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Worried that you’re getting Alzheimer’s Disease?

A lot of people start paying more and more attention to their memory blips as they get older and may chalk it up to the onset of Alzheimer’s disease or other dementia. Most people don’t remember when they were 20 years old and continually forgetting what they went upstairs for or where they dropped their purse off when they got in the house. All of a sudden, in your 60s, 70s, 80s, or 90s, the fear of getting dementia sits in the back of your mind hanging over any episode of forgetting a word, forgetting to call your sister, or forgetting what you just read in the paper. It is important not to freak out just yet! Just as when you were younger, there are a lot of reasons that our memory slips from situation to situation.

Scared brain

Interest is a factor that affects our ability to remember things. Just think about when you were younger and sitting in school listening to a lecture you just couldn’t care less about. Comparatively to a subject you were interested in, which lecture was easier to remember? The subject you were interested in. Another factor that affects memory is focus. When you are distracted by something else whether it’s something that is going on in the same room or something that happened at home, if you’re thinking about something else, it’s much harder to remember the things that are happening right in front of you. And then there is stress. Big. Bad. Stress. If you are stressing over your memory, you’re likely to forget more than if you just relaxed. Stress does a lot of bad things to our bodies, and its effects on memory are just one of them.

Now don’t get me wrong, your general memory and ability to remember different things does naturally decline as you age. This is completely normal. But the only time for concern is when these memory blips start to affect your ability to function in everyday life. Now it is time to visit your doctor.

There are a couple of changes that may indicate you are experiencing abnormal cognitive and memory changes. When you start to notice these, it is time to go see your doctor. These are the 7 Changes of Cognition:

  1. Changes in memory that affect day-to-day activities like losing your wallet and putting your purse in the microwave
  2. Changes in language abilities, often forgetting words and using words that don’t work in a sentence
  3. Changes in the ability to make sound judgement like wearing the proper clothes for the weather
  4.  Changes in mood, behaviour, and personality like going from easy-going to very uptight and hot tempered or from engaging in activities to becoming more recluse
  5. Changes in the ability to perform familiar tasks like preparing your signature dish
  6. Changes in orientation like not knowing where you are or what time, month or year it is
  7. Changes in abstract thinking like understanding complex concepts and using and understanding metaphors

If you do start to experience the 7 Changes of Cognition, you should go see your doctor.

 

 

 

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What is Sundowing?

Have you ever heard of sundowning? Has your PSW told you that your mom experiences sundowning? Has someone at the long-term care home asked if your mom has sundowning before she moves into the home?

Sundowning is when a person living with dementia gradually becomes more agitated or confused and shows personality changes when the day turns into the evening. Most often, this happens around 4pm.

Some common symptoms of sundowning include: sudden behaviour changes, difficulty speaking and thinking clearly, hallucinations, verbal and/or physical aggression, pacing/wandering, paranoia, and increased confusion. As we go through some of the causes of sundowning, you’ll see that sundowning is often just a normal reaction to situations we’ve all experienced.

Sundowing

One of the most common causes of sundowning is simple exhaustion. For someone living with dementia, simple tasks throughout the day are more tiring than for someone without dementia. This is because they have fewer cognitive and physical resources to engage in those tasks and activities like going for a walk, preparing a meal, and having conversations. Just like when you are sick you get tired more easily when doing everyday tasks, people living with dementia experience this feeling daily. And just like when you are tired, you usually get more irritable, have less patience, and react quicker to things that annoy you. The same thing happens with people with dementia. But we call it “sundowning.”

So if exhaustion causes sundowning, then how can you prevent it?

Easy! Take a nap! Who doesn’t like naps after all?! Recharge, try a nap, try sitting quietly out in the sun or in a quiet room. Watching TV or listening to the radio may help but it may be too stimulating to the senses to allow the person recharge.

Another common cause of sundowning is medications wearing off later in the day. Ask your doctor for extended release or timed release medications so that the effects of the medications are more consistent throughout the day. Or perhaps there is a better schedule for taking the medications that results in a steady reaction rather than ups and downs.

