Archive of ‘Memory’ category

Dementia: An Introduction

Have you been, or has your loved one been, diagnosed with dementia? Do you dread the journey that lies ahead? Here are a few facts and resources to help you face this difficult challenge.

Do not be afraid

Almost all of us who are over 50 fear that we will get dementia someday. But not many of us will actually get it. Among people who are over 65 years old, fewer than one out of 12 people (less than 8%) have dementia. Many centenarians (people over 100 years old) do not have dementia (source: The Merck Manual of Health and Aging, p. 307).  Dementia is very different from normal aging. 

What does normal aging look like? Each year, starting at age 25, our brains lose 1% of their processing speed. By age 50, we notice this, with chagrin. We also do not retrieve remembered information as quickly. Imagine how many names you learned before you were 20. Now imagine how many names you learned by age 50. When we are over 50, our “file cabinet” of names has a lot more items in it. No wonder it takes a little while to sift through that large volume of information to find the correct name when we see a familiar face, or hear a familiar voice. These are among the challenges of normal aging.

But remember that normal aging also has many advantages. At age 56, I value highly my life experiences. I would not trade in that hard-earned wisdom for the speed and agility that my brain had when it was young. As a grad student in my 50s, I was fascinated by classes about human behavior. Each concept that my professors presented was something that I could mentally illustrate with my observations of people whom I have known. 

Recall from history and literature that most cultures around the world, in most periods of history, have revered elderly persons as sources of wisdom and keepers of highly-valued traditions. Our culture might be in a minority in that it tends to glorify youth, and dismiss old age.

Get the facts

If you think that you or a loved one is experiencing some memory loss—not just normal aging—I encourage you to get the facts. As in many areas of life, even unpleasant facts are better than out-of-control fears. A good person to ask is your family doctor. He or she, or a member of the clinical staff, is likely to administer a standardized assessment at some point. There are several questionnaires for assessing memory loss that are well-researched, reliable (consistent) and valid (meaningful). These mental-status questionnaires take into account the person’s age and educational level, both of which can affect his or her scores. The questionnaires look not only at short-term memory, but also at the person’s ability to complete several different mental tasks. 

If you or your loved one scores below average for their age and educational level, that does not necessarily indicate dementia. There are several medical conditions that can mimic memory loss—but unlike memory loss, they are entirely reversible. During grad school, I interned in a medical clinic that primarily served older adults. Among my happiest moments were the times that I administered a mental-status questionnaire and found a normal result in a person whose result had previously been below average. These persons’ mental status returned to normal once they were treated for ordinary medical conditions such as urinary tract infection, vitamin B-12 deficiency, or depression. 

Safety first

If your doctor determines, after carefully eliminating all other possibilities, that you or your loved one has dementia, what comes next? Safety! You and your loved one need to think about safety, focusing on 5 areas of possible risk, namely:

  1. Driving. Is it still safe for your loved one to drive? If not, ask your doctor for help in having this difficult conversation with your loved one. What alternatives are available in your community (e.g. special public transportation services for handicapped persons, rural transportation that is sometimes covered by Medicaid, ridesharing services such as Lyft or Uber, and organizations of volunteers who serve elderly persons)? 
  2. Cooking. Sometimes persons with dementia forget to turn off burners on the stove, thereby causing fires. If needed, how can you protect against this?
  3. Medications. Sometimes persons with dementia skip doses or double-up doses of their medicines. Depending on the medicine, this can be dangerous. A first step in medication safety is to buy a pill container with a compartment for each day of the week and each time of day. Fill this pill container for your loved one each week, and check that the medicines have been consumed. Later, if the dementia progresses, you may need to hand medicines to your loved one, and watch him or her take them.
  4. Wandering. Sometimes persons with dementia get lost when they go out on walks. Even frail persons can walk surprisingly far. They may be searching with great determination for a place that they cannot find. Sometimes a person with dementia is searching for a place that no longer exists, such as a childhood home. Caring neighbors can be made aware of your loved one’s tendency to wander, so that they can gently redirect your loved one back home.
  5. Bills and taxes. Persons with dementia can inadvertently cause major financial problems by failing to pay bills or taxes, or by spending imprudently. If your loved one has been diagnosed with dementia, consider helping them find a financial services firm that can regularly pay their bills and taxes. Alternatively, try to persuade your loved one to sign a power of attorney that allows a responsible person to handle their finances for them when the need arises. 

