Items in Caring Currents tagged with Alzheimer's

12 Family Movies to Watch This Holiday Season With Someone Who Has Dementia

Paula Spencer — Tue, 17 Nov 2009 08:00:00 -0000

Looking for a holiday activity someone with dementia can enjoy with the whole family, including kids, during the upcoming holidays? An intergenerational movie is a stress-free way to share time and togetherness.

Here are 12 family movies to consider, organized into three categories: newish movies, old movies, and something different.

New(ish) Movies

Enchanted

Wholesome, cute, and clever, it starts as a classic Disney princess cartoon, then the drawn characters turn into real actors, including Amy Adams and Patrick Dempsey (who look and sound exactly like their cartoon counterparts). It's especially well-suited for grandmas and granddaughters.

A 78-year-old homebody flies away with an 8-year-old; the perfect plot for an intergenerational showing.

Miss Potter

Renee Zellweger stars as children's author Beatrix Potter, and Peter Rabbit (in cartoon form) makes surprise appearances. A happy story (set in England's lush Lake District) that might inspire pulling out the tales of Tom Kitten, Squirrel Nutkin, Jemima Puddleduck, et. al. to read aloud later.

The Water Horse: Legend of the Deep

A 2007 British family film about a Scottish boy who finds an odd egg at the shore of a nearby loch will offend no one and pleasantly surprise everyone. A plus: It's set in WWII, evocative for older viewers.

Spirited Away

Director Hayao Miyazaki, of Japan, made this Oscar-winning masterpiece for slightly older kids, with a wonderfully surreal flavor and equally surreal characters; even if you can't follow the plot, there's always something interesting onscreen.

Older Movies

The Sound of Music

Musicals are a great choice because people with dementia often respond to music well and retain musical memories. And this, of course, is the musical of musicals.

The Glenn Miller Story

The biopic's big band music will resonate with viewers in their 80s.

The Wizard of Oz

Bright colors, great songs, not-too-scary action, and kids love it, too.

Toy Story

Little ones may have missed this modern classic when it was first out in 1995 (and the sequel in 1999), while their grandparents may wax nostalgic about toys their own kids had, like the Slinky dog and Mister Potato Head. If it’s a hit, they can all go see Toy Story 3 in theaters next year.

Something Different

The Adventures of Milo and Otis

Both older and younger generations tend to respond well to animals. This gentle story of a dog and a cat is acted only by a dog and a cat, no humans. Dudley Moore narrates.

March of the Penguins

Another animal flick, this Oscar-winning documentary is slow but absorbing. Young kids might get impatient waiting for the don't-miss hatching of the baby penguins.

Groundhog Day

No, I don't know how the story of a man destined to repeat a single day over and over (until he gets it right) goes over in the mind of someone with dementia, but at minimum, the story's repetition is apt to make it easier to follow.

Alzheimer’s Awareness: Why Bother?

Dennis Fortier — Tue, 03 Nov 2009 08:00:00 -0000

As you may have read elsewhere, November is National Alzheimer’s Awareness Month. But surely, the public is already well aware of this horrible disease. After all, Alzheimer’s has directly affected approximately one in every two families, and the others must have certainly noted its prominent coverage in the news. We don’t really need more awareness, right?

Wrong.

Some of the information below may surprise you. That's to say, it's information about which you're not presently aware. However, by merely learning the seven facts below, you'll be helping to reduce the Alzheimer’s problem. That’s right…making you aware of this information and encouraging you to share it with your social networks will facilitate a more informed and more effective approach to combating the threat we face from this disease.

First, here are a few facts and figures that you may already know. Alzheimer’s currently affects more than 5 million Americans, and that number is likely to triple by 2050. It's the sixth leading cause of death in the USA and is climbing steadily in the rankings. Also, Alzheimer’s is the leading cause of dementia and accounts for about 65 percent of all dementia worldwide. These are all sobering facts but perhaps not new to you.

7 Facts You Need To Know

Now, here are some points you may not know but should. It's the following information that I hope will stimulate discussion and promote a better understanding of the disease. With more discourse, we can begin to erode the lingering stigma that currently prevents some people with early symptoms from seeking timely medical attention.

1) We generally detect Alzheimer’s at the end-stage of the disease.

On average, Alzheimer’s follows a 14-year course from the onset of the first symptoms until death. There's some variability across patients, but 14 years is pretty typical. The more surprising news is that, on average, we diagnose Alzheimer’s in years 8-10 of that disease course. This means that for most patients, symptoms go undiagnosed and untreated for at least seven years, during which time the lesions spread through the brain and cause irreparable damage. Please be aware that we diagnose Alzheimer’s disease far too late to optimize the effects of currently available treatments.

2) Memory loss is not a part of normal aging.

