MemoryZine- The Source for Memory Health and Fitness Improvement

Welcome to the Caregiver Area. This area—while still under construction—is offered as a free service to people with an interest in caregiving to persons they know with memory deficits and/or cognitive impairment from a variety of causes. We have provided general information for caregivers at home.

A more practical piece, the Caregiver's Home Guide to Memory Procedures, is intended to help you try to deal with certain memory tasks of your client at home.

For professional caregivers, we have provided information entitled: Professional Cognitive Rehabilitation and The Memory Works Programs.

For the new caregiver, we have listed selected resources you can contact for more information which may be of interest.

FOR MORE INFORMATION ABOUT ALZHEIMER'S DISEASE

FOR MORE INFORMATION ABOUT LEARNING DISABILITIES

FOR MORE INFORMATION ABOUT ADHD

As always, the information provided on this site is designed to support, not replace, the relationship that exists between a client/site visitor and his/her existing physician or health provider. E-mail your comments to webmaster@memoryzine.com

We have provided general information for caregivers at home.

Serious memory problems have several possible origins. Alzheimer's disease is best known as impairing memory, but people may acquire impaired memory because of head injury, stroke, exposure to poisons, lightning or electrical shock, alcohol, chronic depression, etc. This is written in the hope that readers may be better prepared to cope with the memory problems of those they are caring for as well as themselves.

Even before visiting memoryzine.com and PMI, caregivers of people with cognitive deficits quickly become aware of the kinds of methods that may be helpful to the memory of such a person.

Today, a person with memory impairment for whom you are caring ("client" for short) may have far better assistance in dealing with their memory problems than was possible just a decade ago. The multifaceted memory assistance discussed by PMI may enable clients, relatives, friends, and caregivers ("caregivers" for short) to reduce the incidence of everyday problems which clients once endured and, thereby, ensure more meaningful communication.

Memory assistance is a very new health science. Until just a few years ago, such care was available only in private hospitals and centers for medical research. In recent years, various hospitals around the country established units that conduct memory rehabilitation. Today, caregivers may secure memory assistance information for their clients from local healthcare providers.

Caregiving is typically a very difficult task but progress is being made in helping to make this task not quite as difficult. A caregiver will want to learn a variety of topics to help a client cope with memory problems. The caregiver needs to learn the particular kinds of memory impairments related to the condition of their client. The caregiver will want to learn all the details of a multi-modal approach to memory.

Rarely acknowledged is the caregiver's need to take care of their own memory, as well as their client's, especially if a client's disease progresses. In some cases caregivers may take responsibility for all aspects of the client's life: feeding, grooming, social life, etc. Taking on responsibility for the memory difficulties of another requires the caregiver to take on added memory burdens. These details challenge the memory of the caregiver. This piece is intended primarily to help caregivers deal with their own memory difficulties.

As a caregiver takes on the memory responsibilities of both people, their own memory performance is greatly challenged. Thus, caregivers will want to assist their own memory abilities in the same way recommended here for their clients and also be forgiving of their own memory failings created by the role of caregiver. The Memory Monitor® module in the Memory Works® CD-ROM series is based on a multimodal approach to memory and will be helpful in understanding this more fully. As this module is constantly being improved, the most recent title is optimal, but each will be helpful.

Professional Cognitive Rehabilitation and The Memory Works Programs
Assisting your client/patient's memory depends on raising your patient's level of attention to the things you want to remember, as appropriate. The level and the distribution of your client/patient's attention may be improved through different kinds of procedures presented in the Memory Works Programs. You can use your knowledge of general and specific procedures to help your client/patient by guiding that person through the use of appropriate mental activities. You can facilitate your client/patient's memory readiness by monitoring their modes and improving them when you can. You will want to be alert to your client/patient's social and environment context, and prod your client's memory with external memory aids. Modern memory research shows that memory is assisted best by developing a plan of manipulations made up of the right combinations of manipulations appropriate to specific memory tasks. Preparing memory plans will prepare you to help your client/patient as much as possible. The Memory Works¨ programs each include a Memory Monitor section dealing with the holistic multi-modal model of memory promoted by PMI.

