As a first step towards dealing with dementia, it’s important to know that Alzheimer’s disease and dementia affect memories in different ways.
In order to promote successful moments in our loved one’s day, we must understand the very basic two categories of long-term memory. Please note that our brain and the matter in which our memory functions is very complex and miraculous. But if we can understand the basic differences of Procedural and Declarative memory we can better assist our loved ones with dementia.
Procedural (IMPLICIT) Memory (How to do something)
According to Steven P. Levin, MD “procedural memory is the most basic and primitive form of memory.” Simply put, this type of memory comes from doing something repeatedly. An example of this type of memory is tying our shoes. “Procedural memories are memories that are repeated and become ingrained, almost automatic responses.” Procedural memories are also known as muscle memory.
Declarative (Explicit) Memory (What to say or do)
Dr. Levin describes Declarative Memory as a memory related to recalling a fact or event, a memory that you can consciously recall.
These two types of memories are stored, differently in our brains and because of where they are stored, Alzheimer’s disease and dementia affect them differently.
People need to have a purpose in life and to feel successful. If we understand and work with the memories that are intact we can support the person with dementia and they will have those feelings of purpose and success.
As caregivers it can be very easy to take over. We may think:
• The person is struggling so let me help.
• This is taking too long.
• They can’t do one thing so they probably can do a lot of other things.
• This is how I show I am there for them.
But in reality, we may be causing more harm then good. In fact, we may be creating an instance of learned helplessness.
Put yourself in their shoes; when someone takes over a task you are attempting; how does that make you feel?
• I am not good enough?
• I am not quick enough?
• I have no independence.
• Why bother, they will do it for me.
Please understand that while a person with dementia has problems with their memory, they still have feelings and these feelings can have long lasting effects. Their ability to make sound judgment calls also diminish and your intended goal may be perceived differently than you intended.
Below is an example on how to positively support a person with memory loss due to dementia utilizing Procedural Memory.
There is some truth to the phrase if you don’t use it you lose it. When working with a person with dementia, concentrate on things that the person can do and then provide support for the items they exhibit difficulty with. You should do so in a way that encourages the person to try. For example, when assisting with getting dressed, a prepared environment is the key to success.
A prepared environment:
• Is the room bright enough so that the person can see well?
• Is there privacy? Blinds drawn, door closed?
• Is the room warm enough so that the person is comfortable to disrobe?
• Is it quiet so that they can hear the simple instructions you give them in that calm, quiet, patient voice?
A prepared Caregiver:
• Your demeanor means a lot. Moving at a calm, even pace creates a relaxed atmosphere. If you are rushing about it can create unwanted stimulus.
• Make sure you have the time needed for a person with dementia to get ready. As the disease progresses, they may require more time.
Have all items needed ready so that there is no room for confusion. By organizing and simplifying choices, tasks are more easily understood and less overwhelming.
• Prepare the closet so that shirt and pants are a matched set ready to go. You can provide independence when asking the person which outfit they want to wear and simplifying the choice between “the blue outfit or the green outfit.”
• Have clothes set up on a chair or bed so that they are picked up in the order they normally get dressed. If your loved one normally starts with their underclothes begin there, by having the underpants on top, undershirt or bra next, pants, belt, shirt, then socks last. You are working with procedural memory (muscle memory) so if all their life they put their sock and shoe on their left foot first and then followed with the same scenario on their right, do not change this ritual, it can throw them off. As your loved one is completing tasks, voice support, by stating positive phrases such as, “ That’s it!” or “Looks good.” Studies show that if someone is struggling, positive affirmations benefit the process.
• This is a procedure that your loved one has done for years, a memory that may last. It is important that we encourage our loved ones to actively participate as much as they can in what they can do. Hand over hand movements can trigger the muscle memory and you may see your loved one begin to complete a task.
An example of hand over hand is simply taking your hand, standing on the dominant side of your loved one and gently grasping the participant’s hand and starting the task. Many times after a moment they will begin to take over the task and you can let your hand gently move away. If hand over hand is necessary to complete the task, using the technique gives a sense of control to the participant and compliance with a task is realized.
An example of a positive exercise using Declarative Memory can be as simple as exercise of reminiscing with your loved one.
• Make an unadorned photo album of family members.
• On one page put a picture of the relative from the past and one of the same people from a recent event.
• Label with their name and relationship in large bold letters.
• Sit and have a nice conversation, reminiscing about the past for as long as the person is comfortable.
We all like to talk about past events that we thought were fun or eventful. Think of how wonderful it must be to be able to remember an event when throughout the day you struggle with confusion and memory loss for more recent events.
If we can create successful moments throughout the day it stands to reason that the day will be brighter for both the caregiver and the person with dementia. Working with the knowledge that a person with dementia lives in the moment, let’s do our best to make each moment a successful one for all of us.