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You may be somewhat familiar with the memory changes that may occur as a result of the underlying diseases that may cause Dementia. Have you ever wondered what pathological changes in the brain lead to changes in behavior, movement, communication, or other issues? Each type of Dementia may, especially initially, affect the brain slightly differently, but the good news is, recognizing the changes can provide you the chance to take early steps toward getting a thorough medical workup. It’s a matter of changing your perspective. Noticeable changes = better chances of diagnosing what’s going on. Why is that important? Because many cognitive changes (those that may never or have not yet progressed to Dementia) may be meaningfully addressed if caught early enough. In brief, here are four of the most common causes of Dementia, and their most common changes: Alzheimer’s disease (AD) First described by Dr. Alois Alzheimer in the early 1900s, Alzheimer’s disease causes a number of brain changes, which impact recall, language skills, and more, says Daniel L. Murman, MD, director of the behavioral neurology division in the department of neurological sciences at the University of Nebraska Medical Center in Omaha. Changes typically begin in the hippocampus, two important but small seahorse-shaped sections deep inside the temporal lobes where short-term memories are transformed into long-term memories. Next, the greater temporal lobe areas (two sections located to the sides and behind the ears) are affected – they help people understand language – followed by portions of the frontal lobes (behind the forehead), which help with emotions, language, decision-making, and multitasking. Vascular Dementia (VaD) Small ischemic strokes (mini-strokes) – which limit blood supply to minute sections of the brain – may ultimately cause damage to any number of brain regions over time, gradually, and often in a stepped fashion, inflicting sufficient pathological changes to the brain tissue resulting in major cognitive deficits in many people. Among the many changes are personality, delusions, paranoia, trouble walking, and falling more often. There is not necessarily a rhyme or reason to the brain regions which may be affected by Vascular Dementia; any area that’s damaged by stroke may experience problems. The symptoms which arise are particular to the area of the brain that’s been damaged. Because of this, there isn’t as predictable a disease progression for Vascular Dementia. Lewy Body Dementia (LBD) Discovered by Dr. Friedrich Heinrich Lewy, in the early part of the 20th century, there are two primary subtypes of Lewy Body Dementia: Parkinson’s disease with Dementia, which causes movement symptoms first, and Dementia with diffuse (everywhere) Lewy bodies, which may affect the thinking, emotional, and visual portions of the brain first. If memory is impacted before movement, the brain’s limbic cortex is usually affected initially; this region helps to regulate behavior and emotions. Gradually, it affects the hippocampus – which is instrumental in forming new memories – and the portion of the midbrain which is responsible for movement, known as the substantia nigra. Frontotemporal Dementia/Degeneration (FTD) This form of Dementia is named after the brain regions it typically impacts, the frontal and temporal lobes. As mentioned above, as with other Dementias, these sections affect language and memory but are also substantially responsible for emotional regulation. People may experience early personality changes and loss of language, which impedes their ability to communicate. “People often become more impulsive, disinhibited, less sympathetic and have decreased insight... with relative preservation of memory,” Murman says. Lastly, movement can become impaired, and it’s not uncommon for younger, middle-aged adults, in their 50s to be affected. In addition, unlike many other causes of Dementia, genetics may play a larger role in certain subtypes of the disorder. Lisa Fields is a full-time freelance writer who specializes in health, psychology, sleep, nutrition, and fitness. Her work has been published by Reader’s Digest, WebMD, Women’s Health, Good Housekeeping, Self, and many other publications. Learn more about Lisa at https://www.writtenbylisafields.com . Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

For decades, ten warning signs have been widely publicized and, for the most part, embraced by many as the only list for middle-aged and older adults to recognize signs of possible degenerative cognitive impairment. While serving an important purpose for years, this narrow Alzheimer's-focused "top ten" checklist is now outdated and may contribute to missing some fairly common signs of a Dementia. With Over 200 Causes of Dementia, Which Are the Big Four? The top four Dementias include Alzheimer's, Vascular, Lewy Body, and Frontotemporal. Still, many more conditions and disorders fall under the big umbrella of Dementia - with new subtypes being researched each year. In addition, there are times when pathologies overlap, and when they do, someone is often said to be living with Mixed Dementia. So, it's time to retire the old and incomplete list. After extensive research, the Dementia Society of America® believes that there are at least 22 Clues™ worth following up on by individuals, families, and medical professionals. This deeper and more comprehensive list includes: Some of the 22 Clues May Hide in Plain Sight Short-Term Memory Loss & Repetitive Behaviors Problems with Tasks, Planning & Organizing Believing It's Another Time & Place Difficulty with Senses Like Smell, Taste, Vision & Hearing Challenges with Word Finding Getting Lost in Familiar Places Poor Judgement Sad or Withdrawn Swearing, Disinhibition & Aggression Changes in Gait, Walking, or Balance Lacking Self-awareness of Impairments Tremors & Jerkiness Apathy & Hygiene Problems Uncontrollable Crying & Laughing Changes in Handwriting Hallucinations and Delusions Fabrication of Stories REM Disorder & Other Sleep Issues Rapid Onset of Symptoms Bowel or Urinary Incontinence Drooping Eyelids Heightened Anxiety Not All Cognitive Impairments are Dementia As important as it is to understand that not all Dementias are Alzheimer’s disease, it is equally important to realize that experiencing one or more of these signs and symptoms does not necessarily indicate Dementia. Sleep irregularities, medications, vitamin deficiencies, mood disorders, infections, trauma, other disease processes, and more can cause these symptoms. If you notice these changes in yourself or a loved one, see a doctor. They may want to review your history, administer a cognitive screening, conduct laboratory tests, and use other diagnostic approaches to understand the underlying conditions producing symptoms. Please read our latest publication, The Big Umbrella ™. Contributor: Karen R. Ogden, team member, Dementia Society of America. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

