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Dementia Horizons™ | Workshop 14 | Enhanced Hygiene Video Module [14] Transcript Hello and welcome. Ensuring enhanced hygiene for people living with Dementia can be challenging, especially when they resist bathing or showering. Resistance to these activities is often rooted in fear, discomfort, or confusion. However, with thoughtful preparation, patience, and the proper techniques, caregivers can help make the experience more pleasant and manageable. We will explore practical strategies to overcome resistance to showering for individuals with Dementia, emphasizing the importance of a compassionate and person-centered approach. Before attempting a shower or any bathroom task, spend time creating a safe and comfortable atmosphere. Provide a shower or bath seat for times when the person needs to sit, and pre-install grab bars or other handholds so you, or they, can grab on if needed. Lay down rubber-backed bathroom mats to prevent accidental slips and falls, and to soak up excess water. If your care partner thinks they see someone else in a mirror while using the bathroom, place a sheer curtain over the mirror. Even if you are their long-term care partner, each time you work together, approach the experience with a new appreciation for their current situation. Clearly and confidently communicate each step you're taking, before you begin any new task. This allows the person to prepare themselves, be less fearful and not be surprised. Building a rapport that feels safe and trusting is critical. Start by engaging in a friendly conversation. Talking about one of their favorite topics like a sports team, their days at summer camp, or music they loved in their teens, can help make the interaction more personal and engaging. Please focus on the person before the task, and give them a fun reason to clean up, such as getting ready for an outing, or visiting a friend. In general, when someone is in the middle to later stages of Dementia, they may not think they need a shower or bath. In their mind, it may seem to them like they just took one. Also, the ability to smell odors can become less acute. And so, they may believe that there is no reason to shower or bathe. If using the word shower triggers anxiety, substitute phrases like "wash up", "clean up", or "Let's have a spa day." Addressing toileting needs before showering can prevent accidents and make the process smoother. Ensuring the individual has used the bathroom can reduce anxiety and make them more comfortable. Before entering the bathroom, ensure it is at a comfortable temperature and that all your toiletries are within reach. A warm and inviting environment can make a significant difference. Ensure that the shower room or bedroom has all the necessary supplies, such as towels, soap, and washcloths are readily available. This preparation can help create a sense of security and comfort for the individual. Then focus on their privacy, dignity, and warmth by keeping a large towel over their shoulders while verbally encouraging or assisting with removing their clothes. Sometimes you'll be challenged to do so, but keep the mood as upbeat and fun as possible. Consider playing soft music in the background. Soft, calming music can create a soothing atmosphere. Music has been shown to have a positive impact on mood and can help reduce agitation and anxiety in individuals with Dementia. Providing a soft, colorful sponge, a rubber ducky, or other water-safe object can serve as a distraction and reduce anxiety. These items can be soothing and fun, helping direct an individual's attention during bathing. Hum, or sing a familiar tune to brighten the atmosphere and create a bond between you and your care partner through music. Have the individual within your care start the washing process. It can promote independence and reduce resistance. Guide them through the process and assist as needed. Begin washing with less sensitive areas, such as the feet, legs, and arms. This approach can help the person gradually become more comfortable. Move to the middle of the body, and when appropriate, gently wash the perineal area. This is an area that lies between the genitals and the anus. I'd suggest using a handheld shower wand with a medium-pressure spray, if possible, to clean all the nooks and crannies. Maintain hygiene and comfort, and use fresh washcloths as often as necessary, especially for the face. Offer compliments if resistance develops. Stop, pause, and re-engage differently. Alternatives to consider: One: If the individual is uncomfortable with undressing, consider leaving their gown on and washing it underneath. This can help maintain their dignity and comfort. Two: If a bed bath is necessary, ensure the person is covered with blankets to maintain their dignity and warmth. Three: An under-the-clothes bath can be a more comfortable and less invasive option for individuals who are resistant to undressing. Four: Divide the bath: upper body in the morning and lower body in the evening may make the process less overwhelming. Five: A towel bath, where warm, moist towels are used to cleanse the body, can be a gentle and non-intrusive alternative to traditional bathing methods. No matter how you accomplish the cleanup, a gentle massage with scented lotion can be relaxing and comforting afterward. Focus on the lower back, feet, and hands to help the individual feel pampered and cared for. Expressing gratitude can have a positive impact. Thank the person for their cooperation and participation, reinforcing their sense of autonomy and dignity. Offer compliments to boost their self-esteem and reinforce positive behavior, acknowledge their efforts and cooperation. Share with family or paid caregivers what worked, and what did not, and document those experiences. Incorporating individuals' preferences and experiences into their care plan ensures that their needs are met consistently and compassionately. Showering and bathing should be enjoyable activities for the person, not just tasks to be completed. In conclusion, overcoming resistance to showering and bathing in people living with Dementia requires a patient and person-centered approach. By preparing thoroughly engaging the individual positively and using creative alternatives, caregivers can help make the experience more pleasant and manageable. Prioritizing individual's comfort, dignity, and preferences is essential to providing effective and respectful care. Bathing, showering, brushing teeth, and other daily acts of hygiene that were once normal and even enjoyed are now the subject of anguish, anger, and fear. You've taken on a considerable task that many would avoid. Don't give up. Thank you for being here. Thank you for learning all you can. Every day and every way, seek to be kind, helpful, and loving.         MMXXV Copyrighted, Dementia Society, Inc. All rights reserved. This content may be shared or reproduced in whole or in part for educational or informational purposes, provided that proper attribution is given to the Dementia Society of America® along with a link to the original content.

Did you know that your stomach and your brain are connected? It may sound surprising, but scientists have discovered that the gut and brain communicate with each other all the time. This connection is known as the gut-brain axis. What you eat and how healthy your gut is can affect your mood, memory, and even how well you think. Let's explore how this works and how you can keep your brain sharp by caring for your gut. The Gut-Brain Connection Your gut is filled with trillions of tiny bacteria, known as the gut microbiome. Some bacteria are good for you, while others can cause problems if they grow too much. Scientists have found that the gut and the brain talk to each other through: The Vagus Nerve - A long nerve that sends messages between the brain and the gut. It helps control digestion, emotions, and how stressed or happy you feel. Neurotransmitters – These are chemicals that help brain cells communicate. Did you know that about 90% of serotonin (the "happy chemical") is generated in the gut? A healthy gut can help keep your mood balanced. The Immune System —Your gut is home to a large part of your immune system. If your gut is unhealthy, it can cause inflammation, which has been linked to brain diseases like Alzheimer's and depression. How an Unhealthy Gut Can Harm the Brain If your gut bacteria are unbalanced, it can cause problems such as: Brain Fog  – Trouble focusing and thinking clearly. Mood Swings & Depression  – Bad gut bacteria may lower serotonin levels. Memory Problems  – Poor gut health can increase inflammation in the brain. Certain foods, stress, and even lack of sleep can damage the gut and, in turn, affect the brain. How to Improve Your Gut for a Healthier Brain The good news is that you can improve your gut and brain health by making simple changes in your diet and lifestyle. Here are the best ways to do it, according to the Dementia Society of America ® : Eat More Fiber.  Fiber feeds the good bacteria in your gut.   The best  foods are fruits, vegetables, whole grains, and beans. Include Probiotic Foods. These contain good bacteria that help balance your gut. Best foods: Yogurt, kefir, sauerkraut, kimchi, miso. Eat Prebiotic Foods.  These feed the probiotics and help them grow.   The best  foods are garlic, onions, bananas, and asparagus. Limit Processed Foods & Sugar . Junk food and sugar can cause harmful bacteria to grow. Avoid soda, chips, candy, and fast food. Drink Plenty of Water . It helps digestion and keeps the gut lining healthy. Manage Stress . Stress can harm both your gut and brain. Try breathing exercises, meditation, or spending time outside. Get Enough Sleep  – Poor sleep can disrupt gut bacteria and brain function. Aim for 7-9 hours of sleep each night. Conclusion Your gut and brain are connected in amazing ways. A healthy gut can lead to better focus, improved mood, and even protect against brain diseases. Eating the right foods, managing stress, and taking care of your digestion can boost brain health and help you feel your best. So, next time you grab a snack, remember—you're not just feeding your stomach; you're also feeding your brain! Author:  AI-Assisted Human-Edited Staff Writer We do not endorse or guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, paid or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org Additional Reading: Mayer, E. A., Tillisch, K., & Gupta, A. (2015). Gut/Brain Axis and the Microbiota. The Journal of Clinical Investigation, 125(3),  926-938. DOI: 10.1172/JCI76304 Cryan, J. F., & Dinan, T. G. (2012). Mind-Altering Microorganisms: The Impact of the Gut Microbiota on Brain and Behavior. Nature Reviews Neuroscience, 13(10),  701-712.DOI: 10.1038/nrn3346 Collins, S. M., Surette, M., & Bercik, P. (2012). The Interplay Between the Intestinal Microbiota and the Brain. Nature Reviews Microbiology, 10(11),  735-742. DOI: 10.1038/nrmicro2876 Foster, J. A., Rinaman, L., & Cryan, J. F. (2017). Stress & the Microbiota-Gut-Brain Axis in Visceral Pain: Relevance to Functional Bowel Disorders. Gut, 66(9),  1613-1623. DOI: 10.1136/gutjnl-2017-313872 National Institute of Health (NIH) – National Center for Complementary and Integrative Health. The Microbiome: What Is It and How Does It Affect Health https://nccih.nih.gov/ Harvard Health Publishing – Harvard Medical School. The Gut-Brain Connection: How It Works and the Role of Diet. https://www.health.harvard.edu/

