Archive of ‘Cognitive Functioning’ category

Dementia: An Introduction

Have you been, or has your loved one been, diagnosed with dementia? Do you dread the journey that lies ahead? Here are a few facts and resources to help you face this difficult challenge.

Do not be afraid

Almost all of us who are over 50 fear that we will get dementia someday. But not many of us will actually get it. Among people who are over 65 years old, fewer than one out of 12 people (less than 8%) have dementia. Many centenarians (people over 100 years old) do not have dementia (source: The Merck Manual of Health and Aging, p. 307).  Dementia is very different from normal aging. 

What does normal aging look like? Each year, starting at age 25, our brains lose 1% of their processing speed. By age 50, we notice this, with chagrin. We also do not retrieve remembered information as quickly. Imagine how many names you learned before you were 20. Now imagine how many names you learned by age 50. When we are over 50, our “file cabinet” of names has a lot more items in it. No wonder it takes a little while to sift through that large volume of information to find the correct name when we see a familiar face, or hear a familiar voice. These are among the challenges of normal aging.

But remember that normal aging also has many advantages. At age 56, I value highly my life experiences. I would not trade in that hard-earned wisdom for the speed and agility that my brain had when it was young. As a grad student in my 50s, I was fascinated by classes about human behavior. Each concept that my professors presented was something that I could mentally illustrate with my observations of people whom I have known. 

Recall from history and literature that most cultures around the world, in most periods of history, have revered elderly persons as sources of wisdom and keepers of highly-valued traditions. Our culture might be in a minority in that it tends to glorify youth, and dismiss old age.

Get the facts

If you think that you or a loved one is experiencing some memory loss—not just normal aging—I encourage you to get the facts. As in many areas of life, even unpleasant facts are better than out-of-control fears. A good person to ask is your family doctor. He or she, or a member of the clinical staff, is likely to administer a standardized assessment at some point. There are several questionnaires for assessing memory loss that are well-researched, reliable (consistent) and valid (meaningful). These mental-status questionnaires take into account the person’s age and educational level, both of which can affect his or her scores. The questionnaires look not only at short-term memory, but also at the person’s ability to complete several different mental tasks. 

If you or your loved one scores below average for their age and educational level, that does not necessarily indicate dementia. There are several medical conditions that can mimic memory loss—but unlike memory loss, they are entirely reversible. During grad school, I interned in a medical clinic that primarily served older adults. Among my happiest moments were the times that I administered a mental-status questionnaire and found a normal result in a person whose result had previously been below average. These persons’ mental status returned to normal once they were treated for ordinary medical conditions such as urinary tract infection, vitamin B-12 deficiency, or depression. 

Safety first

If your doctor determines, after carefully eliminating all other possibilities, that you or your loved one has dementia, what comes next? Safety! You and your loved one need to think about safety, focusing on 5 areas of possible risk, namely:

  1. Driving. Is it still safe for your loved one to drive? If not, ask your doctor for help in having this difficult conversation with your loved one. What alternatives are available in your community (e.g. special public transportation services for handicapped persons, rural transportation that is sometimes covered by Medicaid, ridesharing services such as Lyft or Uber, and organizations of volunteers who serve elderly persons)? 
  2. Cooking. Sometimes persons with dementia forget to turn off burners on the stove, thereby causing fires. If needed, how can you protect against this?
  3. Medications. Sometimes persons with dementia skip doses or double-up doses of their medicines. Depending on the medicine, this can be dangerous. A first step in medication safety is to buy a pill container with a compartment for each day of the week and each time of day. Fill this pill container for your loved one each week, and check that the medicines have been consumed. Later, if the dementia progresses, you may need to hand medicines to your loved one, and watch him or her take them.
  4. Wandering. Sometimes persons with dementia get lost when they go out on walks. Even frail persons can walk surprisingly far. They may be searching with great determination for a place that they cannot find. Sometimes a person with dementia is searching for a place that no longer exists, such as a childhood home. Caring neighbors can be made aware of your loved one’s tendency to wander, so that they can gently redirect your loved one back home.
  5. Bills and taxes. Persons with dementia can inadvertently cause major financial problems by failing to pay bills or taxes, or by spending imprudently. If your loved one has been diagnosed with dementia, consider helping them find a financial services firm that can regularly pay their bills and taxes. Alternatively, try to persuade your loved one to sign a power of attorney that allows a responsible person to handle their finances for them when the need arises. 