My name is Jeff Brown. I am 76 years old, not a doctor or therapist, and I do not have a degree in any medical field. What I offer is based on my personal experience only; I have been inverting (hanging upside down) for 42 years. My thoughts and suggestions originate from my logic and critical thinking, and I'll leave the science to the experts. The Rationale for Inversion for Brain Health The brain demands a constant supply of energy - fuel delivered by the blood supply. When resting, our brain consumes about 20% of our body's total energy. 1 Even while sleeping, the brain is active. Our brains are like circuit boards, constantly processing and transmitting electrical signals throughout the body 24-7. It is the body's command and control center. The energy demand is, of course, influenced by our lifestyles and level of activity. The demand for fuel is met by glucose and oxygen delivered to the brain through arteries, veins, and capillaries. I like to think of them as rivers, streams, and smaller tributaries feeding and nourishing everything around them, flowing smoothly, quickly, and efficiently. We know that regular exercise benefits the cardiovascular system, which sends the blood to our brain or command center. A healthy cardiovascular system is an essential factor in longevity and cognitive abilities, and we must invest in our brain's proper function. 2 I suggest that along with heart-healthy exercise, inversion therapy can help maintain brain health throughout our whole life. Such a benefit could help reduce the cost and strain on our health care system. I recommend a ten-minute walk followed immediately with inversion or hanging upside down. In my opinion, by enhancing blood flow to your brain first through cardio exercise and then by inversion, the rush of blood delivers the fuel and oxygen your brain needs for optimal function. One might assume that this relatively simple behavioral change could alter the progression of age-related cognitive decline. With adequate blood flow, expectations for our seventies, eighties, and nineties could be redefined. Following an inversion, I feel more creative, energetic and have more clarity of thought. Physically, the effects of lengthening the spine and relieving pressure on the hips, knees, and ankles are refreshing. Even reversing the pull of gravity on your face is invigorating! I sometimes wonder if the loss of motor skills is associated with the loss of proper blood flow and oxygen to the brain? Could the answer be this simple? Or, is blood flow just one aspect of neurodegeneration? How much of a role does blood flow have in contributing to Dementia and Alzheimer's disease? There are always more questions to be asked. One thing though, clearly and emphatically - Never hang upside down without consulting a doctor or physical therapist first! For some, the practice could cause far more problems than benefits. Inversion is particularly dangerous for those with hypertension, elevated eye pressure or glaucoma, cardiac disease, or obesity. If a doctor clears you, consider adding to your routine walking a mile, then inverting for a couple of minutes. Notes 1 Watts, Michelle E., Roger Pocock and Charles Claudianos. Brain Energy and Oxygen Metabolism: Emerging Role in Normal Function and Disease. Front. Mol. Neurosci., 22 June 2018. Accessed October 6 2021 from: https://doi.org/10.3389/fnmol.2018.00216 2 Northey, Joseph M. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. Accessed September 23, 2021 from https://bjsm.bmj.com/content/52/3/154 For further reading: Kondrashova, T., Makar, M., Proctor, C., Bridgmon, K. A., & Pazdernik, V. (2019). Dynamic assessment of cerebral blood flow and intracranial pressure during inversion table tilt using ultrasonography. Journal of the neurological sciences , 404 , 150–156. https://doi.org/10.1016/j.jns.2019.07.033 Williamson, T. August 11, 2021. What Can Inversion Therapy Do for Your Wellness? Psychreg.org https://www.psychreg.org/inversion-therapy-wellness/ Johns Hopkins Medicine. Vascular Dementia. 2021. Accessed September 23, 2021 from https://www.hopkinsmedicine.org/health/conditions-and-diseases/dementia/vascular-dementia Cherney, Kristeen. What Are the Risks and Benefits of Inversion Therapy? Updated February 28, 2019. Accessed October 7, 2021 from: https://www.healthline.com/health/inversion-therapy Contributor: Jeffrey Brown, guest contributor Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

There is no single explanation for elopement behavior. However, there is one origin: impaired cognitive function affects perception and responses, driving the behavior of the person living with Dementia. Elopement behaviors tend to be temporary in nature, emerging and diminishing as the underlying disease process progresses. The best way to prevent elopement is to understand the conditions that elicit the behavior. Two main categories of triggering conditions are: Those that produce a fight or flight response, and When time/space confusion interrupts planned or purposeful activities. Fight or flight is a biological response to fear, be it a general sense of insecurity or a specific threat. Pain can lead to elopement as a person living with Dementia tries to flee discomfort by changing their environment. Note that pain can be physical or emotional, seen or unseen. Pain may be a product of illness, injury, loneliness, or a feeling of unfamiliarity. Unsuccessful communication, failed execution of ordinary tasks, or unpleasant interactions can leave a person frustrated, exasperated, and