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Better sleep is a protective factor against dementia

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/andree-ann-baril-1494268">Andrée-Ann Baril</a>, <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a> and <a href="https://theconversation.com/profiles/matthew-pase-1494296">Matthew Pase</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Dementia is a progressive loss of cognitive abilities, such as memory, that is significant enough to have an impact on a person’s daily activities. It can be caused by a number of different diseases, including <a href="https://alzheimer.ca/en/about-dementia/what-alzheimers-disease">Alzheimer’s</a>, which is the most common form. Dementia is caused by a loss of neurons over a long period of time. Since, by the time symptoms appear, many changes in the brain have already occurred, many scientists are focusing on studying the risk and protective factors for dementia. A risk factor, or conversely, a protective factor, is a condition or behaviour that increases or reduces the risk of developing a disease, but does not guarantee either outcome. Some risk factors for Alzheimer’s disease and dementia, such as age or genetics, are not modifiable, but there are several other factors we can influence, <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">specifically lifestyle habits and their impact on our overall health</a>. These risk factors include depression, lack of physical activity, social isolation, high blood pressure, obesity, diabetes, excessive alcohol consumption and smoking, as well as poor sleep. We have been focusing our research on the question of sleep for over 10 years, particularly in the context of the <a href="https://www.nhlbi.nih.gov/science/framingham-heart-study-fhs">Framingham Heart Study</a>. In this large community-based cohort study, ongoing since the 1940s, the health of surviving participants has been monitored to the present day. As researchers in sleep medicine and epidemiology, we have expertise in researching the role of sleep and sleep disorders in cognitive and psychiatric brain aging. As part of our research, we monitored and analyzed the sleep of people aged 60 and over to see who did — or did not — develop dementia. <h2>Sleep as a risk or protective factor against dementia</h2> Sleep appears to play an essential role in a number of brain functions, such as memory. Good quality sleep <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2793873">could therefore play a vital role in preventing dementia</a>. Sleep is important for maintaining <a href="https://www.science.org/doi/10.1126/science.1241224">good connections in the brain</a>. Recently, research has revealed that sleep seems to have a function similar to that of a garbage truck for the brain: <a href="https://doi.org/10.1016/j.mad.2023.111899">deep sleep could be crucial for eliminating metabolic waste from the brain</a>, including clearing certain proteins, such as those known to accumulate in the brains of people with Alzheimer’s disease. However, the links between deep sleep and dementia still have to be clarified. <h2>What is deep sleep?</h2> During a night’s sleep, we go through several <a href="http://ceams-carsm.ca/en/a-propos-du-sommeil/">sleep stages</a> that succeed one another and are repeated. NREM sleep (non-rapid eye movement sleep) is divided into light NREM sleep (NREM1 stage), NREM sleep (NREM2 stage) and deep NREM sleep, also called slow-wave sleep (NREM3 stage). The latter is associated with several restorative functions. Next, REM sleep (rapid eye movement sleep) is the stage generally associated with the most vivid dreams. An adult generally spends around 15 to 20 per cent of each night in deep sleep, if we add up all the periods of NREM3 sleep. Several sleep changes are common in adults, such as going to bed and waking up earlier, sleeping for shorter periods of time and less deeply, and waking up more frequently during the night. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=279&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=279&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=279&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=350&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=350&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=350&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Sleep stages, and the role of deep sleep for brain health. (Andrée-Ann Baril)</figcaption></figure> <h2>Loss of deep sleep linked to dementia</h2> Participants in the <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2810957">Framingham Heart Study</a> were assessed using a sleep recording — known as polysomnography — on two occasions, approximately five years apart, in 1995-1998 and again in 2001-2003. Many people showed a reduction in their deep slow-wave sleep over the years, as is to be expected with aging. Conversely, the amount of deep sleep in some people remained stable or even increased. Our team of researchers from the Framingham Heart Study followed 346 participants aged 60 and over for a further 17 years to observe who developed dementia and who did not. Progressive loss of deep sleep over time was associated with an increased risk of dementia, whatever the cause, and particularly Alzheimer’s type dementia. These results were independent of many other risk factors for dementia. Although our results do not prove that loss of deep sleep causes dementia, they do suggest that it could be a risk factor in the elderly. Other aspects of sleep may also be important, such as its duration and quality. <h2>Strategies to improve deep sleep</h2> Knowing the impact of a lack of deep sleep on cognitive health, what strategies can be used to improve it? First and foremost, if you’re experiencing sleep problems, it’s worth talking to your doctor. Many sleep disorders are underdiagnosed and treatable, particularly through behavioural (i.e. non-medicinal) approaches. Adopting good sleep habits can help, such as going to bed and getting up at consistent times or avoiding bright or blue light in bed, like that of screens. You can also avoid caffeine, limit your alcohol intake, maintain a healthy weight, be physically active during the day, and sleep in a comfortable, dark and quiet environment. The role of deep sleep in preventing dementia remains to be explored and studied. Encouraging sleep with good lifestyle habits could have the potential to help us age in a healthier way.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222854/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andree-ann-baril-1494268">Andrée-Ann Baril</a>, Professeure-chercheure adjointe au Département de médecine, <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a> and <a href="https://theconversation.com/profiles/matthew-pase-1494296">Matthew Pase</a>, Associate Professor of Neurology and Epidemiology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/better-sleep-is-a-protective-factor-against-dementia-222854">original article</a>. </div>

Mind

How music is changing the way dementia patients think

New research has proven that music truly is the universal language, with experts discovering how the power of music is helping those suffering with dementia. Music therapists have shown that music brings dementia patients back to the present, with some even finding their voice thanks to the nostalgic memories of the past. According to Registered Music Therapist and Managing Director of music therapy company Music Beat, Dr Vicky Abad, the power of music is not to be overlooked when it comes to degenerative diseases. “Music is a window into people’s pasts,” she said. “It builds on strengths and abilities against a disease that can strip a person of their dignity, abilities and quality of life.” The team at <a href="https://www.tricare.com.au/">TriCare Aged Care and Retirement</a>, who see the devastating impact of dementia each and every day, also experience first-hand the impact music has on residents, with many noticing “unrecognisable” changes in personality when a nostalgic tune is played. Louis Rose, an 80-year-old dementia patient and TriCare resident, was diagnosed with dementia six years ago, and requires assistance with many aspects of day to day life. However, listening to music is one thing he can enjoy on his own. “I grew up in Mauritius and while we didn’t have a lot, we certainly had music. Listening to music has always been an escape for me and a way to relax,” Mr Rose said. “When your brain starts to slow down and you find yourself forgetting things, it can be quite frustrating and confusing. Listening to music has been a way to distract myself from what’s going on in my head, it has helped me so much.” Tamsin Sutherland is a regular live music performer at TriCare facilities across Queensland, and has been able to witness incredible moments with the residents as they come alive as soon as she starts to play. “Watching residents who are often non-verbal sing along to the words is incredible,” she said “It really is like they are coming back to life and reconnecting with who they once were. To be part of that is quite emotional for me.” According to Dr Abad, music can help prevent the restless behaviour that often leads to pacing and wandering, especially in the evenings, which are often difficult times for those battling the disease. “Sundowning usually occurs in the late afternoon as dusk approaches, a time that is also associated with what used to be a busy time period in people’s lives,” she noted. “Personalised music is a simple and effective tool to help residents feel validated in their emotions during this time and provides them an opportunity to experience a calmer state of mind”. Image credits: Getty Images

