Search Results

Dementia is costly, both financially and emotionally. If you or a loved one has been diagnosed with Dementia, you are probably overwhelmed with the prospect of how to financially plan for the future. A trusted partner at a time of need can be a welcome help. One option for managing finances is a pooled special needs trust (SNT). A pooled SNT is administered by a nonprofit organization. The organization makes decisions on how funds from the trust are disbursed on behalf of the trust Beneficiary, makes decisions on who invests the funds, fulfills reporting requirements to government agencies, and stays abreast of changing regulations so that means-tested government benefits (like Medicaid and Supplemental Security Income (SSI)) are not jeopardized. Each Beneficiary’s funds are placed in an individual sub-account. The cash assets from all subaccounts are then “pooled” together and invested as a group. Earnings based on the Beneficiary’s share of the principal are reinvested into each sub-account. A financial record is maintained for each sub-account that reflects all the activity in the account. Each beneficiary or their advocate has access to the financial information either electronically or by mail. Most pooled trusts offer both First Party and Third Party SNTs. A First Party SNT is established with the Beneficiary’s own funds. A Third Party SNT is funded by a third party for the benefit of the individual with dementia or a family member with special needs. A pooled special needs trust makes sense for multiple reasons. It allows one the opportunity to set aside funds that will enrich the quality of life for the Beneficiary. The Beneficiary can benefit from trust administration services including investment and management. All disbursements are for the sole benefit of the Beneficiary. Pooling the funds reduces administrative fees and increases the principal for investment purposes. A pooled SNT will also protect eligibility for Medicaid and Supplemental Security Income in many instances; however, special planning is required for Beneficiaries over the age of 64 for whom Medicaid Long-term Care benefits may be needed. It is strongly recommended that you consult with a Trust and Estates Attorney or Elder Law Attorney who can advise you on how a pooled special needs trust can benefit your situation. When appropriate, an SNT can give you a sense of well-being regarding your own, or your loved one’s, financial future while continuing to live life with quality and dignity. Authored by Joanne Marcus, MSW, Executive Director, Commonwealth Community Trust (CCT). CCT is a 501(c)(3) national nonprofit organization that administers affordable and efficient pooled special needs trusts. CCT was founded in 1990 and is managed by a Board of Directors who serve with a caring heart and without compensation. With years of experience, CCT has a proven reputation as a prudent steward and administrator. For more information about CCT, contact Joanne Marcus, MSW, Executive Director at jmarcus@trustcct.org or 804-740-6930. Visit our website at www.trustCCT.org for access to information and additional resources. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org .

Have you ever taken a cruise, or even thought about doing so? Getting aboard a cruise ship for the first time and not knowing what is coming next might create a bit of fear. Fear that may have kept you from booking the trip for months, and maybe from doing it at all. Not being able to “see land,” or the destination can sometimes lead to anxiety. But turn that understanding around, once experienced, you may not be able to imagine a life without the joy of meeting new people and exploring new cultures. But even well-worn ship captains use tools on every voyage, to safely navigate and make steady progress, a map and a compass. Not knowing what’s coming next can be frustrating and even disastrous, but with guidance and the right information, there can be a steady calm in the midst of the stormiest weather. Dementia, like cancer, is a term often fraught with an enormous amount of fear and anger stemming in large part, from a shortage of information, or sometimes, too much. It's not uncommon for someone who has lived with a chronic and/or life-threatening illness, or who has acted as a caregiver, upon hearing the topic of a specific disease feels so much pain that they do not wish to revisit the experience in any way, shape or form. Repeated exposure may help dampen the immediate response, but deep down, without an ability to process the unpleasant feelings, and without the right tools, it can remain painful for some time. In the case of Dementia, knowing is hard, but good. It's hard because we basically understand the nature of what it is, a gradual loss of cognitive abilities. But it's also good, and valuable because the act of “knowing more” can actually relieve at least some of the anxiety. Having a map and a compass allows you to plan your actions and enhance your responses as you cross the sea of life. Without a doubt, if you believe you or a loved one or friend is experiencing one or more cognitive challenges, it is imperative to sort through what's going on and begin to understand the possible causes, progression (if, in fact, it's Dementia), care or interventions that make the most sense given whatever you learn. Neurologists (brain specialists), and particularly those who specialize in Dementia, are the current “Ship Captains” for a full cognitive workup. That's not to say that primary care physicians don't play an important role, they do. Even trained