How Does Dementia Affect The Ability To Follow Routines
Dementia is a condition that gradually damages the brain’s ability to think, remember, and make decisions. One of the most challenging aspects of living with dementia is the difficulty in maintaining daily routines. What might seem like a simple task to most people – brushing teeth, taking medication at the same time each day, or preparing meals – becomes increasingly difficult as dementia progresses. Understanding how dementia affects routine-following is essential for caregivers, family members, and anyone who wants to support someone living with this condition.
The Connection Between Memory and Routine
Routines are built on memory. Our brains store information about what we do each day, when we do it, and how we do it. This stored information allows us to perform tasks almost automatically without thinking about each step. When someone has dementia, the parts of the brain responsible for storing and retrieving these memories begin to deteriorate. This means that even well-established routines that someone has followed for decades can become confusing and difficult to maintain.
In the early stages of dementia, a person might forget small details about their routine. They might forget whether they already took their morning medication or whether they already had breakfast. As the disease progresses, they may forget the entire routine itself. Someone who has showered every morning for fifty years might suddenly not remember how to start the shower or what order to wash their body in. This is not laziness or stubbornness – it is a direct result of brain damage caused by dementia.
How Dementia Damages Routine Execution
Dementia affects different parts of the brain in different ways. Some types of dementia primarily damage memory, while others affect judgment, planning, and the ability to sequence tasks. When someone needs to follow a routine, they must remember multiple steps and perform them in the correct order. This requires several brain functions working together.
First, the person must remember what the routine is. Second, they must remember the steps involved. Third, they must be able to execute each step correctly. Fourth, they must know when the routine is complete. Dementia can disrupt any or all of these functions.
The prefrontal cortex is the part of the brain responsible for planning and organizing tasks. When dementia damages this area, a person loses the ability to plan their day or organize their activities. They might start getting ready for bed but forget why they started. They might begin brushing their teeth but then wander off to another room and forget what they were doing.
The hippocampus is crucial for forming new memories and retrieving old ones. Damage to this area means that even if someone completes a routine successfully one day, they might not remember doing it the next day. This is why a person with dementia might ask the same question multiple times in one hour or repeat the same story over and over. Their brain is not storing the information properly.
Executive function is the ability to plan, organize, and complete tasks. Dementia damages executive function, making it harder for someone to break down a complex routine into manageable steps. Getting dressed, for example, involves selecting clothes, putting them on in the right order, and fastening buttons or zippers. Someone with dementia might put their shirt on backwards, forget to put on pants, or try to put both legs through one pant leg.
The Impact on Daily Living
The inability to follow routines affects nearly every aspect of daily life. Personal hygiene becomes a challenge. Someone might forget to bathe or brush their teeth. They might not remember to change their clothes or use the bathroom. This can lead to health problems like infections, skin breakdown, and other medical complications.
Medication management becomes dangerous. Many people with dementia take multiple medications at specific times. When they cannot follow the routine of taking medication, they might miss doses or take the same medication twice. This can lead to serious health consequences. Some people might take too much medication, while others might not take enough to manage their conditions.
Meal preparation and eating routines suffer as well. Someone with dementia might forget to eat, or they might eat the same meal multiple times because they forget they already ate. They might forget how to use utensils or might not remember that food needs to be cooked before eating. Nutrition can suffer, leading to weight loss and weakness.
Sleep routines become disrupted. Many people with dementia experience what is called sundowning, where confusion and agitation increase in the late afternoon and evening. They might not remember their bedtime routine and might wander at night. This disruption in sleep can make their daytime confusion worse.
Financial routines become impossible to maintain. Someone with dementia might forget to pay bills, might pay the same bill multiple times, or might give money to scammers. They might not remember how much money they have or what they have already spent.
The Emotional and Psychological Impact
Beyond the practical challenges, the inability to follow routines causes significant emotional distress. Many people with dementia are aware, at least in the early stages, that they are having trouble with tasks they have always been able to do. This awareness can lead to frustration, anxiety, and depression. They might feel embarrassed about needing help with basic tasks. They might become angry or withdrawn.
Routines provide structure and comfort. When someone can no longer follow their established routines, they lose that sense of structure and comfort. This can increase anxiety and confusion. The person might feel lost or unsafe. They might become more agitated or aggressive because they do not understand what is happening around them.
The loss of routine also affects identity. Many people define themselves partly by what they do. A person who has always been organized and punctual might feel like they are losing themselves when they can no longer maintain those routines. This identity loss can be as difficult as the practical challenges of the disease.
How Caregivers Can Help
Understanding how dementia affects routine-following helps caregivers develop strategies to support the person with dementia. One approach is to simplify routines. Instead of expecting someone to follow a complex multi-step routine, break it down into smaller, simpler steps. Instead of saying “get ready for bed,” you might say “put on your pajamas” and then later “brush your teeth” and then “get into bed.”
Visual cues and reminders can help. Placing a toothbrush and toothpaste on the bathroom counter reminds someone that it is time to brush their teeth. A calendar with pictures can help someone remember what day it is and what activities are planned. Labels on drawers and cabinets help someone find what they need.
Establishing consistent routines and sticking to them helps. Even though the person with dementia might not remember the routine, their brain might still respond to the familiar pattern. Doing things at the same time each day, in the same way, can help the person follow along even if they do not consciously remember the routine.
Patience and compassion are essential. When someone with dem
