Archives for February 2014

Association Between Mid- to Late Life Physical Fitness and Dementia

Journal of Internal Medicine, DOI: 10.1111/joim.12202 [Epub ahead of print]

Association between mid- to late life physical fitness and dementia: evidence from the CAIDE study

Kulmala J1, Solomon A, Kåreholt I, Ngandu T, Rantanen T, Laatikainen T, Soininen H, Tuomilehto J, Kivipelto M.



This study investigated the association between perceived physical fitness at midlife, changes in perceived fitness during the three decades from mid- to late life, and dementia risk.


Prospective cohort study.


Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) study.


Subjects were selected from four independent, random samples of population-based cardiovascular surveys and were first examined in 1972, 1977, 1982, or 1987, when they were on average 50 years old. The CAIDE target population included 3,559 individuals. A random sample of 2,000 individuals still alive in 1997 was drawn for re-examinations (performed in 1998 and 2005–2008) that consisted of cognitive assessments, with 1,511 subjects participating in at least one re-examination. Dementia diagnoses were also confirmed from national registers for the entire target population.

Main Outcome Measure

All-cause dementia.


Poor physical fitness at midlife was associated with increased dementia risk in the entire target population [hazard ratio (HR), 1.5; 95% confidence interval (CI), 1.1–2.0]. In participants, odds ratio (OR) was 2.0 (95% CI, 0.9–4.0). This association was significant in apolipoprotein E ε4 allele (APOEε4) non-carriers (OR, 4.3; 95% CI, 1.4–13.3), men (HR, 1.8; 95% CI, 1.1–3.0), and people with chronic conditions (HR, 2.9; 95% CI, 1.3–6.6). A decline in fitness after midlife was also associated with dementia (OR, 3.0; 95% CI, 1.7–5.1), which was significant among both men and women and more pronounced in APOEε4 carriers (OR, 4.4; 95% CI, 2.1–9.1).


Perceived poor physical fitness reflects a combination of biological and lifestyle-related factors that can increase dementia risk. A simple question about perceived physical fitness may reveal at-risk individuals who could benefit from preventive interventions.


Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.


Tips for Good Communication between a Caregiver and an Elderly Person with Dementia

Dear Readers:

While researching caregiving ideas from Europe, I came across the following post from a group called Elsa Care Europe. ELSA is a Multilateral Project funded by the European Commission. It ddresses the learning needs of professional caregivers working in residential and home care services (nursing homes, assisted living centers, adult care centers, home services, and the like) and of relatives caring for frail older people living at home or in residential care.

The following post was written by carers at the Social Innovation Fund in Lithuania. SIF is a non-government organization, established in Lithuania in 1994, as a charity and support foundation

The post has some good ideas. I hope you can try them out.

After reading the post, it is also good to remind ourselves that we need to give our caregivers support and respect for just being and just doing.

~ Jennifer

(Elsa Care Europe)  The list of suggestions below is taken from teaching material used in Sweden in courses for professional caregivers, but we feel that they are as relevant for relatives and informal caregivers [of elderly people with dementia].

  1. When you visit somebody smile, be friendly, and always say your name, even if you are there ten times a day. A good mood, humor and laughter make us all feel better. Make efforts to build rapport and connect the person with dementia with other family members or friends. This builds trust and may enhance communication.
  2. Assess the amount of insight and education the person with dementia and care partner have regarding memory loss. Determine what style of communication they prefer. Make sure you are speaking in terms that can be easily understood. Be clear when you speak, listen, take one thing at a time, tell them what you are going to do, and give them time.
  3. Assess their coping skills. Without doing this you risk overwhelming them and can feel ineffective in supporting them. Allow the person with dementia and their care partner to set the agenda, an agenda and a set of goals chosen by you will not be as effective as those set by them. They will be more likely to follow through on goals they set for themselves and that seem realistic to them. Safety concerns may require that you suggest goals that will take their situation into account.
  4. Show respect! Bear in mind that you are working in another person’s home. Would you like it if somebody came into your home and told you what to do? A lot of respect is required; ring the doorbell, remove your shoes and outdoor clothes when you come indoors. Think about how you would want others to behave in your home.
  5. See the person! They are adults, mostly elderly people who have lived a long and, one hopes, fantastic life but now they are ill. Never forget that. Never treat an adult as a child or somebody you can boss around. Even if they sometimes seem like children when they go back in time, treat them with the respect an adult deserves.

Written by Social Innovation Fund – Lithuania


Oh, Brother! With Parents Aging, Squabbling Siblings Turn to Elder Mediation

(AARP) In 2006, when Ella Bayliss moved from her home of 45 years outside Boston into assisted living, all four daughters agreed that it made sense. Their mother, then 83, was having memory issues and needed more care. But after she was diagnosed with Alzheimer’s and broke her ankle, the former social worker started to decline further, and the siblings were divided over the next step.

Two sisters thought she could stay where she was, while the youngest, Martha Whyte, believed Bayliss should be at a place with more resources. The fourth, in Texas, didn’t see her mother enough to weigh in, and decided to defer to the others.

Because Whyte, 49, lives closest and is her mother’s primary caregiver, she believed she was in the best position to determine her capabilities and needs.