ready to fight or flee their troubled state. Physical needs for food or drink or privacy to meet bathroom needs may produce an emotional state resembling panic in a person living with Dementia. A medical evaluation may identify conditions such as anxiety, depression, infection, urinary issues, or pain that could contribute to an elopement event. These often can be treated by a doctor. Time and space confusion can lead to critical wandering during both planned and spontaneous activities. Routine activities like retrieving the mail or picking up milk at the corner store may become dangerously detoured. A person living with Dementia may feel compelled to travel to a workplace from decades prior or return to a previous home and become lost on the way. To reduce the chance of elopement or critical wandering event: Become a student of your loved one. Observe their behavior and become familiar with their life history to better understand their needs. Learn how their facial expressions, postures, and patterns of eye contact may reveal their emotional, physical, and psychological state. Clues about what drives a person moment to moment are revealed in their life history. Make a record, learn it, and share it with other caregivers. Include significant life events, traumas, achievements, relationships, special places like childhood homes, workplaces, or favorite watering holes. Once equipped to recognize an impending event, use a prepared menu of responses to your loved one's cues. Diffuse an escalating situation with a favorite snack, a cool drink, a warm blanket, a reassuring hug, or a hand on the shoulder, familiar music, or an escorted walk or car ride. Creating a safe and secure, calm, and comfortable environment for your loved one can help manage those moments of escalating fear or frustration. In the home, minimize clutter, consider concealing exits, inspect the window and door lock functions, and utilize voice assistants or monitoring technology. Always working towards prevention, a way to improve outcomes of critical wandering events is to ensure the person is wearing a visible medical ID. Operation KeepSafe ID is a Dementia Society of America® medical ID registry program, offered to those at risk and in need. The program connects an individual's medical ID bracelet to an online profile available to first responders. Request an Operation KeepSafe ID Kit by visiting https://www.operationkeepsafe.org. If your loved one goes missing, neighbors, business owners, and first responders will all play a crucial role. Build this community safety net by using your knowledge of your loved one's patterns and habits to alert people they may encounter to their condition. Explain that they may observe unusual behaviors and ensure they know to contact you if a situation arises. Should it happen that you can't find your loved one, first search the entire home- closets, basements, attics, under beds, and behind furniture. Remember that they may be scared, hiding, or lost- unable or unwilling to answer your calls. Once you determine they have left the house, record the time. Scan the road or sidewalk, then search outdoor areas and buildings. Call on neighbors and family to patrol a ½ mile circle around the home. If, after 15 minutes, you haven't found your person, call 911. The challenges and heartbreak of elopement by those living with Dementia are immense and far-reaching. Understanding what motivates elopement behavior and how to modify it is key to reducing adverse outcomes. Managing a loved one's environment for safety is achieved by employing a multi-layered approach that addresses the pre-, during, and post-stages of elopement. Contributor: Karen R. Ogden, team member, Dementia Society of America. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Roaming. Wandering. Critical Wandering. Elopement. These words, while similar, describe distinct behaviors or situations familiar to those living with or caring for someone with Dementia. From low risk to the threat of death, these behaviors cause concern and can lead to a crisis. When disease processes result in cognitive impairment, several brain regions and their associated functions are affected. Functions essential to the discussion of critical wandering and elopement include: · Orientation in time and space · Short-term memory · Wayfinding · Impaired judgement · Interpretation of images · Language · Coordination Impairment in these functional areas not only complicates activities of daily living (ADLs), they sets the stage for changing emotional states from withdrawal and depression to frustration and rage. In combination, the impairment and resulting emotions can drive behaviors such as pacing, repetitive movements, and routine walking patterns, as well as other compulsive behaviors. As Dementia symptoms progress, harmless wandering can become dangerous as individuals attempt to escape a care setting. The act of exiting a caregiving environment without detection is an elopement . Once caregivers become aware that an individual with Dementia cannot be located, it is labeled a critical wandering event since the person is vulnerable and exposed to danger. 1 Here at Dementia Society of America (DSA), we wanted to know- how common are critical wandering events, and how frequent are adverse outcomes? Because caregivers often find their loved one with Dementia before negative outcomes occur, most critical wandering events go unreported. Those that are reported are generally not consolidated into a central data repository for analysis. Most statistics are scattered across thousands of local police departments nationwide. Understanding the scope and outcomes of critical wandering is even more difficult since when deaths do occur, they are attributed to the specific cause of death – e.g., hypothermia – rather than the elopement preceding the cold exposure. Given these limitations, we examined academic research, the FBI’s missing persons database, and statistics from several states' Silver Alert programs. We project that each year in the United States 198,000 critical wandering events involving persons living with Dementia. Of these, nearly 1 in 3 , approximately 63,000 mothers, fathers, sisters, or brothers, do not return. If not found within 24 hours, the likelihood of a fatality reaches 46% in a mild environment. 