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Research has found that there are benefits imparted by exercising in the natural world or a setting that is rich with the things we find in nature; like plants, fresh air, and wildlife. While gyms serve a great purpose, and some people love them, I prefer to exercise in nature. The natural world provides a deeper and more dynamic level of stimulation for your brain that you simply cannot find at any gym. One study conducted by Richard Louv coined the phrase 'Nature Deficit Disorder'. At first glance, this might sound a bit contrived. However, Louv asserts that human beings are hardwired by evolution to have a connection to nature. Unfortunately, the modern world and the trend for people living in large urban and suburban places reduce the opportunities for people to spend time in nature. This sentiment that exposure to the natural world has an impact on us has been echoed by many people throughout the generations. The father of the National Parks system and one of the first naturalists, John Muir, said: “Civilized man chokes his soul.” Although Muir himself lived a significant amount of his life in Martinez, California just outside of Oakland, the goal in his eyes was not that man needed only urban or natural settings, but that both were of equal value and that people who only embraced urban life were indeed cutting themselves apart from the very therapeutic aspects of a direct relationship with the natural world. 'Green Exercise' involves hiking in nature, or getting involved in other activities in the natural world. For people who live and work deep inside urban areas, this could also extend to things like taking a walk in the park, or along a natural stretch of river, or even getting involved in something like a community garden. When you’re in nature, there is a lot of multimodal stimulation. You’re smelling the trees, flowers and the other scents in the air. You start to notice things like changes in humidity and the presence of birds and other creatures around you. When you’re in the gym you’re going to have certain smells but you can usually predict what those smells are. It’s old gym equipment and rubber mats on the floor. When you’re exercising in nature there is a greater sense of self-awareness, improved mood, increased sense of self-esteem, and even an increase in creativity. People exercising in nature tend to have creative thoughts come to them and find it easier to express those ideas with greater clarity. The bottom line is that exercising in nature does, in fact, elevate the level of your brain and body functions. It’s a win-win for you and nature, and an important way to help build a better brain. I recommend that everybody get out there and do it! Contributor: Dr. Michael Trayford is a Board-Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For additional information, and to learn more, please visit our Author's page. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

