CASLD2 Pam Britton Reese - The Source For Alzheimer - S - Dementia

Pam Britton Reese
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Pam Britton Reese, M.A., CCC-SLP, owns a
A private practice, CommunicAid Plus, where

she provides speech and language services to
children and adults. She is also an educational
b consultant to public and private schools.
o Pam first became interested in Alzheimers

disease (AD) when her mother-in-law was
diagnosed with the disease in 1993. Pams
u consultant work with families as they struggle
with AD led to the writing of this book.
t The Source for Alzheimers & Dementia is Pams second publication with
LinguiSystems. She is also co-author of Autism & PDD: Social Skills Lessons.
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Dedication
For M. D. R., S. B. B., and N. M. B., with love
Acknowledgments
Much as it sometimes takes a team of individuals to care for a person with AD, it also took
a team of people to help me write this book. I would especially like to thank Sandra Bond
Chapman, Ph.D., of the Callier Center for Communication Disorders at the University of
Texas at Dallas, who answered my many questions and graciously shared her knowledge
about Alzheimers disease with me and others. Her enthusiasm for the work of speech-
language pathologists in the field of AD was a direct influence on my decision to write
this book. Thanks also to Susan Rigby, CCC-SLP, for her professional suggestions; Susan
McMillion Mason, attorney-at-law, for her advice on legal definitions; and Judy Cotton and
Nena Challenner for their willingness to discuss the many issues that caregivers face.
To Joe Reese, for his encouragement, editorial comments, and creative help in the writing of
this book, I offer my most grateful thanks.
Please note: All examples of people with AD used in this book come from my personal
experience with AD. Some examples are composites; all have had names or distinguish-
ing features changed to protect the privacy of the individuals. Thanks to all the families
who shared their stories with me.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Section One: Background/Theory
T Chapter One: Characterististics of Alzheimers Disease . . . . . . . . . . . .9
Chapter Two: Possible Causes and Risk Factors . . . . . . . . . . . . . . . . . .14
Chapter Three: Memory and Thought . . . . . . . . . . . . . . . . . . . . . . . . . .20
a Chapter Four: Assessment and Diagnosis of AD . . . . . . . . . . . . . . . . .25
Chapter Five: Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Chapter Six: Communication Breakdowns . . . . . . . . . . . . . . . . . . . . . .51
b Section Two: Intervention and Support
Chapter Seven: Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
l External Memory Aids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Errorless Learning and Spaced Retrieval . . . . . . . . . . . . . . . . . . .62
Swallowing and Eating Problems . . . . . . . . . . . . . . . . . . . . . . . . .63
e Therapy Conversation Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Social Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
Activities for Daily Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Chapter Eight: Caregiver Support Group Agenda . . . . . . . . . . . . . . . .70
Support Group Outline
o Unit One: Legal and Financial Issues . . . . . . . . . . . . . . . .70

Unit Two: Health and Safety Issues . . . . . . . . . . . . . . . . .73
Unit Three: Joyful Sharing . . . . . . . . . . . . . . . . . . . . . . . . .76
f Handouts
Family Planning: Can We Talk? . . . . . . . . . . . . . . . . . . . .79
Legal Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
Possible Financial Resources . . . . . . . . . . . . . . . . . . . . . . .81
Protect Yourself from Fraud! . . . . . . . . . . . . . . . . . . . . . . .83
Information Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
C Safety Pictures
Kitchen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
o Bathroom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
Living Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Outside . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
n Wandering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Caregiver: Take Good Care of Yourself . . . . . . . . . . . . . .92
Communication Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
t Appendix One: Therapy Materials . . . . . . . . . . . . . . . . . . . . . . . . .95

Schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
e Therapy Conversation Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
Daily Life
n Cooking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
Sewing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
Wood Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
t Gardening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108
A New Car . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Wedding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112
s Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114
Elementary School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
High School Prom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118
Pets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120
Table of Contents, continued
Entertainment
Baseball . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
Fishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124
Fairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
Camping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
The Movies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
The Funny Papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134
The Golden Age of Radio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136
Westerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
Elvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Time Line
The Roaring Twenties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Electricity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144
Heroes in the Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
The Thirties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148
World War II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
Political Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152
The Space Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
Social Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
My Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
Eating Out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160
When Are We Going? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Talking on the Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
Answering the Door . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
Getting Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164
Enjoying Meal Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
Social Club . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
Going Away . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167
Self-Care Activities of Daily Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
Morning Routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170
Evening Routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
Brushing Teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172
Washing Hair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173
Using the Toilet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174
Bathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
Taking a Shower . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176
Taking Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
Getting Dressed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178
Shaving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
Appendix Two: Other Forms of Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180
Appendix Three: Recommended Books about AD . . . . . . . . . . . . . . . . . . . . . . . .182
Appendix Four: AD Support Organizations and Web Sites . . . . . . . . . . . . . . . .184
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191
Staff at the assisted living center all knew Mrs. C. She was the resident
behavior problem. She continuously walked and paced in circles around
I her room. Her loud cries could be heard throughout the building. When the
staff attempted to distract or redirect her behavior, she became increasingly
loud and distraught. Nothing worked to calm Mrs. C. Finally, during a visit
n from a consulting speech-language pathologist, the SLP noticed that cold air
from a large air vent was blowing directly on Mrs. Cs chair. Once the temp-
t erature and air flow were adjusted, Mrs. Cs problem behavior disappeared.
r Do you know Mrs. C? Is she a resident at the facility where you work?
Are you the staff member who works with her family? As communication
o specialists, SLPs are in a unique position to help patients with Alzheimers
disease (AD) and their families as they cope with the different stages of the
disease.
d I wrote The Source for Alzheimers & Dementia to help the SLP who works
u with patients with AD whether they live in assisted living centers, skilled
nursing facilities, or in the homes of their caregivers.
c Section One gives background information on the history of AD, the brain
and its role in memory and cognition, and a review of communication and
t behavior. This material may be copied and shared with caregivers.
Section Two contains techniques to help people with mild to severe AD main-
i tain optimal levels of function as well as suggested environmental modifi-
cations to help the person with AD stay safe and oriented. An agenda and
o activities for a six-week caregiver training program is also in Section Two.
There are also four appendixes filled with useful information. Appendix
n One contains therapy materials (sample Schedules, Therapy Conversation
Topics, sample Social Reminders, and visuals for Self-Care Activities.)
Appendix Two defines other forms of dementia. Recommended books
about AD, support groups, and web sites are listed in Appendix Three and
Appendix Four.
I have two goals for you as you use this book. First that you find the treat-
ment suggestions in Section Two useful in your practice. I also hope that
you will be able to share information from this book with family caregivers.
Communication breakdowns remain the most stressful component of living
with ADaffecting every corner of life. I believe that if caregivers under-
stand the nature of communication and what happens when it breaks down,
they will be better able to care for and enjoy the person with AD.
Pam
The Source for Alzheimers & Dementia 7 Copyright © 2000 LinguiSystems, Inc.
“I felt a clearing in my mind
As if my brain had split;
I tried to match it, seam by seam,
But could not make them fit.
The thought behind I strove to join

Unto the thought before,
But sequence ravelled out of reach
Like balls upon the floor.”
-E. Dickinson
Reprinted by permission of the publishers and the Trustees of Amherst College from The
Poems of Emily Dickinson. Ralph W. Franklin, ed., Cambridge, Mass.: The Belknap Press
of Harvard University Press, Copyright © 1998 by the President and Fellows of Harvard
College. Copyright © 1951, 1955, 1979 by the President and Fellows of Harvard College.
“I have lost myself.”
-Auguste D., the first person diagnosed with Alzheimer’s disease
C Background
Auguste D. was suffering from dementia. Dementia is a general term that

h describes a loss of cognitive and linguistic abilities in an adult. Cognition,
problem solving, language, and the ability to do common tasks can all be
a affected. Dementia is not a disease. It is a group of symptoms. There are

many different causes of dementia, some of which are treatable such as
depression or certain thyroid problems. For this reason, a medical diagnosis
p is important. Two of the more common forms of dementia are Alzheimers
disease (AD) and multi-infarct dementia.
t Alzheimers disease AD is the most common form of dementia. Half

of the cases of dementia are attributed to AD
e (Weiner and Gray 1996). It is irreversible and
progressive. Memory, language, judgment, and
personality are all affected.
r Although the cause of AD is unknown, the plaques
and tangles in the brain that are found upon autopsy
confirm the diagnosis of AD. Are the plaques and
tangles a cause or a symptom of the disease?
O Scientists are not sure.
n Multi-infarct dementia This type of dementia is caused by a series of

small strokes. About 20% of dementia cases are
caused by these small strokes (Aronson 1988).
e Symptoms vary depending on the area of the brain
that is damaged. If the cause of the strokes is
controlled, further damage can be prevented.
These two types of dementia are not mutually exclusive. Twenty percent
of people with dementia may have a mixed cause (AD and multi-infarct
dementia). Taken together, they account for 90% of dementia reported.
Although the focus of this book is AD, information and strategies presented
can also be used with individuals with multi-infarct dementia. Because of
the prevalence of AD, the terms Alzheimers disease and dementia are used
interchangeably in this book to refer to the Alzheimers type of dementia.
Chapter One
Characteristics of Alzheimer’s Disease Putting objects in odd places. The
person with AD may find scissors
AD will often go undetected in a person for he put in a cereal box and have no
many years. Families will observe certain memory of putting them there.
problems, but explain them away as Dad
getting older, losing his hearing, or sad Problems completing daily living skills.
over the loss of his sister. Frequently it is Instead of making the needed single
only when the disease progresses to a more serving of oatmeal, the person with
severe state that the families seek a medical AD makes oatmeal for 20 people, and
diagnosis. then forgets it was made at all.
Common characteristics of AD include: 3. Personality changes

Caregivers will often describe their loved
1. A gradual onset of symptoms one as different. A dignified mother
Families will often be unable to pinpoint may curse repeatedly or a happy person
a particular day or time of onset as they may become angry for no apparent
might in the case of a sudden stroke. reason. Other words that may describe
People with AD tend to have good days the personality changes are suspicious
and bad days. On good days, families and fearful.
talk themselves into thinking that the
problems were temporary. However, 4. A loss of speech and language
over time they notice the difficulties of Language skills are lost throughout the
symptoms increasing. course of the disease. Examples of this
loss can be seen in:
2. A loss of memory
Everyone misplaces glasses or forgets to Finding the correct word to say (anomia).
water the plants. The memory loss in This is seen in the earliest stages of
AD is more severe and pervasive. The the disease. A grandmother in the
memory loss can be seen in: early stage of the disease once said,
I didnt know that your car had a
Confusion at work and home. A person TV. She was talking about the radio.
with AD may have difficulty staying
employed because he is unable to Others with AD will sometimes sub-
complete the required work. A retired stitute meaningless or vague words
person may show confusion by using (e.g., stuff, things) for the words they
a gasoline can instead of a watering are unable to recall.
can to water the plants.
Problems understanding language. A
Disorientation to time and place. A patient may not understand complex,
person with AD may not remember multiple-part directions (e.g., After
how to drive home from a familiar you are finished in the bathroom, get
place (e.g., the grocery store). She the extra blanket in the closet, and set
may not remember that it is Saturday the alarm for 6:45.). Even in the
and there is no need to dress for work. early stages of the disease, a patient
may have problems understanding
Chapter One
abstract language (e.g., A bird in the 5. Poor judgment
hand is worth two in the bush.). Persons suffering from AD exhibit poor
judgment in many areas of daily living.
Problems with expressive language. They may give out personal information
Persons with AD are described as over the phone, give money to strangers
producing less information than at the door, or have problems dressing
normal, despite the fact that they (e.g., wearing their underwear on top of
produce as much language their pants).
(Ulatowska and Chapman 1995).
The person with AD has problems 6. Loss of abstract thinking skills
maintaining a narrative. He often Many of the things we do in our lives
talks around a subject or wanders off involve abstract thinking (e.g., balancing
the topic. Pronoun confusion is also a checkbook; driving a car; planning,
seen. The problems of too much shopping for, and cooking a meal for
talking and too little talking are both four people). Sometimes the first sign
described in AD. of a problem is the loss of the ability to
do a familiar task.
Language problems such as echolalia
(repeating words said by others) and 7. Withdrawal from social activities
palilalia (repeating words you have A previously sociable person may with-
already said) are also seen (Kempler draw from conversations or activities.
1995). This may also be a symptom of the
depression sometimes experienced by
Problems communicating wants and people in the early stage of AD.
needs. All of the above problems can
interfere with the ability of the person 8. Perseveration
with AD to communicate his needs. When a person does something repeat-
Compound this with memory pro- edly, that person is perseverating. This
lems and situations such as the might be saying the same story over and
following can happen: over (verbal perseveration) or scrubbing
the toilet again and again in one day
Mrs. Smith has not had any water all (physical perseveration).
day. She does not remember to take a
drink, even though she is becoming 9. Loss of tolerance for stress
dehydrated. She may even say she is The person with AD loses the ability to
hungry when she is thirsty or she may handle the abundance of information
not remember to ask at all. Dehydra- and stimulation in life. A visit from a
tion is often a problem for people beloved young grandchild may add
with AD. enough noise and chaos to a room to
cause that grandparent to have a loud
Problems in articulation. Humming, outburst.
groaning, or repetitive babbling may
be the limit of the expressive output. 10. Physical problems
Muteness is common toward the end Physical problems (e.g., gait disturbances
of the disease. and dysphagia) are usually not seen until
the late stage of the disease.
Chapter One
AD is a progressive disease and looks different at different times. It is often described as
progressing in stages, although at every stage patients exhibit strengths and weaknesses.
The three stages are early, middle, and late. The following graph compares typical abilities
and weaknesses in each stage. These remaining skills are important to keep in mind as you
plan an intervention approach for those with AD.
Treatment of AD
Stages
Good Although there is currently no cure for AD,
Early
Mildly Middle
there is still much that caregivers and speech
affected Late therapists can do. Many different treatment
strategies are discussed in Chapter Seven,
Affected
pages 59-69. Throughout the course of the
Poor disease, people with AD are more alert,
sociable, and communicative with the proper
Physical Senses Cognition/ Self- Communi-
Abilities Memory care cation
types of support and therapy.
Chapter One
Alzheimer’s Disease: Statistics
Alzheimers disease (AD) is a progressive, degenerative disease of the brain and the most
common form of dementia. Some things you should know about Alzheimers disease:
Approximately 4 million Americans have AD. In a 1993 national survey, 19 million

Americans said they had a family member with AD, and 37 million said they knew
someone with AD.
14 million Americans will have AD by the middle of the next century (2050) unless
a cure or prevention is found.
One in 10 persons over 65 and nearly half of those over 85 have AD. A small
percentage of people as young as their 30s and 40s get the disease.
A person with AD will live an average of 8 years and as many as 20 years or more
from the onset of symptoms.
U.S. society spends at least $100 billion a year on AD. Neither Medicare nor most
private health insurance covers the long-term care most patients need.
Alzheimers disease is costing American business over $33 billion a year $26 billion
is the cost to business of caregiving (lost productivity from absenteeism of employees
who care for family members with Alzheimers); the rest is the business share of the
costs of health and long-term care.
More than 7 of 10 people with Alzheimers disease live at home. Almost 75% of the
home care is provided by family and friends. The remainder is paid care costing
an average of $12,500 per year. Families pay almost all of that out-of-pocket.
Half of all nursing home residents suffer from AD or a related disorder. The average
cost for nursing home care is $42,000 per year, but can exceed $70,000 per year in some
areas of the country.
The average lifetime cost per patient is $174,000.
The Alzheimers Association has granted over $82 million dollars in research grants
(since 1982).
The federal government estimates spending approximately $400 million for Alzheimer
disease research in 1999. This represents $1 for every $250 the disease now costs
society.
The Alzheimers Association is the only national voluntary health organization dedicated
to research for the causes, cures, treatments, and prevention of Alzheimers disease and to
providing education and support services to Alzheimer patients, their families, and care-
givers. For further information on statistics, please contact the Benjamin B. Green-Field
Library at the Alzheimers Association at (312) 335-9602 or [email protected].
Reprinted with permission from the Alzheimers Association

1-800-272-3900
<www.alz.org>
Chapter One
“Tell me where is fancy bred?
Or in the heart or in the head?”
-Shakespeare, The Merchant of Venice
C Possible Causes and Risk Factors

h In 1906, Alois Alzheimer, a neuroscientist in Germany, performed an autopsy
on a female patient. She had been his patient for years as she suffered from
a dementia. When he viewed her brain cells under a microscope, he discov-
ered abnormal cells. Some of the brain cells were large and dark. These he
p called senile plaques. Other brain cells looked like tangled threads. These
he named neurofibrillary tangles. Today physicians speak of the telltale
neuritic plaques and neurofibrillary tangles of Alzheimers disease (AD).
t For thousands of years, people did not understand the importance of the
e brain. The heart, the stomach, and the gut were all thought to control our
thoughts and our emotions. Our language reflects this lack of knowledge.
Our hearts are broken or we have butterflies in our stomach, but in reality
r it is the brain that controls us.
In dementia, different parts of the brain are affected. In order to understand

some of the symptoms observed in dementia, it is necessary to understand
how the brain works. Research in recent years has provided a wealth of
T information on how the brain functions. This knowledge helps us under-
stand the cause of the behaviors and problems exhibited by individuals with
Alzheimers disease and suggests strategies for intervention. This chapter
w briefly summarizes the structures of the brain, the functional organization
of the brain, and how the brain works at the cellular level as known to date.
o Brain Structures
Traditionally, the brain has been divided into six or seven parts whose bor-
ders are determined by some of the grooves (sulci) and ridges (gyri) of the
brain. These parts, which can be viewed with the naked eye, include the
left and right cerebral hemispheres. The two hemispheres are connected
by white fibers called the corpus collosum. The corpus collosum sends
messages back and forth between the hemispheres. Each hemisphere is
divided into the following lobes:
frontal lobe
This lobe is responsible for problem solving, organizing and plan-
ning, emotions, and personality. Here is where our social control
Chapter Two
is found. Our frontal lobe keeps us corpus callosum
from telling dirty jokes to Grandma! hippocampus
temporal
lobe
parietal lobe
This lobe interprets and discriminates
sensory input and body orientation in
space. With a problem in this area, a
person may not recognize a part of
her body or may not be able to write.
cerebellum
occipital lobe
upper part of
This lobe receives and interprets spinal cord brain stem
visual information. People with AD
may get lost in familiar environments There are other structures inside the brain,
because of problems in the parietal- which like the hippocampus, cannot be seen
occipital areas that are responsible from the outside. These include:
for guiding self-movement and
maintaining spatial orientation the limbic system
(Tewetsky and Duffy 1999). This system is thought to be involved
with controlling emotions, memory,
temporal lobe and certain aspects of attention. Some
This lobe receives and interprets audi- structures within this system (e.g., the
tory information. Problems hearing mammillary bodies, the amygdala,
or understanding language can arise and the hippocampus) are involved
from disruption of the temporal lobe. in some types of memory and the
If you peel away the temporal lobe, ability to learn new information.
underneath it youll find the hippo-
campus. The hippocampus is impor- the basal ganglia
tant for new learning and recent These are thought to modulate
memories. If a person has damage movement and integrate sensory
to the hippocampus in both hemi- information.
spheres, she can't learn anything
new. (Hallet 1999). the ventricular system
It is made up of four spaces filled
parietal with fluid within the brain. When
frontal
brain cells are damaged or die (such
as can happen in dementia), the
occipital ventricle spaces get larger.
These structures are made up of small

groups of neuron cell bodies. They help
send information between the higher cor-
temporal cerebellum tex and the lower parts of the brain called
the brain stem.
Chapter Two
The brain stem is made up of three more Only a small portion of the motor strip
parts of the brain: controls arm and leg movements, while
a much larger portion of the motor strip
midbrain controls the movements of hands and
It contains nerve pathways and face which are very important for
auditory and visual reflex centers. communication. The motor strip also
receives information from the senses.
pons
It is a respiratory center of the brain. 2. The Sensory System
Many systems throughout the brain make
medulla oblongata up the sensory system. Two important
It controls the heart, breathing (e.g., systems for speech, language, and com-
hiccups), and the ability to swallow, munication are the auditory and visual
cough, and gag. systems. Visual information is processed
in the back of the brain in the occipital
The cerebellum is sometimes considered a lobe. Auditory information is processed
part of the brain stem. It controls voluntary, in the temporal lobe. Information from
coordinated movement. the sensory system is often compromised
in dementia. The visual and auditory
Brain Functions problems of people with AD will be
discussed in Chapter Five.
Another way to describe how the brain
works is to consider the organization of the 3. The Language System
many different parts, all working together The language system is located almost
toward a particular goal or function. Mod- entirely in the left hemisphere for most
ern imaging techniques (e.g., the PET scan) people. Nancy Andreason, in The Broken
have revealed much information about how Brain, describes neurologist Norman
the brain functions. A PET scan tracks the Geschwind's model for how the lan-
blood flow in the brain and provides visual guage system works. In his model, there
images of areas of the brain activated as the are several specialized centers for
person thinks (Hallet 1999). Disruption of language in the brain.
these interactions can be seen in some of the
problems experienced by people with AD. Brocas area governs grammar and the
organization of words into fluent speech.
1. The Motor System The angular gyrus stores information
The motor strip and premotor strip that recognizes language in visual form
control motor movement throughout the and Wernickes area recognizes language
body. The motor strip is located in the in auditory form. Again, information
frontal lobe. Stimulation to the top of the from PET studies shows that other areas
strip causes movements in the legs, and of the brain are activated depending on
stimulation further down, near Brocas the language task (Fischbach 1992,
area, controls movement of the face, Raichle 1992). (See the illustration on
mouth, and tongue. The basal ganglia the next page.) In patients suffering
and the cerebellum interact with the from dementia, the language system
motor strip to help modulate movement. appears broken.
Chapter Two
5. The Frontal System
The largest part of the brain, the frontal
system, controls planning, organizing,
problem solving, attention, personality,
behavior, and emotions. This system
too is affected in persons with dementia.
Whether the damage is to the frontal
system itself or to the communication
pathways between the frontal system
and other important systems has yet to
be determined.
Activation depending on language task
6. The Neuroendocrine System
This system uses hormones to commu-
nicate with glands throughout the body.
4. The Memory System Aggression, appetite, thirst, sleep regu-
The memory system (or rather systems) lation, and the ability to adapt to stress
is located in many different parts of the and change are controlled by this system.
brain (probably in both hemispheres). Problems with appetite, sleep, and aggres-
This is unique among the systems of the sion are symptoms sometimes seen in
brain. Parts of the brain identified in the people with dementia.
memory system (Andreason 1984)
include: The Cellular Level
the hippocampus How then, do these different parts of the

the mammillary bodies brain and different systems communicate?
the septal region of the limbic system They send messages back and forth through
part of the thalamus the connection of billions of neurons. Chem-
icals in the brain called neurotransmitters are
If one of these parts is damaged on one the messengers. Some neuroscientists have
side, memory can remain. However, implicated a breakdown at the cellular level
damage to these parts on both sides of of the neurotransmitters as a possible cause
the brain destroys memory. of dementia.
The highest concentration of the telltale Neurons have different sizes and shapes
plaques and tangles of AD are found in depending on their jobs. Neurons contain
the hippocampus. To understand how small branches (dendrites) that increase their
the memory system functions, the pro- ability to receive information and long tubes
cess or the "how" may be more important (axons) that send information to other cells.
than the "where" or "what" (Calvin and
Ojemann 1994). The "how" of memory Neurotransmitters are located in tiny sacs
function is discussed in more detail in at the ends of the axons. When an electrical
Chapter Three. impulse travels along an axon, neurotrans-
mitters cross a tiny space or synapse to a
receptor site on the next neuron. Fifty
Chapter Two
neurotransmitters have been identified to the shorter protein beta amyloid (Yan et al.
date. Each neurotransmitter fits into its 1999, Sinha et al. 1999, Vassar et al. 1999).
receptor site like a key in a lock (Hallet All people have beta amyloid, but in people
1999). with AD, beta amyloid is not dissolved as it
is normally; it is clumped together to create
the plaques.
Recent scientific work (Patrick et al. 1999)

has also helped with the understanding of
how tangles are formed. The tau protein
typically serves as a support system within
neurons which helps neurons extend con-
nections to other neurons. Something causes
the protein to disintegrate and break loose
Acetylcholine is a neurotransmitter used in from the neuron and make tangles which
the hippocampus and is thought to aid in results in neuron death. Patrick et al. (1999)
forming memories. Acetylcholine levels are have identified a protein, p25, that converts
sharply reduced in people with AD. Other an enzyme called cdk5 from a benign enzyme
neurotransmitters are also found at lower to a deadly one which destroys neurons.
levels in people with AD, but acetylcholine
is the most reduced. When there are not Understanding how the brain functions and
enough neurotransmitters, nerve cells will, what is going wrong can aid in communica-
over time, deteriorate and die. tion. Unusual behaviors seen in AD can
sometimes be explained by an understand-
Once the neurotransmitter crosses the syn- ing of brain anatomy. For example, vision
apse and attaches to the receptor, it either problems would indicate possible involve-
activates a neuron or passes the message on ment of the occipital lobe. Also a good
to other cells. The message system relies on understanding of brain function can help
different proteins and problems with these us see how much is actually preserved. A
proteins could interrupt the message. Two person who struggles to remember past
proteins, beta amyloid and tau, have been events (episodic memory) may still remem-
discovered to be associated with the plaques ber how to do a physical task (procedural
and tangles found in AD (DeKosky 1996). memory). The different types of memory
The plaques are made up of beta amyloid, a are discussed in the next chapter.
protein fragment, and other proteins. Tau is
found in the tangles. Risk Factors
There are many theories about the role of Not only do we not yet understand the bio-
beta amyloid. It may be toxic to neurons or logical processes underlying AD, we also do
cause certain chemical interactions that are not yet know what causes the disease for
fatal to the neurons. Scientists do know that some people.
beta amyloid is a piece of a larger protein
called amyloid precursor protein (APP). APP Scientists have identified some probable risk
usually helps maintain neurons. Enzymes, factors to developing AD. Risk factors are
called secrateses, have been identified that act behaviors or traits that make a person statis-
as scissors to clip off pieces of APP creating tically more likely than someone without the
Chapter Two
risk factor to develop the disease. Risk fac- syndrome produce extra APP which may
tors are not necessarily causes of the disease. be responsible for the plaques that
No factor has been identified as a definite develop in their brains as they age
cause of AD. Most scientists believe that (Wisniewski et al. 1985).
AD probably has many complex and related
causes: 5. Women
Although more women than men have
1. Advanced age AD, this may or may not be related to
The longer a person lives, the greater the fact that women live longer than men
the risk of developing AD. The figure (Bachman et al. 1992).
rises from 3% of people ages 65-74 with
AD to as many as 48% of people ages 85 6. Head injury
and older (Evans et al. 1989). Head injury which causes a loss of
consciousness (Roberts et al. 1991) or a
2. Family history minor head injury early in life (Schofield
Any close relative (first degree) who et al. 1997) may greatly increase one's
develops AD increases risk. chances of developing AD.
3. Genetics Other risk factors being investigated in-

