Depression is common for individuals living with Alzheimer’s Disease. Up to half of those living with the disease experience signs of depression, compared to about 7% for the general public. This higher occurrence is attributed to the neurological changes caused by the disease and the emotional distress accompanying its diagnosis.

At NursePartners, we offer professional assistance and support in the familiar surroundings of home. We have extensive expertise working with Alzheimer’s patients; our entire team is committed to delivering personalized care that prioritizes comfort and well-being. 

In this article, we explore the correlation between Alzheimer’s disease and depression and provide insights on addressing suspected depression in your loved one.

Depression Symptoms in Alzheimer’s Disease

Detecting depression in individuals with Alzheimer’s poses a challenge due to overlapping symptoms. Cognitive decline may further limit their ability to articulate emotions and recognize depression symptoms. Furthermore, depression may present differently in Alzheimer’s patients. 

They may not explicitly express a depressed mood but instead exhibit nonspecific symptoms, including:

• Insomnia
• Loss of appetite
• Unexplained and unresponsive pain
• Fatigue

Signs that may indicate depression in individuals with Alzheimer’s include:

• Frequent use of medical services and office visits
• Persistent reports of fatigue and pain
• Headaches
• Changes in sleep patterns and appetite
• Unexplained gastrointestinal symptoms
• Social isolation
• Increased dependency

Depression symptoms in Alzheimer’s patients may also be less severe, with fluctuating durations and intensity.

What is the Connection Between Depression and Alzheimer’s Disease?

Although depression is not a diagnostic criterion for Alzheimer’s disease, some research suggests that there is a relationship between the two conditions. Depression often occurs during the early and middle stages of Alzheimer’s. Approximately three-quarters of individuals with Alzheimer’s also experience significant depression, which may worsen the prognosis and accelerate disease progression. 

While some individuals with Alzheimer’s also have depression, it remains unclear whether depression is a risk factor, an early symptom, or a reaction to the cognitive decline experienced in Alzheimer’s. Some researchers have proposed a reciprocal relationship between the two conditions. Moreover, individuals with mental health disorders, including depression, have up to four times the risk of developing dementia or other neurodegenerative diseases later in life. 

Depression can serve as a potential risk factor for cognitive decline and the progression of Alzheimer’s, even up to 20 years after receiving a depression diagnosis.

A 2019 review elucidated how depression may contribute to the development of Alzheimer’s by highlighting shared neurobiological features such as neuroinflammation, cerebrovascular disease, and neurodegeneration. These factors lower the threshold for Alzheimer’s presentation in the brain.

Diagnosing Depression in Alzheimer’s Patients 

Diagnosing depression in individuals with Alzheimer’s can be challenging since the symptoms often overlap. There is no single test to detect depression in Alzheimer’s disease, and a comprehensive evaluation by a skilled healthcare professional is necessary. 

The assessment typically includes the following steps:

• A thorough review of the individual’s medical history
• Physical and mental examinations
• Interviews with family members

Some individuals with depression in Alzheimer’s may not meet the full criteria for Major Depressive Disorder (MDD) as per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision. Separate guidelines exist for diagnosing depression in individuals with Alzheimer’s. 

To diagnose depression in Alzheimer’s, a person must exhibit a depressed mood or decreased pleasure in usual activities, along with at least two of the following symptoms:

• Withdrawal or social isolation
• Changes in sleep patterns
• Changes in appetite
• Agitation or slowed behavior
• Irritability
• Fatigue or loss of energy
• Feelings of worthlessness, guilt, or excessive guilt
• Recurrent thoughts of death or suicide

How to Treat Depression in Alzheimer’s 

Treating depression in Alzheimer’s often involves a combination of medication, therapy, and adjustments to daily life. Medications commonly prescribed for depression include selective serotonin reuptake inhibitors (SSRIs). Non-pharmacological approaches such as cognitive-behavioral therapy (CBT) can also be beneficial. 

Other non-medical interventions for depression in Alzheimer’s may include:

• Joining support groups
• Establishing a predictable daily routine
• Planning and engaging in enjoyable activities
• Assisting with daily tasks

Furthermore, certain activities can provide comfort and reassurance to individuals with dementia and depression, including:

• Regular physical activity
• One-on-one interactions with others
• Participating in group activities, such as reminiscence and life story activities
• Modifying the environment by reducing clutter and minimizing bright lights and loud noises

If you notice symptoms of depression or any changes in behavior in your loved one with Alzheimer’s, it is essential to consult a healthcare professional.

Frequently Asked Questions

What stage of Alzheimer’s is depression? 

Depression can occur at different stages of Alzheimer’s disease, with a higher incidence observed during the early and middle stages.

How prevalent is depression in Alzheimer’s patients?

The prevalence of depression in individuals with Alzheimer’s is significant, affecting approximately 40 to 50 percent of patients. This prevalence is notably higher than in the general population, where the incidence of depression is around 7 percent.

