How to communicate with someone who has a cognitive impairment
Firstly I would like to thank Kate Smith from Memory Matters some of the information for this blog.
No two people with a cognitive impairment will communicate in the same way, but here are some ideas that might help.
Memory can be unpredictable, however in general short-term memory tends to be lost first and long-term memory stays with that person for a longer period of time. However, if something emotional or very unpredictable happens during what is otherwise a mundane situation, such as a huge surprise happening during breakfast, then the details about what you ate and drank for breakfast will stay with you longer than other breakfasts. This surprise / emotional memory works like long term memory and can be retained. What is important or emotional to one person, won’t be the same for another, which is why it can therefore be unpredictable what will be remembered.
People with dementia can have difficulty focussing, which can relate to their inability to filter their environment. People without this impairment can focus and concentrate on the thing that they consider important and may not even hear people close by talking to them, if their focus is so strongly fixed on the task in hand, but people with dementia don’t always have this high level of concentration, so if there are multiple things going on in their environment, they might struggle to concentrate on any one of them. This can also be a useful thing, if they become agitated or anxious, as the carer can do something that will distract their attention from what / why they are anxious and change their mood really quickly, such as dropping keys on the floor to create a sudden noise.
The areas of the brain that are affected by dementia are different in each person and if the frontal lobe is damaged, this can lead to issues with both planning and impulse control. The family members of people who have issues with impulse control will be surprised by comments or swear words that can be used, that were never used before. The filter that ensured that their interactions were social appropriate and measured has disappeared and they will both act quickly and out of character for them as they were before. They might become more angry or tearful for example, the display of their emotions is unpredictable.
Another aspect of the loss of impulse control is the loss of ability to plan or manage their lives. If they are thirsty at 10.30am, they might not be able to wait until 11am for their morning coffee, or plan a loo visit etc, so when they realised that they need / want something, they want it now! They might ask for what they want and will have difficulty concentrating until they get it or they might get up and walk off to get it, which could be mid conversation!
Unless the environment is very familiar, that they continue to see / use daily, they could be disorientated, including to parts of their own house they don’t go in regularly, such as the spare room or family members that they don’t see regularly because either they don’t visit or live a long way away. As far as people are concerned, everyone has a name, relationship and visual look and it is possible that they can forget one or more of these aspects, so they might know you are familiar, but not your name or what relationship you are. This can create issues of inappropriate behaviour if the person thinks you are someone else, particularly when sons are misunderstood for husbands or daughters for wives!
What is important is that they feel safe with you, not the information about you that they can remember or not!