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Dementia Aware  

Reduce your dementia risk

What you need to know about reducing dementia risk factors

The world has experienced many epidemics, but most were the result of infectious disease — Black Death,  Spanish flu  — they came and then went away.

The dementia epidemic is not an infectious disease, and we cannot afford to sit by and wait for it to disappear, because it will not. We must fight it, and the only way to stop an epidemic is prevention (Korczyn & Vakhapova, 2007).

There is no cure for dementia, no one single cause of dementia, and no specific diagnostic test to determine who is at risk of dementia.

Given this information, our goal is the prevention of dementia. However, a delay in the onset of dementia would also be an effective preventative strategy, since research has indicated that delaying the onset of dementia by just five years would half its prevalence. 

Dementia Risk Factors

Non-Modifiable Risk Factors:

  • Age
  • Gender
  • Genetics
  • Learning disabilities (Down’s syndrome)

Potentially Modifiable Risk Factors:

  • Alcohol: whilst low to moderate alcohol consumption is associated with lower risks of coronary artery disease and ischemic stroke, alcohol intake exceeding current recommended limits increases the risk of dementia — e.g. Wernicke’s Korsakoff
  • Head Injuries: there is increasing evidence of a link between brain injury and dementia. Recent studies show an increased incidence of dementia, notably Chronic Traumatic Encephalopathy (CTE) in people who sustained multiple concussions
  • Physical Inactivity: lack of physical activity has clearly been shown to be a risk factor for cardiovascular disease, and a potential risk for high BP, obesity, and type 2 diabetes
  • Smoking: is a risk factor for atherosclerosis and stroke both of which can result in vascular dementia
  • Mid-life obesity:  an elevated body mass index (BMI) in middle age appears to be an important risk factor for dementia, type 2 diabetes, stroke and heart disease. Therefore, the maintenance of a normal weight is a worthwhile intervention in the prevention of dementia (Gorospe & Dave, 2007)
  • Depression: people with depression have two times the risk of dementia (Barnes & Yaff, 2011)
  • Mid-life hypertension: hypertension is a well recognized risk factor for stroke and multi infarct dementia and is now a suspected risk factor in Alzheimer’s disease
  • Diabetes: hyperglycemia can have a direct toxic effect on neurons causing oxidative stress and accumulation of advanced glycation end products which affect brain tissues. Diabetes may also lead to dementia through ischemic cerebrovascular disease, and can develop in a cluster of vascular risk factors which can constitute metabolic syndrome which is already known to be a predictor of stroke (Yaffe, 2004)
  • Hyper-cholestrolemia: mid-life high cholesterol appears to be a risk factor for dementia, and atherosclerosis is believed to be involved in the development of dementia, notably vascular dementia and Alzheimer’s disease
  • Cognitive inactivity: based on the concept of use it or lose it

The first World Health Organization Ministerial Conference on Global Action Against Dementia (2015), identified the following strategies that can potentially reduce the risk of developing dementia and/or delay the onset of dementia:

Risk Reduction Strategies:

  • Keep physically activity: exercise for 30 minutes, 4-5 times per week.
  • Lose weight: follow a healthy weight loss plan and exercise program as per your doctor
  • Stop smoking: hypnosis, acupuncture, smoking cessation patches
  • Brain training: work out your brain every day: read, computer games, crossword puzzles, take a course, start a new activity. Several observational studies have indicated that people who do cognitive stimulation activities may have a lower risk of cognitive decline and dementia. Furthermore, studies show that regular brain exercises can improve some aspects of memory and thinking particularly for middle age and older people
  • Manage diabetes: follow diet plan, maintain weight, exercise, take medications/insulin as prescribed, blood tests as ordered, learn to recognize the early signs of low/high blood sugar, and most importantly, schedule regular follow up visits with your Doctor
  • Management of midlife hypertension: limit salt intake, take prescribed medications, stress management techniques, healthy diet, exercise, regular BP checks
  • Healthy eating pattern: reduce saturated fat, limit salt and sugar e.g. Mediterranean diet
  • Management of cholesterol: take medications as prescribed, exercise, reduce fat intake
  • Limit alcohol intake: as per Canadian guidelines, men should have a maximum of 15 drinks per week, whilst women should have a maximum of 10 drinks per week
  • Keep socially engaged: meet with friends, go to social events, volunteer
  • Protect your brain: wear protective helmets when playing contact sports or an activity that may cause a head injury e.g. cycling, skiing, and follow concussion protocol if injured

Given that all these risk factors are largely correlated, it may be that living a healthy, socially engaged life is the best way to prevent dementia, and that one single factor is insufficient to prevent dementia.