A brain disease

Sometimes well-intentioned family members urge a loved one with dementia to try harder to remember information, or to practice skills. Unfortunately, the person with dementia cannot reduce the symptoms by trying harder. Urging them to try harder is based on a misunderstanding of the nature of dementia. Our common experience is the raising of children, who constantly learn new information and gain new skills. It is very hard for us to accept that in a person with dementia, the process goes in reverse—no matter how hard they try, and no matter how hard we try. 

Remind yourself frequently that dementia is a brain disease characterized by biological changes in the brain. Throughout the course of dementia, brain tissue is actually lost. The brain of a healthy, adult human weighs about 3 pounds. The brain of a person with end-stage dementia weighs only 1 pound. Recalling this fact can help a caregiver to be compassionate, patient, and understanding with their loved one who has dementia. Assume that at each stage of the disease, they are doing the best they can with the reduced amount of brain tissue that is left. 

An umbrella term

Dementia is an umbrella term that includes over 100 separate illnesses. Alzheimer’s is the most common form, accounting for over 60% of cases. The second most common form is Lewy Body Dementia, which has a distinctive pattern of symptoms. The third most common form is Vascular Dementia, which can result from strokes—either a major stroke, or a series of minor ones. 

Some helpful books

Here are my favorite books about dementia, with a brief description of each. 

The 36-hour day:  A family guide to caring for people who have Alzheimer Disease, related dementias, and memory loss, by N. L. Mace & P. V. Rabins. This is the classic, comprehensive guide to caring for a loved one with dementia. It can be used as a reference book: check the index for the topic you need, and read a few pages about it. 

Dementia caregiver guide: Teepa Snow’s Positive Approach to Care techniques for caregiving, Alzheimer’s, and other forms of dementia, by T. Snow. This book describes simply and briefly what life is like for a person who has dementia, at each stage of the disease; and gives practical instructions on how you as a caregiver can help the person. 

Alzheimer’s: A Broken Brain, by Dementia Education and Training Program, Tuscaloosa, Alabama. Available from the University of Alabama. Trigger warning: Do not look at this booklet if medical images bother you. This short booklet demonstrates in an unforgettable way that dementia is a brain disease. The booklet states 10 key facts about dementia, one sentence each. Each fact is illustrated with photos of 2 autopsied brains: the brain of someone who died from dementia, contrasted with the brain of someone who died of another cause. The difference between the brain images is dramatic. 

The whisper of the fallen oak: A family’s guide to early, middle, late, and end-stage dementia, by R. Wallace. Available from Wings of Change Publications. This booklet is a short, simple guide to the stages of dementia, and how to care for the person at each stage. 

Caregivers find meaning and purpose

Although caring for a person with dementia can be difficult and exhausting, it can also be extremely fulfilling. In 2016, researchers Cheng, Mak, Lau, Ng and Lam studied 57 caregivers of Alzheimer’s patients. The researchers identified ten positive themes that the caregivers reported, including “a sense of purpose and commitment to the caregiving role… increased patience and tolerance… cultivating positive meanings and humor… developing a closer relationship with the care recipient… and… feeling useful helping other caregivers.”

Key takeaway

The most important thing to remember about your loved one who has dementia is that he or she has the same value, dignity, and worth as you and I do.

The most important thing to remember about your loved one who has dementia is that he or she has the same value, dignity, and worth as you and I do. His or her value as a person is intrinsic, and does not depend on cognitive ability. In order to relate to your loved one, you may need to learn new skills. These skills are worth learning, because the person is worth relating to. If you make the effort to relate to a person with dementia, you will be rewarded in unexpected ways. 

[I wish to thank Laura A. Ellis, LMSW, James W. Ellor, Ph.D., D.Min., LCSW, Dennis R. Myers, Ph.D., LCSW, and Teepa Snow, MS, OTR/L, FAOTA, for teaching me the above material.] 

Written by: Catherine C. Stansbury, LMSW, supervised by Melissa L. Gould, LCSW-S. Catherine is a therapist here at Austin Family Counseling. She is an EMDR Trained Therapist specializing in trauma therapy for adults. She has a Master of Social Work from Baylor University. She is a Certified Practitioner of the MBTI, trained by The Myers & Briggs Foundation; a PAC Certified Independent Consultant, trained by the Positive Approach to Care organization; an associate member of the Aging Life Care Association; and an associate member of the EMDR International Association (EMDRIA).


