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.

“I see trees of green- Red roses too, I see them bloom- For me and for you... “ “You may say I'm a dreamer, But I'm not the only one…” "Almost Heaven, West Virginia. Blue Ridge Mountains, Shenandoah River…" “Bye, bye Miss American Pie- Drove my Chevy to the levee but the levee was dry... ” “Born down in a dead man's town -The first kick I took was when I hit the ground…” “Woah, we're halfway there -Woah, livin' on a prayer -Take my hand, we'll make it I swear… " Surely while reading these lyrics, you experienced a trickle or a flood of memories or maybe the tingle of emotion not born of the present moment. You may recall a moment in time - where you were, who you were with, and what was going on. Or you may be transported back to a period in your life filled with joy, romance, frustration, even grief. How does this happen, and how can we harness that power to enrich and enliven the lives of those living with Dementia? Music and the Brain: What the Research Says Much academic study has focused on how background music affects cognitive processing. Because listening to music elevates arousal (or physiological activity), mood, and the listener’s enjoyment, cognitive performance is also increased.(2) Working memory is tasked with interpreting a series of sounds into the rhythms and melodies that make it music. This helps explain why memories associated with particular songs are often permanently etched in our brains – our cognitive processing was on overdrive when those memories were being recorded and transferred to long-term memory. Music and emotion are intertwined. Not only does heightened arousal fortify memories made while listening to particular pieces of music, but the same is also true for emotions. Increased blood flow to areas of the brain involved in generating and controlling emotions activates the functions of emotion, attention, and memory. (4) Further, consider how rhythm compels us to move. Slow dance with your partner, or the exuberance of singing and dancing with friends. We, as humans, are moved emotionally by music. (3) Early adulthood is filled with new emotions and experiences gained as we move towards independence- these experiences are a big part of how we see our “selves”. So it is not surprising that people most prefer and are most stimulated by music that was popular when they were young adults. Past romantic relationships and experiences with friends and family are most often recalled with the replay of music. (1) As Dementia progresses, using music to help individuals remember their vibrant, youthful “selves” can bring joy to caregivers and patients alike. When one hears a piece of music from years gone by, the pleasant memory and emotion can be experienced again and again. Recognizing that "remembered joy" in your loved one living with Dementia can be just the uplifting moment a caregiver needs. Dementia or not, you can transport back to happy times through music as a reprieve from everyday stresses and frustrations. It's free. It's easy. It’s fun. Do you remember when- we used to sing Sha la la la la la la la la la la te da, la te da? 1 Baumgartner, Hans. 1992. Remembrance of Things Past: Music, Autobiographical Memory, and Emotion, in NA - Advances in Consumer Research Volume 19: pp. 613-620. Accessed September 22, 2020, at https://www.acrwebsite.org/volumes/7363/ 2 Bottiroli, Sara et. al. Frontiers in Aging Neurosci., 15 October 2014. The cognitive effects of listening to background music on older adults: processing speed improves with upbeat music, while memory seems to benefit from both upbeat and downbeat music. Accessed September 22, 2020, at https://www.frontiersin.org/articles/10.3389/fnagi.2014.00284/full 3 Proverbio, A. M. et al. The effect of background music on episodic memory and autonomic responses: listening to emotionally touching music enhances facial memory capacity. Sci. Rep. Accessed September 22, 2020, at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606564/ 4 Lutz, Jäncke. Music, memory, and emotion. J Biol. 2008; 7(6): 21. Published online 2008 Aug 8. Accessed October 5, 2020, at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776393/ 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.

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 Valuable Resource for Learning About Dementia: The Dementia Society of America 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 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.