The point about end-stage detection raises an obvious question about “why” we diagnose this disease so late. There are many contributing factors, but most of them can be reduced through awareness and education. Some patients resist medical attention in the early stages because they fear a stigmatizing label or because they're misinformed to believe that Alzheimer’s can't be treated. Many people, including a startling number of physicians, incorrectly believe that memory loss is a normal part of aging. Improving the timeliness of diagnoses for Alzheimer’s is, in many ways, a problem that can be addressed through awareness and education. Please be aware that memory loss is not a part of normal aging and, regardless of the cause of the memory loss, timely medical intervention is best.

3) Current Alzheimer’s drugs are probably more effective than you think.

Our widespread practice of late detection has many negative consequences. For example, one of the reasons that current treatments are often deemed ineffective is because they're routinely prescribed for patients with end-stage pathology who already have massive brain damage. With earlier intervention, treatment can be administered to patients with healthier brains, many of whom will respond more vigorously to the recommended therapy. Yes, we need better treatments, but a great start would be to intervene earlier with the treatments we already have. Please be aware that currently approved treatments may be more effective than some headlines indicate.

4) Alzheimer’s disease can be treated.

Another treatment related concept about which everyone should be aware is this. Preventing or slowing further brain damage is preferable to letting the damage spread without constraint. Yet, many physicians, patients, and caregivers conclude that any treatment short of a cure is not worthwhile. While today it is true that we have no cure for Alzheimer’s, that doesn't mean there's no treatment. With a good diet, physical exercise, social engagement, and certain drugs, many patients (especially those detected at an early stage) can meaningfully alter the course of Alzheimer’s and preserve their quality of life. Please be aware that “we have no cure” doesn't mean “there is no treatment”.

5) The Alzheimer’s drug pipeline is full.

Here’s another fact of which you should be aware. Through an intense research effort over the past 20 years, scientists have gained a lot of insight about Alzheimer’s disease mechanisms and about other factors that increase the risk for the disease. Much has been learned and some very promising drugs, based on sound theoretical approaches, are in FDA clinical trials right now. While much of the disease remains shrouded in mystery and we may still be a long way from better treatments, it's possible that an effective agent is already in the pipeline. Please be aware that, although we don’t know when, better treatments for Alzheimer’s are certainly on the way.

6) Taking good care of your heart will help your brain stay healthy.

Know this: The health of your brain is very closely tied to the health of your body, particularly your heart. Researchers have shown conclusively that high cholesterol, high blood pressure, and obesity all confer greater risk for cognitive decline. The mechanisms that keep oxygen rich blood flowing through your body play a key role in maintaining a healthy brain. Everyone should be aware about the close association between vascular health and cognitive health. Please be aware that maintaining good vascular health will help you age with cognitive vitality.

7) Managing risk factors may delay or prevent cognitive problems later in life.

There are well-identified risk factors for Alzheimer’s disease that are within our power to manage. These include diabetes, head injuries, smoking, poor diet, lethargy, and isolation. With greater awareness of these facts, we can imagine a world where diabetics take more care to control their blood sugar, where helmets are more prevalent in recreational activities that are likely to cause head trauma, where people smoke less and eat more fruits and vegetables, and where everyone makes a better effort to exercise and to stay socially engaged on a regular basis. While these facts may not be well known, they are all well proven. Galvanizing an effort to publicize them is one purpose of National Alzheimer’s Awareness Month. Please be aware that many risk factors for Alzheimer’s can be actively managed to reduce the likelihood of cognitive decline.

So why bother with Alzheimer’s awareness? Because it's a terrible disease poised to ravage our aging society and the lack of education and awareness has lead to a stigma that prevents a more proactive approach to early intervention. The result is that we diagnose it too late, which hampers the efficacy of available treatments. A more educated public could manage risk factors to minimize the likelihood of Alzheimer’s, could monitor personal cognitive health with greater vigilance, and could seek medical attention at the earliest sign of decline. Physicians could then diagnose problems earlier and prescribe appropriate treatment including diet, exercise, and drugs to slow disease progression as much as possible. In the end, we could have fewer cases, more effective treatment, slower progression, higher quality of life, and lower health-care costs. The social, emotional, and fiscal benefits of awareness and education in this area are too large to quantify.

By reading this article, you have increased your understanding of the problem and raised your awareness about what can be done. That is a great step in the right direction but you can do one thing more. You can help to spread this message.

In the spirit of National Alzheimer’s Awareness Month, please share this article with your friends to promote more widespread awareness. Post it to your Facebook page, mark it in Delicious, Tweet it, Digg it, or e-mail it. It doesn’t matter how you do your part; it only matters that you get it done.