Another very possible cause of sundowning is the reality your loved one is living in. If for example, they are back in their 40’s and their husband always comes home at 5pm, and it’s a little before 5pm now, it’s a natural reaction to get excited or anxious about waiting for their husband to walk in the door. Then what if it passes 5pm and their husband isn’t home yet? Then they could start to get worried and start pacing the home; getting irritable and cleaning vigorously.

Anytime you are working with someone living with dementia, you have to try to get into their head and understand their reality. If you figure out that your loved one is worried that their husband isn’t home yet, try telling them that they called earlier and said that they were going to be late because they had a business meeting, and not to worry. The best way to deal with these situations is to validate your loved one in their feelings and then give a plausible reason as to why their husband isn’t home yet, This reason should be something that would make your mother relax and not worry.

Finding the Balance – Working Against Burnout

As a spouse, caregiving can become incredibly stressful. As you watch your relationship with your wife change from spouse to caregiver, emotions like love and compassion may begin to be shadowed by anger, resentment, guilt, and exhaustion. It is no walk in the park to care for your spouse who has succumbed to the symptoms of dementia.

There are a lot of instances when a spouse will take on all, and I mean all, of the responsibility to care for your loved one. They were responsible for the finances and bills, but are now also responsible for groceries, laundry, and organizing appointments. At first, you may gain a sense of appreciation for your loved one, realizing how much work these tasks actually required. But over time, you may feel it is unfair that what was once a two-person job, now completely falls to you. Now, there’s no time for you to go out with your buddies, to go to the club and hang out with the boys over a whiskey and cigar. There’s no time to go for your daily walks in the woods that always gave you so much peace and relaxation. The days of going to the gym and movies are gone. All your time is spent caring, worrying, and organizing two lives so completely that all of a sudden, you want to scream, cry, and just leave it all behind.

burnout

But you don’t. You stay, and you help. But you can’t do it for much longer. So what do you do now? You couldn’t live with yourself if you just left. Not after an entire life with this person who has given you so much too.

So what are your options?

There are actually a whole bunch of resources out there to support you and your loved one. Using these resources help so that you don’t get burned out and your loved one gets the best possible care and support they need. It’s a win-win! So, let’s look at what’s out there.

First, you have volunteers. The easiest way to get access to a volunteer is through the Alzheimer’s Society chapter nearest you. These volunteers can have a range of purposes but the most common is companionship. Companionship is when a volunteer comes to your home, and spends time with your loved one. Often, they come for 2hrs at a time, once per week. This can vary from person-to-person and from situation-to-situation. During the 2-hour affair, your loved one and their companion will engage in different activities such as cooking or baking, gardening, knitting, going through photo albums, doing crosswords, or just chatting away. Now during this time, you can either stay with your loved one and their companion, you can go off in your home and busy yourself with other things, or you can leave to run errands or go catch a cup of tea with a friend. Usually in these situations, you’ll stay home for the first visit or so until you’ve gained trust in your companion, and then you’ll feel more freedom to go and enjoy your time free of caregiving.

Another great way to find some free time for yourself is through day programs. Some day programs are free, some are a pay-per-service, and others require a membership. Day programs can range from 1-2 hour sessions all the way to full days (9am-5pm). You can find day programs through the VON, the Alzheimer’s Society, LumaCare, and many others.

There is also a service called Respite Care. This is where your loved one goes to a facility for a couple of days to a month or so, and is cared for there. This type of service allows you to gain some much needed rest and relaxation. You are free to go on vacation, go visit relatives and friends, go to the spa, go to that hockey game with the boys. Pretty much do anything you want. There are many retirement homes that offer respite care and can be found in this list. Not all retirement homes offer this service.

Another common stressor when caring for someone with dementia is groceries and meal preparation. But don’t worry, we’ve got you covered here too. Services like Meals on Wheels, or Heart To Home Meals, and Shine At Home all deliver nutritious meals to your home. No need for grocery shopping, cooking, or dishes. Meals on WheelsEnjoy cooking? Then why not try grocery delivery? Many grocery stores now offer pickup and delivery. Loblaws, Metro, and Walmart offer free grocery pickup after you order online. And companies like Anytime Grocery offer grocery delivery.