social workers, nurses, psychologists, psychiatrists, and many other types of healthcare professionals can lend a hand with identifying issues that need more insight and testing. Don't walk out of an annual check-up and say “everything's okay,” if you know in your heart-of-hearts it isn't, or if others you respect and love say that there's something “still going on.” Dig deeper. Get a check-up from the neck-up, as Zig Ziglar used to say. Having a “neuropsych” examination, as well as blood tests, a nutritional evaluation, and maybe even certain scans or more advanced tests are often the right things to do. Eliminate all possible causes, even reversible forms, of cognitive difficulty and as with most major health issues, seek second opinions as necessary. Over the next four months, we're going to more closely explore the following leading forms of Dementia: Alzheimer's Disease, Vascular Dementia, Lewy Body Dementia, and Frontotemporal Dementia. Then we will follow with lesser-known types of Dementia which may result from traumatic brain injury (TBI), repetitive concussions (CTE), infections/viruses (CJD and HIV), alcoholism, and others. Knowledge is like a compass rose, always pointing north, it can guide, empower, and reduce anxiety. Like a ship setting sail to a new port of call, with a good map and a reliable compass, having "knowledge" tools enable you to chart a course towards your best possible tomorrow. Author: Kevin Jameson, Volunteer | President | Chairman. Dementia Society of America. Dementia Society, Inc. does not provide medical advice. Please consult your doctor. Learn more at www.dementiasociety.org .

#FTD #Frontotemporal #Dementia The recent revelation that actor, Bruce Willis, is living with Frontotemporal Dementia (FTD) is a reason to highlight this past post. In 1892, the German neurologist and psychiatrist Arnold Pick described a case involving an elderly patient with progressive loss of speech and Dementia. Later, when the patient died, the autopsy showed that specific brain parts had shriveled. Unlike the overall shrinkage associated with Alzheimer’s Disease, this type of Dementia appeared to target the frontal and temporal lobes. The two frontal lobes, located on the front of each half of the brain, contain the structures that control our executive functions, such as planning, organizing, and solving problems. The frontal lobes also control behavior, emotions, and personality. The two temporal lobes, located on each side of the brain just above the ear, allow us to perceive and recognize faces and objects and transfer short-term memories into our long-term memory banks. It is not surprising to discover that people living with Frontotemporal Dementia (FTD) may no longer seem like the people we once knew. A parent who was once friendly, polite, and careful about their appearance may say and do socially unacceptable things. Emotional blunting, or the inability to express verbal and non-verbal feelings, is another characteristic of this type of Dementia. Another indicator of FTD is difficulty in using and understanding spoken and written language. Language difficulties include repeated mispronunciations and the inability to make appropriate associations between objects and their name. Frontotemporal lobe patients may use words and phrases like “this,” “that,” and “over there” in place of specific nouns and descriptions. People who have Frontotemporal Dementia are not aware of how they have changed. Scientists do not know the cause of Frontotemporal Dementia. However, research demonstrates that genetics often plays a role in its development. Some studies show alterations in genes that code for specific brain proteins in nearly 45 percent of people with family members who have certain types of Frontotemporal Dementia.1 These altered proteins form insoluble deposits in brain neurons. The deposition of the proteins causes the neurons to swell, burst open, and die.2 It appears that genes play a role in nearly 45 percent of people who have Frontotemporal Dementia.1 However, it is also important to remember that for more than 50 percent of Frontotemporal Dementia families, genetics either does not play a role or is not yet an understood factor. Tests are available to determine if the Frontotemporal Dementia that you, or another family member, have is genetic. Deciding to undergo testing is not always easy. It is essential to consider how you and other family members might feel if you should receive positive results. Will knowing make you anxious, relieved, or empowered? Will other family members also want to test? How might this information affect family planning for you or your adult children? Will having a positive test influence your employer or make it more difficult to receive health or life insurance? Anybody would find these and many other questions challenging to answer. Often, people find talking with a genetic counselor can make the decision to test – or not – easier. The genetic counselor, by explaining the technical and emotional issues associated with genetic testing, can help you make a comfortable decision. Afterward, the genetic counselor can explain the test results to you and guide discussion about any further steps you may want to take. References: 1. HS Kirshner, “Frontotemporal lobe dementia: Genetic Distribution and Variation,” http://emedicine.medscape.com/article/1135164-overview#aw2aab6b4 (accessed March 5, 2016). 2. W Leonard, MpH“Causes of Dementia,” http://www.healthline.com/health/dementia (accessed March 6, 2016). Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org .

