tag:theconversation.com,2011:/us/topics/dementia-treatment-5969/articlesDementia treatment – The Conversation2023-07-06T23:49:35Ztag:theconversation.com,2011:article/2080052023-07-06T23:49:35Z2023-07-06T23:49:35ZWhat is ‘sundowning’ and why does it happen to many people with dementia?<figure><img src="https://images.theconversation.com/files/532536/original/file-20230619-134757-tunqcw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4992%2C2612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The term “<a href="https://www.nia.nih.gov/health/tips-coping-sundowning#:%7E:text=Late%20afternoon%20and%20early%20evening,tired%20caregivers%20need%20a%20break.">sundowning</a>” is sometimes used to describe a tendency for people living with dementia to become more confused in the late afternoon and into the night. </p>
<p>At the outset, I should emphasise the term “sundowning” is overly simplistic, as it’s a shorthand term that can encompass a vast number of behaviours in many different contexts. When assessing changed behaviours in dementia, it’s always better to hear a full and accurate description of what the person is actually doing at these times, rather than to just accept that “they’re sundowning.”</p>
<p>This set of behaviours commonly described as “sundowning” often includes (but is not limited to) confusion, anxiety, agitation, pacing and “shadowing” others. It may look different depending on the stage of dementia, the person’s personality and past behaviour patterns, and the presence of specific triggers.</p>
<p>Why then, do such altered behaviours tend to happen at specific times of the day? And what should you do when it happens to your loved one?</p>
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Read more:
<a href="https://theconversation.com/when-someone-living-with-dementia-is-distressed-or-violent-de-escalation-is-vital-205988">When someone living with dementia is distressed or violent, 'de-escalation' is vital</a>
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<a href="https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People living with dementia sometimes become more confused in the late afternoon and into the night.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Fading light</h2>
<p>We all interpret the world via the information that enters our brains through our five senses. Chief among these are sight and sound. </p>
<p>Imagine the difficulty you’d have if asked to perform a complex task while in a darkened room.</p>
<p>People living with dementia are just as dependent on sensory input to make sense of and correctly interpret their environment. </p>
<p>As <a href="https://www.medicalnewstoday.com/articles/314685#causes">light fades</a> towards the end of the day, so too does the amount of sensory input available to help a dementia patient interpret the world.</p>
<p>The <a href="https://www.medicalnewstoday.com/articles/314685#causes">impact</a> of this on a brain struggling to integrate sensory information at the best of times can be significant, resulting in increased confusion and unexpected behaviours.</p>
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<h2>Cognitive exhaustion</h2>
<p>We have all heard it said that we only use a fraction our brain power, and it is true we all have far more brain power than we typically require for most of the day’s mundane tasks. </p>
<p>This “cognitive reserve” can be brought to bear when we are faced with complex or stressful tasks that require more mental effort. But what if you just don’t have much cognitive reserve?</p>
<p>The changes that ultimately lead to symptoms of Alzheimer’s disease can begin to develop for as many as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486209/">30 years</a> before the onset of symptoms.</p>
<p>During that time, in simple terms, the condition eats away at our cognitive reserve.</p>
<p>It is only when the damage done is so significant our brains can no longer compensate for it that we develop the first symptoms of Alzheimer’s disease and other dementias.</p>
<p>So by the time someone first presents with very early dementia symptoms, a lot of damage has already been done. Cognitive reserve has been lost, and the symptoms of memory loss finally become apparent.</p>
<p>As a result, people living with dementia are required to exert far more mental effort during the course of a routine day than most of us.</p>
<p>We have all felt cognitively exhausted, run down and perhaps somewhat irritable after a long day doing a difficult task that has consumed an extreme amount of mental effort and concentration. </p>
<p>Those living with dementia are required to exert similar amounts of mental effort just to get through their daytime routine.</p>
<p>So is it any surprise that after several hours of concerted mental effort just to get by (often in an unfamiliar place), people tend to get <a href="https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning">cognitively exhausted</a>?</p>
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<a href="https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People living with dementia exert a lot of mental effort just to get through their daytime routine.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/elderly-man-sitting-on-bed-8860212/">Pexels/cottonbro studio</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>What should I do if it happens to my loved one?</h2>
<p>The homes of people living with dementia should be <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/gps.5712">well-lit</a> in the late afternoons and evenings when the sun is going down to help the person with dementia integrate and interpret sensory input.</p>
<p>A <a href="https://www.nia.nih.gov/health/tips-coping-sundowning">short nap</a> after lunch may help alleviate cognitive fatigue towards the end of the day. It gives the brain, and along with it a person’s resilience, an opportunity to “recharge”.</p>
<p>However, there is no substitute for a fuller assessment of the other causes that might contribute to altered behaviour. </p>