Now more than ever, accessing helpful Dementia resources from home is essential. With an internet connection, a computer, and the proverbial click of a button, you can discover many free and low-cost Dementia-help programs. We’ve rounded up our top five favorite Dementia help training and video libraries designed to inform and comfort people living with Dementia and their caregivers. Discover more about them below, including what you’ll learn, the cost (if any), and how to watch. (1) UCLA Caregiver Training Videos This online Dementia help video library by UCLA is geared toward caregivers of people living with Dementia. It covers various helpful topics that can make it easier to respond to common behaviors and scenarios. Each video has a written narrative featuring expert explanations and recommended caregiver responses. What you’ll learn: This comprehensive Dementia help video library walks you through everyday challenges for people living with Dementia, such as alcohol abuse, driving, lack of eating, and paranoid thoughts. Additional caregiver video topics include: Bathing Depression and apathy Hallucinations Home safety Sleep disturbances Taking medications Repetitive behaviors Cost: Free How to watch: Browse UCLA’s online video library and select your desired topic. Most videos are available with multi-language subtitles and English and Spanish audio. (2) Care Partner Academy ™ Dementia Horizons ™ Dementia Horizons™, led by Program Director Jeannine Forrest, PhD, is a mission-driven educational program offered within Dementia Society's Care Partner Academy ™. Designed to empower care partners, friends, community members, and professionals, Dementia Horizons addresses the practical skills needed to face the most common challenges of Dementia, while shining a light on ways to build brain health no matter life's circumstances or cognitive status. Ability to receive a Certificate of Completion. Cost: Free (If you use the Coupon Code: DSA100) (3) Living with Dementia Five-Week Online Course Johns Hopkins School of Nursing offers a free, five-week online Dementia help course on living with Dementia. It’s geared toward health professionals and students, people living with Dementia, friends and family caregivers, and others interested in Dementia and quality care. The course’s goal is to explore the global challenge of living with Dementia for individuals, their families, communities, and society. What you’ll learn: Each of the five weeks in the course syllabus includes video segments and structured exercises and activities covering: Week 1: The Brain Week 2: The Person Week 3: The Home and Family Environment Week 4: The Caregiving Community Week 5: Social and Policy Changes Cost: Free to people who want access to the materials without earning a certificate. The fee is $49 for those who want to earn a certificate upon completing the course. How to watch: Learn more about the dementia help course on the Johns Hopkins School of Nursing website and enroll at Coursera.org to access the videos. (4) The Dementia Action Plan Workshop Presented by founder and nationally recognized spokesperson Kevin Jameson, this approximately one-hour Dementia help video is a recorded live talk filmed with a studio audience at the Philadelphia PBS® station affiliate, WHYY-TV. What you’ll learn: This engaging Dementia help seminar covers what to know when dealing with Dementia, including straightforward, empowering steps for navigating life as a caregiver or as the person living with Dementia. Cost: Normally a $9.95 mission-related donation, but please be our special guest and use promo code "FREE" to watch at no cost. (5) Dementia Unplugged ™ Webinars Dementia Unplugged is a monthly educational and conversational webinar developed in cooperation with Jeannine Forrest, Ph.D., R.N. It offers Dementia help and support for caregivers of people living with Dementia. What you’ll learn: Covering topics such as housing and living options, caregiver grief, meaningful activities in the home, agitation triggers, and responding to hallucinations and delusions, Dementia Unplugged is a well-rounded Dementia help forum where audience participation is encouraged. Cost: Free How to watch: Register to access the monthly sessions via Zoom on the first Mondays of every month at 10 am CST. Beyond the Dementia help, videos, and training featured on this list, you can find dozens of helpful dementia videos available on our YouTube channel at no cost. We also invite you to browse our extensive collection of media on our website, including feature films and documentaries for caregivers and people living with Dementia to enjoy from the comfort and safety of your home. 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.

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. What Are The Cognitive Symptoms of Dementia? 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.” 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, everybody has bouts of sleeplessness. House noises, screaming babies, caffeine, or a bed partner who snores, often make it difficult to fall asleep and stay asleep. Eventually, you learn to limit the amount of coffee you drink, the screaming babies grow up, and the snoring bed partner, well ... still snores. Other causes of chronic sleeplessness are sleep apnea, acid reflux, jet lag, swing-shift employment, and ongoing stress that causes insomnia. Sleep Helps Your Brain Repair Itself Discoveries made by Oregon Health and Science University researchers show that sleep deprivation increases the risk of Dementia later in life and may quicken its progression for those who already have the disease.1 Their data show that insufficient sleep increases the production of beta-amyloid proteins that compose the plaques associated with various kinds of Dementia.1 Taking a different approach, the University of California Berkeley Sleep and Neuroimaging Lab researchers have evidence demonstrating the importance of deep non-REM (rapid eye movement) sleep in preventing memory loss. 2 The deep non-REM sleep phase, among other functions, appears to prevent the buildup of beta-amyloid proteins. Their work shows there is a correlation between the accumulation of beta-amyloid proteins, sleep disorders, and Alzheimer's disease. 2 Also, insufficient sleep is a risk factor associated with other health conditions, including obesity, heart disease, and diabetes - all of which increase the likelihood of Dementia later in life. What to do?? First, remember that risk factors do not cause disease but increase the likelihood of having Dementia sometime in the future. Second, and most importantly, modifying behaviors and habits associated with Dementia, such as smoking and obesity, can reduce risk. Sufficient sleep depends on the age of the individual. Seven to 10 hours of sleep per night is considered healthy for adults. 3 However, for adults older than 65, six to eight hours of sleep per night is both normal and healthy. 3 Many older people, believing less than 8 hours of sleep per night is abnormal, resort to sleeping pills. Unfortunately, using medication to ensure sleep increases the risk of Dementia and worsens Dementia for those with the disease. Tips for a Better Night's Sleep People acquire habits and behaviors that unknowingly make it challenging to fall asleep and stay asleep. The National Sleep Foundation offers the following tips to get a good night's sleep.3 Stick to a sleep schedule – even on the weekends. Develop a relaxing routine to prepare your body for sleep. Use your bed only for sleep and sex. If you have trouble sleeping, avoid afternoon and early evening naps. Exercise daily. Make the room where you sleep comfortable and free from disturbing noise or other distractions. Sleep on a comfortable mattress and pillows. Avoid alcohol, cigarettes, and heavy meals in the evening. Wind down - an hour before bed, choose a calming activity such as reading. If you can't sleep, go into another room and do something relaxing or immensely boring until you feel sleepy. Notes: 1. How a lack of sleep can increase YOUR risk of Dementia: Lack of rest prevents the brain from clearing out toxins that trigger Alzheimer's', http://www.dailymail.co.uk/health/article-3387246/How-lack-sleep-increase-risk-dementia-Lack-rest-prevents-brain-clearing-toxins-trigger-Alzheimer-s.html (accessed May 17, 2016) 2. Lack of Sleep May Lead to Dementia: New Research Finds It Makes Brain Vulnerable, https://alumni.berkeley.edu/california-magazine/online/lack-sleep-may-lead-dementia-new-research-finds-it-makes/ (accessed Nov 12, 2022) 3. Healthy Sleep Tips, https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips (accessed May 17, 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. 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.

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 . 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.