Dealing with Dementia

“You’ve got to know when to hold ’em,
know when to fold ’em.”

– Kenny Rogers
Life is a card game. No matter how careful you are,
there will come a time where you are dealt a bum
hand. One of the worst hands you can be dealt is
one with the dementia card. There is virtually nothing you
can do when you receive this hand, and at present precious
little you can do to play the hand, but you still need to play
out the hand you were dealt. I recently have taken on one
of my greatest teaching challenges: teaching lessons to a
person with moderate-to-severe Alzheimer’s disease. How

humbling it is to try to use your vast years of teaching experi-
ence to try to help an individual stave off the ravages of this

affliction. How disconcerting it is to know that there will
most likely come a time when both of us will have to decide
to call it quits and let destiny take its course. How difficult
it will be to decide when that time arrives.
I remember the first time I ever taught a Suzuki group
class. I was an undergraduate student at Southern Illinois
University–Edwardsville and studying with the renowned
Suzuki pioneer John Kendall. I spent my first year with Mr.
Kendall just observing others teach; there were many other
established graduate students from all over the world who
had come to study with Mr. Kendall, and I wanted to get
an inkling of what Suzuki teaching was about. I also had
opportunity to observe the teaching of some wonderful
undergraduates who had themselves grown up in the Suzuki
method in the SIUE program, Kimberly Meier-Sims and

Winifred Crock. And it was inspirational to observe the won-
derful teaching of our program coordinator, Carol Smith.

During my second year at SIUE, I finally felt ready to try
to teach a class and was assigned a Book Three class. It was

a wonderful experience, as that year observing and learn-
ing teaching techniques, teaching styles, how to interact

with students, and seeing how students responded to their
various teachers gave me the luxury of a head start that a
novice teacher wouldn’t usually have. Suzuki Book Three
was a wonderfully comfortable place to start, as the pieces
were still simple enough to digest, yet the students were
old enough to know how to behave in a group class setting.

Over the years I gradually evolved into a more experi-
enced teacher, challenging myself to teach far younger

students, even two-year-olds, and at the opposite end of
the spectrum, vastly more advanced students. The only
way to grow is to push yourself out of your comfort zone.

It took many years, but now I feel almost the same comfort
level teaching three-year old students as I do when I teach
students the Tchaikovsky Violin Concerto. My comfort level
with teaching students on the autism spectrum and teaching
students with other learning disabilities eventually rose
too, partly from working with my own sons. But I really
think trying to teach violin to an adult with Alzheimer’s
disease is my greatest pedagogical challenge. For this I have
needed to fall back on all my 40 years of previous teaching
experience, and even then, I still struggle to know how to
proceed with this task.
Last fall I was asked by one of my current student’s families
if I would be open to teaching an adult with Alzheimer’s
disease. This adult had played violin previously and had
recently been turned away as a student by three consecutive
violin teachers as they did not feel comfortable working
with an adult with this affliction. I did not know what to
expect at the first lesson. I greeted Bob (not his real name)
and he shook my hand, telling me that he had played violin
for a few years. Bob had a weathered look about him that
belied his early 60s age. His wife would accompany him to
lessons then proceed to the waiting room area, as it was
apparent that Bob was used to taking his lessons by himself.
At our first lesson he first handed me an old leather music
pouch and then fixed a gaze towards my face. He said not
a word, but his lips quivered. His countenance radiated a
look of insecurity, much like a deer when sensing danger. I
carefully opened the music pouch, retrieving its contents,
Suzuki Books Two and Three. Instinctively I set the music up
on the music stand. I asked Bob what he wanted to play for
me. He hesitated. Then he reached out his right hand and
gestured towards Suzuki Book Three. Thumbing through
the pages to the first piece his mouth started flickering
again. “This,” he said.
Bob began playing and I assessed what to focus on. He
played in tune, used vibrato, and exhibited decent rhythm.
His bow control was only fair, rather spastic, actually, but
not unlike some other older adult beginners I had started.
Bob’s bow would waver over the fingerboard and often
accidentally hit adjacent strings. His bow directions were
erratic, removing and adding slurs in a seemingly random
fashion. Bob played the first half page well and then he
suddenly lost his place, apparently timing out on his focus.
“Sorry,” he said sheepishly.
I told him all was fine and tried to distract him from his
mistake by complementing him on his vibrato. We would
start with focusing on drawing a straight bow and being

