Saturday, October 17, 2020

Normal Aging or Something More?

 

It can be difficult to separate the normal aging process from the progressive and steep declines typical of Dementia. Examples of genuinely age-related changes are thinning and graying hair, sagging skin, and alterations in vision, hearing, and taste. Other changes, such as heart disease and certain types of memory loss, are not a normal part of aging.

The normal aging process may affect memory by changing the way the brain stores and retrieves information. While healthy aging does not affect long-term memory, it may affect short-term memory by making it difficult to remember such things as the name of a new acquaintance or misplacing keys or eyeglasses. Occasional word-recall difficulties, rather than frequent ones, are another indicator of healthy aging.

How people evaluate isolated events is one way to distinguish normal memory lapses from those caused by dementia. At one time or another, everybody loses a car in a parking lot. With normal forgetfulness, we chalk up those moments of frustration to the number of look-alike cars or having our thoughts elsewhere. A person who has Dementia is sure someone has moved the car.           

Name recall and word-finding are other ways to distinguish memory losses caused by the normal aging process from those resulting from Dementia. A person with occasional age-related memory difficulties might ask for a reminder or wait a moment for the right word to show-up. A person with Dementia frequently has trouble finding and using the right word. To compensate, he or she may use either an awkward substitution or a description in place of the word. For example--a furry animal that purrs to replace the word “cat.” Further, there may be a noticeable decline in his or her capability to maintain a conversation.

Clinicians use the term “impoverished “to describe the Dementia-related changes in language complexity and vocabulary.

The ability to use household items is another indicator of Dementia. Most people find it annoying or frustrating when upgrading a home appliance to one that is heavy in technology or with new features. The source of annoyance often stems from changes in vision or the reduction in dexterity that arthritis may cause. However, people who have Dementia no longer know how to use their familiar dishwasher or drier.

When considering whether a set of symptoms indicates dementia or normal aging, one must evaluate whether the symptoms are a nuisance, problematic, or debilitating. This is best accomplished with the help of appropriate medical professionals and input from caregivers and loved ones.


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 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, September 19, 2020

Sleep. Manage a Risk Factor.




At one time or another, everybody has bouts of sleeplessness. House noises, screaming babies, caffeine, or a bed partner who snores, often make it difficult to fall asleep and stay asleep. Eventually, you learn to limit the amount of coffee you drink, the screaming babies grow up, and the snoring bed partner, well...still stores. Other causes of chronic sleeplessness are sleep apnea, acid reflux, jet lag, swing-shift employment, and ongoing stress that causes sleeplessness. 

Discoveries made by Oregon Health and Science University researchers show that sleep deprivation increases the risk of dementia later in life and may quicken its progression for those who already have the disease.1 Their data show that insufficient sleep increases the production of beta-amyloid proteins that compose the plaques associated with various kinds of dementia. 1  

Taking a different approach, University of California Berkeley Sleep and Neuroimaging Lab researchers have evidence demonstrating the importance of deep non-REM (rapid eye movement) sleep, in preventing memory loss. 2 The deep non-REM sleep phase, among other functions, appears to prevent the buildup of beta-amyloid proteins. Their work shows there is a correlation between the accumulation of beta-amyloid proteins, sleep disorders, and Alzheimer disease. 2

Also, insufficient sleep is a risk factor associated with other health conditions that include obesity, heart disease, and diabetes - all of which increase the likelihood of dementia later in life. 

What to do??

First of all, remember that risk factors do not cause disease but increase the likelihood of having dementia sometime in the future. Second, and most importantly, modifying behaviors and habits associated with dementia, such as smoking and obesity, can reduce risk.

Sufficient sleep depends on the age of the individual. For adults, seven to 10 hours of sleep per night is considered healthy3  However, for adults older than 65-years of age, six to eight hours of sleep per night is both normal and healthy. 3

Many older people, believing less than 8 hours of sleep per night is abnormal, resort to using sleeping pills. Unfortunately, using medication to assure sleep both increases the risk for dementia and worsens dementia for those who have the disease.


People acquire habits and behaviors that unknowingly make it difficult to fall asleep and stay asleep. The National Sleep Foundation offers the following tips to get a good night’s sleep. 3

⦁ Stick to a sleep schedule – even on the weekends.
⦁ Develop a relaxing routine to prepare your body for sleep. 
⦁ Use your bed only for sleep and sex. 
⦁ If you have trouble sleeping, avoid afternoon and early evening naps.
⦁ Exercise daily.
⦁ Make the room where you sleep comfortable and free from disturbing noise or other distractions. 
⦁ Sleep on a comfortable mattress and pillows. 
⦁ Avoid alcohol, cigarettes, and heavy meals in the evening. 
⦁ Wind down - an hour before bed choose a calming activity such as reading. 
⦁ If you can't sleep, go into another room and do something relaxing or immensely boring until you feel sleepy. 


