In part one of this weekly series, I discussed some myths and facts about Alzheimer’s and other forms of dementia. I stressed the most alarming memory problems have less to do with names and events, and more with the inability to access simple rules of living (e.g., how to cook eggs).  

If a person no longer realizes what she was able to do in the past can’t be done now, there may be little confusion. It’s something new never done before. Since there is no experience of loss, there’s no reason to be anxious. But this somewhat blissful state doesn’t occur until well past the onset of dementia. 

The path to the end point is layered with anxiety-producing events. For example, the accounting executive for a Fortune 500 company who no longer can make change for a dollar but remembers completing complex financial transactions. For her, it’s frightening realizing she can no longer access the rules for addition and subtraction.

Five Strategies to Make Internal Rules Concrete for Loved Ones With Dementia

1. Keep the House Organized

The need for structure increases as elements enabling your loved one to make sense of life disappear. Keep everything in the house organized, especially in the rooms your loved one frequents. Also, don’t rearrange the furniture.

2. Stay on Schedule

Knowing something will happen at a specific time can reduce anxiety in a world changing without reason. Having dinner at the same time every day can be calming. 

3. Understand Why the Same Question is Repeatedly Asked

Caregivers often misinterpret the intent of repeated questions. If may not be as simple as not remembering you provided the answer ten minutes ago. The greater the loss of internal rules, the more frightening the world becomes and the more repetitive questions become. 

Devise a strategy to provide connections. For example, not remembering the members of her family and how all are related can be helped by constructing board with pictures of family members with lines or a strand of yarn showing how everyone is connected.

4. Structure the Environment to Make Rules Concrete

There are few things more frightening than facing a simple problem you solved thousands of times in the past and now you don’t have the slightest idea how to begin. I had a patient who lived alone. When I visited, I found her bundled up in multiple layers of clothes. When I asked why, she said she couldn’t remember how to turn on the heat. I placed cards with numbers on them on the wall by the thermostat. Each card instructed her to do one thing. By following the numbers, she could change the temperature whenever she wished. Of course as her dementia progressed, this strategy no longer worked. But for three months it was effective. 

5. Anchor Memory

As your loved one’s ability to remember fades, provide strategies for enhancing the possibility a current event will be remembered. For example, when I visited one of my hospice patients with dementia, she was annoyed with me, saying, “You didn’t come last week like you promised.” I never missed a session with her. The solution was for her to circle the day of my next visit and have her caregiver cross off days as my visit approached.  


In the final article of this series, I discuss a larger, more global attitudinal change presented on a recent NPR show by an improvisational comic whose mother-in-law has Alzheimer’s.