“The conversations with my sisters were incredibly unpleasant about who knows better,” recalls Whyte.

“I’d attended virtually every doctor’s appointment with my mother for the last four years, but the attitude was, ‘She’s the baby sister, what does she know?’ They were always second-guessing me if I made decisions. Yet I’m the one in the emergency room at 2 a.m. It got to the point where we weren’t talking to one another.”

New Solutions to Old Problems

At an impasse, the family turned to elder mediation. In this fast-growing field, a trained, neutral conflict-resolution professional—sometimes an attorney or therapist—meets with adult siblings and, if they’re alive and able, their parents, to sort out contentious or unresolved issues relating to Mom and Dad. The mediator’s job is to defuse the situation and keep the group focused on their common goal: to come up with the best possible outcome for a parent they all love and to preserve family relationships. Everyone gets to talk (or vent or cry) and problem-solve to reach an agreement. In some situations, an elder law attorney, financial planner, caregiver or geriatric care manager also attends to lend his or her expertise.

“Across the country, we’re seeing private mediators, community mediation programs and court-based providers expanding their elder mediation services at a rate far beyond anything we’ve seen before,”

says Robert Rhudy, an attorney, mediator and president of the nonprofitSenior Mediation and Decision-Making Inc.

It’s no surprise that issues involving aging parents offer limitless opportunities for disagreements and all-out fights.

The dissension may revolve around any number of issues:

  • Money—who controls it, distrust of the adult child handling the checkbook, a sibling who has received more than his “fair share” of financial support or bears unequal caregiving costs.
  • Medical and end-of-life choices.
  • Family possessions, including inheritance, guardianship, sale of the parent’s primary or vacation home.
  • Independence and safety (for example, taking away the car keys).
  • Living arrangements or caregiving—one sibling shouldering the burden or being controlling, another not pulling her weight, or someone feeling cut out of the loop.

Other issues include: multiple decision-makers and personalities, economic and geographic disparities among siblings, different expectations, complicated role reversals, ingrained ways of behaving, old “baggage” and personal commitments. As these issue play out, siblings watch a cherished parent decline or deal with loss—and a new industry is born.

Rather than going to court, where a judge calls the shots, mediation is nonbinding and confidential, decisions are made by consensus, and attendance is voluntary. It’s also cheaper than litigation: $150 to $500 per hour for several hours for a private mediator’s time, or a nominal fee if you work through community mediation centers. Family members often share the costs. Another option—doing nothing and letting problems fester—can carry the much heavier price tag of ruptured relationships, impacting interaction with beloved cousins, nieces, uncles and even the next generation.

Coming Apart, Coming Together

“When Mom or Dad have been the hub, and all of a sudden no longer have that role, children don’t have that glue to hold the family together,” says Blair Trippe, the Bayliss mediator.

“Some sibling relationships get stronger, while other brothers and sisters stop speaking. They have to work things out, and are not used to doing that. Mediation helps them develop new communicating and consensus-building skills.”

While Whyte and two of her sisters met with the mediator, another sibling, Roberta Hill, was connected via conference call from Texas. (Beforehand, Trippe had spoken on the phone with each sister to get her perspective and visited Bayliss in assisted living. She was in the hospital the day of the mediation.) The result: The siblings agreed to hire a geriatric care manager to do an assessment of their mother and make recommendations.

“Mediation has reinforced that in order for my mother to get what she needs, the four of us have to work together regardless of our feelings for one another,” says Whyte.

Hill realizes the family was at a stalemate, but regrets that they needed “an outsider to come in and open up family issues that are no one else’s business.”

A Growing National Trend

As the concept of elder mediation gains more exposure, that attitude is likely to change. Earlier this month, at its national conference, the Association for Conflict Resolution offered six elder mediation workshops, while the American Bar Association and the National Academy of Elder Lawyers also have held seminars on the subject. “In five years, elder mediation will be known in the same way as divorce mediation is today,” predicts Arline Kardasis, cofounder of Elder Decisions in Norwood, Mass., which will train 120 elder mediators this year. “Divorce mediation has become almost the norm in some states.”

Says Janet E. Mitchell, an Indiana mediator and cofounder of

“When I tell people what I do, they always say, ‘I could use your service or know someone who can.’ ” Two reasons: Age 85-plus is the largest-growing demographic group in the United States, and 19 million to 22 million children act as family caregivers.

“Most of our parents did not go through this caregiving and life passage the way we are, because they didn’t live as long. Therefore, there’s no model,”

says Francine Russo, author of They’re Your Parents, Too! How Siblings Can Survive Their Parents’ Aging Without Driving Each Other Crazy.

“For the first time in history, adult siblings and their parents have to reengage intensively and long-term even though they have not lived in the same household for 30 or 40 years.”

You’d never know it, though. “A lot of times, all that old stuff from eighth grade is still there,”

says Eileen Schaeffer, an elder law attorney and director of the elder mediation program at Montgomery Conflict Mediation Center in Eagleville, Pa.

“Undercurrents of family conflicts are driving some of the elder conflict even more than the immediate reason that they come to mediation.” That “old stuff” can interfere with sound decision-making.