Growing Through Grief: You Will Never Feel the Same Again… But You May Become Better

Losing a loved one may shatter your life. You may feel numb. You may feel that you can’t think straight. Every heartbreak that you have suffered previously may hit you full force, simultaneously. At times, the pain can almost paralyze you. 

Be patient with yourself. Healing from grief is a slow process. It moves, not at the tempo of technology, but at the tempo of agriculture, as slowly as plants grow. But as you heal, you may discover in yourself new strengths that were not there previously. 

In my case, my mother’s death forced me to re-examine my identity and my purpose in life. This exploration eventually led me to seek a master’s in social work. I discovered that my interests include caring for older adults, persons who are nearing death, and persons who are grieving. 

Each experience of grief is unique, as unique as you are, and as unique as your relationship with the person you lost. But there are some patterns that humans share. It helps to learn these patterns, as they will help you understand yourself and other persons.  

Elisabeth Kubler-Ross’s 5 Stages of Grief

This was the first research model of grief, and it is still used. People do not go through the stages in a neat, sequential way. But they usually experience all 5 emotions, and move in a gradual, bumpy way from shock toward healing. 

  1. Denial (shock)—This is the emotional equivalent of an airbag in a car. It protects you from feeling the impact all at once, which could be overwhelming. 
  2. Anger—You may protest and feel, “This is terrible! This shouldn’t have happened!”
  3. Bargaining—You may think, “I’m trying to regain some control of my life, when I feel so out of control. If I change my life in such-and-such a way, then I should feel less bad.” A religious person may make deals with God, such as, “Dear Lord, if I start teaching Sunday school, You should make me feel less awful.” 
  4. Depression—This stage is not well-named. It’s not depression, but it can look that way. There is a general withdrawing from activities and social life, a conserving of energy. The person may feel powerless, but not hopeless. They are starting to come to terms with the loss.
  5. Acceptance—At this point, you may feel, “This situation stinks. I don’t want it this way. But it’s reality, and I am going to acknowledge it and deal with it as best as I can.”

William Worden’s 4 Tasks of Grief

Again, people don’t go through these tasks in a neat, sequential way. There may be setbacks and cycling. But there is a gradual movement toward healing.

  1. Acknowledge the reality of the loss. State that the person is dead. Describe how it happened, how you learned, and what you saw.
  2. Experience the pain. Face it. Don’t try to pretend that it doesn’t hurt much. It does. Don’t try to dull it out with alcohol.
  3. Adjust to an environment without the person there. The longer that people are in relationship, and the more closely their lives are intertwined, the more adjusting needs to be done.
  4. Withdraw some emotional energy from that relationship and invest it in another relationship. Be careful! You can’t replace one person with another. (We all know a grieving widow or widower who remarried out of loneliness, but chose altogether the wrong person.) Some marriages and other relationships aren’t happy. In this case there may not be much emotional pain after the death. Or there may be intense pain, as the person grieves for a relationship they craved, but never had. Sometimes a loss leads to a new project. A mother whose child was killed by a drunk driver started MADD (Mothers Against Drunk Driving), to try to prevent this tragedy from happening to others. 

Corr & Doka’s 5 dimensions of grief

  1. Emotional
  2. Physical—You may feel cold. (When we feel threatened, blood flow goes to our inner organs, and we feel cold.) You may get sick, since grief weakens the immune system.
  3. Spiritual—Grief may impact your belief system.
  4. Social—It may be hard to socialize, as some people may misunderstand you, or say clumsy things.
  5. Cognitive—You may have poor attention, poor concentration, or difficulty learning new material. Some children who are grieving are diagnosed incorrectly as having ADHD. When these children heal from grief, they do not show ADHD behavior. (This research study was my professor Dr. Helen Harris’s doctoral dissertation.) Some older adults who are grieving fear that they have dementia; but when they heal from grief, they can think just as well as they did before the loss. 

Alan Keith-Lucas’s study of children’s resilience after a loss

Shock and denial: After a significant loss, every child experiences shock and denial. Then there are 2 different paths:

  1. Protest: If the child is allowed to have and express the feelings, “No! This is unfair! This can’t be!” then the child can achieve “mastery,” becoming stronger than before the loss. The key is for the child to learn to express their feeling of anger in a way that doesn’t hurt themself or anyone else. 
  2. Despair and Detachment: If the child is not allowed to protest, the child falls into despair and detachment. These children are not troublesome. However, as adults, they may not function very well. They struggle to keep a job or stay in a relationship.  