7 Facts to be Aware of:

We generally detect Alzheimer’s at the end stage of the disease.
Memory loss is not a part of normal aging.
Current Alzheimer’s drugs are probably more effective than you think.
Alzheimer’s disease can be treated.
The Alzheimer’s drug pipeline is full.
Taking good care of your heart will help your brain stay healthy.
Managing risk factors may delay or prevent cognitive problems later in life.

Is It Ever Okay to Laugh About Alzheimer's?

Paula Spencer — Tue, 27 Oct 2009 07:00:00 -0000

Let me say straightaway that Alzheimer's isn't funny. And yet… there sure are plenty of moments that make you want to laugh. Or me, anyway.

No doubt dementia is a horrible affliction, in the progressive way it erodes the memories and connectedness of someone you love. But it's exactly that long slow progressiveness, the years of everyday living situations, that present so many opportunities for absurdity and comedy —as well as so much need for stress release. And laughter (even cracking a smile) really is a proven stress reliever with healing benefits.

Many people cringe at the idea of finding anything remotely lighthearted about their dementia stories, and I respect that. Humor is a pretty individual taste, too. The black humor batted heartily around in some families (mine) is seen as distastefully verboten in others.

Before you strafe me with indignant comments over daring to suggest that there might just be more pluses than minuses to laughing about Alzheimer's, though, let me point out the following five good reasons to laugh in the face of Alzheimer's or another dementia:

When you both realize something's funny.

A friend's mother once decorated a Christmas tree…in spoons, forks, and knives she'd meticulously tied ribbons around. The next day she walked in the room and said, "Well who did a crazy thing like that?" "You did, Grandma," piped up my friend's 12-year-old. All three generations had to laugh. Mother and son truly weren't laughing at their elder; they were laughing with her.

Many people with dementia are capable of "getting" that they say curious things and make silly gaffes. They can even make jokes at their own expense (especially if they've always been jolly sorts.) My Dad once told me, "I wish I could forget my bowling scores this week, but so far no such luck!"

When you need to let off steam.

For some people, jokes are a form of humor that poke harmless fun. There's that old saw about the doctor diagnosing cancer in a patient. "And there's more, I'm afraid. You have Alzheimer's disease." "Well," says the patient cheerfully, "At least I don't have cancer!"

Politically incorrect? Or a "knowing" moment when swapped between, say, two stressed out family caregivers who get the joke because they’re living it.

When you feel the need to lighten a heavy moment.

Professional caregivers often use little impersonal jokes to distract clients from the indignities of, say, needing help with bathing. There's nothing like unexpected levity to cut tension or alter the mood in a room.

This next example may sound bad written out, but even on her deathbed my mom was making jokes about my dad's memory. Literally, the day she died! Dad has moderate dementia. "At least we'll have our memories," he said to her, sadly. "Not you," she said with a smile breaking through her pain. "You can't remember anything any more!" It sounds cruel, perhaps…but…you had to be there. Lightened the mood in that room.

When you want to normalize the reality of Alzheimer's.

Poking fun at the things that scare or upset us, or that tend to be hidden in shadow, can be a great way to bring it into the light. At the 2008 Oscars, host Jon Stewart introduced the film "Away From Her," about a woman with early-onset Alzheimer's, for which Julie Christie was nominated, this way: “a film about a woman who forgets her husband — Hillary Clinton calls it the feel good movie of the year.”

When the absurdity of the whole situation strikes you.

You find your car keys in the freezer. Your wife tries to pay for groceries by pulling out a sanitary pad from her wallet. Your husband spends his afternoons "debating" the man in the hall mirror (the "nice fella" who happens to look exactly like him). Those are the moments that zap you anew, every time, that life is different now, life will never be the same.

Who can blame you for rolling your eyes and snickering to a friend or sibling over the phone about such incidents? "So today Dad answered the door in his underwear again, only to find the minister struggling to maintain her composure (while Dad was as oblivious as if he were wearing his Sunday best!)." Sure it's "telling tales" on Dad. But some situations just beg to be shared, if only as a way for us to say, "See, I'm not crazy…this really is hard work here!"

Forgetting Faces: What It's Like to No Longer Be Recognized by Your Dad

Paula Spencer — Tue, 20 Oct 2009 07:00:00 -0000

What could be more elementally human than recognizing people -- the loved ones who feature in all your family memories, the friends you wave to on the street, the special face you wake up to every morning? I can't imagine what it must it feel like when Alzheimer's or another dementia turns those once-familiar faces into blanks.

But I well know about being on the receiving end of a blank stare. I've experienced the strange sensation of not being recognized by your own parent.

Intellectually, you understand the day might come. You know it's not unusual that recognizing people will become a challenge for someone with later-stage dementia. But the first time you're called by another name, it jolts. The gulf between you seems to widen.