Parental Wishes

Mom and Dad are typically less interested in what those decisions are than that their kids get along, maintain elder care experts. Out of fear of triggering sibling strife or displeasure from their children, they may not level with family members. Mediators like to visit parents to hear what they’re thinking and, while they’re at it, make sure the children aren’t making decisions for them when they’re perfectly capable.

Parents vital enough to take part may decide not to attend mediation, or to speak at the beginning of the meeting, then leave. (Some siblings also choose not to participate.)

“It’s incredibly debilitating for the parent to see sibling conflict and realize that once they’re gone, their children may have nothing to do with one another,” says Forrest Mosten, a Los Angeles mediator and attorney.

The Blessings of a Neutral Party

Carol Rice, 57, believes a skilled elder mediator might have prevented the rift in her family. After her father died, Rice’s mother, now 92, was afraid to be alone. So Rice and her two sisters suggested that each of the six adult children take turns hosting Mom for two nights. Their mother was onboard, but three of the siblings refused and have bowed out of caregiving, says Rice.

“We can’t understand why they are so detached from my mother, but they are,” says Rice.

“Before this happened, we took trips together and hung out at one another’s house. But everything is different now.”

That wrenching experience prompted Rice, cofounder of the Conflict Resolution Academy in Atlanta, to start offering elder mediation and to train professionals in this specialty. Yet, even if she had had the knowledge,

“it doesn’t matter how trained you are,” believes Rice.

“When you’re the person in the situation, you lose perspective. You need someone who can help the family move forward, maintain the dignity of the parent, and keep relationships you’ve valued all your life.”

As parents live longer, sibling relationships are likely to get tested over and over. “My mother is in good health and this situation could go on for a long time,” says Rice. “I fully expect her to live to be 100. I might not make it, but she will!”

Tips for Finding an Elder Mediator

There is no national credentialing or formal licensing for elder mediators, and states have different requirements. Choose a mediator familiar with elder issues. For referrals, try these sources:

  • Enter “elder mediation” in an Internet search engine plus city or state for local or state-specific mediation associations.

Sally Abrahms writes on aging and boomers for national magazines, newspapers, websites and companies.

The contents of all material available on are copyrighted by AARP.


10 Ways to Deal with Caregiver Stress

(AARP) It’s no secret: Helping to care for a sick or dying loved one exacts a steep emotional toll. One study found that as many as one in three caregivers rate their stress level as high, and half say they have less time to spend with family and friends.

But when you’re caring for others, it’s critical that you first take care of yourself. By not doing so, you put yourself at risk of exhaustion, health problems and even total burnout.

These 10 tips will help keep your stress in check.

1. Put your physical needs first. Eat nutritious meals. Don’t give in to stress-driven urges for sweets or overindulge in alcohol. Get enough shut-eye; if you have trouble sleeping at night, try napping during the day. Schedule regular medical checkups. Find time to exercise, even if it means you have to ask someone else to provide care while you work out. If you experience symptoms of depression — extreme sadness, trouble concentrating, apathy, hopelessness, thoughts about death — talk to a medical professional.

2. Connect with friends. Isolation increases stress. Getting together regularly with friends and relatives can keep negative emotions at bay.

3. Ask for help. Make a list of things you have to do and recruit others to pitch in. Even faraway relatives and friends can manage certain tasks.

4. Call on community resources. Consider asking a geriatric care manager to coordinate all aspects of your loved one’s care. Other service providers, including home health aides, homemakers and home repair services, can shoulder some of the many responsibilities of caregiving. Volunteers or staff from faith-based organizations or civic groups might visit, cook or help you with driving.

5. Take a break. You deserve it. Plus, your ailing family member might benefit from someone else’s company. Think about respite care by friends, relatives or volunteers. Or try for a weekend or longervacation by turning to a home health agency, nursing home, assistedliving residence or board-and-care home; these facilities sometimes accept short-term residents. Adult day centers, which usually operate five days a week, provide care in a group setting for older people who need supervision.

6. Deal with your feelings.Bottling up your emotions takes a toll on your psyche — and even onyour physical well-being. Share feelings of frustration with friendsand family.  Seek support from co-workers who are in a similar situation. Make an appointment with a professional counselor, or join a caregiver support group.

7. Find time to relax. Doing something you enjoy, such as reading, walking or listening to music, can recharge your batteries. Some caregivers meditate or use relaxation techniques such as deep breathing or visualizing apositive place. If you’re religious, you might find that prayer can bea powerful tool.

8. Get organized. Simple tools like calendars and to-do lists can help you prioritize your responsibilities. Always tackle the most important tasks first, and don’t worry if you can’t manage everything.

9. Just say no.Accept the fact that you simply can’t do everything! Resist the urge totake on more activities, projects or financial obligations than you canhandle. If someone asks you to do something that will stretch you toothin, explain honestly why you can’t — and don’t feel guilty.

10. Stay positive. Do your best to avoid negativity. Hold a family meeting or call an elder care mediator to resolve conflicts with siblings and other relatives. Instead ofdwelling on what you can’t do, pat yourself on the back for how muchyou are doing, and focus on the rewards of caring for someone you love.


The contents of all material available on are copyrighted by AARP.


Timeslips: Creative Storytelling for People with Dementia

Dear Readers:

Have you heard about If not, you might find this interesting and something you can try with your loved one.