Are there any similarities between Alzheimer’s disease and Major Depressive Disorder?

Alzheimer’s disease and Major Depressive Disorder share similar symptoms. Both conditions may manifest as apathy, social withdrawal, and impaired thinking. Additionally, the cognitive impairment associated with Alzheimer’s can hinder the expression of emotions typically seen in major depressive disorder.

Impact of Alzheimer’s disease on mental health 

Alzheimer’s disease has a substantial impact on mental health. The progressive neurodegeneration and cognitive decline in Alzheimer’s can give rise to various mental health challenges, including depression, anxiety, agitation, and behavioral changes. Cognitive decline may also affect individuals’ self-awareness of their mental health symptoms.

Professional Nurse Care in Philadelphia, Delaware, and Montgomery Counties

Thinking about the well-being and personal care of your aging loved ones can be daunting. But with NursePartners by your side, you can rely on our team of experienced private certified nursing assistants to provide exceptional support while preserving their dignity and addressing their medical needs. Our team also includes a dementia coach, trainer, and practitioner. NursePartners is proud to be the only company in Pennsylvania to be considered a dementia certified organization by Teepa Snow’s Positive Approach, LLC.

At NursePartners, our caring team assists individuals with personal hygiene, recognizing the importance of maintaining their dignity throughout the process. Moreover, they possess extensive training to deliver comprehensive medical care, ensuring that your loved ones receive the highest level of attention and support they deserve.

To schedule a free consultation, please call 610.323.9800

Sundowning, a term commonly associated with Alzheimer’s disease, refers to the behavioral changes that often occur during the late afternoon and early evening, unrelated to the actual sunset. This phenomenon brings restlessness, agitation, and irritability to individuals with Alzheimer’s, possibly posing a challenge for their caregivers.

At NursePartners, we offer professional care for individuals with Alzheimer’s disease. Our team of trained CarePartners has extensive experience in working with Alzheimer’s patients, offering support and assistance in the comfort of their own homes.

In this article, we’ll explore the concept of sundowning, its impact on individuals with Alzheimer’s, and effective strategies for managing it. By delving into the causes, symptoms, and management strategies of sundowning, this article aims to provide valuable insights and practical guidance to help navigate the complexities of Alzheimer’s care.

What is “Sundowning” and How Does it Affect Those With Alzheimer’s Disease?

“Sundowning” in Alzheimer’s disease refers to the behavioral changes – restlessness, agitation, and irritability – that often accompany the fading of the light. This is usually the time of day when the patient with Alzheimer’s feels edgy. They may feel it is time to change direction and do something new or “head home.”

Sometimes, dusk and the darkness that follows prompts feelings of insecurity. At the same time, this is when caregivers tend to feel worn out and would love to take some time out. Instead, they have to be more vigilant than ever as confusion and distress – often associated with delusions or hallucinations – are synonymous with sundowning.

These behavioral changes or symptoms of sundowning – including wandering, yelling, or pacing – often assail the person with Alzheimer’s well into the night, making the nightly routine difficult as they struggle to fall asleep or stay in their beds. 

This often results in a vicious cycle where both the patient and caregiver are unable to get adequate sleep, and their daytime schedule is thrown out as a result – with sleep deprivation being enough to make even the most easygoing person ratty.

What are the Triggers of Sundowning?

While sundowning usually occurs during the middle and later stages of Alzheimer’s, there are no hard and fast rules. It can take effect at any stage.

Causes of Sundowning

There is no definitive explanation, but several likely reasons have been put forward for sundowning. 

These may include:

• Damage to the brain that causes a disturbance of the Alzheimer’s patient’s biological or body clock, interfering with their sleep-wake cycles.
• A disturbance in hormone levels, which tend to vary during the day.
• Anxiety, depression, and/or boredom.
• The side-effects of prescription medication.
• Not getting enough exposure to sunlight.
• Overstimulation, whether due to a busy or noisy environment.
• Loss of hearing or sight.
• Pain or unmet physical needs such as needing to go to the toilet, fatigue, or hunger. (patients may not be able to express themselves adequately)
• Fewer people may be available later in the day to care for someone with Alzheimer’s, often due to family commitments. 
• Sensitivity to other people’s tiredness causes the patient to feel out of sorts

Identifying which problems might be taking their toll on the patient can help in finding ways to treat the issues. Some may have to do with the time of day, but others are completely unrelated. Sometimes a change of routine during the day may aggravate the person, so it is worth trying to distract them. 

If they seem upset, distraction is an effective strategy that draws the mind away from their stress over whatever it is that seems to be upsetting them, so try diverting their attention to what they love, be it people, foods, pets, or activities.

