DAILY CARE ACTIVITIES - ENHANCING DAILY LIFE OF PWDs

ACTIVITIES

A person with Alzheimer's or other dementia doesn't have to give up the activities that he or she

loves.  Many activities can be modified to the person's ability.  In addition to enhancing quality of life, activities can reduce behaviors like wandering or agitation.   

Choosing Activities                                               

In the early stages of dementia, the person may withdraw from activities he or she previously enjoyed.  It is important to help the person remain engaged.  Having an open discussion around any concerns and making slight adjustments can make a difference.  For example, a large social gathering may be overwhelming, but the person may be able to interact more successfully in smaller groups.

As Alzheimer's progresses, you may need to make other adjustments to the activity. Use the following tips:

·      Keep the person's skills and abilities in mind

A person with dementia may be able to play simple songs learned on the piano years ago. Bring these types of skills into daily activities.

·      Pay special attention to what the person enjoys

Take note when the person seems happy, anxious, distracted or irritable. Some people enjoy watching sports, while others may be frightened by the pace or noise.

·      Consider if the person begins activities without direction

Does he or she set the table before dinner or sweep the kitchen floor mid-morning?  If so, you may wish to plan these activities as part of the daily routine.

·      Be aware of physical problems

Does he or she get tired quickly or have difficulty seeing, hearing or performing simple movements?

·      Focus on enjoyment, not achievement

Find activities that build on remaining skills and talents. A professional artist might become frustrated over the declining quality of work, but an amateur might enjoy a new opportunity for self-expression.

·      Encourage involvement in daily life

Activities that help the individual feel like a valued part of the household — like setting the table — can provide a sense of success and accomplishment.

·      Relate to past work life

A former office worker might enjoy activities that involve organizing, like putting coins in a holder or making a to-do list. A farmer or gardener may take pleasure in working in the yard. 

·      Look for favorites

The person who always enjoyed drinking coffee and reading the newspaper may still find these activities enjoyable, even if he or she is not able to completely understand what the newspaper says.

·      Consider time of day

Caregivers may find they have more success with certain activities at specific times of day, such as bathing and dressing in the morning.

·      Adjust activities to disease stages

As the disease progresses, you may want to introduce more repetitive tasks. Be prepared for the person to eventually take a less active role in activities.

Your approach

                                                                                                             

·      Help get the activity started

Most people with dementia still have the energy and desire to do things 
but may lack the ability to organize, plan, initiate and successfully complete the task.                                   

·      Offer support and supervision

You may need to show the person how to perform the activity and provide simple, easy-to-follow steps.

·      Concentrate on the process, not the result

Does it matter if the towels are folded properly?  Not really. What matters is that you were able to spend time together, and that the person feels as if he or she has done something useful.

·      Be flexible

When the person insists that he or she doesn't want to do something, it may be because he or she can't do it or fears doing it. Don't force it. If the person insists on doing it a different way, let it happen, and change it later if necessary.

·      Assist with difficult parts of the task

If you're cooking, and the person can't measure the ingredients, finish the measuring and say, "Would you please stir this for me?"

·      Let the individual know he or she is needed

Ask, "Could you please help me?" Be careful, however, not to place too many demands upon the person.

·      Stress a sense of purpose

If you ask the person to make a card, he or she may not respond. But, if you say that you're sending a special get-well card to a friend and invite him or her to join you, the person may enjoy working on this task with you. 

·      Don't criticize or correct the person

If the person enjoys a harmless activity, even if it seems insignificant or meaningless to you, encourage the person to continue.

·      Encourage self expression

Include activities that allow the person a chance for expression. These types of activities could include painting, drawing, music or conversation.

·      Involve the person through conversation

While you're polishing shoes, washing the car or cooking dinner, talk to the person about what you're doing. Even if the person cannot respond, he or she is likely to benefit from your communication.

·         Substitute an activity for a behavior

If a person with dementia rubs his or her hand on a table, provide a cloth and encourage the person to wipe the table. Or, if the person is moving his or her feet on the floor, play some music so the person can tap to the beat.

·         Try again later

If something isn't working, it may just be the wrong time of day or the activity may be too complicated. Try again later, or adapt the activity.

(Source:  alz.org -> http://www.alz.org/care/alzheimers-dementia-activities.asp)

MUSIC, ART AND ALZHEIMER'S

Music and Art can enrich the lives of people with Alzheimer's disease.  Both allow for self-

expression and engagement, even after dementia has progressed.

