Dementia, Anxiety, and Quizzes

Anxiety makes thinking more challenging.

Last week was finals week at the university where I work. It’s stressful for students and faculty alike. In fact, the relief I felt finishing finals as a student pales in comparison to the relief I feel submitting finals grades as a professor.

In 25-ish semesters of college teaching, I’ve come to a few conclusions about finals. First, building up a final exam as something completely unique and exponentially more difficult than a “regular” exam doesn’t motivate students to study. In fact, it sometimes puts students in a mindset of “Why bother?” Their intimidation freezes them.

I often try to make a statement before the final to decrease my students’ anxiety. I remember a teacher in high school saying “No matter how you do on this test, I love you all.” I would probably feel a little silly saying that, so I sometimes say, “I don’t judge your entire worth on how you do on this test, and you shouldn’t either.”

What I know is that test anxiety leads to decreased cognition. If your anxiety is out of control, you forget information you know. You mix up terms. You can’t come up with equations and definitions. You wind up not doing well on a test not because you don’t have the knowledge to do well—but because your anxiety clouded your cognition. Our brains don’t work as well when they are stressed.

So why do people seem to be surprised when I explain the same concept applies to people with dementia?

Many cognitive functions—memory, logic, judgment, communication, perception, emotion-regulation—become more challenging as dementia progresses. These functions can become almost impossible to negotiate when we throw stress and anxiety in the mix.

Let me first say that some stressors are unavoidable. Whether or not you have dementia, stress is a part of our lives. If you are a care partner, please know that I am not blaming you for everything that gives your loved one anxiety; I understand that many things are not in your control.

Also, know that I am not judging you or being critical in pointing out some things that you may be doing cause unnecessary stress to someone living with dementia. In fact, I shudder to think of all the times I have (and continue to) create anxiety for those with dementia.

But here’s the thing…decreased anxiety leads to increased function. When someone is less anxious, they are more likely to remember, control their emotions, be capable of planning ahead, and practice good judgement. Think about it—it’s true for those of us without dementia as well.

I could come up with a long list of stuff I’ve done that probably increased anxiety in persons living with dementia. However, a few stick out to me…

(I am going to throw myself under the bus here, so promise me you won’t judge.)

I have a bad habit of simply repeating myself in a louder voice when someone with dementia doesn’t answer my question right away. And guess what? The louder I get, the more angry I sound. And when I sound angry—even when I am not—my friend with dementia is certainly not likely to be able to respond appropriately. Heck, I struggle to answer someone’s question when I think they are angry with me…why would people with dementia be any different?

Even though I repeatedly tell others to stop quizzing people with dementia, I once in a while find myself doing it. Last year, I sat down with group of individuals living with dementia right before Christmas and asked excitedly, “Do you know what holiday is coming up?” Very few people enjoy taking quizzes, but we throw quizzes at people with dementia all the time. Do you know who I am? Do you know what day it is? Do you remember our anniversary?

A quiz is like a cup of anxiety on a silver platter. Keep in mind that people with dementia aren’t necessarily having a good day if they pass your quiz. They’re having a good day if they’re safe and happy. Focus on that instead.

I’m always in a hurry. I move fast (literally). I have a way of bounding into a situation without giving someone a chance to process and identify me. We know that people with dementia struggle to perceive moving object. So stop moving. Stand still for a moment. Give their brain time to interpret what they see. When I move and invade someone’s personal space before they have an opportunity to identify me, I cause them stress. To be honest, I don’t like people in my personal space if they don’t know who I am either.

Another way we cause anxiety to people with dementia is by exhibiting anxiety. Long after someone can understand the words, “I’ve had a terrible day,” they can read the body language of someone who is stressed. And stress is as contagious as a stomach virus on a cruise ship. (To be fair, those of you who are care partners may frequently “catch” anxiety from your loved one with dementia. And then you give it right back….the gift that keeps on giving, right?)

I often tell people that “Emotion lasts longer than cognition.”

Here is what that means…

I cause someone with dementia stress by the way I approach or interact with them. Two minutes later, they may not recall why they are agitated, but they are still agitated. I can’t take back that anxiety once I inflict it on them.

I hear lots of terms to describe people with anxiety that make me cringe…we say they are “acting out”…we say they have “behavioral problems”…we often accuse them of “giving us a hard time.”

When I step back and look at the situation, I often see a person who is anxious. And, if I step back just a bit further, I often see the role that those of us without dementia play in that anxiety.

8 thoughts on “Dementia, Anxiety, and Quizzes

  1. Since diagnosis, people sporadicly ask if I am getting better. (Insert anxiety each time that happens.) I used to respond, in truth, by saying, “Oh, I’m good.” Since then, I have responded with more depth to my answer: “You know? I really don’t know how to answer your question. I will never get better, and telling you that I am worse will only make you sad . . . and I don’t want to make you sad.” Although I appreciate direct, honest responses to questions, my honesty creates a really, awkward moment in the conversation. And, the next time we talk, they again ask if I am getting better.

    Your posts are awesome! I think people are being more intentional in learning about dementia as they come across a loved one with the diagnosis, but not FROM the loved one. Your writing is where the positive changes are happening in our world!

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  2. This is so true – I now think that keeping the emotional climate calm and warm is Job 1, and the rest of the technical details of caring for a person with dementia come second. I used to stress about the latter, with the result being a tense atmosphere. My spouse picked up on the tension and we were off and running – tears, broodiness, health problems, the works.
    In reversing the priority, things are way calmer now. Thanks for helping people to understand this dynamic.

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  3. Another great post. It reminds me of that saying “The person with dementia is not giving you a hard time, they are having a hard time”. Our actions have a ripple effect, whether it be good or bad. Thanks for the reminder.

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