<p><a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/sundowning#:%7E:text=The%20reasons%20why%20sundowning%20happens,to%20sunlight%20during%20the%20day">Unmet needs</a> such as hunger or thirst, the presence of pain, depression, boredom or loneliness can all contribute, as can stimulants such as caffeine or sugar being given too late in the day.</p>
<p>The behaviours too often described by the overly simplistic term “sundowning” are complex and their causes are often highly individual and interrelated. As is often the case in medicine, a particular set of symptoms is often best managed by better understanding the root causes.</p>
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Read more:
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<p class="fine-print"><em><span>Steve Macfarlane is affiliated with HammondCare and the RANZCP. </span></em></p>People living with dementia often become more confused in the late afternoon and into the night. Why, and what can we do about it?Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1582562021-05-09T10:35:52Z2021-05-09T10:35:52ZHow communities can fight the stigma that isolates people with dementia<figure><img src="https://images.theconversation.com/files/398873/original/file-20210505-15-1nb1k52.jpg?ixlib=rb-1.1.0&rect=2471%2C0%2C4953%2C4271&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Isolation and segregation create and reinforce another kind of barrier to those with dementia: stigma.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Keeping people with dementia separated and secured is a common practice, based on the reasonable idea of safety first for the vulnerable. During this pandemic, however, contact with those in care homes, many of whom have dementia, was <a href="https://www.youtube.com/watch?v=CRoDCNMXcJA">cut off at great cost to residents’ mental and physical health</a>.</p>
<p>Isolation and segregation create and reinforce another kind of barrier to those with dementia: <a href="https://theconversation.com/covid-19-stigma-and-the-scandalous-neglect-of-people-living-with-dementia-140817">that of stigma</a>, which can rob people of quality of life, personal agency and the dignity of risk the rest of the population expects as a birthright. </p>
<p>Research shows that experiencing stigma — defined as a mark of disgrace and humiliation — adds to feelings of social isolation, depression and <a href="https://doi.org/10.1177/1471301211421066">abandonment</a> among those with dementia. This stigma <a href="https://www.alz.co.uk/research/world-report-2012">exists worldwide</a>, and trying to educate people at remove from those with dementia has not proved effective at reducing it. </p>
<p>One approach that might help diminish stigma is to build communities that are more welcoming and accepting to people with dementia.</p>
<h2>Segregation is not the answer</h2>
<p>The shame and fear associated with this stigma is so stubborn that people experiencing dementia still act on it, <a href="https://ilcuk.org.uk/wp-content/uploads/2018/10/Compendium-Dementia.pdf">to their own detriment</a>. They wait too long to be diagnosed, losing valuable time, treatment options and social support. Once labelled, they find that old friends, people in their community and even family members drift away. Caregivers also become more isolated. </p>
<p>Segregation for the sake of safety is not the answer to treating people with dementia — now numbering <a href="https://www.who.int/news-room/fact-sheets/detail/dementia">50 million worldwide</a> — as fully human.</p>
<p>During my years as a certified therapeutic recreation specialist in North American care homes, I saw how segregation led to stigma and blocked help for people with dementia. This is why now, as a professor in therapeutic recreation, I am engaging in research that focuses on a growing “<a href="https://www.alz.co.uk/news/dementia-friendly-communities-key-principles-and-global-developments.">dementia-friendly” movement</a>. </p>
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<img alt="A concerned older man and a distraught older woman" src="https://images.theconversation.com/files/398874/original/file-20210505-17-xbwq3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398874/original/file-20210505-17-xbwq3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398874/original/file-20210505-17-xbwq3s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398874/original/file-20210505-17-xbwq3s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398874/original/file-20210505-17-xbwq3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398874/original/file-20210505-17-xbwq3s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398874/original/file-20210505-17-xbwq3s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The stigma associated with dementia is so deep that it may prevent people with early dementia from seeking help.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>This movement seeks to develop support systems for people with memory loss, recognizing them as equals, celebrating their contributions and enabling them to live with purpose inside welcoming communities.</p>
<p>I teach my students that personal relationships are at the core of any therapy that aims to help individuals thrive as they age. To that end, I am exploring the possibilities for <a href="https://doi.org/10.1146/annurev.psych.49.1.65">contact theory</a>, a promising, practical approach to combatting prejudice, to see if it can be applied to the stigma of dementia.</p>
<p>Contact theory posits that <a href="https://doi.org/10.1097/nmd.0b013e31829480df">personal contact enables and supports relationships</a> between majority and minority group members, and is <a href="https://doi.org/10.1016/s0140-6736(15)00298-6">better at reducing stigma</a> than interventions that focus on education. Researchers have found that developing such relationships can reduce prejudice based on <a href="https://doi.org/10.1037/0022-3514.90.5.751">mental illness, race, gender and age</a>.</p>
<p>The ultimate goal, if contact theory works as it has elsewhere, is to extend the concept of age-friendly societies, as described by the <a href="https://www.who.int/ageing/projects/age-friendly-cities-communities/en/">World Health Organization (WHO)</a>, to include dementia-friendly societies. </p>
<h2>‘Dementia-friendly’ communities</h2>
