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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. Key Elements of Enhancing Hygiene in Dementia 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.         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.

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. Tips for Hiring Help 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.         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.

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. Engage in Meaningful Activities at All Stages 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.         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.

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 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 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/ 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.

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 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.

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. Stages of Cognitive Decline 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! Warding Off Cognitive Decline 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://pubmed.ncbi.nlm.nih.gov/34861456/ 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. 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.

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. 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.

Dementia touches the lives of millions worldwide. The collection of symptoms includes impaired memory, thinking, and daily functioning. While factors like lifestyle and environment are significant contributors, genetics can also shape a person’s risk. To understand how genes may contribute to Dementia, it's important to start with what genes are: pieces of deoxyribonucleic acid (DNA). This potent molecule provides instructions for building and maintaining our bodies. We inherit this DNA from both parents. Differences, or mutations, in specific genes, can disrupt their normal function, sometimes leading to harmful effects on the brain and body, including changes in brain tissue that can lead to Dementia. However, as Dr. Anindita Deb , a board-certified neurologist and associate professor of Neurology & Neurosurgery at UMass Chan Medical School in Worcester, Massachusetts, explains, genes aren’t destiny. "People often think that if they have a specific gene, they will definitely develop Dementia, but it’s rarely that straightforward,” she says. “It's the interaction between genetics and environment that determines someone’s risk.” Is Dementia Genetic? In general, for almost every one of the leading pathologies of Dementia—Alzheimer’s, Vascular Dementia, Lewy Body Dementia (LBD), and Frontotemporal Dementia (FTD)—there is evidence of a genetic link for a small percentage of those affected. However, in most people living with Dementia, there isn’t a known inherited cause. Any of the major forms of Dementia can be sporadic  (they occur randomly and aren’t linked to family history) or familial (cases are inherited and run in families due to specific genetic mutations). "There are certain genes that can predispose a person to the development of early or younger-onset Alzheimer's Dementia, which generally runs in families," says Dr. Deb. While finding these genetic links has been groundbreaking information for many of the significant forms of Dementia, including Alzheimer's, many genetic links remain unknown. Dr. Deb emphasizes that genetic predispositions, whether for Alzheimer’s disease-related Dementia or other types of Dementia, don’t guarantee that someone will develop the condition. "Genes alone can’t predict when symptoms will start, how severe they will be, or even if someone will develop Dementia at all. It’s the interaction between genetics and environmental factors that plays a crucial role." Dementia Genetic Factors Here’s a breakdown of the specific genes that impact the various types of Dementia. Alzheimer’s Disease Alzheimer’s disease is a common cause of Dementia, according to the Centers for Disease Control and Prevention . There are two main types of Alzheimer’s disease: young-onset, which typically appears before age 65, and late-onset, which occurs later in life. Less than 10% of Alzheimer’s disease is inherited, according to researchers in the journal Nature . While