Notes:

1. How a lack of sleep can increase YOUR risk of dementia: Lack of rest prevents the brain clearing out toxins that trigger Alzheimer's', http://www.dailymail.co.uk/health/article-3387246/How-lack-sleep-increase-risk-dementia-Lack-rest-prevents-brain-clearing-toxins-trigger-Alzheimer-s.html (accessed May 17, 2016)

2. Lack of Sleep May Lead to Dementia: New Research Finds It Makes Brain Vulnerable, http://alumni.berkeley.edu/california-magazine/just-in/2015-06-02/lack-sleep-may-lead-dementia-new-research-finds-it-makes (accessed May 17, 2016)

3. Healthy Sleep Tips, https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips (accessed May 17, 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 or guarantee products, comments, suggestions, links, or other forms of content within blog posts provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org




Monday, August 31, 2020

Medications: Help, Hurt, or Both?


In the United States, more than seven million people have mild cognitive impairment (MCI) or have dementia. According to Xueya Cai and colleagues, nearly half of these individuals have two additional chronic diseases that require they take five or more medications.1

As a consequence of age-related decreases in kidney and liver function, older people tend to excrete medications at a slower rate and are therefore more likely to experience stronger, and not always reversible, drug-induced side effects. Another factor is the potential for complicated interactions with the other prescribed and over-the-counter medications that older people may take. Research indicates that as people age, they become more sensitive to drugs that act on the central nervous system.2 

One group of medications, the anticholinergics, have recently come under increased scrutiny. This class of drugs slows or prevents the transmission of nervous system information to and from the brain. Some commonly used over-the-counter (OTC) medications, such as antihistamines for cold and allergy symptoms are anticholinergics. Prescription anticholinergic medications relieve symptoms associated with depression, muscle spasms, motion sickness, as well as those used to modify the behaviors associated with mental illnesses such as schizophrenia and bipolar disorder.

It is important to understand that memory loss and confusion along with dizziness or drowsiness may be symptoms of medication side effects, rather than dementia.  Therefore, the clinician must receive from the patient or his or her family a list of ALL prescribed and over-the-counter medications, as well as any dietary supplements and herbals, he or she may take.

 Anticholinergics can also interfere with the effectiveness of medications used to slow memory loss or long-term use, putting people at higher risk for MCI and dementia later in life.1,3 One example are the drugs used to treat overactive bladder: the “gotta go gotta go” kind of urinary incontinence. Medications such as Detrol® and Cymbalta® slow transmission of nervous system information to and from the brain and thereby quiet the unrelenting sensation of “gotta go."

The medications used to slow the memory loss associated with dementia do just the opposite. Drugs such as Aricept® and Namenda® increase communication between nerve cells in the brain. Taking both types of medications at the same time can worsen dementia.

A Wake Forest University of Medicine study shows that nursing home patients receiving individual medications to modify dementia symptoms and improve continence lost the ability to perform basic living skills, such as dressing and feeding themselves, 50 percent faster than those receiving dementia medications alone.4 

One must evaluate the overall risks and benefits of taking a medication known to affect the risk for dementia later-in-life or, in the short-run, worsen the disease. Be sure to discuss with your doctor any concerns about taking a medication that may increase dementia risk. Do not stop taking prescribed or recommended over-the-counter medicines without first consulting with your doctor.
Notes: 
1. Cai Z, N Campbell et al, “Long-term Anticholinergic use and the Aging Brain”, http://www.ncbi.nlm.nih.gov/pubmed/23183138, (accessed April, 25, 2016)

2. Drug-Induced Cognitive Impairment: Delirium and Dementia, http://www.worstpills.org/includes/page.cfm?op_id=459 (accessed, April 25, 2016)

3. Higher dementia risk linked to use of common drugs, GroupHealth Research Institute, https://www.sciencedaily.com/releases/2015/01/150126124721.htm (accessed April 25, 2015). 