2 However, where terrain and climate are hostile to travel on foot, the proportion of fatalities is much higher. When a loved one with Dementia goes missing, the trauma from anxiety, fear, regret, and remorse can emotionally scar a caregiver. This can be a tragic event for people living with Dementia and those who love them. Part of the solution is to understand why they are driven to leave, how to mitigate that behavior, and be prepared for the unfortunate situation should an elopement occur. How Can I Prevent Elopement and Critical Wandering? The Dementia Society offers a no-cost medical ID and online profile to individuals at risk for critical wandering -  Operation KeepSafe iD ®. We highlight the problem of elopement, alongside tools like the KeepSafe iD, for preventing and mitigating the adverse outcomes of such events. We hope you’ll learn and share the information with enthusiasm and urgency, similar to the way we deliver it to you. 1 Gina Petonito, et al. January 2012. Programs to Locate Missing and Critically Wandering Elders: A Critical Review and a Call for Multiphasic Evaluation. The Gerontologist Vol. 53, No. 1, 17-25. Accessed from: https://academic.oup.com/gerontologist/article/53/1/17/614737 2 Koester, Robert J. (1998) The Lost Alzheimer's and Related Disorders Search Subject: New Research & Perspectives. Accessed June 15, 2021, from https://www.dbs-sar.com/SAR_Research/lost_alzheimer.htm . Contributor: Karen R. Ogden, team member, Dementia Society of America. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

We often hear people say, “I am so depressed” or “that news is so depressing.” These expressions describe a short-lived emotion. Long-lasting or multiple episodes of persistent sadness that affect your feelings, thoughts, and behavior - or clinical depression - can affect your risk for developing or accelerating cognitive impairment and possible Dementia. Clinical depression generally requires long-term treatment. Alongside sadness, symptoms of depression include feelings of hopelessness, worthlessness, guilt, decreased energy, difficulty making decisions, changes in sleep habits, significant weight loss or gain, and persistent headaches. Considering the symptoms, it should not be surprising that depression can lead to other health complications. So, how are physical changes in the body and brain related to mood and emotional states? There are several factors at play, among them are neuronal growth and communication, brain size and structure, genetic makeup, and hormones. Changes in these physical factors alter the efficiency or even successful delivery of messages to areas of the brain responsible for emotion, mood, cognition, and more. (1) Since the brain is made of billions of neurons - specially designed cells that send and receive signals - their abundance and structure regulate neural pathways. While the hippocampus region of the brain is instrumental in moving memories from short to long term storage, it also regulates the abundance and growth of neurons. Changes to its size and structure creates a web of effects. Meanwhile, the thalamus a structure within the brain links feelings to sensory input, building emotion-based reactions to a stimulus. These linkages, dependent upon those messages relayed through neurotransmitters, are responsible for physiological responses to the emotion. (1) When sensory information is received by the different regions of the brain, the endocrine system is activated, and hormones deliver messages to targeted organs of the body. Stress hormones produce physiological changes, most often an inflammatory response, to every real or perceived threat to your body. In women, fluctuations of ovarian hormones influence her susceptibility to stress, changes in brain structure and function, as well as inflammatory activity. Exhaustion and depression may result when too little thyroid hormone is produced, a result of dysfunction in neural messaging, endocrine response, or both. (4) The production, transport, and availability of receptors for each type of hormone is dependent upon proteins synthesized as directed by one’s genetic makeup. Genetics also influences a person’s temperament, outlook, and general resilience to life’s challenges. (1) One thing is clear from all of this, depression is complicated. As the subject is studied, a relationship between depression and risk for Dementia has emerged. Evidence concurrently suggests depression is one of the first symptoms of Dementia and that it can accelerate transition between normal cognition to mild cognitive impairment (MCI) and on to Dementia. (2) Consider how the physical factors that produce depressive symptoms may worsen in response to disease processes associated with Dementia. Amyloid plaques, decreased brain blood flow, and misconfigured proteins - the “bad actors” - further interrupt neuronal communication and downstream responses to sensory input. On the flip side, these physical factors of depression may set the stage for progressive cognitive impairment by breaking down neuronal and hormonal pathways. For those already living with MCI, as the severity of symptoms and frequency of episodes increases, so does the risk of developing all-cause Dementia. A 14% increase in risk for each depressive episode has been observed. (2) Specifically, bouts of clinical depression in mid-to late-life can increase the risk of developing Dementia by a factor of two or three. About one-third of people living with any Dementia type experience depressive symptoms. It is worth noting that nearly 50% of those living with Vascular Dementia will experience depression. (2) Because clinical depression can accelerate or worsen Dementia symptoms, treatment should be a priority. One particularly hazardous behavior that worsens with depression is elopement and critical wandering situations where an individual becomes lost to their caregiver. (3) How Can I Deal With Depression Associated with Dementia? Treatment comes in combinations of psychotherapy and medication. Healthy lifestyle habits can both reduce the risk of depression and relieve its symptoms. A healthy diet, regular exercise, social interaction, providing for fun, relaxation, and low-stress living will