The first time Dad introduced me as his "sister," my heart sank. It was a confirmation of what I'd long suspected, that he only vaguely got who I was. He seems to register me as family (as opposed to a total stranger), but can't quite place me. He definitely has no idea where I live, how many children I have, or what I do. I can't remember the last time he used my name. (Except to ask me, "Did you see what Paula wrote in this magazine?")

It sounds horrible to put into words, but the experience has made me feel more detached from him. I still adore him and treat him exactly the same. But he feels more "kidnapped." Each visit, I brace for worse. Last week, he mistook my sister-in-law, his primary caregiver whom he sees all the time, for a doctor or a nurse.

Little wonder I've become very interested in this phenomenon. I can't imagine what the experience of losing this connection to a spouse must be like. Here's what some others have told me about their experiences:

Others' impressions of being "forgotten":

From a wife: "I just pretend like he still knows me. The thing is, every once in awhile he clicks back in, and I know he knows me."
From a son "It used to bother me a lot when my mother would call me by my brother's name, but now I just ignore it. I figure I still recognize her and that's all that matters."
From a daughter: "I can't bear it, so when I visit I say who I am right away, so I don't have to be asked. That way I can go a whole visit pretending that I'm remembered."
From another daughter: "He thinks I'm my mother, who's been dead for several years. I correct him and correct him – I can't help it, and it seems cruel to pretend to be my late mother. But it's hard on me."
From another wife: "I've never been lonelier in my life."

If recognizing people has become a problem for your loved one and you've been forgotten, I'd love to hear what it felt like and how you deal with it.

Alzheimer's Phone Problems: Little Object, Big Headaches

Paula Spencer — Tue, 13 Oct 2009 07:00:00 -0000

Sometimes it's the little things that get you with Alzheimer's. Phone challenges, for example. Difficulty using the telephone is an early sign of Alzheimer's disease. But even once you already know someone has dementia, phone issues can be an ongoing source of trouble.

Any of the following "ring a bell" in your house?

Not recognizing the voice on the other end.

Before she died at 99, my grandmother's deafness had made our weekly phone calls harder as the years went on. But between my shouting and repeating, we somehow managed to have a talk that made us both feel good. Then sometime in her early 90s, Alzheimer's disease made her less likely to answer a ringing telephone, and when she did, she didn't always understand who I was. Eventually it got too hard, and looking back, was sadly the factor that changed our relationship most.

Not recognizing the phone.

Another personal story: My siblings and I began to expect the same drill every time we called home. Moments after answering the phone and saying hi, our mom would say, off to the side in an increasingly agitated tone, "Dear, pick up the phone...no, not that one...that's the TV remote!...no, that's the other TV remote...yes, that one...your daughter's on the phone...." It was funny the first time, and then more and more worrisome as it went on. My dad had then only seemed "forgetful" to us. In his defense, all those black wands with buttons do look a bit alike, but this wasn't a case of occasional misidentification. In hindsight, his telephone confusion was a clear sign of Alzheimer's.

Not saying anything at all.

Gary Joseph Leblanc, who writes a caregiving column for the Tampa Tribune, deserves a shout-out for bringing up this topic of Alzheimer's phone issues, in a reminiscence about his father. His Dad, who had Alzheimer's, would answer the phone at the bookstore they ran together, and remain completely voiceless before hanging up. When asked who it was, "he'd just nonchalantly respond, 'Heck if I know.'"

Dialing 911.

LeBlanc also mentions this risk: Lonely people with dementia who dial 911 just to have someone to talk to. (Maybe because it's an easy and ingrained number?) He also mentions his dad randomly punching numbers which led to accidental international calls.

Picking up the extension to listen in.

Later, when my dad lived with my brother, I'd suddenly notice a raspy breathing while I was chatting with him or his wife. Turns out Dad would sometimes pick up an extension but not announce himself. He wasn't being sly; he simply lacked the wherewithal to join the conversation but liked to listen to us. Of course I always asked to talk to him anyway after I'd get the scoop from my brother, but I learned to ask them to make visual contact on Dad's activity before we discussed any nitty-gritty details about how he was really doing.

Not taking messages.

Another early-stage problem is that someone might seem to manage phone use just fine – but is incapable of writing anything down or remembering to tell anyone else in the house there was a call.

Calling randomly and often.

Sometimes people with dementia remember long-dialed numbers (or how to use speed-dial) and fall into a groove of calling an adult child, friend, doctor's office, or some other target over and over, often at inappropriate times, a behavioral tic.

So what can you do?

