One way to understand progressive changes resulting from dementia is to compare them to the changes that occur as a result of human development.  Dementia unfolds as reverse development.  As a general rule, those skills we learn later in life (e.g., managing investments, complex technology, doing a checkbook, and writing poetry) decline earlier than those learn earlier in life (e.g., toileting, dressing, and language).  The major difference is that as we develop from infancy, we constantly learn new skills and information.  The opposite is true for most dementias.  Learning new skills becomes increasingly difficult or impossible.   Those who are demented must be managed based on skills that are already there and those skills progressively deteriorate.  Dementia is a backward moving target.

The good news is that we can learn a lot about managing dementia by understanding and using principles of good parenting (once we better resolve the personal conflict/sadness that we must parent our spouse or parent).  There are several general ways to approach either caregiving or parenting that work.  Despite the loss of short-term memory, those who are demented usually respond to consistent contingencies and environments structured around their interests and preserved skills.

Catch them being good.  Praise behavior that is desired.  There is a strong tendency to parent and to give care by nagging or punishing.  When someone you care for is doing something that you desire such as taking a shower, sitting quietly or engaged in a desired activity while you get the checkbook done, praise him or her.  Spend the effort when things are good to provide a smile or a hug.

Ignore unwanted behaviors if they do no harm.  Ignore stories with the facts all-wrong or that are repeated, there is no benefit to being correct when there is no harm.  Learn to ignore embarrassing and inconvenient behaviors that do no harm.  It is more important for someone with cognitive decline to be productive and engaged than competent.

Children do not make a mess by intention.  Nor do those who are demented.  If they try to make coffee and it turns out poorly, try to determine if this task has become too hard and beyond current skills.  You would not explain to a two year old what they couldn’t yet understand.  The same holds true for communicating to someone who is demented.  Communication works best with simple one step requests, prompts, and modeling.

Plan and direct time.  Structure activity based on retained competence that does not require short-term memory.  Unstructured situations are often the source of difficult or inappropriate behaviors.  Keep those with cognitive impairment engaged.

Use time out.  If a behavior such as anger is elicited, leave for a short time and return.  Don’t go toe to toe.  If the memory loss is great enough, he or she will often forget what they were angry about and you can start anew – if you have been able to stay calm.

Take care of yourself.  You cannot be either a parent or a caregiver 24-7.   If you fall apart or become ill, you both lose.  You will be a better parent or caregiver if you also manage to tend to your needs with the same dedication that you provide to those for whom you care.