Abnormalities of genes on chromosomes clude cerebrovascular disease, ethnicity,
1, 12, 14, 19, and 21 have been identified depression, brain tissue inflammation,
that are linked to AD in some way. environmental factors (e.g., exposure to
aluminum), low educational level,
Chromosomes 1 and 14 are thought to antioxidants in the diet, and the use of
be responsible for rare cases of early- estrogen in women (Kuhn 1999).
onset AD.
Although we are unable to control the risk
Alpha-2 Macroglobulin (A2M) is a factors identified to date, further research
gene on Chromosome 12 which is can help us to better understand the nature
possibly responsible for making of Alzheimers disease.
someone susceptible to AD (Blacker
et al. 1998).
The gene apolipoprotein E (APOE)

on Chromosome 19 has three varieties:
e2 (associated with reduced risk), e3
(associated with average risk), and e4
(associated with increased risk) (NIA
1996).
Chromosome 21 has the gene for APP

(see page 18).
4. Down syndrome
Down syndrome is caused by a mutation
of Chromosome 21. People with Down
Chapter Two
“There’s rosemary, that’s for remembrance,
pray you love remember:
and there is pansies, that’s for thoughts.”
-Shakespeare, Hamlet
C
h Memory
A half-remembered name, a misplaced purse, a missed appointment

a everyone has experienced these kinds of memory slips. As people age,
memory lapses of this type become more and more common. Memory has
p been thought of as pictures from the past, stored in a special place in our
brains. This is not the complete story. Memory is not a separate item, but
rather a system of different types of memories underlying our thoughts and
t actions and working together.
e First consider that memories are sometimes defined by the amount of time
they are held in our minds. There are situations in which a phone number
is remembered only as long as it takes us to find it in the phone book and
r walk across the room to dial. When the phone call is finished, all memory
of that number may be gone. This is an immediate memory. Short-term
memory occurs when a student memorizes a long list of vocabulary words
and remembers them long enough to take the test. A few weeks later, the
student is unable to give all the definitions that he knew on the day of the
T test. A long-term memory is typically not forgotten over time. A memory
of the first time you rode a bike or the phone number of your first house
h have been committed to long-term memory.
Memories are also defined by what is remembered. Remembering an event,

r like your birthday party when you were nine, is called episodic memory. In
normal aging, some episodic memory is affected. Details of an event may
not be remembered entirely or may be remembered later. Typically aging
e adults can benefit from memory aids such as notes to remember the details.
In AD, however, entire events are lost. A person with AD may not remem-
e ber an event that occurred just minutes before.
At a nearby assisted living center, the special activity of the day was
a trip to go fishing. The staff prepared the participants for the trip
and all shared a fun and exciting day. The participants returned to
the center to enjoy a fish fry of the fish they had caught. Upon
questioning during dinner, not a single person with AD
remembered that they had gone on the fishing trip.
Chapter Three
Although memory aids for episodic memory that their grandmother with AD could still
may be helpful in the early stages of AD, as play certain melodies on the piano.
the disease progresses, these aids are not as
effective. Working memory (Baddeley 1986) or active
memory is the part of the brain that "focuses
Remembering what something means or the attention, makes decisions, and initiates
concept, schemata, world knowledge, and action" (Bayles 1999). In working memory,
linguistic competence is called semantic there is a reaction to sensory stimulation
memory (Tulving 1972). Lexical memory which is stored for a brief time while the
is the memory of words. The semantic information is sorted out. Working memory
memory system helps us remember what is sometimes referred to as "the scratch pad
a cup is and how it is used or the name of of the mind" (Phillips 1999).
the latest teen movie star. In typical aging,
recalling a word becomes more difficult, Finally we also have different systems for
but the meanings of words are retained. retrieving our memories: recall, recognition,
We might experience frustration in that stimulus-response, and learning by doing
we know the word, but cant quite call it (Bayles 1999). Recall is the most difficult
to mind. Later the word comes to us. way to retrieve. The answer to What is his
name? is a recalled memory. However, if
In AD, semantic memory is also affected. you are asked, Is his name Joe or Sam?
Initially a person with AD can still access you only have to recognize the information
semantic memory with cues. For example, when you hear it. In the stimulus-response
if the person is unable to answer What is a system, something triggers the memory.
chair? he may be able to answer What do Leaving your daily medication in sight by
we sit on? As the disease progresses, this the coffee might trigger you to remember to
ability too is lost. The person with AD will take it when you are making your morning
no longer be able to comprehend written or coffee. Learning by doing is what happens
oral requests or instructions. when we practice something over and over
(e.g., riding a bicycle).
The memory of how to ride a bike or play
a game of cards is called procedural memory How might this all work together? Imagine
(Bayles and Tomoeda 1995). Remembering that you are walking into a room. Your eyes
how a task is performed is basic and auto- see smoke, your nose smells a distinct
matic. We do not need to describe how to burning smell, and your ears hear a loud
do something we just do it. This type of buzzing noise.
memory loss is spared in typical aging and
often not as severely affected in the person All these sensations are stored briefly in your
with AD as semantic and episodic memory working memory. The smoke alarm triggers
until the later stage of the disease. you to think something is burning (i.e., the
stimulus-response system). From your long-
One family reported that a father with AD, term memory (i.e., the episodic drawer), you
who often withdrew from family gatherings, retrieve or recall the memory of the last time
was still able to beat everyone at a game of you forgot to set the timer for cookies and
Hearts, something which he had always how the smoke alarm sounds. From the
been able to do. Another family reported lexical drawer you retrieve the words Burnt
Chapter Three
cookies! From the procedural drawer you retrieve the memory that the last time you burned
the cookies, you turned off the oven, took out the cookies with a hot pad (learning by doing
system), scraped them into the garbage, and put the pan in the sink to soak.
All of these types of memory are called stored memory. How these memory systems work
might look like this:
Nondeclarative
Declarative Fact
Procedural Memory
Memory
lexical motor
procedures
habits
semantic episodic
reflexes
(adapted from Bayles and Tomoeda 1995, Bayles 1999, and Phillips 1999)
Chapter Three
Certain types of memory are more spared in These cognitive capacities work together.
persons with AD (e.g., procedural). These We perceive and attend to the smell of fresh
memory types can be used in therapy and baked bread. We remember this smell from
to facilitate the maintenance of certain daily our childhood. We associate this sensation
living skills. Although a loss of memory is with a bread recipe we want to try soon and
one of the hallmark signs of AD, it is not the we throw back our heads, inhale, and say
only form of cognition that is affected. We mmmm. These events all happen within
must keep in mind, however, that memory milliseconds. Fortunately these cognitive
underlies much of the thinking that people do. capacities do not fail at the same time or at
the same rate. Those skills that remain can
Thought help compensate for those lost.
Thought is also known as cognition. Bayles

and Tomoeda (1997) define cognition as
stored knowledge and the processes for
making and manipulating knowledge.
They list the following as basic cognitive
capacities:
attention
perception
comprehension
association
sequencing
reasoning
symbolization
expression
memory
Chapter Three
“A thought went up my mind today
That I have had before.
But did not finish,—-some way back,
I could not fix the year.
Nor where it went, nor why it came

The second time to me,
Nor definitely what it was,
Have I the art to see.
But somewhere in my soul I know

I’ve met the thing before;
It just reminded me t’was all—
And came my way no more.”
-E. Dickinson
Reprinted by permission of the publishers and the Trustees of Amherst College from The
Poems of Emily Dickinson. Ralph W. Franklin, ed., Cambridge, Mass.: The Belknap Press
of Harvard University Press, Copyright © 1998 by the President and Fellows of Harvard
College. Copyright © 1951, 1955, 1979 by the President and Fellows of Harvard College.
“You see, but you do not observe”—Sherlock Holmes
-Sir Arthur Conan Doyle, Scandal in Bohemia
C Assessment and Diagnosis of AD
h AD is such a devastating disease that it affects every area of a persons life.

Yet in the early stages, it is difficult for families to precisely identify the prob-
a lem. It is not uncommon for families to visit many different kinds of health
care professionals in their search for what is wrong. One family took their
father to an audiologist for a hearing evaluation because of the problems he
p had understanding language. Another man sought and received a diagnosis
of depression from a psychologist. And in another case, a geriatric physician
told a family not to worry about AD because their mothers confused episodes
t were just the result of normal aging. In all three cases, the ultimate diagnosis
was AD. Unfortunately, by that time, the families had experienced quite a bit
e of frustration.
There are several reasons for confusion about AD. First we associate forget-
r fulness with normal aging. Although we all know the 90-year-old woman
who lives alone, drives successfully, manages her finances, and even sends
e-mail to great-grandchildren, we also acknowledge that forgetfulness is
common for the majority of older people.
F When is forgetfulness a problem? One common illustration is that if you

forget where you put your keys, it is probably not a problem (except for the
o moment you need them!). On the other hand, if you forget what a key is for,
then the problem is more severe.
u Another reason for confusion is that by ADs very nature, there are good
days and bad days throughout the course of the disease, even moments of
r lucidity in the final stages of the disease. On the good days, families lull
themselves into thinking the problem has resolved itself and that their loved
one is better.
Another point of confusion for families is that some people who have some
of the symptoms we associate with AD receive the diagnosis mild cognitive
impairment(MCI). People with MCI have a memory impairment that is
different from normal aging, but they do not show the same additional
cognitive problems people with AD have (Petersen et al. 1999). It is not
understood whether MCI is a separate, milder form of forgetfulness or if
the same problem underlies MCI and AD. This question is under scientific
investigation.
Chapter Four
Frequently a caregiver will say, If there is speech-language pathologists
no cure, why do we need a diagnosis? First audiologists
families must realize that there are many ophthalmologists, optometrists,
causes of dementia and some of them are opticians
reversible. What looks like AD to the family physical therapists
may actually be symptoms of dementia occupational therapists
caused by treatable medical problems such
as depression, vitamin deficiencies, hypo- Ripich (1995) suggests a protocol for
thyroidism, or a brain tumor. differential diagnosis and assessment of
symptoms of dementia:
A diagnosis of AD can also explain the symp-
toms. One caregiver stated, I was actually 1. case history
relieved to finally get the diagnosis. I knew 2. medical evaluation
something was wrong and I was beginning 3. behavioral assessment (behavior rating
to think that I was crazy! scales and neuropsychological tests)
4. language and communication assessment
A diagnosis can also lead to appropriate med-
ical treatment. Although there is no cure, Case History
there are drug treatments available to slow
the progress of the disease for some people, A careful case history can be taken from
particularly in the early to middle stages. either the person being tested or a family
member or caregiver familiar with the per-
Finally a diagnosis of AD lets the families sons background information. A typical
know that they need to plan carefully for case history includes information about
the future (Kuhn 1999). There is more infor- current mental and physical functioning,
mation on the need for family planning in prescription drugs, and family history. A
Chapter 8. case history for possible AD will also include
information on education level, job history,
AD is a complex condition to diagnose. It and specific information about changes in
has an impact on cognitive, communication, personality, memory, self-care skills, and
and social factors of a persons life. It can speech and language.
only be definitively confirmed when an
autopsy reveals the hallmark plaques and The Alzheimer Dementia Risk Questionnaire
tangles. And yet a probable diagnosis is (Breitner and Folstein 1984) is an example
confirmed 85% of the time with careful of a case history that gathers complete
medical evaluation. information.
Because of the diffuse and complex symp- PRECAUTION: Healthcare professionals

toms seen in dementia, the information should be sensitive to previous experiences
gathered by a multi-disciplinary team is of the families. One caregiver, who had
necessary for diagnosis and treatment. The been in the course of a few months to
medical and health professions that can 1) the family doctor, 2) two neurologists,
3) an optometrist, 4) an ophthalmologist,
contribute to the assessment process are: 5) an audiologist, and 6) a speech-language
physicians pathologist, said, If one more person asks
nurses him what town we are in or to count by 7,
psychologists I am going to scream!
Chapter Four
Medical Evaluation 3. Neurological Examination
Speech; sensory function; and muscle
Medical evaluations can be completed by coordination, tone, and strength are
the patients primary physician. Other physi- evaluated. Neurological problems such
cians experienced with AD include neuro- as Parkinsons disease or stroke can
logists, geriatric specialists, and psychiatrists. cause symptoms of dementia. The
Steps in the medical evaluation include: neurological examination can help
differentiate between a stroke and AD.
1. Mental Status
The physician first completes a screening 4. Brain Scans
of the patients mental status: memory, These tests are sometimes part of the
receptive and expressive language, and medical evaluation. These scans allow
simple calculations. This exam also takes physicians to examine areas that are not
into account educational background. visible with conventional X rays. CT
Speech-language pathologists routinely scans and MRIs are the more commonly
use mental status tests. Some mental used brain scans.
status tests commonly used include:
CAT or CT (computerized axial
Clinical Dementia Rating (CDR) tomography). An X-ray beam is
(Hughes et al. 1982). Evaluates pointed at part of the body and a
orientation, memory, judgment, computer analyzes the tissue density.
problem solving, home and hobbies, This information can help detect a
and personal care. Scored from 0 possible brain tumor as well as
(normal) to 3 (severe dementia). changes in the brain as seen in
Huntingtons disease and Picks
Mini-Mental State Examination disease.
(Folstein, Folstein, and McHugh
1975). Screens a persons orientation MRI (magnetic resonance imaging).
(e.g., person, place, time, memory, Large magnets create a magnetic field
language, copying ability). Scored and then a computer sends radio
from 1 to 30. Bayles and Tomoeda waves to the body and analyzes the
(1995) recommend that an abnormal cells responses. A three-dimensional
score is 24 and below. picture of the inside of the body is
produced. An MRI can detect tumors,
2. Physical Examination strokes, inflammations, infections, and
Certain laboratory tests to rule out the degenerative disease. People with
possibility of diseases which produce pacemakers or other magnetic im-
AD-type symptoms (e.g., cardiac disease, plants are not allowed to undergo
thyroid disease, metabolic problems, MRI testing.
anemia, diabetes, infection) are typically
completed. These could include both PET (positive emission tomography).
blood and urine tests. The persons Radioactive materials are used to
nutritional status and blood pressure measure glucose and oxygen meta-
are also evaluated. bolism of different areas of the brain.
A PET can differentiate AD from
Chapter Four
depression. This test is very expensive Dementia Due to Other Medical
and used predominately in research. Conditions
SPECT (single photon emission All the dementia categories above share
computed tomography). This test common characteristics:
measures regional cerebral blood
flow (rCBF) and is thought to be a memory impairment
less expensive substitute for PET. A cognitive disturbances
SPECT image is quite colorful with impairment of social or occupational
red and white in the regions of high functioning that represents a decline
blood flow and blue in the regions of from the previous level
lowest blood flow. Different types of
blood flow are seen in dementia with The categories differ primarily in the cause
different causes (Weiner, Tintner, and of the dementia. These differences are listed
Bonte 1996). below:
Once all other possible medical causes have Dementia of the Alzheimers Type
been ruled out, the physician may diagnose gradual onset
probable AD. This type of diagnosis is continuous decline
called an exclusionary diagnosis. The ex- no evidence of central nervous sys-
clusionary nature of the diagnosis of AD is tem damage, systemic conditions,
demonstrated in the Diagnostic and Statistical (e.g., folic acid deficiency) or
Manual of Mental Disorders, Fourth Edition substance abuse
(DSM-IV). The DSM-IV (1994) is a system
for differentiating between mental disorders. Vascular Dementia
It is organized around five axes: symptoms of CVA (e.g., gait abnor-
malities, extremity weakness)
Clinical Disorders laboratory evidence of CVA (e.g.,
Personality Disorders/Mental multi-infarctions involving the cortex)
Retardation
General Medical Conditions Dementia Due to Other Medical
Psychosocial and Environmental Conditions
Problems evidence from history, medical exam-
Global Assessment of Functioning ination, or laboratory findings of other
conditions which result in dementia
Dementia is located along Axis I: Clinical such as:
Disorders, but may also be found on Axis III:
General Medical Conditions, depending on HIV
the cause of the dementia. Each diagnostic Head trauma
category (e.g., Dementia) is further divided Parkinsons disease
into subcategories based on diagnostic cri- Huntingtons disease
teria. Subcategories of dementia include: Picks disease
Other medical conditions
Dementia of the Alzheimers Type (e.g., brain tumor)
Vascular Dementia (sometimes still
called Multi-Infarct Dementia)
Chapter Four
Behavioral Assessment person with dementia actually functions in
daily life skills and describe how severely
Behavior evaluations are used to measure the person is affected. Behavior rating scales
functional loss and abilities in people with include:
dementia as they relate to daily living
activities (e.g., self-care, grocery shopping, Dementia Rating Scale (DRS), also
taking medicine, using a calendar). Speech- called (MDRS) (Mattis 1976). The
language pathologists should know about DRS evaluates attention, initiation
behavioral tests and rating scales because: and perseveration, construction,
conceptualization, and memory. Its
they help predict how the dementia useful in later stages of the disease.
may progress.
Global Deterioration Scale (GDS)
they describe the patients full range (Reisberg et al. 1982). The GDS
of behavior function which is useful contains characteristics of seven
when completing the communication stages including clinical descriptions
assessment. ranging from normal to late dementia.
It includes detailed descriptions of
they can support and aid interpreta- how a person functions at each stage.
tion of speech and language findings
(Ripich 1995). Functional Assessment Stages (FAST)
(Reisberg et al. 1984). This scale has
Neuropsychological Tests sixteen stages that correspond to the
GDS. Daily function is evaluated.
These tests measure cognitive function. The
National Institute of Neurological and Com- Brief Cognitive Rating Scale (BCRS)
municative Disorders and Stroke (NINCDS) (Reisberg 1983). The BCRS evaluates
and the Alzheimers Disease and Related five categories (axes):
Disorders Association (ADRDA) recommend
neuropsychological assessment as an impor- 1) Concentration and Calculating
tant part of the diagnosis of persons with Ability
dementia (McKhann et al. 1984). In addition 2) Recent Memory
to assessing intelligence and memory, infor- 3) Remote Memory
mation should be gathered on attention, 4) Orientation
perception, praxis, reasoning, and language 5) Functioning and Self-Help
(Bayles and Tomoeda 1995).
Language and Communication Assessment
Behavior Rating Scales
Evaluation of communication and language
Neuropsychological tests provide information skills should always be an important com-
necessary for the evaluation of dementia; ponent of a diagnosis of AD. For example,
however, they say little about how well the at the Callier Center for Communication
person with dementia functions. Behavior Disorders (University of Texas at Dallas),
rating scales (also called dementia rating Sandra Chapman and her colleagues are an
scales) can provide information on how the important part of the diagnostic team that
Chapter Four
provides a differential diagnosis of dementia. 6) word reading and comprehension
Their work on macro and micro level analy- 7) answering questions
sis of discourse is revealing that subtle dif- 8) reminiscing
ferences in discourse ability may be useful 9) pantomime
in distinguishing between normal aging, 10) conversation
persons with AD, and persons with MCI
(Chapman et al. 1999). Scales of Adult Independence, Language,
and Recall (SAILR) (Sonies 1999). The
What should the assessment battery for SAILR compares responses to family
dementia contain? Bayles and Kaszniak interviews and client interviews. It
(1987) suggest measurement of: provides information on functional
independence.
semantic memory
inference/generalization Severe Impairment Battery (SIB)
discourse (Saxton et. al. 1993). This test
pragmatics, semantics, syntax, and analyzes attention, praxis, con-
phonology struction, naming, visuospatial
communication perception, orientation, memory,
and social skills.
A sample of tests available that meet this
protocol include those specifically designed Although not standardized for use with
for use with patients with dementia: persons with dementia, some examples
of tests which provide information about
Arizona Battery for Communication language abilities, semantics, phonology,
Disorders of Dementia (ABCD) (Bayles and syntax can be found on the next page.
and Tomoeda 1993). The ABCD is
standardized for mild to moderately
impaired persons. It evaluates mental
status, verbal learning and memory,
language comprehension and expres-
sion, and visuospatial construction.
Subtests may be administered sepa-
rately, depending on the information
needed.
Functional Linguistic Communication

Inventory (FLCI) (Bayles and Tomoeda
1994). The FLCI evaluates commu-
nication in moderately to severely
impaired persons. It assesses:
1) greeting and naming
2) writing
3) following commands
4) gesture
5) sign and picture comprehension
Chapter Four
Measure Information
Boston Diagnostic Aphasia Examination (BDAE) expressive and receptive language

(Goodglass and Kaplan 1983)
Western Aphasia Battery (WAB) expressive and receptive language

(Kertesc 1980)
Peabody Picture Vocabulary Test semantics (comprehension)

(Dunn and Dunn 1981)
Boston Naming Test semantics (confrontational naming)

(Kaplan, Goodglass, and Weintraub 1983)
Token Test syntax

(DeRenzi and Faglioni 1978)
Information about the clients reading ability is useful in planning possible intervention
techniques. Reading can be assessed using:
Reading Comprehension Subtest of the ABCD

Literacy Screening (page 36)
Informal assessment tools can provide diagnostic information and identify preserved abilities
that can be used for therapy. The following forms are provided on pages 32-39.
Discourse Checklist Procedural Discourse Analysis

Literacy Screening Delayed Story Retelling Analysis
Summary
As we have seen, the road to a diagnosis of Alzheimers

disease can be a long and winding one for the persons
affected and their families. People with the symptoms
of dementia often merge onto the diagnosis highway at
many different points. An SLP may be the first pro-
fessional approached due to the pervasive language and
communication problems experienced. Or an SLP may
see a family after they have become exhausted (and at
times, confused) by all the other experts they have seen.
The information in this chapter can serve as a road map
to families. SLPs are the perfect professionals to clarify
diagnostic questions that arise.
Chapter Four
Discourse Checklist
Name: ___________________________________________ Date: __________________________
Activity: _________________________________ Setting: ________________________________
Observation Time: ________________ minutes
Instructions: Check the discourse skill observed.
Discourse Skill Yes No Sometimes N/A
Initiation
Gains attention
Greets others
Asks questions
For information
For clarification
For action
Topic Maintenance
Responds to questions
Clarification
Elaboration
Eye Contact
Turn-taking
Easily interrupted
Interrupts others
Long speaking turns
Nonverbal
Proximity
Too far
Too close
Nods head to acknowledge
Gets attention (points, touches other)
Comments: ________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Chapter Four
Discourse Checklist (Sample)
Name: ___________________________________________
Katherine M. 3/15/00
Date: __________________________
Activity: _________________________________
Reminiscence group Setting: ________________________________
seated around table
Observation Time: ________________
15 minutes
Instructions: Check the discourse skill observed.
Discourse Skill Yes No Sometimes N/A

Initiation
Gains attention ✔
Greets others ✔
Asks questions
For information ✔
For clarification ✔
For action ✔
Topic Maintenance
Responds to questions ✔
Clarification ✔
Elaboration ✔
Eye Contact ✔
Turn-taking
Easily interrupted
Interrupts others ✔
Long speaking turns
Nonverbal ✔
Proximity
Too far
Too close
Nods head to acknowledge
Gets attention (points, touches other)
Comments: ________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Chapter Four
Procedural Discourse Analysis
Name: ___________________________________________ Date: __________________________
Instructions: Read the prompt provided (or one of your choosing). Record the patients
response. Identify the steps needed to correctly answer the prompt. Count the
steps actually given by the patient. Analyze the ratio of nouns and verbs used.
Assess fluency and word finding.
Tell me how to make pancakes.
Patients Response:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Ratio of steps included to actual number of steps: ________________
Fluency (circle): Good Average Fair Poor
Word Finding (circle): Good Average Fair Poor
(adapted from Chapman et al. 1999)
Chapter Four
Procedural Discourse Analysis (Sample)
Name: ___________________________________________
James Davenport 5/20/00
Date: __________________________
Instructions: Read the prompt provided (or one of your choosing). Record the patients
response. Identify the steps needed to correctly answer the prompt. Count the
steps actually given by the patient. Analyze the ratio of nouns and verbs used.
Assess fluency and word finding.
Tell me how to make pancakes.
Patients Response:
Well, I never made pancakes too much. Here’s what I do. You need1eggs,
_____________________________________________________________________________
2 3 4
_____________________________________________________________________________
flour, and milk. Put them in the pan . . . just a little bit. That would cook
them, right? How many do you need? You need a thing, oh, a thing to make 5
_____________________________________________________________________________
6
_____________________________________________________________________________
them go over. You can put them on a plate to eat.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
6/13
Ratio of steps included to actual number of steps: ________________
Fluency (circle): Good Average Fair Poor
Word Finding (circle): Good Average Fair Poor
(adapted from Chapman et al. 1999)
Chapter Four
Literacy Screening
Instructions: Cut and fold the page where indicated to create a small book. Staple the left edge. Give the book
to the client. Note if the client turns the pages. Record any comments the client makes which
indicate he/she read the sentence. Note if one font size is easier for the client to read.
3 2
My dogs name is Spot. I live in Sterk.
(Fold 1)
I have a lion. My name is Nof.

