dementia

Dementia Family America (DFA)

How, how? How do we interact toward a family member, or a friend diagnosed with dementia, like our friend Wendy? In her 80’s, she lives alone in the home she shared for decades with her husband Andy who passed away three years ago. She wants to die at home. Her daughter lives four hours away, visits monthly, and pays Wendy's neighbor Susan to monitor her meds and wine, make sure she eats, and take her shopping. 

Wendy was the poster wife of a good-hearted woman. She has many friends, including my wife,  who regularly share a glass of wine with her. On a good day she's a delightful older woman, but her life also has a dark side. Wendy has fallen more than once and can become badly confused about time and place. 

So how, without offending her, do you help a dementia victim who is part the good-hearted woman of her past and part the enfeebled woman of the present? I admit I had not thought about this problem  until I heard Trisha Witham, dementia care specialist at the Aging & Disability Research Center of Barron and Rusk Counties (WI) speak at the October Men's Sheds meeting about interacting with dementia patients without damaging their dignity. Trisha used two videos produced by the Alzheimer’s Association of a 80-year- old woman diagnosed with dementia who lived alone taking public transportation to shop for groceries. In the first video, she was treated coldly by the bus driver, bank personnel and other customers in the store. In the second, she was helped without condescension. https://www.youtube.com/watch?v=Fz8ACEu7Lho 

I asked Trisha about training programs for those, in addition to family and friends, who would likely have contact with dementia victims, such as retail workers and restaurant servers. She referred me to Dementia Friends America(DFA) which has this mission statement:

DFA’s mission is to increase dementia awareness, reduce stigma, and provide quality dementia-friendly resources, education and support that fosters the creation of communities where people living with dementia and their care partners can live, engage and thrive with others.

. DFA’s program emphasizes five key messages:

· Dementia is not a normal part of aging. 

· Dementia is caused by diseases of the brain. 

· It is not just about losing your memory. 

It's possible to live well with dementia. 

· There is more to the person than dementia. 

If you want to help make your community dementia friendly for people like Wendy, consider joining DFA which offers multiple resources, including “train-the-trainer” programs for organizations like Men’s Sheds and videos. Check here for more information. www.dfamerica.org.   

Dementia, the leading cause of disability and second-leading cause of death worldwide, can be reduced 45% by implementing a multi-level program addressing 14 known causes of neurological disorders, according to a recent study published in the prestigious medical journal Lancet. These causes include:

In early life improving, 

· general education.

In midlife addressing, 

· hearing loss, 

· high LDL cholesterol, 

· depression, 

· traumatic brain injury, 

· physical inactivity, 

· diabetes, 

· smoking, 

· hypertension, 

· obesity 

· excessive alcohol.

In later life reducing,

· social isolation

· air pollution

· vision loss.

The Lancet Commissions,  Volume 404, Issue 10452, p572-628, August 10, 2024

Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission

Fortunately, an individual can address, with  education, encouragement, and professional assistance as needed, some of the causes such as reducing alcohol consumption, stopping smoking, increasing exercise, lowering cholesterol levels, addressing hearing and vision loss, and perhaps obesity. Prompt and consistent medical care must be provided to persons suffering from diabetes, depression, traumatic brain injury, and hypertension.

Other causes, such as air pollution and improved education, will require governmental action. In addition, local, state, and federal governments and non-profit sources must provide funds to increase the number of professional care providers and of facilities.  We must demand that politicians and other civic leaders place action to reduce the causes of  this destructive and deadly disease near the top of their priority lists. 

In addition to the Lancet report, credit goes to an article in the August 18, 2024, issue of The Conversation https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzQVzFWlSGdxRXcmRNrbjlXSJXvcand

and to two scholars who contributed to the Lancet report – Eric B. Larson, a general internist at the University of Washington School of Medicine, and Laura Gitlin, an applied sociologist from Drexel University. 

Often the signs of dementia  reveal themns

You can’t control memory loss – only your reaction to it.