A brain disease

Sometimes well-intentioned family members urge a loved one with dementia to try harder to remember information, or to practice skills. Unfortunately, the person with dementia cannot reduce the symptoms by trying harder. Urging them to try harder is based on a misunderstanding of the nature of dementia. Our common experience is the raising of children, who constantly learn new information and gain new skills. It is very hard for us to accept that in a person with dementia, the process goes in reverse—no matter how hard they try, and no matter how hard we try. 

Remind yourself frequently that dementia is a brain disease characterized by biological changes in the brain. Throughout the course of dementia, brain tissue is actually lost. The brain of a healthy, adult human weighs about 3 pounds. The brain of a person with end-stage dementia weighs only 1 pound. Recalling this fact can help a caregiver to be compassionate, patient, and understanding with their loved one who has dementia. Assume that at each stage of the disease, they are doing the best they can with the reduced amount of brain tissue that is left. 

An umbrella term

Dementia is an umbrella term that includes over 100 separate illnesses. Alzheimer’s is the most common form, accounting for over 60% of cases. The second most common form is Lewy Body Dementia, which has a distinctive pattern of symptoms. The third most common form is Vascular Dementia, which can result from strokes—either a major stroke, or a series of minor ones. 

Some helpful books

Here are my favorite books about dementia, with a brief description of each. 

The 36-hour day:  A family guide to caring for people who have Alzheimer Disease, related dementias, and memory loss, by N. L. Mace & P. V. Rabins. This is the classic, comprehensive guide to caring for a loved one with dementia. It can be used as a reference book: check the index for the topic you need, and read a few pages about it. 

Dementia caregiver guide: Teepa Snow’s Positive Approach to Care techniques for caregiving, Alzheimer’s, and other forms of dementia, by T. Snow. This book describes simply and briefly what life is like for a person who has dementia, at each stage of the disease; and gives practical instructions on how you as a caregiver can help the person. 

Alzheimer’s: A Broken Brain, by Dementia Education and Training Program, Tuscaloosa, Alabama. Available from the University of Alabama. Trigger warning: Do not look at this booklet if medical images bother you. This short booklet demonstrates in an unforgettable way that dementia is a brain disease. The booklet states 10 key facts about dementia, one sentence each. Each fact is illustrated with photos of 2 autopsied brains: the brain of someone who died from dementia, contrasted with the brain of someone who died of another cause. The difference between the brain images is dramatic. 

The whisper of the fallen oak: A family’s guide to early, middle, late, and end-stage dementia, by R. Wallace. Available from Wings of Change Publications. This booklet is a short, simple guide to the stages of dementia, and how to care for the person at each stage. 

Caregivers find meaning and purpose

Although caring for a person with dementia can be difficult and exhausting, it can also be extremely fulfilling. In 2016, researchers Cheng, Mak, Lau, Ng and Lam studied 57 caregivers of Alzheimer’s patients. The researchers identified ten positive themes that the caregivers reported, including “a sense of purpose and commitment to the caregiving role… increased patience and tolerance… cultivating positive meanings and humor… developing a closer relationship with the care recipient… and… feeling useful helping other caregivers.”

Key takeaway

The most important thing to remember about your loved one who has dementia is that he or she has the same value, dignity, and worth as you and I do.

The most important thing to remember about your loved one who has dementia is that he or she has the same value, dignity, and worth as you and I do. His or her value as a person is intrinsic, and does not depend on cognitive ability. In order to relate to your loved one, you may need to learn new skills. These skills are worth learning, because the person is worth relating to. If you make the effort to relate to a person with dementia, you will be rewarded in unexpected ways. 

[I wish to thank Laura A. Ellis, LMSW, James W. Ellor, Ph.D., D.Min., LCSW, Dennis R. Myers, Ph.D., LCSW, and Teepa Snow, MS, OTR/L, FAOTA, for teaching me the above material.] 

Written by: Catherine C. Stansbury, LMSW, supervised by Melissa L. Gould, LCSW-S. Catherine is a therapist here at Austin Family Counseling. She is an EMDR Trained Therapist specializing in trauma therapy for adults. She has a Master of Social Work from Baylor University. She is a Certified Practitioner of the MBTI, trained by The Myers & Briggs Foundation; a PAC Certified Independent Consultant, trained by the Positive Approach to Care organization; an associate member of the Aging Life Care Association; and an associate member of the EMDR International Association (EMDRIA).