(Fold 2)
4 1
✃ (Adapted from Bourgeois 1999)
Chapter Four
Delayed Story Retelling
Instructions: Read this fable to the patient. Then have the patient immediately retell the
story. Ask the patient to give the moral of the fable. Then have the patient
retell the story after a 20-minute delay. Record the patients responses on the
analysis sheet, page 38. Details the client needs to remember are numbered.
Count remembered details in each retelling.
The Fox and the Grapes

1
One afternoon a fox was walking
2 3
through the forest and spotted a
4
bunch of grapes hanging from a lofty
branch.
5
Just the thing to quench my thirst,
he said.
Taking a few steps back, the fox

6 7 8
jumped and just missed the hanging grapes. Again the fox took a few paces back and
9
tried to reach them, but still he failed.
10 11 12
Finally giving up, the fox turned up his nose and said, Theyre probably sour
13
anyway and proceeded to walk away.
(The moral is listed for your use only, not the patients.)
Moral: Its easy to despise what you cannot have.
Chapter Four
Delayed Story Retelling Analysis
Name: _____________________________________________ Date: ________________________
Immediate Retelling: ________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
/13
Details remembered: __________
Moral: ____________________________________________________________________________
___________________________________________________________________________________
Delayed Retelling: _________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
/13
(Adapted from Chapman et al. 1999)
Chapter Four
Delayed Story Retelling Analysis (Sample)
Name: _____________________________________________
Sam R. 7/3/00
Date: ________________________
1 2
Immediate Retelling: ________________________________________________________________
One day a fox saw some grapes on a tree. He wanted them ‘cause
3 4 5
___________________________________________________________________________________
he was thirsty. He jumped and jumped, but he couldn’t get them. He gave up
6
___________________________________________________________________________________
because they were sour and rotten. It’s not good to leave fruit on the vine when it’s
___________________________________________________________________________________
time to harvest. Birds eat grapes.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
6/13
Moral: ____________________________________________________________________________
You should always keep trying.
___________________________________________________________________________________
Delayed Retelling: _________________________________________________________________

A fox wanted some, some, . . . they were a fruit. I don’t know any
more.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
1/13
(Adapted from Chapman et al. 1999)
Chapter Four
“Tis in my memory locked, and you yourself shall keep
the key of it.”
-Shakespeare, Hamlet
C Communication
h Did you see those leaves? They turned into squirrels and flew away. The
loss of language that is seen in people with AD is one of the most difficult to
a accept. The progressive deterioration from an occasional lost word in the
early stages to the silence or gibberish in the final stages is frustrating to
both the person with AD and the caregivers. It may seem that the language
p is locked with no key to be found. What families do not always realize is
that although the verbal language is fading, there remain many other natural
t and effective ways for a person to both express his thoughts and understand
what another is trying to say. The key for understanding is communication.
e There are several important concepts to remember when considering

communication:
r Two people are needed for communication: the person with the
message and the person who receives the message. The two
participants are constantly switching roles. One sends, the other
receives and then the roles are switched.
F The sender has a reason to communicate. This is called the intent,

the function, or the why of the message. We communicate to share
i information, to ask for something, to reject something, and to take
part in social interactions. These reasons to communicate are seen
v even in very young children with only emerging language (Bruner

1981) and continue throughout a persons life.
e The sender has a way to communicate (the form of communication).

Speech, gestures, sign language, and writing are forms that are fa-
miliar to everyone, but these are not the only ways to communicate.
Vocalizing, looking, pointing, giving, photographs, line drawings,
crying, whining, head or shoulder shaking, grimacing, aggression,
and tantrums are all forms of communication.
Chapter Five
As the disease progresses, the caregiver needs
to take a larger role in the communication
event. The caregiver can interpret nonverbal
communication, change the way he talks,
and/or change the environment to aid
communication.
Talking Techniques to Aid Verbal

Comprehension
One of the easiest ways to help a person

Reprinted with permission from K. Harrington, For Parents with AD understand the conversation is
and Professionals: Autism in Adolescents and Adults, to use peoples names or nouns instead of
East Moline, IL: LinguiSystems, Inc. 2000.
pronouns. Compare the differences in these
two conversation samples:
A breakdown in communication is often at
the root of problems experienced by care- I couldnt believe it! She told her
givers and those with AD. Communication boss that he was out of line when he
breakdowns can be at best, irritating, and asked her to work late.
at worst, catastrophic. Situations that are I couldnt believe it! Mary told her
considered communication breakdowns boss, Mr. Jones, that he was out of line
include repetitive talking, resistance or when Mr. Jones asked Mary to work
refusal to a request, crying out, screaming, late.
moaning, and other catastrophic events
(Santo Pietro and Ostuni 1997). Chapter Six, Substituting the name of the individual for
pages 51-58, discusses communication break- the pronoun clarifies the subjects of the
downs in more detail. conversation. Along the same lines, it helps
to substitute the name of an object for the
Good communication techniques can often pronoun it:
prevent or avert a communication break-
down. Remember, both the person with AD Bring me the cup is easier to
and the communication partner have these understand than Bring it to me.
multiple ways available to them to send
Another way to aid comprehension is to use
information.
simple, less abstract vocabulary:
In the early stages of the disease, the person I was surprised! Mary told her boss,
with AD can help with communication. He Mr. Jones, that he was wrong when
probably knows the easiest listening and Mr. Jones asked Mary to work late.
understanding situations. Noisy or dis-
tracting environments should be avoided. Easier still is to use short, simple sentences
Helping the communication partner by instead of long, complex sentences to express
saying, I dont understand or providing the same ideas:
clues such as, Say it again, please or
Mr. Jones told Mary to work late.
Slower, please helps keep the commu-
Mary was mad. Mary told Mr. Jones
nication going.
he was wrong. I am surprised!
Chapter Five
Using a different example, remember that An either/or question limits the over-
sentences with an active voice are easier to whelming range of responses to two.
understand than sentences with a passive Similarly, the format of yes/no questions
voice: provides information which scaffolds the
response of the person with AD to a correct
The car hit the dog. (active) answer.
The dog was hit by the car. (passive)
What did you do last night?
One of the most difficult parts of under- (harder)
standing a flowing conversation between
two or more people is the way conversation Did you go to the movies last night?
naturally shifts from topic to topic. A (easier)
communication partner can inform the
person with AD of the topic (e.g., Dad, Another way to use questions to aid verbal
were talking about the beach trip.). expression is to ask relevant questions to
keep the person with AD from losing track
Comprehension Techniques of what he is saying.
names, not pronouns
concrete vocabulary I went to coffee and Sue was
short, simple sentences therethose flowersglory!
active, not passive voice Yesterday I sure did
state the topic of conversation
(adapted from Rau 1993) Relevant question: Did you have coffee
at the center?
Many people with AD can (and want) to
continue to take part in conversations. I had coffee at the center with Sue
Stating the topic or reminding them of the and Jill.
topic reduces the chances of an embarrassing
off-topic comment and increases the chances Relevant question: Is Sue retiring from
of continuing conversation. work?
Talking Techniques to Aid Verbal Yes, Sue is retired now.

Expression
Being the communication partner can be
Communication partners can also structure a challenging dance. The partner must
their language in a way to increase the balance between allowing enough time for
verbal expression of a person with AD. the person with AD to process the previous
The form of the question can have a marked statement or question and reminding the
effect on the response. Which question is person of the topic at hand. Count to 10
easier to respond to? saying, 1 Mississippi, 2 Mississippi, . . .
10 Mississippi. Ten seconds can seem an
What do you want for breakfast? eternity in a conversation, but that is the
amount of time that the person with AD
Do you want cereal or toast for may need to process before speaking.
breakfast?
Chapter Five
Other techniques such as a topic reminder, a Nonverbal Communication
summary, or a rephrase of the message heard
can bring the speaker back to the topic and Nonverbal communication such as body
reduce confusion to both communication language and expression (i.e., how things
partners. are said; the pitch, volume, and intonation)
account for approximately 93% of any
Finally the communication partner needs message (Devito 1993).
to realize the joy of reminiscence. Remini-
scence (sometimes called recollection or Other nonverbal signals include:
remembrance) is when a person looks back
facial expressions: What emotion is
at past events in his life (Harris 1998).
showing on the face?
Persons with AD who can no longer discuss
what happened yesterday or an hour ago body position: How close are the
due to short term memory loss can still take communication partners standing to
part in conversation about events that each other? Are they at eye level or is
happened long ago. one person above or below the other
person?
Reminiscence is an important tool for
another reason. Caregivers can record the body orientation: Are the partners
stories told by the person with AD during facing each other or turned away?
reminiscence sessions early in the disease. gesture: Are there hand or arm
In the later stages, caregivers can use these movements with the message?
same stories as possible conversation topics How many?
or they can simply read the stories to the
person with AD when words are no longer touch: Is one partner touching the
possible. other with the message? Is it gentle?
How expressive are the gestures?
Time spent visiting with a person in the (adapted from Santo Pietro and Ostuni 1997)
late stages of the disease can be difficult
for families to endure because of the silence Mace and Rabins (1989) encourage care-
and non-responsiveness of their loved one. givers to supplement their speech with
Reading favorite stories from the life of the body language (e.g., pointing and nodding).
person with AD helps to fill the silence and
creates a time of sharing. Environmental Changes to Aid
Communication
Expression Techniques
Communication does not happen in empty
Say it a different way. space. We are all constantly surrounded and
Allow processing time. bombarded by sensory information coming
Topic reminders.
in from the environment around us. When
Relevant questions.
we are healthy, we are able to filter out what
Y/N or either/or questions.
Reminisce! is unimportant in the incoming signal and
(adapted from Rau 1993) zero in on what is important.
This skill is increasingly difficult for the

person with AD as the disease progresses.
Chapter Five
The environment around people with AD visual
may directly influence communication. Too auditory
much stimulation can become very stressful; tactile/olfactory
but too little stimulation can have a negative
effect also. The person with AD is in the Visual
middle of a seesaw. If the balance is correct,
he will be the most successful. Too much In addition to normal changes in the eye
stimulation and the person with AD slides which occur with aging, people with AD
into an overwhelming atmosphere. may have problems with depth perception
(Calkins and Chavitz 1996). They may also
have difficulty understanding patterns, signs,
words, and objects that they see. It has been
suggested that visual problems account for
some of the disorientation seen in people
Too little stimulation and the person with with AD (Tetewsky and Duffy 1999).
AD slides into isolation and withdrawal.
First consider the individual with AD. Has
he had an eye examination within the last
two years? If the person with AD has
glasses, does he wear them? Visual acuity
The Perfect Balance should always be addressed.
Environmental factors which contribute to

visual problems include glare, reflections,
insufficient light, uneven light, insufficient
visual contrast between two items (e.g., the
cup on the counter, the printed word on a
Evaluating the Environment page), and visual clutter.
Glare is caused when a direct source
If communication breakdowns are reported,
of light (e.g., sunlight, artificial light)
it is helpful to re-evaluate the environmental
bounces off a hard surface (e.g., vinyl
stimulation occurring. Environmental factors
floors, tabletops, windows) and
can be positive (smell of bread) or negative
restricts vision. Glare can be con-
(a blaring radio). Negative environmental
trolled by adjusting the light source.
factors can increase stress and interfere with
For example, you can adjust sheers,
communication. Positive factors, on the other
curtains, shades, or blinds on win-
hand, can calm or decrease stress and at
dows; adjust interior lights at the
times, facilitate communication. Whether the
switch; or use different light wattage.
person with AD is at home or in a facility,
You can also control glare by changing
these factors need to be considered.
the reflective surface (e.g., adding
tablecloths to shiny tables).
Environmental checklists for use at home or
in a facility are found on pages 47-50. The Hard shiny surfaces also contribute
questions are organized by these factors in to reflections. Windows can create
the environment: reflections when the light inside is
brighter than the light outside.
Chapter Five
Reflections from windows and mirrors light in a room brighter can also help
can be very distracting to a person with increase the contrast.
AD. The same treatments that help
control glare in a room can reduce win- Visual cues to aid communication are dis-
dow reflections. You might consider cussed more completely in Chapter 7.
covering a mirror or removing it from
the wall. Auditory
Insufficient light in a room can cause
As people age, their auditory acuity dimi-
dark, shadowy areas in the corners of
nishes. This is no different for people with
rooms. Some of the confusion caused
AD. In fact, people with dementia have a
in sundowning could be the result of
higher prevalence of hearing loss than
too little light in a room as the sun
normally aging individuals (Weinstein 1995).
goes down. (Sundowning refers to
In addition, people with AD may have
the increased restlessness and/or
problems processing speech (Grimes 1995).
agitation in a person with AD which
A person who uses hearing aids prior to the
is frequently seen in late afternoon or
onset of AD should continue to wear them,
early evening.) Placing several lamps
just as a person would continue to wear
around a room rather than relying on
glasses after the onset of AD.
one central light can reduce shadows.
Halogen lamps with 300- or 500-watt
What about a suspected hearing loss in a
halogen bulbs aimed at the ceiling
person with AD? A person with AD can
increase the amount of non-glare light
take part in an audiological evaulation with
in a room (Calkins and Chavetz 1996).
modifications (Weinstein 1995).
Two-color factors are also important
in the visual environment. Why are SLPs should be aware of the possibility of
school busses yellow and stop signs hearing loss in people with AD and that the
red? We know that people more use of personal hearing aids is not always
easily see red and yellow. successful in newly diagnosed hearing
losses. However, many other options are
Color contrast between objects occurs available to help the person with hearing
when the outline of an object stands loss. Assistive listening devices can amplify
out against its background due to a sound, provide close captioning, or add
difference in color. Monotone colors visual or tactile cues to sound. Some
in a room reduce the outlines that can examples of assistive listening devices are
be seen between objects. A white pictured below.
plate against a red or other dark cloth
at the table is easier to see than a dark
colored plate against a dark tabletop.
Contrast is also a factor in written or
visual prompts. The printed message
should strongly contrast against the
paper its written on. A reminder note
written in pencil will be more difficult
to read than the same note written
with heavy, black lines. Making the
Chapter Five
Environmental modification can aid auditory suggested whenever possible to use with the
comprehension even if there is no diagnosed Conversation Topics, pages 102-155.
hearing loss. Background noise from radios,
TVs, and appliances should be reduced or The Communication Key
controlled. Sound bounces off hard walls
and floors and can create a difficult listening The benefits of good communication skills
situation. Materials such as carpeting on the and successful communication partners for
floor or acoustic tiles on the walls or ceilings people with AD are immeasurable. An ability
can reduce sound reverberations. to communicate enables people with AD:
to maintain a sense of identity.
Tactile/Olfactory
to continue to take part in their own
Things you can touch or that touch you care, through the ability to give and
affect communication both negatively and receive information.
positively. An unpleasant feeling fabric
against the skin or an itchy tag on the back to relieve loneliness and express fear
of the neck may be the cause of unhappiness and anxiety.
in a person with AD. Conversely, a firm, to become a good communication
strong touch alerts a person that you are partner for others.
near and ready to communicate. It is better
to touch the person once you are in sight. to increase cognitive stimulation for
An unexpected touch from behind can startle those with AD.
the person and provoke a negative reaction. (Lubinski 1995)
A light touch is also sometimes unsettling.
Communication skills for persons with AD
Things you can touch help support language and their caregivers is a key to unlocking
comprehension and prompt verbal expres- some memories, increasing verbal compre-
sion in therapy sessions. Objects to touch hension and expression, and understanding
can also be used in natural communication problem behaviors.
settings. For example, a cup can be a prompt
that it is time to get a drink; a basket of clean
towels can be a prompt that it is time to fold
the laundry.
Things you can smell can have either a

negative or positive effect on communi-
cation. Unpleasant odors can distract or
upset. Some smells have very strong
associations for people and can evoke
memories. A sensory stimulation program
for treatment of persons with late stage
dementia includes the use of aromas
(Whiteside and Zimmerman 1998).
Objects to hold and objects that have aromas

with strong associations to events have been
Chapter Five
Home Environmental Checklist
Room ____________________________________ Date ___________________________
Yes No
Visual
Is there glare from windows or lightbulbs without shades?
Are there dark corners in the room?
Is there more than one light source in the room?
Are there curtains on the windows?
Is there contrast between the chairs and floor, plates and table?
Are rooms, drawers, and cabinets labeled with words or pictures?
Is there pleasant visual stimulation at eye level?
Auditory
Is there too much noise from TVs or radios?
Is the floor carpeted to muffle noise?
Is it a noisy time of year? (e.g., extra people or children in the home)
Is there noise from appliances? (e.g., dishwasher, washing machine)
Is there outside noise? (e.g., lawnmower, leaf blower)
Tactile/Olfactory
Are hazardous items removed?
Are appropriate items to handle available?
Are there a variety of textures in the room?
Are room odors pleasant?
Space
Is furniture arranged to support communication?
Are there quiet places for conversation?
Ways to Improve the Communication Environment:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Chapter Five
Home Environmental Checklist (Sample)
Room ____________________________________
linving room 10/04/01
Date ___________________________
Yes No
Visual
Is there glare from windows or lightbulbs without shades? ✔
Are there dark corners in the room? ✔
Is there more than one light source in the room? ✔
Are there curtains on the windows? ✔
Is there contrast between the chairs and floor, plates and table? ✔
Are rooms, drawers, and cabinets labeled with words or pictures? ✔
Is there pleasant visual stimulation at eye level? ✔
Auditory
Is there too much noise from TVs or radios? ✔
Is the floor carpeted to muffle noise? ✔
Is it a noisy time of year? (e.g., extra people or children in the home) ✔
Is there noise from appliances? (e.g., dishwasher, washing machine) ✔
Is there outside noise? (e.g., lawnmower, leaf blower) ✔
Tactile/Olfactory
Are hazardous items removed? ✔
Are appropriate items to handle available? ✔
Are there a variety of textures in the room? ✔
Are room odors pleasant? ✔
Space
Is furniture arranged to support communication? ✔
Are there quiet places for conversation? ✔
___________________________________________________________________________________
Need more light in living room (2 more lamps?)
___________________________________________________________________________________
Shut kitchen door when running dishwasher.
___________________________________________________________________________________
Put pictures of grandkids on wall by couch.
___________________________________________________________________________________
Chapter Five
Facility Environmental Checklist
Name/Facility _________________________________________ Date _____________________
Yes No
Visual
Is there glare from windows or lightbulbs without shades?
Are floors and furniture contributing to glare?
Is there diffused lighting in the area?
Can the light source be adjusted?
Are there curtains on the windows to reduce reflections?
Is there contrast between chairs and floor, plates and table?
Do pictures, colors, or patterns label different areas?
Is printed information at eye level and well contrasted?
Is there pleasant visual stimulation at eye level?
Auditory
Is there too much noise from TVs or radios?
Is there too much noise from institutional appliances?
(e.g., ice machines, floor buffers)
Do hard surfaces (e.g., floors, walls, windows, ceilings) have any
acoustic treatment to reduce sound?
Are PA systems or alarms too loud?
Is there pleasant auditory stimulation available?
(e.g., appropriate music, tapes of bird songs, ocean noises)
Are there quiet areas for conversation?
Tactile/Olfactory
Are hazardous items removed?
Are appropriate items to handle available?
Are there a variety of textures in the room?
Are room odors pleasant?
Space
Is furniture arranged to support communication?
Are there quiet places for conversation?
Is there enough seating for visitors?
Are activity areas accessible?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Chapter Five
Facility Environmental Checklist (Sample)
Name/Facility _________________________________________ Date _____________________
Yes No
Visual
Is there glare from windows or lightbulbs without shades? ✔
Are floors and furniture contributing to glare? ✔
Is there diffused lighting in the area? ✔
Can the light source be adjusted? ✔
Are there curtains on the windows to reduce reflections? ✔
Is there contrast between chairs and floor, plates and table? ✔
Do pictures, colors, or patterns label different areas? ✔
Is printed information at eye level and well contrasted? ✔
Is there pleasant visual stimulation at eye level? ✔
Auditory
Is there too much noise from TVs or radios? ✔
Is there too much noise from institutional appliances?
✔
(e.g., ice machines, floor buffers)
Do hard surfaces (e.g., floors, walls, windows, ceilings) have any
✔
acoustic treatment to reduce sound?
Are PA systems or alarms too loud? ✔
Is there pleasant auditory stimulation available?
✔
(e.g., appropriate music, tapes of bird songs, ocean noises)
Are there quiet areas for conversation? ✔
Tactile/Olfactory
Are hazardous items removed? ✔
Are appropriate items to handle available? ✔
Are there a variety of textures in the room? ✔
Are room odors pleasant? ✔
Space
Is furniture arranged to support communication? ✔
Are there quiet places for conversation? ✔
Is there enough seating for visitors? ✔
Are activity areas accessible? ✔
___________________________________________________________________________________
Put in request to maintenance for curtains or shades in sitting area.
___________________________________________________________________________________
Designate “TV off” times. Talk to Mr. R about problems noted under auditory.
___________________________________________________________________________________
Chapter Five
The Source for Alzheimer’s & Dementia 50 Copyright © 2000 LinguiSystems, Inc.
“Human speech is like a cracked kettle on which we tap crude
rhythms for bears to dance to, while we long to make music
that will melt the stars.”
C -Gustave Flaubert, Madame Bovary
h Communication Breakdowns
Many, many sources discuss the behavior problems of people with AD.
a News stories of people with AD who are lost for days are common. Stories
of people with AD acting violently toward caregivers are whispered. The
p average person would tell you that a person with AD acts crazy and it is
this common belief that adds fear to the diagnosis of AD. Is the person with
AD who repeats that someone is stealing her money demonstrating the para-
t noia of AD, or is she actually expressing fear at all she has already lost? What
is seen as behavior problems may actually be a form of communication.
e To understand the message, the communication partner needs to examine the

message or the intent of the communication.
r Many of the behavior problems that are so hard to understand are the result
of feelings we understand only too well.
Everybody is afraid. People try to erase childrens fears by reading

fairy stories, and the minute the child goes to school she is afraid to
S show her parents a paper with a bad mark. Fear of water. Fear of fire.
Fear of animals. Fear of the dark. Fear of choosing the wrong career
i all these fears became like the notes of a muted, tragic symphony.
(adapted from Simenon 1992)
x Not only fear, but anger, grief, boredom, anxiety, and loneliness are the
messages being communicated. Gray-Davidson (1999) suggests that we
should not use the words of the health profession: paranoia, combative,
perseveration, and hallucination. These words get in the way of our
understanding the message. She suggests rather that we replace:
paranoia with fear

combative with angry and scared
depressed with sad, grieving, or lonely
delusional with misinterpreting
agitated with fearful
compulsive with underoccupied
preseverating with repeating
Chapter Six
wandering with walking that she has asked the question before, but
hallucinating with hearing and vision she is also expressing anxiety over the up-
misperceptions coming trip.
Other factors can cause a communication Communication Tips:

breakdown. Hodgson (1995) reminds us
Distract to an activity (using visual
that communication can also be disrupted by
prompts).
illness, dehydration, improper diet, reactions
to medications, overmedication, and pain. Dont tell about future events too far
ahead.
Many of the communication keys discussed
in Chapter Five can help prevent communi- Analyze the environment during
cation breakdowns. In this chapter we will episodes of anxiety.
examine specific breakdowns, hypothesize
about the intended message, and make sug- Apathy/Withdrawal
gestions to make the communication attempt
successful. We have already discussed the Apathy is seen when the person with AD
keys of simplification, reducing choices, mul- loses interest in a favorite activity or with-
tiple cueing, correcting sensory impairment, draws from social situations. Sometimes
and optimal environmental stimulation. In this is a reaction to a feeling of abandon-
addition, most of the suggestions listed here ment when a person with AD moves to a
follow the principals of nonconfrontation, re- care facility.
inforcement, minimizing anxiety, and dis-
traction (Weiner et al. 1996). Communication Tips:
Structure activities and provide assis-
Often careful observation of the behavior tance (See Activities, pages 67-68).
can reveal the cause of the communication
breakdown. An analysis can indicate the Catastrophic Reactions
trigger for the communication breakdown.
The time of day, the environmental setting, Catastrophic reactions are when the person
and the activity can all be possible causes with AD overreacts unexpectedly with an-
of a communication disruption. The steps gry, wild outbursts. These could be caused
to analyzing the communication breakdown by too much or too little stimulation or the
are provided in the Communication Break- caregiver being too hurried and forceful.
down Analysis (CBA) form on page 57. They are frightening to the caregiver. This
is one time that the caregiver needs to take
Anxiety specific steps. Feldt (1990) recommends
using the Five Rs:
Anxiety is a state of uneasiness and distress
about future uncertainties. This feeling is Remain calm.
often a trigger for the other communication Respond to feelings.
breakdowns. It can occur when the environ- Reassure.
ment is overwhelming. Anxiety often under- Remove yourself.
lies the repeated questions seen with AD. A Return later.
mother who repeats, When are we going to
the doctor? over and over cannot remember
Chapter Six
A catastrophic reaction is a communication Depression
breakdown. Some of the communication
tips listed here will help the caregiver keep What is seen as depression in persons with
a catastrophic breakdown from happening. AD may be apathy and withdrawal (see
above) or may actually be depression.
Communication Tips:
Communication Tips:
Use the CBA form, page 57, to analyze
the cause. Refer for a medical evaluation to
determine if its true depression
Distract before the reaction occurs
(medical treatments are available).
(using visual prompts).
Use the CBA form, page 57, to
Avoid confrontations which can
determine if there is a pattern to
provoke catastrophic reactions.
the depressive symptoms.
Denial Listen to any feelings expressed.
Reassure.
An angry denial can be the response when
mistakes are pointed out. It may also be
Delusions
expressing a denial of the losses that occur
with AD.
A delusion is an incorrect belief. A grand-
mother who believes her neighbors are a
Communication Tips:
cult that hold seances at night (and they
Distract (using visual prompts). truly arent!) is experiencing a delusion.
These can often be frightening to the person
Ignore.
with AD.
Avoid arguing.
Communication Tips:
Disruptive Vocalizing
You cannot convince a person with
AD their belief is incorrect. Do not
This form of communication is seen in the
argue.
late stage of the disease. Yelling, moaning,
and babbling are some of the forms. The Accept the statement.
message may be that the person is feeling
Reassure.
ill or uncomfortable.
Distract (using visual prompts).
Communication Tips:
Hallucinations
Analyze the environment.
Use the CBA form, page 57. Similar to delusions, hallucinations are mis-
interpretations of sensory input of sight,
Consider the possibility of a medical
sound, smell, and/or touch. Certain medi-
problem, pain, or an illness.
cations and illnesses, particularly with fever,
Use comforting sensory stimulation. can sometimes cause hallucinations. Some-
times hallucinations are frightening to the
Chapter Six
person with AD. Or sometimes the person caused by lack of skill for an activity or word-
with AD might calmly report seeing a little finding problems), or a general feeling that
man on the ceiling fan as a matter-of-fact something is wrong.
with no sign of fear and anxiety.
Communication Tips:
Communication Tips:
Person with AD may benefit from a
Refer for a medical evaluation if you peer support group.
suspect medication or an illness is the
Reassure.
cause.
Encourage.
Do not deny its existence.
Reassure. Paranoia/Suspiciousness
If frightened, you may need to use the
Paranoia is the fear that someone is out
Five Rs (See page 52.)
to get you. For persons with AD, this is
Try to orient to reality: I am here or expressed as, Hes stealing my money,
Youre okay. Someone stole my car, or She stole my
jewelry! This paranoia or suspiciousness
Incontinence is the expression of a fear of the many losses
that are a reality (e.g., the loss of memory,
Incontinence, the loss of bladder and/or the loss of language, the loss of skills, the
bowel control, is usually seen in the late loss of the ability to drive). These very real
stage of the disease. If it occurs earlier, it losses can lead to a feeling of fear or vulner-
may be the sign of a medical problem or ability. Sometimes it is also the result of
the result of a communication breakdown. environmental overstimulation or changes
in the routine.
Communication Tips:
Communication Tips:
Refer for a medical evaluation if
experienced early in the disease. Avoid arguing.
Change the environment (e.g., a label Express empathy.