benefit emotional and physical health. The risks and concerns are not reserved for the individual living with cognitive impairment. The work of a caregiver can be extraordinarily stressful, time-consuming, and can lead to less than optimal lifestyle habits that increase the risk for depression. Take time for yourself, look to others for support, and monitor your own well-being so that you and your loved one living with Dementia can thrive even under challenging circumstances. Notes: (1) Harvard Health Publishing. What causes depression? Onset of depression more complex than a brain chemical imbalance. June 24, 2019. Accessed August 25, 2021 at https://www.health.harvard.edu/mind-and-mood/what-causes-depression (2) Dafsari, F.S., Jessen, F. Depression—an underrecognized target for prevention of Dementia in Alzheimer’s disease. Transl Psychiatry 10, 160 (2020). https://doi.org/10.1038/s41398-020-0839-1 (3) Jeong, Jae Gwon et al. “A Relationship between Depression and Wandering in Community-Dwelling Elders with Dementia.” Dementia and neurocognitive disorders vol. 15,1 (2016): 1-6. doi:10.12779/dnd.2016.15.1.1 (4) Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: a social signal transduction theory of depression. Psychological bulletin, 140(3), 774–815. https://doi.org/10.1037/a0035302 Contributor : Karen R. Ogden, team member, Dementia Society of America. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Living with or caring for someone with Dementia is difficult. It can be complicated, emotionally challenging, and lonely. When the person or the caregiver is a part of a sex or gender minority, the difficulties become even broader and more complex. LGBTQ+ individuals living with Dementia may present unexpected challenges for caregivers. Cognitive decline may produce abrupt changes in how one presents themselves to others. Impairments can also lead to emotional reactions to triggers of memories of traumatic experiences. If caregivers are unskilled in Dementia-sensitive communication, a reaction can result in a rejection of care that can take on an aggressive posture. ( 1) Meanwhile, LGBTQ+ older adults are less likely to have children or marry, so more live alone, and a higher proportion are caregivers for friends and other extended relations.1 Without formal designation as a health care proxy, durable power of attorney, or a living will with a Dementia provision, LGBTQ+ caregivers who are not legal or biological family members can be excluded from critical decision making. The prevalence of cognitive decline among the LGBTQ+ community is elevated compared to straight, cisgender populations. A 2019 University of California, San Francisco study found that 1 in 7 (14%) LGBTQ+ participants self-reported cognitive decline, frequent confusion, and memory loss, while only 1 in 10 (10%) straight, cisgender participants reported those conditions.(2) Why is Dementia Risk Elevated in the LGBTQ+ Community? The higher prevalence of cognitive decline among sex and gender minorities likely stems from higher rates of depression, decreased availability or access to quality of health care, and higher rates of smoking, alcohol abuse and obesity. Discrimination and identity concealment may lead to increased social isolation, another known risk factor for Dementia. Today’s older LGBTQ+ adults came to maturity in a time when sexual and gender minority identities were viewed as pathological defects rather than part of a continuum of “normal.” That environment subjected people to stress-influenced health and lifestyle choices, thus putting the population at greater risk for cognitive decline. Still, a sizeable portion of the community- nearly 40% of surveyed LGBTQ adults aged 40 to 61 - believe they are better prepared for aging as they have developed positive personal characteristics and strong support systems, their “families of choice.”(1) Even with these attributes, caregiver members of the LGBTQ+ community are at a greater risk of the adverse effects of caregiving (stress, depression, disability). In the medical and support communities, SAGECare advocates for and educates organizations about person-directed Dementia care for LGBTQ+.(3) Competency trained staff understand the unique needs and concerns of LGBTQ+ older adults. Individuals can have confidence that the help they are seeking will be delivered with compassion and understanding of LGBTQ+ patients and clients. (1) Karen I. Fredriksen-Goldsen,1 Sarah Jen,1 Amanda E. B. Bryan,1 and Jayn Goldsen. Cognitive Impairment, Alzheimer’s Disease, and Other Dementias in the Lives of Lesbian, Gay, Bisexual and Transgender (LGBT) Older Adults and Their Caregivers: Needs and Competencies . Journal of Applied Gerontology, September 2016, Vol 37(5). Pages 545-569, Accessed July 20, 2021 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383534/ (2) Jason Flatt, The Epidemiology of Dementia in LGBTQ Older Adults. Innovation in Aging, Volume 4, Issue Supplement_1, 2020, Pages 748–749, Accesed July 20, 2021 at https://doi.org/10.1093/geroni/igaa057.2695 (3) SAGECare Staff Development/Training. Accessed July 20, 2021 at https://sageusa.care/our-services/coaching-training/ Contributor: Karen R. Ogden, team member of the Dementia Society of America. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

At one time or another, everyone has reason to feel isolated within their surroundings. Sometimes, people purposely isolate themselves to get the quiet time they need to focus and concentrate. Other times it is the circumstance, such as being the caregiver for a loved one, that causes isolation. People who seek isolation usually do not feel lonely. However, involuntary isolation can make people feel entrapped and very, very lonely. Feelings of loneliness can occur with or without the presence of other people. Parties and other social events can be lonely if the need for interaction and inclusion is not met. At the most basic level, loneliness is missing cues that remind us of who we are. How To Lessen the Loneliness of Dementia There are many things caregivers can do to lessen their feelings of isolation and loneliness. First, self-reflection. Frequently, the family caregiver, believing he or she is the only one who can give their loved one the proper care, seems unable to