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.
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.
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.
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
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.
CopyrightŠ 1996-2008 Compact Disc Incorporated. All rights
reserved. Memory Works, MemoryZine, Best Intentions, Nature of
Memory, Cognitive Technology, Memory Monitor, Multi Modal Model,
Memory University, Memory Workout, Memory Assessor and PMI
Practical Memory Institute are registered trademarks, and Memory
Readiness, Ask Doctor Memory, The Memory Doctor, Memory Fitness
Games, Sharper Memory, Memory Institute, Memory Health Notes,
Memory Store, Cognitive Vitality, kIosQ, New Approach to Memory
Fitness, The Source For Memory Health & Fitness and Retraining
Cognition are trademarks of Compact Disc Incorporated.
