Related topics: •  Caring for Someone With Alzheimer's •  Dealing Positively With Alzheimer's Behaviors: Part I

Before your loved one developed Alzheimer's disease, the two of you used to talk about anything and everything. But what do you say now that he can't remember your name?

The right words can be hard to find, but they're more important than ever. Simple, reassuring messages can give your loved one comfort and guidance -- the two things Alzheimer's patients most desperately need.

In Carol Simpson's excellent book At the Heart of Alzheimer's, she discusses the steps caregivers can take to improve communication with their loved one. Among her suggestions:

•Stay positive. Because of the damage the disease does to the brain, you can bombard an Alzheimer's sufferer with "no" and "don't" all day without changing his behavior. Positive suggestions and simple redirection, however, can work wonders. Instead of chastising him for wandering in the middle of the night, ask, "Wouldn't some rest feel good?" And if he's making a mess in his bedroom, try to divert him by showing him some photo albums in the living room.

•Offer praise and encouragement whenever you can. Alzheimer's patients are hurt by or tune out negative words, but thank-you's and compliments go surprisingly far. If you praise a patient for dressing himself, he's much more likely to do it again tomorrow -- especially if he knows how handsome he looks.

•Make directions short, simple, and specific. Again, the brain damage wrought by Alzheimer's makes it hard for a person to process ideas he would normally understand right away. Rather than asking him to help clean up his room, ask him to pick up his socks and put them in the hamper. Instead of telling him to get ready for bed, tell him it's time to brush his teeth. If the simplest directions don't make sense, you may need to make hand gestures or lead by example. For instance, he may need to see you brush your teeth first.

•Keep questions simple. Ask if he would like hamburger or chicken, not if he has any ideas for dinner.

•Once is not always enough. You will have to repeat some instructions and questions over and over again. You're not being ignored. Some things just need to be heard several times before they can sink in. In the early stages of Alzheimer's, you may be able to write instructions down and post them.

•Keep your voice warm and friendly. A harsh, scolding tone will just make your loved one agitated, confused, or distraught. Stay upbeat with him and find another way to vent your frustrations.

•Get his attention. If he isn't ready to listen, your words will be wasted. Give him a gentle touch and don't speak until you have eye contact.

•Speak to him like an adult. A person who's been around for many decades can be deeply embarrassed and offended by baby talk.

•If he yells at you, calls you names, or makes up outlandish stories (such as "you kidnapped me!"), don't take it personally. He's just trying to express anxieties and make sense out of chaos. Look for changes in his environment or daily routine that could be bothering him, gently correct his fanciful ideas, and use soothing words to calm him down.

•Listen carefully. An Alzheimer's patient may not be able to explain his deepest feelings and concerns, but he will give you clues. If he asks about doctor's appointments every day, he may be afraid of exams. Constant references to a lost friend or spouse may be a sign that he's feeling especially lonely. A hug and some quiet talk may help.

A woman whose father died of early onset Alzheimer's recalls that even after her father no longer knew her name, he always responded when she told him she loved him. He would beam and say, as he had before he got the disease, "I love you, too, honey." Sometimes he'd just smile and say, "That's right."

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

Last updated March 6, 2008
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