Lewy Body Dementia (named after Frederich Heinrich Lewy, who in 1912 described the disease) is a spectrum disorder described by a rapid decline in the patient’s cognition and behavior. Hallucinations and delusions, as well as alterations in sleep, heart rate, and digestion, are other Dementia with Lewy body characteristics. Certain subtypes of Dementia with Lewy Bodies cause people to experience shaking, rigidity, and balance difficulties. The presence of Lewy bodies – abnormal brain deposits composed of several proteins located throughout the brain, is the post-mortem diagnostic hallmark. Dementia with Lewy bodies is a rapidly progressing disease. Death usually occurs within five to seven years of diagnosis. Unlike Alzheimer's Disease, Dementia with Lewy bodies does not have predictable stages. Early symptoms of the disease vary. Some people first experience cognitive and memory changes similar to those associated with early Alzheimer's Disease. For other people, the first symptoms may include shaking and a shuffling gait. Sometimes hallucinations are the first symptom. Therefore, a thorough medical exam plays an important role in ruling out other causes such as Parkinson's Disease or the side effects of medications used to treat other illnesses and conditions. Responses to the medications used to treat or reduce the severity of hallucinations can inadvertently confirm a diagnosis of Dementia with Lewy bodies. Unlike people who have Alzheimer's Disease, people who have symptoms commonly associated with Dementia with Lewy bodies can have dangerous, and sometimes fatal reactions to antipsychotic medications such as haloperidol (Haldol) and risperidone (Risperdal). (See References 1 and 2 below.) This finding points to the importance of keeping detailed medical history notes and prescription records. This is especially true for first-time appointments and in the emergency room. Lewy bodies are also found in other brain disorders such as Parkinson's Disease. Many people who have Parkinson's Disease eventually develop the thinking and reasoning difficulties associated with Dementia with Lewy bodies. Conversely, many people who have Dementia with Lewy bodies experience the shaking and shuffling gait associated with Parkinson's Disease. The overlap in symptoms and other evidence suggest that Dementia with Lewy bodies, Parkinson's Disease, and Parkinson's Disease Dementia may share underlying abnormalities. References: Source 1 , accessed March 6th, 2016 Source 2 , accessed March 15th, 2016 Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc . We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts - that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.

Vascular Dementia may account for 12 to 20 percent of all Dementias, and is the second most common age-related Dementia.1 Unlike the gradual progression of Alzheimer's disease, the onset of Vascular Dementia symptoms is often abrupt and occurs when a heart attack or a stroke dramatically reduces blood flow to or through the brain. Hallucinations, rather than the memory loss associated with early-stage Alzheimer's disease, is another indicator of Vascular Dementia. Vascular Dementia can also have a slow progression. This happens when the accumulative damage of transient ischemic attacks – often called TIAs – causes many small areas of brain damage and, eventually, noticeable symptoms. The descriptive name “multi-infarct Dementia” is the term healthcare providers use to describe this kind of Vascular Dementia. Infarcts refer to the many (multiple) areas of non-functioning brain tissue that accumulate over time. Multi-infarct Dementia is the most common type of Vascular Dementia.1 Depending on the location within the brain, multi-infarct Dementia produces a spectrum of physical, behavioral, and emotional changes. An example of a physical change is shuffling or walking with small rapid steps. Behavioral symptoms can include slurred speech, getting lost in familiar surroundings, and difficulty in following instructions. Sometimes people cry or laugh at inappropriate times. As you can now appreciate, telling the difference between Alzheimer's disease and Vascular Dementia can be difficult. If the changes appear rapidly, Vascular Dementia, resulting from a stroke or heart attack, is the likely culprit. To make things even more complicated, many people have both Alzheimer's disease and Vascular Dementia. Their several ways you can reduce the risk for Vascular Dementia. Some of these include: maintaining a healthy blood pressure; eating a healthy, low-fat diet; maintaining a healthy weight; regular exercise; and refraining from or stop smoking.2 It is well worth noting that all of these modifiable conditions and behaviors are ones that affect the cardiovascular system and blood flow to the brain. References: Source 1 , accessed March 4, 2016 (since has since been updated) Source 2 , accessed March 4, 2016 (website has since been updated) Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society , Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts - that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.