accept offers of help from family members, friends, community, or faith-based organizations. When help is accepted, regularly scheduled getaways, hours or days long, can give caregivers the respite they need to relax, reconnect with friends, or participate in a favorite activity. People living with Dementia also experience isolation and loneliness. Friends and family may disappear, and with their disappearance, there are even fewer opportunities for socializing. Eventually, as the condition progresses, isolation and loneliness become inevitable. For those in the early stages of Dementia, living life to its fullness - saying yes to life more than no - can help them cope with the emotions that come with their diagnosis. Join your loved one on their “I’ve always wanted to visit or do" lists. Do silly things together, and encourage activities that preserve family history. It is equally important to give your loved one the pleasure and challenge of arranging activities and extending invitations to family and friends. Doing so becomes a declaration of “I am still here.” With symptom progression, efforts to reduce isolation and feelings of loneliness require help from family, friends, and professional caregivers. Visits to their home or assisted living community or conversations by phone or video can help your loved one recall the roles he or she played within the extended family and community. Other ways include encouraging your loved ones to leave the confines of their room and spend time where people congregate in common-use areas. Interactions with babies, children, pets, and therapy animals may also reduce feelings of lonesomeness. Finally, opportunities for self-expression can help people living with Dementia to feel less isolated and alone. There are many simple ways that range from arts, crafts, and music activities to writing poetry and visiting a nearby nature preserve, to connect people who have Dementia to their authentic or most essential self. Content 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. Please visit our Author's page to learn more and find this title. (Content modified by K. Ogden, team member Dementia Society of America) Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Let's talk about food, eating, and Dementia. How Eating Changes During Dementia Progression A person's eating habits will change as their Dementia symptoms change. In the early stages, those living with Dementia may be able to prepare, consume, and enjoy their meals as they always had. But, they may not be able to recall the foods they ate with which meal on a given day. Middle stages of Dementia present different challenges. As symptoms progress and memory worsen, it may become difficult for the person to recall if or when they ate at all. Meals are skipped or repeated. Navigating the kitchen with all of its appliances, tools, cabinets, and drawers becomes nearly impossible. Failing memory may lead to eating utensils left on the table, unused. At this stage, the sense of smell may become impaired, altering taste and food preferences. Favorite foods become intolerable while an uncharacteristic interest in sweet or salty foods takes their place. Complicating the process, fine motor coordination involved in chewing and swallowing may deteriorate. Behavioral changes like hoarding and hiding food as well as eating non-food items such as soap can also develop in mid-stage Dementia. Over time, meals may become nothing more than cereal and milk. It remains important to encourage healthy eating habits, both for adequate nutrition and to maintain regularity. Still, recognize and respond to your loved one's food choices- prepare small amounts of their favorite snack foods, made available in a way that respects their independence. Later stages of Dementia may leave a person unable to recognize food nor know what to do with it. The person in your care may lose the ability to synchronize chewing, moving food to the back of the mouth, and then swallowing. Pocketing is a related difficulty that occurs when food accumulates between the teeth and cheek. Many methods used to help people with swallowing problems require an ability to follow and remember directions. Often the only solution is for you or other caregivers to hand-feed small amounts of soft or liquefied foods. Be sure to seek advice regarding the types of foods that work best, as well as receive instructions for safe hand-feeding methods and what to do if your loved one does gag and choke. For caregivers, how to address feeding problems may be the first of many end-of-life decisions. The immediate goals are to provide enough calories to prevent weight loss and malnutrition and to devise ways to prevent the aspiration of food into the lungs. Some doctors believe tube feeding is the best way to address this stage of decline. However, research shows that using feeding tubes in patients with late-stage Dementia neither prevents complications nor improves the quality of life. 1 Respect for and the preservation of your loved one's dignity figure into these decisions. While thin lines separate methods to maintain the quality of life, to save a life, and to prolong life -it is for each family of caregivers, hopefully, guided by a living will determine the appropriate path at the end of life. 1. Li, I, MD. "Feeding Tubes in Patients with Severe Dementia," American Family Physician http://www.aafp.org/afp/2002/0415/p1605.html , (accessed September 21, 2016). Content 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. Please visit our Author's page to learn more and find this title. (Content modified by K. Ogden, team member Dementia Society of America) Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Imagine a woodland, blanketed with knee-high snow. On foot, you need to cross. Those first few crossings are tough, lifting your feet high, then crushing the snow underneath. With repetition, you’ve built a path and your crossing is made faster and easier. One day an interesting birdsong catches your attention and you stray from your worn path, starting a new one. For several days, you follow the new path hoping to catch a glimpse of the elusive bird. Now you have two worn paths. Every so often, exploring the reaches of the woodlands, you create and then retrace new paths. A large tree breaks under the weight of the snow, completely blocking your first, main path. Because you branched out, explored new areas, you have options. Applied to the brain in a general way, this scenario represents the real-world value of neuroplasticity. Our brain function relies on fast and accurate communication of sensory inputs and responses, traveling through chains of brain cells (neurons) where chemical neurotransmitters serve as the language of that communication. Well-used neuron chains are in effect the snow-packed paths in the woodland. Developing Cognitive Resilience by Enhancing Neuroplasticity Neuroplasticity describes how experience and environment trigger the brain to form new connections and pathways. Should a brain injury occur - stroke, trauma, or other - neuroplasticity allows for workarounds that can compensate for impaired function. This capacity is crucial to rehabilitative therapies. 