Saturday, February 29, 2020

Make the Time, Don’t Find the Time

If you've been a regular reader of the Dementia Society of America blog, you know that better heart health can lead to better brain health. Exercise is just one way to increase heart health, so, how do we make exercise a priority in our daily habits and among our countless distractions?

Most people are just kind of trucking through their day, trying to get through their tasks and to-do lists. That might involve getting their kids from school, work-related tasks, and hopefully having some time to spend time with friends or make a quick appearance at the gym.

One very telling trend is the number of people that buy a gym membership, yet fail to use it. While several different studies are posting similar statistics, it is estimated that 73% of people with a gym membership either fail to use it at all or use it so infrequently that it imparts no long term health benefits.

The usual trend is that there are a lot of people who sign up for a year-long gym membership as part of a New Year’s resolution. They get this membership with the best of intentions, but by the middle of January or early February, the vast majority of them have stopped going to the gym. One of the most common excuses use is that their lifestyle doesn’t allow them the time to work out regularly.

I have found that the key to developing a successful long-term exercise routine is to develop a mindset of making the time, instead of finding the time.

You should approach it with the same mentality you would if you were scheduling an office meeting every Monday, or making sure that you’re picking up your kids from school at the same time every day.

Some talk about how juggling their career and family, along with other responsibilities, can be a huge obstacle. While this does present challenges and imposes demands on our time, there are those with even more on their plate that still make it a point to make the time to exercise.

The bottom line is that you need to make the time to exercise, because if you try to find it; the day will get by you and you’ll end up sitting on your couch worrying about our waistline while your brain and everything else suffers as a result of not exercising the way you should.

Contributor: Dr. Michael Trayford is a Board-Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For more information, please visit https://apexbraincenters.com/

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Monday, January 27, 2020

Take into Consideration: Planning for the Long Term


Much of Dementia care boils down to anticipating and planning for challenges you will face.

As a first step, the person or persons responsible for a loved one's care must have the legal rights to do so. Legal permission involves becoming the designated power of attorney (POA), or under certain circumstances, the conservator and guardian.

The amount and type of long term care your loved one needs is one of the first decisions you and your family will make.

Concerning home care, who will be the primary caregiver? What happens if it becomes neither realistic nor safe to shoulder caregiving responsibilities alone? Is the next step hiring a paid caregiver? Is the paid caregiver one that you hire or one contracted through a home care service? What are the criteria that make it necessary to transition your loved-one from home to an assisted living facility?

Some individuals fervently believe they will be his or her loved one’s caregiver throughout the illness. However, as is often the case, circumstances change. Therefore, you must anticipate and plan for modifications in the type and amount of care your loved one may eventually need. 

Research the options before you need them!

Contact your friends to discover if they know of a reliable caregiver or affordable homecare support. Look into non-profit organizations that provide various types of home care services. Visit assisted living facilities, speak with the director, ask about the services included in their monthly fees, view their inspection reports, and tour the facility. Learn the differences between a continuum of care, independent living, assisted living, and memory or dementia care. Become familiar with the steps you must take before you can place your loved one in an assisted living facility.

It may be months or even years before you come to this cross-road. However, doing your homework will minimize the time and stress of needing to take, often on short notice, this big step.

Developing the “what, if then, or buts” of medical care is another feature of a long-term care plan. Will your loved-one receive care from his or her family doctor or a Dementia care specialist? Research palliative and hospice care to be sure that preconceived ideas do not color your views. Learn about the purposes for palliative and hospice care, the best time to initiate them, and how they impact quality-of-life and end-of-life care. These last decisions are prone to family conflict and long-lasting feelings of ill-will.

A long term care plan includes funeral arrangements as well as various estate considerations. It’s not ghoulish to plan for the funeral. Cremation, embalming with or without embalming fluid, and burial location – are a few of many examples of the difficult and emotional decisions families make.

Prepare yourself for the eventual transition from caregiver to the representative of the estate. What are the responsibilities and the steps you must take to close the estate?

A long term care plan helps families navigate the challenges that dementia care present. Be sure to frequently review, update, and revise your loved one’s long term care plan.

Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org


Thursday, December 26, 2019

Further Your Understanding: Dementia and Mood


Some people say Dementia turned their once loving and upbeat loved-one into an angry tyrant. Others may describe the changes in behavior and mood as “the same person, only more so.” Usually, “more so” is not good. Rarely does one hear that Dementia turned a difficult person into a pleasant one.