For many families, finances and the cost of dementia care can be one of their greatest worries. Families hope there are sufficient assets to meet the expenses for the next four to 10 years. According to a Care.com Usage and Attitude Family Caregiver survey, in 2014, over 50 percent of families spent more than $5,000 per year to cover out-of-pocket expenses. The same survey reveals that seven percent of survey respondents report having spent more than $50,000 per year to cover the costs of their loved one’s care. Talking about personal finances is often difficult. To make these initial family discussions go as smoothly as possible, invite an elder-care lawyer, a financial advisor, or a geriatric care manager to guide discussion and offer their expertise. The goals of this and ensuing conversations are to define needs and expenses, and based on this information, develop a realistic financial plan. Dementia care is more than house utilities and groceries. Home expenses also include rent or mortgage payments, house maintenance, home, and car insurance, as well as assorted federal, state, and local taxes. Dementia care also involves the out-of-pocket deductibles and co-pays associated with the diagnostic procedures and treatments for dementia and any other medical conditions your loved one may have. Do not overlook the expenses of such things like personal care supplies, equipment rental and purchases, adult daycare, and assisted living fees. Sadly, circumstances may be one where your loved one has neither sufficient savings nor income to pay for the services he or she needs. What happens then? Sometimes families are able and willing to pay the difference--and sometimes not. Long-term care insurance is expensive, must be purchased well before need, and is not long-term in the sense of “forever care.” Often families must resort to state and federally-funded programs. Medicare, parts A, B, and D, and most private insurance policies pay only for expenses not related to having dementia. However, your loved one may be eligible for dementia coverage under one of several Medicare Special Needs Plans or “SNPs.” There are other avenues worth exploring – all of which have specific eligibility requirements. Some of these are Medicaid, a program that helps very low-income people get the healthcare they need, and the Program of All-Inclusive Care for the Elderly (PACE) that provides comprehensive medical services to Medicare and Medicaid enrollees. The United States Veterans Administration (VA) offers a broad range of services to help veterans who have dementia. To take advantage of the various VA programs and services, the veteran must be enrolled in the VA healthcare system. While the veteran does not have to have a service-related injury to receive dementia benefits, the veteran must have an honorable or a general discharge. Other strategies to supplement your loved one’s income include a Home Equity Conversion Mortgage (reverse mortgage), the conversion of certain kinds of life insurance into long-term care insurance, as well as borrowing against the value of a life insurance policy. Disability insurance is another resource when dementia makes employment no longer possible. Community not-for-profit organizations offer many helpful services that can range from household repairs and yard maintenance to elder daycare programs and caregiver respite grants. Sliding scale fees are another not-for-profits feature. Therefore, your loved one will have to meet eligibility criteria, to receive a reduced rate. In summary, money does indeed matter in the setting of dementia, and advance planning is important to provide optimal care for those individuals with dementia. Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice, please consult your doctor. www.DementiaSociety.org

We don't know exactly. What actually causes dementia is a difficult question. There is an infinite number of factors that singly or in combination may increase the risk for, or are associated with having dementia. To add to the mind-boggling complexity, each of us is the outcome of a unique collection of genes, lifestyle behaviors, and environmental exposures. Similar to the word “cancer” the word “dementia” is an umbrella term that includes many kinds of dementia. And again, similar to cancer, the dementias share certain characteristics such as memory loss, but also have ones specific to a particular type of dementia. For example, Alzheimer's disease tends to have a slow progression and vascular dementia tends to progress with bursts of increased disability. In the case of early-onset Alzheimer's disease, the answer might be less complicated than it is for other kinds of dementia. Scientists have identified genes that appear to cause the kind of dementia that strikes people younger than 65-years of age. People who have early-onset dementia genes can pass the trait on to their children. However, even these findings open the door to more questions. Do the early-onset genes actually cause the disease or do they increase the risk to the extent that makes having early-onset dementia a given? Perhaps