It’s called “Yes, and…” and it’s an approach used in improv comedy that entails taking what one person says and building off of it, even if a “yes” in that situation makes little sense.
Such a technique also works well when interacting with someone who has Alzheimer’s disease, says Carolyn Fredericks, MD, a Yale Medicine neurologist who specializes in cognitive and behavioral conditions, including Alzheimer’s.
Rather than correcting the person with Alzheimer’s or prompting them when they can’t remember details, it’s best to “enter their reality,” Dr. Fredericks says. For example, if your loved one repeatedly calls you by the wrong name, it’s OK to go with it and answer to that name. Or if they think the year is 1955, it’s reasonable to not correct them.
Alzheimer’s disease is progressive, and your loved one might have mild, hard-to-detect symptoms in the beginning. It’s also important to note that some memory problems—such as losing your keys or temporarily forgetting a name—can be a normal part of aging.
Alzheimer’s disease, which now affects nearly 7 million people over age 65 in the United States, is distinct in that, in addition to issues with memory, it causes behavioral changes and a decline in mental abilities, including judgment and reasoning. It is marked by three stages: early, middle, and late, with symptoms worsening over time.
Eventually, people with Alzheimer’s disease may no longer recognize their family and friends and will need help performing daily activities like dressing or using the bathroom. Alzheimer’s disease can be a heart-wrenching experience, not only for those who live with it, but for their friends and family members, many of whom become caregivers. Not being able to communicate with a loved one in the same way they once did and watching them change can be extremely difficult.
So, how can we better interact with our loved ones to allow us to stay connected with them?
“Often, caregivers think that if their loved one doesn’t recognize people in a photo, they should remind them of who each person is and see if they can get better. Or if they ask something that they asked five minutes ago, some caregivers will say, 'You just asked me that. Don't you remember?’” she says. “But that is never effective.”
The better strategy, she explains, is to go along with what the loved one is saying and remain calm and reassuring.
Below, Dr. Fredericks offers more advice for caregivers who have a loved one with Alzheimer’s disease.
1. Don’t call attention to memory lapses.
During the early stages, most people have a lot of insight into what is happening with their memory, Dr. Fredericks says.
“Usually, their social graces are intact. If you have a casual conversation with someone with early-stage Alzheimer’s, you might never know there’s a memory problem because they will carefully evade certain details,” Dr. Fredericks says. “If you refer to something they don’t remember, they will politely nod along and say something generic and pleasant.”
But that doesn’t mean they aren’t anxious about their memory issues, she adds. “It can be very painful for them every time they notice their own lapse,” Dr. Fredericks says. “Therefore, drawing their attention to it when there’s nothing they can do will just make them feel bad. It’s not that they are stubbornly refusing to recall the thing you told them a few minutes ago.”
So, if your loved one repeats a question you just answered, the best thing to do is act like you are hearing it for the first time. “That’s their reality, which is that they don’t recall many things that happened recently,” Dr. Fredericks says. “Or, if your loved one believes someone is breaking into their home and stealing their things because they keep losing track of them, instead of telling them that’s ridiculous, maybe say, ‘That must be so confusing and scary to be afraid someone has taken your purse. But here’s your purse, we’re together now, and you’re safe with me,’ and steer the conversation to focus on the present.”
2. Ask about long-ago memories.
Alzheimer’s affects short-term memory much more than long-term memory. “In fact, long-term memory often isn’t affected at all until late in the illness,” Dr. Fredericks says.
With that in mind, instead of asking your loved one what they had for lunch that day, consider talking about their childhood memories. “That can be very fun and a good way to collect family stories and memories,” she says.
3. Consider artistic outlets.
Often, people preserve their artistic abilities as they progress through their illness. Some even become a bit more creative, Dr. Fredericks says.