or picture symbol on the door, a night
light in the bathroom).
possible environmental causes.
Add structure (e.g., suggest the per-
son with AD go the bathroom every Pilfering and Hoarding
two hours). Reduce fluid intake in
the evening. Pilfering (i.e., stealing) and hoarding (i.e.,
gathering and saving large quantities of
Use visual schedule Use the objects or food) are communication break-
Bathroom on page 99. downs often seen in care facilities, but can
also occur in homes. One grandmother
Irritability had an enormous supply of bags of candies
hidden away in her bedroom. Hoarding is
Physical or verbal expressions of irritability an expression of fear and insecurity. It is
may be caused by fatigue, frustration (e.g., related to pilfering, because the person
Chapter Six
with AD may have to steal things to hoard.
Although these behaviors are difficult to Analyze the environment with the
prevent, they generally disappear later in CBA form, page 57.
the disease.
Be flexible.
Communication Tips:
Restlessness/Agitation
Keep important items in a safe place.
Restlessness and agitation is seen as fidget-
Dont argue or scold.
ing, pacing, fussing, wringing hands, and
Analyze the environment in a care rummaging. It is related to wandering and
facility. Are doors to private rooms may have the same communicative function.
labeled to reduce confusion? These activities may be an expression of
anxiety or fear. Memory problems may con-
Repetitive Requests or Statements tribute to the restlessness (i.e., the person is
looking for something and cant remember
This communication breakdown is reported what it is). It can also be an early sign of a
by caregivers as one of the most annoying. catastrophic reaction for some people. (See
Memory problems contribute to this, but catastrophic reactions on page 52.)
they could also be an expression of a feeling
such as boredom, insecurity, and loneliness. Communication Tips:
Communication Tips:
Use external memory aids. (Chapter
the problem.
7, pages 60-62.)
Provide an appropriate activity. (See
Activities in Chapter 7, pages 67-68.)
Give more attention.
Shadowing
Resistance or Refusal
Caregivers sometimes report that the person
Resistance or refusal to do a task (e.g., bath- with AD is clinging, hovering, following
ing or dressing) could be an expression of them from room to room, and/or standing
fear and insecurity. It could also be caused close while the caregiver is working. It is an
by a communication breakdown if the per- expression of insecurity, annoying to the
son does not understand the request. caregiver, but also a passing phase.
Communication Tips: Communication Tips:
Use visual aids or body language with Reassure.

the request. Distract (using visual prompts).
Use Comprehension Communication Give more attention.
Techniques (Chapter 5, pages 41-42).
Reassure.
Chapter Six
Sundowning fear seen in restlessness (above) or the result
of disorientation. It is a problem if the
Sundowning refers to a worsening in a person with AD wanders away from a safe,
persons behavior in the evening or night supervised environment.
time. The person with AD is more agitated.
Wandering or pacing can increase. Some- Communication Tips:
times there is increased disorientation.
Sundowning could be expressing tiredness,
boredom, fear, loneliness, hunger, or be the Provide activities. (Chapter 7, pages
result of the stress that builds up during the 67-68.)
course of the day.
Make doors secure with locks.
Communication Tips: Paint or tape grids in front of doors.
Use the CBA chart, page 57, to analyze Persons with AD sometimes perceive
the environment. the pattern as unsafe to cross.
Provide a mid-afternoon snack. Enroll in the Safe Return Program.

(Contact the Alzheimers Association
Give more attention in the evening. for details.)
The Communication Breakdowns and
Analyze the sleep pattern. Communication Tips were adapted from Gray-
Davidson 1999, Hodgson 1995, Kuhn 1999, Rau 1993,
Santo Pietro and Ostuni 1997, Weiner, et al. 1996, and
Wandering personal notes from an Alzheimer Association
Caregivers Class.
The cause of wandering is poorly understood.
It may be an expression of the anxiety and
Chapter Six
Communication Breakdown Analysis
Name: _____________________________________________ Date: _______________________
Setting: ___________________________________________________________________________
Activity: __________________________________________________________________________
1. Describe the communication breakdown: ___________________________________________
___________________________________________________________________________________
2. Describe what happened just before the communication breakdown (antecedent): _______
___________________________________________________________________________________
3. Describe what happened just after the communication breakdown (consequence): _______
___________________________________________________________________________________
Observe:
Environment Antecedent
Light? Difficult activity?
Noise? Wants attention?
Odors? Wants privacy?
Temperature? Requesting?
Denying?
Activity Consequence
Waiting? Attention?
Unstructured? Redirection?
Transition? Verbal response (positive)?
Specific activity? Verbal response (negative)?
Mealtime? Physical Touch?
Ignored?
Analyze: _______________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Chapter Six
Communication Breakdown Analysis (Sample)
Name: _____________________________________________
Matthew C. 4/08/01
Date: _______________________
Setting: ___________________________________________________________________________
lobby area
waiting for van to go home
Activity: __________________________________________________________________________
1. Describe the communication breakdown: ___________________________________________

loud, disruptive, and repetitive shouting of
___________________________________________________________________________________
“I want to go home.”
2. Describe what happened just before the communication breakdown (antecedent): _______
started pacing
___________________________________________________________________________________
3. Describe what happened just after the communication breakdown (consequence): _______
___________________________________________________________________________________
ignored, but got louder and louder
Observe:
Environment Okay Antecedent

Light? Difficult activity?
Noise? Wants attention? ✔
Odors? Wants privacy?
Temperature? Requesting?
Denying?
Activity Consequence
Waiting? ✔ Attention?
Unstructured? ✔ Redirection?
Transition? ✔ Verbal response (positive)?
Specific activity? Verbal response (negative)?
Mealtime? Physical Touch?
Ignored? ✔
Analyze: _______________________________________________________________
This was a long time to wait for the van. Try: 1)visual prompt “The van
comes at 5:00.” 2) Keep Mr. C in activity area at table task until closer to time to go.
___________________________________________________________________________________
___________________________________________________________________________________
3) Develop memory book of photos for him to look at during unstructured wait times.
Chapter Six
“The past is hidden . . . in some material object . . .
which we do not suspect. And as for that object, it depends on
chance whether we come upon it or not . . .
And suddenly the memory returns.”
C -M. Proust, Remembrance of Things Past
h Intervention
a As recently as 1993, speech-language pathologists (SLPs) did not always

accept patients with AD. One family reported that when they requested
p help for their mother at the nursing home, the SLP told them that she didnt
work with AD patients because it was a progressive disease and nothing
t could be done to help. Fortunately for families grappling with the disease
now, we have a better understanding of treatments that can be used during
the course of the disease to ease the frustrations of caregivers and patients.
e Recent work done by talented SLPs is suggesting strategies for intervention.
As Bayles and Tomoeda (1999) tell us, the key to devising successful treat-
ments for dementia patients is to reduce demands on impaired memory and
r capitalize on spared memory systems.
This chapter covers:
external memory aids and strategies effective in the earlier stages of

S the disease
e therapy strategies to help patients in the middle stage learn small bits
of new information to help improve their quality of life
v strategies for helping with swallowing and eating problems seen in

patients with AD
e conversation topics for cognitive-linguistic therapy on topics such as

sports, family experiences, and historical events
n social reminders for families experiencing common social problems
activities of daily living and suggestions to structure and modify

them to improve the quality of life for people with AD, including
some visual prompts for self-care activities
Chapter Seven
External Memory Aids Instead a calendar should be large with a
clearly defined box for each day. Although
We all use external memory aids (e.g., cal- the calendar below has a clear grid and large
endars, shopping lists, memos, diaries). numbers for the days, the decorative design
According to Hodgdon (1998), visual tools makes it a complicated page to read.
such as these can help people who have
difficulty shifting and maintaining attention
and difficulty blocking out background
noises. These aids can help people in the
early stage of AD, too, especially if the
person with AD has used them in the past.
Research over the last 15 years shows that
memory wallets, memory books, memory
cards, and other forms of written and picture
reminders can help people even in the later
stages of AD (Bourgeois 1990, 1991, 1994).
The location of the calendar is important
Reminder notes also. It should be in clear view and in a
Reminder notes can be used by the person common, well-lit area. Another family that
with AD or the caregiver, but beware of the I worked with assured me that they had a
Post-it note curse! Too many notes left in too calendar. When I visited the home, I found
many different places can be very confusing. it folded up and stuck in a letter holder by
One family reported that a single line on an the computer. Each day was covered with
index card helped curtail repetitive ques- tiny, penciled activities. This calendar was
tioning (e.g., Were meeting Jane for lunch functional for the caregiver, but not for the
today). Reminder notes should be discon- person with AD.
tinued if they confuse the person with AD.
Monthly activity calendars are found in al-
Calendars most every nursing home or assisted living
A monthly calendar in a prominent location center. Although these calendars are often
can also be a good memory aid. But not all large and prominently placed, they are of
calendars are created equal. One family tells little use for people with AD if they are
the story of purchasing a beautiful calendar filled with too much writing and too many
with pictures of gardens, but the calendar activities. To be useful, calendars used at
was tightly wrapped with cellophane. Once home or in a facility should have only
they unwrapped it at home, they realized it personal, meaningful information.
wouldnt help Grandma because the month-
ly pages looked like this:
Chapter Seven
Establish a routine of directing the person Labels
with AD to the calendar when there are Labeling cabinets and drawers with large,
questions about day, date, month, or up- clear lettering can help the person with AD
coming activities. Then the calendar can continue to find things and function in an
be used well into the disease and help environment. Labels can also be used on
alleviate repetitive questioning. Taping a family photographs and hung on walls (e.g.,
strip of white paper over each week as it This is my daughter, Cindy.). Adding brief
passes may also help prevent confusion. text to the actual pictures in this way is often
A daily calendar can be as simple as: more useful than a large cumbersome photo
album that stays in a drawer.
Hello!
Today is Tuesday. Memory Wallets and Memory Books
February 15, 2004 Memory wallets were first designed to
describe personal information about the
person with AD (Bourgeois 1990). The
Schedules patients read the sentences, helping them
Schedules are often seen in nursing facilities, engage in conversation. Memory wallets
but seldom in homes. In both places a per- or books can take many different forms.
sonal daily schedule can: Typically there is one sentence of personal
information per page supported by a picture.
reassure the person with AD about These aids can be as small as index cards
what is happening today clipped together or as large as a notebook.
Memory wallets are most effective when
be used to redirect and answer attached to the person with AD with a clip,
repetitive questions about daily necklace, or pin. A typical memory book
activities might have the following information:
remind and help calm the person

about unexpected changes in the
schedule
As shown on pages 96-100, schedules can

cover entire days, special events, and External memory aids are only useful if the
activities the person with AD is having person with AD uses them. Memory books
problems taking part in. may not be used if the person with AD can
no longer gain information from reading.
Journals or Diaries
If a person with AD is in the habit of keeping Bourgeois (1999) described an informal
journals or diaries, then that is a skill he can strategy that she uses to assess ability to
continue as long as possible. There are sup- read. She puts two sets of sentences (each
port groups for people with AD that use set with a different size of print) in a mock
journal entries kept by the members of the memory book. One sentence is on each
group. Every week the members write on a page. She gives it to the person with AD
given topic and then share their entries with and watches to see if he turns the page and
each other. if he makes a comment after each sentence.
Then she knows he has read it.
Chapter Seven
Another common problem is that the per- the name of her new roommate. You need a
son with AD does not remember to use the photograph of the roommate or the room-
memory aid. The errorless learning and mate herself. First you state her name,
spaced retrieval techniques described below Mary. Then immediately ask the patient
can be used to teach the person with AD to with AD, Is her name Mary? Notice that
look at and use memory aids. this recognition task is much easier than a
free recall task. Do not allow the patient to
Errorless Learning and Spaced Retrieval guess; you do not want any errors. You also
need to teach the patient to pause before
These two techniques strengthen cognitive responding to help reduce impulsive wrong
associations by reducing the demands on answers. Continue to ask if the persons
episodic memory and relying on nondeclar- name is Mary using spaced retrieval. (These
ative memory which is relatively spared procedures are described in the next section).
(Hopper 1999). They are techniques which Once the patient is successful, the question
are effective when paired and are best used becomes, What is her name? In errorless
to directly teach information or procedures learning, provide as many cues as necessary
to improve the quality of life of a patient for a correct response. For example, you
with AD. Errorless learning is an attempt to might say, What is her name? It starts
minimize the number of errors made by the with M. Gradually remove the cues as
patient in a given task. In spaced retrieval, a the patient is successful. Remember that in
patient is told information and then asked to errorless learning there is no guessing and
recall it repeatedly at ever increasing time no trial-and-error learning. When teaching
intervals. new information, always give the correct
information and when teaching a new
Errorless Learning procedure, always demonstrate the correct
Baddeley and Wilson (1994) first described movements.
errorless learning in their work with patients
with amnesia. They found that their subjects Spaced Retrieval
with amnesia learned faster when their mis- Spaced retrieval, or the process of contin-
takes were kept to a minimum. Clare et al. ually recalling information over increasingly
(1999) followed the errorless learning pro- longer periods of time, is a well-known
tocol with people with AD. They used error- technique first described by Landauer and
less learning to teach a group with mild AD Bjork (1978). It can be used to teach pieces
to learn the names and faces of the members of meaningful and concrete information,
in their social club. The patients were able compensatory techniques, or procedures to
to generalize the names from pictures to ac- patients in the moderate stage of AD (Brush
tual faces. Nine months later, they retained and Camp 1998). Patients with AD may not
this knowledge. Errorless learning tech- remember the therapy session, but they will
niques can be used to teach patients with remember the information learned. Thus,
AD information (e.g., someones name) or this technique is particularly successful with
a procedure (e.g., taking a sip of water after patients in the moderate stage of the disease
bites of food to aid the swallow). as they do not become annoyed at the repet-
itive questioning by the therapist.
How does errorless learning work? Lets
imagine you are teaching a patient with AD
Chapter Seven
Brush (1999) suggests the following model drooling, weight loss, coughing or choking,
for using spaced retrieval: refusing certain foods, pocketing of food in
the mouth, pneumonia, dehydration, reflux,
Provide the information (as in errorless or complaints about swallowing difficulties
learning). Immediately ask for the infor- (Swigert 2000). What causes these symptoms?
mation back and reinforce a correct an-
swer with a positive comment. Then Sometimes there are physical changes
repeat the question at time intervals that such as a delayed swallow reflex. Cog-
double in length (e.g., immediate, 30 nitive changes (e.g., decreased memory,
seconds, 1 minute, 2 minutes, 4 minutes, attention, judgment) may also contribute
8 minutes). If an error is made, the infor- to eating and swallowing problems.
mation should be repeated and the ques- Finally environmental distractions may
tioning resumed at the last successful lead to the communication breakdowns
time interval. For example, if the infor- (e.g., wandering, agitation, apathy)
mation was remembered after 8 minutes, which can interfere with eating (Cleary
but forgotten after 16 minutes, then re- 1999).
peat the information and ask for it again
after 8 minutes. There are many excellent sources for infor-
mation on the diagnosis and treatment of
Sometimes a patient may become stuck, dysphagia. These include, but are not
unable to move beyond a certain time limited to:
interval. If that happens, repeat the last
successful time interval until it is learned Alzheimers Disease and Nutrition (1990)
before increasing the time interval again. by S. Finn
Spaced retrieval is more successful if only
one piece of information is taught at a time. Clinical Management of Dysphagia in
Some patients may benefit from the addition Adults and Children, 2nd Edition, (1994)
of written cues which can then be faded as by L.R. Cherney
the patient is successful.
Manual for Videofluorographic Study of
Spaced retrieval can be used to teach names, Swallowing (1993) by J.A. Logemann
addresses, important dates, schedules, routes
around the facility, safety procedures, com- Nutritional Aspects of Dementia,
pensatory procedures for swallowing, or Especially Alzheimers Disease (1990)
transferring from wheelchair to dining room by G. Bucht
chair. It can also be used to teach a patient
to use a memory book or other external The Source for Dysphagia - Updated and
memory aid. Expanded (2000) by N. Swigert
Swallowing and Eating Problems In addition to knowledge about the phys-

iology of the swallow, SLPs need to identify
Dysphagia, or a problem with swallowing environmental factors that affect the safety of
and eating, is sometimes seen in AD, parti- the swallow. Factors to consider include:
cularly late in the disease. Symptoms of
dysphagia include elevated temperature, Is the person in a proper position for
eating?
Chapter Seven
Is the dining area loud or chaotic? Use the Social Reminder Enjoying
Meal Time on page 165.
Is there a television turned on in the
dining area? Therapy Conversation Topics
(Appendix One, pages 102-155)
Is the food cold?
As discussed in previous chapters, discourse
Is the meal provided promptly,
is an early and continuing problem for peo-
without waiting?
ple with AD. Conversation Topics were de-
Is the person with AD frequently veloped to help people with AD participate
offered a drink? in a meaningful conversation with a thera-
pist and/or peers or caregivers. Objects or
The Feeding Behaviors Inventory (Durnbaugh, pictures can be added to help people with
Haley, and Roberts 1996) can also be used AD comprehend language and focus their
to assess eating problems. This inventory attention. Other senses can also be tapped
codes resistive/disruptive behaviors, oral to facilitate conversation.
behaviors, patterns of intake, and styles of
eating. SLPs can use observations such as Objects that have a distinctive feel or smell
these to consult with nursing homes and can at times spark an interaction (Whiteside
care facilities to improve the mealtime and Zimmerman 1998, Hopper et al. 1998).
environment and plan for individual care Harris (1998) suggests using Scratch n Sniff
plans. cards for stimulating the sense of smell in
her reminiscence therapy sessions.
Family caregivers too can benefit from
information provided by an SLP on the Auditory stimulation through music or
optimum mealtime strategies in the home. stories is also an important part of setting
Suggestions for caregivers include: the context for a conversation with a person
with AD. The use of music with the Conver-
Supervise meals. sation Topics is highly recommended. Feil
(1993) uses music as one of her validation
Be sure a balanced diet is eaten. techniques because familiar songs often
remain when words are gone. In addition,
Provide bite-size pieces of food, soft music provides structured reality, order,
foods, and thick liquids that are easier and predictability. It brings something
to eat. familiar to the environment . . . .
(Clair 1996).
Puree soup rather than serve chunky
soups that may be confusing to eat. Not all music is created equal, however,
for people with dementia. Dowling (1995)
Serve food items one at a time. warns that synthesized music, nature tapes,
rhythm bands, radio, a piano being banged
Remind the person with AD to put on, and any music left on for more than a
food in the mouth, to chew, and/or to half-hour are not as enjoyable as carefully
swallow. chosen recordings and songs. These multi-
sensory components are used to enhance
Learn the Heimlich maneuver.
Chapter Seven
functional communication and capitalize on Place memory prompts in the hands
spared recognition and procedural memory of the person with AD. Wait for a
systems (Mahendra 1999). comment.
Conversation Topics include Daily Life (home If there is no comment, make a per-
and work topics), Entertainment (sports and sonal statement about the object.
other forms of recreation), and Time Line Wait again.
(historic news events). Each page outlines
In a group setting, pass the object to
a conversation topic to use for individual or
each person.
group sessions. Music and/or pictures or
objects for stimulation are also suggested for Show the picture to the group or
each topic. individual. Make a comment. Wait.
Two brief paragraphs about the topic set the Use a question provided if necessary
context for the conversation. Level 1 context to prompt conversation.
settings are short in length and use vocabu-
lary and syntax that are easy to comprehend. Be prepared to enjoy and record some
They are appropriate to use with people who of the reminiscences you hear.
need a simple format for comprehension.
Level 2 context settings are linguistically Social Reminders
complex and more difficult. They are appro- (Appendix One, pages 158-167)
priate for use with people in the earlier stages
of AD. Social Reminders were developed to help
caregivers with some of the common
There are also sample yes/no questions mistakes or problems that people with AD
and forced-choice questions that rely on have. These problems are often referred to
recognition rather than recall memory if as embarrassing or difficult behavior.
needed to increase participation. The More often the problems result from a
questions provided are not meant to be miscommunication by one of the commu-
used for evaluation, but rather as prompts nication partners. Either the person with
to conversation. AD misunderstands a situation and is afraid
or confused, or the caregiver has not been
How To Use Conversation Topics able to communicate effectively to prevent
Place suggested objects in a box, suitcase, the problem.
trunk, basket, or other container. Feel free
to use other objects appropriate to the topic. Families report that people with AD will
The objects suggested have more than one ask repetitive questions or make repetitive
sensory component whenever possible. For statements like I want to go home (when
the chosen conversation topic, use the the person with AD is at home) or I want to
following format: drive my car (when driving has been taken
away). Families also report problems with
State the topic: Today were going to pacing, shadowing, hygiene, and using
talk about baseball. appropriate social manners, to name a few.
Play the recommended musical selec- These behaviors are often the result of
tion and/or read the print selection to communication failures. Sometimes these
help set the context for conversation. problems can be alleviated by changing the
Chapter Seven
environment or by distracting the person with ships. Our sense of worth is dependent on
AD to another activity. Social Reminders are how we feel and how successful we are
just one more way to facilitate communication. when we complete certain activities.
Social Reminders use many of the same prin- As the disease progresses, people with AD
cipals as external memory aids. The text is lose certain abilities. This tends to lead to a
brief and concise, and pictures are added to downward spiral from independence to
aid comprehension. Social Reminders are dependence. Caregivers often take over an
included on pages 158-167 as examples. You entire activity, leaving the person with AD
may use them if appropriate or as samples as with a sense of helplessness. The person
you develop your own. Feel free to fill in the with AD then feels worthless and loses the
blanks with photographs or the names of willingness to attempt activities. Caregivers
individuals. at home might say, He cant do anything
anymore or What can we do all day long?
Social Reminders are best given to the per-
son with AD to read just prior to the social Activities have been described as those
event. Some Social Reminders reassure a needed for self-care (e.g., bathing, eating),
person with AD (e.g., My Home) while referred to as activities of daily living or
others explain social situations (e.g., Eating ADLs; and those which require more
Out) or new limitations (e.g., Driving). abstract thinking (e.g., shopping, paying
bills, meal preparation), referred to as
Social Reminders can be used in nursing instrumental ADLs or IADLs (Lawton and
facilities or copied and shared with care- Brody 1969). There are several tools to
givers. SLPs play an important role in assess how well the person is able to
helping caregivers understand that social complete ADLs. These include:
problems are communication breakdowns.
Social Reminders are one way to facilitate The Bartel Index (Mahoney and Bartel
the communication between a caregiver and 1965) measures 10 self-care activities.
a person with AD.
The Functional Independence Measure
Activities for Daily Living (FIM) (Hamilton et al. 1987) assesses
7 areas of independence and includes
As adults, we all like to be able to take care other documentation (e.g., diagnosis).
of ourselves, take care of others, work, and The Functional Status Index (Jette
contribute to society. People with AD are 1980a, 1980b) measures functional
no different. abilities of individuals at home. It
is a self-report measure.
Maslow (1970) described a hierarchy of
needs that people have. First are the basic The Katz Index of ADL (Katz et al.
needs of food, clothing, and shelter. If these 1963) measures independence in self-
needs are met, we then have a need for care activities.
security. Higher on the hierarchy are a
persons needs for identity, control, auto- The Modified Bartel Index (Granger et
nomy, self-esteem, the esteem of others, al. 1975) adds other activities to the
inclusion in a group or larger body, and self-care activities.
meaningful communication and relation- (adapted from Bayles and Tomoeda 1997)
Chapter Seven
Although the functional abilities of the per- 43-50.) Certain areas can be designated for
son with AD are important to know when certain activities to support comprehension.
planning activities, it is also important to The environment should not be too stimu-
consider the activity itself. Zgola (1987) lating. All the safety concerns of both the
suggests that activities must be analyzed environment and the activity need to be
and graded. Grading the activity means noted. For example, conduct cooking activ-
planning for more or less participation by ities in the kitchen rather than mixing and
the person with AD. assembling in an activity room.
highest level of involvement
Scheduling activities to occur at the same
plans, initiates, and executes entire sequence time every day helps make the activities
independently
predictable. (See External Memory Aids,
initiates and executes planned task pages 60-62.) Consider when the person
with AD has high or low energy periods
performs task in structured setting only
when planning certain activities. How long
performs with verbal help should activities last? One assisted living
facility found that 30-minute activities
needs physical help followed by a period of unstructured activity
of about the same length was well tolerated
helps actively
by most of the participants. This same type
helps of schedule could be used at home.
passively
Included here are suggestions of activities

that are routinely completed in most homes.
attends to task presented
Most of them can be modified for use in
lowest level of involvement facilities. Make a step-by-step analysis of
Zgola, J. M. Doing Things: A Guide to Programming Activities for what must be done to complete the activity.
Persons with Alzheimers Disease and Related Disorders, page. 35. Hand-over-hand guidance, visual cueing,
Baltimore: Johns Hopkins University Press, 1987.
and verbal cueing may also be needed for
Activities can be graded from the most successful completion of the activity.
involvement (e.g., planning, initiating, and Activities for people with AD should be
completing an activity independently) to the familiar and allow them to feel successful
least involvement (e.g., passively watching (Dowling 1995).
the activity). In between, some people can
participate if given a verbal prompt, a Music
physical prompt, or a structured setting Listen to music through headphones.
to complete the activity in. To analyze an Play music for resting.
activity, consider the physical, sensory, and Sing favorite songs together.
cognitive demands, and the value of the Watch videos of musicals.
activity to the participant. Repetitive Use music for each part of the day
activities (e.g., folding towels, sanding (e.g., Goodnight Ladies at night).
wood) are usually successful.
Exercise
In addition, environmental demands need Take a daily walk.
to be considered. (See Chapter Five, pages Dance.
Squeeze a small rubber ball.
Chapter Seven
Use an exercise tape. Cut soft cheeses.
Ride an exercise bike. Wash and dry non-breakable cups,
Rake leaves. dishes, and cooking utensils.
Pick up litter while walking. Put ice in glasses.
Sweep the porch, the patio, the Butter bread.
sidewalk, the kitchen, etc. Wipe off the table.
Vacuum. Fold napkins or place them in napkin
Pull weeds. rings.
Do range of motion exercises. Mix juices and dressings.
Do the Hokey Pokey. Complete steps of simple recipes with
help (e.g., caregiver measures and
Activities of Daily Living person with AD pours and stirs).
Housekeeping Table Activities