the relationship between genetics and this form of dementia involves other genes and factors, that in combination, cause early-onset dementia. Genetics may or may not play a role in the onset of other kinds of dementia. For example, approximately 15 to 40 percent of people who have frontotemporal lobe degeneration have a family history that includes at least one other relative who also has or had this kind of dementia. However, only 10 percent of these individuals have a form of disease attributable to specific genes. This means that for 90 percent of cases, scientists have yet to discover genes that increase the risk of having Frontotemporal lobe dementia. Although one cannot change their genetics, it is possible to reduce the risk for dementia by modifying certain lifestyle behaviors. There are many lifestyle behaviors that appear to increase risk for dementia. Some of these include obesity, high blood pressure, smoking, diabetes, and lack of regular exercise. Social isolation, not having meaningful friendships, also appears to increase the risk for dementia. Another risk factor is not having the mental stimulation that comes with acquiring new skills and knowledge. The good news is one can choose to reduce the likelihood of dementia by losing weight, eating a healthy diet, refrain from or stop smoking, exercising, as well as by attending community center activities, or taking classes at a local college or university. Unlike behavioral changes, it’s difficult to impossible to avoid environmental risk factors. While one can make efforts to avoid environmental toxins such as second-hand smoke, it’s not possible to avoid the fumes that come from car exhaust or from certain kinds of building materials. Over the past 50 years, there has been a dramatic change in the 10 leading causes of death. Deaths caused by acute infectious diseases and accidents have given way to lingering diseases such as cancer and dementia – both of which tend to occur later in life. Therefore, for many people, advanced age is their biggest risk factor for having dementia. Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice, please consult your doctor. www.DementiaSociety.org

Alzheimer's Disease (AD) is thought to be the most common kind of Dementia. Researchers estimate that as many as 5.4 million people living in the United States have this type of Dementia.¹ Whereas, when you combine all forms of Dementia together, it is estimated to affect 9 million or more people in the U.S. According to the Centers for Disease Control and Prevention, Alzheimer's Disease is the fifth most frequent cause of death for adults aged 65 years and older.² Further, in high-economic countries³ like the U.S. and Canada, when considering the larger domain - that includes all types of Dementia - Dementia is thought to rank even higher as the third leading cause of death, behind heart disease as number 1 and stroke as number 2. While it is hard to say what actually causes Alzheimer's Disease, we do know the deposition and accumulation of fibrous proteins accompanies irreversible brain damage. It is thought that these insoluble proteins form β-amyloid plaques that disrupt brain architecture alter how brain cells use energy and promote cell death. The second hallmark of AD, also seen by Dr. Alois Alzheimer over 100 years ago under a microscope, is the neurofibrillary tangles of dead and dying neurons seemingly connected to Tau, another type of protein. That's why medical professionals will often speak of the "plaques and tangles" of AD. The result is a slow and progressive decline in memory, thinking, and reasoning skills. Eventually, people lose the ability to swallow and breathe in a coordinated fashion. Even in the absence of other catastrophic diseases such as kidney failure and cancer, Alzheimer's Disease is a terminal illness. Alzheimer's Disease comprises a spectrum rather than a defined set of signs and symptoms. Slow progression, rather than a sudden change, is often the key to differentiating Alzheimer's behaviors from those associated with other kinds of Dementia. Life expectancy after an Alzheimer's diagnosis can be anywhere from four to 20 years. People who have Dementia often die from other causes such as cancer, kidney failure, and cardiovascular disease. The Alzheimer's Association lists the 10 warning signs of Alzheimer's Disease – the first of which is memory loss. After reading the list you might think, How are these behaviors different from what everybody does at one time or another? The difference is the frequency and the ability to make self-corrections. Healthcare providers often use staging to describe the progression and severity of diseases such as cancer, kidney failure, and Dementia. The following staging criteria will help you understand your loved one’s condition and plan for future caregiving needs. Mild or Early-stage Alzheimer's Disease In this first stage, people experience memory loss, difficulty remembering newly learned information, and have trouble completing complex tasks such as planning a family event. Personality changes such as uncharacteristic