Strategies for Managing Sundowning

When managing sundowning, it is important to remember that the familiar helps people with dementia feel more at ease. Listening to and reassuring the patient in a calming manner can also help alleviate their frustrations or confusion. This is one of the reasons why it is beneficial to create a care team earlier in the disease progression. Your loved one and the carepartner will already have formed a trusting relationship when it is needed most.

Tips to Take the Edge off Sundowning

• Restrict the patient’s caffeine, nicotine, and sugar intake, particularly after lunch.
• Alcohol can add to the confusion and stress. The teetotal route is probably safest, but drinking any liquids in the latter part of the day could create issues in terms of increased toileting needs at a time when caregivers may be preoccupied with other things, like preparing dinner.
• Ensure the patient gets daily physical exercise, but a full schedule of activities can be tiring, so space out activities and balance the patient’s schedule with rest between periods of activity. Routine and structure are essential.
• Having the person with Alzheimer’s spend time outside in the sun or near a window, where they are exposed to sunlight, can help reset their body clock.
• If they spend time sleeping during the day, try to ensure these short “power naps” don’t take place later in the day, or they can harm the person’s night-time sleep schedule.
• Avoid overstimulation – if different household members come home in the latter half of the day, things might become more hectic and unsettled for the person with Alzheimer’s. Sensory stimulation like the news channel, crime shows, or loud music might overburden them, causing anxiety. There may be several lines of communication going on between family members that are hard to follow, or there could be a change in caretaker which may be challenging to process. You might want to try calming them by turning on a light-hearted show they enjoy or even giving them simple, repetitive tasks, like folding laundry.
• Giving the Alzheimer’s patient time to decompress in the afternoon might help. Ensuring that they are in a quiet space where there are fewer people, noise has been eliminated as much as possible, and clutter is at a minimum is ideal.
• Talking about a memory that has positive associations for them or dimming the lights in the evening so that the contrast between daylight and night is more tangible is also helpful in overcoming the worst effects of sundowning.

Sleep Disturbances and Sundowning

Sleep disorders in those with dementia are common and can worsen over time as the condition progresses.

Sleep Disturbances Associated with Dementia include

• Insomnia – Studies of the brain waves reveal both dreaming and non-dreaming sleep stages are reduced. Some patients tend to be restless; they might wander or will shout out at night, disturbing their caregivers’ sleep.
• REM (rapid eye movement) behavioral sleep disorder, also referred to as dream-enacting behavior or RBD
• Sleep-disordered breathing – sleep apnea impairs memory and executive function and has also been associated with dementia risk. Ask the patient’s doctor about the treatment available for sleep apnea.
• Difficulty keeping awake during the day
• Restless leg syndrome 

If none of the tips below help, and sundowning remains an issue, a medical examination may pinpoint a problem such as medication side effects, sleep apnea, urinary problems, or pain. Keeping a journal of when the sleep problems occur can assist in the diagnosis.

Some doctors might recommend trying sleep medication for a short while if all else fails, but generally, sleep medication does not help a sleep-deprived patient. It’s not usually recommended for those with dementia as it can cause increased confusion and possibly lead to falls.

There are several ways to change the patient’s bedroom that may help them sleep:

• A dim nightlight and comforting security object might be necessary to help the person sleep better.
• Keep clutter to a minimum and ensure the room is quiet. A calm, dark environment is best for sleep. (Dark, lined block-out curtains or an eye mask might be a worthwhile investment.)
• The temperature should ideally fall between 60 and 67 degrees.
• Lavender essential oil in a diffuser can be a soothing scent often used to help people sleep.
• Cholinesterase inhibitors should not be administered before bed. Monitor the side effects of all medications. Sedatives can sometimes have the opposite effect on people with dementia, so having a geriatric psychiatrist on hand to give advice is advisable. Some doctors may recommend supplements like magnesium, melatonin, and Vitamins B, C, and E.

Self-Care for Caregivers Dealing with Sundowning

Guilt is a common problem for anyone caring for an Alzheimer’s patient, but it is important to recognize you are not alone and that the role of a carer is a stressful one. Stress can be problematic for the patient and carer since burnout is a real danger.

Symptoms of stress include anxiety, exhaustion due to sleep deprivation, lack of focus, depression, anger, irritability, and frustration at the patient because they can no longer do what they were once able to. Withdrawal from friends and even health issues can result from stress, so it is vital to seek help.

Professional Nurse Care in Philadelphia, Delaware, and Montgomery Counties

When it comes to ensuring the personal hygiene and well-being of your aging loved ones, the task can often feel challenging. However, with the support of NursePartners, you have access to a team of experienced private nurses dedicated to maintaining their dignity and meeting their medical needs.

At NursePartners, our compassionate CarePartners specialize in assisting individuals with personal hygiene and understanding the importance of preserving their dignity. Additionally, they are highly trained to provide comprehensive medical care, ensuring your loved ones receive the attention and support they deserve. All carepartners are certified nursing assistants receive five hours of dementia training annually.