some patients living with young-onset (sometimes also called "early-onset familial   Alzheimer’s disease," (EOFAD)) develop the condition from a single genetic mutation passed down in their family, in most cases, inherited EOFAD is tied to an interaction between multiple genes, plus lifestyle and environmental factors. Genetic mutations in the APP , PSEN1 , and PSEN2  genes, alone or in combination, are considered genetic drivers in the risk of developing this young-onset form of Dementia. These mutations disrupt how the brain processes amyloid precursor protein . Typically, the protein is broken down and cleared away, but mutations cause it to build into sticky clumps, known as amyloid plaques. These plaques clog the brain, disrupting cell communication and eventually injuring and killing them. However, for late-onset Alzheimer’s, the APOE  gene, specifically the APOE ε4  variant of this gene, raises the risk of late-onset Alzheimer’s. Vascular Dementia Vascular Dementia is an umbrella term for cognitive decline caused by cerebrovascular disease or impaired blood flow to the brain. This form of Dementia may occur following a diagnosed stroke (post-stroke Dementia) or without a history of noticeable stroke but with signs of silent cerebrovascular damage on brain imaging. While other diseases (like hypertension or diabetes) and environmental and lifestyle factors play a large role in stroke or cerebrovascular disease risk, genetics may also play a role. One key genetic condition, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), is caused by mutations in the NOTCH3 gene. These mutations damage small blood vessels in the brain, increasing the risk of stroke and the possibility of cognitive decline. Other conditions passed down from parents related to Vascular Dementia, such as cerebral amyloid angiopathy (CAA), are linked to genetic mutations, too. Understanding these and other genetic connections to vascular disease could help to identify people at risk and lead to better tools for prevention and intervention. Lewy Body Dementia Lewy Body Dementia (LBD) is categorized into two subtypes: Dementia with Lewy Bodies (DLB) and Parkinson’s Disease Dementia (PDD). While both share the same types of brain changes, their symptoms and how they progress differ based on when cognitive decline and motor symptoms begin. LBD occurs when clumps of a protein called alpha-synuclein accumulate in the brain, disrupting the function of brain cells. These protein clumps, known as Lewy bodies, are the hallmark of both subtypes. Mutations in the SNCA  gene, which encodes the alpha-synuclein protein, and the GBA  gene have been linked to an increased risk of developing both forms of LBD. The GBA  mutation, in particular, may explain why DLB often overlaps with Parkinson’s disease symptoms. Those living with Parkinson’s disease often exhibit signs of LDB. “Around 30% of people living with Parkinson’s disease have Dementia [at time of diagnosis], but not all patients will experience it,” says Dr. Deb, who also serves as co-chief of the Movement Disorders Division at UMass Chan Medical School. "While many Parkinson’s patients have cognitive impairment, especially in executive functioning, it doesn’t always progress to Dementia." Yet, throughout a lifetime, up to 80% to 90% of people living with Parkinson’s disease eventually develop Dementia by the age of 90, according to researchers in Brain Pathology . Researchers have also confirmed a steady link to LBD with specific changes in the APOE gene, and two other new gene discoveries have recently been tied to LBD: B1N1  and TMEM175 . Frontotemporal Dementia Frontotemporal Dementia (FTD) primarily affects the brain’s frontal and temporal lobes, which control personality, language, and behavior. It has several subtypes, including behavioral variant FTD (bvFTD), semantic variant primary progressive aphasia (svPPA), and nonfluent variant primary progressive aphasia (nfvPPA)—all of which are associated with degenerative tissue changes in areas of the brain that support decision-making, behavioral control, emotion, and language. Up to two in every 10 people living with FTD have a genetic cause, according to the UCSF Memory and Aging Center . Specific genetic mutations in the MAPT , GRN , or C9orf72  genes are strongly linked to inherited forms of FTD, with C9orf72 being the most common.   