For people with dementia, their disability is memory loss. Asking them to remember is like asking a blind person to see. (Common questions like “Did you take your pills?” or “What did you do today?” are the equivalent of asking them to remember something.) A loss of this magnitude reduces the capacity to reason. Expecting them to be reasonable or to accept your conclusion is unrealistic. Don’t correct, contradict, blame or insist. Reminders are rarely kind. They tell a person how disabled they are – over and over again.

People living with dementia say and do normal things for someone with memory impairment. If they were deliberately trying to exasperate you, they would have a different diagnosis. Forgive them…always. For example, your wife isn’t purposely hiding your favorite pair of shoes. She thinks she’s protecting them by putting them in a safe place…and then forgets.

Here are some basic Do’s when it comes to communication with someone with dementia:

• Give short, one sentence explanations.
• Allow plenty of time for comprehension, and then triple it.
• Repeat instructions or sentences exactly the same way.
• Avoid insistence. Try again later.
• Agree with them or distract them to a different subject or activity.
• Accept the blame when something’s wrong (even if it’s fantasy).
• Leave the room, if necessary, to avoid confrontations.
• Respond to the feelings rather than the words.
• Be patient and cheerful and reassuring. Do go with the flow.
• Practice 100% forgiveness. Memory loss progresses daily.

Here are some Don’ts:

• Don’t reason.
• Don’t argue.
• Don’t confront.
• Don’t remind them they forget.
• Don’t question recent memory.
• Don’t take it personally.

We’ve put together some specific examples of good and bad communication below, keeping these do’s and don’ts in mind. We also have plenty of tip sheets in various languages regarding more aspects of dementia.

1. “What doctor’s appointment? There’s nothing wrong with me.”
Don’t: (reason) “You’ve been seeing the doctor every three months for the last two years. It’s written on the calendar and I told you about it yesterday and this morning.”
DO: (short explanation) “It’s just a regular checkup.”
(accept blame) “I’m sorry if I forgot to tell you.”

2. “I didn’t write this check for $500. Someone at the bank is forging my signature.”
Don’t: (argue) “What? Don’t be silly! The bank wouldn’t be forging your signature.”
DO: (respond to feelings) “That’s a scary thought.”
(reassure) “I’ll make sure they don’t do that.”
(distract) “Would you help me fold the towels?”

3. “Nobody’s going to make decisions for me. You can go now…and don’t come back!”
Don’t: (confront) “I’m not going anywhere and you can’t remember enough to make your own decisions.”
DO: (accept blame or respond to feelings) “I’m sorry this is a tough time.”
(reassure) “I love you and we’re going to get through this together.”
(distract) “You know what? Don has a new job. He’s really excited about it.”

4. “Joe hasn’t called for a long time. I hope he’s okay.”
Don’t: (remind) “Joe called yesterday and you talked with him for 15 minutes.”
DO: (reassure) “You really like talking with him don’t you?”
(distract) “Let’s call him when we get back from our walk.”

5. “Hello, Mary. I see you’ve brought a friend with you.”
Don’t: (question memory) “Hi Mom. You remember Eric, don’t you? What did you do today?”
DO: (short explanation) “Hi Mom. You look wonderful! This is Eric. We work together.”

6. “Who are you? Where’s my husband?”
Don’t: (take it personally) “What do you mean – who’s your husband?” I am!”
DO: (go with the flow, reassure) “He’ll be here for dinner.”
(distract) “How about some milk and cookies?… Would you like chocolate chip or oatmeal?”

7. “I’m going to the store for a newspaper.”
Don’t: (repeat differently) “Please put your shoes on.”…You’ll need to put your shoes on.”
DO: (repeat exactly) “Please put your shoes on.”… “Please put your shoes on.”

“I don’t want to eat this! I hate chicken.”
Don’t: (respond negatively) “You just told me you wanted chicken. I’m not making you anything else, so you better eat it!”
Do: (accept blame) “I’m so sorry, I forgot. I was in such a rush that it slipped my mind.
(respond positively) Let me see what else we have available.” Leave the room and try again. 

This comprehensive Cleveland Clinic article, written for olde goats, their families, and friends and others concerned about dementia, contains useful information about symptoms and causes, diagnosis and tests, management and treatment, prevention, outlook and prognosis, and living with a victim of dementia.