For more information or to learn more about our services, please call 610.323.9800 for a free consultation today.

After Alzheimer’s disease, vascular dementia is the second most frequently experienced type of dementia. Vascular dementia is the consequence of damaged blood vessels in the brain. This causes a decrease in blood flow to brain tissue, resulting in inadequate oxygen and nutrition supply, which damages brain tissue. Inadequate blood flow harms and can ultimately kill cells in any part of the body, but the risk to the brain is more significant. It differs from other forms of dementia as declines are usually sudden, occurring in a step-like progression versus gradually.

At NursePartners, we understand that dementia can pose many changes that require expertise, personalized care, and compassion. We specialize in helping care for people affected by dementia and offer an option for providing support to individuals as they age in place.

In this article, we’ll cover what you need to know about vascular dementia and what is believed to cause the condition.

What is Vascular Dementia?

Vascular dementia is characterized by alterations in cognitive abilities, which can manifest suddenly after a stroke that obstructs the primary blood vessels in the brain. 

Cognitive challenges may also emerge as mild changes that progressively worsen due to multiple minor strokes or another condition affecting smaller blood vessels, resulting in extensive damage. An increasing number of specialists favor the term “vascular cognitive impairment” (VCI) over “vascular dementia” as it more accurately represents the spectrum of vascular cognitive changes, which can range from mild to severe.

Changes associated with vascular dementia often co-occur with those related to other forms of dementia, such as Alzheimer’s disease and dementia with Lewy bodies. Some studies have discovered that vascular alterations and other brain anomalies may interact to heighten the probability of a dementia diagnosis.

Approximately 5% to 10% of individuals with dementia suffer from vascular dementia exclusively. However, it is more prevalent as a component of mixed dementia. Numerous experts contend that vascular dementia is still underdiagnosed (like Alzheimer’s disease) even though it is acknowledged as a common condition.

What are the Symptoms of Vascular Dementia?

The consequences of vascular issues on cognitive abilities can differ significantly, contingent on the extent of blood vessel damage and the brain region affected. Memory loss may or may not be a prominent symptom, depending on which specific brain areas experience reduced blood flow. 

Vascular damage originating in brain regions responsible for information storage and retrieval might result in memory loss closely resembling Alzheimer’s disease. Symptoms might be most noticeable when they occur shortly after a significant stroke.

Sudden changes in cognition and perception following a stroke may include:

• Disorientation
• Challenges in maintaining focus and concentration
• Decreased capacity to structure thoughts or actions
• Deterioration in the ability to assess a situation, devise an efficient strategy, and communicate with others
• Confusion
• Issues with organization
• Struggles in determining the next course of action
• Memory issues
• Restlessness and agitation
• Unstable walking patterns
• Sudden or recurrent need to urinate or incapacity to control urination
• Apathy or depression

If cognitive and reasoning changes appear closely associated with a stroke, the condition is occasionally called post-stroke dementia.

At times, a distinct pattern of vascular dementia symptoms follows a series of strokes or mini-strokes. Cognitive changes are observed in noticeable downward steps from one’s prior functional level, contrasting with the steady, gradual decline typical of Alzheimer’s disease dementia.

However, vascular dementia can also manifest progressively, similar to Alzheimer’s disease dementia. Moreover, vascular disease and Alzheimer’s disease often coexist. Research indicates that numerous individuals with dementia and signs of brain vascular disease also have Alzheimer’s disease.

Types of Vascular Dementia

There are several types of vascular dementia, all caused by blood supply issues to specific parts of the brain:

Subcortical Vascular Dementia 

This occurs when tiny blood vessels deep within the brain develop thick walls, stiffening and becoming twisted, thereby preventing a regular blood flow. Protein build-up in small blood vessels occurs over time. 

As the patient ages, cerebral amyloid angiopathy, or weakening of the blood vessels can also result. When the vessels cease to operate, the brain cells they supply are starved of nutrients and oxygen and will die. High blood pressure, diabetes, infection, autoimmune disorders, and abnormal aging of blood vessels – known as atherosclerosis – are all factors that can cause the narrowing of the blood vessels.

Stroke-related Dementia or Infarction

An artery in the brain is blocked by a clot that could have formed either in the brain or the heart and may have moved to the brain. A brain hemorrhage may also see high blood pressure weakening a blood vessel and causing it to rupture. There will then be bleeding into the brain, which can cause damage to the brain. This is not as likely as a clot occurring. 

Since health issues that caused the initial stroke may still exist, a further clot could result in more strokes which progressively diminish overall brain function. After a major stroke, symptoms are usually the most apparent. A step downward in thought processes may become noticeable compared to previous levels.

