I went to a breakfast recently and heard a talk on this subject by Myra Schiff, who has written a book called Alzheimer: A Canadian Family Resource Guide which offers in simple language personal vignettes and down-to-earth coping strategies for this disease. (You can order the book by calling 416.486.6446)

Myra, an environmental consultant, works under two assumptions:

1. The behavior of people with dementia makes sense. There are reasons for it... caused by the environment or by other people

2. There are numerous parallels between our behavior and that of those with dementia; for example, if we get angry at a malfunctioning vending machine, some of us have been known to kick the machine..we use behavior to vent our anger or frustration. Dementia sufferers do likewise, since they cannot use words to express thier feelings.

How critical is the environment for those with dementa? Very crucial for their well-being!

• Everyone responds to information derived from their environment; therefore the environment for those with dementia should be clear and well-structured; reduce amgiguity, limit choice. For example, people with dementia often cannot remember what is behind a door or what is in a drawer. Solution: keep the door open and put meaningful pictures on drawers (picture of a sock on sock drawer) .

• Try to create a balanced amount of stimulation..enough to keep the person from getting too bored but not so much that they become agitated. Too much noise, activity, people and visual stimulation create overload.

• Provide the right kind and amount of information; ask people with dementia to process useful information...the day of the week is not necessarily crucial for them to know

• Use contrasting colours for clothing, for example, put white buttons on a black shirt so they are easily visible

• Do not play tricks on people with dementia; avoid placing abstract or distorted artwork on the walls, or use a clock with the 24 hour system; people with dementia cannot process this type of information

Personal note: I have a problem thinking of things for my father to do when no-one can be with him. One evening I brought him up to his room and asked him if he wanted me to turn the TV on (I figured it would be company for him when I left). His response: "do you always turn the TV on the minute you get home?" Touche, Dad.

Karen's Note: One more thing I have learned about this summer...a behavior called sundowning (courtesy of Jim Eagleton's e-mail to me). My father has been showing increased agitation in the evenings..he does not want to come inside from the patio or settle down at night. The problem can be that by the time evening arrives, the person with dementia is exhausted from trying to process the day's information and cannot calm down...pacing, hand wringing are also symptoms. One solution for this is to have the person nap in the afternoon to prevent "environmental overload" too early in the day.