The article lists these symptoms and stages of the disease:

Early symptoms of dementia include:

· Forgetting recent events or information.

· Repeating comments or questions over a very short period.

· Misplacing commonly used items or placing them in unusual spots.

· Not knowing the season, year or month.

· Having difficulty coming up with the right words.

· Experiencing a change in mood, behavior or interests.

Signs that dementia is getting worse include:

· Your ability to remember and make decisions further declines.

· Talking and finding the right words becomes more difficult.

· Daily complex tasks, such as brushing your teeth, making a cup of coffee, working a TV remote, cooking and paying bills become more challenging.

· Lessening of rational thinking and behavior and your ability to problem-solve.

· Sleeping pattern changes.

· Increases or worsening of anxiety, frustration, confusion, agitation, suspiciousness, sadness and/or depression.

· Needing more help with activities of daily living, such as grooming, toileting, bathing and eating.

· Experiencing hallucinations (seeing people or objects that aren’t there).

These symptoms are general symptoms of dementia. Each person diagnosed with dementia has different symptoms, depending on what area of their brain is damaged. Additional symptoms and/or unique symptoms occur with specific types of dementia.

Are there stages of dementia?

No national dementia-related organizations define dementia by numerical stages. The Alzheimer’s Association does, however, define three stages of Alzheimer’s disease. Alzheimer’s disease dementia is the most common type of dementia. Some of the symptoms in these three stages are the same as symptoms for many of the forms of dementia.

Early-stage Alzheimer’s disease (mild)

People in the mild stage of Alzheimer’s disease are still able to function on their own. They may still drive, go to work and socialize. Some changes are happening that may or may not be noticed by the person with Alzheimer’s disease, but may be noticeable by close friends and family members.

Difficulties may include:

• Trouble remembering a person’s      name after being introduced.
• Losing or misplacing multiple      objects.
• Having a hard time coming up with      the right word consistently.
• Trouble planning, organizing,      managing or completing tasks.
• Consistently forgetting what you      just read.

Middle-stage Alzheimer’s disease (moderate)

People in the middle stage of Alzheimer’s disease can be in this stage for many years. They can take part in everyday activities with help. Symptoms are more obvious.

Difficulties may include:

• Confusion about what year/season      it is or where you are.
• Forgetting events and being      unable to recall personal history (phone number, address, the college you      attended, etc.).
• Changes in personality, mood and      behavior, such as becoming suspicious, delusional and performing      compulsive, repetitive actions.
• Changes in day/night sleeping      patterns.
• Controlling your bladder and/or      bowels.
• Wearing clothes for the wrong      season or occasion.
• Wandering and becoming lost.

Late-stage Alzheimer’s disease (severe)

People in the late stage of Alzheimer’s disease can’t carry on conversations, lose awareness of what’s going on around them and can’t control their movement.

Difficulties may include:

• Trouble communicating, which may      include only being able to say a few words or phrases.
• Trouble walking.
• Trouble swallowing.
• Being more prone to infections,      especially pneumonia.
• Requiring 24-hour assistance with      care.

All information taken from the Cleveland Clinic article 

https://my.clevelandclinic.org/health/diseases/9170-dementia 

Avocados and dark chocolate make magnesium decrease dementia risk. 

When it comes to nutrients, prioritizing magnesium could have big benefits for your cognitive well-being. According to research published in the European Journal of Nutrition, a 41% boost in magnesium consumption could lead to less age-related brain shrinkage. And that could help you maintain cognitive function and reduce the risk of late onset dementia. When looking at the magnesium intake of more than 6000 cognitively healthy individuals between the ages of 40 and 73 researchers discovered that participants consuming more than 550 milligrams of magnesium each day had a younger brain age than those getting a normal amount of 350 milligrams. While taking supplemental magnesium can be effective, the better way to get these memory-enhancing benefits is by eating more magnesium-rich foods like avocados, nuts, seeds leafy greens, and dark chocolate.

From “Good Health Lifestyles” Magazine