anger and increasing difficulty in finding the right words, getting lost, or misplacing items are other common signs. With help, your parent, spouse, or sibling may still be capable of independent living. Moderate or Mid-stage Alzheimer's Disease During this phase, people may confuse family members with close friends, forget personal history details such as where they went to school or where they were born, and need help with dressing and personal hygiene. Some people may become restless, suspicious of others, and confrontational. At this stage, your relative will need close supervision and assistance during the day and perhaps a caregiver during the night. Severe or Late-stage Alzheimer's Disease In the course of this last stage, people who have Dementia lose the ability to speak coherently, need help with eating, dressing, using the bathroom, and walking. Eventually, Late-stage Alzheimer's patients lose the ability to swallow and control their bladder and bowels. During this final stage, your loved one will need 24-hour care, either at home or in a Dementia care facility. References: 1. 2017 Facts and Figures: Alzheimer’s Disease Facts and Figures, Download source here: 2017 Alzheimer’s Disease Facts and Figures. (accessed September 18, 2017). 2. ibid 3. 2017 World Health Organization Factsheet Download source here: 2017 World Health Organization Factsheet. Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.

For most of us, we are busy with our daily lives engulfed with family activities, work, education, and all the things that consume our time. We never give it a thought and often take for granted how our senses keep us connected with our world. As we age there are changes confronting us in the realm of our health and quality of life. These changes are age-related and present a disability to be addressed and remedied. Most of these are hearing, vision, speaking, various motor skills, and cognition. Hearing loss is estimated to affect some 39 to 50 million Americans. Research has indicated that almost three out of every four individuals age 80 and above will have at least one disability to deal with. Most often, hearing loss is most common. Dr. Frank R. Lin, MD of Johns Hopkins University has been one of the leading researchers over the past ten years to make the connection with untreated hearing loss being a provocateur in the area of Dementia. Our loved ones and senior friends impacted with hearing loss and some type of Dementia are especially at risk for decreased quality of life. Often these people require special care in a licensed facility with a professional medical staff 24/7. Ideally, I recommend to every one of my patients to have a complete audiological evaluation on an annual basis. Following this guideline as an associated part of having an annual physical by their family physician, enables the audiologist to detect and monitor adverse changes in hearing acuity, abnormalities, and other medical issues to be addressed. This evaluation provides the baseline and documentation on future tests that help the patient later in life. The protocol includes, but is not limited to case history, otoscopic inspection, pure tone (air & bone) audiometry, speech audiometry, tone decay, tympanometry, acoustic stapedial reflexes, and distortion product otoacoustic emissions testing. One avenue where this documentation will be critical is in handling hearing health care for those requiring amplification and knowing what the previous status was for Dementia-affected patients. For the reader of this article, you would undoubtedly be able to participate in and complete an audiological evaluation administered by an audiologist. For a person with advancing Dementia, in a facility such as a nursing home or special care unit, it may be that up to 95% cannot complete or tolerate the standard evaluation. Even though Congress in 1987 mandated a Minimum Data Set for a required evaluation of incoming residents to a facility, it does not guarantee a successful finding, in hearing, comprehending speech, and producing language. For those people with mid to later stages of Dementia, alterations in testing protocol could be required. Behavioral tests are mostly eliminated from the battery. There are many considerations in handling hearing loss, amplification, and proper examination and assessment for the person with Dementia. Since much of the protocol below is rather scientific-sounding and not easily expressed in lay terms, please print out this blog post and/or bring the information to your doctor to get the process underway. A suggested hearing test protocol may include: Case history – Since the patient may not be able to provide complete and accurate information, a family member or friend should be queried. This step will require a review of previous audiologic studies. Otoscopic inspection – The audiologist will utilize an otoscope to examine the outer ear canals and visually assess for any apparent abnormalities. Audiometry for pure tone and speech stimuli – This component requires participation by the patient and tests reliability in subjective