The behaviors associated with early-stage Dementia can be the most difficult. Your loved-one is fighting the imposed changes the diagnosis has brought to his or her life. And you, the family caregiver, do not have the experience to both calm your loved-one and cope with the disquiet this new relationship brings into your life.

As Dementia progresses from early to late-stage, moods, and behaviors worsen. In addition to increasing memory loss, depression, belligerence, apathy, physical aggression, wandering, repetitive questioning enters the picture.

It is useless to try to convince your loved one that what they truly believe is not what it seems. You will never win the argument.

“Distraction and redirection” is one helpful strategy to diffuse the situation. Rather than trying to prove his or her hat was misplaced and not stolen, make a comment about the nice weather and suggest going for a walk. Another way to address your loved one’s concern is to listen and tell him or her you will look into the matter. This simple tactic tells your loved-one you are there; you care, and you will make things right.

“Therapeutic deception” is another approach to managing difficult behaviors. Telling your loved one, “you will make things right,” isn’t a lie. It’s a kindness that gives him or her, and you as well, a few moments of peace. You will find a therapeutic deception is an approach you can apply to various difficult circumstances.

Dementia behaviors may also include some weird and scary things. More specifically, your loved one may experience hallucinations. How you respond to these unsettling behaviors has the potential of turning uncomfortable moments into situations that may necessitate assistance from your local police department or a trip to the emergency room.

Managing the difficult behaviors associated with hallucinations involve a different set of challenges. Telling your loved one, there isn’t any blood on the walls or bugs crawling up his or her back is fruitless. Hallucinations are sensory tricks. Your loved-one sees, hears, or feels something without the stimulus of light, sound, or touch. To prevent a difficult situation from escalating into one you cannot manage, you might say something like, “I cannot see what you see, but I am sure it is very scary.”

You might remind your loved one that you are there and that you will make sure they are safe. Sometimes a hug or a gentle touch will have a calming effect. Other times, when hallucinations cause overwhelming fear, the only thing you can do is take your parent to the emergency room.

Medication to reduce mood and behavioral difficulties is a controversial issue. Some people believe the drugs used to manage behavior are “chemical straight-jackets” meant only to make things easier for the caregiver. Other caregivers subscribe to the philosophy that providing meaningful activities for the person with Dementia, establishing a structured routine, and creating an enriching and pleasant environment can reduce the need for behavior modifying medications. In either case, one has to consider quality-of-life. Medication can reduce pain and suffering. If depression becomes overwhelming, belligerence creates a dangerous environment for the caregiver, or when hallucinations cause unrelenting terror, medication is both the humane and one that supports a better quality-of-life.

All of this is easier said than done, but do try to remember it is the disease that is speaking and not the person you once knew.

Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org


Saturday, November 30, 2019

Make a Not-to-Do List for Better Brain Health

A lot of people have a To-Do list loaded with tasks, errands, and projects that they intend to take care of either during the course of that day or at some reasonable time in the future. Most of the people who have lists like this tend to get a few things done, then transfer whatever was leftover to the new list they write up the following day, week, or month. 

Typically, these lists end up getting so filled with uncompleted tasks that they become daunting. It can even get to the point where your bloated To-Do list is a source of stress. If something isn’t getting done it may be due to procrastination, or it’s simply something that just wasn’t important. Leaving trivial items on your To-Do list bogs down your brain capacity and starts causing you to feel things like worry and fear, which are the two most damaging emotions for the brain.

I encourage my clients to keep a Not-To-Do list. This type of list can actually have several different uses. First and foremost, it’s a sort of garbage can where you can dump meaningless tasks that probably shouldn’t have been on your To-Do list in the first place. 

This turns the list into an exercise in prioritizing. It forces you to sit down and think about what you really need to get done, what you should do, and what really isn’t all that important. Then you can sharpen your focus and execute the important tasks in your life with fervor. 

The other aspect of a Not-To-Do list is to serve as a reminder of bad habits you want to avoid. It might be eating too much sugar, having one too many drinks, or keeping up with your efforts to quit smoking. Writing down bad habits that you know you shouldn’t do can be an empowering way to break negative cycles in your life. 