How To Stop Being Mean To Yourself

“I’m such a burden.”

“I failed the test again. I’m never going to get any better at this.”

“They cancelled plans – they must not like me.”

“Everything I say sounds so unintelligent. I’m such an idiot.”

Any of these statements sound familiar? These statements are examples of negative self-talk. Self-talk is your subconscious inner dialogue that you engage with everyday. The average person has about 6,000 thoughts per day (Murdock, 2020). What do you notice about how you talk to yourself? How do these thoughts make you feel? If the answer is sad, unmotivated, upset, angry, or anything similar to these feelings –  chances are you are being mean to yourself.

Why are we mean to ourselves?

Our inner dialogue is shaped in childhood by the way we internalize how we are spoken to by people around us – caregivers, parents, peers, teachers, relatives. Maybe you had a teacher who said you just weren’t a good writer after failing one too many writing assignments. Maybe your parents dismissed your feelings a lot. All this to say – even though we may have internalized negative thoughts about ourselves for years, we can change these thoughts to positive self-talk statements:

1. Start with awareness.

As with any change we take on in our life – we first need to be aware that there is something that just isn’t working for us anymore. The purpose of explaining the “why” above is to create space to use curiosity (not judgement!) to discover where your inner critic comes from.

2. List evidence against your negative belief about yourself.

You may notice that you say, “I’m such a burden,” a lot. What is evidence in your life that shows that you are not a burden? Maybe you have friends that initiate plans with you. Maybe you have a partner that always asks and genuinely wants to hear about your day.

3. Create a new, positive self-talk statement based on the evidence you listed.

With the example above, the evidence shows that “I am loved”

4. Review the list of evidence often.

Keep a running list of evidence against your negative belief on your phone so that you always have access to it. Look at the list even when you are not being mean to yourself.

5. Practice self-compassion.

It takes time for these evidences to replace your long standing negative self belief – it’s like teaching yourself an entirely new language! Be kind to yourself as you navigate this process by using positive self-talk statements: “I’m doing the best I can.” “I can do this.” “I believe in myself.”

Practice using curiosity to identify your self-talk and how the statements make you feel. Therapy can support this process by providing a safe space to explore where your inner critic comes from and work on creating positive self-talk statements to replace negative ones. Wishing you healing on your journey to self-kindness!

Resources:

Murdock, J. (2020), Humans Have More than 6,000 Thoughts per Day, Psychologists Discover. https://www.newsweek.com/humans-6000-thoughts-every-day-1517963

Written by: Sarah Shah, M.S., LPC-Associate (she/her) supervised by Martha Pasiminio, LPC-S


How Can Chiropractic Care Help with Symptoms of Dementia?

Degenerative diseases of the brain are becoming common with the elderly. According to the Alzheimer’s Association, one out of three seniors dies with a degenerative brain disorder like Alzheimer’s or dementia. In the last two decades, deaths from Alzheimer’s have grown by almost 150%. It’s no secret that dementia and Alzheimer’s Disease are serious problems that require serious care. And, in the same study regarding Alzheimer’s Disease, half of primary care physicians believe that the health-care industry is not prepared to handle the onslaught of dementia.

Symptoms of Dementia

Dementia and Alzheimer’s Disease have similar symptoms. Common symptoms include memory loss, concentration problems, confusion with familiar tasks, difficulty communicating, mood changes, and anxiety.

Types of Dementia

There are several types of dementia, not just Alzheimer’s. Most involve memory loss and confusion, but they manifest with other problems. For example, vascular dementia also include problems that look like stroke side effects, like difficulty walking, temporary paralysis, and other movement problems. Another type of dementia includes Lewy bodies. People with this diagnosis will have periods of being alert, then suddenly drowsy. They also have visual hallucinations and are likely to fall. The other type of dementia is frontotemporal, which manifests in a changed personality where the patient does not know how to behave in a socially appropriate way. People with frontotemporal dementia often struggle to communicate and they become obsessive. As people move through the stages of dementia, they lose their social awareness, their personalities change, and lose bladder and bowel control. Most people with dementia problems are over age 65, but there are younger people between 45 and 65 who show signs of the growing problem.