a bit more observant of bowings. I
asked Bob to play the A section of the
Martini Gavotte from memory and
to watch his bow to keep it parallel
to the bridge and on the highway
(halfway between the bridge and the
fingerboard). He did okay, but his bow
thrashed around even though he was
supposedly watching it. I told Bob I
could help him keep his bow straight
by guiding it while he bowed. With
Bob’s bow parked nicely on the string
I proceeded to reach over to grasp his
bow stick at the balance point. Bob
flinched as if I was going to hit him.
So, I decided to go through greater
lengths to enumerate exactly what I
was planning to do so Bob would have
a better understanding. I told Bob to
hold his bow on the string without
moving it, and then I would grasp the
bow stick while he was holding it so
that I could help him guide it by using
both of our hands.
I even more gingerly reached over to
hold Bob’s bow while it was frozen on
the string. Bob still flinched, but less
so than before. Putting my hand on his
bow stick, we were now ready to start to

play together. But then Bob did some-
thing totally unexpected, he entirely

let go of his bow, I suppose thinking I
was planning on taking the bow from
him. Clearly, he had forgotten I had just

told him that we would be jointly bow-
ing together. Needing to change tactics,

I then decided to put a pencil into one
of the violin’s F-holes for his bow to use
as a guardrail to keep the bow from
drifting on to the fingerboard. “This
process is going to be trickier than I
had thought,” I thought.
In our second lesson, Bob played
Martini Gavotte again, but this time
he did not make it past the first couple
lines before getting lost again and
again. I tried playing alongside him
and that seemed to help a little. When
he lost his place he sometimes could
get back on track when he heard me
playing the correct notes, quickly
self-correcting his fingers to match
my pitch. But there were unexpected
problems. He obviously heard the

correct note I had played, and his
brain probably even knew that note
from the recesses of his long term
memory (having learned this piece
years earlier), but it seemed he could
not always remember which string
and finger combination would work
to produce that note, so he randomly
tried any finger and string until he
found the one that matched pitch. It
was very strange to me as even my
six-year-old students could reproduce

a correct pitch if I played it first, know-
ing what string the note was on, and

what finger played that note. I noticed
Bob’s problem only escalated over the
months of lessons. Eventually when he
searched for a lost pitch, he would even
shift his hand totally out of position
into third and fourth positions to find
a half step that could have easily been
be played with the adjacent finger. This
hope-and-group method to find a note
was extremely inefficient, and after
two or three attempts, usually futile.
After a few lessons we decided it best
to go to a shorter easier piece and
started working on Chorus from Judas
Maccabaeus, the shortest piece from
Book Two. I played in unison with Bob,
and he got though about two-thirds
of it before he got totally lost. I played
the next measure that he should have
played, expecting him to repeat it back
to me. Bob asked, “Where?” So I pointed
to measure 17 in the music, then played
it again for him. Bob could not even
find the first note. I tried to help him
saying, “D, A3,” but this did not help.
Thinking Bob perhaps had too much
to focus on, I told him I would do the
bowing for him and all he would have
to do is play the fingering. I sang the
finger numbers on pitch for measure
17 to utilize his aural memory, then
placed his ring finger on the A3 spot

before we started to ensure Bob start-
ing on the correct note. Then I went to

take his bow from him so I could do the
bowing. When I took his bow out of his
hand Bob got the novel idea of deciding
to give me his violin too, taking it off
his shoulder and handing it to me. So,
another tried and true teaching tactic

was in this case rendered ineffective.
Pedagogical techniques that I had used
so effectively with even my incredibly

young students were clearly not work-
ing. I began to feel like I had to “think

outside the box.”