How to best deal with Alzheimer's phone problems depends on your specific situation. Some ideas to consider:

Switch to cell-only service, if you live in the same house as someone with Alzheimer's.
Place phones only in the rooms where the person who has Alzheimer's doesn't go (for example, in your bedroom and in a landing at the top of the stairs).
Use call-forwarding so that home calls go to your cell.
Turn down ringers. This may prevent the phone from being answered but not prevent outgoing calls.
Use caller ID to follow up on who phoned.
Consider an easy-to-use model like this Memory Phone which has visual-cue buttons so the user can easily dial family members or emergency help (for people in earlier disease stages).
Another option: a dialless phone, which receives calls but doesn't permit dialing – a possible substitute for those who like to call at all hours.
Realize that not being able to dial for help or emergency services is not merely a sign of Alzheimer's but a sign that someone may no longer be able to live alone.

Alzheimer's phone problems can be annoying -- and, even more important, dangerous.

World Alzheimer's Day and Why People With Alzheimer's Need It

Paula Spencer — Wed, 16 Sep 2009 07:00:00 -0000

On World Alzheimer's Day, Monday, September 21, most people with Alzheimer's disease won't be able to participate in an Alzheimer's Association Memory Walk. But they directly benefit from events like these being held around the world.

That's because World Alzheimer's Day events are meant not only to raise funds for research but to raise awareness about Alzheimer's and people with Alzheimer's disease. That makes this World Alzheimer's Day an opportunity for each of us to think about what messages we'd like to give to those who aren't yet affected by this living tragedy called Alzheimer's.

So here are three facts about Alzheimer's that I want the whole world to know:

1. Alzheimer's is not an inevitable effect of aging.

Senility doesn't strike everyone; it's a terrible disease. In a generation, much has been done to change this old public misperception. The fitting theme of World Alzheimer's Day this year is "See it Sooner." Early detection can slow disease progress and improve quality of life.

2. Scientists still aren't sure what causes Alzheimer's disease.

That makes funding research and clinical trial participation an imperative, because we're frankly less close to a cure than many people wish.

3. What people with Alzheimer's need most are caring people and caring resources.

A cure would be nice. But a more realistic, immediate, and achievable goal is to make coping resources available to all people with Alzheimer's and every caregiver, in every community. The love and caring most of us have in spades. The hands-on help for the relentlessness of this condition that kidnaps our loved ones out from under us is what we could all use more of.

What three things do you want the world to know about Alzheimer's on this World Alzheimer's Day?

What Is Someone With Dementia Thinking?

Paula Spencer — Tue, 08 Sep 2009 07:00:00 -0000

Parents are known to gaze into their babies' eyes and wonder, What's going on in there? Adult children of parents who have Alzheimer's disease or another dementia do the same thing.

I know, because I found myself wondering about my own dad's self awareness just the other day. A recent stroke left him wheelchair-bound. This is a big change for someone who was in a bowling league 'til this spring, at 87. But the stroke also seemed to worsen his dementia. He's living in a rehabilitation facility for now, and when I visit and find him lined up with other wheelchair-bound elders in the dementia unit, watching TV, I can't help thinking that he's doing exactly what he swore he never would: "sit around with a bunch of old people who don't know any better." Thing is, he doesn't seem to mind it.

As Alzheimer's, a progressive disease, worsens, it robs the ability to have conscious awareness. What does that mean for caregivers?

In early/mid stages of Alzheimer's:

Most people are aware of initial cognitive changes in themselves (whether they say anything about it or not).

Self awareness doesn't disappear overnight. Research has shown that many people are relieved by a diagnosis of Alzheimer's, rather than upset, because they finally have a logical explanation for something unnerving that's dogged at them.

What helps: Taking action. Take expressed concerns about memory loss or other mental-functioning changes seriously. Recommend an evaluation, given that early interventions can help slow Alzheimer's progress. With someone already diagnosed, press the importance of making decisions regarding the future handling of health and legal affairs while the person is still able to express preferences.

The sense of self struggles to understand the changes, at first.

Some people try to explain it away: "I guess I'm getting old" or, "I never did have a good memory for detail." Some people willfully ignore changes, to the point where they don't seem bothered by them at all. Others actively and pragmatically work around failures of memory or cognition: They write notes, cede tasks that are too difficult, work crosswords or buy computer games to stimulate their brains.

What helps: Empathy and understanding. Don't pooh-pooh such observations. Look for ways to support the person's shortcomings: More clocks, a notebook in every room for keeping track of things, multiple pairs of sunglasses or tissue packs, or whatever seems to get misplaced often.

Awareness of the dementia effects can come and go.

Like my dad, one day, the person may seem quite out of it, but the next be more engaged and "like his old self." Sometimes he used to catch himself, as if he realized this was the fifth retelling of an anecdote (though then he'd tell it anyway!).

What helps: Knowing these fluctuations are normal. Just because the person had clarity one moment, doesn't mean it will persist. Although the disease is progressive, it brings good days and bad days, a graph that would look more bumpy than slanted down a bit more each day.

In later stages of Alzheiemr's:

The person is often or always oblivious to their condition.