Music

Music can be powerful.  Studies have shown music may reduce agitation and improve behavioural issues that are common in the middle-stages of the disease. Even in the late-stages of Alzheimer's, a person may be able to tap a beat or sing lyrics to a song from childhood. Music provides a way to connect, even after verbal communication has become difficult.

Use these tips when selecting music for a person with dementia:

•   Identify music that’s familiar and enjoyable to the person. If possible, let the person choose the music.

•   Choose a source of music that isn't interrupted by commercials, which can cause confusion. 

•   Use music to create the mood you want. For example, a tranquil piece of music can help create a calm environment, while a faster paced song from someone's childhood may boost spirit and evoke happy memories.

•   Encourage movement (clapping, dancing) to add to the enjoyment.

•   Avoid sensory overload; eliminate competing noises by shutting windows and doors and by turning off the television. Make sure the volume of the music is not too loud.

Art

Art projects can create a sense of accomplishment and purpose.  They can provide the person with dementia — as well as caregivers — an opportunity for self-expression.

When planning an art activity for someone with middle- to late-stage Alzheimer's, keep these tips in mind:

·      Keep the project on an adult level.  Avoid anything that might be demeaning or seem child-like.

·      Build conversation into the project.  Provide encouragement, discuss what the person is creating or reminiscence.

·      Help the person begin the activity.  If the person is painting, you may need to start the brush movement.  Most other projects should only require basic instruction and assistance.

·      Use safe materials.  Avoid toxic substances and sharp tools.

·      Allow plenty of time, keeping in mind that the person doesn’t have to finish the project in one sitting.

(Source:  Alz.org -> http://www.alz.org/care/alzheimers-dementia-music-art-therapy.asp)

SUNDOWNING

Sundowning, or sundown syndrome, affects some people who have Alzheimer's disease and dementia. People with dementia who "sundown" get confused and agitated as the sun goes down - and sometimes through the night.

Sundowning may prevent people with dementia from sleeping well. It may also make them more likely to wander. Due to the stress it puts on caregivers, sundowning is a common cause of  caregiver burnout.

Symptoms of Sundowning

Sundowning happens to nearly 20% of people who have Alzheimer's disease or other kinds of dementia.

People who sundown may become more:

·      Forgetful

·      Confused

·      Delirious

·      Agitated

·      Anxious

·      Restless

People with sundowning often have trouble sleeping.  They may:

·      Pace the floor

·      Wander

·      Yell

·      Become combative

Sundowning typically peaks during the middle stages of Alzheimer's. It gets better as the disease progresses.

What Causes Sundowning?

The causes of sundowning are not well understood.

Some research suggests that sundowning may be related to changes to the brain's circadian pacemaker. That's a cluster of nerve cells that keeps the body on a 24-hour clock.

Studies in mice suggest that chemical changes in the brain that are characteristic of Alzheimer's disease may play a role. Researchers found that older mice make more of an enzyme that's associated with anxiety and agitation before they go to sleep than middle-aged mice do.

Several things may increase the risk for sundowning. These include:

·      Pain

·      Severe constipation

·      Poor nourishment

·      Being on too many medications

·      Infection

·      Noisy and disruptive sleeping environment

Treatments for Sundowning

Ways to make sundown syndrome less severe include:

Activity - Being more active during the day may help Alzheimer's patients sleep better at night. You can:

·      Discourage daytime naps.

·      Encourage exercise, like walking.

·      Encourage hobbies that get dementia patients up and moving.

Healthy Diet - Caregivers should make sure Alzheimer's patients eat properly:

·      Limit caffeine and sugar to the morning hours.

·      Plan an early dinner.

·      Keep snacks light before bedtime.

Medical Advice - A doctor can look for physical problems like pain, infections, or bladder problems that may be contributing to night time confusion and agitation. They should also regularly review prescription medications to make sure they are still needed.

Light Therapy - Exposure to bright lights, like the sun, during the day may reduce some sundowning symptoms, especially when used in combination with exercise, like walking.

Good Sleeping Environment - Allow the patient to change bedrooms or to sleep in a favourite chair or couch. Keeping the room partially lit may also help to reduce confusion when the person wakes during the night.

Calm Reassurance - Gently help your loved one remember where he is and what time it is. Avoid arguing and offer reassurance that he is OK.

(Source:  WebMD.com)

Hope For Early Alzheimer's Test In Spinal Fluid

New research led by Nottingham University in the UK suggests abnormal levels of seven proteins in spinal fluid could be markers for the early stages of Alzheimer's disease, raising hopes of a test for a disease that is difficult to diagnose at the beginning. The researchers write about their findings in the Journal of Alzheimer's Disease.