A lot of people have a To-Do list loaded with tasks, errands, and projects that they intend to take care of either during the course of that day or at some reasonable time in the future. Most of the people who have lists like this tend to get a few things done, then transfer whatever was leftover to the new list they write up the following day, week, or month. Typically, these lists end up getting so filled with uncompleted tasks that they become daunting. It can even get to the point where your bloated To-Do list is a source of stress. If something isn’t getting done it may be due to procrastination, or it’s simply something that just wasn’t important. Leaving trivial items on your To-Do list bogs down your brain capacity and starts causing you to feel things like worry and fear, which are the two most damaging emotions for the brain. I encourage my clients to keep a Not-To-Do list. This type of list can actually have several different uses. First and foremost, it’s a sort of garbage can where you can dump meaningless tasks that probably shouldn’t have been on your To-Do list in the first place. This turns the list into an exercise in prioritizing. It forces you to sit down and think about what you really need to get done, what you should do, and what really isn’t all that important. Then you can sharpen your focus and execute the important tasks in your life with fervor. The other aspect of a Not-To-Do list is to serve as a reminder of bad habits you want to avoid. It might be eating too much sugar, having too many drinks, or keeping up with your efforts to quit smoking. Writing down bad habits that you know you shouldn’t do can be an empowering way to break negative cycles in your life. It can also be a tool to help you identify sources of stress in your life. You might include things on the list like ‘I’m not going to get angry in traffic today’, or ‘I’m not going to let my annoying co-worker get to me’. When you think about all of these things and how they can all add up, a Not-To-Do list can be a very powerful stress management tool! Many successful people, like Tim Ferris, are advocating Not-To-Do lists. It allows them to be much more proactive and productive than the actual To-Do-list. At the same time, it also invokes creativity and innovation, because you’re no longer bogging down your brain with things that are seemingly not that important. Sit down and brainstorm about what is not serving you well on your list and in your life. Then compile a Not-To-Do list. You might find that it will become more important than your To-Do list. This is a really powerful tip to ramp up your brain for peak performance and better brain health. Contributor: Dr. Michael Trayford is a Board-Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For more information, please visit https://apexbraincenters.com/ . The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Some people say Dementia turned they're once loving and upbeat loved one into an angry tyrant. Others may describe the changes in behavior and mood as “the same person, only more so.” Usually, “more so” is not good. Rarely does one hear that Dementia turned a difficult person into a pleasant one. The behaviors associated with early-stage Dementia can be the most difficult. Your loved one is fighting the imposed changes the diagnosis has brought to his or her life. And you, the family caregiver, do not have the experience to both calm your loved one and cope with the disquiet this new relationship brings into your life. As Dementia progresses from early to late-stage, moods, and behaviors worsen. In addition to increasing memory loss, depression, belligerence, apathy, physical aggression, wandering, repetitive questioning enters the picture. It is useless to try to convince your loved one that what they truly believe is not what it seems. You will never win the argument. “Distraction and redirection” is one helpful strategy to diffuse the situation. Rather than trying to prove his or her hat was misplaced and not stolen, make a comment about the nice weather and suggest going for a walk. Another way to address your loved one’s concern is to listen and tell him or her you will look into the matter. This simple tactic tells your loved one you are there; you care, and you will make things right. “Therapeutic deception” is another approach to managing difficult behaviors. Telling your loved one, “you will make things right,” isn’t a lie. It’s a kindness that gives him or her, and you as well, a few moments of peace. You will find a therapeutic deception is an approach you can apply to various difficult circumstances. Dementia behaviors may also include some weird and scary things. More specifically, your loved one may experience hallucinations. How you respond to these unsettling behaviors has the potential of turning uncomfortable moments into situations that may necessitate assistance from your local police department or a trip to the emergency room. Managing the difficult behaviors associated with hallucinations involve a different set of challenges. Telling your loved one, there isn’t any blood on the walls or bugs crawling up his or her back is fruitless. Hallucinations are sensory tricks. Your loved one sees, hears, or feels something without the stimulus of light, sound, or touch. To prevent a difficult situation from escalating into one you cannot manage, you might say something like, “I cannot see what you see, but I am sure it is very scary.” You might remind your loved ones that you are there and that you will make sure they are safe. Sometimes a hug or a gentle touch will have a calming effect. Other times, when hallucinations cause overwhelming fear, the only thing you can do is take your parent to the emergency room. Medication to reduce mood and behavioral difficulties is a controversial issue. Some people believe the drugs used to manage behavior are “chemical straight-jackets” meant only to make things easier for the caregiver. Other caregivers subscribe to the philosophy that providing meaningful activities for the person with Dementia, establishing a structured routine, and creating an enriching and pleasant environment can reduce the need for behavior modifying medications. In either case, one has to consider the quality of life. Medication can reduce pain and suffering. If depression becomes overwhelming, belligerence creates a dangerous environment for the caregiver, or when hallucinations cause unrelenting terror, medication is both humane and one that supports a better quality of life. All of this is easier said than done, but do try to remember it is the disease that is speaking and not the person you once knew. Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Much of Dementia care boils down to anticipating and planning for challenges you will face. As a first step, the person or persons responsible for a loved one's care must have the legal right to do so. Legal permission involves becoming the designated power of attorney (POA), or under certain circumstances, the conservator and guardian. The amount and type of long-term care your loved one needs is one of the first decisions you and your family will make. Concerning home care, who will be the primary caregiver? What happens if it becomes neither realistic nor safe to shoulder caregiving responsibilities alone? Is the next step hiring a paid caregiver? Is the paid caregiver one that you hire or one contracted through a home care service? What are the criteria that make it necessary to transition your loved one from home to an assisted living facility? Some individuals fervently believe they will be his or her loved one’s caregiver throughout the illness. However, as is often the case, circumstances change. Therefore, you must anticipate and plan for modifications in the type and amount of care your loved one may eventually need. Research the options before you need them! Contact your friends to discover if they know of a reliable caregiver or affordable homecare support. Look into non-profit organizations that provide various types of home care services. Visit assisted living facilities, speak with the director, ask about the services included in their monthly fees, view their inspection reports, and tour the facility. Learn the differences between a continuum of care, independent living, assisted living, and memory or dementia care. Become familiar with the steps you must take before you can place your loved one in an assisted living facility. It may be months or even years before you come to this cross-road. However, doing your homework will minimize the time and stress of needing to take, often on short notice, this big step. Developing the “what, if then, or buts” of medical care is another feature of a long-term care plan. Will your loved one receive care from his or her family doctor or a Dementia care specialist? Research palliative and hospice care to be sure that preconceived ideas do not color your views. Learn about the purposes for palliative and hospice care, the best time to initiate them, and how they impact quality-of-life and end-of-life care. These last decisions are prone to family conflict and long-lasting feelings of ill-will. A long-term care plan includes funeral arrangements as well as various estate considerations. It’s not ghoulish to plan for the funeral. Cremation, embalming with or without embalming fluid, and burial location – are a few of many examples of the difficult and emotional decisions families make. Prepare yourself for the eventual transition from caregiver to representative of the estate. What are the responsibilities and the steps you must take to close the estate? A long-term care plan helps families navigate the challenges that dementia care presents. Be sure to frequently review, update, and revise your loved one’s long-term care plan. Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