Multi-infarct Dementia 

This occurs after small blockages repeatedly affect blood flow to a specific brain region. As more strokes take place over time, whether apparent or silent, vascular dementia increases. The individual effects of blockages may not be obvious, but in time, the symptoms of impairment become increasingly noticeable.

Mixed Dementia 

This condition occurs when symptoms of both vascular dementia and Alzheimer’s exist. Of those diagnosed with dementia, around 5% to 10% have vascular dementia alone, but generally, it presents with mixed dementia. Experts see vascular dementia as a common problem but say it often goes undiagnosed in the same way Alzheimer’s disease does.

Common Risk Factors for Vascular Dementia 

Aging 

Vascular dementia is not common before age 65. This risk increases as patients approach their 90s.

Previous cardiac events

Brain damage associated with a stroke, mini-stroke (transient ischemic attack), or a heart attack can increase the risk of developing dementia.

Atherosclerosis

High levels of low-density lipoprotein (LDL) and triglyceride are associated with a heightened risk of developing vascular dementia. Deposits of cholesterol and plaques building up in the arteries and narrow blood vessels reduce nutrient-rich blood to the brain.

High blood pressure

Extra strain on blood vessels everywhere in the body increases the risk of vascular problems in the brain.

Homocysteine in the blood

High levels can damage blood vessels and cause blood clots and heart disease.

Diabetes

High glucose levels tend to destroy blood vessels.

Smoking

This habit damages the blood vessels, increasing the risk of atherosclerosis.

Obesity and lack of physical activity

Being overweight is a commonly recognized risk factor for vascular diseases.

Atrial fibrillation (AF)

The condition known as atrial fibrillation is when the heart’s upper chambers beat irregularly and are rapidly out of sync with its lower chambersion. AF can cause blood clots to form in the heart that can travel to the blood vessels in the brain.

Family history of dementia and/or CADASIL

Cerebral autosomal dominant arteriopathy (CADASIL) with subcortical infarcts and leukoencephalopathy is a genetic disorder that often leads to vascular dementia. A parent with the gene for CADASIL can pass it on to a child – the disorder affects blood vessels in the brain’s white matter. Symptoms include depression, migraine headaches, seizures, and severe depression. This tends to begin when the patient is in their 30s.

Differentiating Vascular Dementia from Other Types of Dementia

Vascular dementia and other similar conditions are difficult to distinguish since they share common signs and symptoms. Depending on the individual, the location, and the size of the area impacted by blood flow impairment, vascular dementia symptoms vary. If vascular changes occur in brain regions where information is stored and retrieved, memory loss may present like that associated with Alzheimer’s disease.

If only a tiny zone in a part of the brain that controls memory is affected, the patient might seem forgetful, but this does not necessarily alter their ability to carry out normal functions, whereas if a larger area is affected, they might have difficulty thinking and solving problems. Memory problems might actually be severe enough to reduce their ability to do tasks they previously had no problem completing.

In the case of vascular dementia, problem-solving and the speed at which thinking occurs are usually most affected, whereas memory loss tends to be more commonly associated with Alzheimer’s disease.

How is Vascular Dementia Diagnosed? 

Since vascular dementia does often go unrecognized, cognitive screening by a qualified professional is advised for high-risk candidates, including patients who have suffered a stroke or transient ischemic attack (TIA) or whose heart or blood vessels may be at risk. Depression is also a factor that those with vascular disease should be screened for since it is possible that this, too, may contribute to cognitive impairment.

Early diagnosis is beneficial since treatment can help prevent further deterioration. It is essential that those who commonly experience issues with their thinking and/or memory chat with their doctor, who will usually refer their patients to a specialist for testing.

Neurocognitive testing is used to evaluate skills like problem-solving, reasoning, memory, and judgment. This requires hours of written or computerized tests and can help distinguish vascular dementia from other types of dementia and Alzheimer’s. A Neuropsychiatric evaluation may also be done to eliminate a psychiatric condition that resembles dementia.

Besides a physical exam and medical history, the doctor may decide to run the following imaging tests:

• Computed Tomography (CT) 

This technology uses X-rays and a computer to make detailed axial images or “slices” of the brain.

• Magnetic Resonance Imaging (MRI) 

This brain imaging machine uses large magnets, radio frequencies, and computer technology to create detailed images of the brain, and can indicate whether there has been a recent stroke or other vascular brain alterations, the severity of which might be in keeping with impairments noted during the above mentioned neurocognitive testing. A CT or MRI could reveal evidence of a recent stroke or other brain abnormalities and can also assist in detecting a build-up of fluid in the brain or tumor.

• FDG-PET scan

This brain scan lights up regions of the brain using a tracer.

• Electroencephalogram (EEG) 

Electrical activity is measured in the brain using an EEG.

Reducing the Risk of Vascular Dementia

Improving heart health can help limit the risk of vascular dementia. 