responses. There will be some that may not tolerate the headset or canal inserts nor provide reliable information. Research has shown that only 5% may be able to complete this step. Tympanometry and acoustic stapedial reflexes; impedance testing – This assessment will show whether a perforation, abnormal middle ear pressure or fluid is present and requiring otologic intervention. Distortion product otoacoustic emissions (DPOAE) testing – This is a truly objective test to determine the status of the outer hair cells of the cochlea. Normal responses are seen in threshold levels up to 35 dBHL. The frequency range of DPOAE is 1500 to 6000 Hz. Amplification check – The doctor of audiology will clean, check, repair as needed, readjust, and refit the patient’s amplification if they are a current wearer. If replacement is indicated, this will be noted. As for a new fitting to a patient who has not previously been fitted, it will not be advised due to issues involving the reliability of the assessment and tolerance of fitting. If you wish to explore this subject further, please contact a board-certified & licensed private practice doctor of audiology today. Hearing loss, once addressed, may result in a much richer and more meaningful quality of life for all those affected! Contributing Author: Dr. Patrick M. Murphy, Au.D., M.Ed., CCC-A, FAAA http://www.murphyhearingservices.com/ The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Late-stage Dementia can create an inability to retell specific personal and family histories. Dementia might make long-held treasured memories slow and difficult to retrieve or morph into something different from how you remember them. Research shows that people who have a terminal illness desire opportunities to give as well as to receive. Compiling a family's history through recordings and other activities is a gift the person with Dementia can provide to their family. Together, family members and their loved-one can explore the treasure trove of stored photographs and other memorabilia. With or without the assistance of a professional videographer, audio and video recordings give another perspective on the people and events that molded your loved one's life and perhaps influenced yours as well. Before getting started, it is essential to consider the permanence and availability of electronically stored photographs and audio and video recordings. Floppy discs and hard discs have been obsolete for many years. Compact discs (CDs) and hard drives are quickly becoming phased out - and there is no reason to assume that cloud computing will last forever. Probably the best solution, in addition to electronic storage, is to make hard (paper) copies of photographs, scanned memorabilia, and transcripts of audio recordings. With the help of online self-publishing services, you can design a beautiful book that contains selected images, transcripts, and commentary. Some ideas: 1. Video record your loved one as they tour their home or another meaningful location. Ask "tell me about questions" to get the stories associated with framed photographs, a chipped and repaired vase, or a lovely rose garden. Encourage further discussion by asking logical follow-up questions. And above all – listen!! 2. Record your loved one as they recall various events, such as a fascinating fishing trip, birth, or having fought in the Vietnam War. 3. Create a memory box containing small objects plus a few sentences describing each item's significance. Have your loved one write memory "tweets" on slips of paper. Memory Tweets might be like, "Make my steaks medium rare and my eggs over-easy, "or "I remember the day you were born. The sun was shining, and I was the happiest person alive." Implementing these tips can help preserve family history in the context of memory loss in Dementia. Notes: 1. KE Steinhauser, et al. "In Search of a Good Death: Observations of Patients, Families, and Providers," https://www.researchgate.net/publication/12497721_In_Search_of_a_Good_Death_Observations_of_Patients_Families_and_Providers (accessed May 2, 2016) Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts- that have been provided to us with permission or otherwise. Dementia Society does not provide medical advice; please consult your doctor. www.DementiaSociety.org

Family caregivers often feel stressed, exhausted, anxious, sad, angry, and sometimes hostile. However, caring for a person who has Dementia does more than affect behavior. According to psychiatrist Dr. Linda Mah and colleagues, unrelenting stress and anxiety compromises health as well as contributes to increased risk for depression and Dementia. Many of their findings are sobering. Their discovery that unrelenting anxiety and stress damages areas of the brain that regulate emotional responses, thinking, and memory, is particularly relevant. They conclude that some treatments relieving depression may aid in repairing the damage created by caregiving stresses. But don't let Dr. Mah’s findings be another reason to cause worry in your already stress-filled life. Having risk factors does not mean you are