Mind

Husband and wife with dementia reunite after 30 years apart

A former husband and wife with dementia have been reunited after 30 years apart when they moved into the same care home. Nancy, 86, and Stan, 91, were first married in 1957 in Edinburgh, despite their parents "forbidding" their romance and not approving of their union. The couple went on to have three children and lived happily, until Nancy was nearly killed by a brain haemorrhage when she was in her mid-50s. Nancy had to undergo life-altering surgery and a lengthy recovery time, which ultimately led to the downfall of her relationship with Stan and they filed for divorce. After their split, Stan met another woman when he was in his 70s, while Nancy never had another romance. When Nancy and Stan entered their 80s, they both began to show signs of dementia and could no longer care for themselves. Around Christmas time last year, their daughter Karen made the decision to put her father Stan, who suffered a fall while being cared for in Scotland, in the same home as Nancy, which is where she captured the heartwarming footage of them being reunited. In the clip, Nancy tells Stan he is "not bad looking for his age", while her ex-husband replies, "I recognise your face but I couldn't place who it was". The couple then agree to go on a date together and have a cup of tea, before having a kiss for "old time's sake." <p style="font-size: 16px; box-sizing: inherit; margin: 0px 0px 5px; padding: 0px; border: 0px; vertical-align: baseline; caret-color: #323338; color: #323338; font-family: Figtree, Roboto, 'Noto Sans Hebrew', 'Noto Kufi Arabic', 'Noto Sans JP', sans-serif; outline: currentcolor !important;">The video was posted to TikTok by Karen's daughter Sarah-Ashleigh, who spoke to the <a href="https://www.dailymail.co.uk/news/article-13196325/Heartwarming-moment-former-husband-wife-dementia-reunited-care-home-30-years-apart.html" target="_blank" rel="noopener">Daily Mail</a> about the family's decision to put both Nancy and Stan in the same care home. <div class="embed" style="font-size: 16px; box-sizing: inherit; margin: 0px; padding: 0px; border: 0px; vertical-align: baseline; outline: currentcolor !important;"><iframe class="embedly-embed" style="box-sizing: inherit; margin: 0px; padding: 0px; border-width: 0px; border-style: none; vertical-align: baseline; width: 600px; max-width: 100%; outline: currentcolor !important;" title="tiktok embed" src="https://cdn.embedly.com/widgets/media.html?src=https%3A%2F%2Fwww.tiktok.com%2Fembed%2Fv2%2F7341697620181519648&display_name=tiktok&url=https%3A%2F%2Fwww.tiktok.com%2F%40sarahashleighflorals%2Fvideo%2F7341697620181519648&image=https%3A%2F%2Fp16-sign-useast2a.tiktokcdn.com%2Fobj%2Ftos-useast2a-p-0037-euttp%2F4189e3105ed04778a3de6a83a40077b6_1709372224%3Fx-expires%3D1712448000%26x-signature%3DcpIHZABQ%252FDnAqGU7bJYeryVnJlU%253D&key=59e3ae3acaa649a5a98672932445e203&type=text%2Fhtml&schema=tiktok" width="340" height="700" frameborder="0" scrolling="no" allowfullscreen="allowfullscreen"></iframe></div> "We were so worried how this would go. It's so good to see them be friends again," she said. "Dementia is a horrible disease, but it's moments like this which we really just hold on to." "Granny struggles a bit more in general and gets anxious and confused but I think having someone there who she knows has done wonders for her." "She's always looking for him (even when he's right next to her) and they sit together a lot and bicker like the married couple they used to be." "Love might not be the same kind of love forever, it is a shape shifter, but it never leaves." "Their marriage didn't last forever but just seeing them have a friendship again just shows that love never dies." Image credits: TikTok

Caring

Demi Moore shares emotional birthday tribute to Bruce Willis

Demi Moore has shared an emotional tribute to her ex-husband, Bruce Willis, to mark his 69th birthday. The Die Hard actor, who was diagnosed with <a href="https://www.oversixty.com.au/news/news/bruce-willis-forced-to-retire-after-medical-diagnosis" target="_blank" rel="noopener">frontotemporal dementia</a> last year, was pictured holding on to Moore's arm, as they shared a candid moment on the couch. “Happy birthday, BW! We love you and are so grateful for you ♥️,” Moore captioned the series of photos posted on Instagram. She also shared a photo of the actor, smiling lovingly at his grandchild Louetta, who Willis and Moore’s oldest daughter, Rumer welcomed in April 2023. The final photo Moore shared was a throwback picture of Willis smiling as he posed with their three daughters Rumer, Scout and Tallulah, who are now all in their 30s. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/C4tOhkVOmAp/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C4tOhkVOmAp/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Demi Moore (@demimoore)</a> </div> </blockquote> Fans were quick to share their birthday messages and admiration for their relationship. “Thank you for providing a loving example of parenting even after divorce. ❤️ You’re helping your children more than you know 🥰,” one wrote. “Their relationship is the sweetest thing ever ❤,” another added. “Absolutely love how, even though Bruce and Demi are divorced, they love and respect each other as parents and grandparents ❤🙌,” a third commented. His daughters have also shared their birthday tributes, with Rumer sharing throwback pictures with the caption: “Oh Daddio, to be loved by you is such a gift." “You are the funniest, most tender, charming, out of this world silly, talented and magical papa. “Looking through these photos ... I am just filled with the deepest gratitude that we chose to spend this life together. “I am your first baby and, man, sometimes I wish I could be tiny enough to just cozy up on your chest again and laugh and cuddle you. I love you so deep in my bones I don’t know how my muscles hold them," she added. “You are the greatest papa I could ever hope for. Thank you for your generosity, your silliness and heart. “Lou loves you so big." <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/p/C4s81d9RTU0/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C4s81d9RTU0/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Rumer Glenn Willis (@rumerwillis)</a> </div> </blockquote> Rumer's sister Scout also shared a tribute and said: “dad is one of my best friends, perhaps now on a deeper level than ever honestly. I cherish his affection and the immense freedom with which he’s always loved us.” Willis’ wife Emma Heming Willis, also shared a sweet message to the actor with a photo of him holding their two daughters, Mabel Ray, 11 and Evelyn Penn, 9. “Just like you, we simply adore him. What you might not know, but maybe you could imagine, that being wrapped in his arms is the safest place in this whole wide world,” she said. “He’s a true gentle man. With so much love to give and share. That’s what I get to see, his true core. I can tell you, it’s so pure and ever so good. “Happy Birthday my love. You are the gift that keeps giving 💞.” Images: Instagram

Caring

Popular TV host diagnosed with same condition as Bruce Willis

Popular American TV host Wendy Williams has shared her diagnosis after being plagued by "hurtful rumours". The 59-year-old's medical team announced in a lengthy statement that she has been diagnosed with aphasia and frontotemporal dementia: the same conditions actor Bruce Willis is battling. The news comes after Williams' family confirmed she had checked in to a facility to treat cognitive issues. “Questions have been raised at times about Wendy’s ability to process information and many have speculated about Wendy’s condition, particularly when she began to lose words, act erratically at times, and have difficulty understanding financial transactions,” her medical team said. They said Williams' symptoms first began in 2023, and was diagnosed with the neurological conditions just weeks later after undergoing a series of tests. Her team said both conditions have “already presented significant hurdles in Wendy’s life”. “Wendy would not have received confirmation of these diagnoses were it not for the diligence of her current care team, who she chose, and the extraordinary work of the specialists at Weill Cornell Medicine,” they said. “Receiving a diagnosis has enabled Wendy to receive the medical care she requires.” Williams chose to share the news to “advocate for understanding” and to “raise awareness” for the difficult conditions. “Unfortunately, many individuals diagnosed with aphasia and frontotemporal dementia face stigma and misunderstanding, particularly when they begin to exhibit behavioural changes but have not yet received a diagnosis,” her team said. “There is hope that with early detection and far more empathy, the stigma associated with dementia will be eliminated, and those affected will receive the understanding, support, and care they deserve and need." “Wendy is still able to do many things for herself. Most importantly she maintains her trademark sense of humour and is receiving the care she requires to make sure she is protected and that her needs are addressed." “She is appreciative of the many kind thoughts and good wishes being sent her way.” The TV presenter has previously been open with her medical battle with Graves’ disease and lymphedema, as well as other significant challenges related to her health. Image credits: Getty Images

Caring

"What a life I’ve had": Author announces own death after years of battling dementia

Wendy Mitchell has died aged 68 after documenting her brave battle with dementia. The author from Walkington, East Yorkshire, became the best-selling writer after she was diagnosed with early onset vascular dementia and Alzheimer's in July 2014. She shared her philosophical outlook on living with the condition in her acclaimed 2018 memoir Somebody I Used To Know and in her 2022 book What I Wish I Knew About Dementia. In an <a href="https://whichmeamitoday.wordpress.com/2024/02/22/my-final-hug-in-a-mug/" target="_blank" rel="noopener">open letter</a> shared online, the author announced her death and revealed that she had refused to eat or drink towards the end of her battle. "If you’re reading this, it means this has probably been posted by my daughters as I’ve sadly died," she began. "Sorry to break the news to you this way, but if I hadn’t, my inbox would eventually have been full of emails asking if I’m OK, which would have been hard for my daughters to answer… "In the end I died simply by deciding not to eat or drink any more," she wrote. She added that the last cup of tea she had, her "final hug in a mug" was "the hardest thing to let go of". "Dementia is a cruel disease that plays tricks on your very existence. I’ve always been a glass half full person, trying to turn the negatives of life around and creating positives, because that’s how I cope." Mitchell said that the language used by doctors can "make or break" how someone copes with dementia, and instead of saying there's "nothing they can do" it is better to tell them they will have to "adapt to a new way of living". "Well I suppose dementia was the ultimate challenge. Yes, dementia is a bummer, but oh what a life I’ve had playing games with this adversary of mine to try and stay one step ahead," she wrote in her final blog post. She also said that she had always been resilient, which has helped her cope with whatever life throws in her way. Mitchell has been an advocate for assisted dying in the UK, and said that "the only legal choice we shouldn’t have in life is when to be born; for everything else, we, as humans, should have a choice; a choice of how we live and a choice of how we die." She added that the way she died was an active choice as she doesn't want "to be an inpatient in a hospital, or a resident in a Care Home," as "it’s just not the place I want to end my years." "My girls have always been the two most important people in my life. I didn’t take this decision lightly, without countless conversations. They were the hardest conversations I’ve ever had to put them through. "This was all MY CHOICE, my decision. So please respect my daughters' privacy, as they didn’t choose the life I chose, of standing up to and speaking out against dementia." She then thanked everyone for their support and left with a touching final message. "So, enjoy this knowing that dementia didn’t play the winning card – I did." Images: Daily Mail