Books—Some of my favorite books about grief are:

  • Doka, Grief is a Journey 
  • Neeld, Seven Choices: Finding daylight after loss shatters your world 
  • O’Brien, The New Day Journal 
  • Wings of Change Publications, The Nature of Grief: Honoring and Healing the Seasons of Loss. 

Are you currently grieving? 

We experience grief not only when a loved one dies, but also when we lose anything that is important to us, such as our health, a job, or a treasured relationship. If you are grieving, it would be my honor to share your journey with you. Grief is too hard a journey to travel alone.

[I wish to thank Dr. Helen Harris and Dr. Richard D. Grant, Jr., for teaching me the above material.] 

Written by: Catherine C. Stansbury, LMSW, supervised by Melissa L. Gould, LCSW-S. Catherine is a therapist here at Austin Family Counseling. She is an EMDR Trained Therapist specializing in trauma therapy for adults. She has a Master of Social Work from Baylor University, where one of her internships was in a hospice agency. She is a PAC Certified Independent Consultant, trained by the Positive Approach to Care organization; a Certified Practitioner of the MBTI, trained by The Myers & Briggs Foundation; and an associate member of the Aging Life Care Association.




An Open Letter to 2020-2021 College Students

Dear College Students,   

What a year it has been for you all. I want to speak to you directly because I feel that the unique ways you have had to adjust to the myriad changes that have occurred this year are often overlooked. I work with college students in my clinical practice, and I want to reassure you that your grief and disappointment are real and justified. 

I remember watching the news in the early months of the COVID-19 pandemic and hearing that elderly individuals and college students were most at risk. I was grateful to hear someone acknowledge how difficult this time has been for you all. Not only have you had to pivot to virtual learning and face an increased risk of exposure to COVID-19, but you have been isolated from your friends and social gatherings. With limited access to these social supports, it is expected that you would feel depleted.    

In college, your friends are more like family. You live with them, you go to class and study with them, and you share your life with them in ways that were not always possible with your childhood friends. These friendships engender a level of relational intimacy that is seldom replicated during other times in your life. Moreover, you are in a stage of human development wherein you are forming your identity in the context of your relationships with others. This is precisely why it has felt like such an insurmountable task to quarantine apart from your peers and refrain from connecting with them regularly. 

You have probably heard many people tell you that college will be “the best four years of your life.” College is certainly a fun and exciting time, but it is not devoid of hardship and adversity. When you feel sad, scared, or lonely, you start to think you are doing something wrong because you are not having the time of your life. The pandemic has added another emotional reaction to this lofty expectation for your college years: anger. 

I have heard so many of my clients express how frustrated and devastated they are that they are not having the college experience they always imagined. Please understand that it is normal to feel this way. We are all grieving the loss of our pre-COVID realities, and your “new normal” has been anything but normal. Your old assumptions no longer fit your current circumstances, and accepting this is no small task. 

I know how easy it can be to compare your struggles to those of others. People in our community and around the world are suffering. This pandemic has taken loved ones, jobs, and our sense of safety and security. However, you are not immune to the damage it has caused, and your distress is worthy of care and attention. 

To quote Brené Brown, “empathy is not finite, and compassion is not a pizza with eight slices. When you practice empathy and compassion with someone, there is not less of these qualities to go around. There is more. Love is the last thing we need to ration in this world. Hurt is hurt, and every time we honor our own struggle and the struggles of others by responding with empathy and compassion, the healing that results affects all of us.”

I want to remind you of how resilient you are. You forged your own path by going to college and building a life apart from your family. This requires courage, and doing so amidst a global pandemic has tested you in ways you never thought possible. I challenge you to practice self-compassion by treating yourself how you would treat someone you love. You are weathering this pandemic the best you can, and your best is always enough.  

For Reference: 

“Rising Strong: How the Ability to Reset Transforms the Way We Live, Love, Parent, and Lead” by Brené Brown, Ph.D., LMSW

“Self-Compassion: The Proven Power of Being Kind to Yourself” by Kristin Neff, Ph.D.

Written By: Claire Taylor, LPC- Associate Supervised by Lora Ferguson, LPC-S 


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