Those with dementia-Best ways to talk with them

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Follow alzheimersideas on twitter
The Dementia Caregiver's Little Book of Hope [Kindle Edition]

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Alzheimer's Association.

In Alzheimer's, talking to a loved one can be very frustrating. Here are 3 tips that can help.

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For someone with Alzheimer’s disease, another dementia or memory loss, simply communicating with loved ones can be a challenge. For family members of people with Alzheimer’s and related dementia, these speech and communication issues can be very frustrating. 

The best way to deal with these issues is to try to put ourselves in their shoes to see what we can do to improve communication with someone who has Alzheimer’s or a related dementia.

1. Make sure you have their attention

1. You can reduce the frustration and confusion by simply ensuring that you have their attention before communicating with them. Making eye contact with a person with Alzheimer’s disease or another dementia is a critical first step to begin communication with them.
   
   Don’t assume that just because you’re in front of someone with Alzheimer’s disease or a related dementia that they are paying attention to you. Alzheimer’s robs people of their peripheral vision, so if you are even standing just a little bit off to someone’s side, they might not see you.
2. Another challenge for people living with Alzheimer’s disease is difficulty concentrating, so to be sure that the person you are trying to communicate with is paying attention to you. An easy way to address them by name and wait for them to respond before continuing your communication.
   
   Use simple sentences and slow down.

1. Once you’ve established a connection and have a person with Alzheimer’s disease or another dementia’s attention, the worst thing you can do is try to communicate too much, too quickly.
   
   For example: Instead of asking – “We’d like to take you out to dinner. Would you like to go for steak, seafood, pizza or a buffet?” – it would be much better to break those questions into separate parts. In that scenario, you just threw too much at a person with Alzheimer’s or dementia. There is the question of whether they want to go out to dinner; then you have offered three choices. This makes communication very difficult for someone with Alzheimer’s disease.
   
   Since they are two separate decisions, first see if they are up for going out to dinner, and then determine where they go.
   
   While it may seem loving, caring and considerate to offer flexibility and choices, a person with Alzheimer’s disease, another dementia or memory loss can easily feel overwhelmed by too many options. It’s usually better to just offer two choices or your communication will be hindered. If you don’t understand the speech and communication challenges facing a person with Alzheimer’s disease, other dementias or memory loss, it is easy to become frustrated as well.
2. Finally, don’t put anyone on the spot.
   
   All too often, well-meaning relatives and friends unwittingly create anxiety for their loved ones with Alzheimer’s by asking things like “you remember John, don’t you?” or “what did you have for breakfast?”
   
   To someone with dementia, this can feel like a pop quiz that they do not know the answers to. What if they don’t remember John or what they had for breakfast? You could be setting them up to feel embarrassed or ashamed.
   
   Alzheimer’s disease and other forms of dementia do not make people forget how to feel these emotions, so while these are well-meaning questions, it would be much better to simply phrase them a little differently. Saying “Hey mom, John from our old neighborhood is here to see you,” or “How was breakfast today?” is much less likely to create anxiety or confusion, which significantly increases the likelihood of a positive experience for the person with dementia.

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Again, a person with Alzheimer’s disease, another dementia or memory loss will be frustrated if they are forced to keep dealing with all that they cannot remember and the difficulty they have with speech. The frustrations with speech and communication, unfortunately, are a common struggle for people with Alzheimer’s and other dementias, and can be exacerbated by loved ones who don’t appreciate the speech and communication challenges that someone with dementia faces.

There is a lot to know about Alzheimer’s disease and dementia, specifically about speech and communication.

• You can get more information about communicating with people living with dementia by calling the Alzheimer's Association. They have a nationwide, 24/7 Helpline at 800.272.3900 for help with speech and communication issues, whether the diagnosis is Alzheimer’s or another dementia.They are available day and night with information, emotional support, caregiving tools and referrals to healthcare, financial and legal resources with translation services available in more than 200 languages.

Causes of sundowning

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter
The Dementia Caregiver's Little Book of Hope [Kindle Edition]


The Ohio State University, 

In "SUNDOWNING SYNDROME," people with dementia show high levels of anxiety, agitation, overactivity and delirium. It typically occurs in late afternoon and evening, before their normal time to go to bed. Learn how brain biology explains “sundowning.” 

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COLUMBUS, Ohio – Valuable research provides the best evidence to date that the late-day anxiety and agitation sometimes seen in older institutionalized adults, especially those with dementia, has a biological basis in the brain.

