His large hands, spotted with age, quivered atop the jacket bunched on his lap.

He said he didn't know what Sprite Zero was when his wife asked him if he wanted something to drink. Frustration was evident in her voice as she curtly told him that he liked it, that she had ordered one for him from the flight attendant making the rounds on this long plane ride to the East Coast.

He fumbled the cup after a few sips, spilling the clear soft drink on his coat and sloshing a little on his jeans and her pants. She berated him, wondering aloud how she'd get through the rest of the trip. She turned away, mumbling her aggravations into the small window.

Several minutes later, he quietly asked if he could have something to drink. He was thirsty.

"No," she said, chastising him again for spilling his soda.

He asked again. She told him to chew on the ice.

The more he asked, the harsher the response became. He eventually gave up and dozed off, the cup of ice clutched in his hands.

Although our plane was at cruising altitude, I felt as though I was standing at the window of someone's home, watching a very uncomfortable scene.

The memory haunted me for days. I called several experts on Alzheimer's and dementia and learned that such interactions are all too common among couples when one is living with such an impairment.

Moments like these can serve as a warning signal to friends, family and others that a caregiver may need help.

Caregivers often express a high level of frustration with their memory-impaired spouses, said Erika Wasser, a licensed clinical social worker at Sutter Medical Center's Memory Clinic in Sacramento.

"There's a tremendous sense of disappointment because it isn't what you had planned," she said. "There's a process of accepting that it's a disease, and there's a behavioral component that is so hard to cope with."

To see the person that you love, the person you had anticipated gracefully growing old with, suddenly unable to remember common tasks can be devastating.

"The thing you hear most from the caregiving mate is that they've lost their partner, that it's like having another child to take care of," Wasser said. "It is heartbreaking to hear what people go through with dementia and the toll it takes on couples and families."

Some spouses acknowledge that they talk sternly to – or even yell at – memory-impaired spouses, but that doesn't mean the message is getting through.

In many situations, the emotional content or tone of what a spouse is saying is more important than the facts, said Beth Ober, a UC Davis human development professor who researches the brain and aging.

The worst thing you can do is start shouting at them.

"If they feel like the person who is talking to them is putting them down, they feel that on an emotional level, even if they might not be able to express it," she said.

Better is to speak in a calm, reassuring voice, conveying messages in simple, validating terms. But that's easier said than done, she said, especially when the person is asking the same question for the 10th time in as many minutes.

"It takes a heck of a lot of patience and sometimes (caregivers) do fly off the handle and get upset," Ober said.

If frustration is evident, it might be a good opportunity for someone – be it a friendly neighbor on a plane or a family member – to attempt to gently intervene.

If Denise Davis, program director of the Sacramento branch of the Alzheimer's Association of Northern California and Northern Nevada, had been in my spot on the plane, she would have attempted to start a conversation with the man after the drink incident.

It might have helped put him at ease and helped the wife without making her feel like she was imposing on other passengers, Davis said.

"I would have asked if I could get another drink for both of them," she said, adding that she also would have included small talk in the chat.

Volunteers with the association often carry cards when they travel and offer them, and help, if they witness weary, irritated caregivers. Davis estimated that 60 percent of the time it's accepted, even appreciated. But 40 percent of the time there's embarrassment, a phrase along the lines of "How dare you?" muttered.

"It's the exhaustion that comes with the caregiving. … There isn't room to have any sort of discussion with a stranger," Davis said. "I'll say something like 'I do apologize, I didn't mean to step into your business but just wanted you to know you're not alone.'

"Many, many families are working through the same issues and it's nothing to be ashamed of."

Family, friends and neighbors can help, too. Don't wait for a relative to ask or for an invitation to come over. Tell them when you'll help and what you'll do. Insist on taking the patient to coffee or lunch. Spend time with the loved one while the caregiver attends a support group meeting.

Find a way to include yourself in the weekly or daily routine.

Help the person providing the care to understand that it's OK to take some time for themselves.

"If we can't take care of ourselves first as a caregiver, we're not going to do a very good job of taking care of our loved one," Davis said.

And if we're not doing what we can to support the caregivers among us, who will?

DEMENTIA BY THE NUMBERS

500,000

The estimated number of Californians with dementia, most commonly Alzheimer's disease.

5.2 million

The estimated number of people nationwide with Alzheimer's disease in 2008.

10 million

The number of Americans of the boomer generation expected to develop Alzheimer's.

Here are more resources for family and friends of those with Alzheimer's disease

Tips for communicating with Alzheimer's patients: www.alz.org/living_with_ alzheimers_communication.asp

Local support groups

Sacramento: 11:30 a.m. to 12:30 p.m. on the third Tuesday of the month, 530 Bercut Drive, Suite A. (916) 930-9080. Drop-ins welcome

Elk Grove: 10 to 11:30 a.m. every Tuesday, Sunrise at Laguna Creek, 6727 Laguna Park Drive. (916) 930-9080

Folsom: 10-11:30 a.m. the second Friday of the month at Folsom Senior Center & Arts Center (conference room), 48 Natoma St. (916) 930-9080

Rocklin: 7-8:30 p.m. the fourth Wednesday of the month, Casa De Santa Fe (in the clubhouse), 3201 Santa Fe Way. (916) 652-4776

Roseville: 6:30 to 8 p.m. on the third Thursday of the month, Main Timbers Lodge, Sun City Roseville, 7050 Del Webb Blvd. (916) 930-9080

Woodland: 6:30 to 8 p.m. on the second Tuesday of the month, Yolo Adult Day Health, 20 N. Cottonwood St. (530) 666-8828

Find many more support groups in the Sacramento region at www.alz.org/norcal.

Source: Alzheimer's Association of Northern California and Northern Nevada

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