It can also be a tool to help you identify sources of stress in your life. You might include things on the list like ‘I’m not going to get angry in traffic today’, or ‘I’m not going to let my annoying co-worker get to me’. 

When you think about all of these things and how they can all add up, a Not-To-Do list can be a very powerful stress management tool!

Many successful people, like Tim Ferris, are advocating Not-To-Do lists. It allows them to be much more proactive and productive than the actual To-Do-list. At the same time, it also invokes creativity and innovation, because you’re no longer bogging down your brain with things that are seemingly not that important.

Sit down and brainstorm about what is not serving you well on your list and in your life. Then compile a Not-To-Do list. You might find that it will become more important than your To-Do list.  This is a really powerful tip to ramp up your brain for peak performance.

Contributor: Dr. Michael Trayford is a Board-Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For more information, please visit https://apexbraincenters.com/.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org


Thursday, October 31, 2019

Risk and Dementia – Genetics


For some types of diseases that cause Dementia to occur, there is a genetic association for having the disease by the time an individual is 60-years of age or older. It’s a subtle distinction, but people who have the altered gene inherit the risk and not the disease itself. In fact, Dementia is not a disease, rather, it is the expression of the cognitive challenges that come about because of the changes in brain tissue, caused by a particular disease.

This post mainly focuses on Alzheimer-caused Dementia but there are many other causes, e.g., Lewy body, Vascular, Frontotemporal, et al.

On the bright side, knowing that you have an inherited risk factor gives you the opportunity to do those things known to reduce risk - maintain a healthy weight, refrain from smoking, engage in socially and intellectually satisfying activities, exercise, and eat a heart-healthy diet.

For the most part, the at-risk genes change how the body processes cholesterol and other blood lipids. Therefore, it’s not surprising to find that having high cholesterol blood-levels is another risk factor associated with having Dementia later-in-life.

Early-onset familial Alzheimer disease (eFAD) is inherited Dementia that affects people as young as 30 years of age. (1) Unlike traits that are observable shortly after birth, such as eye color, symptoms of eFAD do not appear until the individual is 30-years of age or somewhat older. By that time, it is likely he or she has one or more children and may have unknowingly passed the early-onset gene to them.

Fortunately, there are DNA tests that can identify the presence of the increased-risk genes as well as those that cause eFAD. 

Making the decision to undergo testing is difficult. Will knowing make you feel anxious, relieved, or empowered? Will other family members also want testing? How might this information affect family planning for you or your adult children? Will having a positive test for a specific cause of Dementia risk factors or early-onset disease influence your employer, your career, or make it more difficult to receive health insurance? (2)

Often, people find talking with a genetic counselor can make the decision to test--or not--easier. The genetic counselor, by explaining the technical and emotional issues associated with genetic testing, can help you make a personally comfortable decision. Afterward, the genetic counselor can explain the test results to you and guide discussion about any further steps you may want to take. (2)

You can find more information about genetics and genetic counseling on the following webpages: National Association of Genetic Counselors (https://www.nsgc.org/page/find-a-genetic-counselor)and the American Board of Genetic Counselors (https://www.abgc.net/about-genetic-counseling/find-a-certified-counselor.aspx/). Both of these sites may help you find a genetic counselor located near your home.

Notes:
1. What is Early Onset Familial Alzheimer Disease? http://www.alzforum.org/early-onset-familial-ad/overview/what-early-onset-familial-alzheimer-disease-efad (accessed April 26, 2016)
2. Genetic Testing and Counseling for Early Onset Familial Alzheimer Disease, http://www.alzforum.org/early-onset-familial-ad/diagnosisgenetics/genetic-testing-and-counseling-early-onset-familial (accessed, April 26, 2016)

Want to Know Even More?
Alzheimer Disease Genetics Fact Sheet, https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-genetics-fact-sheet#genetics
(accessed, April 26, 2016)


Contributor: Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.


The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Monday, September 30, 2019

Exercise in Nature to Build a Better Brain

Research has found that there are benefits imparted by exercising in the natural world or a setting that is rich with the things we find in nature; like plants, fresh air, and wildlife.

While gyms serve a great purpose, and some people love them, I prefer to exercise in nature. The natural world provides a deeper and more dynamic level of stimulation for your brain that you simply cannot find at any gym.

One study conducted by Richard Louv, coined the phrase 'Nature Deficit Disorder'.