“It can be something as simple as arranging flowers or coloring, or as complex as painting or doing sculpture. These parts of the brain don’t get affected very early, and even during advanced Alzheimer’s, people can find comfort in listening to music or participating in certain artistic activities,” Dr. Fredericks says. “My grandmother died from Alzheimer's disease, and even in the end stages, when she was barely alert, I would give her my earbuds and put on her favorite opera, and she would just light up. It was amazing.”
If your loved one is a bookworm, it can be hard for them to enjoy reading as the disease progresses. “People will tell me they used to love reading novels with complex plots and characters but find themselves struggling to keep it all straight and, as a result, re-read the same chapter,” Dr. Fredericks says. “For some patients, what might work is finding shorter forms of reading. For one patient, she switched from reading books to magazines instead. For others, they could join a book club to benefit from the social aspect of it, which is more important than if they remember plot details.”
4. Encourage physical activity.
While regular cardiovascular exercise is known to reduce someone’s risk of developing Alzheimer’s, less is known about how it can help someone with the disease, Dr. Fredericks says.
“There's some evidence that exercise helps with early-stage memory loss, and more limited evidence that it helps as you get into more severe stages of the disease,” she says.
But even if data is lacking, Dr. Fredericks says there are benefits to exercise for people with Alzheimer’s—if it’s something they enjoy.
“It helps people's mood, it helps people sleep better, it helps people's cardiovascular health and their overall wellness,” Dr. Fredericks says. “And it doesn’t have to be powerwalking on a treadmill. It can be Zumba or water aerobics. Anything that combines exercise with socialization is great.”
Dancing is also an excellent option, she says. “Some people may find that even if they don't remember the name of their last dance partner, they remember how to waltz. The cognitive aspect of following or leading a partner’s movements is good for the brain. And the basics of dance are one of those things that's like riding a bike—it’s in your motor system,” Dr. Fredericks says.
5. Make plans to keep your loved one safe.
It’s a good idea to stay one step ahead of your loved one’s disease in terms of planning, Dr. Fredericks tells families.
“Maybe you don’t think they need any help at home, but just in case they did, what would it look like to have a companion come every morning for three hours to watch them? What would be the life implications of that? What would be the financial implications of that? Just have that plan ready for when you need it,” she says. “Usually, a family member will realize more care is needed. And that’s almost always the right time to pull the trigger on the plan you've already made.”
Often, driving is an issue that comes up early.
“If I’m working with a patient with Alzheimer’s and I sense they might not be safe behind the wheel, yet they are still driving, I will recommend they get a formal driving evaluation,” Dr. Fredericks says. “Often, I’ll advise that rather than going through the Department of Motor Vehicles, they work with an occupational therapist or, in Connecticut, Easterseals will do a 360-degree evaluation of their peripheral vision and reaction time in a simulator. I’ll then get a report that says, for example, that this person can continue to drive locally, but they'd like to see them back in six months. And if they think there's something they can coach them on, they will offer additional sessions to work on that.”
Safety at home is another issue, and risks can include leaving the stove on or leaving the door wide open. “For each one, we think about the right solution. It might be telling your loved one that they need to have a buddy when they are cooking on the stove but that it’s OK to use the microwave to heat something up,” Dr. Fredericks says.
6. Get support for yourself.
The Alzheimer's Association has resources for caregivers, including a 24-hour hotline (800-272-3900) that people can call for support. They also have a care coordination program, which offers information about senior day programs with transportation and other services.
Additionally, Dr. Fredericks recommends caregivers connect with support groups or another community of people going through the same experience.
“Many caregivers will say, ‘Oh, that’s just going to be depressing, I don’t want to do that,’ but there are groups—for instance, for people who have a loved one with early-stage symptoms, that can be helpful, many of which meet on Zoom if you don’t want to travel,” she says. “There’s one-on-one psychotherapy or counseling, which is a great option, too.”
Getting some form of regular support early on is so important, she adds. “A lot of people wait until they're crushed by the weight of what's going on before they'll even consider seeking help, but the sooner, the better,” she says.