Growth of Dementia Diagnoses

Dementia and Alzheimer’s Disease have both been studied extensively in recent years. Dementia diseases do not have cures, but researchers believe that the cure is somewhere in the brain. There are several ways to treat dementia and Alzheimer’s, but the diseases will continue to run their course until the patient is no longer living. Dementia – the degenerative brain disease – is practically at an epidemic level, as the growth over the last twenty years shows. Fortunately, there are treatments available, including chiropractic care. When you recognize how chiropractic care works, it becomes easy to see why a neurological problem like dementia can be treated with a health-care program that values the spine.

Causes and Prevention

The latest research shows that there are several factors that increase the risk of developing dementia. They include hypertension, hearing impairments, diabetes, social isolation, excessive alcohol consumption, smoking, obesity, head injury, physical inactivity, and air pollution.
Research also shows that prevention for dementia should start at a young age and continue through the elder years. All children should receive primary and secondary education. The dangers of drinking alcohol and smoking cigarettes should be shared with the public so people will avoid both to reduce their risks of developing dementia. Public health should train people to eat healthy foods so they avoid developing type-2 diabetes and other obesity-related problems. With healthy diets, people sleep better and are less likely to develop hypertension.

It is also important for people who need hearing aids to get them. Hearing loss is often a precursor to dementia. Finally, people should be able to live in communities that do not have excessive air pollution and homes should be free of second-hand smoke. Dementia care should include multidimensional treatments for the whole body. And, this is where chiropractic care comes into play. Many dementia patients take medications, but they only cover the problem, not solve it. Because so many people have dementia, Medicare is covering chiropractic care as a treatment because the care has proven to improve health, cognitive function, and life in general.

How Chiropractic Care Helps People with Dementia

Chiropractic care is dedicated to the maintenance of the central nervous system including the brain and spinal cord. Dementia and Alzheimer’s are degenerative brain disorders, so chiropractic care directly affects parts of the body affected by these diseases.

Feeding the Brain

There is research that shows the brain needs to have certain nutrients to function properly. When those nutrients are blocked, the brain changes and loses certain functions. When there are subluxations or misalignments in the spine, the body and the brain do not work as they should. Chiropractic care realigns the spine by removing the subluxations. The result is that
nerves can operate properly so nutrients can reach the brain, returning the spine and brain to normal function.

Typical Treatment Options

At this point, chiropractic care does not cure dementia or Alzheimer’s, but it does serve as a realistic treatment. Chiropractors work with patients who have problems with spine-related pain, joint stiffness, and extremity pain. Research shows that many of those problems manifest themselves as acute pain or restricted mobility. Most chiropractors use similar treatments:
● Myofascial therapies
● Ischemic compression
● Mechanical percussion
● Muscle stretching
● Thrust manipulation

Collaborative Changes to Meet Patient Needs

Patients who needed neurorehabilitation usually needed treatments that were different from the typical movement-related choices. According to research, people who needed chiropractic care for neurological conditions, like dementia, had chiropractors who developed collaborative plans with other health care providers. The programs required longer visits and non-standard treatment ideas. Chiropractors had to adapt to each patient’s cognitive issues and problems with communication.

Slowing Memory Loss

Chiropractic care is not a miracle solution for any degenerative brain disease, but it can help ease the symptoms. Some patients have found that chiropractic care has slowed their memory loss. Chiropractic care will not bring back lost memories, but research shows that thoughtful,
collaborative chiropractic will help maintain the status quo. Chiropractic care also helps improve musculoskeletal function in dementia patients.


If you have a loved one who is suffering through a type of dementia, you want the best for them. Rather than watching them go through the daily struggles, a chiropractor might be able to help slow the speed of degeneration. Your health care provider and a chiropractor can work together to improve your loved one’s quality of life, even in just a small way.

If you or a loved one is suffering from dementia check out this blog about counseling services for dementia related concerns.

Written By: Dr. Brent Wells.
Dr. Brent Wells, D.C. founded Better Health Chiropractic & Physical Rehab and has been a chiropractor for over 20 years. His chiropractic practice has treated thousands of Juneau patients from different health problems using services designed to help give long-lasting relief. Dr. Wells is also the author of over 700 online health articles that have been featured on sites such as Dr. Axe, Organic Facts, and Thrive Global. He is a proud member of the American Chiropractic Association and the American Academy of Spine Physicians. And he continues his education to remain active and updated in all studies related to neurology, physical rehab, biomechanics, spine conditions, brain injury trauma, and more.



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