When FTD is genetic, just one of these genes is affected. Some mutations are linked to certain FTD subtypes. For instance, MAPT  mutations most often present as bvFTD. GRN  mutations may result in mixed PPA or nonfluent variant PPA. Finally, C9orf72  mutations are linked to bvFTD with unique tendencies for particular symptoms, such as hallucinations or delusions. Hope for the Future As research advances, scientists continue to uncover the complex genetic factors that contribute to the various types of Dementia. This knowledge is opening doors to targeted therapies and more personalized prevention strategies and offering hope for a brighter future for those impacted by Dementia. Author Bio: Courtney W. Chan  is a Boston-based freelance medical writer. References: ●       Interview with Dr. Anindita Deb, MD , Board-Certified Neurologist (Movement Disorder Specialist), Co-Chief of the Division of Movement Disorders, and Associate Professor of Neurology and Neurosurgery at the University of Massachusetts Chan Medical School. ●       Centers for Disease Control and Prevention. What Is Dementia? 2024. https://www.cdc.gov/alzheimers-dementia/about/ . ●       Longitudinal Clinical, Cognitive, and Biomarker Profiles in Dominantly Inherited Versus Sporadic Early-onset Alzheimer’s Disease. Brain Communications . 2023.   https://academic.oup.com/braincomms/article/5/6/fcad280/7321528 . ●       Diagnosis and Management of Dementia with Lewy Bodies: Fourth Report of the DLB Consortium. Neurology . 2017.   https://pmc.ncbi.nlm.nih.gov/articles/PMC5496518/ . ●       Genetics of Vascular Dementia – Review from the ICVD Working Group. BMC Medicine . 2017.   https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0813-9 . ●       Nature. 1987: Finding the first Alzheimer’s gene. 2024.  https://www.nature.com/articles/d41586-024-02884-7 . ●       UCSF Memory and Aging Center. Familial Alzheimer’s Disease.   https://memory.ucsf.edu/genetics/familial-alzheimer-disease . ●       UCSF Memory and Aging Center. Familial FTD. https://memory.ucsf.edu/genetics/familial-ftd . ●       The Epidemiology of Dementia Associated with Parkinson's Disease. Brain Pathology , 2010. https://pmc.ncbi.nlm.nih.gov/articles/PMC8094858/ . ●       Frontotemporal Dementia: A Clinical Review. Seminars in Neurology . 2019. https://doi.org/10.1055/s-0039-1683379 . ●       Cedars-Sinai. Dementia with Lewy Bodies (DLB). https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/dementia-with-lewy-bodies-dlb.html . ●       National Institutes of Health. Genetic study of Lewy body dementia supports ties to Alzheimer’s and Parkinson’s diseases. 2021. https://www.nih.gov/news-events/news-releases/genetic-study-lewy-body-dementia-supports-ties-alzheimers-parkinsons-diseases . ●       National Institute on Aging. Alzheimer’s Disease Genetics Fact Sheet. https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/alzheimers-disease-genetics-fact-sheet . ●       Harvard Health Publishing. Alzheimer’s in the Family: What You Need to Know. https://www.health.harvard.edu/mind-and-mood/alzheimers-in-the-family . ●       National Institute of Neurological Disorders and Stroke (NINDS). Lewy Body Dementia. https://www.ninds.nih.gov/health-information/disorders/lewy-body-dementia . ●       MedlinePlus. 2 Types of Lewy Body Dementia. 2019. https://magazine.medlineplus.gov/article/2-types-of-lewy-body-dementia . ●       Investigation of the genetic aetiology of Lewy body diseases with and without dementia. Brain Communications. 2024.   https://academic.oup.com/braincomms/article/6/4/fcae190/7685922 . ●       Cerebral Amyloid Angiopathy: The Vascular Pathology and Complications. Journal of Neuropathology & Experimental Neurology . 1986. https://doi.org/10.1097/00005072-198601000-00007 . ●       Cedars-Sinai Medical Center. Autoimmune Diseases in ALS Patients Linked to Genetic Mutation. https://www.cedars-sinai.org/newsroom/autoimmune-diseases-in-als-patients-linked-to-genetic-mutation/ . ●       Amyloid precursor protein processing and Alzheimer's disease. Annual Review of Neuroscience . 2011. https://pmc.ncbi.nlm.nih.gov/articles/PMC3174086/ . ●       UCSF Memory and Aging Center. Frontotemporal Dementia. https://memory.ucsf.edu/frontotemporal-dementia . ●       An update on genetic frontotemporal dementia. Journal of Neurology . 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6647117/ . 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.