Given that one in three babies born today will develop dementia in their lifetime (Lewis, 2015), it is never too young to develop good habits, but mid-life (age 40-64) is a good time to start making healthy choices if you are not already doing so.  



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Dementia myths exposed

Dementia Aware: what you need to know about dementia myths and misconceptions

Advances in health care and technology has enhanced longevity, and people are healthier and living longer than ever before.

This has resulted in an increased prevalence of dementia (Alzheimer’s Disease International & WHO, 2012).

Dementia is highly stigmatized and universally feared. It is often perceived as a normal part of ageing and that people with dementia do not live a normal, happy life and will become unpredictable, aggressive and/or wander.

These misconceptions have resulted in many people not seeking diagnosis and treatment, and those already diagnosed with dementia feeling shame, fear and embarrassment, becoming socially isolated and reluctant to ask for help.

By promoting a better understanding of dementia, raising public awareness and engagement, including respect for the human rights of people with dementia, and dispelling these myths and misconceptions, we can reduce stigma and discrimination and foster greater participation, social inclusion and integration for all people with dementia.

Dementia is a normal part of ageing: False

While the number of people with dementia is growing as the world population ages, dementia is not a normal part of the ageing process.

Certainly, the prevalence of dementia increases with age, for those over 80 years old, the prevalence is higher than 20 per cent and it continues to climb to over 30 per cent in those aged about 95 years old.

However, dementia can occur in people as young as 30 years old, and many people with Down’s Syndrome develop dementia at a much younger age (approximately 55 years old).

Recently, there has also been an increased incidence of men (often professional athletes) aged 40-75 years old being diagnosed with probable CTE (chronic traumatic encephalopathy), and most people with early onset Alzheimer’s disease usually develop symptoms of the disease in their 40s and 50s.

A recent study in the U.K. identified 43,000 people under the age of 65 are living with Young Onset Dementia (YOD).

Dementia and Alzheimer’s disease are the same: False

Dementia is a syndrome due to disease of the brain, usually chronic, characterized by a progressive, global deterioration in intellect including memory, learning, orientation, language, comprehension and judgment (WHO 2016).

There are over 100 types of dementia of which Alzheimer’s disease is the most common. Other types of dementia include vascular dementia, Lewy Body dementia and frontotemporal dementia.

Because each dementia affects the brain in different ways, they produce different symptoms; however, the three most common symptoms all dementias share include: loss of memory, mood changes and communication problems.

All people with dementia will become agitated/aggressive: False

Dementia affects each person differently and each person will react to events and circumstances in his/her own way. While most people with dementia will experience some behavioural changes e.g. overreaction, hoarding, repetition, disorientation, sundowning, not everyone will become agitated and/or aggressive.

Most often, behaviours are a result of increased confusion and/or anxiety and fear due to changes in the brain, as well as frustration from a decline in the person’s ability to process information and communicate his/her needs.

Behaviour is usually an expression of an unmet need e.g. thirsty, in pain, fatigued, and it is important to try and understand why the person with dementia is behaving in a way.

All people with dementia will wander and get lost: False

While wandering is quite common amongst people with dementia, not every person with dementia wanders. Wandering can be very worrying for those concerned for the person’s safety and well being.

It is important to remember that people with dementia who are wheelchair dependent can also wander and become lost. Like behaviour, it is important to understand there is always a reason for the person wandering, including:

  • Boredom
  • Confusing night with day
  • Discomfort or pain
  • A response to a dream believing that it has happened in real life
  • A change in the environment
  • Searching for something or someone from the past e.g. going home, going to work
  • People who have been used to walking long distances, or used to walk to work
  • Excess energy
  • Forget where he/she is going and why e.g. the store and then unable to find way home

People with dementia can’t function, can’t have a quality life and can’t enjoy activities: False

People with dementia can function, can have quality of life and can enjoy activities; in fact, many people live meaningful, happy, fulfilled lives. Quality of life is possible by making some lifestyle choices:

  • Eating right
  • Keeping the brain stimulated
  • Exercising (overwhelming research suggests that any type of aerobic exercise has a significant and beneficial impact on the brain and the body)
  • Participating in development of dementia policies/programs
  • A willingness to accept support/help
  • Continuing to pursue activities that give joy
  • Maintaining a social connection with the community

As the dementia progresses and more help is required, people with dementia can still participate in activities (modified to meet one’s ability and need), they can still feel joy, laugh, smile, give and receive love, they can still be in the moment and share that moment with others.