4. Dual Treatment to Treat AD Symptoms and Behaviors, https://www.sciencedaily.com/releases/2008/04/080430134230.htm (accessed, April 25, 2016)

For Further Reading
Medications to Avoid in the Elderly, http://www.virginiageriatrics.org/consult/medications/medsList.html (accessed April 24, 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 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


Sunday, July 19, 2020

Fortify Your Brain through Use


“Use it or lose it" is a common expression we hear referring to physical and athletic abilities, maintaining hands-on skills, or the capabilities that come with formal education. Similar to how physical fitness and improves health and quality of life, brain fitness as a product of intellectual stimulation may reduce risk or help slow or lessen the impacts of Dementia.

Researchers and healthcare professionals use the terms “brain reserve” and “cognitive reserve” to describe the protective factors that brain anatomy and education have on the onset and progression of dementia. Often, researchers and clinicians do not distinguish between the two and use the term cognitive reserve. However, there are subtle differences between the two kinds of reserve. One can think of brain reserve as computer hardware and cognitive reserve as operating software.

Brain reserve, rather than reducing risk for Dementia, is brain resiliency or the ability to maintain adequate function in the face of increasing brain damage. In this case, researchers believe it is inborn brain architecture along with the number of neurons and connections between brain structures that create resiliency.

Physical methods such as using microscopes to examine pieces of brain tissue and medical imaging technologies to locate areas of high and low brain activity are the ways researchers assess brain reserve. 

Cognitive reserve is the affect brain exercise has on making the brain better able to resist the behavioral and intellectual declines Dementia cause. Researchers and clinicians use behavioral assessments, such as the mini-mental status exam, to evaluate cognitive resiliency. 

Brain fitness is one of the best ways to reduce the risk of age-related dementia. And should Dementia enter your life, brain-fitness may help to slow or lessen the impacts of the disease. Participating in physical activities such as baseball, flying radio control airplanes, hiking, or dancing requires both coordination and the ability to make split-second decisions.
 
Hands-on learning refers to making something or acquiring a new skill. Whether self-taught or with the assistance of a knowledgeable person learning how to build furniture, watercolor, construct a raised-bed garden, or to become proficient at using Photoshop, requires high-level thinking and problem solving, concentration, and creativity. 

Levels of participation in both physical, hands-on activities and formal education reduce the risk for Dementia and make the brain better able to resist the behavioral and intellectual declines of Dementia. 

Sadly, the progressive nature of Dementia eventually overwhelms the cognitive reserve that once supported adequate behaviors and abilities. When this happens, there is a rapid decline in cognition as well as in the ability to perform tasks of daily living such as getting dressed without assistance.

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 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

Friday, June 26, 2020

Caring Touch as a Way to Communicate


A crying baby elicits a predictable response from its parents or grandparents. An adult swoops in, lifts the baby in their arms, and snuggles, cradles, maybe even rocks the baby as the cries diminish, their breathing settles, the baby calms. As babies become children and even young adults, soothing and reassurance comes by way of hugs, pats on the back, a quick shoulder rub, or a hand laid on a forearm. These seemingly simple touches have enormous effects because they are hard-wired in human development. It should not be surprising then, that physical contact is a vital tool for those caring for loved ones with Dementia.

No matter one’s age, human touch enhances communication by expressing emotion and offering reassurance. In a scientific study, a “sender” was asked to convey a range of emotions - happiness, sadness, surprise, disgust, anger, fear, etc. – by touching the “receiver’s” forearm from behind a curtain. Receivers were able to accurately identify the emotion 48 - 83% of the time(1). No words spoken, no facial expressions visible – only variations in touch!

As a caregiver, the suggestion “Let’s get ready to go” may be easier to accomplish if accompanied by a warm hand on a shoulder. A gentle touch by a caregiver can improve compliance with requests, and offer reassurance when fear or concern is detected. Human touch increases the feeling of wellbeing by decreasing cortisol levels (the "stress“ hormone) and increasing oxytocin levels (the “love” hormone). If our goal is to care, comfort, and protect our loved ones with Dementia, the power of simple touch cannot be ignored.

From simple to professional, therapeutic massage intensifies the benefits of simple touch and introduces several more. Regular therapeutic massage lessens physical pain, decreases the physical symptoms of stress, reduces depression symptoms, improves immune function, and enhances attentiveness1. Because of these benefits, therapeutic massage should be on the menu of options for a loved one living with Dementia.

Lastly, we must not overlook the value of social interaction and connectedness delivered by a caring human touch. Humans are, after all, social animals. No matter the advances in technology, it is clear that when human touch is withheld, a void remains that cannot easily be filled with spoken words or digital screens.  