Have you ever felt stressed, distracted, or overwhelmed? If so, you’re not alone! Life can be busy and sometimes stressful, but meditation and mindfulness are simple ways to help your brain feel calmer and function better. These practices have been around for thousands of years, and scientists now know that they can improve brain health, memory, and focus. Let’s explore how they work and how you can start using them. What Are Meditation and Mindfulness? Meditation is a practice where you sit quietly, focus on your breathing, and clear your mind. It helps your brain slow down and relax. Mindfulness means paying close attention to what’s happening now—your thoughts, feelings, and surroundings—without judging them. It helps you stay focused and present in the moment. Both meditation and mindfulness help the brain feel more balanced, less stressed, and better at handling emotions. How Meditation and Mindfulness Help the Brain Scientists have studied meditation and mindfulness and found terrific benefits for the brain, including: Reducing stress and anxiety —Meditation helps lower cortisol levels, the hormone that rises with stress. A calmer brain means less anxiety and a better mood. Improving focus and attention – Mindfulness trains the brain to focus on one task at a time, which helps with tasks such as schoolwork, reading, and remembering things. Strengthening memory – Meditation helps increase the size of the hippocampus, the part of the brain that controls memory. This effect enables you to remember things more effectively and learn faster. Boosting emotional health – Regular meditation can make you feel happier and more positive by increasing activity in the brain’s prefrontal cortex, which controls emotions. Helping with sleep – Meditation calms the mind, making it easier to fall and stay asleep. A well-rested brain works much better. Protecting the brain from aging – Meditation may help prevent memory loss and brain diseases, such as Alzheimer’s, by keeping brain cells healthy. How to Start Practicing Mindfulness and Meditation You don’t need any special equipment to start meditating—just a quiet space and a few minutes each day! Here are some easy ways to begin, according to the Dementia Society of America ®: Try deep breathing – Sit quietly, close your eyes, and take slow, deep breaths. Focus on each breath as it goes in and out. Pay attention to your senses —Walk outside and notice what you see, hear, and feel. This will help you stay present in the moment. Take a break from screens —put away your phone and sit quietly for a few minutes, taking a moment to notice your surroundings. Use a guided meditation app – Apps like Calm, Headspace, or Insight Timer offer short, beginner-friendly meditation sessions. Practice before bed – Meditating 5 minutes before sleep can help you relax and fall asleep faster. Conclusion Meditation and mindfulness are simple yet powerful ways to improve brain health, reduce stress, and boost memory and focus. A few minutes a day can make a significant difference in how you feel and think. So why not give it a try? Your brain will thank you. Author:  AI-Assisted Human-Edited Staff Writer Additional Reading: 1. Tang, Y. Y., Hölzel, B. K., & Posner, M. I. (2015). The Neuroscience of Mindfulness Meditation . Nature Reviews Neuroscience , 16(4), 213–225. DOI: 10.1038/nrn3916 2. Goyal, M., Singh, S., Sibinga, E. M., et al. (2014). Meditation Programs for Psychological Stress and Well-Being: A Systematic Review and Meta-Analysis. JAMA Internal Medicine , 174(3), 357–368. DOI: 10.1001/jamainternmed.2013.13018 3. Hölzel, B. K., Carmody, J., Vangel, M., et al. (2011). Mindfulness Practice Leads to Increases in Regional Brain Gray Matter Density. Psychiatry Research: Neuroimaging , 191(1), 36–43. DOI: 10.1016/j.pscychresns.2010.08.006 4. Zeidan, F., Johnson, S. K., Diamond, B. J., et al. (2010). Mindfulness Meditation Improves Cognition: Evidence of Brief Mental Training. Consciousness and Cognition , 19(2), 597–605. DOI: 10.1016/j.concog.2010.03.014 5. Davidson, R. J., & McEwen, B. S. (2012). Social Influences on Neuroplasticity: Stress and Interventions to Promote Well-Being. Nature Neuroscience , 15(5), 689–695. DOI: 10.1038/nn.3093 6. Harvard Medical School. Mindfulness Meditation May Ease Anxiety and Mental Stress. https://www.health.harvard.edu/ 7. National Institutes of Health (NIH) – National Center for Complementary and Integrative Health. Meditation and Mindfulness: What You Need to Know. https://www.nccih.nih.gov/ We do not endorse or guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, paid or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Some cognitive decline is normal with age. However, when people experience a decrease in particular skills, like thinking, reasoning, remembering, and ambulation, severe enough to interfere with daily living, they may be on the road to developing the syndrome of Dementia - the cluster of symptoms brought on by one or more neurological diseases or disorders that negatively affect the brain. Dementia symptoms can range from mild to severe and, by definition, will likely worsen with time. There are several different types of Dementia brain pathologies. The four most common are: Alzheimer's Disease-related Dementia. This type of Dementia is common among older adults. Alzheimer's disease is marked by a buildup of proteins (sticky amyloid plaques) and neuron destruction (tau tangles) that affect cognitive functions. How these changes come about is not entirely known, but genetic, lifestyle, and environmental factors likely play a role. Dementia symptoms such as short-term memory loss and an inability to reason are early hallmarks of this disease. Vascular Dementia . This type of Dementia is linked to various conditions, such as cardiovascular and lung diseases, that affect oxygen and blood flow in the brain. These Dementia symptoms can appear gradually or occur suddenly. Strokes increase the risk for vascular Dementia, but not everyone who has a stroke develops Dementia. Lewy Body Dementia (LBD). This grouping of Dementia syndromes is seen with abnormal deposits of the protein alpha-synuclein in the brain. Also known as Lewy bodies, these deposits affect chemicals in the brain that cause brain changes, leading to difficulty thinking, sleep and visual disturbances, and problems with movement, behavior, and mood. Frontotemporal Dementia (FTD). This type of Dementia is marked by damage to neurons in the frontal and temporal lobes of the brain. Symptoms include unusual behaviors, trouble communicating with others, emotional issues, difficulty finding words, walking, and performing tasks at work and home. Why is Differentiating Dementias Important? Making the proper diagnosis and pinpointing the type of Dementia is the first step toward managing and treating it appropriately, says Vijaya B. Kolachalama, PhD , associate professor of medicine at Boston University and an author of a 2024 study in Nature on using artificial intelligence to differentiate the diagnoses of Dementia. "It's critically important to have the right diagnosis because some patients may have reversible conditions," he says. "For example, if there is a vitamin deficiency causing Dementia, then giving the patient supplements can help. If their Dementia is not reversible, you can do certain things to make sure the patient is managed well." How is Dementia Diagnosed? When a patient exhibits cognitive difficulties, healthcare providers perform a number of Dementia screenings to try to determine what the cause might be. Tests include a physical exam and lab work to check levels of various chemicals, hormones, and vitamins in the person's blood and urine. Reviewing the person's family and medical history can help provide other vital clues, including what medications the person is on (some can cause memory issues). If there are other factors at play, such as heavy alcohol use or a recent brain injury, that may be causing cognitive symptoms. Other tests likely to be used include cognitive and neurological tests to evaluate a person's memory, problem-solving skills, and reasoning abilities. Brain scans such as magnetic resonance imaging (MRI) and computed tomography (CT) may also help identify if there are structural changes in the brain tied to cognition. When patients exhibit behavioral or mood changes, they may also undergo psychiatric evaluations to determine whether they are depressed or have other mental health conditions that could be contributing to the symptoms. Types of Diagnostic Tools to Differentiate Dementias It isn't easy to differentiate Dementias from each other. A person can have more than one type at the same time. Still, researchers have developed many tools to help providers determine what changes are occurring in the brain and evaluate the kind of cognitive decline that is