Why People with Dementia Say No (And What to Do About it)

Why People with Dementia Say No (And What to Do About it)

There are methods you may work together with somebody who has dementia to reduce using the phrase “No”, and to get them to cooperate extra simply.

By Rita Jablonski
Alzheimer’s Studying Room

Folks with dementia say “NO” to just about each query or request.

That is an unbelievable problem for caregivers.

On this article, I clarify one motive for the continuous no’s … and supply methods for stopping and managing the negativity.

Dementia Sufferers are Folks Too

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Patterns of Reminiscence Loss and Retrieval Issues

All dementias share this similar widespread function: transferring backwards in time.

  • The newer reminiscences go away first, adopted by older reminiscences. 

Individuals with dementia “unlearn” duties and talents in reverse order. The duties discovered earliest in childhood, similar to feeding oneself and eradicating clothes, are the final to be misplaced.

Some reminiscences are buried deep within the mind. Retrieval, or the flexibility to get reminiscences and produce them to the floor, will get worse. Singing and music, by the best way, are retrieval paths. If the entrance door of the home is locked, at all times strive the again door … it could be unlocked. Or strive a aspect window.

Music makes use of totally different paths to get to buried reminiscences, which is why somebody who now not talks out of the blue sings together with a favourite hymn or music.

What’s the Distinction Between Alzheimer’s and Dementia

“Mama” and “NO!”

The earliest phrases uttered by babes are often “mama” and “no.” Any father or mother can relate to the “NO” phrase.

“NO” is how we shield kids from hurt and educate them the right way to behave. Even when we make the house atmosphere as protected as attainable, “NO” stays essential as our youngsters become older and go exterior into the world.

They be taught to make use of “no” to determine boundaries. “Simply say no” and “No means no” at the moment are embedded in our tradition.

When the toddler first makes use of the phrase “no,” she or he isn’t refusing something. They’re merely attempting out their enamel and tongues, repeating this cool new factor they discovered to do. When my youngest was studying to speak, and “no” was one in all his earliest phrases, his older sister beloved to tease him by asking him questions — figuring out his response:

Older sister: “Need some ice cream?”

Little brother (smiling and reaching for the spoon): “NO!” 

Older sister: “Sorry, little man, you stated ‘no.’” (Older sister places spoon of ice cream in her mouth.) 

Little brother begins to cry and wail. 

Mother: “DO NOT MAKE ME COME OVER THERE! STOP TEASING YOUR BROTHER!!” (and numerous different issues that I in all probability shouldn’t have stated however different dad and mom will perceive).

As adults, we proceed to make use of the phrase “no.”

Typically, we use it to guard ourselves from unfavorable decisions: “No, I’m NOT going to (make that buy, eat that meals, inform my supervisor that this latest thought is admittedly silly, and so on.).”

Typically, we battle to make use of the NO phrase to keep away from being over-committed or to set boundaries, for concern that we could also be disappointing others. The underside line is that our use of the phrase “no” begins across the similar time we’re studying to feed ourselves with our fingers and is used a number of instances a day all through our maturity and older age.

Using the phrase “no” ultimately turns into a procedural reminiscence. A procedural reminiscence is the reminiscence of the right way to do one thing. Procedural reminiscences, which embrace feeding oneself and brushing one’s enamel, will stay even after we lose different reminiscences, like why or after we ought to do one thing.

How Alzheimer’s Impacts the four Reminiscence Techniques of the Mind

Dementia and “NO”

As folks with dementia transfer backward in time, it is smart that using the phrase “no” stays. The flexibility to say “no” might be among the many final reminiscences and talents misplaced by an individual with dementia. 

Similar to my instance above, the data of the which means could go away although the flexibility to make the phrase stays.

How the Lack of Reminiscence Works in Alzheimer’s Illness, and How Understanding This Might Assist You

Past Sure/No Questions

When working with individuals with dementia, we instantly be taught NOT to ask sure/no questions. We modify our techniques and say, “Time to take a shower,” or “Listed below are your medicines.” The dreaded NO nonetheless occurs. Why?