Note 1: Field, Tiffany. 2011. Developmental Review. (30) 2010 367-383. Touch for socioemotional and physical wellbeing: A review.    Accessed May 29, 2020, from https://www.radboudcentrumvoormindfulness.nl/wp-content/uploads/2019/02/artikel-4.pdf

Contributor:  Karen Ogden, DSA Team Member

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 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, May 25, 2020

A Little Help Here! Assistive Technologies for Caregiving


For many of us, the words “medical alert” immediately brings to mind the campy 1980s television commercial where “Mrs. Fletcher” cries out her trademarked line. It is a grim reminder that, according to the National Safety Council, falls are the leading cause of accidental deaths among people seventy-five years of age and older. 1

Older adults fall when they lose their footing, trip on rugs, or miss a stair. Changes in balance, vision, and muscle tone, resulting from or in addition to medication side effects, are other risk factors. Dementia adds another layer of risk when your loved one no longer associates wet floors with falls, the odor of burnt food with fire, or connects landmarks to location. 

Caregivers worry about these and other safety issues. When a caregiver does not live nearby, these concerns become especially worrisome. 

There have been remarkable improvements in alert systems since the days of "I've fallen and cannot get up." Modern assistive technologies include a suite of smartphone apps communicating with video and other monitoring systems. These apps can notify a caregiver their loved one is less active than expected, has left a defined area, if a home appliance has not been turned on or off, even when their blood pressure has exceeded their normal range. 
 
Other kinds of assistive technologies help people in the earlier stages of Dementia stay in his or her home for as long as is possible. Video calling allows for virtual check-ins while smartphone apps and voice-activated assistants can remind people to take their medication.  

Some assistive technology systems use recorded verbal reminders, while others provide visual instructions and larger key-pad buttons. Therefore, it is crucial to choose a system or device that matches your loved one's ability to use them.

Older, less advanced technologies continue to provide a safety net. Stand-alone GPS tracking devices can provide location information for your loved one, should wandering be an issue. Some states continue to provide a public service using television, radio, and the internet to broadcast missing person information. The value of simple medical identification bracelets or accessories shouldn’t be underestimated. They offer peace of mind that your loved one will receive appropriate care and assistance if in trouble.

Assistive technologies, though they may keep your loved one as safe as is possible, they do not replace friends and family, a warm smile, a calming hug, or a gentle touch.

Caregivers welcome the respite from unrelenting worry and stress assistive technologies can provide. However, ethical issues must be considered, including seeking informed consent to install assistive technologies in a person's home. The dignity of the individual, respect for privacy, as well as acknowledgment of his or her advance directives are other areas of ethical concern. 

For More Information:


AARP. June 2018 Tech Solutions That Make Life Easier for Dementia Care. https://www.aarp.org/health/dementia/info-2018/technology-caregiving-dementia-patients.html

Notes:
1. Slip, Trip and Fall Protection for Older Adults, http://www.nsc.org/learn/safety-knowledge/Pages/safety-at-home-falls.aspx (accessed March 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 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

Sunday, April 19, 2020

Read! Exercise for Your Brain



Most people have an innate desire to learn, and language is the primary tool for learning. Reading is an important mechanism for the delivery of information to the brain to be solidified as acquired knowledge. Reading is critical for your own personal and cultural development because it relates to so many factors in your life. The benefits are broad and significant.

First, the mental stimulation of reading is vital for brain health. It is quite literally exercise for the brain. Synapses fire, neurotransmitters are released, and hormones begin circulating. Reading material that evokes an emotional response actually stimulates the brain to produce hormones specific to the physical expression of those feelings. 

Next, memory is improved by reading. When you read a novel, for it to make sense, you must remember different characters and plot elements. Keeping all of these things in play has your short term memory working hard. This also requires, and so with repetition improves, the focus and concentration you need to follow the action through the course of the story. 

And don’t forget that the escapism offered by novels can also be an excellent stress management tool.

Analytical skills are also engaged through reading. Stimulating novels keep you involved - trying to figure out where the story is going. Technical books, however, require that you reason out how all the different pieces of information come together as a concept, procedure, or system. 

Reading also improves writing ability as vocabulary and variations in sentence structure are introduced or reinforced.  

The bottom line is that reading to learn something new is better for your brain than simply reading for entertainment. Still, even an entertaining novel offers the mental stimulation you wouldn't find passively watching TV or streaming media.

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/cognitive-decline-asheville-nc/.

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 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