This can be achieved by:

• Giving up smoking 
• Limiting alcohol consumption
• Maintaining a healthy weight
• Doing regular exercise
• Ensuring blood pressure, cholesterol, and blood sugar are kept within recommended limits
• Eating a healthy, low-fat diet 
• Taking prescribed cholesterol-lowering medications (when necessary) to reduce the risk of strokes and heart attacks that could lead to vascular dementia. (The aim is to limit plaque deposits inside the brain’s arteries.)

How is Vascular Dementia Treated?

Working with a doctor to tailor a treatment plan to the patient’s circumstances is ideal. Evidence points to the fact that lifestyle changes, like a healthy diet and exercise and giving up smoking and alcohol, all improve outcomes and can also aid in postponing or preventing further health issues.

Depending on the effects of the stroke, rehabilitation could aid in improving compromised speech, movement, strength, and general living skills for a quicker return to independence. Mobility training, range of motion therapy, motor skill exercises, as well as therapy for communication and cognitive disorders might be employed, among other forms of treatment, to assist the patient. 

Drugs have not been approved by The U.S. Food and Drug Administration (FDA) for the treatment of the symptoms of vascular dementia, but clinical trials indicate that people with vascular dementia might gain some benefit from drugs approved for the treatment of Alzheimer’s symptoms. 

Treatment works mainly on underlying diseases such as hyperlipidemia, hypertension, blood clotting problems, or diabetes mellitus to prevent worsening symptoms of vascular dementia. Medicines, such as cholinesterase inhibitors, are also used to treat dementia symptoms, and antidepressants can assist with depression.

Blood flow to the brain can be improved by surgeries, such as stents, angioplasty, and carotid endarterectomy.

Living with Vascular Dementia

NursePartners’ approach to caring for dementia patients is rooted in Teepa Snow’s GEMS™: Brain Change Model, which categorizes dementia stages by likening them to the unique characteristics of six different gemstones. This approach helps understand and meet the needs of individuals affected by dementia.

Like gemstones, people benefit from different care and settings to shine at full capacity, so rather than focusing on what has been lost, individuals are looked at as precious, unique, and capable. Knowing what has changed and what is still possible, communication and care for the individual become more effective.

The GEMS™ Brain Change Model Classification System Categorizes Stages of Dementia as follows:

Sapphire

In response to the aging process, Sapphires may feel “blue” despite no significant changes in cognition or signs of dementia.

Diamond 

This initial stage of dementia occurs with the first signs that something is “off.” Diamonds are “clear and sharp,” they have established routines and enjoy feeling competent, valued, and in control. This stage sees them being nudged from their comfort zone. Diamonds can function as they have in the past, but they tend to become territorial, and boundaries are blurred.

Emerald

Green emeralds are “on the go.” They may be flawed and a little vague, getting lost in their past. Communication and comprehension can be issues, with emeralds often asking who, what, where, and when questions. These gems are most comfortable when doing familiar tasks. They like to engage and feel helpful so that they have a purpose.

Amber 

Ambers are directed towards sensations and their wants and needs. They tend to live in moments and like to touch, gather and manipulate objects. This exploratory urge can land them in trouble as they have little safety awareness. They have trouble understanding and struggle to express their needs, so activities should be familiar and preferably stimulate the senses.

Ruby 

Rubies experience changes in depth perception, and their fine motor skills are almost non-existent. Sensory changes mean that assistance is often necessary when it comes to using utensils, brushing hair, dressing, and moving about. Hand-under-hand assistance helps rubies feel the “safety and security” they crave.

Pearl 

Layered and hidden in an outwardly unattractive shell, pearls tend towards introversion. There is often an inability to move or respond. With a reduced awareness of the world, pearls enjoy pleasant sounds and voices they are familiar with, and they cling to moments of connection.

A fundamental respect for these stages allows the care partner to better understand their client’s needs. Once an in-home assessment has been carried out, NursePartners creates a care plan to help the individual live in the comfort of their home. Activity lists are devised, and communication techniques are developed to aid patients in the various stages.

Professional Help for Late-Stage Dementia Available in Philadelphia, Montgomery, Chester, and Delaware Counties

At NursePartners, we train all CarePartners in the GEMTM methodology engaging with clients, focusing on what they still can do, and letting go of what they cannot. 

Even at the most advanced stage of dementia, you can find new ways to make the person feel valued and with purpose.

To learn more about how we can engage your loved one with Vascular dementia, Alzheimer’s disease, or another form of dementia, call us at 610-323-9800.

When someone you love is diagnosed with Alzheimer’s disease or another form of dementia, it can be devastating. It is hard to deal with the gradual erosion of their short-term and then long-term memories. When our loved ones no longer recognize us, it can be incredibly heartbreaking. 