Caring

Bruce Willis' heartwarming reaction to granddaughter amid dementia battle

Bruce Willis' daughter Rumer has shared what the actor is like as a grandfather, amid his battle with frontotemporal dementia. Rumer candidly revealed that the now-retired actor is “incredibly loving and kind” and despite his FTD, his face “lights up” whenever he sees his granddaughter Louetta. “His face lights up when he sees Louetta,” Rumer told <a href="https://nypost.com/2024/02/01/entertainment/bruce-willis-face-lights-up-with-granddaughter-amid-dementia-battle/?utm_medium=browser_notifications&utm_source=pushly&utm_content=Entertainment/Living%20Audience&utm_campaign=4164834" target="_blank" rel="noopener">The New York Post</a>. “And I’m just so grateful to have that kind of spark of mischief and fun and and play no matter what age I am.” Louetta is Rumer’s 9-month-old baby girl with partner, Derek Richard Thomas. Rumer also shared that her father is most like David Addison Jr, a character he played on the hit 80s show Moonlighting. “So charming, so funny, so silly … kind of mischievous glint in his eye, kind and sweet,” she said. “And so I feel like that’s really the epitome of who my dad is. “And that is so true to this day.” Despite his dementia diagnosis, Rumer said that her father has not lost any of his trademark silliness and sense of humour. “He’s so incredibly loving and kind,” she said. “My dad is absolutely the reason I (have) my taste in music (and) some of my humour. “Both of my parents are so silly.” In 2022 Bruce's family announced that the Die Hard star was going to retire, as he was diagnosed with <a href="https://www.oversixty.com.au/news/news/bruce-willis-forced-to-retire-after-medical-diagnosis" target="_blank" rel="noopener">aphasia</a>, a disorder that affects a person’s ability to communicate. A year later it was revealed that it had progressed to <a href="https://www.oversixty.com.au/health/caring/cruel-disease-bruce-willis-given-heartbreaking-new-diagnosis" target="_blank" rel="noopener">frontotemporal dementia</a>. His family have since kept fans updated on the star's health. Images: Instagram

Mind

What’s the difference between memory loss and dementia?

When it comes to memory loss, it's normal to become a little more forgetful as we age. However, it’s important to know the difference between a standard level of memory loss, and the early signs of dementia. Researchers at the University of New South Wales (UNSW) say it is crucially important to distinguish between the physical decline of ageing, and the more sinister reality of cognitive decline. Associate Professor Simone Reppermund from the Centre for Healthy Brain Ageing says, “As we age, we get more frail, and it may be difficult to walk longer distances or to have the range of motion to drive a car.” “But that's unrelated to cognitive decline, and this is where dementia or cognitive impairment comes in. A person with dementia at some point will not be able to do the things they once could do without thinking, such as drive a car, because they get confused and are no longer able to process the sensory information required to do this.” Prof. Brodaty went on to say that some cognitive decline is part of normal ageing. “As we age, we become slower in our processing speed. We’re not as good at remembering things, particularly when they’re not able to be logically sorted and connected.” But it’s not all bad for older folks, as some things are known to improve with age. “As we age our vocabulary improves, our judgement improves, our ability to organise things improves. In everyday tests where we can sort, say, 10 grocery items into different categories, we do just as well as the younger person because we can use those strategies to compensate. There is also evidence that we become wiser as we get older.” According to <a href="https://www.dementia.org.au" target="_blank" rel="noopener">Dementia Australia</a>, it’s when people encounter difficulties with the following on a regular basis that there could be some underlying cognitive cause worth investigating. These difficulties include: <ul> <li dir="ltr" aria-level="1"> Trouble remembering recent events </li> <li dir="ltr" aria-level="1"> Trouble finding the right word </li> <li dir="ltr" aria-level="1"> Trouble remembering the day and date </li> <li dir="ltr" aria-level="1"> Forgetting where things are usually kept </li> <li dir="ltr" aria-level="1"> Difficulty adjusting to changes in routine </li> <li dir="ltr" aria-level="1"> Trouble understanding written content or a story on television </li> <li dir="ltr" aria-level="1"> Difficulty following conversations in groups </li> <li dir="ltr" aria-level="1"> Problems handling finances </li> <li dir="ltr" aria-level="1"> Difficulty with everyday activities </li> <li dir="ltr" aria-level="1"> Losing interest in activities that were previously enjoyable </li> </ul> Researchers and medical experts say that even if encountering these difficulties has not become a huge hurdle, it is important to be assessed by a doctor. Some conditions can cause symptoms similar to illnesses of cognitive decline, and can be reversed and prevented if caught early enough. While Professor Brodaty says there is no cure for most types of dementia and no known way to prevent it, we can certainly delay the onset of it. “There are certain risk factors that make it more or less likely to develop cognitive decline and dementia, including physical and social inactivity. Being inactive, not engaging in social activities, a poor diet and too much alcohol are all risk factors.” Even then, Professor Brodaty says, “it’s never too late to start, and never too early to start” making changes that maintain and protect your brain health into old age. Image credits: Getty Images

Mind

Maintaining friendships after a dementia diagnosis can spur feelings of joy and self-worth

<a href="https://theconversation.com/profiles/colleen-whyte-1281976">Colleen Whyte</a>, <a href="https://theconversation.com/institutions/brock-university-1340">Brock University</a>; <a href="https://theconversation.com/profiles/darla-fortune-1363967">Darla Fortune</a>, <a href="https://theconversation.com/institutions/concordia-university-1183">Concordia University</a>, and <a href="https://theconversation.com/profiles/rebecca-genoe-1363968">Rebecca Genoe</a>, <a href="https://theconversation.com/institutions/university-of-regina-3498">University of Regina</a> What would our lives be like if we could no longer depend on our most cherished friendships? The people who know us best, who have been there through our ups and downs, and share a history with us? For many people living with dementia, this is a reality. Over 500,000 Canadians <a href="https://alzheimer.ca/en/about-dementia/what-dementia/dementia-numbers-canada">are currently living with dementia</a>, and a diagnosis often leads to <a href="https://www.alzscot.org/news/friendship-and-dementia">a loss of friendships</a> and social opportunities. The reactions of friends greatly affect the experience of someone living with dementia. When friends distance themselves because they don’t know what to say or presume they no longer know how to interact with their friend, a person with dementia can experience <a href="https://www.researchgate.net/publication/275353356_Friendships_for_People_Living_with_Dementia_in_Long-Term_Care">feelings of isolation and loneliness</a>. When people living with dementia can depend on their friends, they continue to enjoy meaningful leisure activities, experience <a href="https://doi.org/10.1093/ageing/afx186">feelings of joy and self-worth</a>, and see themselves as <a href="https://alzheimer.ca/en/take-action/become-dementia-friendly/meaningful-engagement-people-living-dementia">valued members of their social circles</a>. <a href="https://dementiaandfriendship.ca/">Our research</a> had us interview friends together, asking them to share tips and strategies for navigating dementia. We heard moving stories of deepened bonds of friendship, genuine acceptance and the joy of simply being together. <h2>Adapting to changes</h2> Our research allowed us to speak with people who shared a 70-year friendship and couldn’t imagine life without each other. We learned that for some, a neighbourhood walk together was an opportunity to say a quick hello and how a weekly trip to the pub enabled some friends to connect and re-connect in a familiar space. People living with dementia and their friends <a href="https://doi.org/10.1017/S0714980821000301">may adapt to changes</a> brought about by the diagnosis in several ways. For example, they may prioritize their friendship by setting aside time for regular phone calls and visits. They may alter the way they think about the friendship by being accepting of the changes. They may also use practical strategies, like providing reminders for plans, and offering additional support when spending time together. Friends of individuals living with dementia may seek ways to <a href="https://doi.org/10.1177/1471301220980898">continue enjoying meaningful time together</a>. Sometimes this involves identifying activities that are comfortable and familiar. It may also involve providing direction and encouragement to support the continuation of enjoyable experiences, such as visiting a favourite restaurant. For some, additional comfort may come from hanging out as a group because there is extra support available if needed. <h2>Open and honest communication</h2> Open and honest communication is key to maintaining any friendship and becomes particularly important following a diagnosis of dementia. Yet, that may be the biggest challenge. Below are <a href="https://dementiaandfriendship.ca/">some questions that friends might find helpful</a> to ask over a cup of coffee, on a walk or in a quiet, shared moment: <ul> <li>What do you value about our friendship? Can I tell you what our friendship means to me?</li> <li>What is one thing I do that makes you laugh? Here’s something you do that makes me laugh…</li> <li>How can we make sure we maintain our friendship (i.e., talk on the phone, over the internet, go for coffee)? How often do you want to connect? How do we need to change our time together? What can stay the same?</li> <li>How can we support each other to continue enjoying the leisure activities that are meaningful to us?</li> <li>What are the best times and days to plan activities (i.e., morning, afternoon, weekday, weekend)? Are there exceptions?</li> <li>Do we need to schedule something in advance (need time to prepare, or get more rest the day before) or can we be spontaneous?</li> <li>Where do you feel safe and able to be yourself?</li> <li>When we are in public and you need me to step in for you, how will I know? What is “our” signal?</li> <li>What do I do if I notice you’re starting to make decisions that are not like you?</li> <li>Can I ask you these same questions in a few weeks?</li> </ul> The need for friendship <a href="https://alzheimer.ca/en/help-support/im-living-dementia/living-well-dementia/staying-socially-connected">does not diminish with age</a> and <a href="https://www.psychologytoday.com/ca/blog/happiness-in-world/201312/the-true-meaning-friendship">friendships continue to deeply enrich our lives</a>. Given that a dementia diagnosis often puts individuals at an increased risk of social isolation, we must pay careful attention to understanding ways to ensure that friends remain engaged with their networks in personal and meaningful ways. The first step is to trust in the friendship and begin to explore how it can be sustained over time.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/187038/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/colleen-whyte-1281976">Colleen Whyte</a>, Associate Professor in the Department of Recreation and Leisure Studies, <a href="https://theconversation.com/institutions/brock-university-1340">Brock University</a>; <a href="https://theconversation.com/profiles/darla-fortune-1363967">Darla Fortune</a>, Associate Professor, Applied Human Sciences, <a href="https://theconversation.com/institutions/concordia-university-1183">Concordia University</a>, and <a href="https://theconversation.com/profiles/rebecca-genoe-1363968">Rebecca Genoe</a>, Professor, Kinesiology and Health Studies, <a href="https://theconversation.com/institutions/university-of-regina-3498">University of Regina</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/maintaining-friendships-after-a-dementia-diagnosis-can-spur-feelings-of-joy-and-self-worth-187038">original article</a>.