apparent, says John O'Brien , FMedSci, professor of Old Age Psychiatry and NIHR emeritus senior investigator in the Department of Psychiatry at the University of Cambridge School of Clinical Medicine in England. Once reversible causes have been ruled out, further testing may be necessary. Specifically, O'Brien recommends a verbal episodic memory test for Alzheimer's disease, which might include reading the person a list of words or a short story and then asking them to recall the information immediately and again after a delay. O'Brien also says that providers should use the international consensus criteria established for Dementia with Lewy bodies and frontotemporal Dementia as a checklist. If the patient has several symptoms on the list, it can suggest they have that type. The international consensus criteria of Dementia with Lewy bodies, as an example, include Dementia examinations to look for four clinical features: pronounced variations in the person's attention and mental alertness, visual hallucinations, signs of Rapid Eye Movement (REM) sleep behavior disorder, and movement issues such as tremors and rigidity. According to the same international consensus body, the behavioral variant of Frontotemporal Dementia (FTD) is a possibility with at least three of the following findings: exhibiting socially inappropriate behavior, apathy, lack of empathy, compulsive behaviors, changes in taste and diet, and functional decline in managing tasks. Imaging such as MRI, CT, and positron emission tomography (PET) or single-photon emission computed tomography (SPECT) of the brain's frontal lobe should also be used to determine whether someone has FTD, O'Brien says. Researchers hope to find even better ways of diagnosing FTD earlier and distinguish it from other Dementia types better. One area under scrutiny is biomarkers - specific proteins that may be found in higher amounts in blood or cerebrospinal fluid in patients with FTD. A handful of biomarker blood tests are available today, and many are being studied for their role in Dementia diagnosis. Sensitive blood tests that predict the level of beta-amyloid in the patient's brain, for instance, are available to doctors. The results could be a clue to the type of Dementia the person has, but these blood tests are not used alone for a diagnosis. Genetic testing may also play a role in helping to inform a diagnosis of FTD, which has been tied to several genetic mutations and can run in families. Brain imaging tests such as CT, MRI, and PET can help determine whether vascular or other issues cause the Dementia symptoms a person is exhibiting, O'Brien says. These pictures of the brain uncover damage, such as tumors, stroke, shrinkage of brain areas, or abnormal deposits or destruction (sticky plaques or neuronal tangles). Other diagnostic tools are in development and hold promise for differentiating Dementias. For example, Kolachalama and colleagues at Boston University are developing a tool that uses artificial intelligence (AI) to help distinguish the causes of a person's Dementia. The differential AI Dementia diagnosis model uses several data types, including demographics, health history, neurological tests, physical exams, and MRI scans. Kolachalama says their AI tool must still be tested in clinical settings. Still, early indications show that when combined with these data sets, the tool performs better than neurologists' assessments alone. Contributing Author : Beth W. Orenstein Beth W. Orenstein is a freelance medical writer. A magna cum laude graduate of Tufts University, Orenstein has written for HealthDay, EverydayHealth, and the National Psoriasis Foundation and is a regular contributor to American Legion Magazine's Living Well and Radiology Today. The author's opinions are not necessarily those of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, paid or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

A recent editorial in JAMA Neurology (1) suggested that there may be a general decline in Dementia risk in the future because of better brain health due to worldwide improvements in the standard of living, education, and prevention and treatment of serious diseases. This provocative speculation contradicts the more common and dire predictions of a significant increase  in Dementia as the world’s population ages. In this article, we explore the latest ideas about normal aging and cognitive decline with an eye on the future.      Most older people remember many ordinary things, like how to sing a familiar song and tie a shoe. Many people currently live into their 90s and beyond without any significant signs of cognitive impairment. It may take them longer to recall a word or a name, but their general language ability, vocabulary, and reasoning capacity can remain relatively intact. What does tend to decline in normal aging is mental flexibility. Reliable recollection of facts, events, and practical knowledge becomes more complex, and it may become challenging to use newly learned information. Multitasking and executive functioning that requires speed, verbal, and mathematical reasoning typically slow down, especially after age 70. In his book “Why We Remember” (2), Charan Ranganath suggests that we think of memory like a desk cluttered with crumpled-up scraps of paper. If you think about urgently rooting around on that messy desk, trying to find something important that you’ve scribbled on one of those crumpled scraps, you may begin to feel what it’s like to lose access to your memory. Mild Cognitive Impairment (MCI) occurs when there is more difficulty with memory and thinking than expected at a person’s age. Although a person with MCI can still be independent, they may struggle with ordinary tasks and may feel easily frustrated, disorganized, and overwhelmed. In a 2014 study (3) of people whose average age was 70, about 30 percent of people who had been diagnosed with MCI later developed Dementia. Dementia involves a further decline in memory and thinking skills, most commonly due to damage to the brain from a variety of causes. A specific disease-modifying drug for Dementia is not currently available, but some symptoms and underlying causes can be treated. Mild Dementia is characterized by increased confusion, and reading and writing can become difficult or impossible. Repetitive or inappropriate questions and inaccurate answers can make conversation challenging, and it is not unusual for people living with Dementia to become disoriented, leave a safe place, and get lost. There is likely to be impulsive behavior, a diminished capacity for empathy, and, eventually, difficulty recognizing family and friends. At its most severe, a person with Dementia may become utterly dependent on others to manage their basic activities of daily living. A definitive diagnosis of Dementia is complicated because the clinical evidence (seen by a doctor in their office or experienced by loved ones at home) of Dementia is very varied. That said, Alzheimer's disease (AD) pathology, specifically, is defined by physical damage to the brain tissue: clumps of proteins in the brain in the form of beta-amyloid plaques and neurofibrillary tangles. There is a highly accurate commercially available blood test (4) that detects these proteins, and there are two drugs approved by Medicare (lecanemab and donanemab) that dissolve some of the beta-amyloid plaque. Still, they have relatively modest benefits and will not reverse a person’s memory loss or provide lasting improvements. Lecanemab, for example, is said to delay the progression of AD by about five months (5). These drugs require an extensive commitment of time and money, and they have a high risk of serious side effects. Drug regulators in several countries have declined to approve the drugs out of concern that the risks outweigh the modest benefits, and several major US healthcare institutions have opted not to give the drug to anyone with a problematic genetic profile (6). As part of the search to identify cognitive impairment at the earliest possible point so that effective treatments can be developed to prevent and delay the development of Dementia, the concept of Subjective Cognitive Decline (SCD) has recently appeared in the cognitive continuum (7).  It is derived from the requirement by Medicare that the physician ask a patient over 65, at their annual wellness visit, whether they’ve been having any issues with their memory. Participants 60 years and older with normal cognition who participated in the large Framingham Heart Study were asked slightly different variations of that single question, “Do you feel your memory is becoming worse?” Study participants were followed for up to 12 years. If they had answered “Yes,” indicating SCD, it was found that, over time, they had an increased risk of developing cognitive decline and all-cause dementia. On average, SCD preceded the development of MCI by 4.4 years, AD by 6.8 years, and all-cause Dementia by 6.9 years. This supported the premise that SCD could be an early or pre-symptomatic manifestation of impending neurodegeneration, and early detection is believed to improve the potential for treatment and prevention of further decline. While research continues to focus on diagnosis, treatments, and cures, considerable emphasis has shifted toward studying lifestyle and environmental modifications that can reduce the risk and delay the development of cognitive decline. Investing in preventative health (8,9), like being fitted for hearing aids, has been shown to reduce brain damage due to normal biological aging (10). A 2024 article (11) estimates that “…nearly 50 percent of all Dementia cases are preventable…” Experts agree that along with physical exercise or staying socially active, engaging in cognitively stimulating activities or hobbies can help protect against cognitive decline by building mental muscle or “cognitive reserve” (12,13). And these activities have virtually no downsides! Some healthy lifestyle and environmental modifications that have been scientifically validated to reduce the risk of cognitive decline are listed below and discussed here (14). Eat healthily, the so-called MIND diet. Find a way to exercise regularly to whatever degree is possible for you. Breaking a sweat builds your brain. If you aren’t working or socially active, consider volunteering or getting involved somewhere to be socially and intellectually stimulated. Try to get the best medical care possible if something seems to be physically or psychologically wrong. Ask your doctor to adjust medications that affect cognition. Correct even mild hearing or vision loss; reduced activity in the brain due to age-related sensory changes can lead to faster rates of atrophy and an increased risk of cognitive decline and dementia (15). Address sleep problems: untreated, they may contribute to cognitive decline and affect the brain's resilience (16). Moderate or eliminate alcohol consumption and stop using tobacco products. Minimize stress. Widespread prioritizing of healthy habits will have a measurable impact on the future incidence of cognitive decline. Perhaps, hopefully, our grandchildren will learn whether improved brain health, supplemented by the development of targeted treatments and cures, will result in a decrease in the future risk of cognitive decline. Contributing Author: Carol A. Butler, Ph.D. References Vemuri, P. 2024.  