The excuses or justifications fade away as self awareness fades. This can be a dangerous thing (as in the person who continues driving) or a blessing (as in the case of someone like my dad, who would be far more distressed about the extent of his condition if he were conscious of it)

What helps: Trust your gut. If the person seems content and uncomplaining, he or she may indeed be content, living in the moment. If the person is oblivious to the dementia but a threat to himself or others, you can't wait for clarity to kick in; you have to take action.

Emotional responses flatten or become misplaced – but remain.

I blogged recently about the amazing strength and importance of emotions in those who suffer with Alzheimer's, even for people deep into the disease process. You don't have to be aware of your limitations to be depressed or frustrated by them.

What helps: Physical contact. Touch is a messenger of reassurance and love. Offer a hug. Touch the person on the back or knee before you speak to avoid alarming them. Advanced Alzheimer's patients often find it soothing to stroke a tactile stuffed animal or hold a blanket.

Social skills and inhibitions fade as the social self unravels.

As a growing child learns what's socially appropriate, he shows fewer problem behaviors, like stripping off clothes on a whim or saying whatever pops into one's head. For someone who has Alzheimer's or, in particular, frontotemporal dementia, the opposite occurs. The social self unravels. A sense of what's appropriate or other sensibilities one once believed disappear, causing the person to say or do things that distress (hypersexual behavior, accusations of stealing, etc).

What helps: An ongoing social life. Even when it gets trying because of social inappropriateness, maintaining a social life (visits with relatives, conversation, the companionship of a pet) is important. Many researchers believe social connections help slow the disease process. It's not a cure, obviously, but like hugs and understanding, it never hurts.

When Caregiving for Someone With Alzheimer's, Emotions Are All-Important

Paula Spencer — Tue, 18 Aug 2009 07:00:00 -0000

Feelings outlast facts. That's the key kernel of wisdom behind a fresh approach to dementia care that can make the difference between frustration and contentment for people with Alzheimer's and other forms of cognitive impairment -- and between frustration and understanding for their caregivers.

All of us have an emotional "temperature" that changes minute by minute. People are said to get "hot and bothered," for example, or to be "coolly detached." I know you know how your own impatience rises when you're asked the same question for the thousandth time. Likewise, resentment can simmer when your plans are usurped by your family member's needs. (All perfectly natural, by the way.)

For someone with Alzheimer's disease, emotions outlive the ability of language, memory, and understanding to express them. Working within this truism -- keeping the person's emotional temperature constant -- results in daily life that's mellower and easier. In the United Kingdom, it's known as SPECAL (Specialized Early Care for Alzheimer's) care or as "contented dementia," after a book of the same name that's just come out in paperback there. In the United States, this idea sounds like habilitation, the concept pioneered in 2004 by Caring.com dementia expert Joanne Koenig Coste in Learning to Speak Alzheimer's.

Some valuable ways to harness the power of emotion:

1. Understand that the person's behavior is largely fueled by their emotions.

Koenig Coste explains that what seems like a cognitive mixup (asking a spouse "who are you?" or wandering and getting lost) almost always has an underlying emotion, such as fear or apprehension, which drives the behavior. That's why you have to change the environment or your own expectations to set up an everyday world that is calm and reassuring. "It is care partners' unrealistic expectations that most often trigger frustration, verbal agitation, and physical aggression," she says. "Most behavioral changes in a person with progressive dementia are rooted in the frustration of being unable to master an emotional or physical environment that feels like foreign territory."

2. Keep your own emotions on as even a keel as you can.

Why does the person you look after sometimes seem to be in an inexplicably foul or jolly mood? Emotional reaction can outlast the memory of what made the person feel that way in the first place. Say you asked your mother to set the table but she forgot why she went to kitchen once she arrived there. When you ask her again, even a little impatiently, she explodes. What gives? She probably still feels mad at herself for forgetting (the emotion lingers even though she has no idea herself why she's mad or that she forgot). Conversely, a positive experience (a happy visit, an outing) might not be remembered a day later, but its positive emotional response can percolate on.

3. Join in the moment, rather than forever correcting the person.

Say you're in the doctor's office waiting room and the person keeps asking anxiously whether it's time for the plane to take off yet. It's likely he has long-term memory associated with travel. The wait and the chairs are triggering memories of an airport waiting area. Challenging his assumption and correcting him over and over may simply make him frustrated or even frightened. In contrast, by living within his wrong assumption, he's able to feel like himself, in control. Just say confidently, "Not yet." (And by the time the doctor is ready, he will probably shift to this new information and forget all about the "trip.")

4. Tap the power of touch.

Whether it's a sympathetic pat on your back or a nice 7-second "Alzheimer's hug" (long enough to be registered by someone with cognitive deficits), the body collects emotional info through touch, even if nobody speaks a single word.

