Repetition and Counting in Dementia: What It Means and What to Do About It

Patients with Alzheimer’s and other forms of dementia may repeat numbers, count frequently, and recite mental math, or other familiar phrases, aloud. This repetitive behaviors might be physical, too, like repeated gestures or obsessive rubbing. Known as perseveration, this behavior is a symptom of the underlying condition, whether it be dementia or Alzheimer’s, and while it isn’t an intentional effort to communicate any particular message, it does carry meaning — and dementia experts and caregiving consultants say it may also provide an opportunity to interact and connect.

Why do dementia patients count out loud?

According to Dementia care expert Teepa Snow, this repetitive behavior, known as perseveration, can be a manifestation of a person’s inability to switch from one task or thought to another.

“Because individuals typically retain the ability to use rhythmic language and counting long after they have lost formal language skills, they are using what they have left to communicate,” Snow told Being Patient.

Repetition of numbers may also provide a sense of comfort and familiarity in a world that may feel increasingly unfamiliar as cognitive abilities decline, she noted.

As the condition progresses, people living with dementia can lose their language skills and ability to form sentences. Repeating numbers can act as a way for them to express themselves and provide comfort. 

What should you do about dementia-driven counting and repetition?

Repetition in people living with dementia can also be an indicator they are trying to express a specific need or concern, ask for help, or cope with frustration or anxiety, Snow pointed out. If you’re hearing this perseverating or repeating, caregiving consultants advise, check in on the person’s emotional condition and try to measure if they are feeling emotionally charged or trying to express a need.

A few of the things that might be driving the behavior include:

• physical discomfort; 
• stress or anxiety;
• an unaddressed physical need;
• disruption to a routine
• feeling ill at ease or unsettled in one’s environment.

What stage of dementia is repetition?

Verbal repetition is a common symptom in all stages of a person’s dementia diagnosis, but it is most common in mid to late stages of dementia. Each person’s experience with dementia and Alzheimer’s varies significantly, and some individuals may not show this behavior until later in the progression of the disease.

Similar to repetitive verbal actions, many people living with moderate to advanced dementia use non-verbal behavior, such as tapping a surface repeatedly, bodily movements and gestures, intense facial expressions, or crying out.

Other communication changes that can take place in the middle stage of neurodegenerative disease progression include that people living with dementia gradually lose their ability to find words, follow conversations, and understand others. 

This can manifest itself in difficulty finding the right word and getting “stuck,” as Snow puts it, losing their train of thought, repeating questions, counting, reverting to a native language and resorting to non-verbal communication.

How do you stop dementia patients from repeating themselves?

Should you tell someone with dementia that they are repeating themselves — or try to stop the behavior? Experts advise that if the repetitive verbal or physical behavior isn’t harmful, it’s best to accept that it’s happening, and find strategies to cope with it. Rather than correcting the behavior or telling the people they are repeating themselves, evaluate the person’s emotional state and what’s at the root of it.

Repetition can come in waves throughout the day — and it can and be triggered by environment. Snow offered some gentle approaches to address repetition. However, she noted, they’re only going to be of help temporarily. 

“If they seem ‘stuck’ on a particular phrase and you are needing a break, you can try to break the pattern by interjecting with another form of rhythmic movement, music, or sound. Then you can try to transition them to another activity,” Snow advised. 

Sometimes the individual might be engaging in this activity simply because they aremay be bored — they might respond well to a and simply requires a new activity to engage in. Provide structure through activities like listening to music (which can be very therapeutic for people even in the later stages of dementia), watching a show, or playing with a ball or fidget toy, to name a few examples., or looking through photographs.

“If they seem ‘stuck’ on a particular phrase and
you are needing a break, you can try to break the
pattern by interjecting with another form of rhythmic
movement, music, or sound.” 

“Or, try directing them to a more purposeful use of the sound.” Snow suggested. “For instance, if they are repeating numbers aloud, try assisting them with counting objects instead.”

Can you still communicate with someone experiencing these symptoms?

According to Dr. Maggie Ellis, a senior lecturer in psychology at the University of St. Andrews, a communication technique called adaptive interaction is a method caregivers can use to respond to someone who’s perseverating. This approach involves mirroring a person’s actions and sounds. It can lead to breakthroughs in social contact between people living with dementia and caregivers. Ellis told Being Patient that it “helps family members and professional caregivers to understand more about what is possible and retained for people with advanced dementia.”

“It changed my life immensely,” one care partner, Martin Philips, told Being Patient of employing adaptive interaction with his wife Linda, to mimic her repetitive physical gestures “because I knew she was still in there.”

AUTHOR BIO:

Lauren Fetten lives in Los Angeles and is a graduate of Scripps College where she studied Economics and Chinese.