<p>The WHO defines an age-friendly city as one that “encourages active aging by optimizing opportunities for health, participation and security in order to enhance quality of life as people age.” However, a specific call to address stigma around aging and dementia — a double-whammy of discrimination — is not explicit in the WHO’s approach.</p>
<p>Around the world, the WHO promotes and evaluates such things as walking programs, accessible transit and recreation facilities, housing options, health services and many senior-friendly activities to ease the potential hardships of aging and to promote inclusion. Access to these kinds of services should not disappear when memory does. </p>
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<img alt="An older woman playing cards with a younger woman" src="https://images.theconversation.com/files/398875/original/file-20210505-19-1oqsbyr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398875/original/file-20210505-19-1oqsbyr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398875/original/file-20210505-19-1oqsbyr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398875/original/file-20210505-19-1oqsbyr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398875/original/file-20210505-19-1oqsbyr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398875/original/file-20210505-19-1oqsbyr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398875/original/file-20210505-19-1oqsbyr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">University students living in long-term care facilities and spending time each week with their older neighbours in exchange for rent is an example of integrating and supporting people with dementia.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>A dementia-friendly community would adapt physical and social aspects of an environment to ensure well-being and continuity of life for everyone. This would explicitly address stigma within the WHO’s current framework. Related activities could help move communities worldwide from segregation to tolerance to true inclusion of all people as we age.</p>
<p>This is where the tenets of contact theory may prove beneficial. Recent initiatives show that finding ways to bring people with and without dementia together in support of the same goal can counteract the stigma of dementia. This type of activity helps move the “dementia friendly” concept from rhetoric to reality. </p>
<p>Examples include: </p>
<ul>
<li><a href="https://www.bloomberg.com/news/articles/2015-10-02/a-nursing-home-that-s-also-a-college-dorm">University students living in seniors’ housing</a> and spending time each week with their older neighbours in exchange for rent </li>
<li><a href="https://www.uvic.ca/news/topics/2018+choir-dementia-voices-motion+news">Choirs that bring people with and without dementia</a> together in song </li>
<li>Intergenerational programs that enable <a href="https://www.youtube.com/watch?v=-GH_LjHbEgA">school-aged children to develop relationships with long-term care residents</a> </li>
</ul>
<p>These initiatives result in people with dementia feeling included, valued and respected, and the creation of meaningful relationships for all.</p>
<p>Contact theory is not a perfect solution, and widening the world of people with dementia is not risk-free. For example, there is a risk of people with dementia <a href="https://www.uea.ac.uk/news/-/article/why-people-with-dementia-go-missing">getting lost or going missing</a>. </p>
<p>Despite these limitations, there is reason to feel optimistic that aging-friendly programs can be applied to dementia. I believe that if more people without memory loss interact and create friendships with those who have it, stigma will decrease. Adopting attitudes of inclusion based on personal experiences could result in friendlier, more equitable communities.</p>
<p>People with dementia cannot help forgetting. So it is up to us to remember that they are important members of society who deserve lives as connected and meaningful as our own.</p><img src="https://counter.theconversation.com/content/158256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sienna Caspar receives funding from Alzheimer Association of Canada</span></em></p>‘Dementia friendly’ communities seek to support people with memory loss, recognize them as equals, celebrate their contributions and enable them to live with purpose in welcoming communities.Sienna Caspar, Associate Professor, Faculty of Health Sciences, University of LethbridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1137752019-05-23T10:32:31Z2019-05-23T10:32:31ZThe reality of caring for someone with dementia – stressful but rewarding too<figure><img src="https://images.theconversation.com/files/274349/original/file-20190514-60570-1s8mbif.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Pexels</span></span></figcaption></figure><p>Dementia is set to become one of the biggest global health challenges of our generation. In the UK alone there are around 850,000 people living with the disease and this figure is <a href="https://www.alzheimers.org.uk/about-us/news-and-media/facts-media">projected to more than double by 2051</a>. </p>
<p>Those of us who don’t develop dementia will probably end up caring for someone who does. According to Carers Trust, there are nearly 700,000 <a href="https://carers.org/key-facts-about-carers-and-people-they-care">family carers of people with dementia</a>. Without these unpaid carers, the UK economy would have to find <a href="https://www.alzheimers.org.uk/about-us/news-and-media/facts-media">£11 billion a year to cover the cost of dementia care</a>. This makes dementia carers an invaluable resource for both the people they care for and society as a whole. </p>