About TimeSlips

TimeSlips offers an elegantly simple revolution in long-term care – a clear shift from “managing behaviors” toward using the arts to engage and build community. In an age when medicine offers few treatments for dementia, TimeSlips provides hope through meaningful communication and connection.

While we started way back in 1998, we became an independent non-profit in 2013.

We Provide

  • Online Certification to Indviduals in our improvisational storytelling method
  • Training for Organizations on how to building a creative community of care, engaging elders, staff, families, and volunteers
  • A Creativity Journal for one-on-one use (available through Attainment Co.) Ideal for families, home care, and hospice
  • Online Trainings that support student (high school and higher education) service learning
  • FREE online storytelling software that let’s you create together and share your stories with others around the world. Come and play today! Start a story!

What Does Research Say?

  • Research suggests that TimeSlips increases the quality and quantity of engagement between staff and residents – modeling person-centered engagement on whole units! Click HERE to read the study.
  • TimeSlips is featured on the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality’s Innovation Exchange!  See our profile here.

Watch the video here:


In 1996, TimeSlips founder Anne Basting was curious…

could improvisation and creative drama techniques that were so powerful for healthy older adults prove helpful for people with Alzheimer’s and dementia?

After trying many reminiscence-based techniques, basting shifted toward imagination – and the improvisation sessions took off.

With a dozen delightful stories in hand, she wrote a play to share them with the larger community.

That play, was called…TimeSlips. Since then TimeSlips has:

  • created training manuals for facilitators
  • conducted and published research on the method
  • staged plays inspired by the stories
  • curated art exhibits inspired by the stories
  • trained over 2,000 TimeSlips Facilitators across the world
  • embedded the method in over 30 facilities/organizations
  • assembled an amazing team of Master Trainers
  • created a “service learning” program for students
    in high school, college, and medical school
  • created an online training (2011)
  • created free, custom storytelling software (2011)
  • became an independent non-profit (2013)
  • was awarded Rosalinde Gilbert Foundation Award for Innovations in Alzheimer’s Caregiving (2012)
  • was awarded Metlife Leadership Award through the National Center for Creative Aging (2013)
  • received international press recognition through NPR, Today Show, NYT’s, Boston Globe, Chicago Tribune, Milwaukee Journal
  • created an internship/fellow program for students across the world (2014)

Sound interesting? Check out the TimeSlips stories here:



Tips on Boosting Spirits in Alzheimers Caregiving

(Mayo Clinic with Angela Lunde) We’re busily preparing for our annual Meeting of the Minds dementia conference taking place St. Paul on March 1st. You can still register at I’d love to see you there, and if you are, stop by the Mayo Clinic booths and say hello.

I’m so pleased to share with you an article I asked my friend and colleague Karen Love to write. Karen is a gerontologist with expertise in dementia and is an incredible teacher and advocate for person-centered care.

Below, she talks about the need for meaningful engagement, and that it’s about so much more than just staying busy.

Boosting Spirits, by Karen Love.

The changes that occur in the brains of people living with Alzheimer’s are invisible to the eye. This means it can be difficult for caregivers to know what abilities and functions are being impacted.

There’s one significant change that generally occurs early in those living with Alzheimer’s. Knowing about, and understanding this change, offers the potential to significantly impact the quality of life for both the person with the disease and those who care about the person.

Those living with Alzheimer’s lose the ability to begin an activity or find interesting things to do on their own. If caregivers don’t know about this, they could mistakenly conclude that the person is unmotivated or no longer interested or able to do things. As a result, the person can spend long days doing nothing, leading to boredom, agitation, anxiety and frustration.

Being engaged in interesting and meaningful things in daily life is essential for overall well-being. People living with Alzheimer’s often just can’t think of and find things to do because of changes in the brain. This means that caregivers, family and friends can play an important role.

To know what types of activities might be of interest to people living with Alzheimer’s, think about their lifelong interests. For instance, people who have loved being around animals such as dogs, cats or birds will still enjoy being around them. At some point, they won’t have the cognitive ability to care for the pet, but they will still enjoy the companionship.

Similarly, someone who loved to cook likely will still enjoy cooking but with modifications. One friend’s mother-in-law used to love to cook. Now living with dementia, she can’t manage meal preparations, but my friend includes her in the kitchen activities and gives her things to do that she can easily manage such as cutting up apple pieces and tearing lettuce for salad. Her mother-in-law enjoys the work and beams from the praise she gets from the rest of the family.

My father had Alzheimer’s, and it was a little challenging initially finding activities for him because his lifelong interests were working as an executive and doing repairs around the house. Neither seemed replicable for someone living with Alzheimer’s. Our family began thinking along slightly different lines about what brought him joy and then it became easy to come up with ideas.

He loved to walk, eat with family, watch children play and dance with my mom. He had fun and we enjoyed doing these things with him because we knew they brought him joy.

You may have to think a bit creatively, but it’s well worth it. Carving a little time to come up with ways to keep a person living with Alzheimer’s engaged can help offset some of the negative effects of the disease. And you may discover that it helps you both stay emotionally connected.