Just be sincere about it. New research shows that our bodies read emotions through touch with amazing specificity. A Depauw University psychologist asked blindfolded subjects to guess which of eight emotions a stranger was trying to convey simply through the use of touch: anger, fear, happiness, sadness, disgust, love, gratitude, or sympathy. The subjects understood correctly which emotion was being communicated between 50 to 78 percent of the time. (Pure chance would put the correct-guess rate at 11 percent.)

Obviously one's cultural background and age may play a role in how different kinds of touch are perceived. This study was done with college students. But the basic idea -- that we "read" emotion through touch -- holds up, even (perhaps especially) in people with cognitive deficits.

5. Open your heart to the idea that emotion is not only deep and primal, but transcendent. For both of you.

This anecdote, which I heard in yesterday's Sunday sermon, is a beautiful reminder that emotions have a language all their own. It seems my minister had gone to visit an old mentor, who had significant aphasia following a stroke and could only speak disjointed nonsense and random sounds. Still, the minister, who felt presence in the elder's eyes, proceeded to tell him all about his life. Before leaving, he asked his old mentor for a benediction.

The elder placed his hands on the younger minister, looked into his eyes, and proceeded to speak -- gibberish -- for five minutes. Any intended verbal message was lost.

Yet my minister says he was as stirred as he'd felt by any blessing he'd ever received. (And if you'd heard his broken voice relate this, you'd know he really meant it.) He understood -- as the former mentor also understood -- that the strong emotion behind the words remained heartfelt, strong, and true.

How to Hang Out With Someone Who Has Alzheimer's

Paula Spencer — Tue, 04 Aug 2009 17:15:53 -0000

My 87-year-old Dad, who has dementia, had nine visitors recently: his grandchildren, who ranged in age from 4 to 17. Four of my own kids and my six nieces and nephews made a lively parade as they threaded through the halls of the care facility where he's doing stroke rehab. Their chattering and bouncing reminded me that although visiting a nursing care facility can feel unnatural if you're not used to it, in some ways nothing could be more natural than what sometimes happens when life at either end of the spectrum connects.

Grownups, in particular, often find it awkward to spend time with a loved one with Alzheimer's or another form of dementia: What do you say to someone who hasn't followed the news in months or years, who can't remember what he ate for breakfast, who you know will try your patience asking you the same questions or getting stuck on the same anecdote over and over?

Watching these kids interact with Grandpa, though, was a living list of tips on how to make a happy visit.

Give a big hello. "Hiya Grandpa, it's me, Brock!" said the 5-year-old, getting both the warm welcome and the helpful self-identification right.
Get physical. The youngest, naturally, climbed right in Grandpa's lap. I also noticed him taking their hands as he spoke to each child and, of course, kids don't flinch. They like physical contact, too. Actions speak louder than words as cognitive ability declines, which makes body language and the reassurance of physical touch so important.
Start sweet. "So can we eat the cookies now?" someone piped up as soon as we'd said hi. Of course! A tub of cookies passed around the room puts everyone at ease because, at least in my experience, if there's one thing grandpas and children can't resist, it's the primal happiness of cookies.
Dive right in. "Grandpa, do you like Jimi Hendrix?" my teenage son asked after playing his guitar for him. I found myself biting my lip over this particular ice breaker: Grandpa didn't have any idea who Jimi Hendrix was 20 years ago, and certainly doesn't today. "Yes, I do," Grandpa replied, and they both smiled. That particular conversation didn't go anywhere, but at least my son wasted no time in picking up a natural patter.
Find common ground in music. I've previously written about my son playing guitar at the nursing facility and how music can be a stress cure. What's inspiring about kids is how comfortable they are just doing what they like – my son played some super-lively rockabilly jams – and their enthusiasm alone is what's welcomed and picked up on. I suggested a calmer classical song, and it didn't go over nearly as well. Hmmm, maybe Dad would like Jimi Hendrix!
Talk about yourself. Conversation covered last spring's track season, loose teeth, an accidental self-haircut with blunt scissors, favorite brands of cookies, what grade everyone would be in this fall. Point being, you can talk about almost anything, so long as the conversation isn't upsetting and doesn't feel like a "test" to the person with dementia. The minutiae of everyday life is often easier than discussing the past (and often makes for good laughs). It's not really what you say that matters; its that you're setting a pleasant mood as you're sitting there saying it.
Show and tell. Grandpa seemed very interested in all the wiggly teeth in the room. Not sure what the lesson is there; maybe another form of nonverbal communication!
Be patient with repetition. "And what grade are you in?" my dad asked each child over and over. (By the time we went 'round the room once, you can imagine the question seemed fresh to him when we got back to the first face.) The children, bless their hearts, never moaned, "You just asked me that!" They seemed to intuitively understand that he couldn't hold the fact in his head, and just as matter-of-factly kept on supplying the answer. Which is just what you should do. ("He forgets a lot," one fourth-grader observed. "It's just that old-timer's disease."
Look at old photos and ask questions. My Dad has a couple of short photo albums, the kind with just one or two pictures per page (not too overwhelming) in his room. The pictures are of his boyhood and hometown, which seems to be where his long-term memory is best preserved, providing the most comfort. "Who's that? Who's that?" one of the kids would ask over and over, and he'd tell them.
Go outside. There's a pretty courtyard outside my dad's room. "Can we go out there? Can we? Can we?" the kids quickly wanted to know. Kids are drawn to the outdoors, like few things (other than computers and video games!). We wheeled Dad out and sat in the sun, the change of scenery doing us all good.