Relationships

More than a third of people with dementia don’t know they have it – what to do if you suspect your partner has the condition

<a href="https://theconversation.com/profiles/kate-irving-1493654">Kate Irving</a>, <a href="https://theconversation.com/institutions/dublin-city-university-1528">Dublin City University</a> Around <a href="https://www.bbc.co.uk/news/uk-england-67613465">36% of people</a> in England with dementia are unaware they have the condition, according to a new report from the Dementia Commission. <a href="https://chamberuk.com/wp-content/uploads/2023/12/231127-Dementia-Commission-Report-Embargoed.pdf">The report</a> suggests things health and care professionals can do to improve spotting early signs of dementia. But what can you do if you think your partner has the condition? And how can you broach the topic with them? If you are worried about your partner having dementia, here are some useful things to know. Dementia is a term for a range of diseases (for example, Alzheimer’s) which develop over time (months and years) and cause problems with memory and reasoning, communication, changes in personality and a reduction in a person’s ability to carry out daily activities, such as shopping, washing, paying bills or cooking. Dementia can present very differently in each person, so it’s about knowing what’s normal for your loved one. A person who has always been conscientious and organised starting to unravel is very different from a scatterbrained person just being slightly more scatterbrained. Grief and stress can affect memory yet not be the start of dementia. But they can also mask the start of dementia: we call this “diagnostic over-shadowing”. There are also age-related changes to cognition. For example, we take longer to learn when we get older. But a one-off event – no matter how dramatic – is not necessarily dementia. It’s about looking for a pattern of decline. If you see these changes happen in a short space of time (weeks or days) it is unlikely to be dementia and could be something more serious. This requires urgent investigation by a doctor. <h2>Greatest fear</h2> Dementia is one of the greatest fears of our age. The horror of perceived loss of self can cause people to avoid discussing the issue, discussing it in an unhelpful way (such as criticising or inadvertently humiliating) or discussing it with other relatives, but not the person they are noticing changes in. Over time, this can cause a lack of trust to develop. Discussing memory problems openly with the person at the point of a memory failure or if they raise the concern is best. Of course, it takes courage and makes us face our own vulnerability. Sometimes the person will be in denial or lack insight into the memory problems (this can be a symptom of dementia, but isn’t always). If someone raises a concern about their memory issues, I would urge you not to minimise this, as it probably took courage to admit their concerns. I heard a relative say to my mother: “Oh, you left the pot on the stove. I lost the car in the multistory the other day.” My mother had dementia – the relative did not. If they are adamant that they do not have concerns, this is harder to deal with. One approach is to say: “I know you are not concerned, but I am concerned and I wonder if you would see a doctor to ease my worries?” Also explaining that memory problems can at least to some extent have reversible causes means a visit to the doctor to at least rule these out is an important step. It may also be encouraging to say to the person: “If there is something with your memory that will get worse over time, would you want to know?” (Most people <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408568/">answer yes</a> to this). <h2>Seeing a GP</h2> If your partner agrees to visit a GP, it is helpful to prepare by filling in a diary for a week with the kind of memory (or other) problems experienced, what was happening at the time and the effect of the memory failure. This can be shared with a GP to help them to understand the issues. When people hear even the suggestion of the word dementia, they are faced with the uncertainties of what will become of them, of what they will lose, what they can keep up and where they will end up. These uncertainties are often shared with family members. But research shows that positive aspects of timely diagnosis <a href="https://www.scie.org.uk/dementia/symptoms/diagnosis/early-diagnosis.asp">outweigh fears</a> over time. At the same time, there are often ongoing stresses to do with memory impairments or confusion. With these stresses, everyday life can be troublesome, family relationships can suffer, and people can find it difficult to be supportive of each other. Being honest and open is the best policy. Stating that we are in this together, I want to help, let’s meet whatever happens head on, can help. If a person becomes resistant, it may be there is another family member who might better assist the person.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219172/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kate-irving-1493654">Kate Irving</a>, Professor of Clinical Nursing, <a href="https://theconversation.com/institutions/dublin-city-university-1528">Dublin City University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/more-than-a-third-of-people-with-dementia-dont-know-they-have-it-what-to-do-if-you-suspect-your-partner-has-the-condition-219172">original article</a>.