(Because the benefits of engagement and interaction are so significant, Karen collaborated with a researcher from Penn State University, Elia Femia, PhD, to study the evidence base for engagement. They ended up creating FIT Kits to further the research and develop dementia engagement products for the general public. See for more information.)


By Angela Lunde

© 1998-2015 Mayo Foundation for Medical Education and Research. All rights reserved.


When Your Mother Says, “I Want to go Home!” and Your Father Says, “You’re Trying to Poison Me!”

(Care Crossroads) Managing various behaviors during the course of Alzheimer’s disease can be challenging, but there are ways to improve the odds that an individual with dementia will respond positively while minimizing your own stress. One approach is Validation—a technique that confirms a person’s right to feel a certain way regardless of the situation. By validating the person’s experience, you are meeting the person where he or she is and sending a message of acceptance. Another approach is redirection—a behavioral intervention that shifts the individual’s focus, by distracting the person or moving away from an undesired topic or behavior to something more pleasant.

When your mother says, “I want to go home!”

Instead of saying, “This is your home! You’ve only lived here for 30 years!” Try saying, “Of course you want to go home! Your house was the prettiest on the block. Why don’t you tell me about those tulips you planted in your front yard?” Why? When someone wants to go “home,” it really signals a desire for a sense of safety and familiarity. Bring mom “home” by reuniting her with her favorite memories of what home represents.

When your wife says, “Get away from me, you’re not my husband!”

Instead of saying, “But I am your husband! Look at our matching wedding rings. You know, you really upset me when you don’t remember who I am.” Try saying “You must love your husband very much. I can tell by the way you talk about him. Why don’t you tell me about your wedding day?” Why? Memory loss can cause individuals to forget even their closest loved ones. When your wife becomes agitated, respect her space, validate the love she feels for her spouse, and allow her to talk about “him” while you are sitting right beside her.

When your father refuses to eat and says, “You’re trying to poison me.”

Instead of saying, “That’s ridiculous! Eat your meal and stop making up crazy stories!” Try saying, “Dad, I understand if you are feeling afraid, but I want you to know that I would never let anything bad happen to you. By the way, this meatloaf is delicious. Let’s have some together and you can tell me all about the fishing trip.” Why? It is difficult, if not impossible, to rationalize with people with dementia. Instead of trying to orient Dad back to reality, instill a sense of safety, and demonstrate it by eating the same meal as him or taking a bite from his plate.

When your sister says, “You stole my money! Give it back!”

Instead of saying, “I’m sick and tired of you accusing me every time you hide your money. You stuffed it in your drawer five minutes ago.” Try saying, “Oh no, your money is missing? I can see why you’re upset. Well, don’t you worry because I am going to help you look for it.” Why? It is common for people with dementia to hide items and forget where they are moments later. Since it can be embarrassing to admit this, individuals sometimes accuse others to take the focus off themselves. Rather than trying to deflect blame, simply let your sister know that you understand how she feels and that you want to help her resolve the situation. Then walk her over to the drawer and ask her to open it. When your sister finds her money, allow her to take pride in finding it all by herself.

When your grandmother says, “I have to leave now. I need to pick up Jimmy from school.”

Instead of saying, “Grandma, Jimmy is a grown man. He’s 60 years old. You’re not going anywhere.” Try saying, “Oh Grandma, you have always been such a loving mother to Jimmy. Why don’t you come with me to get a drink of water and tell me all about what you love to do with Jimmy after school?” Why? People with Alzheimer’s disease often live in the past by re-creating experiences that happened long ago. Despite the fact that Grandma hasn’t picked Jimmy up from school in decades, her maternal instinct is still very strong and she feels an urgency to follow the same routine from earlier years. Take this as an opportunity to reunite your grandmother with those happy memories; by distracting her, she will forget about leaving.

Frequently Asked Questions


Q. My loved one is abusive, throws things and curses at me all the time. How do I handle this behavior?

A. People with Alzheimer’s disease tend to experience confusion and disorientation, which can influence their perception of reality. If their judgment is impaired, they may have trouble distinguishing right from wrong, and it’s not uncommon for them to take their aggression out on even the closest family members. Their confusion can appear in many ways, such as attacking caregivers because they no longer recognize them or negatively associate them with someone from the past.

First and foremost, you should discuss this behavior with the person’s primary care physician. There may be a treatable medical problem, such as a urinary tract infection or dehydration, which could be worsening the symptoms of Alzheimer’s disease and contributing to aggression.

Cursing and throwing things are common ways for people with Alzheimer’s disease to express their agitation. While your initial response may be to yell and try to get to the bottom of this behavior, the truth is that people with Alzheimer’s disease may not be able to express why they are upset. Often times, it is because of this inability to express their feelings or discomfort that they become aggressive in the first place.

If your loved one becomes physically dangerous or violent, your first priority should be to assure the person’s safety and your own safety. The key to doing so is to remain calm while providing reassurance. One way to do this is by speaking to your loved one, eye to eye, in a soft tone and reminding the person that you are there to help.


Q. How do I handle sundowning syndrome?

A. Many individuals with Alzheimer’s disease experience increased confusion and agitation in the late afternoon and early evening—a symptom known as sundowning. Most sundowning emerges in the middle stages of the disease and slowly worsens as the disease progresses. Like with other behavioral challenges you may face as a caregiver, it often helps to make changes to the environment, daily routines and the ways you interact with your loved one. Although it is unlikely that any one technique will reverse or completely fix the situation, it is important to carefully consider all options and customize interventions to the specific person and situation.