The interplay of genes, environment, and lifestyle is responsible for most of our vulnerability and disease resistance. The influence of modifiable environmental and lifestyle factors has recently become a source of interest and optimism in the research on age-associated cognitive decline because several of these factors have been shown to impact (some positively, some negatively) the likelihood of experiencing cognitive decline that may or may not progress to Dementia. Mental Flexibility As We Age Mental flexibility usually decreases with age. Consciously remembering facts, events, and practical knowledge may become more challenging. Multitasking and executive functions that involve quick thinking, verbal communication, and mathematical reasoning tend to slow down, particularly after reaching 70 years of age. The capacity to quickly retrieve recently acquired information may diminish. Mild Cognitive Impairment (MCI) is characterized by cognitive deterioration beyond normal aging expectations. It can stem from a neurodegenerative disorder or be linked to factors such as vitamin deficiency, sleep disturbances, or medication side effects, potentially allowing for reversibility. Individuals with MCI often experience heightened memory and cognitive challenges, leading to difficulties in daily tasks, verbal expression, feelings of frustration, disorganization, and being overwhelmed despite maintaining some level of independence. While many individuals reach their 90s and beyond without showing any signs of Dementia, a gradual decline in cognitive abilities could lead to the development of Dementia. Research suggests that around 10 to 15 percent of individuals with Mild Cognitive Impairment (MCI) may progress to Dementia. However, a 2024 study found that this progression occurred in about 30 percent of participants with MCI, whose average age was 70. Heightened confusion, memory issues, and difficulties in communication, reading, and writing characterize Dementia. Common symptoms include repetitive questioning, wandering, impulsivity, and diminished empathy. In its advanced stages, individuals with Dementia often rely heavily on others to assist with their daily activities. What Factors are Associated with Cognitive Decline? Researchers can conclude the likelihood of developing certain diseases by collecting data on thousands of individuals and tracking them over many years or until their passing. The U.S. National Death Index (NDI) holds more than 100 million death records, enabling researchers to link a person's cause of death with information about their environment and lifestyle during their earlier years. Recent extensive research utilizing the NDI to conduct follow-ups years later on individuals who participated in significant studies has revealed that elements such as diet, physical activity, social engagement, and specific physical and behavioral factors play a role in developing and advancing cognitive decline. For instance, age-related hearing impairment has been proven to heighten the likelihood of cognitive decline in older adults. However, addressing this impairment with a hearing aid may diminish the risk. Below is a concise overview of certain factors linked to a higher or lower likelihood of cognitive decline. It is important to note that these factors are not direct causes or safeguards against decline; they have been demonstrated through extensive scholarly research involving large populations to have a statistically notable influence on risk. Factors that have been linked to HIGHER Dementia risk Diabetes, hearing and vision loss, high blood pressure, and high or low HCL cholesterol are common in older adults and can be treated and improved in almost all cases. Obesity and poor bone health often result from unhealthy eating patterns. A common source is consuming too many ultra-processed, food-based products full of additives and stripped of nutrients, such as packaged snacks and desserts, sugary breakfast cereals, processed meats, sweetened beverages, and instant soups. A sedentary lifestyle and social isolation have been linked with an increased risk of developing Dementia. This is also true of binge drinking and excessive alcohol consumption, smoking, chronic stress, depression, and the lack of deep sleep. Nightmares, post-traumatic stress disorder, and regular laxative use have also been identified as risk factors that may be modifiable. Factors that have been linked to LOWER Dementia risk Healthy eating habits are protective, including a high-fiber diet. It is helpful to consume leafy green vegetables and orange fruits because they contain carotenoid antioxidants, which defend against several degenerative disorders and enhance the immune system. Also important are fruits (apples, berries, cherries), onions, soybeans, and teas that contain dietary flavanols, compounds that have anti-cancer, anti-inflammatory, and anti-viral properties. The Mediterranean diet (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801)  and the MIND diet (Mediterranean diet intervention for neurodegenerative delay)  (https://www.hsph.harvard.edu/nutrutionsource/healthy-weight/diet-reviews/mind-diet/ ) are recommended. Regular exercise is crucial (see the article, "Get Moving! The value of exercise in reducing the risk of cognitive decline." CaringKind Newsletter 