At first glance, this might sound a bit contrived. However, Louv asserts that human beings are hardwired by evolution to have a connection to nature. Unfortunately, the modern world and the trend for people living in large urban and suburban places reduces the opportunities for people to spend time in nature.

This sentiment that exposure to the natural world has an impact on us has been echoed by many people throughout the generations. The father of the National Parks system and one of the first naturalists, John Muir, said: “Civilized man chokes his soul.”

Although Muir himself lived a significant amount of his life in Martinez, California just outside of Oakland, the goal in his eyes was not that man needed only urban or natural settings, but that both were of equal value and that people who only embraced urban life were indeed cutting themselves apart from the very therapeutic aspects of a direct relationship with the natural world.

'Green Exercise' involves hiking in nature, or getting involved in other activities in the natural world. For people who live and work deep inside urban areas, this could also extend to things like taking a walk in the park, or along a natural stretch of river, or even getting involved in something like a community garden.

When you’re in nature, there is a lot of multimodal stimulation. You’re smelling the trees, flowers and the other scents in the air. You start to notice things like changes in humidity and the presence of birds and other creatures around you.

When you’re in the gym you’re going to have certain smells but you can usually predict what those smells are. It’s old gym equipment and rubber mats on the floor.

When you’re exercising in nature there is a greater sense of self-awareness, improved mood, increased sense of self-esteem, and even an increase in creativity. People exercising in nature tend to have creative thoughts come to them and find it easier to express those ideas with greater clarity.

The bottom line is that exercising in nature does, in fact, elevate the level of your brain and body functions. It’s a win-win for you and nature, and an important way to help build a better brain. I recommend that everybody get out there and do it!

Contributor: Dr. Michael Trayford is a Board-Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For more information, please visit www.ApexBrainCenters.com/memory.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Thursday, August 29, 2019

Dementia Risk Factors: Alcohol

The health benefits that various foods and diets to improve overall health or lower risk for disease is a newsworthy topic. Some reporters state that eating fiber-rich fruits, vegetables, and whole grains helps us to maintain a healthy weight as well as may lower risk for colon cancer. Others assert the Mediterranean diet, one which encourages replacing red meat for fish and chicken, saturated fats with olive oil, and refined carbohydrates with whole grains, reduces the risk for heart disease, certain cancers, and diabetes.

Many research studies are touting the benefits of red wine on lowering cholesterol blood levels and thereby reducing the risk of heart disease, strokes, cataracts, and colon cancer. Though a controversial area of research, some studies indicate drinking moderate amounts of red wine may slow declines in brain function. 

With respect to consuming wine and other alcoholic beverages - moderation is the keyword. However, most people are unsure of how much is a moderate amount. According to the Dietary Guidelines for Americans, a low to moderate alcohol consumption is no more than one drink a day for women and older adults, and two for men. One drink is usually one 1/2 ounce or 15 grams of alcohol, which equals approximately 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor. (Note 1)  

These dietary guidelines refer to the amount consumed on any single day and not as an average over several days. In other words - do not save your daily allocation for a weekend binge.

Alcohol-related brain damage, (ARBD) conditions that include Wernicke-Korsakoff syndrome  (WKS) and alcoholic Dementia is the result of drinking too much alcohol over several years. (Note 2) Though both types of ARBD exhibit Dementia-like symptoms, neither condition is true-Dementia. (Note 2) The difference between ARBD and a Dementia such as Alzheimer disease is in the ability to treat or stop the progression of symptoms.

Consuming more than the recommended amounts of alcohol does increase the likelihood of developing Alzheimer disease and vascular Dementia later in life. However, researchers have yet to establish the scientifically measurable relationship between alcohol consumption and risk for Dementia. The reasons are many and include research entirely dependent on reported observations and evaluating the variables that, in combination with alcohol consumption, affect the long-term risk for Dementia. 

However, one can state with certainty, the more you drink, the greater the likelihood of developing Dementia later in life. High alcohol consumption also increases the risk for stroke, heart and liver disease, and depression – all of which are well-known Dementia risk factors. 


Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.


The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Notes: 
1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition, Washington, DC; 2015, http://health.gov/dietaryguidelines/2015/guidelines/
(accessed June 15, 2015).
2. What is Alcohol-related Brain Damage?, https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=98 (accessed June 16, 2016).