1 But neuroplasticity is also key to managing risk and slowing the progression of neurocognitive disorders, including those resulting in Dementia. New and novel experiences, no matter the type, lay down new pathways connecting different areas of the brain, building cognitive resilience. These pathways allow for learning a new task or committing to memory the sights, sounds, and sensations of a new destination. They open up a network of routes for neuro-communication that can be used for a range of functions much broader than the original task or experience would suggest. While repetition builds stronger pathways, a recent investigation suggests that prolonged experiences such as physical exercise or stress can change the language of communication between neurons, substituting one neurotransmitter for another. A study of mice running in a wheel demonstrated both the switch-up in neurotransmitters and an overall improvement in coordination and motor learning.2 Not only did they run faster, but the mice also had an improved ability to walk a tightrope and balance on a rotating rod. This process, the neurotransmitter switch, is of interest to researchers examining mechanisms behind stress-induced diseases. It will also be important as we learn how targeted exercise might be used as a treatment for other diseases. Another related area of study with great potential is neurogenesis- the creation of new neurons. Neurogenesis is regulated by neurotransmitters – think of the study of mice in the running wheel. While neurogenesis is slowed by stress and aging, rates can be accelerated by physical exercise and brain exercise, for example learning new concepts or skills. Of course, many other molecular mechanisms also affect the process of neurogenesis.3 Neuroplasticity is as complex as it is crucial to our cognitive health. A technical summary would be that curiosity, physical activity, and novel experiences enhance neuroplasticity through mechanisms such as the neurotransmitter switch and neurogenesis. A practical summary though - while the main path may be easy, it would serve us well to tread more paths. Even better, use different tools like skis, snowshoes, or crampons, and skills like using a bird guide, binoculars, and journaling your experiences. 1 Ackerman, Courtney E., MA. What is Neuroplasticity – A Psychologist Explains. Accessed 4/15/2020 from https://positivepsychology.com/neuroplasticity/ 2 University of California Television. 30 June 2017. “Neuroplasticity: Our Adaptable Brain with Nick Spitzer”. [Show ID: 32521] Accessed 15 April 2021 from https://www.youtube.com/watch?v=DXA_iTG3XSM 3 Ming, Guo-Li, and Hongjun Song. “Adult neurogenesis in the mammalian brain: significant answers and significant questions.” Neuron vol. 70,4 (2011): 687-702. doi:10.1016/j.neuron.2011.05.001 Accessed 15 April 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106107/ Contributor: Karen R. Ogden, team member , Dementia Society of America. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Many people find talking about their end-of-life wishes extremely uncomfortable. Yet, when asked, nearly everyone has strong convictions about their end-of-life care. Some might say, “Do everything possible to prolong or save my life." Others might say the same, so long as they have a "good quality of life." Your loved ones want what's best for you, but they cannot read your mind. Such difficult decisions require your guidance. Meaningful end-of-life choices require both introspection and research. For some, religion is their guide - for others, their decisions come from life experiences. Making decisions about treatments such as tube feeding and cardio resuscitation require that you learn why and when doctors may opt to use or not use these procedures. Palliative and hospice care is another facet of your end-of-life care. Another word for palliative care is comfort care. Patients continue to receive standard treatments for their conditions. However, as the disease progresses, patients receive increasing amounts of comfort care. An example of comfort care is using medication to relieve pain rather than treating the source of pain surgically. Hospice, an extension of palliative care, provides patients and their families care and support from a team of healthcare providers and counselors. Volunteers may give families time they need to attend to their personal needs and other matters. Palliative and hospice care are not, as many believe, "pull the plug." Rather, it indicates the recognition that a patient will not be cured of their condition, that it will ultimately cause their death. End of Life Wishes There are several ways to get the information you need to write realistic and meaningful end-of-life wishes. The Conversation Project is an initiative by a non-profit organization that provides tools for individuals to self-evaluate their end-of-life wishes. Downloadable guides provide helpful suggestions to prepare and initiate conversations with family members. 