Improving trends in brain health explain declining dementia risk? JAMA Neurology , 81(5):442-443. Published online March 25, 2024.  Ranganath, C. 2024. Why We Remember . Doubleday, New York. Roberts RO et al. 2014. Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal. Neurology Jan 28; 82(4): 317-325. Palmqvist, S. et al. 2024. Blood biomarkers to detect Alzheimer disease in primary care and secondary care. Jama, 332(15):1245-1257.   van Dyck CH et al. 2023. Lecanemab in early Alzheimer’s disease. NEJM , 388:9-21. Bogdanich, W. and Kessler, C. What Drugmakers Did Not Tell Volunteers in Alzheimer’s Trials. New York Times October 23, 2024. Kang, M. et al. 2024.  Subjective cognitive decline and longitudinal assessment and risk for cognitive impairment. JAMA Psychiatry , published online July 3, 2024.Van Dyck, C. et al. 2022. Taquet, M. et al. 2024. The recombinant shingles vaccine is associated with lower risk of dementia. Nature Medicine .30, 2777-2781. https://rdcu.be/dXxnR    Veronese, N. et al. 2022. Influenza vaccination reduces dementia risk, a systematic review and meta-analysis. Ageing Research Reviews , 73. https://doi.org/10.1016/j.arr.2021.101534 Marinelli J. et al. 2022. Association between hearing loss and development of   dementia using formal behavioural audiometric testing within the Mayo Clinic Study of  Aging (MCSA): a prospective population-based study. The Lancet Healthy Longevity.  3(12): E817-824. Livingston G et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet Commissions 404 (10452): 572-628. Krivanek TJ et al. 2021. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Disease June 1; 81(3): 871-920. Blumen, H. et al. 2024. Cognitive reserve proxies are associated with age-related cognitive decline- not age-related gait speed decline. Neurobiology of Aging . 141:46-54. Butler, C. 2024. Lifestyle modifications for brain health. https: www.dementiasociety.org/post/lifestyle-modifications-for-brain-health Smith, D. 2024. How hearing and vision loss increase the risk of dementia. https://www.nytimes.com/2024/08/08/well/mind/hearing-vision-dementia-risk.html Ho, P. et al.2024. Sleep, 24-hour activity rhythms, and subsequent amyloid-B pathology. JAMA Neurology , 81(8): 824-834. Authors' opinions are not necessarily those of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, paid or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Caring for someone living with Dementia can be a tough job. It's a role filled with emotional highs and lows, requiring considerable patience and strength. Finding ways to manage stress and emotions is crucial for caregivers. One effective method may be Cognitive Behavioral Therapy (CBT). Let's explore how CBT can help Dementia caregivers lead a healthier and more balanced life.   Understanding Cognitive Behavioral Therapy   First, what exactly is Cognitive Behavioral Therapy? CBT is a type of talk therapy in which you sit with a therapist and talk through your feelings and thoughts. The key idea behind CBT is that our thoughts, feelings, and actions are connected, and changing negative thoughts can help improve our emotions and behaviors.   Stress Reduction   Caregiving can often feel like a 24/7 job with no breaks. This continuous stress can lead to burnout, where a person feels extremely tired and unable to cope. CBT comes into play by teaching care partners techniques to manage their stress more effectively. For example, a therapist might help a caregiver identify and work on changing stressful thoughts. Instead of thinking, "I can't do this anymore," CBT would help them think, "This is hard, but I can handle it."   Better Emotional Management   It's normal for caregivers to experience a range of emotions, from sadness and frustration to guilt and anger. These feelings are natural, but they can be overwhelming. CBT helps by offering tools to manage these emotions more effectively. Caregivers learn to recognize their emotional triggers and understand how to calm themselves when faced with challenging situations.   Improved Relationships   CBT can also enhance caregivers' interactions with the person they're caring for. Sometimes, misunderstandings or communication gaps can create additional stress. CBT techniques help caregivers communicate more effectively by teaching them to express their needs and feelings clearly, without becoming upset or angry, thereby easing the situation and strengthening their relationship with the person they care for.   Coping with Change   As Dementia progresses, the person's abilities and behaviors can change dramatically, which can be challenging for caregivers to handle. Often, at the beginning, the relationship is relatively balanced, resembling a type of partnership. We prefer to refer to someone acting as a "care partner" in this situation. However, over time, the burden of caring usually shifts to the person who is not living with Dementia, and their role evolves to giving care. In other words, they are now a "caregiver." In these cases, CBT typically helps them adapt to these changes by setting realistic expectations and learning to accept things they cannot change. It teaches them to focus on what they can control: their reaction and attitude towards the situation.   Encouraging Positive Thinking   One of the core parts of CBT is cultivating a habit of positive thinking. Caregivers are often so focused on the needs of the person they are caring for that they forget to appreciate the good moments. CBT encourages them to notice and appreciate these joyous times, which can boost their morale.   Enhancing Self-Care   Finally, CBT emphasizes the importance of self-care. For caregivers, taking care of themselves is often at the bottom of their to-do list. CBT sessions can include setting goals for self-care activities, such as regular exercise, hobbies, or spending time with friends and family. These activities help reduce stress and prevent caregiver fatigue.   Conclusion   Caring for someone with Dementia is no easy task, and caregivers need to have support systems in place. Cognitive Behavioral Therapy is a valuable tool that offers this support. It helps caregivers manage stress, handle emotional ups and downs, improve communication, cope with changes, and appreciate the positive aspects of caregiving.   If you're a caregiver feeling overwhelmed, consider cognitive behavioral therapy (CBT). It could be a step towards better managing your duties and enjoying them more. Remember, taking care of your mental health is just as important as the physical care you provide. Contact the Association for Behavioral and Cognitive Therapies here to find a CBT therapist. Author: AI-Assisted Human-Edited Staff Writer We do not endorse or guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, paid or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Many people want to keep their brains sharp, especially as they age. In the United States, over-the-counter (OTC) supplements for brain health have gained popularity. These products claim to improve memory, focus, and brain function. But do they work? The Dementia Society of America ® explains what these supplements are, what’s in them, and whether they help your brain. What Are Brain Health Supplements? Brain health supplements are pills, powders, or drinks that people buy without a doctor’s prescription. They are sold in stores and online, often labeled as “memory boosters” or “focus enhancers.” These supplements contain ingredients like: Omega-3 fatty acids – found in fish oil – may support brain function.  B Vitamins – contribute to energy levels and brain cell health.  Ginkgo Biloba – a plant extract that some believe enhances memory.  Caffeine – present in coffee and tea, it can increase alertness.  