Clip coupons. Cut and paste collages using items
Fold laundry or towels. like magazine pictures and pieces of
Match socks. ribbon or other trim.
Dust furniture. Draw or paint using watercolors,
Help with laundry (e.g., gather dirty chalk, markers, and colored pencils.
clothes, sort light and dark). Work simple puzzles.
Empty wastebaskets. Make clay figures.
Polish silver. Sort decks of cards by color.
Wipe off tables/patio furniture. Sort or arrange dominoes.
Stack newspapers for recycling. Wrap gifts.
Sort bottles and plastics for recycling. Write letters (even if you dont mail
Water/mist plants. them).
Feed the pet. Sort mail.
Sort and wrap coins. Sort small objects in a purse.
Roll yarn into a ball or string onto a Count tickets.
spool. Plant seeds.
Help make the bed. Look at family photographs.
Polish shoes. Make birdfeeders, fill feeders, or
string Cheerios for the birds to eat.
Meal Preparation/Clean-up Sand wood.
Wash vegetables. Use rubber stamps to make a design
Set the table (e.g., put out placemats, on paper.
plates, etc.). Sort items (e.g., nuts and bolts,
Sort and put away silverware. colored pom-poms, textured cloth
Fill salt and pepper shakers. squares, pipe cleaners)
Put dishes away. Use adult coloring books1.
Put groceries away.
Organize cans of food. 1
Ruth Hellers Designs for Coloring series, Price Stern Sloan
Publishers.
Scrub the sink. Dover Publications also offers a wide variety of topics to
Chop soft fruits and vegetables for color (e.g., Butterflies, Ancient Rome, African Designs, Stained
salads. Glass).
Chapter Seven
Self-Care What can I do to keep my loved one
safe?
Caregivers report that the loss of a persons What can I do to keep from going
ability to complete self-care activities is often crazy myself?
distressing both to the person with AD and
the caregiver. As we have seen in the dis- Some of the techniques, strategies, and
cussion of external memory aids, pages 60- information in this chapter and in the next
62, visual reminders can often help in the chapter (Caregiver Support Group Agenda)
early stages of AD. Morning and evening will answer a few questions, but AD is a
routine schedules, pages 96-100, serve as an disease that will not go away. Caregivers
example of how to use visuals to help a will find some comfort in trying another
person get through a routine self-care time. approach which I call joyful sharing.
The self-care steps can be read or posted Joyful sharing is a process in which the
near the self-care activity area. The self-care person with AD and the caregiver join
steps may be reproduced if appropriate, or together in a time of communication which
you may want to write your own. both find enjoyable. Joyful sharing requires
that you live in the moment, in the world, in
Conclusion the reality of the person with AD.
What can I do? is a common question from Batiuk and Ayers in the Crankshaft
caregivers, but what is the real question? cartoon use their characters, the McKenzie
sisters, to explore the experience of living
What can I do to make AD go with AD. One of the sisters has the disease,
away? the other is the caregiver. In the cartoon
What can I do to make my loved one below, the sisters are enjoying a shared
healthy again? reminiscence from long ago, not concerned
What can I do to keep my loved one about acting in an odd or strange way. It is
busy and active? a perfect illustration of joyful sharing!
CRANKSHAFT ©1999 Mediagraphics, Inc.

Reprinted with permission of UNIVERSAL
PRESS SYNDICATE. All rights reserved.
Chapter Seven
Caregiver Support Group Agenda
The agenda in this section is intended as a guideline for a caregiver support

group. These sessions provide information on a wide range of issues that
can affect family caregivers. Presenting all the information listed here in
C one setting may be overwhelming to families. Use discretion in tailoring the

outlines to your support group by selecting portions that are suitable to their
specific needs and training.
h The reproducible handouts, pages 79-93, contain useful information to share
a with families at the meetings and can also be used in conjunction with
family consultations. Suggestions for reference books and brochures are
p made with each topic.
Goals:
t To provide patients with AD and their caregivers with basic
information about financial, legal, health, and safety issues; and
e caregiver stress
r To suggest techniques caregivers may use to improve communication

with the person with AD
Unit One: Legal and Financial Issues
E This topic is presented first to emphasize the importance of decision-making

while the person with AD is still able to take part in the planning. You
i many want to invite a local legal or financial expert on estate planning and
elder issues to give a presentation during this unit.
g I. The importance of planning for the future for families facing

Alzheimers disease
h A. Families will need to meet to plan for future needs.

B. Meetings and discussions are best held early in the disease.
t 1. The person with AD may show where important papers are.

2. The person with AD may explain financial assets and
obligations.
3. These important decisions are made as a partnership between
family members.
C. All family members should be invited. (Handout 1, page 79)
1. Be open to compromise.
2. Make decisions by consensus. Even though everyone may not
agree, they should still follow the decisions.
Chapter Eight
Unit One: Legal and Financial Issues, continued
3. Do not bring up issues from the past.

4. Be thoughtful of others feelings; do not attack each other.
D. If the primary caregiver works, he or she should investigate the Family and Medical
Leave Act.
1. Employers with 50 or more employees must grant up to 12 weeks of unpaid leave
a year for the care of a parent, spouse, or child with a serious health condition.
(AD is a serious health condition.)
2. The leave can be taken all at once or used intermittently.
II. The importance of completing legal paperwork as soon as possible

A. The person with AD needs someone trustworthy to act in his/her behalf sometime
in the future.
B. The person with AD should be able to choose that person for him/herself.
C. The person with AD should state his/her preferences on legal issues to the desig-
nated person.
D. The family should find a lawyer with experience in geriatric and estate planning
issues to help them make decisions and complete the paperwork. The National
Academy of Elder Law Attorneys, (520) 881-4005, will make referrals.
(Handout 2, page 80)
1. Durable Power of Attorney for financial decisions
2. Durable Power of Attorney for health care
3. Living Will
4. Will
5. Living Trust
6. Conservators, Guardians, and Trustees
III. The importance of reviewing financial affairs

A. Review assets and financial documents.
1. Location and account numbers of checking and savings accounts
2. Stocks, bonds, insurance policies, retirement accounts
3. Social security and/or retirement payments
4. Home, rental property, valuable personal collections
B. Consider current expenses
1. Expenses for shelter, food, and medicine
2. Home mortgage or other debts
C. Consider potential expenses
1. Medical treatment
2. Prescription drugs
Chapter Eight
3. Adult day supervision

4. In-home care
5. Full-time residential care
6. Nursing home care vs. assisted living care
D. Consider resources to help cover costs. (Handout 3, pages 81-82, for more information)
1. Personal resources
a. Personal savings and investments
b. Personal property/Reverse mortgages
2. Insurance
a. Private health insurance or employee group insurance
b. COBRA (Consolidate Omnibus Budget Reconciliation Act of 1985)
c. Disability insurance (according to policy in place)
d. Long-term care insurance
e. Life insurance policies
3. Government programs
a. Medicare
b. Medicaid
c. Social Security Disability Income
d. Social Security Income (SSI)
e. Veterans benefits
f. Tax benefits
E. Use protective measures. (Handout 4, page 83)
1. Monitor all bills and checks. Have mail sent to caregiver or other family
member at a different address or P.O. Box.
2. Use electronic transference of social security checks and other sources of income.
3. Cut down on junk mail.
4. Cut down on telephone solicitations.
Unit One Resources

Handouts
Family Planning: Can We Talk?, page 79
Legal Decisions, page 80
Possible Financial Resources, pages 81-82
Protect Yourself from Fraud!, page 83
Publications available from the Alzheimers Association (1-800-272-3900; 919 N. Michigan

Avenue, Suite 1100, Chicago, IL 60611 or a local chapter)
Taxes and Alzheimers Disease
Private Long-term Care Insurance: To Buy or Not to Buy
Understanding Medicaid Long-term Care: A Primer for Alzheimers Disease
Steps to Understanding Financial Issues: Resources for Caregivers
Steps to Understanding Legal Issues: Planning for the Future
Chapter Eight
Other Publications
Carlin, V. F. and Greenberg, V. E. Should Mom Live with Us? And Is Happiness Possible If
She Does? NY: Free Press, 1992.
National Handbook on Laws and Programs Affecting Senior Citizens. Chicago: American
Bar Association, 1998.
Strauss, P. J. and Lederman, N. M. The Elder Law Handbook: A Legal and Financial Survival
Guide for Caregivers and Seniors. NY: Facts on File, 1996.
Unit Two: Health and Safety Issues
People with AD experience changes in their ability to remember and reason which can lead
to potentially dangerous situations. This unit will first target safety issues and then review
possible health issues. Use Handouts 6-9 to prompt discussions about safety. A listing of the
safety hazards pictured in the handouts is on pages 89-90. You may want to invite a nutri-
tion expert as a guest speaker on health topics.
I. The importance of safety issues

A. The need for an emergency contact sheet (Handout 5, page 84)
1. Important phone numbers: police, fire, ambulance, poison control center,
primary physician, neighbors, nearby relative, and where to contact primary
care-giver if needed
2. Special instructions: medications, allergic reactions, hearing/vision loss, etc.
B. The need to learn basic emergency procedures
1. CPR, Heimlich maneuver, seizure response, other first-aid skills
2. Make a first-aid kit.
C. Evaluating the home for safety (Handouts 6, 7, and 8, pages 85-87)
1. Kitchen
a. Put sharp knives and cleaning products out of sight.
b. Remove knobs from stoves and ovens.
c. Supervise food preparation activities.
2. Bathroom
a. Adjust the hot water temperature to a safe temperature.
b. Install safety seat and grab bars in bathtub and toilet areas.
c. Be sure area is well lit.
d. Lock medicines in a safe place.
e. Avoid any tripping hazard (e.g., bathmat).
3. Living room
a. Remove clutter on floors and stairs.
b. Light room to eliminate dark corners.
Chapter Eight
Unit Two: Health and Safety Issues, continued
c. Remove area rugs which might cause falls.

d. Add hand rail to stairs.
e. Remove large potted plants on the floor which might cause falls.
f. Remove mirrors which can cause confusion.
4. Fire safety
a. Install smoke alarms.
b. Install fire extinguishers.
c. Supervise smoking.
d. Keep matches out of reach.
e. Place an ID sticker on bedroom window.
5. Remove guns and firearms from home.
D. Evaluating the outdoors for safety (Handout 9, page 88)
1. Lock all cars.
2. Lock gates.
3. Keep equipment and tools in a locked garage or tool shed.
4. Keep garden hoses off walkways.
5. Remove plants with berries or nuts that might be poisonous and tempting to eat.
E. Driving
1. Point of disagreement even among professionals there is a lack of medical and
legal guidance on when to terminate driving.
2. Only California requires retesting of driving skills if AD diagnosed
3. Restrict from dangerous driving conditions (e.g., rush hour, bad weather, night
driving).
4. Use Social Reminder Driving, page 159.
5. Ask Am I comfortable letting my children or grandchildren ride with this
person? If no, end driving.
6. Enlist physicians prescription: Do not drive car due to medical condition.
7. Ask physician to revoke license.
8. Make car unavailable or inaccessible.
F. Wandering (Handout 10, page 91)
1. The need for identification such as a medical ID bracelet or necklace (Sources
include: Bodyguard Medical ID tags, 1-800-383-7790; or Custom ID Products:
Medic ID, 1-800-439-8899). Inscribe with:
a. Name
b. Phone number
c. Words memory impaired
2. Sew name and phone tags into clothing.
3. Alzheimers Associations Safe Return Program (Scholarships available)
P.O. Box A-3956, Chicago, IL 60690. For a one time registration fee, Safe Return
provides:
a. Identification products including bracelet or necklace, clothing labels, and
wallet ID card
Chapter Eight
Unit Two: Health and Safety Issues, continued
b. 24-hour, toll-free 800 number

c. Registration in a national database
d. Access to 17,000 law enforcement agencies
e. Connection to more than 200 community based Alzheimers Association
chapters around the country
II. The importance of health concerns

A. Medications
1. Observe the person with AD taking medication to insure proper dosage, etc.
2. Caregiver could administer the medication, if needed.
3. Use other reminders
a. Weekly pill organizer
b. Written reminder notes
c. Clock that beeps to remind of dosage
B. Proper nutrition
1. Meal time
a. Prepare foods that are easy to swallow.
b. Verbally prompt to swallow if needed.
c. Reduce noise, confusion, and other distractions.
d. Several small meals may be preferred to three big meals.
e. Consider formal swallowing evaluation if problems are occurring.
2. Dehydration can be a problem with inadequate fluid intake.
a. Signs include dry skin, worsening mental function, low fluid output during
urination, and skin tenting (pinch the skin gently; if it stays tented, the
person is dehydrated)
b. Coffee and tea (diuretics) also reduce body fluids.
3. Consider home-delivered meals or Meals on Wheels.
4. Use the Golden Diners program or another senior citizen meal program.
Unit Two Resources

Handouts
Information Sheet, page 84
Safety Pictures, pages 85-88
Wandering, page 91
Publications available from the Alzheimers Association (1-800-272-3900)

Just the Facts: Driving
Just the Facts: Nutrition
Just the Facts: Safety
Safe Return brochure and fact sheet
Steps to Enhancing Your Home: Modifying the Environment
Chapter Eight
Unit Three: Joyful Sharing
There is no doubt that caring for a person with AD is one of the most stressful things a person
can experience. This unit provides suggestions for improved communication (often the
central cause of caregiver stress) and where to find hope and happinessa search I call
joyful sharing. Some caregivers will need more help and support than this support group
can provide. Guidelines are suggested to help caregivers determine if and when they need
help dealing with grief, guilt, and anger.
I. Caregiver stress management (Handout 11, page 92)

A. Care of the body
1. Routine medical and dental checkups
2. Healthy food (the Food Pyramid)
3. Exercise
B. Grief as a normal human reaction
1. Stages
a. Denial
b. Anger and depression
c. Letting go
d. Acceptance
2. Ups and downs
3. Physical signs
a. Insomnia
b. Loss of appetite
C. Individual or family counseling
D. Keep a sense of humor
E. Play
F. Sleep
1. Establish a restful routine.
2. Limit intake of alcohol and caffeine if having sleep problems.
3. Consult a physician if problems continue.
G. Ask for help.
1. Specific requests to family members
2. Specific requests to friends and neighbors
II. Communication tips

A. Improve communication (Handout 12, page 93, and information in Chapter 5)
B. Communication breakdowns (information in Chapter 6)
Chapter Eight
Unit Three: Joyful Sharing, continued
III. Finding happiness and hope in AD (Gray-Davidson 1999)

A. Happiness
1. Learn to enjoy reminiscing with your loved one. Short-term memory may be
damaged, but long-term memory often remains.
2. Recognize the special abilities that often remain and enjoy them (e.g., playing a
musical instrument, drawing, playing a particular game).
3. All people (with and without AD) enjoy the same things (e.g., a good meal,
animals, babies, a beautiful view, the feel of warm dirt in a spring garden).
4. People with AD still enjoy hugs and other forms of affection. Sit close and look
at pictures together.
5. Learn to enjoy the present moment together. What is past is in the past and
what is in the future is not yet here.
B. Hope (Hodgson, 1995)
1. Hope in research
2. Hope in friendship
3. Hope in living the moment
Unit Three Resources

Handouts
Caregiver: Take Good Care of Yourself, page 92
Communication Tips, page 93
Other Publications and Materials

Richmond, M. Caring for the Caregiver. Journeyman Publishing, 1993. P.O. Box 2720,
Santa Cruz, CA, 95063. Request title #5009, ISBN 1-56995-009-3.
Publications available from the Alzheimers Association (1-800-272-3900)

Caregiver Stress Signs to Watch for, Steps to Take
Respite Care Guide: How to Find Whats Right for You
Steps to Enhancing Communication: Interacting with Persons with Alzheimers Disease
Steps to Planning Activities: Structuring the Day at Home
Steps to Understanding Challenging Behaviors: Responding to Persons with Alzheimers
Disease
Chapter Eight
Unit Three: Joyful Sharing, continued
Other Resources
These publications on caregiving are recommended to include in a lending library for the
group. In addition, you might want to include the books marked with an asterisk in the
reference section, pages 191-199. Allow time for the people in attendance to browse and look
through the books.
Coughlan, P. B. Facing Alzheimers: Family Caregivers Speak. NY: Ballentine Books, 1993.
Dass, R. and Gorman, P. How Can I Help? Stories and Reflections on Service. New York: Knopf,
1986.
Davidson, A. Alzheimers: A Love Story: One Year in My Husbands Journey. Seacaucus, NJ:
Carol Publishing Group, 1997.
Dyer, J. In a Tangled Wood: An Alzheimers Journey. Dallas: Southern Methodist University

Press, 1996.
Gillick, M. R. Tangled Minds: Understanding Alzheimers Disease and Other Dementias. NY:
Penguin Putnam, Inc., 1999.
Grant, L. Remind Me Who I Am, Again. London: Granta Books, 2000.
Hanh, T. N. Being Peace. Berkeley: Parallex Press, 1987.
Kushner, H. When Bad Things Happen to Good People. NY: Avon Books, 1981.
Mother Teresa. Life in the Spirit. San Francisco: Harper, 1982.
McKay, M., Rogers, P. D., and McKay, J. When Anger Hurts: Quieting the Storm Within.
Oakland, CA: New Harbinger Publications, 1989.
Sogyal, R. Tibetan Book of Living and Dying. San Francisco: Harper, 1993.
Veniga, R. A Gift of Hope. Boston: Little, Brown and Co., 1985.
Chapter Eight
Family Planning: Can We Talk?
Families should plan to meet more

than once to discuss the care of the
person with AD. The goal of the
meeting should be to make a plan.
This is not the time to discuss other
family issues. Here is a list of things
to accomplish:
❍ Make a list of the greatest needs.
❍ Decide which needs require immediate action

and which can wait for future action.
❍ List the needs according to urgency.
❍ Discuss what time or money is

needed to act on the needs list.
❍ Determine who will do what. The results

may not always seem fair, but the goal is
care of the loved one with AD.
❍ Close the meeting with positive

comments about what has been
accomplished.
(adapted from Gray-Davidson 1999)

Chapter Eight: Handout 1
Legal Decisions
If the person with AD is able, he/she should be the one to make as many of these
decisions as possible.
Power of Attorney: This is a written document which must be witnessed and

notarized that gives one person the authority to act on anothers behalf. This
permission can be limited to a specific time period (e.g., during recovery from brain
surgery) or it can be for an unlimited time period (e.g., in the case of dementia). The
unlimited power of attorney is called durable power of attorney.
Durable Power of Attorney for financial decisions (also called Durable Power of
Attorney for property): This type of power of attorney allows the designated
representative or agent to manage property and finances. This person can make
financial decisions about future costs of care.
Durable Power of Attorney for health care: This type of power of attorney
designates a person to make all health care decisions and end-of-life decisions
for the person granting the authority. It can also include the persons specific
directives and wishes.
Living Will: This document gives another person the authority to make end-of-life
health care decisions only.
Will: The person with AD should have an up-to-date will.
Living Trust: This is a written agreement where the person affected (the grantor)
gives a person or a bank (trustee) permission to control financial assets according
to certain directions. It also gives directives on how assets are to be distributed after
death. This must be set up with the help of an attorney.
Sometimes the disease is so advanced that the person with AD will be unable to
take the protective steps listed above. In that case, courts may appoint a guardian,
conservator, or trustee (called fiduciaries) to act in behalf of the person affected.
This can only be done through the court system and can be a lengthy and costly
procedure. It is important to make these decisions as soon as possible with the help
of the person with AD.
Guardian or Conservator: This person has the power to take care of the person and
manage the property of the person unable to care for him/herself.
Trustee: This is a person appointed to manage a trust for the care and benefit of the
beneficiary.

Possible Financial Resources
Personal Resources
Personal savings and investments
Personal property
A reverse mortgage is available to a person over 62. A person is
allowed to convert some of the equity of his/her home into cash and
still retain ownership.
Insurance
If the person with AD is under 65:
Private health insurance or employee group insurance may be in effect.

Investigate how health expenses from AD will be covered.
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) may be

needed if the person leaves work or loses health care due to reduced hours
due to AD. Under COBRA, the employee may continue with the health
plan coverage for 18, 29, or 36 months (depending on circumstances). The
insured person pays the full cost of the coverage. This may be useful until
the person becomes eligible for Medicare at age 65 or other private health
insurance becomes available.
Disability insurance pays income (according to the policy in place) for an

employee who is no longer able to work because of illness or injury.
Long-term care insurance pays some money (according to the policy in

place) for long-term care. These policies all differ, so examine them
carefully.
Life insurance policies will sometimes allow you to borrow from the cash
value or pay accelerated death benefits. Check the policy to see if these
are available.

Possible Financial Resources, continued
Government Programs
Medicare is the primary source of health coverage for people over 65.
It does not cover long-term nursing home care. For information about
Medicare coverage, Medicare HMOs, PPOs, and POS plans and
Medigap supplemental insurance, call 1-800-638-6833 or visit
Medicares Web site at <www.medicare.gov>.
Medicaid pays for medical coverage for people with very low income
or people in long-term care who have used up personal resources.
Laws govern a person giving away financial resources to qualify for
Medicaid. As Medicaid is funded by the federal and state
governments, information on Medicaid in each state can be found by
contacting that states human or social services departments. Other
information can be found at <www.hcfa.gov/medicaid/mcaicnsm.htm>
or <www.familiesusa.org/medicaid/>
Social Security Disability Income (SSDI) is for workers under age 65

who meet the Social Security Administrations definition of disability.
Call 1-800-772-1213 or visit <www.ssa.gov> for information.
Supplemental Security Income (SSI) is for people 65 or older who are

disabled or blind and have very limited income and assets.
Call 1-800-772-1213 or visit <www.ssa.gov> for information.
Veterans benefits may be available to veterans. Call 1-800-733-8387 for

information.
Tax benefits may be available (e.g., deductions or credits on income

tax). For tax information, consult your tax advisor or the IRS.
Call 1-800-829-1040 or visit <www.irs.ustreas.gov> for information.

Protect Yourself from Fraud!
Junk mail
D
Write:
Mail Preferences Service
Direct Marketing Association
P.O. Box 9008
Farmingdale, NY 11732
Include the persons full name, address, and any spelling

variations of name.
Ask your local post office to stop delivering third-class mail.
Telephone solicitations
Write:
D
Telephone Preference Service
P.O. Box 9014
Farmingdale, NY 11735
Call Opt Out Request Line (1-888-567-8688) to reduce credit card

solicitations.
Fraud
D
Report suspected fraud attempts to:
National Fraud Information Center: 1-800-876-7060
State Agency on Aging: 1-800-677-1116 (to get local number)
(adapted from Kuhn 1999)

Information Sheet
Name: ______________________________________________________________
Phone: ______________________________________________________________
Address: ____________________________________________________________
_____________________________________________________________________
General Information
Medications: ______________________________________________________
__________________________________________________________________
Enjoys doing: _____________________________________________________
Dislikes: __________________________________________________________
May: _____________________________________________________________
__________________________________________________________________
Important Phone Numbers

Primary caregiver: _________________________________________________
Primary physician: _________________________________________________
Poison Control Center: _____________________________________________
Neighbor: _________________________________________________________
Relative: __________________________________________________________
911
Emergency: _______________________________________________________
Other Emergency Numbers: ________________________________________
Special Instructions: _________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Kitchen

Bathroom

Living Room

Outside

Summary of Safety Hazards
(pictured in Handouts 6-9, pages 85-88)
Kitchen (Handout 6, page 85)
Stove: Open flames or hot heating elements can cause burns. Removing the knobs from the
stove and oven can eliminate the temptation to turn them on. If the person with AD is still
cooking, careful supervision is needed to prevent burns.
Kitchen counter: Knives, cleaning products, electric appliances, and alcohol should be stored
out of sight and in a secure area.
Small rug: Small area rugs are a tripping hazard.
Water temperature: Check the temperature setting on the hot water heater. It should not be set
high enough for the water to scald.
Overflowing garbage: Garbage should be covered or out of sight.
Fire extinguishers and smoke alarms: Fire extinguishers and smoke alarms should be installed.
Supervision during all cooking activities is recommended.
Bathroom (Handout 7, page 86)
Medicine cabinet: Medicines should be stored in a locked cabinet or box.
Safety devices: Safety devices such as grab bars, non-slip safety mats, and shower chairs can
be used in the tub area.
Glass shower doors: Glass shower doors can be dangerous if someone falls.
Water temperature: Check the temperature setting on the hot water heater. It should not be set
high enough for the water to scald.
Toilet: The toilet can be made safer with the addition of grab bars near the toilet and elevated
toilet seats. Battery operated fluorescent lights over the toilet add more lighting.
Electric appliances: Electric appliances should be stored in a secure area. Their use should be
supervised.
Bath mat: Bath mats create a tripping hazard.
Chapter Eight
Summary of Safety Hazards, continued
Living Room (Handout 8, page 87)
Staircase: The stairs need a hand rail for support. Secure carpeting on the stairs to prevent
tripping. Remove objects on the stairs which could cause tripping.
Windows (glare): Large, uncurtained windows create glare in a room. Draw curtains if glare is
a problem.
Rugs: Small rugs create a tripping hazard.
Clutter: Clutter on table tops can cause confusion. Clutter on the floor is a tripping hazard.
Light sources: One central light source can cause shadows in corners of rooms. Lamps can
eliminate the shadows, but be careful that cords dont present a tripping hazard.
Smoking: Smoking is a health and fire hazard. If the person with AD smokes, he or she must
be supervised. Remove cigarettes and matches and keep them in a secure location.
Small stool: Placement of small pieces of furniture can cause tripping.
Potted plants: Large plants on the floor create tripping hazards and poisonous berries may be
dangerous if eaten.
Mirror: Cover or remove mirrors if they cause confusion and disorientation.
Outside (Handout 9, page 88)
Car: Driving can be a problem (Social Reminder, page 159). Cars should always be locked.
Power tools: Store power tools and gasoline in a secure area. Supervise their use.
BBQ equipment: Matches and lighter fluid are fire hazards; a hot grill can cause burns.
Always store matches and lighter fluid in secure areas and supervise grilling.
Swimming pool: Area around swimming pool should be locked. Access to pool area should be
limited to supervised times.
Access to wandering: Gates should be locked to prevent wandering.
Bushes with berries: Check to see if berries are poisonous. Remove plants and replace with
plants that don't tempt eating.
Hose on walk: Hoses, tools, toys, and other objects left lying about can cause tripping.
Chapter Eight
Wandering
What?
Wandering is the name of a behavior or communication breakdown that happens when a
person with AD tries (often repeatedly) to leave the place where he or she is. This can
happen at a nursing home or a home.
Who?
Person with AD:
Wears an ID bracelet or necklace.
Wears clothing with name and phone number written inside.
Carries another ID in wallet or purse.
Carries phone number for AAs Safe Return Program 1-800-272-3900.
Caregiver:
Make taking a walk together part of daily routine.
Use communication tips from Chapter 5.
Neighbors:
Keep names and phone numbers at hand. (Handout 5, page 84)
Police:
May keep photo and fingerprints of person with AD on file.
Keep information available (e.g., age, hair color, eye color, blood type, medical
condition, allergies, any identifiable jewelry or body markings).
When?
Wandering is typically seen in the middle stages of the disease. It can occur at any time and
caregivers need to be prepared.
Where?
Safety precautions to take inside your home:
Put locks high or low on doors and out of normal line of vision.
Place signs and nightlights in home to guide walking.
Use special doorknob covers that need pressure to turn.
Put chimes or bells on doors to alert you to the door opening.
Safety precautions to take outside your home:

Secure access to swimming pools or other water.
Lock gates.
Identify unsafe areas (e.g., steep stairs, busy streets, high balconies). Secure
access to these areas.
Why?
There are many different reasons: disorientation, fear, anxiety, desire to go home, attempt
to escape an environment that may seem unsafe or unpleasant. (See Chapter 5, page 56, for
more information on wandering.)