Dementia: Good news!

What you need to know about the national dementia strategy

Canadians will remember June 22 as a milestone in the fight to combat dementia.

On Thursday, just before they recessed for the summers, MPs passed Bill C-233, a national strategy for Alzheimer's disease and other dementias.

Canada is the 30th country to develop a national strategy to address the overwhelming scale, impact and cost of dementia.

"For the more than half a million Canadians living with dementia and their families, this is an important milestone," says Pauline Tardif, CEO of the Alzheimer Society of Canada.

"A national strategy enables a coordinated approach to tackling dementia in Canada that will impact the lives of those affected in tangible ways."

As our population ages, the number of people with dementia will climb rapidly. This has the potential to overwhelm the health care system which is already ill equipped to respond to the challenges of dementia. Research is necessary, but we must ask ourselves this question:

  • What if we have no cure for Alzheimer’s disease in the next 10-15 years? What happens then?

Dementia needs to be recognized as a provincial and federal health care priority now.

We need a more ambitious public approach to dementia, and municipalities, regional districts, community organizations and the business communities need to work together to provide a range of solutions to deliver improved quality of life for people with dementia, and their caregivers.

Without a medical breakthrough, dementia will become the most significant social and economic challenge of the 21st century.

For over a decade, numerous groups including the Alzheimer Society of Canada, the Canadian Medical Association, dementia care advocates, people with dementia, caregivers and families across Canada have been calling on the federal government to create and implement a National Dementia Strategy in response to the dementia crisis.

To help you understand what the federal government’s response has been to the dementia crisis so far, here is a quick synopsis:

  • In 2014, the federal government launched the National Dementia Research and Prevention Plan and invested $183 million in dementia research over a 5-year period (2014-2019)
  • In November 2016, the Senate Committee on Social Affairs, Science andTechnology submitted a detailed report to the federal government on the issue of dementia in Canadian society. The report, “Dementia in Canada:  A National Strategy for Dementia-friendly Communities,” called for province wide priorities for improving dementia care throughout the healthcare system, and made 29 recommendations aimed to achieve quality care and support for people with dementia from prevention to end of life care. The report received overwhelming support
  • On Jan.30, 2017, the Senate Committee hosted a panel discussion on Parliament Hill to petition the federal government to create AND implement a National Dementia Strategy now.

Then, the  announcement Thursday, which couldn’t have been more timely with the release of the World Alzheimer Report 2016, estimating that by 2020, the number of people with dementia in Canada would increase to 620,000 (compared to 556,000 in 2015) and by 2030, that number is expected to rise to 886,000.

What does a national strategy mean for people with dementia?

It enables a coordinated approach to tackling dementia in Canada that will impact the lives of those affected in tangible ways (Pauline Tardif, CEO of Alzheimer Society of Canada, 2017). It will also begin to address the overwhelming scale, impact and cost of dementia.

To develop and implement this strategy, the federal government will need to work jointly with the provinces and territories, as well as health stakeholders, other organizations, and the Alzheimer Society of Canada. 

Most importantly, to be a true dementia strategy, the Government should establish a consultation process with people living with dementia, the caregivers and families.

The benefits of a National Dementia Strategy include:

  • Inclusion of people with dementia in developing/implementing strategy
  • Investment in dementia research: early detection and prevention
  • Expansion and improvement in quality of care and quality of life for people with dementia, across the continuum of care, including primary care, community care and palliative care
  • Improve the care, education and supports provided to caregivers and families
  • Expansion of standardized dementia care education and development of dementia care skills for all health care professionals
  • Development of resources to address stigma and public awareness 




Living well with dementia

What people with dementia need to know to live well with dementia

Dementia is not a life sentence; it is just another detour in your life’s journey, and you can continue to live a full and happy life.

As the dementia changes, you will have to compensate for loss, enhance your abilities, develop talents and create a new future invested with hope and meaning. It will take a little work, a lot of patience and a willingness to accept support, but you can live a meaningful, purposeful life.

Do not allow your mind to imprison you; do not surrender to the dementia. We live our life through stories, and we all have a story, so why not consider dementia as an unfolding narrative of a new chapter of your life story.