Herbs such as ashwagandha – thought to reduce stress. Do Brain Health Supplements Actually Work? Scientists   are still unsure if these supplements improve brain function. Some studies suggest that certain ingredients, like omega-3s and B vitamins, may support brain health, especially for people who don’t get enough from food. However, many other ingredients lack scientific evidence to support their effectiveness. There Is No Magic Pill  – The U.S. Food and Drug Administration (FDA) does not test supplements for effectiveness before they are sold. This means companies can claim their products help the brain, even without strong evidence. Not a Cure for Memory Loss  – Some supplements say they prevent the diseases that cause Dementia or Alzheimer’s disease, but no supplement has been proven to do this. The Dementia Society of America® reminds the public to be cautious of products that make these claims. Are There Any Risks? While most brain supplements are generally safe, some may have side effects or interact with certain medications. Too Much of a Good Thing  – High doses of specific vitamins, like B6 or B12, can cause nerve problems. Blood Thinners  – Ingredients like Ginkgo Biloba may thin the blood and increase the risk of bleeding problems. Fake or Unregulated Products —Some supplements do not contain what they promise since the U.S. supplement industry is little regulated. Better Ways to Support Brain Health Instead of relying on supplements, scientists recommend proven methods to keep your brain healthy: Eat a Brain-Boosting Diet  – Foods like fish, nuts, berries, and leafy greens help brain function. Exercise Regularly  – Physical activity improves blood flow to the brain. Get Enough Sleep  – The brain needs rest to function correctly. Stay Mentally Active  – Reading, puzzles, and learning new things help keep your brain sharp. Stay Social  – Talking to friends and family helps memory and mental well-being. Conclusion While brain health supplements are popular in the United States, there is limited evidence that they enhance memory or focus. Some ingredients may have mild benefits, but they do not cure memory loss or brain diseases. Instead of relying on supplements, people can maintain a strong brain by eating a balanced diet, exercising regularly, and engaging in mentally stimulating activities. A healthy lifestyle is the best way to support brain health for life! Author: AI-Assisted Human-Edited Staff Writer Additional Reading: National Institutes of Health (NIH) – Office of Dietary Supplements. Dietary Supplements for Cognitive Function, Dementia, and Brain Health. https://ods.od.nih.gov/ U.S. Food and Drug Administration (FDA). Caution on Dietary Supplements for Brain Health and Memory Claims. https://www.fda.gov/ National Center for Complementary and Integrative Health (NCCIH). Can Supplements Help with Memory and Thinking? https://www.nccih.nih.gov/ Harvard Medical School. Brain Supplements: What Works and What Doesn’t? https://www.health.harvard.edu/ American Academy of Neurology (AAN). The Truth About Over-the-Counter Memory Supplements. https://www.aan.com/ We do not endorse or guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, paid or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Your brain is one of the most critical parts of your body. It helps you think, feel, and move. But what happens when your brain gets hurt? Scientists have found that brain injuries can sometimes lead to brain diseases later in life. Let’s explore how this happens and what we can do to protect our brains. What is a Brain Injury? A brain injury happens when something damages the brain. This injury can be caused by: A blow to the head (like in sports or car accidents) A fall (especially in older adults or young children) A stroke (when blood flow to the brain is blocked) A lack of oxygen (like drowning or choking) Brain injuries can be mild, like a concussion, or severe, like a traumatic brain injury (TBI). Some injuries heal quickly, while others cause lasting damage. What is a Brain Disease? A brain disease is a condition that affects the brain's functioning over time. The Dementia Society of America ® provides a list of the more common brain diseases: Alzheimer’s disease (AD) – may cause Dementia, which includes memory loss and confusion. Cerebrovascular disease (VaD) – may cause Dementia, which may include instability/falls, as well as personality and other cognitive changes. Lewy Body Dementia (LBD) – may cause Dementia and can include memory loss, tremors, and hallucinations. Frontotemporal Degeneration (FTD) – may cause Dementia, which can include behavioural challenges and issues with speech and mobility. Parkinson’s disease (PD) – may affect movement and balance. Some portion of those living with PD will develop Dementia. Chronic Traumatic Encephalopathy (CTE)  – often linked to repeated head injuries, and a cause for developing Dementia. Brain diseases can make it harder to think, move, or remember things as one ages. How Brain Injuries Can Lead to Brain Diseases When the brain gets injured, it tries to heal itself. But sometimes, the damage is too severe, and over time, this can lead to brain diseases. Here’s how: Inflammation in the Brain After an injury, the brain becomes inflamed, like a bruise on your body. If inflammation lasts too long, it can damage brain cells and increase the risk of brain diseases. Repeated Head Injuries and CTE Athletes who participate in football, boxing, or soccer often experience repeated blows to the head. Over time, these injuries can lead to CTE, which affects memory, mood, and thinking. Damage to Blood Flow Injuries can damage blood vessels in the brain, making it more difficult for the brain to obtain oxygen. Poor blood flow increases the risk of strokes and Dementia. Buildup of Toxic Proteins Some brain injuries cause the brain to produce harmful proteins, which are linked to diseases like Alzheimer’s and Parkinson’s. How to Protect Your Brain There are several ways to protect your brain: Wear a helmet  when riding a bike, playing sports, or engaging in other high-risk activities. Buckle your seatbelt  to avoid head injuries in car accidents. Prevent falls  by keeping floors clear and using handrails to support your balance. Stay active  with exercise, which keeps blood flowing to the brain. Eat brain-healthy foods  like fish, nuts, and leafy greens. Give your brain rest  after an injury—don’t rush back to sports or work too soon. Conclusion Brain injuries can have profound effects, and sometimes, they lead to brain diseases later in life. By understanding the risks and protecting our brains, we can maintain our health and well-being for years. Take care of your brain—it’s the only one you’ve got! Author:  AI-Assisted Human-Edited Staff Writer Additional Reading: Centers for Disease Control and Prevention (CDC). Traumatic Brain Injury & Concussion. https://www.cdc.gov/traumaticbraininjury/ National Institute of Neurological Disorders and Stroke (NINDS). Traumatic Brain Injury: Hope Through Research. https://www.ninds.nih.gov Alzheimer’s Association. Head Injuries and Dementia Risk. https://www.alz.org Mckee, A. C., Stein, T. D., Kiernan, P. T., & Alvarez, V. E. (2015). The Neuropathology of Chronic Traumatic Encephalopathy. Brain Pathology, 25(3),  350–364. DOI: 10.1111/bpa.12248 Smith, D. H., Johnson, V. E., & Stewart, W. (2013). Chronic Neurodegenerative Consequences of Traumatic Brain Injury: From CTE to Alzheimer’s Disease. Brain Injury, 27(3),  365-372. DOI: 10.3109/02699052.2013.865357 Mayo Clinic. Concussions and Brain Injuries. https://www.mayoclinic.org We do not endorse or guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, paid or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Dementia Horizons™ | Workshop 16 | Meaningful Activities Video Module [16] Transcript Welcome. Thank you for joining me today. Dementia is a progressive condition that affects memory, thinking, behavior, and the ability to perform everyday activities. It is divided into three stages, early, middle, and late. Each stage presents unique challenges and requires different approaches to care and engagement. Meaningful activities can enhance the quality of life for individuals living with Dementia, providing a sense of purpose, reducing distress, and improving overall well-being. This video offers practical tips and ideas for creating meaningful activities tailored to each stage of Dementia. In the early stage of Dementia, individuals may experience mild memory loss and changes in cognitive function, but can still participate in many activities with minimal assistance. This stage focuses on maintaining independence, stimulating the mind, and encouraging social interaction. This can include puzzles and games, word searches, crosswords, Sudoku, and jigsaw puzzles. Encourage reading books, newspapers, or magazines, and writing letters or journaling. Introduce new hobbies such as painting, playing a musical instrument, or learning a new language. The key is to work on learning something new and different to challenge the brain. Physical exercise is crucial for overall health, improving mood and reducing anxiety. Consider regular walks in the park or around the neighborhood, or exercise classes, yoga, tai chi, or dance classes and gardening. Planting flowers or vegetables provides a sense of accomplishment. Maintaining social connections can be described as a meaningful activity, and can help prevent feelings of isolation and depression. This can be accomplished by joining a book club, participating in senior center activities, attending faith-based services or joining hobby groups. Consider volunteering, participating in community service, or helping at local organizations. Regular visits and outings with family and friends are wonderful ways to sustain relationships. Encourage regular, shorter visits to prevent fatigue. Be sure to share how best to communicate or engage differently, as language skills and the ability to initiate conversation or activities can be altered. Include creative and therapeutic modes of expression. Many people with Dementia enjoy arts and crafts, such as drawing, painting, knitting, or scrapbooking. Music is another important way to spend time. You can play an instrument, sing or listen to your favorite songs, take photos or create albums or scrapbooks. As Dementia progresses to the middle stage, individuals may require more assistance with daily activities, and experience increased confusion and memory loss. Activities should be simplified, and focus on familiar tasks that provide comfort and enjoyment. It is important to adapt activities to match the person's abilities. This means simpler puzzles and games, such as larger pieces of jigsaw puzzles, matching games and picture-based activities, short stories, audio books, and magazines with lots of pictures. Consider looking at old photos, discussing past experiences, and creating a memory box with cherished items. Also, physical activities such as chair exercises, stretching, seated yoga, or gentle movements should be modified to ensure they are safe and enjoyable. Enjoy playing balloon volleyball: a fun, low impact way to stay active. Try nature walks: short walks in familiar, safe environments. It may be appropriate to investigate adult day programs designed for individuals with Dementia. Continue to support creative activities focusing