The next couple of lessons we fo-
cused on only two items: Chorus and

the G major two-octave scale. My

thought was that the most predict-
able pattern in all of music was a scale

because you always played consecutive
fingers, so if Bob practiced the scale,
he wouldn’t get lost when scales came
up in Chorus because his fingers had
just played that scale pattern seconds
before. I played Chorus with him until
he predictably got lost. We practiced
his miscues five times correctly for
every incorrect version as I do with my
students using our “Repetition Ratio

Rule.” Then we went back to the begin-
ning to see if he would be able to get

past those spots. Most of the time when
we again reached the just-practiced
spot, Bob would again get lost. With
most of my students, when they get lost
it is because the notes skip to another
string or finger, but Bob was getting
lost even on the scale passages. It was
then that I decided to start each lesson
with the G major scale so both the
aural memory and the muscle memory
would be in his short-term memory.

Going through the scale was not auto-
matic at all; Bob would always lose his

place in the first five notes, most often
when he had a string change. I tried to
get him to practice the note before the
string crossing going to the new string,
but Bob only said, “Where?” Bob could
not start in the middle of a scale, no
matter how much we tried, so we had
to go back to the beginning of the scale
each time. But when we did that Bob
would always get lost after four or five
notes. I told Bob that a scale was good

to practice as the order was quite pre-
dictable and it was like counting, “0, 1,

2, 3, 0.” I had him count out loud: “0, 1,
2, 3, 0, 1, 2, 3.” Bob didn’t seem to make
the connection of counting to finger
numbers, so I again was stymied in my
teaching approach.

I racked my brain over the weeks
trying to find the best way to help
Bob learn to play a scale. He obviously
had good long-term aural memory,
as he had played scales in his past,
but knowing what the note sounded
like and being able to find the correct

fingers to play that note was seem-
ingly short-circuited. His short-term

memory wasn’t good enough for me
to sing the fingers out loud or tell him
the correct fingers he needed to play.
When I did that and helped him place
bow on the string, he would always
ask, “Where?”
It was after five weeks of lessons that
I finally came across a tactic that
worked! I did the bowing for him with
my right hand moving his bow arm
while I physically moved his fingers
to the correct scale note with my left
hand. Voila. After doing it five times
(hand over hand) every time he missed
a finger, he was starting to learn the
scale. If Bob could not remember the
fingerings to the scale, the muscle
memory of his fingers just might.
Practicing violin in this fashion took
forever, but it seemed to help. After

all, we were in no hurry to progress,
we were just trying to forestall the
ravages of his Alzheimer’s. I decided
to monitor how far he got in the scale
each lesson with a stick figure drawn
on a piece of highlight tape and put
the lesson date on the tape. We made
progress from beginning of the lesson
to the end of the lesson, and sometimes
actually surpassed the amount he
had been able to play in the previous
lesson. I decided to use this highlight
tape to monitor progress in his Chorus
and took special delight in showing
Bob he had gotten further into Chorus
than he had gotten the previous week.
When I mentioned this to Bob, he
resonated with joy and cracked a smile.
I think I had given him some hope that
his dementia was not always a one-way
street. He was still capable of turning
back the clock!
W hile I physically moved Bob’s

fingers for him to learn notes, I no-
ticed sometimes his fingers became

rigid. I was not sure if he was resisting
me, or if this was a condition of his
Alzheimer’s. But moving his fingers
was painstaking and tedious, and I

had hoped that I could eventually
find a way to get Bob to remember
how to play a scale totally on his own.
Upon further reflection, I got an idea
I thought might work: imagery. “Your
left thumb is the Walgreens cashier.
The first customer lines up at the
register (first finger on the G string
tape closest to the thumb). Then the
next customer lines up behind the first
customer (second finger). Once the
third customer lines up (third finger),
it is Walgreen’s policy to open a new
register, and you hear on the speaker,
‘I see three.’” So, the next register is
the adjacent D string and customers
start lining up at that register once it
is opened. Filling the D-string register
opens up the A-string register.
Bob would still mix up the order of
his fingers in a scale, and even though
I’m sure he had the concept of waiting

in line still safely stored in his long-
term memory, he couldn’t quite make

the connection to his left-hand fingers
lining up in a consecutive order. Still,
with the strategy of using his aural
long-term memory by playing along
with him and concurrently utilizing

his muscle memory by moving his
fingers or his bow for him, interjecting
a few metaphors like “using the next
finger in line,” we did make progress
from beginning to the end of each
lesson. We worked on Chorus the
same way and each week monitored
his progress with my stick figures
primitively drawn on highlight tape.
Because there was no retention from
lesson to lesson, our musical goal was
to just maintain what we had. Winning
was out of reach; our goal was not to

lose, to “break even.” But our overarch-
ing goal was to try to use his violin

lessons to reconnect neural pathways

that had been short-circuited by his Al-
zheimer’s disease.