3:4) https://www.caringkindnyc.org/2022v3-newsletter . Hearing aids, cataract surgery, and other interventions that improve the ability to communicate can lower your risk of cognitive decline. Stimulating cognitive activities (crossword puzzles, games, reading) may build cognitive reserve. Social activities (dancing, art classes, and other recreational and leisure activities that involve building relationships with others) are also linked with reducing the risk of cognitive impairment. It is also essential to minimize the consequences of physical illness with interventions like getting an annual influenza vaccination. Covid-19 and RNA vaccines have not yet been convincingly linked to lowering the risk of developing Dementia. Still, because they minimize the risk of serious illness, it is reasonable to think they may also reduce the risk of cognitive impairment. If you have type 2 diabetes, treatment with metformin shows evidence of reducing the risk of neurodegenerative disease. A large study published in February 2024 about the use of Viagra and similar erectile dysfunction (ED) drugs has produced fascinating results. These drugs dilate blood vessels and have been shown to increase blood flow in the brains of animals. Men who received the most prescriptions for ED pills throughout the study had a significantly lower risk of developing Dementia. Further study is necessary to understand whether the drugs can protect against Dementia (for women as well as for men) or whether men who are less prone to the disease are more likely to use those drugs. A Healthy Lifestyle May Lead to Better Brain Health Recent speculation, as stated in a JAMA Neurology editorial dated March 25, 2024, suggests that the enhancement of brain health resulting from global advancements in living standards, education, and healthcare could potentially reduce the risk of Dementia in the future. This contrasts with the typical grim forecasts of a notable rise in Dementia cases as the global population ages. Only time will reveal the accuracy of these predictions. In the meantime, why not push yourself to integrate a healthy lifestyle and environmental changes linked to improving cognitive function? Here are several lifestyle modifications for better brain health: Eat healthily. Find a way to exercise regularly to whatever degree is possible for you. Even modest increases in physical activity are beneficial. 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. Contributing Author: Carol A. Butler, Ph.D. Carol A. Butler was born and educated in New York City. She graduated from the Bronx High School of Science, Queens College, and New York University, receiving her Master's and Doctoral degrees. She has a private practice in Manhattan, providing psychotherapy for individuals and couples and clinical supervision for other therapists. She is currently active in the areas of research and treatment of various forms of Dementia, including Alzheimer's disease. She is a N.Y. State licensed Psychoanalyst with advanced training in mediation, arbitration, clinical supervision, and the treatment of sexual dysfunctions and addictive disorders. She has co-authored eight books and many articles. 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.

Top 10 Tips for Communicating with Persons with Dementia Interacting with a loved one living with Dementia can be difficult. Dementia impacts memory, language, and cognitive abilities, making it challenging for individuals to comprehend and reply. Nonetheless, with patience, empathy, and appropriate techniques, you can enhance the positivity and significance of conversations. A professional care manager can also offer crucial support by providing customized strategies and solutions to your loved one's needs. Here are our top 10 tips for effective communication, along with insights on how a care manager can assist in making the journey smoother. Tip 1. Keep it Simple and Direct Use simple words and short sentences to prevent overwhelming your loved one. Steer clear of lengthy or complex explanations. Keep sentences clear and direct. If they don't understand initially, try rephrasing rather than repeating. Care managers can help family members simplify language and adapt their communication style to match their loved one's current cognitive abilities. Tip 2. Be Patient and Allow Extra Time Dementia may reduce processing speed. Allow your loved one ample time to think and reply, resisting any urge to hurry them. Silence is acceptable as it helps them collect their thoughts. Professional care managers are skilled in methods that encourage calm and respectful communication and can impart these skills to families. Tip 3. Avoid Correcting or Criticizing Disputing or correcting them can result in frustration and confusion. If their recollection differs, it's usually best to let it go unless it's significant. Care managers assist family members in recognizing the importance of acknowledging feelings and emotions, even when the details are incorrect. They can provide guidance on how to handle conversations smoothly. Tip 4. Focus on Feelings, Not Facts Often, your loved one's emotions are more important than the specific words they use. Instead of focusing on correcting any mistakes, acknowledge the feelings they express and respond to those. Care managers can offer strategies to help you pay attention to emotional