We’re not done yet. What about homemaking? Do you hate the days when you have to clean the toilet? Do laundry? or vacuum? Again, there’s a service for that. We understand that in a partnership, one person doesn’t do everything. Both spouses worked as a team to accomplish the daily doings of life. But when one gets sick and can’t contribute as much anymore, you can be sure that there is a service out there to help you out. Companies like Retire-At-Home and Bayshore offer these types of services.


Most importantly, don’t do it alone. We all need help, whether it’s as simple as screwing in a light bulb, someone to vent to, or as complex as getting help with personal care like going to the bathroom or getting dressed. We all need help and there is certainly no shame in that.

One of the best things you can do for your loved one is to take care of yourself. If you’re not in good shape, then you won’t be able to support your loved one. It’s like the concept on a plane: put your own oxygen mask on first, then help others with theirs. If you don’t put your mask on first, you’ll only be able to help a handful of people before you collapse. But if you put yours on first, you can go around the entire plane and help everyone with theirs.

Can Ketones Prevent Alzheimer’s Disease?

Often in Alzheimer’s disease, there is a reduction in the brain’s use of glucose (sugar) for energy. This means that the brain isn’t able to properly function because it’s not getting enough energy to carry out all of its jobs. In fact, when parts of your brain don’t get enough energy, the brain cells start to degenerate and die.

But, this inability to absorb glucose is not consistent across all parts of the brain. In people with Alzheimer’s disease, some parts of the brain are able to absorb adequate amounts of glucose while other parts can’t absorb enough. So, if the front part of the brain doesn’t absorb enough glucose, then it starts to get damaged and you’ll likely see problems with decision making and judgement.

There is hope though! A study in 2016 was done that showed the brain – even when glucose absorption is impaired – can still absorb ketones! Ketones are another energy molecule that your brain can use. We are also seeing that when a person living with Alzheimer’s disease is put on a treatment that increases ketones, their symptoms of dementia are improved!

Let’s take a closer look at ketones.

Ketones are an alternative source of energy for the brain. They are made in our bodies when we break down fat. The only time fat is broken down for energy is when the body has used all of the carbohydrates (glucose) available. Some common reasons for people to start breaking down fat include: fasting, starvation, eating a low-carb diet, eating a ketogenic diet, after a long bout of exercise, or uncontrolled Type 1 Diabetes. Watch this video for a great campfire analogy on ketones.

There are 3 types of ketones:

  1. Acetoacetate
  2. Beta-hydroxybutyric acid
  3. Acetone

Ketones

Acetoacetate is the first ketone to be made from the breakdown of fat. Then Beta-hydroxynutyrate is made from acetoacetate; and Acetone is simply a byproduct of acetoacetate which doesn’t actually get used by the brain.

 


Now it becomes quite difficult to get someone with pre-Alzheimer’s disease/Mild Cognitive Impairment or someone already with Alzheimer’s disease to start eating a Ketogenic diet. However, there are products that you can buy to help your body use ketones faster for brain energy. The aim, is to supply ketones to the parts of the brain that aren’t able to absorb glucose for energy. This way, those parts of the brain are still getting enough energy to perform their vital functions and helps to maintain healthy brain cells. In theory, you are preventing or delaying the onset of dementia. Studies are also looking at the ability of the ketogenic diet to treat and possibly reverse dementia. Now dementia by definition is irreversible and progressive, but there are ups and downs during the course of the condition. The ketogenic diet could lift the person back up to a higher functioning status and researchers predict that this could occur among people in the earliest stages of Alzheimer’s disease. Right now however, the best evidence in the use of ketones as brain fuel is for people who have Mild Cognitive Impairment before dementia or Alzheimer’s disease.

The Stigma About Alzheimer’s Disease

You got a diagnosis of Alzheimer’s disease.

Your friends find out.

Your friends stop coming around.

People stop asking for your opinion.

You get excluded from conversations.

People talk about you as if you weren’t there.


This is the stigma of living with Alzheimer’s disease or other dementia


The stigma of dementia often comes from a lack of knowledge and understanding of what dementia even is. A lot of people get scared from the stereotypes that a person living with dementia will randomly hit or attack you. A family friend of mine actually said that she wouldn’t go and see one of her very good friends because she was worried that she would get punched or kicked unpredictably.