Concerning the environment, watch for “triggers” that seem to further confuse, frustrate or agitate the person with dementia. For example, excess stimuli and clutter might aggravate sundowning. In addition, it helps to increase indoor lighting before dusk.

Tune in to daily routines that may be causing moments of failure or confusion. It may help to keep your loved one awake during the day, do only simple, calming activities in the afternoon, and make sure the person is well-fed and well-hydrated.

Lastly, in terms of interacting with your loved one, pay special attention to your use of certain words and phrases, body language and tone. Set the tone by modeling the mood and behavior that is appropriate for the situation. Stay calm, offer support and remain focused on positive themes—even if your loved one has a shift toward an unpleasant mood.

Sexual Intimacy

Q. How does Alzheimer’s disease affect someone’s sexual experiences?

A. There is no across-the board answer to this question. The way Alzheimer’s disease and related illnesses affects a person’s sexual life can vary, based on such factors as someone’s past sexual history and the stage of the disease.

In the milder stages of dementia, many individuals who were sexually active  in the past remain active and continue to enjoy the experience. For others, emotional distress may lead to sexual withdrawal and feelings of inadequacy, or resentment and anger because of sexual difficulties.

As a partner, you can encourage your loved one to discuss his or feelings, emphasize the value of your relationship with or without sexual relations, and, if desired, seek professional counseling.

Later on in the disease process, some individuals with dementia may forget how to make love, may become less considerate of a partner’s needs, and may exhibit inappropriate and aggressive sexual behavior, such as exposing private parts. They may forget that you’ve just engaged in sexual activities and demand more relations, which can lead to anger if denied.

In general, it will be up to you to redefine sexual intimacy and adjust to the physical and emotional changes in your relationship.  Even when sexual intimacy is not possible, individuals with dementia need the safety, touch, comfort and security that come from being with a person they trust.

In rarer instances, people with dementia exhibit sexually aggressive behaviors, such as fondling, or at¬tempting or having intercourse with others. These acts of sexual disinhibition result from brain damage, especially in the frontal and temporal lobes of the brain, that has disrupted the individual’s ability to control responses or can be a reaction to unmet needs.

To avoid putting you, your loved one and others at risk, it is important to discuss these issues with a healthcare professional and identify the causes and options for treatment and behavioral interventions.


Copyright 2013 Alzheimer’s Foundation of America


What’s Causing Your Memory Loss? It’s Not Necessarily Alzheimer’s

( For physicians and families intent on pinning down a diagnosis, one major complicating factor is the existence of so many kinds of dementia. More than 50 conditions can mimic or cause dementia.

Alzheimer’s disease is by far the most common intractable condition. But other causes of irreversible dementia include blood vessel diseasevascular dementia), other degenerative disorders (frontotemporal lobar degeneration, Parkinson’s disease, Huntington’s disease), slow-growing brain tumors, or infections of the central nervous system (Creutzfeldt-Jakob disease, AIDS dementia, neurosyphilis).


  • More than 50 conditions can cause or mimic the symptoms of dementia.
  • A small percentage of dementias are reversible. Symptoms subside when the underlying problem is treated.
  • Two common examples are dementia caused by vitamin B12 deficiency or an underactive thyroid (hypothyroidism).
  • Getting the right diagnosis is important so that you know what options you have.

In some types of dementia, treatment will improve mental functioning, and in a small percentage, the dementia is completely reversible if treatment begins before permanent brain damage occurs. That’s why it is important to report to a doctor any signs of dementia as early as possible.

Reversible Dementias

Reversible dementias are often easier to diagnose than irreversible dementias because they are usually accompanied by other, obvious symptoms. In the following conditions or situations, however, dementia may be the primary, or even the only, symptom. Proper treatment may improve or even restore cognitive functioning.


Delirium causes changes in mental functioning that can closely resemble dementia, but there are two important differences:

  • Speed of onset. The mental changes in delirium develop quickly, often in a matter of hours or days. In contrast, dementia evolves over months or years.
  • Level of consciousness. In delirium, consciousness is either clouded or fluctuates between drowsiness and alertness. Dementia doesn’t affect the level of consciousness.

Delirium is considered a medical emergency, in part because it’s often the main expression of a sudden, life-threatening illness. Elderly people are also susceptible to delirium after surgery.

Alcohol withdrawal syndrome presents the classic picture of delirium. Similarly, delirium can occur from abrupt withdrawal from benzodiazepines, a group of anti-anxiety drugs that includes diazepam (Valium), chlordiazepoxide (Librium), and alprazolam (Xanax).

Toxic Reactions to Drugs

Medications are common culprits in mental decline. With aging, the liver becomes less efficient at metabolizing drugs, and the kidneys eliminate them from the body more slowly. As a result, drugs tend to accumulate in the body. Elderly people in poor health and those taking several different medications are especially vulnerable.