signals, allowing you to understand better and address your loved one's needs. Tip 5. Use Nonverbal Communication Sometimes, a soft touch or a friendly smile can communicate more effectively than words. Nonverbal signals can express comfort, empathy, and connection, mainly when words are difficult to express. Care managers are skilled in nonverbal methods and can demonstrate these to family members, fostering a sense of connection and support for all involved. Tip 6. Minimize Distractions Background noise from a television or a crowd can be overwhelming. Aim to communicate in a quiet, serene setting to help them concentrate more effectively on the conversation. Care managers can help establish a communication-friendly environment by rearranging rooms or adjusting routines, making interactions less stressful. Tip 7. Be Positive and Reassuring Individuals with Dementia frequently experience anxiety or insecurity. A positive tone and reassuring language can significantly impact their sense of safety and worth. Professional care managers are skilled in techniques that foster a calm and comforting environment. They can assist families in developing positive communication habits and provide resources for handling difficult emotions. Tip 8. Ask One Question at a Time Asking multiple questions at once can be confusing. It's better to ask one question at a time, simplifying responses, particularly with yes or no questions when feasible. Care managers can assist families in creating dementia-sensitive questions, facilitating smoother and less frustrating conversations for all parties involved. Tip 9. Embrace Their Reality Individuals with Dementia frequently recall events differently or may not recognize present situations. Rather than arguing, try to engage with them in their reality. This approach can facilitate stress-free bonding. Care managers are adept in techniques like reality orientation and validation, assisting families in knowing when and how to accept a loved one's perspective for their comfort and well-being. Tip 10. Practice Self-Care and Seek Support Assisting a loved one with Dementia can be emotionally demanding. It's essential to prioritize your well-being and seek assistance when necessary. Care managers are available to support both families and the individual with Dementia. They offer resources, organize care, and can help facilitate family discussions to address everyone's needs effectively. Supporting a loved one with Dementia involves more than performing daily tasks; it's about fostering moments of connection and comprehension. Professional care managers are experts in assisting families to manage these challenges with empathy and skill. They grasp the intricacies of Dementia and can provide essential communication tools, access to resources, and a customized plan suited to your family's requirements, easing the challenges of communicating with persons with Dementia. Having a professional care manager with you means you're not facing this journey alone. They act as a caring guide, assisting you in forming meaningful connections and lightening the load, allowing you to concentrate on cherishing quality time with your loved one. The Dementia Society of America® supports the advantages of care management, and as a Corporate Partner of the Aging Life Care Association®, we encourage you to use this link,  www.findacaremanager.org,  to find a professional closest to you or your loved one. 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.

Travel provides numerous benefits to cognitive functioning. Travel is more than just an escape from the daily grind — it is a catalyst for cognitive growth and enhancement. The experiences we gain from exploring new places extend far beyond relaxation and pleasure, actively helping to develop and refine our cognitive skills. This article explores how traveling enriches our lives with unforgettable memories and experiences and dramatically benefits our cognitive functions, including creativity, problem-solving, and emotional intelligence. Stimulating Creativity Through New Experiences One of travel's most significant cognitive benefits is the enhancement of creativity. When we travel, we expose ourselves to new environments, cultures, languages, and experiences that challenge our typical thinking patterns. This exposure breaks down the cognitive barriers of familiarity and routine that often stifle creativity. According to several studies, people who travel and interact with diverse cultures tend to have more creative insights and are better at generating innovative solutions. The novelty of new places stimulates the brain, encouraging neural pathways to expand and connect in new ways. For example, navigating a foreign city or trying to communicate in another language forces the brain to devise creative strategies, strengthening cognitive flexibility and creative thinking. Enhancing Cognitive Flexibility and Problem-Solving Skills Travel inherently involves encountering and overcoming challenges, from navigating unfamiliar public transportation systems to handling unexpected changes in plans. Each of these situations is an exercise in problem-solving and adaptability. As we face these challenges, our brains are prompted to engage in complex thinking processes involving logic, reasoning, and decision-making. Over time, these mental exercises