The findings could help explain “sundowning,” a syndrome in which older adults show high levels of anxiety, agitation, general activity and delirium in late afternoon and evening, before they would normally go to bed.

“It’s a big problem for caregivers.  Patients can get aggressive and very disruptive,” said Tracy Bedrosian, lead author of the study and a doctoral student in neuroscience at Ohio State University.

“There have been a few clinical studies documenting sundowning, but until now there hasn’t been research in animals to see what’s going on in the brain to explain this.”

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The important study found that aged mice showed significantly more activity and more anxiety-like behaviors in the hours before they would normally sleep when compared to middle-aged mice – just like sundowning in humans.

In these aged mice, the researchers found changes in parts of their brain associated with attention, emotions, and arousal, all of which could be associated with the behavior seen in sundowning.

In addition, mice that were genetically engineered to have an Alzheimer’s-like disease also showed more anxiety before sleep than did other mice.

“Some people have argued that sundowning could be explained just by a buildup of frustration of older people who couldn’t communicate their needs over the course of the day, or by other factors,” said Randy Nelson, co-author of the study and professor of neuroscience and psychology at Ohio State.

“But our findings suggest there is a real phenomenon going on here that has a biological basis.”

The study appears in the online Proceedings of the National Academy of Sciences.

In the first experiment, researchers compared middle-aged adult mice (7 months old) with aged mice (29 months old) that would resemble humans in their 80s.

Results showed that the aged mice were significantly more active than middle-aged mice in the two to three hours before they would normally go to sleep.

“The middle-aged mice had a distinct pattern of activity, with three peaks of activity during their waking hours,” Bedrosian said.

“But the aged mice had a flattened rhythm in which they showed the same level of activity throughout their active period.”

Evenings

That means that in the evening, when the middle aged mice would slow down compared to their peak activity levels, the aged mice kept going.

The mice were also tested for anxiety-like behaviors at two different times during their waking hours.  The mice were placed in a maze where they were allowed to explore open areas – which are more anxiety-producing – or hide in enclosed areas.

The middle-aged mice showed consistent levels of anxiety at both times of the day.  However, the aged mice showed more anxiety when tested soon before they would have gone to sleep, which is consistent with sundowning, Bedrosian said.

There were also differences in the brains of the aged mice when compared to the middle aged mice.  The researchers looked specifically at the cholinergic system, because loss of function in that system is associated with dementia and many of the circadian changes associated with ageing.

Findings in aged mice showed greater expression of a certain enzyme – acetylcholinesterase – before sleep than earlier in the day.  High levels of this enzyme are associated with anxiety and agitation.

However, in the middle-aged mice, there were no time-of-day differences in the expression of this enzyme.

Nelson noted that drugs used to control levels of acetylcholinesterase are sometimes used on dementia patients, although there has been no research evidence that it actually had an effect on sundowning.

These drugs include:

Brand Name	Generic Name
Aricept	donepezil
Exelon or Ebixa	rivastigmine
Reminyl or Razadyne	galantamine or galanthamine

“These drugs were prescribed for other purposes, but it also seemed to calm patients down.  Now we have some evidence on why it works,” Nelson said.

Anxiety, Agitation & Proteins

The researchers also found differences in expression of two other proteins in the brains of the aged mice that are also associated with behavioral disturbances.

“All of these results converge to suggest there are changes in the cholinergic systems of aged mice that may be contributing to the anxiety and agitation symptoms that we documented,” Bedrosian said.

In another experiment, the researchers used mice that were genetically engineered to develop Alzheimer’s-like disease in their brain.  They were compared, at nine months of age, to similar wild-type mice of the same age.

The Alzheimer’s-like mice showed more anxiety-type behaviors when tested before they would normally sleep than they did when tested earlier in their waking period.  That is consistent with sundowning in humans, the researchers said.

However, the wild-type mice showed no differences in anxiety levels based on the time of day they were tested.

Nelson said one of the theories about sundowning is that it is tied to disruptions that often occur in the biological clocks of older people, where their sleep-wake cycles are fragmented.

To test this theory, the researchers also treated the aged mice with melatonin for four weeks in order to help consolidate their circadian rhythms.  However, this treatment did not work to reduce anxiety issues in the mice.

Nelson said melatonin alone may not work because it doesn’t deal with the disruptions in the cholinergic system that was identified in this study.

“We need to study whether treating cholinergic dysfunction alone or in combination with melatonin treatment will help deal with sundowning symptoms,” he said.

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SOURCE:
The Ohio State University