Topics that a caregiver of a patient with memory problems should also know include:
	Understanding the Cognitive System—the operation of the cognitive system that provides a positive and realistic view of cognitive performance.
	Care of Physical Condition—actions that enhance general attention and cognitive performance by improving physiological states.
	Care of Emotional State—actions that enhance general attention and cognitive performance by improving emotional and motivational states.
	Correction of Poor Attitudes and Habits—actions that eliminate distracting behaviors and thereby enhance cognitive performance.
	Social Skills that Aid Cognitive Processes—alters social interactions to selectively direct attention to information that facilitates cognitive performance.
	Use of External Aids to Cognitive Processes—directs attention to objects and events to facilitate cognitive processes.
	Content Processes—directs attention to the meaning of information to enhance registration and retrieval.

CAREGIVER'S HOME GUIDE TO MEMORY PROCEDURES
How to Help a Person with Low to Moderate Cognitive Impairment to Learn and Remember

The Practical Memory Institute seeks to help caregivers help clients with low to moderate cognitive impairment to learn and remember. PMI teaches four kinds of procedures for learning. STRENGTH procedures which make a memory stronger. ATTRIBUTE procedures which lead a person to pay attention to a special property or feature of a memory and make a memory more distinctive and memorable. An ASSOCIATIVE procedure which leads a person to connect a memory being formed to a prior memory. Finally, BACKUP, a procedure which enables a person to make a backup memory which has the same information of the original memory that has been learned by another of the first three.

If a client needs to remember certain information, you or someone else can help them use his or her memory. A caregiver can do so by engaging the client in using one of three procedures. The first procedure boosts the strength of the new memory trace that your client is trying to acquire. For example, suppose your client has been introduced to a new doctor who will be involved in treatment. You can make the doctor's name stronger in your client's memory by asking the client to say aloud the doctor's name several times.

The second kind of procedure makes a memory easier to remember by paying attention to a certain attribute of a memory. For example, another way to get your client to learn the new doctor's name is to have the client pay attention to certain attributes of the name. For example, you may write the name out and ask the client how many letters are in the name and what is the name's first letter.

The third kind of procedure leads a person to pay attention to associations between this memory and a past memory. Yet another way to get your client to learn something is to have them think of a past experience that has something in common with the memory to be acquired. For example, help your client to learn the new doctor's name by reminding her/him of a previous doctor that they recall and point out that the new doctor is like the previous doctor in providing help to the client.

The fourth procedure involves creating a backup memory by helping to think of one together and helping the client rehearse it. Backup memory is made by creating a visual image or a rhyme that has the same meaning as the original. For example, people create backup memories of someone's name, such as the new doctor, by thinking of an object that sounds like the name. If the new doctor's name were Bill, you might have the client imagine the doctor presenting his bill (Bill). The most effective approach provides greater strength, more attributes, and more associations.

As you can see, these four procedures have different effects. The strength manipulations are good for assisting your client to hold some information briefly. If you need her/him to retain a memory longer, use attributes or associations. If it is crucial that a client learn certain information, you will want to guide them through the use of one or more procedures, especially the backup procedure. Your client will naturally like certain procedures and not others. If you recognize that your client does not like a certain procedure, then you can try one from the pool of procedures presented below.

STRENGTH PROCEDURES These procedures foster better attention or more rehearsal. Generally, the memory traces formed by these procedures do not last long.
	Acting Out. Have the client act out the information you want him or her register in memory (if possible).
	Reflection. To facilitate a client's memory of day-to-day events, ask them to think back on a day's activities at the end of the day. This might also be repeated the next morning.
	Rehearsal. Have the client repeat the items to be learned over and over; if necessary, repeat the items for the client.
	Cumulative Rehearsal. Have the client repeat items in successively larger groups, such as two items at a time, then three items at a time and so on. For example, in learning a shopping list (consisting of bread, eggs, fruit, and milk), say "bread, bread-eggs, bread-eggs-fruit, bread-eggs-fruit-milk."
	Spaced Rehearsal. Have the client repeat the items at increasing time intervals in which each successive interval is twice as long as the preceding one. For example, bread-eggs-fruit-milk -- bread-eggs-fruit-milk ---- bread-eggs-fruit-milk -------- bread-eggs-fruit-milk ---------------- bread-eggs-fruit-milk, and so on.