They suddenly don’t know your name, face and how you are related.  They may even confuse their children to be their parents. You may remember the lessons your parents taught, the love they shared with your spouse, or the fun times you had together, but they simply don’t recognize you anymore. It’s as if you’ve vanished from their consciousness. Dementia has robbed them of the opportunity to know their grandkids and great-grandkids, to grow old with the love of their life, and to spend quality time with you and other loved ones.

How do you cope when your parent forgets who you are? What can you do when your spouse or friend looks at you as if you were a stranger? 

The team at NursePartners understands that caring for a loved one with dementia can be incredibly difficult, and it usually comes with its fair share of heartache. However, there are still things that you can do. This article will explore how you can help them remember you.

Strategies for Helping a Relative with Dementia Remember

When it comes to Alzheimer’s disease and other forms of dementia, memory loss and confusion are usually the first signs that something has gone awry. You may observe that your loved one forgets recent events while they have zero problems remembering their wedding day, how they got their first job, or when they skipped school to hang out with friends.

Thankfully, all hope isn’t lost. There are some practical ways you can help your loved one to remember their connection to you:

• Introduce them to activities or hobbies they enjoyed when you were in the picture. These may include watching their favorite movies, playing songs they love, gardening, or studying a foreign language. And speaking of other languages, check out this video which may give you a glimmer of hope.
• Hang photos that capture special moments in their lives on the walls throughout the house or in a photo album. Be sure to include ones that show both of you over the years up to the present. In this video, you’ll see just how effective it can be.
• In some instances, a scent can jog the memory. If they loved a perfume or aftershave you used – resume wearing it around them. If they associate the smell of freshly baked cookies with you, then get into baking mode on some days.

It’s amazing what a little trip down memory lane can do! When you talk about memories that you both share, it can help your loved one feel connected to you. It can also help trigger their memories and help them feel more like themselves. Watch this video to see what we mean.

How NursePartners Can Help

Coping with the heartache of a loved one no longer recognizing you can be challenging, but it is possible. Having a team like NursePartners by your side can make things much more manageable. 

For 20 years NursePartners has been supporting families by providing compassionate and experienced home care to their aging loved ones, including those who live with dementia. Our team comprises the best Certified Nursing Assistants (CNAs) who serve in Philadelphia, Montgomery, Chester, and Delaware Counties.

We also use The GEMS™: Brain Change Model designed by world-renowned occupational therapist Teepa Snow to help you to connect and care for your loved ones at every stage of dementia. In 2022 we became the first agency in Pennsylvania and the 13th worldwide to be accredited by Dr. Snow’s Positive Approach to Care® (PAC).Contact us today by calling 610.323.9800 for a free consultation.

Physical exercise is crucial in maintaining a healthy lifestyle and overall well being. Studies have shown that regular physical activity can positively affect brain function and cognitive health, including improved blood flow to the brain and stimulation of brain cell growth.

For patients with dementia, regular exercise is vital for physical fitness and maintaining a sense of purpose, pleasure, and self-confidence. 

At NursePartners, our private nurses are trained in the Teepa Snow Positive Physical Approach to Care™, a specialized approach for caring for individuals with dementia. Our certified nursing assistants provide high-quality care for patients in Philadelphia, Montgomery, Chester, and Delaware Counties.

In this article, we will discuss the effects of physical activity and how it can slow cognitive decline.

What Role Does Physical Activity Play in Reducing the Risk of Dementia?

Dementia is a collection of symptoms related to cognitive decline that can be debilitating. Contrary to popular belief, dementia may not directly result from aging. This means that steps can be taken to decrease the risk of developing dementia. 

New research has shown that a small daily dose of high-intensity exercise may be beneficial. In one study, researchers found that brief periods of physical activity that cause sweating can increase BDNF (brain-derived neurotrophic factor) levels. BDNF is a molecule that plays a role in the formation of new neural connections and the survival of brain cells. These findings have piqued the interest of researchers who hope to utilize this protein to improve brain health.

Can Physical Exercise Reduce the Risk of Developing Dementia?

According to the Alzheimer’s Society in the UK, which has analyzed the results of 11 different studies, regular aerobic exercise is one of the most significant lifestyle changes a person can make to reduce the risks of being diagnosed with dementia. (The risk of dementia is reduced by around 30%.)

Even those in their eighties who do physical exercise are less likely to develop dementia. Moreover, a literature review has revealed that studies focused on physical activity and the link with brain function showed less brain shrinkage in older people. It is suggested a cognitive decline in later life is less likely for those who participate in aerobic exercise.

Does Physical Exercise Have Benefits for People With Dementia?

Where patients with dementia are concerned, regular exercise is vital to maintaining a healthy lifestyle, a sense of purpose, pleasure, and confidence. Socializing, which is often part and parcel of physical activity, is beneficial in that it helps reduce stress and depression, which are commonly experienced by those with dementia.

Improving communication and social skills through exercise improves the patient’s self-esteem and frame of mind and encourages further interaction, reduced isolation, and a sense of wellbeing. 