Caregiver: Take Good Care of Yourself
Routine medical and dental checkups
Healthy food Exercise
Social activities Sense of humor
Play Sleep
Limit alcohol and caffeine
Ask for help

Communication Tips
Who What
I’m
hungry.
It takes two people to Someone has a message.

communicate.
Where How
Consider the environment. Try

to reduce noise and distractions.

Therapy Materials
Schedules
Today (long schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
A Today (short schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98
p Single Activity (using the bathroom) . . . . . . . . . . . . . . . . . . . . . . . . . . .99
p Evening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
Therapy Conversation Topics . . . . . . . . . . . . . . . . . . . . . . .101

e Social Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
n Self-Care Activities of Daily Living . . . . . . . . . . . . . . . . . .169
d
i
x
O
n
e
Appendix One
Today (long schedule)
7:30 Go with _____________ to breakfast.
9:30 Home. Watch TV or read.
10:30 Fold laundry.
11:00 Lunch.
11:30 Go for a walk with _____________.
12:00 Rest.
1:00 Eye doctor appointment.
3:00 Grocery store.

Appendix One: Schedules
Today (long schedule), continued
4:00 Home. Put groceries in pantry.
5:00 Set table.
5:30 Dinner.
6:00 Pull weeds.
7:00 Watch TV.
9:00 Bathe.
10:00 Bedtime.

Today (short schedule)
Today is Monday.
3:00 Eye doctor.
Tonight Sue and the kids are here for dinner.

Use the Bathroom
Put a check in the blank for each visit.
7:00 _____________ bathroom
9:00 _____________ bathroom
11:00 _____________ bathroom
1:00 _____________ bathroom
3:00 _____________ bathroom
5:00 _____________ bathroom
7:00 _____________ bathroom
9:00 _____________ bathroom

Evening
5:00 _____________ will come home.
5:30 _____________ will cook dinner.
I help _____________.
6:30 We eat dinner.
7:30 Take plate to the sink.
Dry dishes.

Therapy Conversation Topics
Daily Life
Cooking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
Sewing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
Wood Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
Gardening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108
A New Car . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Wedding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112
Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114
Elementary School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
High School Prom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118
Pets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120
Entertainment
Baseball . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
Fishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124
Fairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
Camping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
The Movies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
The Funny Papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134
The Golden Age of Radio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136
Westerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
Elvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Time Line
The Roaring Twenties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Electricity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144
Heroes in the Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
The Thirties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148
World War II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
Political Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152
The Space Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
Appendix One: Therapy Conversation Topics

Cooking

Cooking
Memory Prompts: wooden spoon, wooden rolling pin, measuring spoons and Yes/No Questions
cups, pie pan, bowl, muffin tin, cookbooks, recipe cards, apron, assorted Do you use eggs and flour to make a
extracts (to smell) cake? (yes)
Music: Someones in the Kitchen with Dinah, Billy Boy, Yes, We Have No Does maple syrup taste good on a
Bananas, Thats Amoré hamburger? (no)
Does the refrigerator keep food hot?
Context Setting: (no)
The Source for Alzheimers & Dementia

Do you use a frying pan to scramble
Level 1: I love to cook. I cook meatloaf ground meat, egg, and ground
eggs? (yes)
crackers mixed together. I cook fried okra. Slice the okra and mix it with egg

and cornmeal. Then fry it. I love to barbecue ribs too. What do you like to Do you use a rolling pin to make a pie
cook? crust? (yes)
Forced-Choice Questions
103
Level 2: I love to cook meatloaf, always a different way. Squishing the cold
ground meat together with yellow, runny eggs and crushed crackers, it feels Is an apple or a carrot a fruit? (apple)
slippery and scratchy at the same time. Then I put the mixture in the pan to
bake. Mmmmm, it smells good! Do people eat pancakes or hot dogs for
breakfast? (pancakes)
I love to cook fried okra. You cut the okra into little sections and then moisten Are fruit or vegetables in a cobbler?
it with eggs and then dump the little okra segments in yellow cornmeal. Then (fruit)
you fry the okra until it is crisp.
Do you bake cookies or ice cream in an
oven? (cookies)
And I love to barbecue over charcoal, cooking baby back ribs slowly, very
slowly, always basting on a special barbecue sauce until the ribs are tender and Do you make salad with lettuce or
just a little crunchy along the edges. I love to eat them with corn on the cob French fries? (lettuce)
that just oozes with butter and has salt all over it.
Thats what I love to cook. How about you?

Sewing

Sewing
Memory Prompts: different textures and types of cloth, buttons, zipper, Yes/No Questions:
thimble, sewing patterns, pincushion, measuring tape, other sewing notions
Do shirts have buttons? (most)
(e.g., rickrack)
Is a thimble used on a toe? (no)
Music/Poetry: The needles eye that doth supply Are pins kept in a pincushion? (yes)
The thread that runs so true.
Many a beau have I let go Do patterns help you make clothes?
Because I wanted you. (yes)

Does a sewing machine use electricity?
Context Setting: (modern ones do)

Level 1: My mom taught me how to sew. She showed me how to thread a Forced-Choice Questions:
needle. She always made me use a thimble. I still stuck my fingers Ow! I
Do you use scissors or a knife to cut
learned to make an apron and then a dress. I loved to sew, but I hated putting
cloth? (scissors)
in zippers!
105
Does thread go in a needle or a spoon?
Level 2: The first thing I ever made by sewing was an apron. I was 8 years old. (needle)
My mother showed me how to thread the needle. I hated trying to put that Would you use satin or denim for a
little tiny thread through the little tiny needle hole. I cut a piece of cloth the pair of pants? (denim)
right size for an apron and one for the sash. The material was covered with
little blue flowers. I made two rows of large, loose stitches across the top of the Do pins or staples keep pieces of cloth
rectangle of cloth. Then my mom showed me how to pull the threads to draw together while you sew? (pins)
up the cloth into little pleats. I attached the sash to the top and hemmed the Would you put rickrack on a little girls
bottom of the cloth. It was the first piece of clothing I sewed, but it wasnt my dress or a mans shirt? (little girls
last! dress)

Wood Working

Wood Working
Memory Prompts: toolbox; hammer; wrench; screwdrivers (Phillips and Yes/No Questions:
flathead); sandpaper; sawdust; turpentine (to smell); safety goggles; assortment Do you use a hammer with nails? (yes)
of nuts, bolts, and washers
Do you use sandpaper to make wood
Music: Pop Goes the Weasel rough? (no)
Do you use a hammer to cut wood?

Level 1: I remember the first time my dad let me into his workshop. We sanded Do you use a wrench to tighten and
pieces of wood. Measure twice and cut once my dad always said. He even loosen bolts? (yes)
let me use his sharp tools that day to cut the wood. We worked all afternoon. Should you measure twice and cut

When we finished, my mom had a new birdhouse for her birthday. once? (yes)
Level 2: Ill never forget the smells in my dads workshop: turpentine and Forced-Choice Questions:
sawdust. My dad never let me handle his tools.
107
Do you use a hammer or a screwdriver
with nails? (hammer)
Theyre not toys, Son, he would say.
Does a carpenter or a mechanic work
I remember my surprise one day when my dad told me we had a job to do with wood? (carpenter)
together. I must have been 5 or 6 years old. He had some old scraps of wood Does a saw or a hammer cut wood?
that he showed me how to sand. Ouch, I got a splinter! He showed me the (saw)
plan we were going to use. We used an old tape measure to measure the
lengths of wood. My dad always said, Measure twice, cut once. Do nails go in wood or paper? (wood)
Do you store tools in a basket or a
We penciled the marks on the wood and he helped me use the saw. Back and toolbox? (toolbox)
forth, until the lengths were right. He held the pieces together and showed me
where to put the nail. My dad had to start the nail, but then I got to finish. We
drilled a big hole in one side and then we were finished. My mom had a new
birdhouse for her birthday!

Gardening

Gardening
Memory Prompts: seed packets, bulbs, gardening tools (e.g., small shovel, Yes/No Questions:
trowel, clippers), small tubs of gardening soil (to feel), gardening gloves,
Is a measure of land an acre? (yes)
watering can, mister
Do plants need water to grow? (yes)
Music: White Coral Bells, An English Country Garden Do you plant seeds to grow radishes?
(yes)
Context Setting:
Can you use a hoe to weed? (yes)

Level 1: I like getting the garden ready in the spring. First you till the soil. Does a hard freeze help young plants?
Break up the clods. Then rake the soil smooth. Use your hands to make the (no)
rows and drop the seeds in. Then its time to wait for the seeds to grow. Little

plants in straight, green rows. Forced-Choice Questions:
Does an apple grow on a tree or a vine?
Level 2: The best part of gardening was the first green shoots. Getting the soil
(tree)
ready was not bad because you would burrow your hands in it after you had
109
tilled and it was always warm. If you had worked hard, there were no clods, Is it easier to grow a tomato from a
the good rich-smelling loam just powder falling through your fingers. And you seed or a plant? (plant)
could rake it, carefully and smooth, making sure it was a perfectly even bed to Do farmers use tractors or trains?
make rows in. But the best was still that morning a week or so later when, (tractors)
whether you had planted corn or beans or okra or whateverthat morning
when you came down and a perfectly straight row of little green tips were Does John Deere or John Smith make
shining at you from out of the soil. It was your garden and it smelled like the tractors? (John Deere)
soil. The little buds had just escaped the ground, getting ready to spring up Is dirt or rocks better in a garden?
straight and be plants. (dirt)

A New Car

A New Car
Memory Prompts: empty oil containers, auto repair tools (e.g., wrench), Yes/No Questions:
chamois cloths (to feel)
Do you ever need to change the oil in a
car? (yes)
Music: Merry Oldsmobile, Little Blue Coupe, Little Old Lady from Pasadena
Do you sometimes need to add air to
Context Setting: the tires? (yes)
Can you use jumper cables to start the
Level 1: We went to look at cars. We were not going to buy one. We saw a radio? (no)

Chevrolet Bel Air. It was beautiful and red. It had fins. It smelled like a new
car. I had to climb in the back. My dad looked under the hood. How could we Do you push in the clutch to shift
ever resist? We just had to buy that car! gears? (yes)

Did Henry Ford make the first
Level 2: We were not going to buy a new car. Not today. We were just looking. Oldsmobile? (no)
Folks, this is a 1956 Chevrolet Bel Air. Its the finest car made.
We cant buy today. We just want to look. Forced-Choice Questions:
111
Thats quite all right. Why dont you get in here? Get behind the wheel.
If the car doesnt start, is it because of
Oooohh, look at those fins!
the battery or a flat tire? (battery)
Theyre horizontal stabilizers. They keep the car on the road.
Look at that one! Does a mechanic or a doctor repair a
Oh, we dont want a red one. Do we? car? (mechanic)
Look at the way it shines! Do you need a jack or a fork to change
Come here, young man. Why dont you climb in the back? a tire? (jack)
And you would climb in the back. And there would be the smell of the new
car. No one can ever describe how a new cara brand new car sitting in the Do you need to add antifreeze in the
showroom how it smells. winter or the summer? (winter)
Is the battery charged by the generator
And your father would be walking around the car, looking at the engine, then or the spare tire? (generator)
talking about trade-ins and interest and other things.
And you would know, running your hand over the beautiful, spotless seat
covers, that you were all going to drive home in the 1956 red Chevrolet Bel Air.

Wedding

Wedding
Memory Prompts: bridal veil, garter, bride and groom cake top, wedding photos Yes/No Questions:
Is a woman getting married called a
Music: Froggie Went A-Courtin, Let Me Call You Sweetheart, Wedding bride? (yes)
March
Is a man getting married called a
Context Setting: groom? (yes)
Does a flower girl carry toys? (no)
Level 1: At the wedding, everything was going wrong. The best man lost the ring.

The bridesmaid ripped her dress. The air conditioning wasnt working. Does a bride have bridesmaids?
Everything cost too much. Then the wedding started. The best man was there (usually)
with the ring. The music started. The bride was beautiful. Everything was okay. When you sneak away to be married, is

it called eloping? (yes)
Level 2: Because it is a wedding, everything has gone wrong. One of the
bridesmaids ripped her dress. The best man left the ring in the motel room. Forced-Choice Questions:
He has taken a car to get it, but he is stuck in a traffic jam. He cant be late
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Do brides and grooms say, I do or I
because theres another wedding at four oclock. The air conditioning is not
wont? (I do.)
working.
Is the party after a wedding called a
Because it is a wedding, everything has gone wrong. Now it is time to start. reception or a disco? (reception)
The brides family is seated on one side. The grooms family is seated on the Does the bride wear a wedding ring or
other side. The organ music starts. THE BEST MAN IS BACK! THE RING IS a wedding belt? (wedding ring)
HERE!
Are the first words of the wedding
And now, everyone is filing inthe groom, the best man, the groomsmen, the march, Here comes the bride or I
bridesmaids, the maid-of-honor. like the bride?
(Here comes the bride)
There is a hush. The Wedding March starts . . . Tum tum ta ta, Tum tum ta ta Is the grooms helper the best man or a
. . . Everyone turns. The bride enters, holding the arm of her father. She looks baseball player? (best man)
up and smiles. The groom, far down at the altar, smiles back at her.
And because it is a wedding, everything is all right.

Baby

Baby
Memory Prompts: rattles, cloth diapers, baby clothes, baby powder (to smell), Yes/No Questions:
bottles Do babies cry a lot? (yes)
Music: lullabies (e.g., Rock-A-Bye Baby, Hush, Little Baby, Irish Lullaby) Do babies drink from bottles? (many
do)
Context Setting: Do babies sometimes need to be
changed? (yes)
Level 1: It is late at night. The baby is crying. You wonder, Is the baby wet?

Is the baby hungry? Is the baby lonely? You change the diaper and pick the Do you pat a babys head to burp it?
baby up. Walk, walk, walk the baby. Rock the baby. Sing a quiet song. The (no)
baby goes to sleep again. The house is quiet. Do most babies like to be rocked? (yes)

Level 2: It is two AM, very dark and very quiet, except for the baby crying in Forced-Choice Questions:
the other room, and it is your turn. The hardwood floor is cold against your
Do babies wear diapers or blue jeans?
bare feet. You lean over the crib and you instantly smell why the baby is
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(diapers)
crying. You reach for a clean cloth diaper, just beside the crib.
Do little babies crawl or jump? (crawl)
You carefully remove the safety pins, big safety pins, and lay them on the table. Do babies drink milk or coffee? (milk)
Then you hold the babys feet together and lift his legs so that his little bottom
comes up off the crib sheet. You slide the dirty diaper out and carefully put it Do babies sleep in cribs or chairs? (cribs)
on the table because it must be washed out. Do you sing lullabies or marches to
babies? (lullabies)
Then you wash the baby with a warm, wet washcloth. The crying is softer now.
You put a new, dry diaper on, and fasten it snug with the pins. Then you pick
the baby up and hold the little body, firm and warm against your shoulder.
Your hand is behind his head.
Walk, walk, walk.
The baby is asleep againand the house is quiet.

Elementary School

Elementary School
Memory Prompts: laptop chalkboards and chalk, school photographs, apples Yes/No Questions:
Is elementary school for two years?
Music: America the Beautiful, School Days, Youre a Grand, Old Flag
(no)
Context Setting: Does a teacher use a blackboard? (yes)
Do children go to school in the
Level 1: The school day passed slowly. We had fun at recess, but then it was summer? (not usually)
time to work. I would write on a tablet of paper. There was an Indian chief on

the cover. Sometimes I wrote on the blackboard. Id always look at the clock. Do children play on the roof at recess?
I wanted it to be three oclock and time to go home. But it would only be ten (no)
oclock in the morning. Do children learn to read at school?

(yes)
Level 2: We would come in from recess where we had been playing softball.
I remember it being very hot and, of course, we were sweating. The line was Forced-Choice Questions:
long behind the water fountain. Thomas Owens always stood behind me, and
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Do children ride a bus or an airplane to
when it was finally my turn, he would poke me in the ribs to make me stop
school? (bus)
drinking.
Quit! Do children need pencils or yo-yos at
What? school? (pencils)
Quit! Can children eat lunch or supper at
Im not doing anything! school? (lunch)
There were always several wads of chewed-up bubble gum in the bottom of the
fountain and the little stream of water was always warm. Do children sit at desks or on sofas at
school? (at desks)
Our classroom was on the second floor. We would have to write things on Do children who misbehave have to sit
tablets of coarse paper. On the tablets cover was the head of an Indian chief in in the corner or in the sink? (in the
full headdress. I can remember seeing tiny flakes of wood in the paper, and my corner)
arm, still sweating from recess, made dark, wet stains on whatever I had
written.
I would look up at George Washingtons picture and at the clock beside it. I

was hoping it would be three oclock and time for the final bell so that we could
go home. But it was just after recess, only ten oclock in the morning.
High School Prom

High School Prom
Memory Prompts: class ring, prom photos, yearbooks, corsage (to smell) Yes/No Questions:
Can high school graduates go to
Music: Thatll Be the Day, Last Dance, The Band Played On, The
college? (yes)
Tennessee Waltz
Do sophomores go to high school? (yes)
Context Setting: Do students go to high school for four
years? (yes and no)
Level 1: It is time for the prom. The theme is Night in Paris. Some girls made a

giant Eiffel tower out of wire and paper. Fast songs by Buddy Holly are played. Do students have more than one
Everyone likes the slower songs best. Couples dance slowly. It is the Senior teacher? (yes and no)
Prom, 1965. Can students play football and

basketball at school? (yes)
Level 2: This is my favorite high school memory. It was the night of the prom.
The theme of the prom was Night in Paris, so the town Civic Center was Forced-Choice Questions:
decorated to look like Paris, France. The juniors made an Eiffel Tower out of
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Is the prom a dance or a test? (dance)
baling wire and a lot of papier-mâché. Along the walls of the Civic Center were
little tables with red checkered tablecloths and on them there were candles. Are seniors or freshmen ready to
graduate? (seniors)
The lights went down and the music started. It was 1965. Buddy Holly was When you graduate from high school,
singing, Thatll be the dayuhohthatll be the dayuhoh. do you get a magazine or a diploma?
(diploma)
But the song was too fast. Some couples danced. But many of the girls stood
by one wall talking and giggling. Is the high school run by a principal or
a doctor? (principal)
Another song started. This song was played over and over. It was the song In your last year of high school, are you
you could dance to in 1965. Floyd Cramer. Last Dance. It was simple and slow. a senior or a mechanic? (senior)
Above the Eiffel Tower a silver ball turned slowly. Light glittered around the
walls as the ball turned. The boys crossed the floor to the girls, took their
hands, and led them onto the dance floor. They rocked back and forth, all the
couples, moving slowly around the huge, papier-mâché Eiffel Tower.

Pets

Pets
Memory Prompts: stuffed animals, feeding bowl, catnip mouse, dog bone, Yes/No Questions:
bird cage
Are dogs good pets? (most)
Music: How Much Is that Doggie in the Window? B-I-N-G-O Do cats drink milk? (some)
Does a pet bird live in a cage? (yes)
Context Setting:
Do dogs sometimes get fleas? (yes)
Level 1: This is my favorite pet story. I had a beagle named Smokey. He loved Do fish live in the sink? (no)

to chase squirrels. One day he chased a squirrel into the pasture. Bayooooo!
Bayoooo! He chased that squirrel right up into the tree. The squirrel climbed Forced-Choice Questions:
to the top and Smokey was right behind him. That beagle had somehow

Do dogs bark or sing? (bark)
climbed the tree. When Smokey saw where he was, he started to yelp and cry.
I helped him down. He licked me all over. He was my favorite dog. Do dogs wear collars or hats? (collars)
Do cats purr or growl? (purr)
Level 2: Everyone has a favorite pet story. Here is mine. It was a cold day. My
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brothers and my father and I were in the north pasture, gathering wood for the Do dogs have kittens or puppies?
fireplace. Smokey, our beagle, was digging in the clumps of brush. Suddenly (puppies)
he went tearing away after a red squirrel. Bayoooo! Bayoooo! Do cats scratch or clap? (scratch)
Hes gonna get that squirrel!
No! Squirrels in the tree!
And it was truethe squirrel had reached a huge hackberry tree, bare of limbs.
He leapt into it, claws scratching, and disappeared into a hole in the trunk. We
went back to work. Some minutes later my brother said, Look!
I turned my head and will never forget what I saw. At the top of the tree was
the squirrel. And in the middle of the tree, working his way up, thirty feet off
the ground, was our dog Smokey. The beagle had climbed the tree!
Just then Smokey realized how far off the ground he was. He started yelping
and crying. Ive forgotten how I climbed high enough to get my arms around
him. But I remember him licking my face as I climbed down with him. He was

my favorite dog ever.
Baseball

Baseball
Memory Prompts: baseball, glove, pennant, baseball cards Yes/No Questions:

Are there 12 players on a baseball
Music: Take Me Out to the Ball Game team? (no)
Context Setting: Are three strikes an out? (yes)
Does the pitcher throw the ball to the
Level 1: I always liked a new baseball glove. I was a catcher. I always got a catcher? (yes)
catchers mitt. I bought it at the store with my dad. We rubbed oil on the

glove. It had a special smell. Does the batter try to catch the ball? (no)
Did Babe Ruth play baseball? (yes)
Level 2: What I remember most about baseball is the new glove. The glove was

always special. It could be a Wilson or a Rawlings glove. But you would go Forced Choice Questions:
buy it with your dad. It might be a mitt if you were a first baseman or a
Are there five or nine players on a
catcher. The two of you would bring it home, and the weather would be very
baseball team? (nine)
hot. In the garage was always a can of neats-foot oil. The two of you slathered
123
the oil all over the glove. I can still remember the smell of the oil in the dark, Are two or three strikes an out? (three)
hot garage. Then you would put a baseball in the glove, fold the oiled glove Are four or five balls called a walk?
tight around the ball, and tie it with strong cord. The next morning the glove (four)
had a pocket; it was ready.
Was Ty Cobb or Lou Gehrig called The
Georgia Peach? (Ty Cobb)
Is the baseball championship called the
City Series or the World Series?
(World Series)

Fishing

Fishing
Memory Prompts: tackle box, fishing rod, assortment of lures (Be careful to Yes/No Questions:
remove hooks for safety.)
Do you put a worm on a hook? (yes)
Music: Gone Fishing Can you fish in an ocean? (yes)
Is a marlin a saltwater fish? (yes)
Context Setting:
Can you fish from an airplane? (no)
Level 1: I remember fishing with my dad. It was summer. We went to the creek Can you fish in the winter? (yes)

near our house. We took drinks and crackers. We always used worms for bait.
I would feel a nibble, then another. The bobber would go under the water. Forced-Choice Questions:

Is a bass a fish or a lizard? (fish)
Now, yank! said my dad.
Do most people fish in the winter or the
Usually the fish got away. But we didnt care. My dad and I had fun fishing. summer? (summer)
125
Can you fish in a swimming pool or a
Level 2: I remember going fishing with my dad on the creek near our farm. We river? (river)
would dig up worms from our garden. Then we would go to a filling station,
early in the morning, and get RC colas and some Vienna sausages with Does an outboard motor or an
crackers. The fishing hole was a couple of miles from the farm and it would eggbeater power a boat? (outboard
take us over half an hour to make our way to it, walking through tangles and motor)
briars. The sun would just be up and the summer air getting warmer when we Would a bass strike at a lure or a spare
would cast out into the middle of the creek and watch the red plastic bobbers, tire? (lure)
sitting upright in the water, just waiting for something to take the bait. After
awhile, there would be a nibble, and then another, and finally the bobber would
disappear.
Now! Yank now!
Sometimes the fish would get away, and even if we caught it, it would never be
much more than a perch or sunfish. But that wouldnt matter. What was fun
was that it was my dad and me, fishing on the creek.

