The Busy Brain: Cognitive Activities With Dementia Patients
Every evening, Bangalore homemaker Mythili C and her mother-in-law Shantalakshmi have a small ritual. Mythili sometimes folds the clothes and asks Shantalakshmi to sort them out by colour. “I’ll say give me the red part or white hankerchief.” Sometimes they sit and sort through the kitchen utensils or even the kids’ toys. “There are times when she is irritable and unable to do anything beyond two minutes but I keep at it as I feel it keeps her involved and gets her to think, even if for a little bit,” says Mythili. Shantalakshmi has Alzheimer’s Disease and is one of the 4.1 million people living with dementia (Alzheimer’s is the most common form of Dementia) in India, according to the World Alzheimer’s Report 2015.
Dementia is an umbrella term that describes a wide range of symptoms associated with a decline in memory and thinking skills. A person with dementia needs mental stimulation and cognitive activities that could help stir memories, keep them engaged and sustain an emotional connect. The 2011 World Alzheimer’s Report says that routinely providing individualised cognitive stimulation to those with mild to moderate stages of dementia can produce short-term improvements and may reduce decline in cognitive function. It’s something that Mythili has been trying to do. While searching through the internet will throw up suggestions like solving puzzles, making a memory album, listening to familiar music among suggested cognitive activities, Dr Soumya Hegde, Associate Director and Consultant Geriatric Psychiatrist, Nightingales Centre for Ageing & Alzheimer’s, Bangalore says, caregivers need to keep in mind the person’s interest and familiarity with something before making a care plan including activities that can provide mental stimulation for a dementia patient.
“A cognitive activity is any activity that makes you think. It doesn’t necessarily have to be Sudoku or a puzzle just because that was suggested. The idea is to stimulate their mind and keep them engaged,” she adds. When Dr Hegde helps families of dementia patients make a care plan, she keeps it practical. “The primary caregiver and the family need to sit back and see what was the person doing before this. You need to understand what the person enjoys doing. Many times, a puzzle or Sudoku is an alien concept to the person with dementia. Do remember that when you are introducing them to a new activity as it is difficult for them to learn new skills.”
Pune based marketing consultant Gail Sinha’s mother has Vascular Dementia brought on by a stroke. She tried out textbook cognitive activities (puzzles, craft, etc) with her mother for few months before realising it was leading to more irritability and anxiety. Now Sinha lets her do things at her own pace, while trying to keep her engaged in various ways. Dr Hegde often faces families who tell her the patient (their mother, a housewife all her life for instance) never did anything. In such cases, she suggests they involve the person in household chores that may seem familiar. “Don’t make it sound to the patient like they have to do this. Make it sound as if you need the help and that the person can help you do this. The choice of words is important to get them to start.”
“E,g, if the person is someone who was extremely involved with housework, you can make her sit comfortably, put a pile of dishes next to her, give her a dishcloth and ask her to wipe one by one. The idea is to engage them in activities they find meaningful and are familiar with,” she reiterates. Another activity could be watering plants or asking the person to pick out or suggests ingredients for a sandwich; asking them to pick out an apple or orange from a basket of fruits, among others.
Follow The Patient’s Pace
It’s important to remember that a dementia patient’s attention span may be as little as one minute. Dr Hegde mentions an important point: The person who is doing cognitive activities with the dementia patient needs to have the time to spare and be around. “They need to understand that what was planned as a half hour activity, may last only for 5 minutes. The person who is doing the cognitive activities with the patient needs to understand that the patient may not be willing to do it beyond few seconds and that they need to have the patience to wait and try again.”
Dr. Hegde’s first communication to caregivers is to ask them to get help. “If they are the primary caregivers of the patient like the wife for instance, then taking care of a dementia patient and engaging them in stimulating activities is a full time job. You cannot do this in the middle of household chores and need to engage someone else for it.”
Sinha does not push her mother to do things beyond a point. In the three years that her mother has had dementia, Sinha has tried doing things that her mother, an ex-teacher, previously enjoyed, such as simple word games and math problems. As her mother’s cognitive abilities have declined further, Sinha has tried to keep her brain stimulated in the simplest of ways. “When she is sitting down, if the TV is on and ads are playing, we will ask her which ad it is and she will sometimes recognise the logo and tell us. There are times when we give her a bunch of forks and spoons and ask her to separate them. We also ask her to help us arrange the clothes she wears. The idea is to bring in aspects of attention, organisation and decision making,” Sinha adds. Over the years, her mother’s attention span has diminished to a few minutes. There are times when she is angry and wants Sinha or the other caregiver to stop. They follow her lead and restart after few minutes. “We don’t know why she is angry or irritable, perhaps because she is unable to do these things, perhaps she is tired but we do not want to agitate her further.” Patience, in big doses, is the key here.
Dr Hegde says anxiety, anger and signs of irritability is a dementia patient’s way of communicating when they can’t find the right words. It is important for the caregiver to try and understand the reason. “E.g., many do not want to take a bath. Perhaps they feel embarrassed that they need to take off their clothes in the presence of someone, perhaps they don’t like the feel of water.” Instead of pushing, Dr Hegde suggest a different approach. “Have very few people around for this activity to make it comfortable for the patient. Avoid a bath instead and sponge if possible.”
The caregiver also needs to look at altering few household habits to make it easier for a dementia patient instead of pushing them to do things. “Think what can I do to make it simpler and easier for the patient,” comes Dr Hegde’s suggestion.
Here are some simple activities suggested by Dr Hegde that you or a primary caregiver can do to keep a dementia patient stimulated, engaged and connected to whatever extent possible at home. While these are proven methods tried and tested to target specific cognitive areas to prevent deterioration, remember that it could be exhausting. Keeping a dementia patient stimulated throughout the day is a huge task and it is enough, even if a small part of it is achieved.
* Involve the person in a process like making an orange juice. Right from identifying the fruit to cutting an orange under supervision and squeezing it if they are able to would be an activity involving cognitive and motor skills. It doesn’t have to limited to orange juice, it can be making sambhar or rasam or any activity in the kitchen.
* If you have a garden, talk about the flowers in it when you take them out there or when you are plucking them.
* Try and engage them in conversation if activities are bogging them down. The key is to keep them engaged. Initiate a conversation and give them a chance to talk and connect.
* Try and do something different everyday.
* If they enjoy music, listen to what they have enjoyed in the past and talk to them about it.
* If you wish them to do a puzzle, one good way to make them involved is with a child. Suggest that grandpa might like to help the child to solve a puzzle and ask if they could do it together. Or ask them to pick a colour and give the child while he is drawing. It would make the person feel like he is helping the grandchild out.
* If you are playing games as a family, like Pictionary or cards, try to involve your loved one with dementia or at least make them a part of the conversation.
* Encourage people to visit and talk to the person. Remember while having a conversation, you don’t have to greet or talk in a different way. Information is seeping in, though it takes longer for the person’s brain to interpret the information and process what to say. A smile on your face registers faster than words in the mouth. Look them in the eye and talk as that makes a big difference; keep your hand on their hand, it conveys warmth and that you are trying to be with them.
*For their evening walk, take them for a visit to a children’s park. Make them sit where the children are playing. The noise and hustle bustle can be stimulating.