Mind

Early indicators of dementia: 5 behaviour changes to look for after age 50

<a href="https://theconversation.com/profiles/daniella-vellone-1425451">Daniella Vellone</a>, <a href="https://theconversation.com/institutions/university-of-calgary-1318">University of Calgary</a> Dementia is often thought of as a memory problem, like when an elderly person asks the same questions or misplaces things. In reality, individuals with dementia will not only experience issues in other areas of cognition like learning, thinking, comprehension and judgement, but they may also experience <a href="https://www.alzint.org/u/World-Alzheimer-Report-2021.pdf">changes in behaviour</a>. It’s important to understand what dementia is and how it manifests. I didn’t imagine my grandmother’s strange behaviours were an early warning sign of a far more serious condition. She would become easily agitated if she wasn’t successful at completing tasks such as cooking or baking. She would claim to see a woman around the house even though no woman was really there. She also became distrustful of others and hid things in odd places. These behaviours persisted for some time before she eventually received a dementia diagnosis. <h2>Cognitive and behavioural impairment</h2> When cognitive and behavioural changes interfere with an individual’s functional independence, that person is considered to have dementia. However, when cognitive and behavioural changes don’t interfere with an individual’s independence, yet still negatively affect relationships and workplace performance, they are referred to as <a href="https://alzheimer.ca/sites/default/files/documents/other-dementias_mild-cognitive-impairment.pdf">mild cognitive impairment (MCI)</a> and <a href="https://doi.org/10.1186/s13195-021-00949-7">mild behavioural impairment (MBI)</a>, respectively. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169943/">MCI and MBI can occur together</a>, but in one-third of people who develop Alzheimer’s dementia, the behavioural symptoms come <a href="http://dx.doi.org/10.1016/j.jagp.2019.01.215">before cognitive decline</a>. Spotting these behavioural changes, which emerge in later life (ages 50 and over) and represent a persistent change from longstanding patterns, can be helpful for implementing preventive treatments before more severe symptoms arise. As a medical science PhD candidate, my research focuses on problem behaviours that arise later in life and indicate increased risk for dementia. <h2>Five behavioural signs to look for</h2> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=525&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=525&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=525&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=659&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=659&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=659&fit=crop&dpr=3 2262w" alt="Illustration of five behaviour changes that may indicate risk of dementia" /></a><figcaption>Spotting behavioural changes can be helpful for implementing preventive treatments before more severe symptoms arise. (Daniella Vellone)</figcaption></figure> There are <a href="https://doi.org/10.3233%2FJAD-160979">five primary behaviours</a> we can look for in friends and family who are over the age of 50 that <a href="https://doi.org/10.1186/s13024-023-00631-6">might warrant further attention</a>. <h2>1. Apathy</h2> <a href="https://doi.org/10.1002%2Ftrc2.12370">Apathy</a> is a decline in interest, motivation and drive. An apathetic person might lose interest in friends, family or activities. They may lack curiosity in topics that normally would have interested them, lose the motivation to act on their obligations or become less spontaneous and active. They may also appear to lack emotions compared to their usual selves and seem like they no longer care about anything. <h2>2. Affective dysregulation</h2> <a href="https://doi.org/10.1016/j.jad.2023.03.074">Affective dysregulation</a> includes mood or anxiety symptoms. Someone who shows affective dysregulation may develop sadness or mood instability or become more anxious or worried about routine things such as events or visits. <h2>3. Lack of impulse control</h2> <a href="https://doi.org/10.1002%2Ftrc2.12016">Impulse dyscontrol</a> is the inability to delay gratification and control behaviour or impulses. Someone who has impulse dyscontrol may become agitated, aggressive, irritable, temperamental, argumentative or easily frustrated. They may become more stubborn or rigid such that they are unwilling to see other views and are insistent on having their way. Sometimes they may develop sexually disinhibited or intrusive behaviours, exhibit repetitive behaviours or compulsions, start gambling or shoplifting, or experience difficulties regulating their consumption of substances like tobacco or alcohol. <h2>4. Social inappropriateness</h2> <a href="http://dx.doi.org/10.1017/S1041610217001260">Social inappropriateness</a> includes difficulties adhering to societal norms in interactions with others. Someone who is socially inappropriate may lose the social judgement they previously had about what to say or how to behave. They may become less concerned about how their words or actions affect others, discuss private matters openly, talk to strangers as if familiar, say rude things or lack empathy in interactions with others. <h2>5. Abnormal perceptions or thoughts</h2> <a href="https://doi.org/10.1038/s44220-023-00043-x">Abnormal perception or thought content</a> refers to strongly held beliefs and sensory experiences. Someone with abnormal perceptions or thoughts may become suspicious of other people’s intentions or think that others are planning to harm them or steal their belongings. They may also describe hearing voices or talk to imaginary people and/or act like they are seeing things that aren’t there. Before considering any of these behaviours as a sign of a more serious problem, it’s important to rule out other potential causes of behavioural change such as drugs or medications, other medical conditions or infections, interpersonal conflict or stress, or a recurrence of psychiatric symptoms associated with a previous psychiatric diagnosis. If in doubt, it may be time for a doctor’s visit. <h2>The impact of dementia</h2> Many of us know someone who has either experienced dementia or cared for someone with dementia. This isn’t surprising, given that dementia is predicted to affect <a href="https://www.ctvnews.ca/health/nearly-one-million-canadians-will-live-with-dementia-by-2030-alzheimer-society-predicts-1.6056849#:">one million Canadians by 2030</a>. While people between the ages of 20 and 40 may think that they have decades before dementia affects them, it’s important to realize that dementia isn’t an individual journey. In 2020, care partners — including family members, friends or neighbours — spent <a href="https://alzheimer.ca/sites/default/files/documents/Landmark-Study-1-Path-Forward-Alzheimer-Society-of-Canada-2022-wb.pdf">26 hours per week</a> assisting older Canadians living with dementia. This is equivalent to 235,000 full-time jobs or $7.3 billion annually. These numbers are expected to triple by 2050, so it’s important to look for ways to offset these predicted trajectories by preventing or delaying the progression of dementia. <h2>Identifying those at risk</h2> While there is currently no cure for dementia, there has been progress towards <a href="https://alzheimer.ca/en/about-dementia/dementia-treatment-options-developments">developing effective treatments</a>, which <a href="https://alzheimer.ca/en/about-dementia/do-i-have-dementia/how-get-tested-dementia-tips-individuals-families-friends/10">may work better earlier in the disease course</a>. More research is needed to understand dementia symptoms over time; for example, the online <a href="https://www.can-protect.ca/">CAN-PROTECT study</a> assesses many contributors to brain aging. Identifying those at risk for dementia by recognizing later-life changes in cognition, function as well as behaviour is a step towards not only preventing consequences of those changes, but also potentially preventing the disease or its progression.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213954/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/daniella-vellone-1425451">Daniella Vellone</a>, Medical Science and Imaging PhD Candidate, <a href="https://theconversation.com/institutions/university-of-calgary-1318">University of Calgary</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/early-indicators-of-dementia-5-behaviour-changes-to-look-for-after-age-50-213954">original article</a>.

Mind

"More bad days than good": Sad new pics of Bruce Willis emerge

Bruce Willis' family are "soaking up every moment" with the Hollywood legend, as his health is continuing to deteriorate. The 68-year-old's family have shared new heartbreaking photos of the actor, which show a steep decline in his appearance and capabilities since the onset of his health issues. Willis was diagnosed with frontotemporal dementia at the beginning of 2023, nearly one year after announcing his retirement from acting due to aphasia, which causes difficulties with speech. Since his diagnosis, his family have continued to share updates on the actor's condition. Now, a source close to the family has revealed that the star’s health has worsened in recent weeks, and now there are “more bad days” than good. “Bruce has good days and bad days, but in the last two months, there are many more bad days than good,” a source told <a href="https://www.usmagazine.com/celebrity-news/news/how-bruce-willis-family-is-supporting-him-as-he-battles-dementia/">US Weekly</a>. “This experience has brought the whole family even closer together. No one knows how much time Bruce has left, so they’re soaking up every moment they get with him.” Another source added that the four-time Golden Globe winner “has around-the-clock care, but at least one family member is always with him.” The beloved Hollywood action star has been spending his days alongside his wife, Emma Heming, ex-wife Demi Moore, and their collective five children, who all care for him throughout his difficult health journey. Image credits: Getty Images / Instagram

Caring

4 tips to help your loved one with dementia enjoy the festive season

<a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> The festive season is fast approaching, and if you’re organising celebrations with family or friends, you might be grappling with a seemingly endless to-do list. But as you make these plans, it’s important to consider how you can best include any friends or loved ones living with dementia. While no two people experience dementia in the exact same way, <a href="https://www.dementia.org.au/about-dementia/what-is-dementia">dementia</a> often affects the way people process and respond to their environment. Too much stimulation – like a lot of noise and activity at a Christmas party – can be overwhelming and may cause confusion or agitation. Finding ways to create a <a href="https://www.healthdirect.gov.au/creating-a-calming-home-for-people-with-dementia#:%7E:text=The%20physical%20environment%20is%20important,in%20and%20enjoy%20everyday%20activities.">safe environment</a> at home for your loved one with dementia will help maximise the chances everyone has a good time. <h2>1. Plan ahead, but be flexible</h2> Planning celebrations can be overwhelming for everyone involved, and having excessive expectations can raise stress levels. Try to keep <a href="https://www.dementia.org.au/information/about-you/i-am-a-carer-family-member-or-friend">expectations realistic</a> and in line with the current needs of your friend or loved one living with dementia. For example, people with dementia may experience <a href="https://www.dementia.org.au/information/about-you/i-am-a-carer-family-member-or-friend/personal-care/eating">changes in their appetite</a> or food preferences, or difficulties chewing and swallowing. These changes might make some of the things on your festive menu unappetising or difficult to eat. Be guided by the needs and preferences of the person with dementia and keep options limited to one or two special foods if larger banquets are likely to be overwhelming. Things can change quickly for people living with dementia and their abilities will likely <a href="https://www.dementia.org.au/about-dementia/what-is-dementia/progression-of-dementia#:%7E:text=A%20person%20with%20dementia's%20abilities,over%20a%20number%20of%20years.">vary from day to day</a>. Try to be flexible and have a backup plan in place. For special events, plan to record speeches or ceremonies to share when things are quieter. If you’re planning a large event, consider having a smaller gathering with your loved one with dementia and just a few special people. <h2>2. Stick to the familiar</h2> The sudden appearance of lots of decorations <a href="https://www.dementia.org.au/sites/default/files/helpsheets/Helpsheet-TipsToAssistSocialEngagement03-TipsForHolidayCheer_english.pdf">may be overwhelming</a> for a person with dementia and trigger a negative sensory reaction or distress. Ensure decorations are safe and familiar and put them up slowly over a period of a few days. Try to also stick to familiar traditions and routines. <a href="https://www.alz.org/help-support/caregiving/daily-care/daily-care-plan">Daily routines</a> are an important way of supporting people with dementia and sudden changes <a href="https://memory.ucsf.edu/caregiving-support/behavior-personality-changes#I-Investigate-Possible-Causes">may result in agitation and distress</a>. Stick to routine eating, bathing, and rest times where possible throughout the holiday period. For many people with dementia, long-term memories are less affected than <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/memory-loss">more recent memories</a>. Familiar family traditions can therefore be a good way to <a href="https://www.dementia.org.au/national/support-and-services/carers/therapies-and-communication-approaches">reminisce</a>. Family keepsakes or <a href="https://www.dementia.org.au/sites/default/files/20110303-NSW-LifeHistoryBook.pdf">memory books</a> can also help connect with stories from past celebrations. <h2>3. Have a quiet space</h2> Try to have <a href="https://www.scie.org.uk/dementia/supporting-people-with-dementia/dementia-friendly-environments/noise.asp">a quiet place</a> where the person living with dementia can go if things become overwhelming. Designating a support person who can stay with them throughout the day and take them to a separate room or area away from the action can help to keep things calm. Having some familiar objects or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432607/#:%7E:text=Passive%20music%20listening%20is%20reported,et%20al.%2C%202013">quiet music</a> in the space can be a good way to block out the noise of activities and reduce agitation. <h2>4. Make sure everyone has a part</h2> Everyone wants to feel a part of the activities on a special day, including people living with dementia. Ensuring everyone has a role to play may mean modifying tasks to suit the abilities of the person with dementia. For example, if you’re hosting an event at home, try to get your friend or relative with dementia involved in the kitchen by tossing the salad or helping to set the table. People with dementia are still the same person, even if their abilities have changed or they can no longer communicate their needs and feelings like they used to. It’s important to treat everyone with dignity and try to include your friends and loved ones with dementia in celebrations whenever possible. <h2>Sometimes, you can’t be together</h2> Despite the best laid plans, sometimes it won’t be possible to share in festive celebrations with your loved one living with dementia. More advanced dementia, <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Pages/racf-latest-advice.aspx">aged care visitor restrictions</a> or even just distance can keep many of us apart from our loved ones. Be prepared for this separation to bring up your own feelings of <a href="https://www.alz.org/help-support/caregiving/caregiver-health/grief-loss-as-alzheimers-progresses">grief or sadness</a>. Look after your mental health as well as the person with dementia. Caring responsibilities still largely <a href="https://www.pmc.gov.au/sites/default/files/resource/download/national-strategy-gender-equality-discussion-paper_0.pdf">fall to women</a> and it’s important to share the load. Where possible, the holidays can be a good time to think about giving primary carers a break to help them recharge for the year ahead. If you’re caring for someone with dementia and need support, <a href="https://www.dementia.org.au/support">Dementia Australia</a> or <a href="https://www.carergateway.gov.au/about?utm_source=google&utm_medium=paid-search&utm_campaign=10841470526&utm_adgroup=146956908840&utm_term=&gclid=CjwKCAjw9-6oBhBaEiwAHv1QvI1uJVJRppcDJtdgYNTDeObUk1tyrNUtLGBqpp3ytjb_khYkGExICBoC_5EQAvD_BwE">Carer Gateway</a> offer useful resources.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/214944/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/4-tips-to-help-your-loved-one-with-dementia-enjoy-the-festive-season-214944">original article</a>.