Study co-author Dr Kevin Morgan, Professor of Human Genomics and Molecular Genetics at Nottingham, told the press on Tuesday that the findings are "a new lead for improving early diagnosis of Alzheimer's disease".

An early diagnosis of Alzheimer's disease would help people prepare for the future and also enable them to be involved in clinical trials at a much earlier stage of the disease, when treatments are more likely to show positive results, he added.

About 820,000 people in the UK have dementia, of which Alzheimer's disease is the most common form. Dementia often develops slowly and is not always obvious in the early stages. It can be difficult to distinguish from the mild forgetfulness often seen in normal ageing.

Morgan and colleagues compared samples of cerebrospinal fluid (CSF) from 33 people with Alzheimer's disease, 10 people with mild cognitive impairment, and 20 healthy older people. Mild cognitive impairment is a condition where people have problems with thinking and memory but not to an extent that it interferes with everyday life.

They compiled profiles of the proteins in each sample and then compared them with each other to see if they could find something distinctive in the samples from people with Alzheimer's disease.

The results showed that the samples from people with Alzheimer's diseases tended to have higher levels of four proteins, and lower levels of three other proteins.

A protein called SPARCL1 proved to be the strongest predictor for Alzheimer's. When the researchers tested the samples using only this protein, they could tell whether a person had Alzheimer's disease to an accuracy of 65%.

This accuracy went up to 95% when they tested for abnormal levels of all seven proteins.

The researchers repeated the tests with a new set of CSF samples from 32 healthy people and 30 people with Alzheimer's disease. This time, when they tested for all seven proteins, the accuracy was 85%.

The team now plans to use their findings to develop a blood test for an early diagnosis of Alzheimer's disease.

Morgan said:

"It will also be important to investigate what causes these specific proteins to change as Alzheimer's develops."

By understanding the underlying changes in the biochemistry of Alzheimer's, we have a better chance of developing new treatments, he said, adding that:

"Dementia can only be defeated through research, and I hope these findings could take us a step closer to that goal."

Dr Marie Janson, Director of Development at Alzheimer's Research UK, who part-funded the study, said the findings have "opened up a new avenue for research".

She emphasized how difficult it is to diagnose Alzheimer's, as memory problems can be symptomatic of various conditions.

"This study has the potential to help create a vital tool for doctors to identify patients that need further investigation - but these results must now be followed up in order to achieve that goal," she added.

(Source: Medical News Today, 12 February 2012)

Advice to Keep Dementia at Bay

Recently, researchers looking into cognitive decline and dementia have made encouraging findings. Although it was believed that the adult brain could not develop new neurons (or brain cells), scientists have learned in the past decade or so that the human brain is pliable and adaptive. The brain can actually add new neurons even late in life and continually form new connections among existing neurons -- a phenomenon known as neuroplasticity.

This means that while an aging brain may have signs of damage, it can often compensate for them, at least initially. And engaging in mentally stimulating activities like reading, taking a class or playing board games is one way to bolster this process.

This compensation process depends on your "cognitive reserve," the extra, perhaps unused, amount of cognitive ability that can make up for the loss of brain functioning when your brain shows signs of dementia due to the death of cells and their replacement by beta-amyloid plaques. Genetics, early childhood stimulation and education level can influence cognitive reserve but are essentially immutable once you're an adult.

Fortunately, studies have found that you can also increase your cognitive reserve and delay the onset of dementia through a variety of intellectually stimulating leisure activities in middle and later life.

A study in the journal Neurology, for example, found that among 101 people who eventually developed dementia, those who frequently participated in one or more activities, such as reading, writing, doing crossword puzzles, playing card or board games, having group discussions or playing music experienced memory decline more than one year later than those who participated in these activities less often. These pursuits built cognitive reserve and delayed dementia as much as a higher education level did.

It's worth noting that researchers have discovered that watching television is a passive activity that doesn't really stimulate the mind at all; on the contrary, watching television is associated with an increased risk of cognitive decline. One study found that TV watchers were 10 percent more likely than nonwatchers to experience cognitive impairments over a five-year period. A possible explanation: Time spent in front of the TV means less time for the mental, social and physical activities that can help delay dementia.

(Source:  John Hopkins Health Alert, 9 January 2012)

Prevention Tip - Exercise Against Alzheimer's ...

What can we do to fight dementia? There is ever-growing evidence that exercise is both highly therapeutic and powerfully protective.

