Can A Person With Dementia Learn New Things?

Written By Joy Foster, MA, CCC-SLP

“You can’t teach an old dog new tricks!” …or can you? And what about persons with Dementia? Can you teach someone with this life-altering neurological disease something new? You would be surprised to hear that you CAN do just that! Of course, there are a few conditions that contribute to this, but it may be comforting to know that your loved one might just be a good candidate for an easy-to-learn strategy called “Spaced Retrieval”. During the pandemic, my mom has been spending a LOT of time inside like we all have. And although she had a neighbor who took interest in her and took her for walks occasionally, sometimes she wouldn’t go. Having the benefit of working with a team of physical and occupational therapists for years, I knew that with her Dementia mom needed something else to help maintain her balance, endurance, and provide a little exercise everyday. Something that could potentially reduce falls! But I knew I couldn’t do that without helping her remember what to do and more importantly…WHY to do it. What to do? Well, mom used to love and HATE working out to Richard Simmon’s oldies videotape (she was never into a lot of exercise, but tried to motivate herself when she could - good ole Richard!). But THAT kind of exercise wasn’t going to fit the bill either since that type of physical activity was no longer appropriate for a person with Dementia. She needed something to increase her heart rate naturally, but without thinking about it as “exercise”. Sweeping and vacuuming are often recommended by physical and occupational therapists as just such an exercise, since it’s something many folks do daily anyway. These tasks utilize mental and physical activity combined together to improve balance, coordination and endurance. I thought “Mom has a light weight, cordless vacuum!!” The plan was hatched! The only challenge would be getting her to buy-in on it!!...a more formidable task with mom than you might think! What is Spaced Retrieval? As a new speech language pathologist, I was fortunate enough to learn this technique early on in my career and have used it frequently with my patients. The basic idea behind new learning with spaced retrieval is repetition, but not just any kind of repetition. You must use what we speech therapists call “faded cues”. In other words, you will start to fade your reminders to your loved one over time - which is where “spaced retrieval” got its name. Here’s the technique broken down into chunks: Step 1: Identify what it is that you would like your loved one to remember - maybe it’s remembering to use a medication dispenser. Maybe it’s remembering to lock their brakes on a wheelchair before standing up. Be advised that you need to select one small item, not 2 or 3. Choose something that is simple. And as your loved one accomplishes remembering each task, you can then move onto another item later on. Step 2: Find something that your loved one likes to do or talk about (i.e. read aloud together, or talk about old memories, cut coupons, or folding laundry - especially enjoyable is folding children’s or babies clothes, or playing an simple game together). You will be using this later on in the sequence, so keep this task handy. Step 3: Stay focused throughout this process - but keep it light and friendly. This is where Step 2 comes in. You will use your loved one’s favorite thing to do as a momentary distractor from verbal repetition. Many folks with Dementia do not like to be told something over and over - they may say “You know - I’m 80 years old! I’ve been cleaning a house my entire life! I don’t need to be told to vacuum!” Troubleshooting tip: as you sit down to do spaced retrieval - don’t tell your loved one that you are going to “make them remember to vacuum”. Instead - explain that you wanted to read this new magazine together or play their favorite game (make sure it’s a simple game they CAN still play). Step 4: Casually mention during the enjoyable task that “I read the other day that older adults who vacuum regularly have much better health!” At some point, you might also throw in “I got out this old vacuum for you to try it! It’s light weight and really fun to use”. Show your loved one it’s fun to use this particular light-weight vacuum by doing it yourself at some point during the conversation. Step 5: Shift back to the fun task briefly ( i.e. continue reading aloud, talking about old memories). Step 6: After a few minutes, casually mention that you also read recently that “older adults with memory loss can remember things!” You could ask if they have heard about this yet? This gives them time to “be the expert” and feel confidence being an older, wiser person. If they give you a blank stare, I’ve often been successful stating “Mom, you know with your memory loss - which I know you are aware you have some trouble with from time to time- you might be surprised to hear you can start to remember things again! Do you want me to teach you the method I read about?” Step 7: Hopefully by step 7, you have figured out how to get your loved one’s buy-in and have gained their confidence in the idea that you are about to help them remember again! If you have come to a brick wall at this point, continue reading this article below for more of an explanation on appropriateness or candidacy for use of this technique. Step 8 - The last and most important step is verbal repetition - so essentially it goes like this: ask the question, then answer, then question, then answer - until it starts to stick. Here’s that sequence with my mom as an example:

• Question: “Mom, do you remember what I said about vacuuming?”

