If you’re caring for someone with dementia caused by Alzheimer’s disease or another brain disorder, it can be hard to truly understand how your loved one sees the world as their disease progresses. The 7 ‘A’s of Dementia, or anosognosia, amnesia, aphasia, agnosia, apraxia, altered perception and apathy, represent changes that can happen in dementia patients because of damage to their brain.

Appreciating these possible changes can help you better connect with your loved one and use positive strategies to support their care. Though it is important to understand that someone living with dementia may not experience all of the ‘A’s, they can appear in combination with each other and symptoms may be different for every person.

The 7 ‘A’s of Dementia

1. ANOSOGNOSIA

Anosognosia is often mistaken for denial, stubbornness or embarrassment. In fact it is actually brain damage that can make it difficult for dementia patients to recognize their impairment. Awareness can change from day-to-day or even hour-to-hour, and this can make your loved one’s behaviour unpredictable. They may resist help, refuse treatment, become angry and defensive or dangerously overestimate their abilities.

Care Strategies for Anosognosia in Dementia

• Don’t try to convince your loved one that they have dementia and instead make changes to help them live safely.
• Approach added support or care as an opportunity to do more of what they enjoy, instead of making it about chores around the house.
• Try, “It’s a beautiful day outside. Let’s go for a walk together,” rather than, “You can’t go for a walk alone, you’ll get lost.”
• Be discreet, chose your battles and try to let things go if they aren’t an immediate safety issue.

2. AMNESIA

Amnesia is memory loss that usually impacts short-term memories first and eventually affects long-term memories as the disease advances. Damage to the brain can cause a person living with dementia to repeat things over and over, become overwhelmed by too much or new information, forget loved ones and lose their sense of time. Amnesia is often the most obvious sign of dementia and is also thought to be the most heartbreaking.

Care Strategies for Amnesia in Dementia

• Speak slowly using short, simple sentences.
• Be as patient as possible. If you’re asked the same question repeatedly, try your best to respond as if it’s the first time.
• Use signs around the house for visual cues and display photos of family and friends. Reminiscing together can also help trigger memories of special people.
• Follow a daily schedule to make it easier for your loved one to remember what usually happens during the day.

3. APHASIA

Aphasia refers to impaired communication skills affecting the ability to speak, understand language and read and write. Early in the disease’s progression you may not notice that your loved one is struggling to understand you, but with time they may use inappropriate or non-existent words, revert to a first language or become very difficult to understand.

Care Strategies for Aphasia in Dementia

• Speak slowly and clearly and give your loved one extra time to respond.
• Use non-verbal communication including visual cues, gestures and touch when appropriate.
• Try to avoid sudden movements, a tense face or frustrated tone as your loved one will focus on your body language as they try to understand you.
• Watch for non-verbal cues that your loved one is in pain or discomfort if they can’t communicate in traditional ways.

4. AGNOSIA

Agnosia is the inability to recognize objects or people using the senses. For example, a dementia patient may burn themselves with hot water, eat something that isn’t food or brush their hair using a toothbrush. Agnosia can also cause distress during personal grooming times as a caregiver can be mistaken for a stranger.

Care Strategies for Agnosia in Dementia

• Always introduce yourself and anyone else providing direct care.
• Demonstrate how an object is used before giving it to your loved one.
• Label regularly used items around the house including appliances and bathroom fixtures.
• Keep dangerous items out of reach.

5. APRAXIA

Apraxia is the loss of motor skills needed for movement and coordination. Activities of daily living like bathing, dressing, walking and eating can become difficult and a loved one may struggle with buttons on remote controls, phones and microwaves. These cognitive changes can cause dementia patients to say ‘no’ when they’re encouraged to do something—not because they don’t want to, but because they forget how.

Care Strategies for Apraxia in Dementia

• To encourage independence, break down tasks into small, individual steps. Use pictures, write down each step or set out clothes in the correct order, for example.
• Always minimize distractions when you are giving instructions.
• Use adaptive clothing with Velcro instead of buttons or zippers and assistive devices in the kitchen and bathroom.
• If the task isn’t essential and your loved one can’t understand you, set it aside and try again later.

6. ALTERED PERCEPTION

Altered Perception can make someone living with dementia misinterpret their environment and struggle with how high, long, wide, deep or near things are. This can make it hard to move through physical spaces and can cause paranoia and delusions. A dementia patient may think that bathwater is too deep, dark floors are a dangerous ditch, or scattered clothes are a stranger.

Care Strategies for Altered Perception in Dementia

• Ensure that your loved one has regular eye tests and that their prescription is correct on any glasses they wear.
• Try to remember how your loved one may be seeing the world and why this can be scary and stressful instead of trying to convince them that they are wrong.
• Walk across a floor surface or place a clean foot in the tub to demonstrate the depth to reassure your loved one.
• Upgrade your lighting, add assistive equipment where helpful and keep the living space uncluttered.

7. APATHY

Apathy can make someone with dementia lose interest in what is happening around them because of problems with the brain’s motivation pathways. They may find it hard to start and complete a task, have low energy or show very little emotional response to events—both good or bad.

Care Strategies for Apathy in Dementia

• Change the way you suggest activities. Instead of, “Do you want to go visit your sister?” say, “It’s time to see Doris. Here are your coat and shoes.”
• A person with apathy may find it easier to do an activity once it becomes a habit. As much as possible schedule activities and outings on consistent days/times.
• To motivate your loved one, do more of the things they enjoy, whether that’s visiting grandkids, watching movies or cooking together.

While not everyone living with dementia will experience all of the 7 ‘A’s, as a caregiver it is helpful to recognize these changes so you can find the strategies and responses that work best for you and the person you are caring for.

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