Caring

4 ways to support someone with dementia during extreme heat

<a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Our ability to adapt our behaviour to changes in temperature takes a significant amount of thought and decision making. For example, we need to identify suitable clothing, increase our fluid intake, and understand how to best keep the house cool. A person with dementia may find some or all these things challenging. These and other factors mean, for someone with dementia, extreme heat <a href="https://pubmed.ncbi.nlm.nih.gov/31520832/#:%7E:text=Conclusion%3A%20Heatwaves%20increased%20the%20risk,heat%2Drelated%20Alzheimer's%20disease%20burden.">can be deadly</a>. But as the temperature rises, friends, relatives and carers can help. <h2>El Niño means there are challenges ahead</h2> The recent declaration of <a href="https://www.abc.net.au/news/2023-09-19/bureau-of-meteorology-el-nino-blog/102875154">another El Niño</a> means we need to think about how we can best support those more vulnerable to be safe during the warmer months. Extreme heat and bushfires bring unique challenges for someone with dementia. Bushfires have a significant impact on older people’s mental health. But they generally <a href="https://www.health.act.gov.au/sites/default/files/2023-03/PATH_Impact%20of%202019-20%20Bushfires%20on%20a%20Cohort%20of%20Older%20Adults_REPORT_V3_0.pdf">bounce back</a> quickly. However, for someone with dementia, extreme heat can lead to a <a href="https://www.sciencedirect.com/science/article/pii/S0013935119305110">significant deterioration</a> in their overall health and they may not recover. Emergency evacuations can also be confusing and distressing for a person with dementia, so it is important to think ahead. <h2>Why are people with dementia more at risk?</h2> Dementia can affect the parts of the brain that help <a href="https://academic.oup.com/brain/article/138/11/3360/332653?login=true">regulate</a> our body temperature. Some <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243665">medications</a> can also increase someone’s sensitivity to heat. Problems with memory and thinking associated with dementia <a href="https://www.alzheimers.org.uk/get-support/daily-living/drinking-hydration">means</a> remembering to drink or communicating you are thirsty can be challenging. Heat can affect everyone’s mood. But if someone with dementia becomes dehydrated this can <a href="https://www.alzdiscovery.org/cognitive-vitality/blog/can-dehydration-impair-cognitive-function">increase</a> confusion and agitation, making it harder for them to know how to cool down. A person with dementia can also wander and become lost, which can be dangerous in extreme heat. <h2>4 ways to support someone with dementia</h2> 1. Avoid dehydration and heatstroke Try to avoid dehydration by encouraging someone to drink throughout the day. It’s better to have <a href="https://pubmed.ncbi.nlm.nih.gov/31769256/">small amounts</a> of liquid regularly instead of a large amount all at once. Little and often will help maximise hydration while avoiding sudden trips to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dementia-continence-issues#causes-of-incontinence-in-people-with-dementia">the bathroom</a>. Try to offer different types of drinks, or ice blocks. Placing drinks in sight can help as a reminder to drink. Choose foods with a high liquid content, such as fruit, salads, cool broths and yoghurt. Look out for <a href="https://www.nia.nih.gov/health/hot-weather-safety-older-adults#:%7E:text=Signs%20of%20heat%20stroke%20are,as%20under%20shade%20or%20indoors.">signs of heatstroke</a>, such as increased confusion beyond what the person would usually experience. Heatstroke may be more difficult to spot in someone living with dementia so it is important to check in when possible and to help them cool down if needed. 2. Cool the home Try to modify their home to make it easier to stay cool. Some air-conditioners have complex settings so make sure the temperature is set appropriately and the person with dementia knows how to use the controls. It is important to keep blinds and curtains shut where possible to reduce heat. However, ensure the <a href="https://www.scie.org.uk/dementia/supporting-people-with-dementia/dementia-friendly-environments/lighting.asp">lighting is adequate</a> to avoid falls. Try to support the person to make suitable clothing choices for the season by having cool, lightweight options easily available. 3. Think about communications early If someone with dementia lives alone, consider how you will maintain contact in an emergency. Some people may not realise many landlines don’t work in a power outage, and of course, mobile phones can’t be recharged. Ensure the person with dementia has access to an <a href="https://www.telstra.com.au/support/category/home-phone/uninterruptible-power-supply">uninterruptable power supply</a>. This can help maintain communication for a few hours in a blackout. 4. Have an evacuation plan In case of fire, flash flooding or severe storm, <a href="https://dementiaresearch.org.au/wp-content/uploads/2017/10/2447_DCRC_Prep_natural_disaster_EBook_5.pdf">have an evacuation plan</a>. If the person with dementia attends a day or respite centre, know their plan too. The situation can change quickly in an emergency, and this can be particularly overwhelming for people with cognitive issues. Understand that someone with dementia may become distressed when their routine is disrupted. So be prepared with some simple activities or comfort items, current medications, and any specific medical information. Stay up-to-date with <a href="http://www.bom.gov.au/">current warnings</a> and act early whenever possible. <h2>We can all help</h2> It’s not just carers of people with dementia who can help. We can all ensure people with dementia stay safe and cool this spring and summer. So remember to check in on your relatives, friends and neighbours or arrange for someone to do so on your behalf.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213987/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/4-ways-to-support-someone-with-dementia-during-extreme-heat-213987">original article</a>.