• Answer: “Yes, it improves my health and I should do it everyday”

Tip: make sure that your loved one repeats that same statement every time, it’s important to say the answer together out loud until your loved one can say it on their own correctly! This is based on errorless learning research (see more later on this). Important! each time you have your loved one state the answer, you just double the time until before asking the question again…i.e. Asking the question again 10 seconds, then 20 seconds, then 40 seconds, then 80 seconds, then 2 minutes later and so on….until you reach about 40 minutes time that they are successfully recalling and correctly stating the answer. You will eventually no longer have to state the correct answer aloud alongside your loved one. They will miraculously start to verbally recall the answer independently!! Tip: In getting started, after a few minutes, casually mention that you also read r recently that “older adults with memory loss can remember things!” You could ask if they have heard about this yet? This gives them time to “be the expert” and feel confidence being an older, wiser person. If they give you a blank stare, I’ve often been successful stating “Mom, you know with your memory loss - which I know you are aware you have some trouble with from time to time- you might be surprised to hear you can start to remember things again! Do you want me to teach you the method I read about?” Tip: Mom and I spent about 2 hours between enjoyable tasks, doing the dishes together throughout that morning - and I would just casually insert that question again and again through nonchalant conversation to support our more formal spaced retrieval training that day- “Hey mom, did you know that I learned the other day that vacuuming is a great exercise for older adults?” Mom: “oh really!” Me: “Yes - you and I - we’ve been talking about it all morning!” Mom: “Huh! Yup you said it helps balance, right?” Me: “Yes, yes it does!”

What is errorless learning? Errorless Learning is a technique that was first introduced in persons with TBI (traumatic brain injury). It was found that the use of teaching something without error was much more successful than learning through trial and error. An example of this - a student with TBI is asked “What is the capital of Colorado?” If the student says in error “Los Angeles” they are much more likely to remember Los Angeles next time that same question is posed. However…..if that same question is asked “What is the capital of Colorado?” with faded cues, it is more successful! So the teacher answers that question out loud for the student like this: Question: “What is the capital of Colorado?” Answer: outloud together with the student (to ensure errorless learning) “Denver!” Who is appropriate for Spaced Retrieval? In my training as an Speech Therapist, we were taught candidacy screening to ensure patient appropriateness for this techniques, such as asking a person to remember something very simple for 30 seconds - i.e. What is my name?. If successful, then technically they are considered a good candidate. However, in my experience as a speech therapist, persons with mild to moderate stage Dementia are appropriate. However, that said, I have trialed this technique with about every stage, except severe stage. Each patient and situation will vary, but it sure can’t hurt to try out the steps above and see if it works! Don’t forget also that patients with Dementia have good and bad days. They may even have a better time of day that they are more mentally fit or they are just in a better mood. One other important note: In my personal opinion and with experience to back my thoughts, patients with mental illness in combination with Dementia (i.e. Anxiety, Depression, Bipolar, Narcissistic Personality Disorder) are less likely to benefit. However, I’ve never just blanketly thrown out trialing someone with this technique. You may have to just be more sneaky in trying to get your loved one to engage in conversation about “learning to remember new things again”. You know your loved one better than anyone else. You may just be the best person to engage in spaced retrieval training! Possibly even better than your local, friendly speech therapist! Was mom ever successful in learning new things? Back to my own trial with my mom using spaced retrieval training - it worked!! Even my family (especially dad) was shocked that mom actually got up and vacuumed that day for at least 15 minutes! She was not only able to physically perform the task, she was agreeable to it! And able to repeat back and tell me why it was important! To be sure, this ability to remember things will need to be repeated and maintained over time. Don’t expect your loved one to get up the next morning and just start vacuuming! They will need friendly reminders and potentially a few “sessions” (as we speech pathologists call it) of spaced retrieval treatment from you. So I don’t know that mom has continued to vacuum everyday. She lives in Arizona with my dad and sister. It would ultimately be up to my dad who lives with her to maintain this benefit for her. In your case, it may be another family member, like a daughter, son, or sibling who is around most often. To learn more: https://www.youtube.com/watch?v=FiLzX1r8RVI Spaced Retrieval Training for Memory: A 'How To' Guide for Clinicians