusual conversations or behaviors, spending time with others benefits them.
- Aerobic exercises stimulate the development of new neurons and positively affect cardiovascular health and mood. Ensure daily walks and, if possible, visit a park. Parks provide an opportunity for socialization and activities like feeding birds.