People living with dementia are still people. Their behaviours and actions can be predicted if you pay attention to mood, surroundings, environment, and life history.

Stigma

A lot of people too, will “write off” a person with dementia because they feel there is nothing that can be done. There is a lot that can be done. It is true that dementia is progressive and will end in death, but there are lots of things you can do to make the last years of life happy and productive. Just as when someone gets a diagnosis of terminal cancer, you still do things with and for that person.

Others may believe that people living with dementia don’t understand what’s going on around them or what’s being said. This sentiment is also wrong and the line of thinking allows people to treat those living with dementia without dignity and respect. People living with dementia can understand what is happening around them. They pick up on people’s emotions easily and react accordingly. For example, if you are arguing with someone and the mood is very negative, your loved one with dementia may react with anger, sadness, or a want to protect – depending on their personality. One of the easiest ways to influence a person living with dementia into a positive mood, is to generate positive vibes, smile, and laugh.

Also, people with dementia can still contribute in many aspects of life and society. These people have lived. They have years of experience, memories, and lessons learned. Many of our WWII survivors are +85 years, and can pass on incredible teachings that influence politics, business, and how you live your daily life. Talk to a veteran and learn about communities coming together to support each other through the Great Depression, and learn gratitude for what you have as compared to what they had – Freedom and Security for one. They have skills and wit. I knew a man with dementia who handmade acoustic guitars, another who built ships in bottles, and a woman who knitted her entire family’s wardrobe. These dying skills and trades are useful and fun to engage in and it is in our elders and those living with dementia who retains this information. It’s not in a book or on the Internet. It’s in your grandmother and grandfather.

Lastly, dementia is like any other illness or condition. People don’t want to be labeled by it. If you had cancer, do you want to be known and treated as that woman with cancer? Or do you want to be known and treated as Kathy, the wife, mother of 2 boys and 1 girl, a mechanical engineer, and a sister to John and Diane? You’d want to be treated as a human with a present, past, and future life.


There are all these causes of stigma towards dementia out there, but there are 3 simple ways you can stop it, and help your loved one living with dementia to live well.

3 Ways to Combat the Dementia Stigma:

  1. Stand Up – Don’t put up with comments that distort the image of dementia into a negative light. Learn and inform people of the facts; don’t be afraid to ask questions and learn more.
  2. Treat with Respect and Dignity – Remember that people living with dementia are people first. They are not defined by the diagnosis. In fact, being treated with disrespect and without dignity can really impact a person’s health and well-being. So much so that symptoms can worsen and progress at a much faster rate. Treat each person how you would want to be treated.
  3. Continue your relationship – be a good relative/friend and support your loved one. The worst thing for someone living with dementia is for their friends and family to leave as soon as the diagnosis is given.

 

What’s the Difference between Alzheimer’s Disease and Dementia?

People often ask us, “what’s the difference between Alzheimer’s disease and dementia?” Are they the same thing? Is Alzheimer’s disease a type of dementia? Is dementia a type of Alzheimer’s disease? Well actually, Alzheimer’s disease is a CAUSE of dementia.

Dementia is an umbrella term used to describe a set of symptoms. Dementia is not a disease in and of itself, it is actually a syndrome. This collection of symptoms are caused by something else. Alzheimer’s disease is one of the possible causes. Other causes of dementia may include Lewy bodies, hypertension (or high blood pressure), and concussions.

Dementia is a progressive syndrome, primarily affecting older adults aged 65+, characterized by cognitive decline that ultimately affects a person’s ability to live independently.

There are 3 key ideas in this definition of dementia:

  1. Dementia is progressive in nature, meaning that it will get worse to the point of death.
  2. Dementia affects cognition, or any function produced by the brain, including memory, judgement, decision making, visual and auditory perception, and behaviour.
  3. Dementia reduces a person’s ability to live on their own because that person now has difficulty getting dressed, eating, going to the bathroom, showering, moving about the house, and getting up and down from a chair or a bed. These are the activities of daily living.