If you've been a regular reader of the Dementia Society of America blog, you know that better heart health can lead to better brain health. Exercise is just one way to increase heart health, so, how do we make exercise a priority in our daily habits and among our countless distractions? Most people are just kind of trucking through their day, trying to get through their tasks and to-do lists. That might involve getting their kids from school, work-related tasks, and hopefully having some time to spend time with friends or make a quick appearance at the gym. One very telling trend is the number of people that buy a gym membership, yet fail to use it. While several different studies are posting similar statistics, it is estimated that 73% of people with a gym membership either fail to use it at all or use it so infrequently that it imparts no long-term health benefits. The usual trend is that there are a lot of people who sign up for a year-long gym membership as part of a New Year’s resolution. They get this membership with the best of intentions, but by the middle of January or early February, the vast majority of them have stopped going to the gym. One of the most common excuses use is that their lifestyle doesn’t allow them the time to work out regularly. I have found that the key to developing a successful long-term exercise routine is to develop a mindset of making the time, instead of finding the time. You should approach it with the same mentality you would if you were scheduling an office meeting every Monday, or making sure that you’re picking up your kids from school at the same time every day. Some talk about how juggling their career and family, along with other responsibilities, can be a huge obstacle. While this does present challenges and imposes demands on our time, there are those with even more on their plate that still make it a point to take the time to exercise. The bottom line is that you need to take the time to exercise, because if you try to find it; the day will get by you and you’ll end up sitting on your couch worrying about your waistline while your brain and everything else suffers as a result of not exercising the way you should. Contributor: Dr. Michael Trayford is a Board-Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For more information, please visit https://apexbraincenters.com/ The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

It's so easy for family caregivers to get stuck in the daily routines of their loved one's care. Each new day brings the same as the last– make breakfast, dole out medication, struggle with their hygiene, and manage challenging behaviors. The sameness can contribute to your emotional and physical exhaustion and strain your capacity to be a warm and loving son, daughter, husband, wife, or friend. Taking the time to be mindful of creative needs can give both of you a refreshing mini-vacation from illness. Making and finding art opportunities for your loved one may not be as difficult as it may appear. Watercolors, paper, brushes, and a kitchen table and you are good to go. Share the creative process with your loved one. Making art together also makes memories. Many community and senior centers offer art classes for people in early and mid-stage dementia. Contact your local Agency on Aging or other organizations that provide local support and counseling services for people who have dementia and their families. Another easy way to find art programs is by searching the internet using keywords such as "art and dementia". Narrow your search by including the name of your state, city, or town. If you come up empty-handed, just ASK. You have everything to gain when you explain to senior center directors and directors of other organizations the need for art programs customized to meet the needs of people who have dementia. Other options are the art education programs that many museums and, some galleries, offer. The Museum of Modern Art (MoMA), in New York City, has set the standard for making art accessible to those with Dementia. With the guidance of specially trained museum docents, visitors explore selected museum collections where they can see and, when appropriate, touch wall art and sculpture. Interactive installations may invite viewers to experience sight, touch, and sound. The conversation about art and the environment is another facet of the MoMA program. However, feelings and memory – not art history – are the inspirations for meaningful interactions and conversation The MoMA website gives a complete description of the MoMA Project. (https://www.moma.org/visit/accessibility/ ) Search the internet to locate nearby programs. Type in the name of the state followed by descriptive words such as “museum,” “Alzheimer,” “Dementia,” and “outreach.” The year after my mother’s death, I decided to volunteer some of my newly realized free time to the dementia community. I developed a curriculum that I hoped the “artists” would find satisfying and challenging. The outcome was a brief presentation to a local support group was four eager participants and their spouses. The three men and one woman had various types of dementia. Over the year, the artists learned basic design principles, made relief prints, painted self-portraits, and designed and printed T-shirts for themselves and their family members. Donations covered the cost of supplies. I expected the spouses would take their off-duty time to run errands. But as it turned out, they formed an impromptu support group and spent the class time in a nearby coffee shop. Soon, “just coffee” morphed into family dinners. One of my most precious moments was when one man told me that the art class made him feel that he was becoming something rather than losing what he had once been. Make art as a spice to life! Want to Know More? 1. “I Remember Better When I Paint.” https://www.youtube.com/watch?feature=player_embedded&v=54AtoQVGfwU (Accessed February 26, 2016) 2. Hayes, J. and S. Povey, The Creative Arts in Dementia Care: Practical Person-Centered Approaches and Ideas. London , England: Jessica Kingsley Publishers, 2010. Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon . The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