on enjoyment, rather than the end result or the finished product. Simple projects like coloring, collage-making, or decorating items. Listen to music, sing along to familiar songs, or play simple instruments like maracas, or encourage the person to tell stories from their past. In the late stage of Dementia, individuals often have severe cognitive and physical impairments and need full-time care. Activities should focus on sensory stimulation, and maintaining comfort and dignity. Focus on engaging the senses to evoke positive emotions and memories. Use soft fabrics, textured objects and hand massages. Engage familiar scents like lavender, baking cookies or flowers. Offer favorite foods and drinks that evoke pleasant memories. Listen to calming music and nature sounds, or read aloud. Watch videos of nature, family photo slideshows, or light displays. Even during the later stages of Dementia, gentle movement can be beneficial: guided movements to maintain flexibility and circulation, to promote relaxation and reduce discomfort. Assist with short walks in safe, familiar environments. Don't forget to provide comfort and emotional support at this stage. Engage in gentle conversation, holding hands and providing reassurance. Play recordings of family members or friends. Minimize noise to maintain a peaceful setting. A sense of security can be created by caring for a soft doll or stuffed animal. Caregivers can also offer quilts with various textures and attachments to keep hands busy. Caregivers, be patient and flexible. Understand that abilities and preferences may change from day to day. Be willing to adapt activities accordingly. Allow the person to do as much as possible independently, offering support only when necessary. Offer praise and encouragement to boost confidence and motivation. Focus on the process, not the outcome. The enjoyment and engagement in the activity are more important than completing it perfectly. Enjoy the moments together. It is an invaluable life skill to learn. Creating meaningful activities for individuals with Dementia requires understanding their abilities, preferences, and the stage of their condition. By focusing on activities that promote cognitive stimulation, physical movement, social interaction, and creative expression, a caregiver can significantly enhance the quality of their loved one's remaining life. Remember, the goal is to provide joy, comfort, and a sense of purpose, helping individuals living with Dementia to live their lives to the fullest. Once again, you've taken the time to consider all the wonderful ways you can help your loved one. As discussed today, non-medical therapies can have the greatest impact on both you and the one you care for. You are the light and sunshine that make all things possible. Thank you for joining me today to learn more about how to create meaningful activities.         MMXXV Copyrighted, Dementia Society, Inc. All rights reserved. This content may be shared or reproduced in whole or in part for educational or informational purposes, provided that proper attribution is given to the Dementia Society of America® along with a link to the original content.

Dementia Horizons™ | Workshop 15 | Hiring Help Video Module [15] Transcript Hello and welcome. Caring for your loved one living with Dementia can be a challenging and demanding responsibility as the syndrome progresses. Professional help often becomes necessary to ensure the well-being of both the individual with Dementia and their care partners. Hiring paid help can provide much-needed relief and specialized care, but it can be daunting. Although this program seeks to explain the process and offer practical advice for hiring paid help in the home, you may also wish to consider hiring a professional care manager to assist you in creating a care plan and manage the overall process. There are organizations that represent professional care managers. Please visit our website, dementia society.org , and search for care management options. It's certainly an avenue you may want to explore. Okay. Before we review the hiring process, it's essential to recognize when additional help is needed. Indicators that it might be time to hire professional assistance include: Increased care needs. When the loved one's condition deteriorates, they may require constant supervision and assistance with activities of daily living, also known as ADLs, such as bathing, dressing, and eating. Caregiver burnout. Family caregivers feel overwhelmed, exhausted, or unable to manage their own health and responsibilities. Safety concerns. The top priorities to address are fall risks; behaviors requiring vigilant monitoring; barriers to providing care in the home, such as steps or lack of handicap accessibility; or simply lack of physical strength needed to care for another person, like the ability to lift a heavy weight. Acknowledging these signs is the first step towards seeking help and ensuring the best care for your loved one. Paid help can vary significantly in terms of services offered, and the level of expertise provided. I'll now discuss the various care services that families find helpful. It is essential to hire individuals who have received some level of formal Dementia care training. Ask for the names of training programs they have completed, as well as how and when they receive continuing education. Moreover, it is important to know the three typical types of care workers, as it will help you decide which type of professional suits your loved one's current situation. Over time, you'll likely need some combination of all three. Let's start with companion care . Companions provide social interaction, and assistance with non-medical tasks such as housekeeping, food preparation, and transportation. Home health aides , they offer more comprehensive personal care like bathing, dressing, and medication reminders. Note that generally, home health aides are not legally allowed to administer medications in many jurisdictions. Nurses , they provide family education and medical care, such as administering medications, managing medical equipment, and performing health assessments. Let's turn our attention to preparing for the hiring process. Before contacting agencies or potential caregivers, it's important to gather relevant information and prepare thoroughly. Start by making a detailed list of your loved one's care requirements, including daily routines, medical conditions, and any concerning Dementia-related behaviors. Then set a budget. Determine how much you can afford to spend on paid help. Consider factors like your loved one's financial resources, insurance coverage, and potential benefits from programs such as Medicaid or Veteran's Assistance. It will be important to know if the person with Dementia has long-term care insurance. Otherwise, most care is paid out-of-pocket. One important consideration. There are jurisdictions that permit family members to become paid caregivers. Check with your local Area Agency on Aging or a care management professional, and they should be able to share with you if it is allowed where you live. There is usually an application process. Okay, next, create a job description. Outline the responsibilities and qualifications you expect from a caregiver. Be specific about duties, working hours, and any special skills needed, such as experience with Dementia care. There are several ways to find potential caregivers, so let's review a couple of them. Home care agencies. These agencies employ a range of caregivers and handle screening, training, and payroll. They should be able to match you with caregivers who have experience with Dementia. Direct private hiring is another option. You can independently hire a caregiver through job postings, personal recommendations, smartphone apps, and online caregiver registries. This approach may provide more flexibility and cost savings, but it requires more effort in terms of screening, coordination of schedules, management of payroll and taxes, and possibly increased liability insurance. Next is the caregiver interview. The interview process is crucial for finding the right caregiver. Here are some steps to ensure a thorough interview, whether you are hiring from an agency or privately. Ask about the candidate's experience with Dementia care, their approach to handling challenging behaviors, and their ability to perform specific tasks outlined in the job description. Assess their personality, communication skills, and especially their ability to connect with others. A good caregiver should be patient, compassionate, and adaptable. A ready smile, the ability to laugh, and an approachable manner are subtle, but essential interpersonal skills that can go a long way to creating a loving and caring environment. Then request and contact references to verify the caregiver's qualifications, reliability, and past performance. If you are hiring privately, conduct a background check. A cursory search on the internet will turn up paid services to make the background check a bit faster and more detailed. You can also simply type someone's name into a search engine or look through social media for any information you can glean. Obviously, caregiver agencies should be doing all of this on their own, and that can be a major time saver and one reason to use them. Ensuring the safety and trustworthiness of the caregiver is paramount. When you conduct comprehensive background checks, although not an exhaustive list, pay particular attention to these points. Verify that the caregiver has no criminal history that would pose a security risk. Ensure that they have a clean driving record, especially if they'll be required to drive your loved one anywhere. And lastly, confirm any certifications or training the caregiver claims to have, especially those related to Dementia care. Requesting copies of their certificates of completion is not beyond reasonable. Once you've selected a caregiver, it's vital to establish clear expectations and boundaries. Develop a detailed plan outlining daily routines, medication schedules, emergency contacts, and specific instructions for managing Dementia symptoms. Have a