Researchers and people with dementia both agree that it is important to continue to look after your health, your mind, your body and spirit, and to stay engaged after a diagnosis of dementia.

Living Well Care Plan:

Health

Despite receiving a diagnosis of dementia, it is still important to look after your health.

The healthier you are, the less likelihood of visits to the hospital, of developing new medical conditions, of experiencing delirium.

To keep healthy, you should:

  • Eat a healthy diet – follow the Canada Food Guide or recommendations of doctor/dietician
  • See doctor regularly
  • Take your medications. Discuss any vitamin supplements or herbal preparations with your doctor
  • If you have a pre-existing medical condition: diabetes, high blood pressure, follow your healthcare plan
  • Stay hydrated, drinking 6-8 glasses of water daily helps prevent constipation, bladder infections, decreases risk of delirium (3)

Mind

Keeping the mind and body active and eating a healthy diet helps you feel good, think more clearly and may even slow down changes in the brain.

Activities that stimulate the brain include reading, talking with others, singing, puzzles, playing cards. If you are no longer able to read, try books on tape.

Body

Physical activity not only keeps you fit, but also helps you feel less stressed and more energetic. If you do not exercise regularly or are trying a new activity, remember to talk to your doctor first.

Also, if you are unable to do an activity you previously enjoyed, such as golf, do not despair, with some creative planning, any activity can be changed to suit your strength and abilities.

For example, if you are unable to play a full round of golf, try nine holes, or mini-golf. If you are wheelchair dependent, try bocce ball or tai chi.

Staying Engaged

Continuing to participate in day-to-day activities, visiting with family/friends, socializing and doing activities you enjoy can instill feelings of confidence and self worth, of belonging and being a part of your community.

Being engaged also helps to prevent further decline, distract from sad/negative feelings, and get pleasure and meaning in life. 

Emotional Care

Many people with dementia say that they have chosen to not worry about their future, but rather strive to appreciate and enjoy what they have today (Downs & Bowers, 2008).

There will be good days and bad days, that’s life. Try to keep a positive outlook, smile, laugh, share stories, join a support group, attend church (4)

Daily Life

Maintaining a routine is a valuable strategy to reduce the complexity of every day life. Familiar plans and activities allow people with dementia to rely on their embodied skills, a kind of automatic pilot that requires less explicit effort (Nygard & Ohman, 2002).

Slow down and allow yourself time to complete a task, make lists, accept offers of help. Remember, you don’t need to ‘do it all’.

Support

Support can be from a healthcare agency, a friend, Alzheimer Society of B.C., a homecare service.

At first, you may not need any help, but over time, you may find you tire more easily, take longer to do a task or have difficulty completing a task. Accepting support is not a sign of weakness or laziness; the willingness to accept help means that you are taking control of your life.

Also, by accepting support, you will have more energy and time to do the things you enjoy Support can be accepting a ride to the store, your home cleaned, lawn mowed, or help with bathing or medications.

These small acts will help you remain independent at home and to spend more time with those you love.

Planning

Take control of your life. Make legal, healthcare and financial decisions, talk to your loved ones about your wishes. Keep a journal, a video recording, a memory book, write letters to your loved ones (1,2).

  • Make a will
  • Power of attorney
  • Representation agreement
  • Advance directives

Environment

Living at home requires a balance between minimizing risk and maximizing independence. Many people with dementia have found assistive technology to be helpful, and there are devices that provide prompts and safeguards which can help you be independent and safe in your own home.

Assistive devices include:

  • medication reminders
  • cooker monitoring, smoke and CO2 detectors
  • speaking clocks, electronic calendars, preprogram telephones
  • raised toilet seat, hand held shower, bath seat
  • Medical alert system, fall detection alert: www.medicalert.ca/safelyhome.com; www.lifeline.ca

For more information, see Dementia Aware articles:

  • Financial, legal, health care matters
  • Dementia to-do list
  • Dementia and delirium
  • Dementia and emotion


More Dementia Aware articles

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About the Author

Tracey Maxfield, RN, BSN, GNC(c), DDS, is a dementia educator, consultant and advocate with over 35 years experience working with dementia populations in the U.K. and Canada.

She has worked in a variety of heath-care settings: acute care, palliative care, community care, residential care, physicians offices and community health centres..

Maxfield is a Central Okanagan Purple Angel Dementia Ambassador.

She can be reached at [email protected].



The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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