The list of drugs that can cause dementia-like symptoms is long. It includes:

  • antidepressants
  • antihistamines
  • anti-Parkinson drugs
  • anti-anxiety medications
  • cardiovascular drugs
  • anticonvulsants
  • corticosteroids
  • narcotics
  • sedatives


People sometimes manifest dementia-like symptoms—forgetfulness, disorientation, inattentiveness, and slowed responses—when they are depressed. This so-called pseudodementia can masquerade as the depression that often accompanies Alzheimer’s disease, but there are subtle differences.

  • Pseudodementia. In pseudodementia, the depressed mood begins before there is any mental decline. Typically, the person complains about memory loss or lack of concentration, looks sad or worried, and speaks in a flat, expressionless tone.
  • Depression. In Alzheimer’s-related depression, the mental decline comes first, and the person usually tries to conceal memory problems, rather than call attention to them.

Vitamin B12 Deficiency

Dementia could be a symptom of pernicious anemia, a rare condition caused by low levels of vitamin B12. In people with pernicious anemia, the bone marrow produces red blood cells that are both larger and less numerous than normal (see illustration).

In older people, the first symptoms of pernicious anemia are often confusion, slowness, irritability, and apathy. Other symptoms of pernicious anemia include:

  • yellowish skin
  • fatigue
  • shortness of breath
  • headaches
  • numbness or tingling in the hands and feet
  • trouble keeping balance

Usually the B12 deficiency that underlies pernicious anemia is not caused by a lack of B12 in the diet. That’s because this vitamin is plentiful in eggs, dairy products, meat, fish, and poultry, and it’s efficiently stored in the liver.

Instead, a B12 deficiency usually occurs because an individual can’t absorb the vitamin from food. Fortunately, B12 injections, if started early, can remedy the deficiency and alleviate the symptoms of pernicious anemia.


Hydrocephalus (“water on the brain”) is an excess of cerebrospinal fluid around the brain. The fluid is secreted by the ventricles (cavities in the center of the brain). It circulates around the spinal cord and is absorbed by veins on the external surface of the brain.

Congenital hydrocephalus is usually diagnosed shortly after birth, but normal-pressure hydrocephalus occurs in a small number of elderly people. This condition can result from head trauma, brain hemorrhage, or meningitis (inflammation of the membrane covering the brain), but most cases occur spontaneously without an obvious preceding illness.

In addition to developing dementia, people with this condition lose bladder control and walk in a slow, hesitant manner, as if their feet are stuck to the floor. A surgically implanted tube (shunt) that drains fluid from a cavity in the brain (the lateral ventricle) to the jugular vein or to the abdomen brings rapid improvement, provided treatment is started soon after the symptoms appear.


Brain tumors may be malignant (cancerous) and therefore capable of invading surrounding tissue. Or they may be benign (self-contained).

Brain tumors can interfere with cognitive functioning and cause personality changes. Depending on their location, they can trigger other symptoms, such as headaches, seizures, or vomiting.

The first symptoms of slow-growing tumors frequently resemble dementia, especially in older people.

Subdural Hematomas

Hematomas are blood clots caused by bruising. When they are located in the subdural area, between the brain surface and the thin membrane that covers it (the dura), they can cause symptoms that mimic Alzheimer’s disease. Such subdural hematomas can also be life-threatening, causing coma and death.

Most subdural hematomas are caused by severe head trauma sustained in automobile crashes.

But elderly people sometimes develop subdural hematomas after a very minor (and, therefore, often forgotten) head injury. As blood oozes into a closed space, the hematoma enlarges and begins to interfere with brain function.

Removing the clot within weeks of the injury may restore mental function. However, the symptoms often evolve so slowly that diagnosis is delayed for months.

Thyroid Disease

An overproduction of thyroid hormones (hyperthyroidism) is commonly caused by Graves’ disease, while an underproduction (hypothyroidism) usually results from Hashimoto’s thyroiditis. Both disorders can cause dementia-like symptoms.

  • Hyperthyroidism. To diagnose hyperthyroidism, physicians use a simple blood test that measures levels of thyroid hormones. Surgically removing the thyroid or destroying it with radioactive iodine usually corrects the cognitive problems.
  • Hypothyroidism. This is diagnosed by measuring the level of thyroid-stimulating hormone circulating in the blood. Physicians usually recommend thyroid hormone replacement, but this treatment doesn’t always reverse the dementia.


Wernicke-Korsakoff syndrome, an irreversible state of confusion and amnesia in alcoholics, results from thiamine deficiency due to long-term malnutrition. But consuming excessive amounts of alcohol for a decade or more can also cause impaired thinking that resembles Alzheimer’s disease.

In dementia due to alcoholism, memory, orientation, and attention deteriorate, although verbal skills are not always severely affected. In this type of dementia, abstinence may partly restore mental functioning.

Irreversible Dementias

Although there are many causes of irreversible dementia, the following conditions are among the most common. In some cases, prompt treatment can prevent further damage, but lost cognitive functioning cannot be restored.

Alzheimer’s Disease

Alzheimer’s is distinguished from other dementias at autopsy by the presence of sticky beta-amyloid plaques outside brain cells (neurons) and fibrillary tangles within neurons. Although such lesions may be present in any aging brain, in people with Alzheimer’s these lesions tend to be more numerous and accumulate in areas of the brain involved in learning and memory.