contingency plan for situations when the primary caregiver is sick or unavailable. This could involve having a list of backup caregivers or arranging short-term care through an agency, if needed. Discuss and agree on house rules such as policies on smoking, alcohol, recreational drug use, guns, visitors, vaccinations, cell phone use, and any contingencies for household emergencies. Establish regular check-ins to discuss your loved one's progress, any issues that arise and any adjustments needed in the care plan. Monitoring and evaluation are crucial to ensure your loved one receives the best care. You can make unannounced visits to observe the caregiver's interactions with your loved one, and ensure they are following the care plan. Schedule regular discussions to assess the caregiver's performance and discuss changes in your loved one's condition or care needs. Despite careful planning, challenges may arise. Here are some strategies to address common issues. Conflict resolution: address conflicts calmly and directly. If an agency is involved, discuss concerns with the caregiver and agency and seek to understand their perspective. As Dementia progresses and changes over time, care needs will change. Talk with the agency and or caregiver to address any modifications that are required. As I hinted at previously, hiring private paid help involves certain legal and financial responsibilities. Here are detailed insights: Employment contracts: create a written agreement detailing the terms of employment, including job duties, hours pay, and termination conditions. Payroll and taxes. Understand your obligations regarding payroll, taxes, workers' compensation, and other employment-related taxes. Consider using a payroll service to manage these tasks. Lastly, there is insurance. Ensure the caregiver is covered by appropriate liability insurance and consider obtaining a bond for added protection. Hiring paid assistance can greatly improve the quality of life for individuals and alleviate the burden of constant worry. You can find a caregiver who will provide compassionate and effective care by understanding the type of help needed, by preparing thoroughly, conducting careful interviews and background checks, and setting clear expectations. Ongoing monitoring addressing challenges, and seeking support for yourself, will ensure a successful caregiving arrangement that benefits everyone involved. I hope that what you've learned allows you to confidently and successfully staff the roles that are most needed, with people who truly care. Thank you for joining me.         MMXXV Copyrighted, Dementia Society, Inc. All rights reserved. This content may be shared or reproduced in whole or in part for educational or informational purposes, provided that proper attribution is given to the Dementia Society of America® along with a link to the original content.

Dementia Horizons™ | Workshop 13 | Driving Concerns Video Module [13] Transcript Welcome. For many of us, driving means a sense of independence, freedom, self-reliance, autonomy, and adventure. Being told that you can no longer drive after 50-60 years of doing so, can be very hard on a person's sense of ego and independence. This video will focus on how to address safety concerns for people who are beginning to show signs of minor cognitive impairment, or possibly are in the very early stages of a diagnosed or undiagnosed disease, that is manifesting as the syndrome of Dementia. Let's start by pointing out that driving is a complex task requiring life and death decision-making, and all sorts of other important cognitive and physical capabilities. As a refresher, Dementia is not a disease. Instead, it is a cluster of progressive symptoms that result from one or more underlying brain diseases or disorders. Medically, it's a syndrome if the symptoms progress to the point of requiring help to complete one or more activities of daily living. That alone, coupled with other cognitive deficits that a doctor can assess, is usually enough to be diagnosed as Dementia. To be clear, if someone has been diagnosed with cognitive impairments advanced enough to be called Dementia, they should not drive, period. Full stop. In fact, most state motor vehicle laws prohibit a person from maintaining a driver's license in such cases. We agree. As our bodies age, it is common for changes to impact our ability to drive safely, and those changes can be downright dangerous for those whose brains are declining a bit faster than what we consider normal for one's age. Moreover, when it comes to driving, there are other people's lives to consider in addition to our own. These changes in ability include problems with depth perception, estimating distance and spacing, narrowing of peripheral vision, difficulty discerning shapes, staying in a lane and understanding road signs, remembering directions and rules of the road, knowing when to stop or speed up, having the motor reflexes to stop suddenly or change direction, keeping impulses in check under stressful conditions or situations. If someone is in the very early stages of cognitive impairment, it does not mean that the person must automatically stop driving. However, when there are noticeable declines in ability, discussing any concerns about driving is essential. Some individuals with minor cognitive impairment continue to maintain insight and self-awareness, and can recognize the need to limit their driving. It may mean that they stick to driving on very familiar roads, avoid days and times that usually have heavy traffic, avoid driving in the rain, sleet, or snow, or driving at dusk or at night. Recognize Any Driving Concerns When Being a Passenger Are they becoming lost in familiar places? Have they successfully used GPS directions on their phone, but now they're getting confused using the apps? As a passenger, observe if they mix up the brake and gas pedals, or have a hard time dealing with four-way stops. Do they drive too slowly and impede traffic, fluctuate in levels of alertness and drowsiness, see things or people that do not exist, become nervous and aggravated while driving, have difficulty changing lanes as well as entering or exiting the highway, have unexplained dents or scrapes, experience frequent fender benders, or damage the wheels or tires by bumping into curbs? What can you do? You may be able to obtain a formal driving evaluation by contacting your State Department of Motor Vehicles. Follow the guidelines for your state, but this type of evaluation should be repeated at regular intervals. Also, it's not uncommon for doctors and hospitals to refer individuals to occupational therapists. They should be able to help with various functional assessments, including driving skills. Make a list of transportation alternatives. Ask friends and family to offer car rides, and find out if there are any community volunteer groups that offer transportation help. Use on-call smartphone apps that summon a driver to the person, along with taxis. Eliminate the need to drive by using online shopping for home delivery of groceries and more. Some individuals and families even find ways for a barber or hairstylist to make home visits. Consider having a transportation buddy for socialization and support. You can also contact your Area Agency on Aging to determine what transportation services may be available in your area. It can become problematic if the person living with minor cognitive impairments progresses to Dementia and starts to lose the insight or knowledge that they are no longer safe to drive. They can resist. They can refuse to stop driving. Or maybe they agree to stop, but forget what they decided days later. Sometimes the only thing that makes them stop is having their doctor or medical professional take the blame, and write on the prescription pad a note that clearly states in large capital letters: DO NOT DRIVE. Alternatively, a private conversation with a non-medical authority figure, such as their faith leader, attorney, accountant, or financial advisor can make a difference. Getting them to come to grips with the change may take more than one approach. However, there are times when the spouse, adult child, or advocate must step in, to maintain the safety of the driver, passengers, other drivers, bicyclists, or pedestrians. Before it's too late, consider hiding the keys, disabling the car, or taking it to the repair shop for work to be done, work that never seems to end. It may become necessary to find secure storage, or sell the vehicle. Selling the car to a family member at a good price benefits both the seller and the buyer. Donating it to a nonprofit, or giving it to a friend in need, may ease the pain of getting rid of it. This is often a tough time: parenting a parent, a reversal of roles. It is also a good opportunity to seek support to address your conflicted feelings, which can often include guilt, anger, and resentment. This is the time to remember that the overall goal is safety for the person with Dementia and other drivers or pedestrians on the road. This safety supersedes the person's anger and desire to drive. Addressing driving safety now is much easier than having to possibly address all that would be involved if someone is seriously injured or even killed on the road. When you are the one who takes away the keys or car, know that you are caring for that person in a way that fills in for the insight that is now lacking. By approaching driving concerns thoughtfully and proactively, you can help ensure the safety and well-being of individuals with Dementia while maintaining their dignity and independence and allowing them to live a more worry-free life. The subject of driving is stressful for all involved. Thank you for listening and watching. You are taking positive steps to help keep your loved one and others safe. Thank you again. I wish you peace on your journey.        MMXXV Copyrighted, Dementia Society, Inc. All rights reserved. This content may be shared or reproduced in whole or in part for educational or informational purposes, provided that proper attribution is given to the Dementia Society of America® along with a link to the original content.