Fairs

Fairs
Memory Prompts: fair ribbons, midway prizes (e.g., small stuffed animals) Yes/No Questions:
Can a cow win a ribbon at a state fair?
Music: Meet Me in St. Louis, Our State Fair
(yes)
Context Setting: Can a pie win a ribbon at a state fair?
(yes)
Level 1: We loved the State Fair! Mom always took canned preserves. One year Does the cattle barn at a fair have
she won a red ribbon. My dad liked the stock barns. He would look at the red carnival rides? (no)

Hereford bulls. My brother and I loved the Automobile Building with all the
new cars. We all went to the midway at night. We ate corn dogs. We rode the Is a Ferris wheel at a state fair? (yes)
giant roller coaster. Can you get cotton candy at a state

fair? (yes)
Level 2: There was nothing like the State Fair for us. My brother and I would
look forward to it all year, and when the cool crisp days of October came Forced-Choice Questions:
around, we knew it was near. Mom would have canned her preserves, every
127
Are pigs or motorcycles at fairs? (both)
year thinking to win a blue ribbon and never doing much better than a red.
Dad would be anxious to go to the stock barns, to look at the prize-winning Are state fairs in the fall or spring?
sheep or the fat, red Hereford bulls, all standing in the stalls with FFA boys (fall)
currycombing them. Those places would be our first stop, but then we would Is cotton candy pink or blue? (both)
head for the Automobile Building to see the new model Fords or Chevrolets. I
liked the shiny red ones that they would let you sit in, the upholstery smelling Does the best animal get a blue or
the way that only new cars do. yellow ribbon? (blue)
Would you win stuffed animals in the
And after that, of course, the midway. KNOCK DOWN TWO MILK midway or the animal barn? (midway)
BOTTLES! JUST TWO MILK BOTTLES WINS YOU A . . .
We never won. And it looked so easy. But it wasnt important. Because you
could always smell the corn dogs. And you always knew that you were going
to ride The Lightning Roller Coaster, way up high over the fairground,
watching the lights come on and the city glittering in the cold October night.

Camping

Camping
Memory Prompts: map, camping gear (e.g., flashlight or lantern, canteen, Yes/No Questions:
binoculars) Do you need a sleeping bag when you
camp? (sometimes)
Music: Home on the Range, Green Grass Grew All Around, Shine On,
Harvest Moon Do you cook over a fire when you
camp? (sometimes)
Context Setting: Can you camp in national and state
parks? (yes)

Level 1: I like to go camping when it is cold. Put up the tent before it gets dark.
Then build the campfire. You need lots of kindling and little sticks to start it. Can you take electrical appliances
Then build the fire bigger. At night you can look at the stars. You can tell when you camp? (only if your

stories around the campfire. Bacon frying for supper smells good. campsite is equipped)
Do binoculars help you see things far
Level 2: You do the best camping when it is cold, I think, and you can get down away? (yes)
in a draw or ravine, out of the north wind thats whistling over you. You get
129
there in the late afternoon, knowing that in winter the sun will be a gray disk Forced-Choice Questions:
low in the sky, and that it will get dark quickly. Then one of you stakes the tent,
Do you camp in a tent or a house?
while the other gathers wood. You have to start with tiny little splinters of
(tent)
kindling, good and dry. Then you need a lot of branches that are about as thick
as your finger and bigger ones maybe wrist size. Arrange them like a tepee and Do you fish or go to the movies when
you can watch the air drafts sucking the young, bright orange fire up through you camp? (fish)
the top of the tepee, while you gradually drag bigger logs around the campfire. Do you sleep in a sleeping bag or a bed
Then you fry the bacon in an old skillet and get the coffee going. when you camp? (sleeping bag)
You might tell stories later on when the wind is howling in the trees above, or Is it quiet or noisy when you camp?
you might wander up into a clearing to watch the stars late at night; but (usually quiet)
somehow I think nothing is ever better than that first smell of bacon on the Could you see a deer or a traffic light
campfire youve made. when you camp? (deer)

Football

Football
Memory Prompts: football, pennants, cheerleader pom-poms, football helmet Yes/No Questions:
Are five people on a football team?
Music: On Wisconsin or the Notre Dame fight song
(no)
Context Setting: Does the quarterback sometimes throw
the ball? (yes)
Level 1: Everyone in my family loved the Dallas Cowboys football team. We Is the championship game called the
watched every game. Were the Redskins better this year? No, Tom Landry Super Bowl? (yes)

would always have some tricks. The great players were Jethro Pugh, Roger
Staubach, and Bill Bates. Different people were on the team each year, but we Is a field goal four points? (no)
still loved the Dallas Cowboys! Is a touchdown six points? (yes)

Level 2: All of the women in the familyeven my grandmother after years Forced-Choice Questions:
and years of protesthad learned that the Dallas Cowboys went with Thanks-
Do football players need a football or a
giving. The family would all have gathered by ten that morning, uncles and
131
golf tee? (football)
granddads and new young dads standing out on the lawn, women busy in the
kitchen. And there would be huge kettles, boiling water, all kinds of dressing, Do football players wear a helmet or a
turkey, spinach, and beans, fresh green beans, cooking down while the smells cap? (helmet)
got richer and richer. The meal was always over by three oclock because thats Do players try to tackle or tap other
when the Cowboys were on. players? (tackle)
Bill, I believe the Redskins are a little better this year. Is the National Football League the
NFL or the AFC? (NFL)
Yeah, they won that first game. But this one counts, and old Tom Landrys got Does a cheerleader say cheers or
a few tricks hes gonna play on them. speeches? (cheers)
Then all of the men and boys would go to the living room where it would be
peaceful and quiet. And the game would start. Don Meredith. Bob Lilly. Lee
Roy Jordan and Jethro Pugh. Later Roger Staubach and Drew Pearson and Bill
Bates and . . . .

The names always changed . . . But they were always the Cowboys.
The Movies

The Movies
Memory Prompts: picture of movie stills, photos of movie actors (e.g., Cary Yes/No Questions:
Grant, Katharine Hepburn, Jimmy Stewart, John Wayne, Humphey Bogart),
Was Humphrey Bogart in Casablanca?
popcorn, movie tickets
(yes)
Music: theme songs from memorable musical movies (e.g., My Fair Lady, The Did Katharine Hepburn and Spencer
Music Man, The Sound of Music, Oklahoma, Gone with the Wind) Tracy make movies together? (yes)
Did movies always have sound? (no)
Context Setting:

Did John Wayne make westerns? (yes)
Level 1: My favorite time to go to a movie is in the afternoon. The theater is Did Katharine Hepburn play Scarlett
empty. I get popcorn, candy, and a hot dog. The popcorn is salty and buttery. OHara? (no)

I like to watch all the previews. I love going to the movie in the afternoon. I
like musicals best. Forced-Choice Questions:
Was Judy Garland in The Wizard of Oz
Level 2: People have different ways to see movies. Some people like to go to
133
or The Wizard of Menlo Park?
the big night when the movie opens. They like the crowds. They like to stand
(The Wizard of Oz)
in line and watch a new release in a jam-packed movie house.
Was Harvey a giant rabbit or a giant
I like to go to the movies in the afternoon, on a weekday if I can, when almost cow in the Jimmy Stewart movie
no one else is there. A big part of it is the concession stand. Harvey? (a giant rabbit)
Can I get you something, Sir? Was Gregory Peck or Cary Grant in To
Id like a large popcorn, buttered. I want a hot dog with a little mustard on Kill a Mockingbird? (Gregory Peck)
it. I want a large Coke. And I want a package of Milk Duds.
You can just barely carry all of this into the darkened theater. Its very cool in Did Abbot and Costello make comedies
the theater and its almost impossible to see as the door closes behind you. or tragedies? (comedies)
Your eyes have to adjust. You sit down, put your Coke safely on the floor, and Do people usually eat popcorn or
cram a few big handsful of popcorn into your mouth. Its very salty and the spaghetti at the movies? (popcorn)
butter is oily on your fingers. You take a slurp of Coke through a straw. Then
you set the box of popcorn beneath the seat and eat the hot dog.
Now the previews are showing. The feature movie will start soon. Anything

will be good because its a summer afternoon and youre at the movies.
The Funny Papers

The Funny Papers
Memory Prompts: comic strips (e.g., Blondie, Dick Tracy, Felix the Cat, Yes/No Questions:
Lil Abner, Flash Gordon, Superman, Batman, Peanuts) Can Superman fly? (yes)
Music: none Is Batman a super hero? (yes)
Does Dagwood always eat giant
Context Setting: hamburgers? (no)
Level 1: We loved to read the funny papers. On Sunday they were always in Does Snoopy sleep on his doghouse?

color. Peanuts was our favorite. Lucy always fooled Charlie Brown. He (yes)
tried to kick the football and Whump. He always landed on his back. Good Are the funnies on TV? (no)
grief!

Forced-Choice Questions:
Level 2: We read them every morning and so they become a part of our lives.
Is Clark Kent Superman or Flash
They are like the holidays. Fall comes and the colors change and it smells like
Gordon? (Superman)
burning leaves. Lucy holds the football on a kicking tee and says, Ill hold the
135
football, Charlie Brown, and you run up and kick it. For the first few years, he Does Batman drive a Batmobile or an
would always do it, and she would always pull it away, and he would fly up in Oldsmobile? (Batmobile)
the air and come downWHUMP!on his back. Then she would stand over Does Lil Abner live in the hills or in
him and give some advice like, Never believe everything that people tell you. the city? (in the hills)
In later years, he would not try to kick the football until she had assured him Is Snoopy a dog or a cat? (dog)
that this time he was actually going to get to kick it. And he would always Is Dick Tracy a police officer or a
believe her. I guess life is like that. Good grief! firefighter? (police officer)

The Golden Age of Radio

The Golden Age of Radio
Memory Prompts: audiotapes of radio programs from the 30s, 40s and 50s; Yes/No Questions:
photos of vintage radios Was Milton Berle a comedian? (yes)
Music: William Tell Overture (from The Lone Ranger), When You Wish Upon Did Orson Welles write War of the
a Star, That Aint Right, Dont Fence Me In, Im Making Make-Believe Worlds? (yes)
Did the Lone Ranger ride a horse
Context Setting: named Buddy? (no)

Level 1: Every Thursday night we listened to the radio. All the people in the Were Fibber McGee and Molly on the
city listened to the same programs. Our favorites were Burns and Allen, The radio? (yes)
Lone Ranger, and Bob and Ray. Sometimes we heard important news on the Did Lowell Thomas have a news

radio. One time we heard President Roosevelt talk about the bombing of Pearl program? (yes)
Harbor as a day that would live in infamy.
Forced-Choice Questions:
Level 2: On Thursday nights at 6:30, the town was deserted. It seemed that no
137
Was Gunsmoke a western or a comedy?
one was on the roads or sidewalks. It was like a ghost town. But all along the
(western)
streets, there were lights in open windows. You could walk along the sidewalks
and the same voices would be coming from each house. The voices were Was Kate Smith a singer or a gossip
louder as you went by. Then they became fainter, but they were replaced by the columnist? (singer)
same voices, getting louder now, at the next house down the street. Do radio stations have call letters or
call numbers? (call letters)
Freeman Gosden and Charles Correl. Arthur Godfrey. Or it might be Jack
Benny. Put up your hands, Benny! Your money or your life! Long silence. Was Jack Benny generous or stingy
Well? Im thinking! All along the street, laughter. with his money? (stingy)
Did Jack Benny play a violin or a
And now all of us are gathered around the big wooden radio, listening as the trumpet? (violin)
static crackled . . . We have nothing to fear . . . but fear itself. And, some
years later . . . December 7, 1941. A day that will live in infamy.
Are those voices still out there somewhere, floating in space? That golden age
of radio.

Westerns

Westerns
Memory Prompts: photos of TV westerns and movie personalities (e.g., Gene Yes/No Questions:
Autry, Hopalong Cassidy, Roy Rogers, Tom Mix, James Arness) Were westerns popular TV shows in the
50s? (yes)
Music: theme music from television or movie westerns (e.g., Gunsmoke), I
Walk the Line, Your Cheatin Heart, Do Not Forsake Me, Yellow Rose of Was Wagon Train a TV western? (yes)
Texas Was James Garner in Maverick? (yes)
Context Setting: Were Ben Cartwrights sons named

Adam, Hoss, and Little Jeffrey? (no)
Level 1: My favorite television western was Gunsmoke. James Arness was the Did James Arness play Festus? (no)
marshall, Matt Dillon. He and Festus and Doc and Miss Kitty lived in Dodge

City. There were new adventures every week. Marshall Dillon kept law and Forced-Choice Questions:
order in the town.
Was Gary Cooper or Cary Grant in
High Noon? (Gary Cooper)
Level 2: There are, of course, the great Western heroes of the old movies. There
139
was Roy Rogers. Gene Autry. Hopalong Cassidy. There was John Wayne and Did a sheriff or a mayor keep law and
there was Tom Mix. All of them were great heroes. order in the west? (sheriff)
Did people travel west in wagon trains
The best Westerns came in the 1950s on Saturday or Sunday nights. Our family or airplanes? (wagon trains)
would wait all week for Gunsmoke. The best Gunsmoke shows were the earlier
ones that only lasted half an hour. It would be eight oclock and Marshall Did towns in the Old West have
Dillon would step out into that long street in Dodge City. Someone would have sidewalks or boardwalks?
called him out. You could only see his back while the theme music played. (boardwalks)
Was there a famous gunfight at the OK
Then POW POW! Two shots and the other guy would always fall down dead Bank or the OK Corral? (OK Corral)
at the other end of the street. Marshall Dillon never lost.

Elvis

Elvis
Memory Prompts: photos of Elvis (young or old) Yes/No Questions:

Was Elvis last name Presley? (yes)
Music: any Elvis songs
Did Elvis sing You Aint Nothing but
Context Setting: a Hound Dog? (yes)
Was Elvis from New York? (no)
Level 1: I remember the first time I saw Elvis. He was on the Ed Sullivan show.
He carried his guitar. His eyes were black. His hair was a little long. When he Was Elvis drafted into the Navy? (no)

sang, he moved his hips in a way I never saw before. The girls all screamed. Was Elvis home in Memphis called
That was the day music changed forever. Graceland? (yes)

Level 2: I remember it very well. We were all sitting in front of the television Forced-Choice Questions:
because it was Sunday night and Ed Sullivan was about to come on. He was
Was Elvis home in Memphis or
going to have The Flying Wallendas and a new comedian named Johnny Carson.
Nashville? (Memphis)
141
We had just finished watching Lucky Strikes Hit Parade. That was a music Was Elvis old or young when he died?
show in which Snooky Lanson, Giselle McKensie, or someone else like that (young)
would sing the top ten songs of the day. This particular Saturday, Snooky Did Elvis marry Priscilla or Penelope?
Lanson had sung his arrangements of two of my favorites, The Ballad of Davy (Priscilla)
Crockett and How Much Is that Doggie in the Window?
Did Elvis wiggle or stand still when he
We were enjoying Ed Sullivan. But about halfway through the show, a young sang? (wiggle)
southern man came on. We thought he might be a magician or a comedy act. Was one Elvis song Love You Lots or
He had the strangest nameand he was stock still, staring out at the audience Love Me Tender?
with coal black eyes under hair much too long. And sideburns! The music (Love Me Tender)
started very suddenly, YouaintanuthinbutahoundoggaCryinallthetime!
And he was twisting and gyrating and moving and dancing and then he
stopped suddenly. And all the teen-aged girls in the audience screamed!
My father shook his head in disbeleif. Then he left the room. But I just
watched as all the girls kept screaming. And the world, even though I didnt

know it, had changed forever.
The Roaring Twenties

The Roaring Twenties
Memory Prompts: pictures of Model Ts, flappers, people dancing the Yes/No Questions:
Charleston Did women get to vote in the 20s?
(yes)
Music: Aint We Got Fun?, The Sheik of Araby, Im Nobodys Baby, Yes,
Sir, Thats My Baby, Five Foot Two, Eyes of Blue, Yes, We Have No Was alcohol legal during Prohibition?
Bananas (no)
Was Louis Armstrong called
Context Setting: Satchmo? (yes)

Level 1: Do you remember these things from the Roaring Twenties: Prohibition, Was a flapper a girl with a short skirt?
Al Capone, Gangland War in Chicago, flappers, speakeasies, the Charleston? (yes)

Did the stock market crash in 1949? (no)
I remember one time. We drove our car to the old railroad track. We waited.
The Red Ball Express roared by. Inside were the New York Yankees. They were Forced-Choice Questions:
going back to New York from spring training. Babe Ruth was inside that train.
143
Was the Charleston a dance or a
bridge? (dance)
Level 2: Do you remember the Roaring Twenties? My memories are vague
because I was just a boy, on the farm, hearing stories, seeing things in the paper. Was Rudolph Valentino an actor or a
Al Capone. Gangland war in Chicago! The flappers. Charleston! Charleston! president? (actor)
Mansions on Long Island, wherever that was. Great touring cars pulling up Is jazz a type of music or a type of ice
circular driveways, men with tall hats and women with short skirts, getting out cream? (music)
to go into huge estates and dance the Charleston. Will Rogers.
Is Little Orphan Annie a real child or
And one night in late March, 1927, we cranked the old car up and drove half a comic strip? (comic strip)
way between Lancaster and Waxahachie. We sat beside the old InterUrban Did Prohibition make liquor or beef
Railroad track for two hours. Then it came. The Red Ball Express. It was illegal? (liquor)
coming up from Florida, heading north. It roared by as we watched. The
bright windows of the train were just golden blurs. Then it was gone. We
werent able to see anyone inside, but it didnt matter. Inside that train were
The New York Yankees, returning from spring training. Between Lancaster and
Waxahachie, Texas, on a March night in 1927, I had been that close to Babe

Ruth.
Electricity

Electricity
Memory Prompts: lightbulbs or flashlights, pictures of people working by Yes/No Questions:

lantern or candle light, candles and candlesticks (light the candle) Did Thomas Edison invent the
lightbulb? (yes)
Music: none
Were the first lights in peoples homes
Context Setting: often drop lights? (yes)
Did the REA bring electricity to farms?
Level 1: We were the first farm in the county to get electricity. Huge towers and (yes)

poles went up. No more oil lamps. Soon we also had radios and phonographs.
My grandmother didnt trust electricity. She always plugged up the electric Did people use flashlights for light
outlets at night so the electricity wouldnt leak out! before electricity? (no)

Does electricity make an iron cold? (no)
Level 2: My father was on the Board of Directors of the REA, the Rural Electric
Association. One Tuesday every month we would sit in the car in the nearby Forced-Choice Questions:
town while he and the board met. I got to know Mr. Farrow, the director of the
145
Did most people get electricity in the
REA, and I got to know many of the linemen who fixed the lines when storms
1800s or 1900s? (1900s)
blew them down. I even remember a picture taken in our home when I was
around one year old. We were one of the first farms in the county to get Did Thomas Edison or Benjamin
electricity, and the picture was taken for publicity. Franklin invent the lightbulb? (Thomas
Edison)
Still, it is impossible for me to imagine what changes in the life of my parents Can electricity shock you or shoot you?
and grandparents those lines brought about. They eliminated the coal oil lamp. (shock you)
The huge towers and poles, striding across the farmland like so many invaders
from Mars, and the lines singing in the wind. I wonder what it must have been Did people use flashlights or oil lamps
like to see an electric lightbulb for the first time? before electricity? (oil lamps)
Do more people heat their homes today
Soon thereafter came phonographs and radios. What would it have been like to with electricity or coal? (electricity)
hear them for the first time? I only remember a story about one grandmother
who insisted that the electric outlets be plugged up every night. The electricity,
she feared, would seep out into the room.

And still, I must admit, I dont understand why that doesnt happen.
Heroes in the Air

Heroes in the Air
Memory Prompts: model airplanes, aviator glasses and/or helmet, photos of Yes/No Questions:
old planes and pilots Did Charles Lindbergh fly alone from
New York to Moscow? (no)
Music: Blue Skies, Off We Go (Air Force song), Come Fly with Me
Was the Spirit of St. Louis a boat? (no)
Context Setting: Did a movie called Wings win the
first Oscar? (yes)
Level 1: I loved model airplanes when I was little. I made them out of balsa

wood and plastic. I made models that looked like Flying Tigers. I made Was Amelia Earhart the first woman to
models that looked like British Spitfires. I wonder, did Charles Lindberg and fly across the Atlantic? (yes)
Amelia Earhart make model airplanes when they were young? Was the Zeppelin a blimp that carried

passengers? (yes)
Level 2: Airplanes are first for children. As a child, you would go into the five-
and-dime store and buy a model and some Testors glue. You started with Forced-Choice Questions:
balsa wood models bought for a quarter. Then you bought models for sixty-
147
Did Charles Lindbergh land in France
nine cents. They were made by Revell, and they were the most wonderful
or Spain? (France)
models. Exactly accurate. Plastic and in bright colors. They were The Flying
Tiger, with the snarling teeth of a tiger on the decal to be applied just under the Did Lindbergh cross the Atlantic or the
propeller. The Flying Tiger hung in your room, gray and ready for battle, Pacific Ocean? (Atlantic)
circling in gentle air currents blowing through open windows beside the British Did Lindbergh cross the Atlantic alone
Spitfire and the German Messerschmidt. And the next model (it would be a or with a friend? (alone)
Japanese Zero I got just that morning at the store)this model would be put
together even more carefully, so that no glue smudges would be seen on the Was Amelia Earhart a woman who flew
clear plastic canopy. airplanes or drove cars? (flew
airplanes)
And years ago, other children played with other models, learning of the Was the Spirit of St. Louis an airplane
propeller, the struts, the wings, the flaps. Wally Post. Charles Lindberg. And or a boat? (airplane)
the little girlhow strange, a little girl playing with airplanes! The little girl,
who was, one foggy morning, to fly off into the sky, not to stop until she had
flown around the world. The little girl that we never saw again. I wonder,
what was Amelia Earharts favorite model airplane?

The Thirties

The Thirties
Memory Prompts: photos from the Depression (e.g., soup lines, the Dust Bowl) Yes/No Questions:
Was the Great Depression in the 1950s?
Music: It Dont Mean a Thing (If It Aint Got that Swing), I Wanna Be (no)
Loved, Only a Paper Moon, Blue Moon, The Way You Look Tonight,
They Cant Take that Away from Me, A-Tisket, A-Tasket, Over the Did people lose their jobs in the
Rainbow Depression? (yes)
Did Franklin Roosevelt say, The only
Context Setting: thing we have to fear is fear itself?

(yes)
Level 1: No one had any money in the 1930s. But one night, in 1939, we had
enough money for a movie. The movie theater was like a palace. It had huge Was the Dust Bowl in the 1930s? (yes)

chandeliers. We stood in line for the movie. Inside, it got dark. The movie Were Bonnie and Clyde gangsters in the
started. It was Gone with the Wind, one of the greatest movies of all time. 1930s? (yes)
Level 2: When you talk about the 1930s, Most people think of The Great Forced-Choice Questions:
149
Depression. The images are all there clouds of dust rolling in on terrible
Was Baby Face Nelson a gangster or
West winds, driving farmers off their Oklahoma farms. Caravans of poor
a doctor? (gangster)
people driving out to California, trying to make a living picking lettuce. Farms
foreclosed by the local bank. The Great Depression. No one had any money. Was the Dust Bowl or the Soup Bowl in
Oklahoma? (Dust Bowl)
But at the end of the Thirties, I remember one year especially well. It was 1939 Was Clark Gable or Jimmy Stewart in
and there was a great theater on a downtown city street. The theater was like a Gone with the Wind? (Clark Gable)
palace. Huge chandeliers hung from the ceilings. There were three balconies.
Three! The line to get into the theater snaked around the block. There was no Was Franklin Roosevelt or Dwight
money, but people had found enough to get in that night. And once in, finally, Eisenhower president in the Thirties?
the great room grew dark. Everyone was breathless. Then came the music (Franklin Roosevelt)
Taras Theme. It was the first scene of the greatest movie of all time Gone Was Benny Goodman The King of
with the Wind. Swing or The King of Swat? (The
King of Swing)

World War II

World War II
Memory Prompts: pictures from World War II (e.g., the flag being raised at Yes/No Questions:
Iwo Jima) or of famous people (e.g., Eisenhower, Churchill, Roosevelt, Hitler,
Did the French attack Pearl Harbor?
Mussolini)
(no)
Music: When the Lights Go on Again (All Over the World), Ill Be Seeing Did Germany invade France? (yes)
You, Sentimental Journey, The Boogie-Woogie Bugle Boy Did MacArthur say, I shall return?
(yes)
Context Setting:

Was D-Day on June 6, 1944? (yes)
Level 1: This happened to my brother in World War II. He was in Pattons Was the U.S. allied with Germany and
army. He was in the Battle of the Bulge in 1944. One day he was leaning on a England? (no)

tree to light a cigarette. When he woke up, he was in a hospital. A German
sniper had shot him. The bullet went through his helmet, but did not kill him. Forced-Choice Questions:
After that he always walked with a limp, but he came home.
Was Hitler the leader of Germany or
151
England? (Germany)
Level 2: We were sitting around the dinner table when FDR told us about the
day that would live in infamy. The Japanese had attacked Pearl Harbor. Jack, Did the U.S. troops land in Normandy
my older brother, got up and walked over to the window. Ill go, he said, or Brittany on D-Day? (Normandy)
but I dont think Ill come back. I feel it. I wont come back. Did the Germans or the Japanese bomb
Pearl Harbor? (Japanese)
We all went, all of the brothers. I spent four years overseas in the signal corp.
I was in Palermo and Casablanca, and finally Naples. Living in tents the whole Was Ernie Pyle a soldier or a reporter?
time, I never got warm. Four years, cold every day. And wet. (soldier)
Did Germany or Japan surrender on V-J
Jack became a lieutenant in the infantry. He was in Pattons army. His unit was day? (Japan)
retreating during the Battle of the Bulge, in 1944. They saysomeone had seen
it, I guessthat he leaned up against a tree to light a cigarette. The snipers
always went for the officers.
He woke up in a hospital in Brussels. The bullet had gone through his helmet
and creased his brain. It damaged a nerve. He would never again walk

without a limp. But he was coming home. His feeling had been wrong.
Political Conventions

Political Conventions
Memory Prompts: photos of political conventions, campaign materials Yes/No Questions:

(e.g., political signs, political candidates buttons) Are Republicans a political party? (yes)
Music: Happy Days Are Here Again, Hail to the Chief Are Democrats a political party? (yes)
Is a cat a symbol for the Democrats?
Level 1: Political conventions were always in the summer. We would listen to Is the elephant a symbol for the

them on the radio. In 1956, Eisenhower was the Republican nominee. Who Republicans? (yes)
would the Democrats nominate? The voting went on until late at night. There Do presidential candidates sometimes
was a roll call of the states: Mister Chairman, the Great State of Alabama casts have debates? (yes)

its votes for the next President of the United States: Adlai E. Stevenson. And
then we went to bed. Forced-Choice Questions:
Do political conventions nominate
Level 2: Political conventions used to be fun. In the summer of 1956, there were
153
presidents or governors? (presidents)
wonderful conventions. Speech after speech after speech. Who would the
Democrats nominate? Finally, the great roll call of the states: Is the donkey the symbol for Democrats
or Republicans? (Democrats)
Mister Chairman, the Great State of Alabama wishes to take this opportunity Is the elephant the symbol for
to cast all thirteen votes for the next President of these United States . . . Democrats or Republicans?
(Republicans)
And the commentators: Yes, Chet, it looks like its getting closer and closer. It
may go down to the last state. Do state delegates vote on candidates
for governor or president? (president)
Inconclusive. More haggling. One oclock in the morning. Wyoming will cast Are presidential political conventions
its votes for the next President of the United StatesAdlai E. Stevenson! held in the summer or the winter?
(summer)
Then bands playing Happy Days Are Here Again and confetti and wild
delirious people. And we would go to bed exhausted, believing in our hearts
that Adlai E. Stevenson would be the next President of the United States.

