Glossary: the words they'll use

Doctors, facilities, and forms speak a dialect nobody teaches you. Here's the decoder: what each term actually means for your week, not the textbook version.

ADLs: Activities of Daily Living

The basic six: bathing, dressing, toileting, transferring (getting up), continence, eating. Facilities and insurers count how many need help. It's the yardstick for care levels and coverage.

IADLs: Instrumental ADLs

The complicated life tasks: cooking, driving, money, medications, phone. These fail first. Trouble here is often the earliest sign.

MCI: Mild Cognitive Impairment

Memory/thinking worse than normal aging but not yet dementia. Some MCI progresses, some doesn't. Translation: watch, plan, and treat what's treatable, not a dementia sentence.

Sundowning

Late-afternoon/evening restlessness, confusion, or agitation as the tired brain runs out of reserves. See the Evening restlessness card.

Showtiming

The short, polished rally performed for visitors, doctors, and phone calls, followed by collapse. Why distant family says "she seems fine." (The note to send them.)

Delirium

Sudden confusion (hours–days) from infection, medication, dehydration, or hospitalization, not the dementia progressing, and usually treatable. The most important word on this list: sudden change = call the doctor today.

TIA: Transient Ischemic Attack (mini-stroke)

Stroke symptoms (slurred speech, face drooping, arm weakness) that pass within minutes to a day. A warning shot, not a false alarm: call the same day, because the next one may not pass.

Atrial fibrillation (AFib)

An irregular heartbeat that lets blood pool and clot, then throws clots to the brain, a major driver of stroke and vascular dementia. Treating it (blood thinners, rate control) is dementia prevention as much as heart care.

Small vessel disease

Years of high blood pressure or diabetes stiffening the brain's tiniest blood vessels. The most common engine behind vascular decline, usually invisible until an MRI goes looking.

Infarct

A patch of brain tissue lost when blood flow to it was blocked: a stroke's permanent footprint, big or small. "Multi-infarct" means many small ones have quietly added up.

Executive function

The planning, sequencing, and judgment skills: what to do first, how to follow a recipe, managing money. In vascular dementia these often fail before memory does: sharp at cards, lost trying to make coffee.

Anosognosia

The disease damages the very brain circuits needed to notice the disease. They're not stubborn or in denial. The brain genuinely can't register the deficit, which is why arguing about it never works.

REM sleep behavior disorder (RBD)

Acting out dreams (shouting, punching, falling out of bed) because the body's normal sleep paralysis fails. An early flag for Lewy body dementia; worth mentioning to the neurologist even if it started years earlier.

Normal pressure hydrocephalus (NPH)

Fluid buildup in the brain causing a specific triad: shuffling walk, bladder urgency, confusion. One of the few dementia look-alikes that's actually treatable (a shunt), worth ruling out before accepting a permanent diagnosis.

Anticholinergic

A drug family (Benadryl, many "PM" sleep aids, some bladder and allergy pills) that fogs an aging brain and is linked to faster decline. Bring the full medication list to a pharmacist and ask by name: any anticholinergics in here?

Care partner (vs. caregiver)

Two words for the same devotion, quietly debated online. Care partner honors the early years, when it's still a two-way collaboration; caregiver is honest about the later ones, when the work mostly runs one way. Neither is wrong. The right word is whichever fits your day, and the kindest move is to ask the person what they'd want. (You'll also see "person living with dementia" replacing "sufferer" or "victim," the same instinct: the person first, the disease second.)

Validation

Responding to the feeling instead of correcting the fact. The core communication move of dementia care.

Redirection

Gently steering attention to something else instead of confronting: "Let's have tea before we go."

Therapeutic fib

A small protective untruth ("the car's in the shop") that prevents suffering the person can't process. Kindness in translation, not deception for convenience.

Hand-under-hand

Sliding your hand under theirs so they keep the feeling of doing while you quietly guide. (Ch. 3, with video.)

Respite

Any arranged break for the caregiver: hours to weeks. Fundable through AAAs, state programs, and vouchers. Not a luxury; the load-bearing wall.

Adult day program / day club

Structured daytime activities, meals, and supervision: hours of engagement for them, a standing break for you. Often the single best-value service in dementia care.

AAA: Area Agency on Aging

Your region's government-funded hub for aging services: respite money, benefits counseling, home help. Every U.S. address has one. Find it via 1-800-677-1116.

GUIDE Model (Medicare)

A Medicare dementia-care program: a care navigator, a 24/7 support line, caregiver training, and respite dollars, at no extra cost, if the practice participates. Ask any neurologist or primary care office directly: "do you participate in GUIDE?"

Geriatric care manager (aging life care professional)

A hired professional (usually nurse or social worker) who assesses, plans, coordinates, and referees family conflicts. Costs money; often saves multiples of it.

Memory care

A locked (secured) residential unit designed for dementia: trained staff, wander-safe layout, dementia-appropriate activities. A specialty layer above assisted living.

Skilled nursing facility (SNF, "sniff")

A nursing home providing medical-level care. Also where Medicare rehab stays happen after hospitalizations.

Palliative care

Comfort-and-quality-of-life medical care that can run alongside other treatment at any stage. Not hospice; ask for it earlier than feels natural.

Hospice

Comfort-focused care when a doctor certifies a life expectancy of ~6 months if the disease runs its course (re-certifiable; people can graduate). Brings nurses, equipment, respite, and a 3am number. Families' most common regret: "we wish we'd called sooner."

POA: Power of Attorney (durable)

The document naming who handles money/property when they can't. "Durable" = survives incapacity. Without it: guardianship court.

Healthcare proxy / medical POA

Who speaks to doctors for them. Different document from the financial POA; you want both.

Advance directive / living will

Their written wishes for medical care when they can't say: resuscitation, hospitalization, feeding. Their voice, saved for later.

POLST / MOLST

A doctor-signed medical order version of those wishes that EMTs and ERs must follow. The fridge/wallet version of the advance directive; ask the doctor to complete one when appropriate.

DNR: Do Not Resuscitate

The specific order declining CPR. Without paper, the default everywhere is maximum intervention.

Capacity

The legal ability to understand what you're signing or deciding. Fades with the disease, the reason paperwork is a now thing. Task-specific: someone may retain capacity for simple decisions after losing it for complex ones.

Guardianship / conservatorship

The court process where a judge appoints a decision-maker after capacity is gone and no POA exists. Slow, public, expensive: the thing early paperwork avoids.

Medicaid look-back (5 years)

When applying for Medicaid long-term care, the state reviews 5 years of financial transfers; gifts in that window can delay eligibility. Why elder-law advice early is worth ten times its fee.

Spend-down

Reducing countable assets to reach Medicaid eligibility, with rules about what's protected (a spouse's share, the home in many cases). Elder-law territory; don't improvise it.

Elimination period

The 30–90 days you pay out of pocket before a long-term-care insurance policy starts paying benefits: a deductible measured in days, not dollars. File the claim the day paid care starts; the clock doesn't run itself.

Elopement

Facility-speak for wandering away from a safe area. Why memory-care doors are secured and why wandering programs exist.

Neuropsychological evaluation

The long paper-and-pencil testing session that maps exactly which abilities are affected, useful for diagnosis, driving decisions, and capacity questions.

Anticipatory grief

Grieving someone still alive, in installments. Normal, heavy, and it has a home in Chapter 5.

No match. Try fewer letters, or ask the 24/7 helpline; they translate jargon all day.