Unlocking brain health and resilience.   Remarkable discoveries have been unfolding among the congregation of the School Sisters of Notre Dame. This unique exploration into the lives of these dedicated women has provided valuable insights into the mysteries of brain health and cognitive resilience. Let’s delve into the fascinating world of the Nun Study and uncover the secrets it holds about maintaining a healthy brain, including a peculiar finding that nuns with the pathology of a Dementia did not necessarily exhibit its symptoms.   The Nun Study Reveals Secrets of a Healthy Brain Initiated in 1986 by Dr. David Snowdon, the Nun Study focuses on a group of Catholic nuns whose lives have been dedicated to faith, service, and education. What makes this study particularly intriguing is its connection to brain health and aging. The nuns generously agreed to donate their brains for postmortem analysis, allowing scientists to examine the relationship between their lifestyles, cognitive abilities, and the physical state of their brains.   Healthy Aging and Cognitive Reserve The results of the Nun Study have been groundbreaking, revealing a strong connection between certain lifestyle factors and cognitive health. One key concept from this research is the idea of cognitive reserve. Cognitive reserve refers to the brain’s ability to withstand damage and continue functioning optimally even in the face of aging or neurological diseases.   Education and Cognitive Reserve The nuns, many of whom were highly educated, exhibited a remarkable cognitive reserve. Education acts as a shield for the brain, providing a reserve that allows people to maintain cognitive function despite the wear and tear occurring over time. Investing in education enriches our brains and fortifies our cognitive resilience.   Social Engagement and Emotional Well-Being Beyond education, the Nun Study highlights the importance of social engagement and emotional well-being in maintaining cognitive health. The nuns who reported greater satisfaction in their lives and had strong social connections exhibited lower rates of cognitive decline. This emphasizes the holistic nature of brain health, acknowledging the interconnectedness of brain, body, and spirit.   Physical Exercise and Brain Benefits In addition to intellectual and social factors, physical exercise emerged as a crucial element in the Nun Study. The nuns who engaged in regular physical activities demonstrated better cognitive performance and a reduced risk of developing cognitive disorders. This reinforces the well-established link between a healthy body and a healthy brain.   The Enigma of Dementia Pathology One of the most intriguing aspects of the Nun Study is the discovery that some nuns who had the pathological signs of a disease associated with Dementia did not exhibit its symptoms. This "secret" phenomenon challenges conventional wisdom about the direct correlation between the presence of brain pathology and the manifestation of cognitive decline.   The Role of Cognitive Reserve in Defying Dementia Researchers hypothesize that the strong cognitive reserve built through education, social engagement, and intellectual stimulation protects against the outward expression of Dementia-related pathology. These nuns, despite having the physical markers of disease in their brains, maintained cognitive function due to the resilience fortified through a lifetime of intellectual pursuits and social connections.   Education as a Lifelong Journey Education doesn’t end with a diploma or a degree; it is a lifelong journey. Embrace the joy of learning, explore new subjects, and challenge your brain regularly. The Nun Study findings have shown us that each nugget of knowledge contributes to the cognitive reserve, building a resilient foundation for the challenges of aging.   Nurturing Social Bonds Cultivate meaningful relationships with family, friends, and community. Social engagement not only brings joy and fulfillment but also acts as a protective factor against cognitive decline. Make time for conversations, shared experiences, and laughter, recognizing the profound impact of human connection on brain health.   Prioritizing Emotional Well-Being Pay attention to your emotional well-being. Practice mindfulness, manage stress, and seek support when needed. The Nun Study underscores the significance of emotional health in preserving cognitive function, emphasizing the intricate connection between mental and emotional well-being.   Embracing Physical Activity Incorporate regular physical activity into your routine. It doesn’t have to be strenuous; a brisk walk, dancing, or gardening can offer substantial brain benefits. The Nun Study’s insights have taught us that taking care of our bodies directly contributes to the longevity and vitality of our brains.   Conclusion The Nun Study has given us a profound understanding of the factors contributing to brain health and cognitive reserve, including the intriguing revelation that some people with a disease pathology may not exhibit its symptoms. As we navigate life’s journey, let us heed the call to action embedded in this research. By embracing education, nurturing social bonds, prioritizing emotional well-being, and engaging in regular physical activity, we can fortify our cognitive resilience and lead fulfilling lives, maintaining the vibrancy of our brains well into the golden years. The School Sisters of Notre Dame have not only left a legacy of service and faith but have also gifted us with invaluable lessons on how to age with grace, wisdom, and a resilient brain.   A Call to Action As we reflect on the lessons from the Nun Study, it becomes clear that we can shape our cognitive destiny. The call to action is simple yet profound: Invest in your cognitive reserve. Whether through continued learning, fostering social connections, maintaining emotional well-being, or engaging in regular physical exercise, there are many avenues to build a better brain. What Can I Do?   Start small: Try writing your name and address on a piece of paper with your nondominant hand. If you’re right-handed, do it with your left. Don’t worry about perfection or legibility. Just complete the task as best you can. Then, repeat the process a few times to make incremental improvements.  Dust off a recipe book and get the ingredients to make a meal you’ve never made or one that your parents made that you haven’t had in ages. Lastly, get and read Dr. David Snowdon’s book “ Aging with Grace ” through your local library, bookstore, or online. Additional Selected Reading: Snowdon, D. A., Kemper, S. J., Mortimer, J. A., Greiner, L. H., Wekstein, D. R., & Markesbery, W. R. (1996). Linguistic ability in early life and the neuropathology of Alzheimer's disease and cerebrovascular disease. Findings from the Nun Study. Annals of the New York Academy of Sciences, 800(1), 175-179. Snowdon, D. A. (2003). Healthy aging and dementia: findings from the Nun Study. Annals of Internal Medicine, 139(5_Part_2), 450-454 . Bennett, D. A., Schneider, J. A., Tang, Y., Arnold, S. E., & Wilson, R. S. (2006). The effect of social networks on the relation between Alzheimer's disease pathology and level of cognitive function in old people: a longitudinal cohort study. The Lancet Neurology, 5(5), 406-412 . Mortimer, J. A., Snowdon, D. A., & Markesbery, W. R. (2003). Head circumference, education and risk of dementia: findings from the Nun Study. Journal of Clinical and Experimental Neuropsychology, 25(5), 671-679 . Aging with Dignity (Publisher of Five Wishes). (n.d.). About Five Wishes. Retrieved from https://fivewishes.org/about/ Click here to go to the magazine.