Body

Insider spills on Liza Minnelli's condition

After spending years in the limelight entertaining people, Liza Minnelli now lives her life secluded, according to an insider. The 77-year-old is receiving round the clock care while she's living alone at home surrounded by her dogs, favourite movies, and the memories of her stardom. The actress, known for her role as Sally Bowles in the movie Cabaret, reportedly doesn't leave home much because her condition has deteriorated. "Liza doesn't leave home much anymore," an insider told the National Enquirer. "She's surrounded by her dogs, her favourite movies and her memories. "She has spent a lifetime making other people happy, now it's time to focus on herself." However, there is still some hope that the actress might return to the stage for one last goodbye. "She does have plans to return to the stage one more time to say goodbye, even if it's in a wheelchair," the same insider said. Minelli has dementia which is reportedly getting worse, and in 2000 she was diagnosed with viral encephalitis, which is an inflammation of the brain which causes weakness or loss of movement in parts of the body, difficulty speaking, confusion or disorientation, among other things. She hasn't been seen in public for nearly a year. "Liza often fidgets, her hands shake, and she looks look horrible," a source said about the star's condition to RadarOnline.com at the time. "She sometimes doesn’t know who she’s talking to and has a hard time focusing." Images: Getty

Caring

"I'm really worried": Broadcasting icon reveals incurable condition

British broadcasting legend Alistair Stewart has shared the details of his devastating diagnosis, just after announcing his retirement. The 71-year-old shared that after suffering a series of strokes, he was diagnosed with vascular dementia. The news comes after he announced his retirement, after a 50-year career in the media that saw him in prominent roles with both ITV News and GB News. In an interview on GB News, Stewart explained that he first began feeling "discombobulated" six to nine months ago, which left him fearing he had "early onset dementia." He told his GB News colleague Camilla Tominey, "I wasn't forgetful but things like doing your shoelaces up properly, making sure your tie was straight, remembering the call time for your program is four o'clock not five o'clock – not turning up early or late – and stuff like that." "And I then decided I might have something wrong up here." He went on to explain he went to his GP to explain his symptoms, to which his GP recommended he have a scan to determine the diagnosis. When his scan results came back, he was told he'd had a series of minor strokes. "And it was like a scene from Casualty or Emergency Ward 10 because the results came back and I had indeed had a series of minor strokes – that are called infract strokes." "Not the big one where your face falls down and your arm goes doolally. But it's like pepper shots and the cumulative effect of that is that I had a diagnosis of early onset vascular dementia." His condition is "incurable" however Stewart says he is following doctor's advice to try and slow the progression of the condition. Since receiving his diagnosis, Stewart has retired from his role at GB News after more than 50 years as a journalist and broadcaster. He shared in a statement, "I'm nearly 71 and I still get the most tremendous lift from live television – it's the best job in the world." "However, the rigours of preparing for two live interview shows a week, and commuting from Hampshire to London for them, are considerable. I want to reduce my commitment while I'm still ahead as an old broadcaster, rather than an ancient one." Image credits: Getty Images

Caring

More than a game: Crosswords and puzzles may reduce dementia risk

Playing games, doing crosswords, writing letters or learning something new are all associated with reduced dementia risk in older adults, according to a large, long-term study. A team of Melbourne and US-based researchers study tracked 10,318 older Australians over a period of ten years (2010 to 2020), collecting detailed information on the types of leisure activities they engaged in, along with regular health checks and cognitive assessments. The study is <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807256" target="_blank" rel="noreferrer noopener">published</a> in JAMA Network Open. Paper co-author Dr Joanne Ryan from Monash University says “the findings show that engaging in mentally stimulating activities can help preserve cognitive function and may help delay the onset of dementia.” “We know the importance of physical activity. We need to think about helping to keep our mind stimulated as well.” <iframe title="Why do Women Live Longer than Men? And What About Gender Diverse People?" src="https://omny.fm/shows/huh-science-explained/why-do-women-live-longer-than-men-and-what-about-g/embed?in_playlist=podcast&style=Cover" width="100%" height="180" frameborder="0"></iframe> Adult literacy activities such as writing, using a computer or taking education classes were associated with an 11% lower risk of dementia, the study found. Active mental health activities such as playing games or doing puzzles were associated with a 9% lower risk. Creative activities like craft or woodwork and passive mental activities (reading books, watching television or listening to the radio) also reduced risks but to a lesser extent. Meanwhile, social activities were not associated with dementia risk. Ryan says this was a “little bit unexpected”. But she says it’s possible one of the reasons is those who volunteered to participate in the study were broadly already socially engaged. The median age of those participating in the study was 73.8 years. Around 2% of the cohort participating in the study developed dementia, Ryan says. Dementia risk varies depending on age and health status of individuals, she says. For instance, “we know that the risk of dementia actually increases exponentially as you get then over 80 years and over 90 years,” she says. Image credits: Getty Images <div id="contributors"> <a href="https://cosmosmagazine.com/health/body-and-mind/more-than-a-game-crosswords-and-puzzles-may-reduce-dementia-risk/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/petra-stock">Petra Stock</a>. </div>

Mind

What is ‘sundowning’ and why does it happen to many people with dementia?

<a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> The term “<a href="https://www.nia.nih.gov/health/tips-coping-sundowning#:%7E:text=Late%20afternoon%20and%20early%20evening,tired%20caregivers%20need%20a%20break.">sundowning</a>” is sometimes used to describe a tendency for people living with dementia to become more confused in the late afternoon and into the night. At the outset, I should emphasise the term “sundowning” is overly simplistic, as it’s a shorthand term that can encompass a vast number of behaviours in many different contexts. When assessing changed behaviours in dementia, it’s always better to hear a full and accurate description of what the person is actually doing at these times, rather than to just accept that “they’re sundowning.” This set of behaviours commonly described as “sundowning” often includes (but is not limited to) confusion, anxiety, agitation, pacing and “shadowing” others. It may look different depending on the stage of dementia, the person’s personality and past behaviour patterns, and the presence of specific triggers. Why then, do such altered behaviours tend to happen at specific times of the day? And what should you do when it happens to your loved one? <h2>Fading light</h2> We all interpret the world via the information that enters our brains through our five senses. Chief among these are sight and sound. Imagine the difficulty you’d have if asked to perform a complex task while in a darkened room. People living with dementia are just as dependent on sensory input to make sense of and correctly interpret their environment. As <a href="https://www.medicalnewstoday.com/articles/314685#causes">light fades</a> towards the end of the day, so too does the amount of sensory input available to help a dementia patient interpret the world. The <a href="https://www.medicalnewstoday.com/articles/314685#causes">impact</a> of this on a brain struggling to integrate sensory information at the best of times can be significant, resulting in increased confusion and unexpected behaviours. <h2>Cognitive exhaustion</h2> We have all heard it said that we only use a fraction our brain power, and it is true we all have far more brain power than we typically require for most of the day’s mundane tasks. This “cognitive reserve” can be brought to bear when we are faced with complex or stressful tasks that require more mental effort. But what if you just don’t have much cognitive reserve? The changes that ultimately lead to symptoms of Alzheimer’s disease can begin to develop for as many as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486209/">30 years</a> before the onset of symptoms. During that time, in simple terms, the condition eats away at our cognitive reserve. It is only when the damage done is so significant our brains can no longer compensate for it that we develop the first symptoms of Alzheimer’s disease and other dementias. So by the time someone first presents with very early dementia symptoms, a lot of damage has already been done. Cognitive reserve has been lost, and the symptoms of memory loss finally become apparent. As a result, people living with dementia are required to exert far more mental effort during the course of a routine day than most of us. We have all felt cognitively exhausted, run down and perhaps somewhat irritable after a long day doing a difficult task that has consumed an extreme amount of mental effort and concentration. Those living with dementia are required to exert similar amounts of mental effort just to get through their daytime routine. So is it any surprise that after several hours of concerted mental effort just to get by (often in an unfamiliar place), people tend to get <a href="https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning">cognitively exhausted</a>? <h2>What should I do if it happens to my loved one?</h2> The homes of people living with dementia should be <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/gps.5712">well-lit</a> in the late afternoons and evenings when the sun is going down to help the person with dementia integrate and interpret sensory input. A <a href="https://www.nia.nih.gov/health/tips-coping-sundowning">short nap</a> after lunch may help alleviate cognitive fatigue towards the end of the day. It gives the brain, and along with it a person’s resilience, an opportunity to “recharge”. However, there is no substitute for a fuller assessment of the other causes that might contribute to altered behaviour. <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/sundowning#:%7E:text=The%20reasons%20why%20sundowning%20happens,to%20sunlight%20during%20the%20day">Unmet needs</a> such as hunger or thirst, the presence of pain, depression, boredom or loneliness can all contribute, as can stimulants such as caffeine or sugar being given too late in the day. The behaviours too often described by the overly simplistic term “sundowning” are complex and their causes are often highly individual and interrelated. As is often the case in medicine, a particular set of symptoms is often best managed by better understanding the root causes.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208005/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-sundowning-and-why-does-it-happen-to-many-people-with-dementia-208005">original article</a>.