1 The advance directive, or a living will, is a set of instructions that details the types of medical and life-sustaining measures you may want. This document includes the instruction to "keep me clean, comfortable, and free of pain or discomfort so that my dignity is maintained, even if this care hastens my death." This last phrase gives permission to family members and clinicians to evaluate your wishes in the context of humane care. For example, it would be inhumane to give last-ditch cardio-resuscitation to a person who has severe osteoporosis as the procedure would crush the patient’s ribcage. Your advance directive is a legally binding document that requires your signature and the signature of at least one other witness or a certified notary depending on where you live. Advance directive forms are available from your healthcare provider, local agency on aging, or your state health department. Five Wishes is a product of the non-profit organization, Aging With Dignity.2 They designed an advanced directive template that also addresses personal, emotional, and spiritual issues in addition to meeting medical and legal criteria. Your family members must know where to find your end-of-life care documents. To make it as easy as possible, do not put your documents in a bank safety deposit box. Also, give a copy to your doctor so that he or she can include it in your medical records file. And yes, you may amend your end-of-life documents. Notes : 1. The Institute for Healthcare Improvement, http://www.ihi.org/Engage/Initiatives/ConversationProject/Pages/default.aspx (accessed, September 11, 2020) 2. Aging with Dignity, https://www.agingwithdignity.org/five-wishes (accessed September 11, 2020) For Further Reading: Frontline: Facing Death, http://www.pbs.org/wgbh/pages/frontline/facing-death/educational-module/decisions-near-end-life/ (accessed Sept 11, 2020) Content 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. Please visit our Author's page to learn more and find this title. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Lewy body Dementia, or Dementia with Lewy bodies, is the second most common type of progressive Dementia following Alzheimer’s disease. The disease is characterized by protein deposits in nerve cells in the brain regions that control thinking, memory, visual processing, and motor control. In this article, we’re taking a deep dive into Lewy body Dementia to explore its origins, symptoms, and treatments, and therapies that can help you or a loved one navigate your Dementia journey. Fact # 1: Lewy body Dementia is one of the primary causes of Dementia in older adults. Usually beginning after age 50, Lewy body Dementia affects more than one million people in the United States. Experts have discovered that it appears to affect more men than women, making gender one of the primary risk factors. Other risk factors include advancing age and a family history of Lewy body dementia or Parkinson’s disease. Fact # 2: Lewy body Dementia is named after the scientist Fredrich H. Lewy. While researching Parkinson's disease in the early 20th century, the German-born American neurologist Friedrich H. Lewy discovered abnormal protein deposits on the brain later called Lewy bodies. When these Lewy body proteins build up, they can disrupt the brain's normal functioning and cause problems with how the brain works, affecting memory, movement, thinking skills, mood, and behaviors. Fact # 3: Lewy body Dementia is a progressive disease with a range of cognitive and physical symptoms. The symptoms of Lewy body Dementia emerge slowly and gradually worsen with time, making it a progressive disease. In the early stages, people living with this type of Dementia may experience mild symptoms that allow them to function relatively normally. As the disease advances, people may notice changes in alertness and attention or movement and posture, including confusion, hallucinations, and muscle stiffness. In the later disease stages, people living with Lewy body Dementia often depend on others for assistance and care. Fluctuating alertness and thinking functions Repeated visual hallucinations Parkinsonian symptoms REM sleep behavior disorder, where people act out dreams while sleeping Fact # 4: Lewy body Dementia can be hard to diagnose. There is no single test to diagnose Lewy body Dementia. Doctors diagnose the disease by ruling out other conditions with similar symptoms. For instance, Lewy body disease shares similar symptoms with Parkinson's and Alzheimer's diseases, causing experts to speculate that it might be related. Lewy body Dementia diagnostic testing may include neurological and physical exams, mental ability assessments, blood tests, brain scans, and heart tests. In addition to the test findings, a Lewy body disease diagnosis requires a progressive decline in thinking abilities and two of the following: Fact # 5: Currently, there is no cure for Lewy body Dementia, but treatments and therapies can help alleviate the symptoms. Doctors often use medications to help people living with Lewy body Dementia. Alzheimer’s and Parkinson’s disease medications can treat neurological and physical symptoms, while other medications can offer relief from sleep and movement problems. Some people living with Lewy body Dementia find non-drug approaches helpful, such as modifying the environment to reduce distractions, receiving soothing responses for reassurance, and following daily routines with simple tasks. Physical, occupational, speech, and mental health therapies can also play a role in symptom relief. Our Ginny Gives grant program provides other healing therapies that help people connect through art, music, dance, and touch. Fact # 6: There are many supportive resources available to help people living with Lewy body Dementia and their families and caretakers. Our supportive resources provide much-needed information, local resources, and life-enrichment programs to enhance the lives of individuals and families affected by Lewy body and other types of Dementia, including: Truthful definitions to expand your vocabulary Care education to guide your decisions Dementia help resources to further your understanding and learn how to help Brain health information from reliable and trustworthy sources Relevant and topical streaming program for individuals and caregivers. No-fee memorial registration to pay tribute to a life well-lived To learn more about our programs and offerings that can help people living with Lewy body disease and other types of Dementia, contact us online or call 1-800-DEMENTIA (1-800-336-3684). Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.