Alzheimer’s disease is characterized by plaques and tangles in the brain. These deposits interfere with brain function which affect memory, sequencing ability, judgment, and many other cognitive functions. Alzheimer’s disease is progressive, as more and more brain cells are affected by the plaques and tangles. This means that symptoms get worse and the need for assistance in daily life heightens.

plaques and tangles

As mentioned above, there are many other causes of dementia. You may have heard of Vascular dementia. This dementia is caused by any condition that affects the vasculature, or blood vessels in your body. For example, cardiovascular diseases like high blood pressure and heart disease can cause vascular dementia. The most common cause of vascular dementia is a stroke. A stroke is when something blocks the blood flow to the brain partially or completely resulting in reduced blood flow to the brain. When the brain (or any part of your body for that matter) doesn’t have enough blood, it starts to degenerate. That means crucial brain cell connections are destroyed and this results in symptoms like memory loss, impaired judgment, and difficulty with communication.

So, dementia is not a disease in and of itself. It is a set of cognitive symptoms that are caused by another illness or condition. Alzheimer’s disease is a cause of dementia.

 

The Canadian National Dementia Strategy

Last week we presented an infographic to show you the impact of dementia on Canada. Thankfully,  on June 22, 2017, Bill C-233 received Royal Assent and became law in Canada. This law, “An Act respecting a national strategy for Alzheimer’s disease and other dementias” mandates that all provinces and territories across Canada work together to develop and implement a national dementia strategy that addresses 7 key areas. By mandating the implementation of this national dementia strategy, Canada has ensured that something actually gets done to support all people affected by dementia.

The seven key areas that must be addressed include:

  1. Develop national objectives to decreased suffering and reduce the burden of dementia on society;
  2. Encourage investment in all areas of research related to dementia;
  3. Working with other countries to combat dementia (because dementia is a global pandemic);
  4. Nation-wide development and dissemination of diagnostic and treatment best practices;
  5. Nation-wide dissemination of best practices on how to improve quality of life for people living with dementia and their caregivers achieved through care integration, chronic disease prevention and management, community services, and family supports;
  6. Supporting the development and dissemination of information on prevention, management, and early treatment; and
  7. Create recommendations and guidelines for best practices in care delivery and daily programming.

And it doesn’t stop there. By June 2019, and every year after that, the Minister of Health must give a report on how the National Dementia Strategy is doing along with any new recommendations.

Dementia pandemic

So what does all this mean to you?

It means that you and your family will be receiving better care and support. It means that we will start coordinating with other countries who are leading the way in dementia care (such as the Netherlands), and learn from how they have successfully, and not so successfully, supported their citizens who are affected by dementia. It means that we should be able to reduce the currently projected cost of dementia in dollars, but also in its cost to productivity and personal stress.

It means that Canada isn’t ignoring you. It means that Canada has realized that Alzheimer’s disease and other dementias cause a lot of pain and suffering. It means that Canada believes you shouldn’t go it alone.

With projections estimating a rapid increase in the number of people living with dementia and subsequent cost to Canadian society, it is imperative we launch a coordinated attack. In the end, this National Dementia Strategy will improve the quality of life of everyone affected by the disease.


Next steps: Funding. It’s all fine and dandy to design a fantastic dementia strategy, but we need funds to put it in place. However, the strategy isn’t finalized yet, so until then, we won’t know how much money we’ll need to implement it. Until then…

The Stats

Statistics infographic

 

It is clear that the numbers are going to increase over the next foreseeable future. It’s a good thing then that the government has issued a National Dementia Strategy that includes dollars. Read next week for more information on this strategy and what it means to you and your loved ones.

Gone Missing!

Written By Eleanor Pineau

So your loved one living with dementia often leaves the house without telling you – better known as “wandering,” but this isn’t an accurate description. People generally don’t wander aimlessly. Most often, they “wander” because they are looking for someone, something, or something to do. Common causes of people “wandering” include:

  • Boredom
  • Walking was a common activity they used to do
  • Pain – walking helps to soothe pain
  • Looking for food because they are hungry
  • Looking for the bathroom
  • Looking for a friend
  • The belief they need to get to work

There are soooo many reasons someone gets up to walk around. Just like you and I get up to go places and do things – we do not sit around in a chair all day.

Missing personNow the most troublesome result of walking about is when a loved one living with dementia leaves the house when you are unaware. What if they get lost? What if they get too cold or too hot? What if they fall and no one can find them? These are all questions that run through your mind when your loved one goes missing because they walked out the front door. But don’t fret, there are lots of things you can do to prevent them from leaving, and to find them if they do leave.