The leading theory is that the damage to the brain results from inflammation and other biological changes that cause synaptic loss and malfunction, disrupting communication between brain cells. Eventually the brain cells die, causing tissue loss (see illustration). In imaging scans, brain shrinkage is usually first noticeable in the hippocampus, which plays a central role in memory function.

The hallmark symptom of Alzheimer’s is difficulty in recalling new information. As Alzheimer’s progresses, the following may occur:

  • Memory loss. This may be severe enough to disrupt daily life (for example, the person may get lost in a previously familiar neighborhood).
  • Cognitive decline. The individual may also experience decline in cognitive ability (finding it hard to make decisions, solve problems, or make good judgments).
  • Mood or personality changes. An individual with Alzheimer’s may undergo significant changes in mood and personality (such as becoming more irritable, hostile, or apathetic).

Alzheimer’s is severely debilitating, and death usually occurs within three to nine years after it is diagnosed. Five drugs have been approved for treating Alzheimer’s, but they alleviate symptoms only slightly.

Vascular Dementia

Some cognitive problems stem from insufficient blood flow to portions of the brain. The decrease in blood flow is often the result of atherosclerosis (the accumulation of fatty deposits on artery walls) in the blood vessels that feed the brain. The resulting interruption of blood flow creates areas of dead tissue.

These events—which are in fact tiny strokes—often go unnoticed, because each one damages just a small part of the brain and doesn’t cause long-term impairment. But the cumulative damage can lead eventually to large areas of dead brain tissue, and symptoms such as confusion, impaired thinking, slurred speech, and paralysis may arise.

People with vascular dementia usually have one or more of the following risk factors:

  • hypertension (high blood pressure)
  • cardiovascular disease
  • diabetes
  • a history of stroke

The classic symptom of vascular dementia is an abrupt mental change, sometimes accompanied by paralysis or slurred speech. The mental deterioration proceeds in a “stairstep” pattern—a person suffers a sudden cognitive decline, the decline levels off, and then new strokes cause another sudden decline.

Degenerative Diseases

Most dementias are caused by degenerative diseases, conditions whose deterioration cannot be stopped. Alzheimer’s disease is the degenerative disease that is most often responsible for dementia, accounting for more than 50% of cases. Frontotemporal lobar degeneration, Parkinson’s disease, and Huntington’s disease account for approximately 25% of all dementias.

Frontotemporal Lobar Degeneration. This group of diseases, formerly called Pick’s disease, is characterized by atrophy of the front part of the brain, including the frontal and temporal lobes. It is often confused with Alzheimer’s disease because the symptoms are sometimes identical. Some experts believe it may be the second most common dementia, after Alzheimer’s disease.

The cause of frontotemporal lobar degeneration is unknown, but some variants can run in families, and it is sometimes associated with gene mutations. People with frontotemporal lobar degeneration exhibit symptoms such as:

  • prominent aphasia (impaired ability to use language) early in the illness
  • loss of inhibition, resulting in sociopathic or hypersexual behavior
  • loss of emotional responses such as fear
  • compulsively putting objects in their mouths.

Parkinson’s Disease. This is a movement disorder resulting from a deficiency of dopamine, a neurotransmitter involved in coordinating muscle activity as well as memory function.

Its hallmarks include tremors, rigid limbs, and difficulty starting or stopping movement. Mild cognitive problems are common early in the disease, and dementia occurs in 30% to 80% of Parkinson’s patients in the late stages.

Some people with Parkinson’s disease develop dementia because they also have Alzheimer’s disease. In other cases, the dementia is associated with hallucinations and appears to be linked to damage in the limbic and cortical areas of the brain. This variant of Parkinson’s is called Lewy body dementia.

Drugs that increase dopamine transmission, such as levodopa (Sinemet), help control the physical symptoms of Parkinson’s but don’t improve mental function.

Huntington’s Disease. Huntington’s disease is a rare inherited disorder linked to an abnormal gene on chromosome 4. Its symptoms include involuntary writhing movements and dementia, and they often begin between the ages of 20 and 40.

Mental disturbances may occur before or after physical problems appear, and people are often difficult to care for because of their irritability, aggressiveness, and erratic behavior. Medications can control the movement and mood disorders, but they don’t stop the disease from progressing.

Infectious Dementias

Virtually any infectious agent that attacks the central nervous system can cause dementia.

Creutzfeldt-Jakob Disease. This is a rare, rapidly progressive dementia caused by a type of infectious agent called a prion. The initial symptoms are fatigue and subtle changes in behavior. Typically, the disease progresses to movement problems, seizures, coma, and—within a year—death.

AIDS Dementia. This form of dementia occurs in people with AIDS. The dementia can develop rapidly, sometimes in a matter of weeks, and consists of forgetfulness, inattentiveness, and thinking difficulties.

Neurosyphilis. Before the introduction of penicillin, up to 30% of dementia patients admitted to mental institutions had neurosyphilis. This disorder, which develops about 15 years after syphilis infection, is now rare, because syphilis is typically treated before it reaches that point.

Adapted with permission from A Guide to Alzheimer’s Disease, a special health report published by Harvard Health Publications.


© All rights reserved.