Of course ten kids in a small room gets overwhelming fast, and so this visit didn't last long. I'm not recommending a crowd scene for a visit with someone who has dementia. But the cookies? The casual chitchat? These and all the rest of the things that kids do so naturally are worth sharing with someone you know who might be more leery of what can, with patience and insight, be a lovely, lovely visit.

Is This Alzheimer's Prevention Advice Worth Changing Your Life Over?

Paula Spencer — Wed, 29 Jul 2009 19:46:15 -0000

Were you among the thousands last week who raised your evening glass of wine in toast to the news that a daily tipple appears to protect older adults from dementia? Or maybe you were tempted to add vitamin D and the spice turmeric to your diet, with the goal of warding off Alzheimer's, a link suggested by a different new study.

Many an informed, health-conscious caregiver is spurred to action by the latest research. But past studies have also sung the praises of things like avoiding aluminum, the omega 3 fatty acid DHA, and ginko biloba in the fight against Alzheimer's, associations that later didn't seem to hold up.

So which lifestyle tweaks to adopt? That's what I asked Gary Small, director of the UCLA Center on Aging, a psychiatrist, neuroscientist, and prolific author (The Memory Bible, iBrain, The Longevity Bible). Small was just back from the International Conference on Alzheimer's Disease in Vienna, where many of the latest Alzheimer's news stories were announced. (But "no breakthroughs," he reports.)

Small says what to tell people eager for actionable advice is a question he struggles with often as an expert in the trenches. Three guidelines to keep in mind:

1. Remember that evidence isn't the same as proof.

"It's easy to overinterpret new results," Small says. A study that finds an association between drinking coffee and a lowered risk of Alzheimer's only means that someone with a past history of this particular behavior seems less likely to have a future outcome. "It doesn’t prove cause and effect," he says.

Case in point: Last fall, Small published a study showing that midlifers familiar with searching the Internet triggered more areas of the brain involved in complex reasoning than those who read books. The resulting headlines, he said, read like, "Google Is Making Us Smarter." Some reports mentioned past research showing that using technology to keep the mind active can help stave off Alzheimer's.

"It may make you better able to find a movie but not stave off Alzheimer's at all. People need to separate out what's real and definite from what's possible," Small explains. "Yes, there's evidence suggesting that if you use your brain, you won't get dementia, but there's no proof. There's also evidence that if you learn memory techniques, you will improve your memory."

2. Consider the source, but also consider your own doctor's input.

Anybody can concoct a "study." Hallmarks of reliable research include: Publication in a creditable medical journal, where it must meet rigorous standards and is reviewed by peers before being released. Researchers affiliated with major research institutes and universities. Randomized controlled trials, whose subjects are randomly assigned to a treatment group (who receive the therapy being tested) and a control group (who get a standard treatment or placebo). In a double-blind controlled trial, neither the patients nor the researchers know who's in which group. Large sample size * Take place over a long period of time

Many of the avoid-Alzheimer's headlines du jour meet standards like these – but still may not make sense for you individually. For example, a report in the new [Archives of Internal Medicine] finds that certain blood pressure medications, the so-called centrally-acting ACE inhibitors, seem to reduce the inflammation that contributes to the development of the disease, while other anti-hypertensives don't. Worth making a switch if you're really worried about dementia? That's a complex choice to make in concert with your doctor--which, of course, is why you're wise to follow all these promising-if-not-perfect studies.

Few findings are black-or-white, Small emphasizes; it's mostly shades of grey.

3. Realize that old news is sometimes the best news.

When it comes to avoiding dementia, worry less about finding a fresh magic bullet in the fine points (e.g. which spices to consume) and direct your best efforts to the bigger picture of what we know fuels good health, including brain health: "Get more physical exercise, lower stress, get mentally active," Small sums. When you hear research pointing to the same outcomes repeatedly, that's worth noting.

Much as we'd all like to hear that headline that will cure or prevent Alzheimer's, it's unlikely to be in tomorrow's paper, which leaves us reading the reports that will be there with both interest and common sense.