Firstly, sometimes people living with dementia leave the house at night because their sleep-wake cycles have been flipped. This means they are asleep during the day and awake during the night. It is important to flip this back to normal so that your loved one is asleep when you are asleep and therefore unable to watch them. Strategies to do this include:

  1. Exercising during the day so they are tired at night
  2. Taking melatonin tablets which is a naturally occurring neurotransmitter responsible for circadian rhythms (sleep-wake cycles)
  3. Taking them to a day program so they are engaged throughout the day and can’t take naps as often or for as long

Ever heard of “Cabin Fever?” Well even though people living with dementia have short-term memory loss, they do experience cabin fever if they are in the same place for hours and days on end. So it is quite normal for your loved one to want to leave the house. Look at yourself for instance. How have you felt after staying at home for an entire day? Like you need to get out, to go and talk to someone, to go an do something? What I am getting at is that people living with dementia need to get outside their home environment frequently. If they don’t have this opportunity, they will make the opportunity and leave without your supervision. So another way to prevent your loved one from leaving the house while you are unaware is by making it a daily habit to go for walks in the park or go pick up groceries and do errands.

It is also important that you are prepared for the case when you’ve done all you can to prevent your loved one from leaving, but it happens anyways. There are a couple of things that you can do that will speed the process of finding your loved one. Firstly, you can turn the house alarm on to the “stay” feature. This will alert you when your loved one leaves the house without you knowing. That way, they won’t be able to get too far before you are able to find them. You can also get your loved one a Medic Alert bracelet or necklace so that if they are found on the street, the person who found them can identify that they have dementia and who know who to call. Further, you can purchase a GPS tracking system. They come in all shapes and sizes from watches to shoe insoles. Make sure your loved one actually likes the equipment you buy or they will just take it off and then it’ll be useless. Lastly, you can form a relationship with your local police department if your loved one is frequently leaving the house. This way, the police already know who you and your loved one are, and will devise strategies to get them home quickly and safely.

 

 

2 Big Ds: Diabetes and Dementia

Diabetes is another “Big D” in the medical world, inflicting much pain and suffering. There has been some research coming out on the influence of diabetes on the risk of getting dementia. Most of the past research has focused on how Type 2 Diabetes increases the risk of dementia in older age. These studies have shown that Type 2 Diabetes increases the risk of developing dementia by only about 15-60% (depending on the study) when compared to people without diabetes. Often, the most common type of dementia people with diabetes suffer from is vascular dementia because of the damage done to blood vessels from diabetes. You’ve heard of people with diabetes having to get their foot amputated – this is because of poor blood flow. As an extension of this poor blood flow, people with diabetes can experience poor blood supply to other parts of their bodies such as their brain. When this happens, it can escalate to Vascular Dementia.

But what about the population with Type 1 Diabetes? Great question! A study was just released on February 1st in the Journal of Neuroepidemiology which focused on the effect of Type 1 Diabetes (aka insulin-dependent, or young onset) on the risk of developing dementia.

The figures are devastating. It was found that Type 1 Diabetes increases the risk of developing dementia by 1.2-3x (or by 120-300%) when compared to people without dementia. THREE TIMES!!! That is a lot!

So why do we see this stark difference in the risk of developing dementia between people with Type 1 vs Type 2 Diabetes?

One hypothesis could be that the onset of Type 1 diabetes is often much earlier than Type 2 diabetes. As a result, the detrimental effects of Type 1 diabetes have a much longer time to exert their influence on the body than in Type 2. Therefore, you may see a lot more cumulative damage in someone with Type 1 Diabetes.

What other reasons do you think Type 1 diabetes is such a greater risk factor for dementia than Type 2?

 

What to take from this? If you have Type 1 diabetes, be sure to be diligent in your self care. Make sure you’re eating well, exercising often, and taking your insulin as prescribed. Same goes for if you have Type 2 diabetes. Take care of yourself to prevent the onset of dementia. And remember, diabetes is just a RISK FACTOR for dementia. Having diabetes doesn’t mean you are going to get dementia.