Decision Making and Attention Seeking

One of the interesting aspects of dementia that folks don't always consider is the individual's ability to still make decisions.  The decision making functions don't just disappear overnight.  There is a certain amount of reasoning which may be present for some time into the individual's decline.  The challenge is that we really don't have a way to measure how much reasoning or decision making capability still is available at any one time.  One day, the individual may seem quite cogent and the next may not seem so lucid.  This capacity, even in a damaged state, allows the individual to engage in activities which are attention seeking in way which seem logical to them even if they seem illogical to us.

Lyn has been working to establish a new attention seeking behavior.  Every Monday morning, Lyn's speech therapist comes to the house to conduct their hour long session.  Normally, Lyn is able to sleep until she wants to get up.  On Monday's, Mom wakes her in plenty of time for her to get dressed and have some breakfast before her therapist arrives.  For the past several weeks, instead of getting ready, Lyn would sit in front of her computer and not respond much to Mom.  Then when the therapist arrived, Lyn would stumble out of her room acting like she just woke up.  She would act in a tired and surly manner.  This would evoke irritation (attention) from Mom and sympathy (attention) from the therapist.  The therapist would encourage Lyn to get up a bit earlier and eat breakfast.

Another example of this kind of decision making/attention seeking comes from a colleague of mine who is dealing with her father's Alzheimer's.  Apparently, the gentleman was engaging in inappropriate behavior with other residents at the nursing home.

The interesting thing with both Lyn and the gentleman is that they both were making choices to behave as they were.  When confronted and told the behavior was unacceptable, Lyn's behavior changed.  Yesterday, she was dressed, fed and happy when the therapist arrived. When confronted, the gentleman stated he knew what he was doing and wanted more attention than his wife was giving him.


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