Equally important was to keep Bob’s spirits up during the
process, keeping him doing something
he loved, playing the violin, for as long
as we could.
Over the months Bob had more and
more trouble putting down the correct
fingers on the correct finger tapes,
so I formulated a new color-coded
system. I decided to use a blue tape for
his first finger tape, and concurrently
put a stripe of that blue tape on his
index fingernail. I used a silver tape
for second finger tape to go with a
matching silver-striped fingernail, red

was for third finger, and I did not put
a fourth finger tape on so there would
be fewer tapes and thus less confusion
(see photo). I told Bob to put the blue
fingernail on the blue first tape, etc.

My tactic was only marginally success-
ful. Matching colored fingernails to

the corresponding colors of tape was
probably only correct about 60 percent
of the time.
Six months of lessons went by. I was
to the point of unpacking Bob’s violin
and bow for him and bringing them
in to the studio. Bob did well enough
in each lesson, but when the lesson
ended, he seemed not to know where
he was or what to do next. I told him to
follow me to the adjacent room where
his wife was waiting. Many times, I
would need to take his arm and lead
him to that room. Because he always
seemed at ease in the lesson, there
must have been something comforting
to him when he played his violin, but
transitions seemed to unsettle him. It
was then that I began to wonder if we
were nearing the time when all this
would have to come to an end.
I learned at the end of summer from
Bob’s wife that the challenge of the
violin was starting to overwhelm
him and that they had decided not to
continue lessons when the fall term
started. He had become saddened
when he practiced his pieces at home,
as he could recall that he had once
been able to perform them perfectly
from memory, and now he could not
get even through one line of those
pieces. The time had come when it
was best to stop. A profound sadness
permeated me. Even though I knew I
was up against long odds in trying to
stave off the progression of his illness,
I still felt failure. It felt hollow inside to
know that I could not keep him going
on his violin, and it felt even worse

knowing that his overall health prog-
nosis after this was grim. As painful

as that was, I knew at the same time
my feelings were only a drop of water
in the sea of anguish that his family
was feeling. That made me feel worse,
as I didn’t just let Bob down, I had let

his whole family down when my best
intentions fell futilely to the floor in
spite of everything I had tried.
I cannot say with any certainty that
anything I had done over his nine
months of lessons had any impact in

staving off the progression of his Al-
zheimer’s. I would like to think so, but

how do I really know? In each lesson
we made real progress in what he was
able to do, but I knew at the same time
there would not be any retention the
next week. His wife told me in our last
lesson together that Bob was so happy
he started lessons with me, and that if
he would have started earlier with me,
she thought he would still be playing
for a bit longer. She said she knew it
was the right time to quit, as what
had been making Bob happy was now
making him sad.
Dealing with dementia tugs at one’s
inner self. Teaching hyperactive and
learning-disabled children is difficult
enough, but in your heart, you know
the odds for progress are eventually in
their favor. The same cannot be said
for dementia. When it comes time to
“fold ’em,” the sting of defeat is unlike
any other teaching experience I have
ever had. But the smiles and sporadic
short-term successes in the lessons
will always resonate with me. Even if
my teaching made no difference at all
in the progression of Bob’s illness, it
seemed to at least make a temporary
difference in Bob’s enjoyment of his
life. Those many times when Bob tried
with difficulty to play something and
together we found a way to make it
happen would elate Bob, and his smile
was priceless. Bob and I had such a
special journey together that might
not have happened had either of us
been reticent to take on a challenge.
There is always a reason to try to do
something helpful, even if the odds
are stacked against you. The game of
life is difficult to win. Eventually at
some future point, at some age, we all
succumb. But by enjoying the process
of playing the game, relishing the
small successes, and happily “breaking
even,” we come away winners.