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 exercised 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 the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

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 is other areas of ethical concern. For More Information: Silver Alert https://silveralertbill.com/ 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, https://www.nsc.org/home-safety/safety-topics/older-adult-falls (accessed March 26, 2016 - website link has since been changed) 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. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

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 a 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 the 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 the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

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 them to 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, 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 is 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 Medications: Help, Hurt or Both? 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 using 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, https://geriatricscareonline.org/ProductAbstract/american-geriatrics-society-updated-beers-criteria-for-potentially-inappropriate-medication-use-in-older-adults/CL001 (accessed April 24, 2016 - website has since been relocated) Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon . The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor . www.DementiaSociety.org

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 as 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. We chalk up those moments of frustration to the number of look-alike cars or having our thoughts elsewhere with normal forgetfulness. 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 cognitive 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, Ph.D. , is a freelance medical and science writer for the Dementia Society and the author of “ An Unintended Journey: A Caregiver's Guide to Dementia.” The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Imagine your loved one is showing symptoms of cognitive decline or was diagnosed with Dementia. You need to investigate and understand more about what their future may look like and how you can support them as their loved ones. Say it's 1980. Where would you start? You might pick up the phone to talk with your friend whose mother had Dementia. Or you’d head to the public library. Pulling open the long drawers of the alphabetical card catalog, you would flip through the titles and copy call numbers of books that might help. Next, scan the shelves, find the books, peruse their table of contents, take them to a table, scan, read, and take handwritten notes. In 1995, you may supplement the card system with a computer that helps you find articles in physically bound periodicals stacked on library shelves. You may find yourself sitting in front of a boxy machine through which you view items stored on microfilm. These tasks take attention and patience, time, and persistence. Jump ahead to the year 2000. Computers have made their way into homes, schools, and public libraries. Instead of reading books and magazines, you search the internet for “Dementia” and read the resulting information- book excerpts, news articles, journal publications, credible scientific research, and statistics on your screen. Return to the present—a new Dementia diagnosis. So much has been learned and shared. So much information is available to you, so much so that it may feel overwhelming. Where do you start? Of course, all the printed resources remain available at your library and local bookstore. Streaming video content has become a fixture. Documentaries, non-fiction television series, university lectures, courses, and professional presentations are all available with a point and click. The key is to find sources that are credible and trustworthy. A great starting place is our website Dementia Society of America . In an easy-to-use format, it will guide you to the practical information a family member or caregiver needs to understand and manage day-to-day concerns while caring for a loved one with Dementia. Should you want to take a deep dive into the types of treatments for and current research on Dementia, the site will connect you to valuable, credible sources. One such source is the National Institute on Aging: Alzheimer's Disease and Related Dementias page, compiled by the U.S. Health and Human Service Department. To examine specific topics like palliative care, agitation in your loved one, communication techniques, and so much more, explore the Dementia-specific programs offered at Dementia Unplugged . Hearing the thoughts and experiences of experts and practitioners in the field can make a lasting impression on your care and understanding of those with Dementia. This approach is not unlike that phone conversation you may have had in 1980. The difference is that the questions and the answers come from knowledgeable sources, experts, or first-hand experience. This mix of information and personal connection is informative and reassuring, like a conversation with a trusted friend. Finally, when it comes down to caregiving logistics, the Dementia Answers Directory will help you find the professionals and organizations who can help you along the way. Organized into categories of care needs, searchable by location or keyword, it connects you to the resources you’ll need. Like the Internet, the directory’s content will expand over time. Help and answers are available. You have options for how and where to find it; choose the media that works best for you. The journey is, after all, yours, but not yours alone. There is a community of people with the same worries, joys, challenges, and successes - ready to help you along the way. Contributor: Karen R. Ogden, Dementia Society of America, team member. Updated 2/1/2023 The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org