The Space Race

The Space Race
Memory Prompts: photos of rocket launches, familiar astronauts, Tang Yes/No Questions:
powdered drink mix
Was Sputnik a French satellite? (no)
Music: Fly Me to the Moon, theme from 2001: A Space Odyssey Did we have a space race with the
Russians? (yes)
Context Setting: Was Alan Shepard the first American in
space? (yes)
Level 1: The Russians went into space first with Sputnik. We wanted to be first

on the moon. In July, 1969, the whole world watched and listened. As Neil Did Russia put the first man into space?
Armstrong stepped onto the moon, he said, One small step for man, one giant (yes)
leap for mankind! Was Gus Grissom the first man on the

moon? (no)
Level 2: It all began with Sputnik. The unthinkable had happened. The
Russians had beaten us into space. As a little boy/girl, you dreamt that you Forced-Choice Questions:
would be the first to fly to the moon. And then the Russians went into space.
155
Was our space race with Russia or
Before us! All around the country, schools started teaching more science. More
Germany? (Russia)
math. We had to beat the Russians! And we did.
Did Sputnik orbit the Earth or go to
Suddenly there was Cape Canaveral and pictures of huge rockets taking off in a Mars? (orbited the Earth)
burst of white fire so bright that people could see it for twenty, thirty miles Were the moon missions called Apollo
away. Alan Shepard circling the Earth with all school children standing outside or Jupiter? (Apollo)
looking at the sky, knowing that once every so many minutes he would be
passing above; going around the world. Was James Lovell or Neil Armstrong
the first man on the moon? (Neil
Then in 1969, in July, the whole world was watching. The broadcast was gray Armstrong)
and there was static. Walter Cronkite was the anchorman. We all remember his Did the astronauts on Apollo 13 die in
voice, Walter Cronkites deep voice: space or make it safely home? (made it
Were getting the signal now. Here it is . . . safely home)
Like an old Flash Gordon movie, the space figure made its way down the
ladder and jumped.
One small step for man, one giant leap for mankind.

And we were on the moon!
Social Reminders
My Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
Eating Out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160
When Are We Going? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Talking on the Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
Answering the Door . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
Getting Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164
Enjoying Meal Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
Social Club . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
Going Away . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167
Appendix One: Social Reminders

My Home
This is my home.
_____________ is here with me.

(person)
We have lived here for _____________ years.

(number)
We can _____________ together.

(activity to distract)
I am safe at home with _____________.

(person)

Driving
I should not drive.
I might crash.
I might hurt someone.
I might get lost.
It is not safe for me to drive.

Eating Out
I am going to eat at _________.

(place)
I might have to wait for a table.
The waitress will take my drink order.
After she brings the drinks, she will take my food order.
I will wait a short time for the food.
When everyone is finished eating, I will go home.

When Are We Going?
Today I am going to _____________.

(place)
I will leave at _____________.

(time)
_____________ will take me.

(person)

Talking on the Phone
Sometimes I have trouble understanding people on the phone.
I can let the answering machine answer.
Just a minute
I can say, Just a minute and get _____________ to talk on the phone.
(person)
I do not have to answer the phone.

Answering the Door
The door stays locked for safety.
Someone might ring the bell.
Wait. Do I know the person at the door?
I will not open the door if I do not know the person.
The door is locked for safety.

Getting Help
I might need help.
I can call _____________.

(person)
The phone number is _____________.

(phone number)
_____________ will help me if I need it.

(person)

Enjoying Meal Time
I take a little bite of food.
I put my fork down.
I chew slowly.
I take a sip of drink and swallow.
I eat slowly and enjoy my meal.

Social Club
Today I go to _____________.
(place)
I leave at _____________.
(time)
_____________ will take me.

(person)
I will see my friends.
I will eat.
_____________ will pick me up at _____________.

(person) (time)

Going Away
_____________ is going to _____________.

(person) (place)
_____________ will stay in _____________ for _____________ days.

(person) (place) (number)
The calendar shows when _____________ will come home.

(person)
I can check the calendar every day.
_____________ will come home in _____________ days.

(person) (number)

Self-Care Activities of Daily Living
Morning Routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170
Evening Routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
Brushing Teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172
Washing Hair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173
Using the Toilet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174
Bathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
Taking a Shower . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176
Taking Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
Getting Dressed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178
Shaving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
Appendix One: Self-Care ADLs

Morning Routine
Use the toilet.
Wash hands.
Wash face.
Brush teeth.
Brush hair.

Evening Routine
Use the toilet.
Undress.
Take a bath.
Put on pajamas.
Brush teeth.

Brushing Teeth
Wet the toothbrush.
Remove the cap from the toothpaste.
Squeeze a little toothpaste onto the toothbrush.
Brush teeth.
Spit.
Rinse mouth and spit again.
Rinse toothbrush.

Washing Hair
I put water on my hair.
I pour a small amount of shampoo in my hand.
I rub my hands around on my hair.
I scrub my scalp with my fingers.
I put water on my hair. I rinse until the suds are gone.

Using the Toilet
I tell _____________ when I need to go.

(person)
I pull down my pants.
I use the toilet.
I wipe myself with toilet paper.
I flush the toilet.
I wash my hands.

Bathing
I will take a bath at _____________ oclock.
I will take off my clothes.
It is okay. I am safe.
I will get in the water.
_____________ will help me wash.

(person)
I like to be clean.

Taking a Shower
I will take a shower at _____________ oclock.
I will take off my clothes.
It is okay. I am safe.
_____________ will help me.

(person)
The water will splash on my face.
I like to be clean.

Taking Medicine
The doctor wants me to have medicine.
_____________ will tell me when to take medicine.

(person)
I will put the medicine in my mouth.
I will take a drink of water.
I will swallow.
I will feel better.

Getting Dressed
_____________ helps me to choose clothes.

(person)
I will put on my underwear and socks.
I will put on my pants.
I will put on my shirt.
I will put on my shoes.
I look nice.

Shaving
(with electric razor for safety)
Turn on the electric razor.
Shave one cheek and jaw.
Shave the other cheek and jaw.
Shave my chin.
Shave my upper lip.
Is all the hair gone?

Other Forms of Dementia
Sometimes the diagnosis is not Alzheimers disease. Remember that the

diagnosis of AD is an exclusionary diagnosis. A doctor will look for many
other things that could be causing the dementia, and only when those have
A been eliminated as possibilities will the doctor diagnose AD. (Types of de-
mentia can be classified as degenerative, as caused by infection, or caused
by inherited metabolic disorders.) Some, such as Parkinsons disease, are
p more familiar to families. Others, such as Lewy Body dementia, are less
familiar and often puzzling to caregivers when used by professionals. This
is a brief overview of some causes of irreversible dementia that are some-
p times diagnosed instead of AD.
e Degenerative Dementias
Lewy Body Syndrome

n There are possibly two forms: Lewy Body Variant of Alzheimers disease
or Lewy Body Dementia. Lewy bodies are protein deposits found through-
d out the cortex. In the case of Lewy Body Variant, the Lewy bodies are found
alongside the plaques and tangles of AD. In Lewy Body Dementia, the Lewy
bodies may or may not be found with the plaques and tangles. Hallucina-
i tions, some Parkinson-like symptoms of gait disturbance, and a more rapid
progression than AD characterize this form of dementia.
x Picks disease
In Picks disease, there is degeneration of nerve cells particularly in the fron-
tal and temporal lobes. This type of dementia is characterized by dramatic
changes in personality and social behavior (giggling and silliness is some-
T times reported) but memory is not affected until later in the disease.
Huntingtons disease
w Huntingtons disease is an inherited, degenerative disease that affects
the brain and the rest of the body. Intellectual decline, involuntary body
o movements, and emotional disturbance characterize it. This disease was

called chorea in past times due to the uncontrolled body movements.
Parkinsons disease
Parkinsons disease is a disorder of the central nervous system. It is char-
acterized by tremors, muscular rigidity, poor balance, and decreased mus-
cular activity. It is slowly progressive and dementia often co-occurs. A
severe shortage of the neurotransmitter dopamine is linked to the disease.
Progressive Supra nuclear Palsy

Progressive supra nuclear palsy is a rare, degenerative brain disorder.
Symptoms can include vision problems (e.g., blurred or double vision),
Appendix Two: Other Forms of Dementia

Other Forms of Dementia, continued
dysphagia, motor or balance problems disease of the brain. It is also sometimes

(e.g., falling, difficulty walking, slow move- called subacute spongiform encephalopathy
ment), and personality changes in mood or (SSE). Microscopic vacuoles or holes appear
behavior. Dementia is mild. The cause is in the brain, giving it a spongy appearance.
unknown. The cause is currently thought to be a prion
(short for proteinaceous infection particle).
Irreversible Dementia Caused by Infection A prion is neither a virus nor other known
infectious agent. It is thought to be an un-
Creutzfeldt-Jakob disease conventional agent consisting of a protein.
Creutzfeldt-Jakob disease is a rapid, pro-
gressive dementia caused by an infectious
Appendix Two: Other Forms of Dementia

Recommended Books About Alzheimer’s Disease
Books for Children
Bahr, M. The Memory Box. Morton Grove, IL: A. Whitman & Co., 1992.
A Baumann, K. & Conners, E. Through Taras Eyes: Helping Children Cope with
Alzheimers Disease. Rockville, MD: American Health Assistance
p Foundation, 1995.
Cargill, K. Nanas New Home: A Comforting Story Explaining Alzheimers

p Disease to Children. Abilene, TX: Krisper Publications, 1997.
e Delton, J., Tucker, D., and Robinson, C. My Grandmas in a Nursing Home.

Niles, IL: Albert Whitman and Co., 1986.
n Guthrie, D. Grandpa Doesnt Know Its Me. New York: Human Sciences
Press, 1986.
d Karkowsky, N. Grandmas Soup. Rockville, MD: Kar-Ben Copies, Inc., 1989.
i Kibbey, M. My Granny. Minneapolis, MN: Carolrhoda Books, 1988.
x Potaracke, R. Nannys Special Gift. New York: Paulist Press, 1993.
Rappaport, D. But Shes Still My Grandma! New York: Human Sciences

Press, 1982.
T Sanford, D. and Evans, G. Marias Grandma Gets Mixed Up. Portland, OR:
Multnomah Press, 1989.
h Schein, J. Forget-me-not. Toronto: Annick Press, 1988.
r Whitelaw, N. A Beautiful Pearl. Morton Grove, IL: A. Whitman & Co., 1991.
e Books for Teenagers
Nonfiction:
e Frank, J. The Silent Epidemic. Minneapolis, MN: Lerner Publications Co.,
1985.
Young, A. E. Whats Wrong with Daddy? Worthington, OH: Willowisp Press,

1986.
Appendix Three: Recommended Books about AD

Recommended Books About AD, continued
Fiction:
Graber, R. Doc. New York: Harper and Row, 1986.
Kehret, P. Night of Fear. New York: Dutton, 1994.
Kelley, B. Harpos Horrible Secret. Redfield, AR: Ozark Publishing, Inc., 1993.
Klein, N. Going Backwards. New York: Scholastic, 1986.
Smith, D. B. Remember the Red-Shouldered Hawk. New York: G.P. Putnams Sons, 1994.
Appendix Three: Recommended Books about AD

AD Support Organizations and Web Sites
(These are web sites that I have found helpful. There are of course many,
many more that you may find. Be careful to investigate the sources of the
information you find on the Internet. You will want to use reliable sources.)
A The Alzheimers Association

This organizations mission statement is to provide leadership to eliminate
p Alzheimers disease through advancement of research while enhancing care
and support services for individuals and families. Information on the site
includes: Medical Issues, Research, News Updates, The Facts, and Taking
p Care. Information available about contacting local chapters.
e www.alz.org 800-272-3900
Alzheimers Disease International

n This international organization is based in London and is an umbrella
organization of 50 national Alzheimers Association groups. Its purpose is
d to improve the quality of life for people with dementia and their caregivers.
It offers links to resources, publications, and the international groups.
i www.alz.co.uk
Alzheimers Society of Canada

x This site offers information in English and French. Information includes
Frequently Asked Questions, Guidelines for Care, News & Events,
Physicians Corner, Forums, Resources, and Also of Interest. Its a voluntary
organization that promotes policy changes and funds research.
F www.alzheimer.ca
Alzheimers Society of UK
414-488-8722 (US) 800-616-8816 (Canada)
o This site covers England, Wales, and Northern Ireland. Information includes
Dementia, Help for Carers (caregivers), News & Events, and 20 Common
u Questions.
www.alzheimers.org.uk
r The Alzheimers Disease Education and Referral Center (ADEAR)

This site is a service of the National Institute on Aging (NIA) under the
auspices of the US Department of Health and Human Services. Information
includes Whats New, Information and Referral, NIA News, Alzheimers
Disease Publications (over 5,300 educational materials on AD), Clinical Trials
Database, and links to other federal resources.
www.alzheimers.org 800-438-4380
Appendix Four: Support Organizations/Web Sites

AD Support Organizations and Web Sites, continued
Alzheimers.com
This site is dedicated to preventing and treating the cognitive decline of AD and providing
current information. It is inspired by, but not affiliated with the Alzheimers Association.
Information includes The Basics, Risk Factors, Diagnosis, Treatments, and Coping &
Resources. Material is written under the direction of a staff of professional medical writers
and reviewed by an advisory board of professional and family caregivers.
www.alzheimers.com
Alzheimer Europe
This site serves European countries and has information in English, French, German, Spanish,
Dutch, Portuguese, Swedish, Danish, and Finnish.
www.alzheimer-europe.org
Dementia Web
This site is based in London and is sponsored by the Dementia Research Group and CANDID
(Counselling and Diagnosis in Dementia). Information is included on research findings, early
onset AD, and drug guidelines. There is also a caregiver support chat room.
http://dementia.ion.ucl.ac.uk
Alzheimer Web
This site covers current information available about medical advances and information for
caregivers. It is edited by a neurologist, Dr. David Small, and is based in Australia.
http://werple.mira.net.au/~dhs/ad.html
Agenet.com
This information and referral network is designed to Bridge the Distance between aging
parents and adult children by providing actionable information on products and services.
Topic areas include Geriatric Health, Geriatric Drugs, Legal, Insurance, Financial, and
Caregiver Support. It has links to books on dementia.
www.agenet.com
Elderbooks.com
This is the site of a leading publisher of books about AD. Selected titles include My
Mothers Voice by Sally Callahan, Activity Ideas for the Budget Minded by Debra
Cassistre, and Show Me the Way to Go Home by Larry Rose. Many other books are
available.
www.elderbooks.com

Amazon.com
Type in Alzheimers or Dementia. Hit Search and watch out. Hundreds of related titles are
available.
www.amazon.com
Universities and Hospitals:

(Some universities and hospitals offer AD sites. These include, but are not limited to:)
www.ohioalzcenter.org
This site is sponsored by the University Alzheimer Center, Cleveland, Ohio.
http://alzheimer.ucdavis.edu
This site is sponsored by the University of California at Davis Alzheimer Disease Center.
www.adrc.wustl.edu/ALZHEIMER
This site is sponsored by Washington University Alzheimers Disease Research Center, St.
Louis.
Site for Children:
www.angelfire.com/ma/alrac/kidsad.html
Contains Whats Wrong with My Grandma, A Gift You Can Make, Things You Can Do,
and Kids Stories (personal accounts of AD written by children).
Sites for Related Dementias:
Picks Disease
www.pdsg.org.uk
http://dementia.ion.ucl.ac.uk/candid
Lewy Body Syndrome
www.ccc.nottingham.ac.uk/~mpzjlowe/lewy/lewyhome.html

Huntingtons Disease
www.hdsa.org
www.had.org.uk
Creutzfeldt-Jakob Disease
www.cjdvoice.org
http://members.aol.com/crjakob/intro.html
Down Syndrome and AD
www.TheArc.org/misc/alzbk.html

Glossary
alpha-2 macroglobulin (A2M): a gene which may make a person at risk for developing AD
acetylcholine: a neurotransmitter in the brain that is greatly reduced in people with AD
ADLs (activities of daily living): activities or skills used for self-care (e.g., brushing teeth)
and other more abstract tasks (e.g., paying bills)
apolipoprotein E (APOE): a gene associated with increased risk of developing AD
amyloid precursor protein (APP): a protein in the brain that supports growth of neurons and
helps maintain them
anomia: difficulty remembering a specific word
anxiety: a state of uneasiness and/or distress about future uncertainties
axons: long, tube-like extensions on neurons
beta amyloid: a short, sticky piece of protein that has been clipped off the larger protein
(APP) that is found in the neuritic placques (See neuritic placques on page 189.)
CAT or CT scan (computerized axial tomography): a type of brain scan using X rays;
sometimes used as part of the diagnostic battery for AD
catastrophic reaction: when a person with AD overreacts unexpectedly to a situation with

angry outbursts
cdk5: a benign enzyme in the brain which is thought to be converted to an enzyme that
causes tau to collapse and twist into the neurofibrillary tangles found in the brain in
AD (See tau on page 190.)
dehydration: a condition in which a person is not getting enough fluids
delusion: an incorrect belief that cannot be changed
dementia: a group of symptoms including a loss of cognitive and linguistic skills in an adult.
There are many causes of dementia including AD and multi-infarct dementia.
dendrites: small branches on the ends of neurons which increase the neurons ability to
receive information
DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition):

publication of the American Psychiatric Association; contains criteria used to describe
types of dementia including AD
Glossary
Glossary, continued
durable power of attorney for financial decisions (also called durable power of attorney for
property): a legal document that allows the designated representative to manage
property and finances
durable power of attorney for health care: a document that designates a representative to
make all health care decisions and end-of-life decisions for the person granting the
authority
dysphagia: a swallowing disorder
echolalia: when a person repeats words or sentences said by others
episodic memory: memory of the events of a persons life
errorless learning: a technique first described by Baddely and Wilson (1994) in which
mistakes made by people with memory problems are kept to a minimum as they learn
new information
external memory aids: visual tools (e.g., calendars, memos, lists) that are used as memory
reminders
guardian (or conservator): a person appointed by the courts who has the power to take care
of someone who is unable to care for him/herself and manage that persons property
hallucinations: misinterpretations of sensory information (e.g., sight, sound, smell, touch)
lexical memory: memory of words
living trust: a written agreement where the person affected (the grantor) gives a person or a
bank (trustee) permission to control financial assets according to certain directions.
This must be set up with the help of an attorney.
living will: a document that gives another person the authority to make end-of-life health
care decisions only
MCI (mild cognitive impairment): a memory impairment that does not include the
additional cognitive problems of people with AD
MRI (magnetic resonance imaging): a test using large magnets which produces a three-
dimensional image of the brain; sometimes used as part of the diagnostic test battery
for AD
MID (multi-infarct dementia): a type of dementia caused by a series of small strokes
neuritic placques: clusters of beta amyloid seen in large numbers in the brains of people
with AD
Glossary
Glossary, continued
neurofibrillary tangles: twisted pieces of the tau protein found in large numbers in the
brains of people with AD
neurotransmitters: chemicals (e.g., acetylcholine) in the brain that help nerve cells
communicate with each other
palilalia: describes when a person repeats his or her own words over and over
paranoia: fear or suspiciousness that someone is trying to hurt you in some way
PET (positive emission tomography): an imaging technique which uses radioactive

materials to measure glucose and oxygen metabolism in different areas of the brain;
used predominately in research
perseveration: describes when a person does something repeatedly; can be verbal (saying
something over and over) or physical (doing something over and over)
power of attorney: a written document (which must be witnessed and notarized) that gives
one person the authority to act on another persons behalf. If it is written to last
beyond the point of mental incapacity, it is called durable power of attorney.
procedural memory: memory of a learned motor task
secratases: enzymes in the brain
semantic memory: memory of facts or concepts about the world
spaced retrieval: the process of continually recalling information over increasingly longer
periods of time; first described by Landauer and Bjork (1978)
SPECT (single photon emission computed tomography): a test which measures cerebral
blood flow; sometimes used in place of PET scans
sundowning: restlessness and/or agitation in a person with AD which increases in the late
afternoon or early evening
tau: a protein in the brain that is normally found in the internal structure of neurons. In AD,
tau collapses and twists, forming neurofibrillary tangles.
trustee: a person appointed by the courts to manage a trust for the care and benefit of the
beneficiary (e.g., a person with AD)
working memory: active memory that makes decisions and initiates actions
Glossary
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References 1-04-9876543

CASLD2 Pam Britton Reese - The Source For Alzheimer - S - Dementia

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CASLD2 Pam Britton Reese - The Source For Alzheimer - S - Dementia

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Pam Britton Reese

Copyright © 2000 LinguiSystems, Inc.

All of our products are copyrighted

A private practice, CommunicAid Plus, where

o Pam first became interested in Alzheimers

l External Memory Aids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

o Unit One: Legal and Financial Issues . . . . . . . . . . . . . . . .70

t Appendix One: Therapy Materials . . . . . . . . . . . . . . . . . . . . . . . . .95

t behavior. This material may be copied and shared with caregivers.

o activities for a six-week caregiver training program is also in Section Two.

The thought behind I strove to join

-Auguste D., the first person diagnosed with Alzheimer’s disease

Auguste D. was suffering from dementia. Dementia is a general term that

a affected. Dementia is not a disease. It is a group of symptoms. There are

t Alzheimers disease AD is the most common form of dementia. Half

n Multi-infarct dementia This type of dementia is caused by a series of

Common characteristics of AD include: 3. Personality changes

 Approximately 4 million Americans have AD. In a 1993 national survey, 19 million

 The average lifetime cost per patient is $174,000.

Reprinted with permission from the Alzheimers Association

-Shakespeare, The Merchant of Venice

C Possible Causes and Risk Factors

In dementia, different parts of the brain are affected. In order to understand

These structures are made up of small

 the hippocampus How then, do these different parts of the

Recent scientific work (Patrick et al. 1999)

3. Genetics Other risk factors being investigated in-

 The gene apolipoprotein E (APOE)

 Chromosome 21 has the gene for APP

A half-remembered name, a misplaced purse, a missed appointment 

h have been committed to long-term memory.

Memories are also defined by what is remembered. Remembering an event,

Thought is also known as cognition. Bayles

Nor where it went, nor why it came

But somewhere in my soul I know

-Sir Arthur Conan Doyle, Scandal in Bohemia

C Assessment and Diagnosis of AD

h AD is such a devastating disease that it affects every area of a persons life.

F When is forgetfulness a problem? One common illustration is that if you

Because of the diffuse and complex symp- PRECAUTION: Healthcare professionals

 Functional Linguistic Communication

Boston Diagnostic Aphasia Examination (BDAE) expressive and receptive language

Western Aphasia Battery (WAB) expressive and receptive language

Peabody Picture Vocabulary Test semantics (comprehension)

Boston Naming Test semantics (confrontational naming)

Token Test syntax

 Reading Comprehension Subtest of the ABCD

 Discourse Checklist  Procedural Discourse Analysis

As we have seen, the road to a diagnosis of Alzheimers

Name: ___________________________________________ Date: __________________________

Activity: _________________________________ Setting: ________________________________

Observation Time: ________________ minutes

Instructions: Check the discourse skill observed.

Discourse Skill Yes No Sometimes N/A

Instructions: Check the discourse skill observed.

Discourse Skill Yes No Sometimes N/A

Name: ___________________________________________ Date: __________________________

Tell me how to make pancakes.

Ratio of steps included to actual number of steps: ________________

Fluency (circle): Good Average Fair Poor

Word Finding (circle): Good Average Fair Poor

(adapted from Chapman et al. 1999)

Tell me how to make pancakes.

o Pam first became interested in Alzheimers

t Alzheimers disease AD is the most common form of dementia. Half

Approximately 4 million Americans have AD. In a 1993 national survey, 19 million

The average lifetime cost per patient is $174,000.

Reprinted with permission from the Alzheimers Association

the hippocampus How then, do these different parts of the

The gene apolipoprotein E (APOE)

Chromosome 21 has the gene for APP

A half-remembered name, a misplaced purse, a missed appointment

h AD is such a devastating disease that it affects every area of a persons life.

Functional Linguistic Communication

Reading Comprehension Subtest of the ABCD

Discourse Checklist Procedural Discourse Analysis

As we have seen, the road to a diagnosis of Alzheimers

Name: _________________ Date:

Activity: _ Setting:

Name: _________________ Date:

Tell me how to make pancakes.

Tell me how to make pancakes.

My dogs name is Spot. I live in Sterk.

Moral: Its easy to despise what you cannot have.

Name: _____________________ Date:

F The sender has a reason to communicate. This is called the intent,

e The sender has a way to communicate (the form of communication).

Talking Techniques to Aid Verbal Yes, Sue is retired now.

Room __________ Date _

Everybody is afraid. People try to erase childrens fears by reading

paranoia with fear

Change the environment (e.g., a label Express empathy.

Use visual aids or body language with Reassure.

Provide a mid-afternoon snack. Enroll in the Safe Return Program.

Name: _______________________ Date: _

external memory aids and strategies effective in the earlier stages of

v strategies for helping with swallowing and eating problems seen in

e conversation topics for cognitive-linguistic therapy on topics such as

activities of daily living and suggestions to structure and modify

remind and help calm the person

r To suggest techniques caregivers may use to improve communication