Alzheimer’s/Dementia Part III: How to Speak Dementia-Thought of the Day

Stan Goldberg, PhD

Who would think there is anything humorous about Dementia? Most people who experience it or their caregivers wouldn’t. But humor and improvisation may be a key element to reducing anxiety and creating joy for both you and your loved one.

In Part I of this series I discussed some of the facts and myths about Alzheimer’s and dementia. In Part II I presented five simple strategies for making concrete the internal rules dementia patients may have problems accessing. In this final part, I’ll present an alternative way of interacting based on the principles of improvisational comedy.

Stop Correcting

My third-grade teacher’s main goal in life was to correct every mistake I made–from how I wrote my name to how I drank my milk. It wasn’t a joyful year for me. Before I said anything, I wondered how she would respond.

I saw the same type of interactions as a hospice volunteer watching paid and family caregivers of dementia patients. “No, Laura, today is not Tuesday. Don’t you remember you have your bath on Tuesdays? You had a bath yesterday, right? So yesterday was Tuesday. Isn’t that true?” Laura shook her head, and I’m sure she didn’t know what she agreed to. And if she did, the correction did little than make her realize how joyless life became.

Truth is Overrated

There is a belief it’s important for people with dementia to distinguish between what’s real and what isn’t. Caregivers assume correcting a person’s misperceptions reduces confusion. I believe the importance of honesty with dementia patients is over-rated, and the need to bring them “back to reality” may be detrimental to their happiness.

Truth is valuable when there is symmetry between the worlds in which people live. For example, it would be important my wife and I have a similar understanding of what happened at a family gathering. But what if our worlds are different? If my mind was intact and she suffered from memory deficits and a deteriorating executive functioning? Why is it important to correct her account of whether it was Uncle George rather than Aunt Audrey who made the insulting comment?

These are the types of inaccuracies corrected hundred’s of times a day with dementia patients. What is the purpose of becoming my third-grade teacher if the errors aren’t dangerous? Unnecessary corrections do little other than reinforce the realization dementia is taking away even simple abilities.

Improvisation and Fantasy

Researchers at the Alzheimer’s Disease Center at Northwestern University’s Feinberg School of Medicine are testing whether unscripted theater games can affect the well-being of dementia patients.

I know it has a positive effect. A friend of mine rarely corrects her mother’s factual errors. Instead, they engage in a banter that stays in the present, creating fantasies and often comedic exchanges. “I’m going to live until I’m a hundred,” her mother said. Her daughter’s response was, “Ok, Mom, but that’s it!” They both laughed, then constructed scenarios of what she would do on the way to one hundred.

The daughter could have used a somber heartfelt response such as “I’ve enjoyed taking care of you. You are a blessing to me.” Though compassionate, I doubt if it would produce the joyfulness her mother experienced from my friend’s humorous response.

Living In the Moment

Little is humorous about dementia, but an improvisational style, one relying less on memory and executive functioning and more on playfully staying in the present can do much to alleviate anxiety and provide the joy someone with dementia needs.

A Little Experiment

For one day count the number of times you correct your loved one’s inaccuracies and note the general state of her joyfulness. Then make a determined effort the next day not to correct anything unless the factual error could result in physical or emotional harm. Play with her responses, creating scenes or stories that may have no relationship to the “truth.”

Ask yourself at the end of the day if she is happier than the previous day filled with constant corrections. Given a choice between truth or joy, I’ll choose joy every time–and so will your loved one.

Preventing Senior Moments, by Stan Goldberg

Offers practical and achievable prevention strategies for senior moments.