1. Watch this Video "Staying Active may deter Alzheimer's" for insights to help get your new year in motion.

2. BRAIN CONNECTIVITY BOOSTED BY DIFFERENT "ALZHEIMER'S WALK"

A group of “professional couch potatoes,” as one researcher described them, has proven that even moderate exercise - in this case walking at one’s own pace for 40 minutes three times a week - can enhance the connectivity of important brain circuits, combat declines in brain function associated with aging and increase performance on cognitive tasks.

The study, in Frontiers in Aging Neuroscience, followed 65 adults, aged 59 to 80, who joined a walking group or stretching and toning group for a year. All of the participants were sedentary before the study, reporting less than two episodes of physical activity lasting 30 minutes or more in the previous six months. The researchers also measured brain activity in 32 younger (18- to 35-year-old) adults.

Rather than focusing on specific brain structures, the study looked at activity in brain regions that function together as networks.

“Almost nothing in the brain gets done by one area - it’s more of a circuit,” said University of Illinois psychology professor and Beckman Institute Director Art Kramer, who led the study with kinesiology and community health professor Edward McAuley and doctoral student Michelle Voss. “These networks can become more or less connected. In general, as we get older, they become less connected, so we were interested in the effects of fitness on connectivity of brain networks that show the most dysfunction with age.”

Neuroscientists have identified several distinct brain circuits. Perhaps the most intriguing is the default mode network (DMN), which dominates brain activity when a person is least engaged with the outside world - either passively observing something or simply daydreaming.

Previous studies found that a loss of coordination in the DMN is a common symptom of aging and in extreme cases can be a marker of disease, Voss said.

“For example, people with Alzheimer’s disease tend to have less activity in the default mode network and they tend to have less connectivity,” she said. Low connectivity means that the different parts of the circuit are not operating in sync. Like poorly trained athletes on a rowing team, the brain regions that make up the circuit lack coordination and so do not function at optimal efficiency or speed, Voss said.

In a healthy young brain, activity in the DMN quickly diminishes when a person engages in an activity that requires focus on the external environment. Older people, people with Alzheimer’s disease and those who are schizophrenic have more difficulty “down-regulating” the DMN so that other brain networks can come to the fore, Kramer said.

A recent study by Kramer, Voss and their colleagues found that older adults who are more fit tend to have better connectivity in specific regions of the DMN than their sedentary peers. Those with more connectivity in the DMN also tend to be better at planning, prioritizing, strategizing and multi-tasking.

The new study used functional magnetic resonance imaging (fMRI) to determine whether aerobic activity increased connectivity in the DMN or other brain networks. The researchers measured participants’ brain connectivity and performance on cognitive tasks at the beginning of the study, at six months and after a year of either walking or toning and stretching.

At the end of the year, DMN connectivity was significantly improved in the brains of the older walkers, but not in the stretching and toning group, the researchers report.

The walkers also had increased connectivity in parts of another brain circuit (the fronto-executive network, which aids in the performance of complex tasks) and they did significantly better on cognitive tests than their toning and stretching peers.

Previous studies have found that aerobic exercise can enhance the function of specific brain structures, Kramer said. This study shows that even moderate aerobic exercise also improves the coordination of important brain networks.

“The higher the connectivity, the better the performance on some of these cognitive tasks, especially the ones we call executive control tasks - things like planning, scheduling, dealing with ambiguity, working memory and multitasking,” Kramer said. These are the very skills that tend to decline with aging, he said.

3. Video and Article "10 Ways Exercise Fights Dementia"

Exercise is good, but it's hard to do. Get motivated by learning 10 ways it helps your brain prevent & fight dementias such as Alzheimer's.

4. Video and Article "Walking is Best Brain Protector. The Easiest and The Cheapest"

A recent study that shows walking not only protects the brain, but can help improve memory in older adults. Watch Dr. Morgan Sauer from the St. Vincent Longevity Center.

(Source: The Alzheimer's Weekly and Dementia Weekly, 2 January 2012)

Latest Study : Risk for Dementia Rises When Diabetes, Depression Meet

When people with type 2 diabetes also struggle with depression, their odds for a third worrisome condition - dementia- goes up markedly, a new study suggests.

Specifically, patients with type 2 diabetes are twice as likely to develop dementia three to five years after being diagnosed with depression compared to nondepressed people with diabetes, researchers found.

"We've known for years that diabetes is a risk factor for dementia," explained study lead author Dr. Wayne Katon, a professor and vice chair of the department of psychiatry and behavioral sciences at the University of Washington's School of Public Health in Seattle. "In fact, having diabetes itself probably doubles the risk for dementia," Katon added.

"We've also known that a very common accompanying condition with diabetes is depression," Katon said. "Some 20 percent of diabetics have depression. And now our data suggests that if you do have depression in addition to diabetes, it actually doubles again the already increased risk for dementia that diabetic patients face."