predestined to develop Dementia. Risk factors do not cause the disease; risk factors increase the probability of (someday) having the disease. There are many reasons why it is important for family caregivers to get relief from the months and years of doing more than their abilities, circumstances, and resources would normally withstand. Caregivers have several options available to them in order to reduce their stress. One of them is to look closely at their own behavior. Some family caregivers feel they are the only person who can give their loved one the proper care. Usually, this is not true. Often family members and friends can step up as good substitute caregivers and will volunteer to help if the primary caregiver appears interested or receptive. In addition to family and friends, community and faith-based organizations provide affordable respite care. Local nonprofit support groups, as well as the U.S. Administration on Aging, are examples of community resources. The Catholic Charities and Jewish Family Service are examples of faith-based, nonprofit organizations that, regardless of ethnicity or religion, can give the primary caregiver time away from his or her full-time care commitment. Adult daycare is another possibility. Located in community senior centers, nursing homes, churches, synagogues, hospitals, and schools, adult daycare provides stimulation and companionship for seniors who need medical assistance and other kinds of supervision. Usually open during business hours, adult daycare centers give the family caregiver time to go to work, to attend to personal business, or to relax while knowing their loved one is safe. Family caregivers use respite time in different ways. Some sleep, while others go shopping, spend time with friends, read, walk, or take time to participate in a favorite hobby or sport. Make an effort to set aside time for a daily 15- to 30-minute break for an enjoyable physical activity such as walking. Good times to grab these important moments are when your loved one is asleep, is in the doctor’s office, or when a friend or relative pays a visit Schedule longer respite breaks for the same time each week. Plan ahead so you will know how you will spend that precious time. That way, even on a difficult day you will always have something to look forward to doing. But whatever you decide, make respite a priority before feelings of exhaustion, isolation, and resentment take over. Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society of America does not provide medical advice. Please consult your doctor.

On the surface, the idea of making your bed might seem mundane. However, there are significant benefits to making your bed each morning. Many successful organizations, including the military and Psychology Today, have looked at the benefits that making your bed has for the brain. It’s something that a lot of people often leave behind. You wake up, the room is dark, you take a quick shower, and go about your day. Then you come home at night and you see a big pile of blankets and sheets right in the middle of the bed and you accept that it still needs to be made. Sometimes it can even be a little bit stressful to not have your bed made when all you want to do is go to sleep. There is mounting evidence to support the fact that making the bed in the morning contributes towards making a person happier and more successful. A recent online survey of 68,000 people, which is a fairly substantial base of people, found that 59% of people don’t make their beds and 27% do. The remaining 12% were people that have someone else, like a housekeeper, make their bed for them. They also found that 71% of the bedmakers consider themselves to be generally happy with their lives. 62% of non-bed makers admitted to being generally unhappy. Of course, these results can vary by the life circumstances of the individual. It can extend to their job satisfaction, owning a home, exercising regularly, proper diet, feeling well-rested. These things are all associated with people that fix their beds every day. There is a basis behind fixing your bed each morning. What happens is you wake up and right away you’re training your brain to do a task and attend to an activity that makes you feel good. As a result, you start your day with a sense of accomplishment. This sets the tone for the rest of your day and carries over to completing other tasks. It is the start of the snowball effect that encourages you to keep a proactive attitude throughout the rest of your day. When you stop and think about it, it only takes a couple of minutes in the morning to stop and make your bed. Start developing the habit, stick with it, and see what happens. I guarantee it will help to start your day off on the right foot because it’s the little things that make a difference. Contributor Author: Dr. Michael Trayford is a Board Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For additional information, and to learn more, please visit our Author's page. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice, please consult your doctor. www.DementiaSociety.org