Too Many Phrases Not Sufficient Reminiscence

  • Folks with worsening dementia can solely “maintain onto” a couple of phrases at a time.

We frequently use sentences which are too lengthy. Or we attempt to “clarify” why medicines are essential.

Logic and explanations don’t work. There may be not sufficient obtainable reminiscence to course of this info. When the variety of phrases are better than the mind capability, the mind falls again on the procedural reminiscence of “no.”

An Alzheimer’s Communication Tip – No Extra Blah Blah Blah

Shrinking Temporal Lobes Trigger Receptive Aphasia

The temporal lobes (beneath the ears) shrink in Alzheimer’s dementia and frontotemporal dementia.

These similar lobes are sometimes broken after strokes, which causes the receptive aphasia we see with post-stroke sufferers.

The temporal lobes hyperlink sounds to phrases. Because the temporal lobes shrink, folks with dementia now not perceive speech.

In actual fact, I’ve noticed that many individuals with average dementia begin to act as if they’ve a listening to drawback: “Huh?” “What?” “What did you say?” “I can’t perceive.”

The listening to works however the skill of the mind to tug the phrase out of the mind dictionary and hyperlink it to the sound is damaged.

Our phrases, then, lose which means. The end result? Automated “no.”

Alzheimer’s Care, Why Do the Deeply Forgetful Say No So Usually

Methods to Decrease “No”

There are methods you may work together with somebody who has dementia to reduce “No.”

Begin with Your Look

Throughout a latest residence go to, one in all my nieces took my image with out my data. I used to be listening intently to one thing my sister was telling me. The image stunned me. I appeared so severe and considerably … imply. I used to be frowning and wrinkling up my brow. I had no thought I appeared like that. This made me suppose: after I’m working with folks with dementia, do I seem like this after I’m targeted?

Gently smile. Loosen up your brow. These two small steps will soften your options and make you seem extra relaxed and pleasant. Folks with dementia, particularly within the average to extreme phases, rely extra on nonverbal cues than spoken language.

How the Smile is a Highly effective Communication Instrument in Dementia Care


Assist what you need to say with gestures. I’ll make a “include me” gesture with my fingers. I additionally NEVER maintain or pull somebody with dementia. The result’s a tug-of-war, and you’ll lose.

As an alternative, I gently place their fingers on my wrists and I stroll backwards or side-by-side. Strive it. Additionally, nod your head and smile if you end up getting the response you need.

2 Nonverbal Communications Suggestions for Alzheimer’s Caregivers

Make it Obscure

As an alternative of claiming, “Let’s go brush your enamel,” strive “Let’s go have enjoyable.”

Don’t decide, I do know it sounds tremendous bizarre (and creepy). For causes I’ve not but found out, I’ve gotten folks to the lavatory with the enjoyable sentence.

Alzheimer’s Care Be a Information

Placing It All Collectively

At first, a few of these concepts will really feel bizarre. Play with the strategies, and see what works greatest for you and your member of the family.

I’ve some sufferers with whom I barely communicate as a result of the spoken phrases set off unwelcome or troublesome (for me) behaviors.

I’ve different sufferers with whom I sing all the time I’m offering care. It’s considerably trial and error, however the outcomes are well worth the experimentation!

Extra on Dementia Care from Rita Jablonski

10 Commandments of Alzheimer’s Caregiving

Sleep Drugs for Alzheimer’s and Dementia Sufferers

My Father with Alzheimer’s Stares at Us and it Feels Creepy

Caregiver Alert: The Connection Between Gum Illness and Alzheimer’s Illness

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Rita Jablonski, PhD CRNP is an internationally acknowledged skilled in dementia behaviors. She is tenured professor on the College of Alabama at Birmingham and a funded researcher, with over 50 publications and e book chapters to her credit score. Rita blogs at  Make Dementia Your B*tch. She affords caregivers teaching and steering for caregivers at DementiaCentric Options.

Writer Alzheimer’s Studying Room
Creator Rita Jalonski
July, 2018
Title: “Why Folks with Dementia Say No (And What to Do About it)”

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