ATTRIBUTE MANIPULATIONS Attribute manipulations are designed to lead a client to learn more attributes (features) than he or she would otherwise register. The more attributes included in a memory trace, the better. Each attribute provides another way to retrieve the trace.
	Description. Verbally describe to a client what she or he should learn. Then ask the client to repeat what you said. For example, to learn someone's face, describe for a client the shape of the eyes, nose, mouth, etc., and then have the client give the description back to you.
	Question. If you want a client to remember certain information or an event, ask the client a variety of questions about what you want learned. Ask them questions such as: who? what? where? when? why? to what purpose? under what conditions? how? in what manner? how much? how many? how often? for how long? in what?
	Self-referencing. A good way for your client to learn is for them to relate to the information to themselves. Thus, ask the client how the information to be learned might relate to some aspect of the client's past. For example, in learning a shopping list such as bread-eggs-fruit-milk, you might ask the client to decide how much he or she likes each of these items and how often you should buy them.

ASSOCIATION MANIPULATIONS Association manipulations are used when the information is difficult to learn. For example, when a client is to learn a set of directions he or she must register the steps of the directions in a certain order.
	Verbal. Ask your client if one item to be learned reminds them of another event. For example, in trying to learn a shopping list of bread-eggs-fruit-milk, ask the client whether milk is mixed with eggs when making scrambled eggs.
	Link the Present With Past Events. Ask the client to determine similarities between a current and a past event. You may point out to him or her that a recent event is like a story that you know. For example, your client may associate the current event with a previous time shopping when he or she bought fruit to help with digestion.
	Clustering (meaningful). Direct your client to organize items to be learned into clusters where items in a cluster have similar meanings. For example, to learn milk, eggs, bread, and fruit, group the items by use—milk and egg is mixed to prepare French toast, etc.

BACKUP MEMORIES After your client has learned something by use of one or more of the three procedures above, protect this memory by creating a back-up memory. This procedure generates another way to learn the information. For example, a description of the first memory might be restated. Fruit is good for your digestion. Fruit is a good source of vitamin C. As a result, if both descriptions are stored in memory, it is doubly likely that the original information may be recalled.
	Abbreviation. If your client has to remember to pick up a few items at a friend's house, create a word for them that stands for the items by making a word out of the first letters of the items. For example, to remember the shopping list, bread-eggs-fruit-milk, form the smaller word—BEFM.
	Similar Meaning. Ask your client to think of a word that is similar or synonymous with the word to be learned. For example, in learning the list, bread-eggs-fruit, substitute 'loaf' for bread, 'omelette' for eggs, and 'citrus' for fruit.

FOR MORE INFORMATION ABOUT ALZHEIMER'S DISEASE

Having accurate, current information about dementia also is important. The Alzheimer's Disease Education and Referral (ADEAR) Center is a clearinghouse supported by the National Institute on Aging. For more information about Alzheimer's disease and multi-infarct dementia, contact:

ADEAR Center
PO Box 8250
Silver Spring, MD 20907-8250
toll-free 800-438-4380

Families often need information about community resources, such as home care, adult day care, respite programs, and nursing homes. This information usually is available from State and Area Agencies on Aging. For help in finding the appropriate agency in your area, call the Eldercare Locator, toll-free at 800-677-1116.

FOR MORE INFORMATION ABOUT LEARNING DISABILITES

The International Dyslexia Association (See: Dyslexia)
Learning Disabilities Association of America
4156 Library Rd.
Pittsburgh, PA 15234
Tel: (412) 341-1515; Fax: (412) 344-0224

Learning Disabilities Network
72 Sharp St., Suite A-2
Hingham, MA 02043
Tel: (781) 340-5605; Fax: (781) 340-5603

National Center for Learning Disabilities
381 Park Ave., Suite 1401
New York, NY 10016
Tel: (888) 575-7373; Fax: (212) 545-9665

FOR MORE INFORMATION ABOUT ADHD

Attention Deficit Information Network (Ad-IN)
475 Hillside Avenue
Needham, MA 02194
(781) 455-9895

Provides up-to-date information on current research, regional meetings. Offers aid in finding solutions to practical problems faced by adults and children with an attention disorder.

Children and Adults with Attention Deficit Disorders
(CH.A.D.D.)
499 NW 70th Avenue, Suite 101
Plantation, FL 33317
(800) 233-4050

A major advocate and key information source for people dealing with attention disorders. Sponsors support groups and publishes two newsletters concerning attention disorders for parents and professionals.

NOTICE
The limited information provided on this site is provided as a courtesy only. It is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her personal physician.

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