If you are caring for someone with dementia due to Alzheimer’s disease or other brain disorders, it can be difficult to  truly understand how your loved one sees the world as the disease progresses. Agnosia, Amnesia, Aphasia, Agnosia, Apraxia, Altered Perception, and Apathy represent the 7 A’s that can occur in people with dementia due to damage to the brain.

By appreciating these potential changes, we can better connect with loved ones and use successful strategies to support their care. People with dementia may not experience all of the A’s, it’s imperative to understand that they can occur in combination and symptoms can vary from person to person.

1. ANOSOGNOSIA is most often mistaken for stubbornness, denial and/or embarrassment. It can make it difficult for dementia patients to recognize the impairment due to the damage to the brain. This can change from hour-to-hour or day-to-day which can make your loved one’s behavior/reactions unpredictable. You may find your family member resisting your help, refusing treatment, becoming angry/defensive, and/or overestimating their abilities (sometimes to a dangerous level).

This may help:

  • Don’t attempt to convince your loved one that they have dementia. Instead, make changes that help them live safely.
  • Recognize that additional support or care is an opportunity to do more of what they enjoy…
  • Use language such as: “It’s a beautiful day. Let’s take a walk together” instead of ‘You can’t go out alone for a walk. You’ll get lost”.
  • Pick your battles and if there isn’t an immediate safety issue, try to let things go.

2. AMNESIA is a form of memory loss that usually impacts our loved one’s short-term memories in the beginning and eventually, once the disease advances, it affects long-term memories. People living with dementia due to damage to the brain tend to repeat things over and over, becoming overwhelmed by too much information. They may forget their loved ones and experience a loss of their sense of time. Amnesia is usually the most obvious sign of dementia and also tends to be the most emotionally impactful to all involved.

This may help:

  • Use short, simple, and direct sentences while speaking slower.
  • Be patient. If you find you’re asked the same question over and over, try to remember that they aren’t doing it on purpose and respond as though it’s the first time they’ve asked.
  • Use visual cues and display photos of friends and family throughout the house. Not only is it pleasant, it can help trigger memories.
  • Create and follow a daily schedule. This will make it easier for your loved one to remember what happens throughout the day.

3. APHASIA refers to communication skills impairment. Aphasia affects a person’s ability to speak, understand language, read and write. Early in the disease’s progression, it may not be obvious that your loved one is struggling to understand what you are saying. In time, it will be more apparent as they use inappropriate, nonsensical, or non-existent words. They may revert to a first language and/or become extremely difficult to understand.

This may help:

  • Speak slowly and clearly.
  • Be patient, while giving your loved one the additional time to respond.
  • Provide non-verbal communication. Include visual cues, gestures, and light touch when appropriate.
  • Speak slowly and clearly and give your loved one extra time to respond.
  • Be aware of your facial expressions. Your loved one will pay attention to your body language as they attempt to understand you. Sudden movements, a tense face, and/or a frustrated tone will be very apparent to them.
  • Pay attention to nonverbal cues that your loved one is using. This can often be a signal of pain or discomfort. While this isn’t our traditional way to communicate, it is going to assist you in determining issues when language is a struggle.

An older woman talking with a younger woman.

4. AGNOSIA is the loss of the ability to recognize familiar people or objects by sight, touch, taste, smell, or sound. For example, they may burn themselves with hot water or eat something that has gone bad. This can be very worrisome as they can get injured or sick.

This may help:

  • No matter how odd it feels, always introduce yourself (and anyone else that provides your loved ones care).
  • Show how an object is used before giving it to your loved one.
  • Clearly (and regularly) label items around the house such as lights, appliances, personal hygiene items (think hair and toothbrush), and anything else that they may need during the day/night.
  • Keep dangerous items out of reach.

5. APRAXIA is the inability to complete a practiced and familiar motor task such as buttoning a shirt. Your loved one may desperately want to carry out the task. Even though the desire to complete the task is present and all of the parts of the brain needed are functioning, the communicative link between the ‘thinking’ and ‘doing’ parts are broken. You can imagine how incredibly frustrating this would be. Daily living activities like bathing, dressing, walking, and eating can become virtually impossible and no matter how much they would like to complete the task, you may find them saying ‘no’ often – this isn’t because they don’t want to do it, it’s because they don’t remember how.

This may help:

  • No one wants to lose their independence. You can break down tasks into small, bitesize steps. Use pictures for cues, write down individual steps to complete a task, or set out clothes in the correct order. This will encourage your loved one to do more on their own.
  • Minimize distractions when giving instructions.
  • Utilize adaptive clothing, such as those with Velcro instead of buttons and provide assistive devices in the kitchen and bathroom.
  • If a task isn’t under a time constraint, simply set it aside to try again later.

6. ALTERED PERCEPTION can make someone living with dementia get confused and struggle with the height, length, width, depth or how close something may appear. Moving through physical spaces can make it difficult and can cause paranoia, and delusions.

This may help:

  • Make sure your loved one has regular eye exams and that their prescription glasses are current and up to date.
  • Remember (and remind yourself daily) that your loved one is seeing the world much differently then they once did and attempt to understand that this can be very scary and stressful.
  • Don’t try to convince them that what they are experiencing is wrong.
  • Walk across the floor or put your foot in the tub to show the depth to provide some reassurance to your family member.
  • Upgrade your lighting/switches, and add assistive equipment when/where you are able.
  • Keep your home (and their common areas) clean and uncluttered.

7. APATHY can make someone with dementia appear to lose interest in what is happening around them. This is because of the brain’s motivation pathways. You may find your loved one lacks energy, shows little emotional response (whether good or bad), and lacks motivation.

This may help:

  • Change the approach; instead of saying, “Do you want to go visit your sister?” say, “It’s time to see Doris. Here are your coat and shoes.”
  • Make it a habit. Your loved one with apathy may find it much easier to do something once it’s a routine. As often as possible, schedule activities and outings during consistent times/days.
  • Do things your loved one enjoys, whether it’s visiting friends and family, watching movies, or cooking together.

While not everyone living with dementia will experience all of the 7 ‘A’s, as a caregiver it is helpful to recognize these changes so you can find the strategies and responses that work best for you and the person you are caring for.

Getting a Compassionate, Innovative Home Care Service