However, the study authors noted that the absolute risk of dementia for any one person with depression and diabetes remains relatively small - about one in 50.

Katon and his colleagues published their research, which was supported by the U.S. National Institutes of Health-funded Diabetes & Aging Study and the Diabetes Study of Northern California, in the Dec. 5 online edition of Archives of General Psychiatry.

The authors noted that depression and diabetes are among the most prevalent health issues facing American seniors.

What's more, each of the two conditions seem to independently raise the risk for developing the other: Being diabetic bumps up the likelihood of becoming depressed, while being depressed boosts the risk for developing diabetes.

In the new study, the researchers focused on more than 19,000 California residents with diabetes between the ages of 30 and 75.

Nearly one in five of the patients were also deemed to be experiencing "clinically significant" depression, the authors noted.

After monitoring for the onset of dementia over a three- to five-year period, the research team found that just over 2 percent of those who had both diabetes and depression went on to develop one or more forms of dementia, including Alzheimer's disease.

By contrast, just 1 percent of patients who had diabetes alone ended up developing dementia during that period.

But the authors also noted that many of the things that can boost the odds for depression among diabetic patients, such as eating a poor diet, maintaining a sedentary lifestyle and/or smoking, are modifiable behaviors. This means that patients and physicians alike have some clear targets for interventions to lower depression risk, and possibly dementia risk as well.

"So the important thing to focus on here is that there are very effective treatments for depression," said Katon. "And so if you're a diabetic who does have depression it's very important to get it attended to. Just as important as getting your diabetes itself treated."

Dr. Robert Friedland, chair of neurology at the University of Louisville School of Medicine in Louisville, Ky., agreed.

"It is not surprising that they should find a relationship between depression in diabetics and a higher risk for dementia," he said. "But I would point out that although both diabetes and dementia have genetic influences, there are also clear things people can do to lower their risk for both. For example, avoiding obesity by eating a relatively low-fat diet and engaging in regular physical exercise can help to prevent both diabetes and depression. And, therefore, dementia as well."

There's more on the diabetes-depression link at the American Diabetes Association.

(Source: HealthDay News, 5 December 2011)

Some People With Alzheimer's Take Conflicting Drugs - Common medications might block action of dementia drugs like Aricept

Many Alzheimer's patients who take cholinesterase inhibitors to slow their brain disease also take drugs that counter the effects of those Alzheimer's medications, a new study says.

Clinical trials have shown that cholinesterase inhibitors such as Aricept (donepezil) have a modest impact on the functional and cognitive decline caused by Alzheimer's disease, noted the researchers at the Group Health Research Institute in Seattle.

"Cholinesterase inhibitors are today's primary therapy for slowing Alzheimer's disease," study leader Denise Boudreau said in an institute news release.

"Anticholinergic properties are often found in drugs commonly used to treat gastrointestinal disorders, allergies, urinary incontinence, depression and Parkinson's disease, and they can have negative effects on cognition and function in the elderly. There's concern that if someone is taking both types of drugs - cholinesterase inhibitors and anticholinergic medications - they will antagonize each other, and neither will work," she explained.

Common anticholinergic medications include Benadryl (diphenhydramine) and Ditropan (oxybutynin), which is prescribed for overactive bladders.

Boudreau and colleagues analyzed data from more than 5,600 patients aged 50 and older who had cholinesterase inhibitors prescribed to them for the first time between 2000 and 2007. Of those patients, 37 percent also took at least one anticholinergic drug and more than 11 percent took two or more anticholinergic drugs.

Among the patients who took both classes of drugs, dual use generally lasted three to four months, but one-quarter of the patients used both classes of drugs for more than a year.

The researchers also found that 23 percent of patients who received a new prescription for cholinesterase inhibitors were already using at least one anticholinergic drug, and 77 percent of those patients continued taking an anticholinergic drug after they began taking a cholinesterase inhibitor.

"It's reassuring that we did not observe an association between simultaneous use of the two types of drugs and increased risk of death or nursing home placement," Boudreau said in the release. "But concomitant use of these drugs is, at the very least, not optimal clinical practice."

The study was published online October 22, 2011 in the Journal of the American Geriatrics Society.

Alzheimer's patients often have multiple health problems, which may help explain why doctors might prescribe conflicting medications for these patients, the researchers said.

More information:
U.S. National Institute on Aging has more about Alzheimer's medications.
Alzheimer's Association => Learn more about Alzheimer's Medications

Source: Group Health Research Institute, News Release, October 25, 2011