can lead to improved cognitive flexibility, making it easier for us to switch between different tasks and solve problems more efficiently. Moreover, having to adapt to different cultural norms and social cues can enhance our cognitive flexibility, allowing us to better handle ambiguity and complexity in everyday situations. Improving Memory and Learning Efficiency Travel also positively affects memory and learning. The rich sensory experiences provided by new environments enhance the brain’s ability to retain and recall information. The novelty of new experiences increases the brain’s neuroplasticity, leading to the formation of new memories and neural connections. When we travel, we often pay more attention to our surroundings and the events happening around us because of their unfamiliarity and novelty. This heightened awareness results in more vivid and lasting memories. Additionally, learning about the history of a place or picking up phrases in a new language can stimulate the hippocampus, the area of the brain involved in learning and memory processes, thereby improving our capacity to learn new information quickly and efficiently. Boosting Emotional Intelligence and Empathy Traveling frequently involves interacting with people from various backgrounds and cultures. These interactions can significantly enhance a person’s emotional intelligence and empathy. Understanding and adapting to different cultural contexts improves our ability to read and respond to the emotions of others. Experiences such as witnessing diverse social customs or engaging in local traditions can deepen our empathy and appreciation for other perspectives. This not only enhances social skills but also contributes to greater tolerance and respect for diversity. Emotional intelligence, a critical component of successful interpersonal interactions and leadership, is thus markedly improved through the experiences gained from travel. Creating Strong Social Connections Traveling in a group can be a special way to forge new friendships. The shared experiences of travel naturally foster close bonds and mutual understanding among group members. When you travel with others, you have unique experiences together that aren’t part of everyday life. Whether it’s marveling at a sunset, navigating a busy market, or overcoming the challenges of a hike, these shared experiences can form the foundation of lasting friendships. Travel often involves unexpected challenges that require cooperation and support: dealing with lost luggage, finding your way in a new city, helping each other through physically demanding activities. Acts of kindness and support during travel can build trust and appreciation, strengthening bonds between group members. And after traveling together, many groups decide to keep in touch through social media, reunions, or subsequent trips. The desire to relive the good times can lead to more gatherings and interactions, further nourishing and cementing these friendships. Conclusion: Traveling Can Build a Better Brain Travel — whether solo, with a partner or friends, or in a diverse group — offers profound benefits to cognitive development and functioning. It nurtures creativity, enhances problem-solving skills and cognitive flexibility, improves memory and learning efficiency, and boosts emotional intelligence and empathy. Each journey we embark on contributes to the enrichment of our minds, shaping us into more adaptable, intelligent, and compassionate people. As we explore new horizons, we discover the world and unlock the potential of our own cognitive capacities. Wanderlust can build a better brain! --- One of the most significant cognitive benefits of travel is the enhancement of creativity. What Can I Do? 1. Try some armchair traveling when you receive those slick brochures for cruises or packaged tours. Look closely at their itineraries and find the stops on a map (online or in an old-school atlas). Why did they choose that destination? What history or natural beauty would you be exposed to? Build a better brain by imagining what it would be like to be there.   2. Act like a tourist in your own town. Find your local visitors center if you have one. Get some of the free brochures and maps it offers, and consider striking up a conversation with others looking for local travel ideas. Share your favorites and learn why others see your town as interesting.   3. To paraphrase Detective Steve McGarrett from Hawaii Five-0, “Book it, Danno.” Put a date on the calendar, along with a destination, and make it happen. Your brain will thank you. Additional Selected Reading: Leung AK, Maddux W, Chiu, CY. Multicultural Experience Enhances Creativity: The When and How. American Psychologist 63(3):169-81, April 2008. Maddux WM, Galinsky AD. Cultural borders and mental barriers: the relationship between living abroad and creativity. J Pers Soc Psychol 2009 May; 96(5):1047-61. Cole S, Hua C, Peng S, Wang W. Exploring the Relationship of Leisure Travel with Loneliness, Depression, and Cognitive Function in Older Adults. Int J Environ Res Public Health. 2024 Apr 18;21(4):498. Maddux WW, Adam H, Galinsky AD. When in Rome ... Learn why the Romans do what they do: how multicultural learning experiences facilitate creativity. Pers Soc Psychol Bull. 2010 Jun;36(6):731-41. 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.