Mind

When someone living with dementia is distressed or violent, ‘de-escalation’ is vital

<a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Today’s <a href="https://www.abc.net.au/news/2023-05-18/cooma-aged-care-home-police-woman-in-hospital-taser/102361018">reporting</a> about the alleged tasering of a 95-year-old woman living at the Yallambee Lodge aged care home in New South Wales has brought the issue of behaviours and psychological symptoms of dementia into <a href="https://www.abc.net.au/news/2023-05-19/advocates-say-taser-clare-nowland-shows-aged-system-failure-/102365442">sharp focus</a>. Over half of those living in residential care <a href="https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/aged-care-and-support-services-used-by-people-with-dementia/residential-aged-care">have a dementia diagnosis</a> and up to 95% of those living with dementia will <a href="https://www.ncbi.nlm.nih.gov/books/NBK551552/#:%7E:text=Behavioral%20and%20psychological%20symptoms%20of,%2C%20and%20caregiver%20well%2Dbeing.">experience such behaviours</a> at some point during their passage through the illness. Common behaviours that might be shown by those living with advanced dementia include agitation, anxiety, attempts to leave care, aggression, apathy, sleep disturbance, aimless pacing, psychosis and aggression. The full circumstances surrounding Wednesday’s events are unclear and they are subject to an <a href="https://www.abc.net.au/news/2023-05-19/advocates-say-taser-clare-nowland-shows-aged-system-failure-/102365442">investigation</a> by police. That may take some time. What is clear, however, is that there is much room for improvement in the way behaviours and psychological symptoms of dementia are managed in residential care. Situations that end with police involvement should be avoided. <h2>Calling for help</h2> In its final report in March 2021, the <a href="https://agedcare.royalcommission.gov.au/">Royal Commission into Aged Care Quality and Safety</a> <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-recommendations.pdf">recommended</a> “all workers engaged by providers who are involved in direct contact with people seeking or receiving services in the aged care system undertake regular training about dementia care and palliative care”. Currently, it is not infrequent for police to be called to respond to incidents in care homes. While programs have been implemented to better equip police to respond to the specific need of those <a href="https://www.nationaltribune.com.au/police-and-psos-better-equipped-to-support-people-living-with-dementia/">living with dementia</a> this work is still in its infancy. Aggression and agitation are two of the most common behavioural symptoms that lead to referral to specialist support services. Dementia Support Australia is a Commonwealth-funded service that has supported aged care homes and home-based carers in managing behaviours and psychological symptoms of dementia since 2016. There were <a href="https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/aged-care-and-support-services-used-by-people-with-dementia/dementia-support-australia">8,702 referrals</a> to the service between January and June 2022. The number of referrals has increased in recent years. As an organisation at the frontline of dementia support, we extend our deepest sympathies to the 95-year-old aged care resident, her family, Yallambee Lodge staff and everyone else touched by this devastating incident. One of the advantages of having a national service such as this is that it has enabled the development of a national database that documents not only the nature and severity of the behaviours prompting the referral, but those factors that are most commonly identified as triggers for these behaviours. <h2>3 leading causes</h2> Aggression and agitation are not diagnoses in themselves, but symptoms. Symptoms have causes, and these must be identified in order to adequately address behaviour. The leading contributing factors we have identified in relation to behaviours are: 1. Unidentified or under-treated pain This is relevant in over 50% of the cases we see. Earlier research on pain management in the setting of advanced dementia has shown those with a dementia diagnosis who are admitted to hospital with hip fractures tend to be prescribed only a fraction of the analgesia given to <a href="https://pubmed.ncbi.nlm.nih.gov/10799790/">those without dementia</a>. 2. Carer approach Care staff receive only minimal levels of training in dementia care as part of their basic qualification and are often unfamiliar with communication strategies tailored towards those with cognitive impairment. Currently, the minimum qualification for a personal care worker involves no compulsory units in <a href="https://www.dementia.org.au/about-us/news-and-stories/news/are-aged-care-workers-required-have-dementia-training">dementia competency</a>. While we do not know the full circumstances from the events this week, the Royal Commission has made recommendations to improve care for those living with dementia. Carer approach is an issue in about a third of the cases we see. 3. Over- and under-stimulation In about one quarter of Dementia Support Australia cases boredom and loneliness and/or an environment that does not take into account the specific needs of those living with dementia are an issue. Other common causes of changed behaviour include mood and anxiety disorders, communication difficulties, <a href="https://theconversation.com/what-is-delirium-194631">delirium</a>, sleep problems and poor carer knowledge of the specific likes/dislikes of the individuals they are caring for. <figure><iframe src="https://www.youtube.com/embed/WE65yrnsrPk?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>People with dementia may react to uncertainty in unexpected ways.</figcaption></figure> <h2>Prevention and calming things down</h2> The best way to manage most behavioural changes is to prevent the circumstances that lead to their development in the first place. Prevention is always better than cure. Once behaviours are occurring, there is no single correct way to <a href="https://www.dementia.org.au/national/support-and-services/carers/behaviour-changes/aggressive-behaviours">de-escalate</a> them. The appropriate de-escalation strategies will always be specific to what has caused the altered behaviour in the first place. Unfortunately, when behaviours have escalated to the point where police attendance is required, the responding officers are unlikely to be equipped with the necessary information about the person and their circumstances. That means they won’t be equipped to respond with effective and specific de-escalation strategies. One case in the United States from 2020 involved the arrest of a 73-year-old woman living with dementia, who had left a local store without paying for items <a href="https://edition.cnn.com/2021/04/27/us/loveland-police-officers-video-use-of-force/index.html">worth a small amount</a>. A <a href="https://edition.cnn.com/2021/04/16/us/loveland-lawsuit-use-of-force-arrest/index.html">lawsuit</a> filed following the arrest alleged it resulted in a fractured arm and a dislocated shoulder, and raised national concerns about the way first responders interact with those experiencing cognitive disabilities. Australia needs to learn from yesterday’s events and respond. If you are caring for someone with dementia there is help available. <a href="https://www.dementia.com.au/">Dementia Support Australia</a> is a free service, fully funded by the Australian government. Referrals can be made 24-hours a day by calling 1800 699 799.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/205988/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Image credits: Shutterstock <a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, Head of Clinical Services, dementia Support Australia, & Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/when-someone-living-with-dementia-is-distressed-or-violent-de-escalation-is-vital-205988">original article</a>.

Mind

Slowing down in old age may point to a more sinister concern

It’s widely accepted that we tend to lose muscle strength and general mobility as we get older, which tends to make completing general tasks, and simply moving through the world, more difficult. While these aches and pains are a common symptom of getting older, new <a href="https://www.ecu.edu.au/schools/medical-and-health-sciences/our-staff/profiles/post-doctoral-research-fellows/dr-marc-sim">research</a> conducted by the Edith Cowan University (ECU) indicates this could also be a signal for another sinister health concern of ageing: late-life dementia. Research teams from ECU’s Nutrition & Health Innovation Research Institute and Centre for Precision Health have investigated the link between muscle function and dementia, examining more than 1000 women with an average age of 75. In collaboration with the University of Western Australia, the team measured the women’s grip strength and the time it took for them to rise from a chair, walk three metres, turn around and sit back down — known as a timed-up-and-go (TUG) test. These tests were repeated after five years to monitor any loss of physical performance. Over the next 15 years, almost 17 per cent of women involved in the study were found to have had a dementia event, categorised as a dementia-related hospitalisation or death. The team found lower grip strength and slower TUG were significant risk factors for presenting with dementia, independent of genetic risk and lifestyle factors such as smoking, alcohol intake and physical activity levels. The women with the weakest grip strength were found to be more than twice as likely to have a late-life dementia event than the strongest individuals. A similar relationship emerged between TUG performance and dementia, with the slowest in their TUG test more than twice as likely to experience dementia than the quickest. Senior researcher Dr Marc Sim said grip strength may be a measure of brain health due to the overlapping nature of cognitive and motor decline. “Possibly due to a range of underlying similarities, grip strength may also present as a surrogate measure of cardiovascular disease, inflammation and frailty, which are known risk factors for dementia,” Dr Sim said. Dr Sim went on to say that the findings could help healthcare professionals to identify dementia risk in patients earlier. “Incorporating muscle function tests as part of dementia screening could be useful to identify high-risk individuals, who might then benefit from primary prevention programs aimed at preventing the onset of the condition such as a healthy diet and a physically active lifestyle.” “The exciting findings were that decline in these measures was associated with substantially higher risk, suggesting that if we can halt this decline, we may be able to prevent late-life dementias.” Image credits: Getty Images

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When someone living with dementia is distressed or violent, ‘de-escalation’ is vital

Slowing down in old age may point to a more sinister concern

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Catalogues

Travel

Health

Lifestyle

Finance

Entertainment

Property

Information

Keep up to date

Search

Better sleep is a protective factor against dementia

How music is changing the way dementia patients think

Husband and wife with dementia reunite after 30 years apart

Demi Moore shares emotional birthday tribute to Bruce Willis

Popular TV host diagnosed with same condition as Bruce Willis

"What a life I’ve had": Author announces own death after years of battling dementia

Bruce Willis' heartwarming reaction to granddaughter amid dementia battle

What’s the difference between memory loss and dementia?

Maintaining friendships after a dementia diagnosis can spur feelings of joy and self-worth

More than a third of people with dementia don’t know they have it – what to do if you suspect your partner has the condition

Early indicators of dementia: 5 behaviour changes to look for after age 50

"More bad days than good": Sad new pics of Bruce Willis emerge

4 tips to help your loved one with dementia enjoy the festive season

4 ways to support someone with dementia during extreme heat

Insider spills on Liza Minnelli's condition

"I'm really worried": Broadcasting icon reveals incurable condition

More than a game: Crosswords and puzzles may reduce dementia risk

What is ‘sundowning’ and why does it happen to many people with dementia?

When someone living with dementia is distressed or violent, ‘de-escalation’ is vital

Slowing down in old age may point to a more sinister concern

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