Physical activity improves sleep, and even in dementia patients, it has proven essential for enhancing memory, slowing mental decline, and maintaining motor skills. Fitter, more flexible patients with dementia are generally able to dress, clean, cook, and get about without too much assistance, making life less difficult for the individual and their carers.

In addition, physical exercise helps caregivers distract and deal with the patient’s more challenging behavior. There is usually less evidence of aggression and wandering.

Aside from the cognitive benefits, exercise can also be beneficial to dementia patients’ overall physical wellbeing:

The benefits of regular physical activity may include:

• A lowered risk of type-2 diabetes, stroke, and cancers, such as breast and colon cancer.
• Better heart and blood vessel health which can reduce the risk of high blood pressure and heart disease.
• Better bone density profile for those who exercise regularly. This means that they’re less likely to suffer from weak, porous bones that might be prone to fracturing, possibly causing disablement.
• Helps ease constipation 
• Improved muscle strength and balance, which can help prevent falls

What is Aerobic Exercise?

Different studies have used varying criteria to determine what constitutes physical activity. They generally refer to a sustained 30-60 minutes of aerobic exercise—the kind of brisk exercise that increases the heart rate and makes you breathe more deeply—being done five days a week over at least a year. 

This depends on the individual being well, not experiencing pain, or showing signs of over-exercising.

Don’t worry about how you’ll ever manage ballet or kickboxing lessons after years of sedentary living. The exercise criteria of these studies do not refer only to running or playing a sport but also include less taxing activities such as brisk walking, gardening, and housework.

The daily quota of 30-60 minutes of exercise can be split into 10 or 15-minute sessions of different activities done throughout the day.

Types of Exercise

Although there are numerous activities you can take on, this list comprises a few examples of exercises that virtually anyone can participate in during the early and middle stages of dementia.

• Walking does not require specialized equipment; it can be done wherever you are, and the distance, time, and gradient can be adapted to suit any ability. Some organizations arrange group walks, which can also become an enjoyable social activity.
• Seated exercises can be conducted at home or in a group setting. These exercises are less strenuous than exercises done while standing up and are worthwhile for those who sometimes experience dizziness when moving into an upright position. Repetitions can be slowly increased.

Examples of what you can do while seated include: marching, raising heels and toes, bicycling the legs, raising and lowering, or circling the arms, raising opposite arms and legs, and turning the upper body from side to side. You can even dance in a seated position!

• Dance forms are many and varied, from ballroom to line dancing. This is a social activity and may not seem like exercise, making it a good option as you will be more likely to enjoy dancing than weight training. It reduces stress and builds agility, flexibility, and strength.
• Gardening is another healthy and enjoyable activity that allows the individual to spend time outdoors in the fresh air. Gardening is recommended for people at any stage of dementia. Tasks may be as simple as weeding, pruning, gathering up piles of cuttings, and depositing them in the barrow or compost heap. Alternatively, mowing and raking are ideal for fitter individuals.
• Swimming is a good cardio-vascular activity and improves balance. For obvious reasons, it should be conducted under supervision, but water is a soothing medium and the sensation of being immersed in water has a calming effect.
• Tai chi is a gentle combination of physical movement and meditation which is particularly useful in improving balance, agility, and stability.

What about Exercise for those with Advanced Dementia?

Remaining active reduces the need for constant supervision and adaptations such as stair-lifts. There is no one-size-fits-all to the question of how much activity is needed in advanced dementia since each individual is different. A doctor or physiotherapist can make suggestions on appropriate exercise.

As dementia progresses, activities will need to take into account abilities that have been lost, and activities should not involve new learning. Do the activities at times that suit the patient. If seeing family, do this when they are more receptive. 

If they are restless in the late afternoon, that may be the perfect time to take a walk. Ensure they wear some other form of identification in case they wander off and get lost.

Let them practice entrenched skills at their own pace. These might include watering gardens and sweeping or buttering bread—tasks that make them feel included and useful. 

Patients may have problems with visual perception and coordination. Too much stimulation, crowds, movement, or noise will likely overwhelm the patient, while positive associations with, say, music and dancing, animals, or young children can help them engage. Good lighting, uncluttered surfaces, and simple instructions focusing on one manageable step at a time are ideal.

Ensure they are hydrated and that they wear sunscreen and a hat outdoors. If they become dizzy, faint, or experience pain, consult a doctor.

To find out what exercises might be appropriate in the later stages of dementia, click here.

Nurse Care in Philadelphia, Montgomery, and Delaware Counties

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Private nurses are well-trained to offer exceptional nurse care and extend warmth and love to your aging and ailing relatives. They are well-equipped to help your loved ones with their medical and day-to-day needs. 

At NursePartners our private nurses are screened thoroughly for compassion and competence. Contact us today by calling 610-323-9800 for a free consultation.