While rummaging through a bathroom drawer for a new toothbrush, I recently noticed a little blue suede jewelry box. I had never seen it before. Inside, I discovered a pin recognizing my wife's 20-year membership in the Medical Group Managers Association. Her career began at a regional medical program and a leading medical school. For over 35 years she served as an administrator, business manager, and consultant for medical practices.

About 15 years ago, I began to notice that she would make notes before meetings with the group's board or officers. To me that seemed a waste of time. Always before, she could recall from memory what expenses had been for various budget items. I assumed that bigger groups and larger budgets explained her need for notes.

Looking back, I realize that, unknown to either of us, her intellectual capacity was declining.

That was the first change in a continuing series of shifts in her mind. Those shifts require shifts in me and in my way of dealing with her. They can be very difficult, but with patience and thought, living with someone with dementia can be enlightening and even enjoyable.

My wife has always been a positive, good-natured, and highly skilled person.

Now, though, she asks, "Did I feed the dogs yet?"

If I answer, "You just did," she may cry or react with anger, saying, "I guess I should just quit talking!"

Through 40-plus years of married life, my wife and I seldom argued. We disagreed on various things, but never faced any disputes where agreement was out of reach.

I have a longtime friend who works regularly with persons with dementia. Recently I explained to her about the frequent problem of dealing with my wife's depression and anger, and asked how to prevent them. With pursed lips and half a smile, her reply was, "The first rule is, get used to always being wrong."

Three years ago, we downsized to a retirement community. This January we took our first real vacation since our move. We went to Rockport, Texas, on the Gulf Coast, and rented the cabin in which we had stayed three times before. During those four weeks, I learned and relearned several principles for enjoying married life in spite of a spouse's diminished mental capacity. I suspect these principles could be helpful to other aging couples or children of aging parents facing similar challenges.

Maintain a connection with the immediate past. Two weeks after arriving in Rockport, I went to buy groceries. When I returned, my wife asked, "How long have we been here?"

When I told her two weeks, she cried and mumbled, "I don't remember anything before two days ago."

I began reminding her of things we had done—driving along the coast, going to church, watching pelicans plunge into the canal and egrets wade along its banks. She had faint memories of a few of those things.

So I gave her my daily calendar and told her to write everything she could remember since leaving Kansas City. Each morning after that, I would ask what she remembered from the day before and suggest that she write those things down. During the remainder of our vacation, she could look back at what we had done. That day-to-day connection seemed to calm her anxiety.

Prepare for new and different situations. I should have prepared my wife for unfamiliar surroundings to ease her comfort with them. On previous vacations, we took lots of pictures—of the cabin we use, its dock, sail and power boats moored on both sides, and the Rockport area. Next year, for a couple of weeks before we go I'll show her those pictures and take them along for her to look at as we travel. When we arrive, it won't seem a totally new or strange place.
This practice can also be employed to refresh memories of family members and friends with whom we haven't had contact lately.

Compliment and reinforce remaining memory. Complimenting a person with diminished memory when he or she remembers something from the day, days, or weeks before can reduce angry responses and hurt feelings.

"See, your memory is just impaired, not completely gone," I'll say to my wife.

Also, learn to accept the person's forgetfulness without making replies that may emphasize it. If my wife asks whether we're going anywhere today, I answer, "Yes, I believe you have a doctor's appointment." I've almost trained myself not to say, "Yes, like the three times you asked before, you have an appointment with the doctor at three."

Eliminate decision making. Another helpful practice is to eliminate the need for persons with memory impairment to make decisions. After my wife's father died, I repeatedly suggested going back to western Oklahoma to see her only sister, who had been ill. Several times I suggested calling Marcy, her niece, to ask whether her sister was well enough for a visit.

After several months, I decided we'd go. On the day we left, I asked whether she had ever called Marcy. She replied, "No, I don't know her."

I said, "She's your niece, your sister's daughter."

She answered, "Yes, but I don't know her."

When she saw Marcy, she quickly recognized her.

In that case and others, I found that instead of asking her to make decisions, it's better to make decisions myself and assume her agreement. On our trip, I'd say, "Let's go drive along the bay," or "I'd like some Mexican food. How about that place on the way to Corpus Christi?"

Suggesting and assuming cooperation without ordering or commanding usually gets agreement.

Take advantage of professional help.

Psychological help. A psychologist can often provide coping assistance to the patient with dementia and the family caregiver. Visits with a psychologist help persons with dementia verbalize their feelings and can show the caregiver helpful skills to employ.

Writing down what my wife had done on our vacation each day was her psychologist's idea, not my own. When we got home, I saw that the memory book included far more than a written record of activities. It included sections for pictures, maps, schedules of daily activities, recommended exercises, and coming events (such as her 50-year high school reunion this Easter). The idea for using pictures before future trips came from seeing that section in the psychologist's memory book.

Psychiatric help. Persons with dementia experience angry flare-ups and frequent depression. My wife is a classic example. An accountant by training, she did our taxes for over 40 years. Now she can no longer balance our checkbook. For decades she planned multi-million-dollar budgets. Her medical administration career ended when she realized she could not complete the annual budget for the foundation she worked with.

A geriatric psychiatrist can prescribe appropriate medications to lessen the depression and anxiety that often accompanies dementia because of those skill losses.

Neurological help. A neurologist can diagnose the type and severity of dementia, prescribe appropriate medications, and make referrals to needed helpers. My wife's neurologist sent her to a psychologist who specializes in testing mental function. Her evaluation emphasized the need for treating her depression.

Care for yourself. An important piece of advice came from the friend I mentioned earlier, who works closely with people with dementia. She stressed that I need to take time to renew my strength as a caregiver. Many resources are available for caregivers, and one place to begin is Aging Information with the Johnson County Area Agency on Aging. Just call 913-715-8861.

Accept the inevitable. At present, medications for dementia, such as Alzheimer's disease, which is perhaps its worst form, can slow its progress but cannot cure it.

My mother died with Alzheimer's disease. For the last years of her life, I flew to Oklahoma every two months to visit with her for a few hours, and then flew back to Kansas City the same day. I still remember the day I visited her in Little Bird's Nursing Home and asked, "Do you know who I am?"

She smiled broadly and shook her head no. It hurt, but I was thankful she was in a nursing home owned by a neighbor of many years and cared for by a nurse she had helped train when she was still a nurse herself.

Someday, like my mother, my wife may not know who I am. But each day with her dementia gives me the opportunity to learn skills that enable me to show love for the important person she has been in my life for 50 years, come August.