<p>As a psychologist, I am fascinated by the “hidden strength” that enables some carers to thrive. Something that researchers term “resilience” – which is <a href="https://www.cambridge.org/core/journals/reviews-in-clinical-gerontology/article/what-is-resilience-a-review-and-concept-analysis/B94C9BEAD7F43E1297EC9443DD24CA5C">defined as</a>: “the process of negotiating, managing and adapting to significant sources of stress or trauma”. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/25410637">In our earlier research</a> from 2014, we examined whether spousal dementia carers could achieve resilience and, if so, what resources they drew on to facilitate their capacity for resilience. We found that just under half of the carers were resilient under the definition given above. Research shows that resilient dementia carers are more likely to be protected from <a href="https://www.tandfonline.com/doi/abs/10.1080/13607863.2010.501063">depressive symptoms</a> – dementia carers are typically more depressed and have <a href="https://www.ncbi.nlm.nih.gov/pubmed/12825775">lower levels of well-being than non-dementia carers</a>. Resilient carers are also less likely to admit their loved one into <a href="https://www.ncbi.nlm.nih.gov/pubmed/17284556">residential care prematurely</a>. </p>
<h2>Strength and courage</h2>
<p>As part of our research, Mrs Wi, a 69 year old woman who had been caring for her husband for four years, explained her role as “a contract you would never sign up for”. But despite acknowledging the burden of care-giving, Mrs Wi accepted her husband’s diagnosis and put measures in place so that he could continue to live independently: “He used to go out every Monday and every Friday playing snooker and that hasn’t stopped … I’ve told his friends right from the beginning about [him] having Alzheimer’s”. </p>
<p>Another carer, Mrs C, showed no signs of distress and adopted a positive outlook throughout the nine years she had been caring. With reference to her husband’s diagnosis, Mrs C said: “I tried to be positive and say all they’ve done is give it a name. You’re still the same person you were yesterday.” </p>
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<img alt="" src="https://images.theconversation.com/files/274347/original/file-20190514-60545-166f6lq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/274347/original/file-20190514-60545-166f6lq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274347/original/file-20190514-60545-166f6lq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274347/original/file-20190514-60545-166f6lq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274347/original/file-20190514-60545-166f6lq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274347/original/file-20190514-60545-166f6lq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274347/original/file-20190514-60545-166f6lq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Life can still be sweet, even with dementia.</span>
<span class="attribution"><span class="source">Pixabay</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>I interviewed the carers twice between 2011 and 2014. During that time a lot had changed. All reported deteriorating health of their loved one, some had admitted their loved one into residential care and others had been bereaved. Some had been through both. And yet more people had become resilient than not. <a href="https://www.ncbi.nlm.nih.gov/pubmed/30449140">This suggests that resilience is not fixed</a> – carers can become resilient despite the stress associated with care-giving.</p>
<h2>Singing and laughing</h2>
<p>It is clear from our research that humour and positivity are important facilitators of resilience, as Mr G explains: “I laugh and I sing and she laughs … my neighbour said it’s a good job we’ve got a detached house”. Social support is also important, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27438380">especially from friends</a>: “We are like family … we exchange sad stories or glad stories every week … I think that’s why I’m so stable because I talk to so many people who are in the same boat” (Mrs L). </p>
<p>Carers who engaged in services that enabled them to “give back” were also more likely to be resilient: “I do voluntary work … I’m a carer talking to the carers … I know it sounds daft but it’s a break away, its different, and yet you’re helping others” (Mrs Wi). Family support was valued by all carers who had access to it, but only on their own terms, so as not to relinquish feelings of <a href="https://www.ncbi.nlm.nih.gov/pubmed/25410637">independence and autonomy</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/274345/original/file-20190514-60563-n820y4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/274345/original/file-20190514-60563-n820y4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274345/original/file-20190514-60563-n820y4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274345/original/file-20190514-60563-n820y4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274345/original/file-20190514-60563-n820y4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274345/original/file-20190514-60563-n820y4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274345/original/file-20190514-60563-n820y4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There are ways to make life easier and more enjoyable for a person with dementia.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/women-friends-friendship-helping-1577910/">pixabay</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
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<p>Of course, no one would deny that dementia care is stressful, but it’s clear that many carers have successfully adapted to their role. They draw on their own individual characteristics and resources within their immediate and wider social environment to build their capacity for resilience. </p>
<p>This is important, because it shows that people can live well as dementia carers. Current research and dementia care services are <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/hsc.12115">typically problem-focused</a>, and designed to alleviate burden in carers. But by promoting resilience and the positive and rewarding aspects of care-giving, we can help to improve the day-to-day lives of both carers and the people they care for.</p><img src="https://counter.theconversation.com/content/113775/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Warren Donnellan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some carers actually thrive in the face of dementia, here’s why.Warren Donnellan, Lecturer, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/355882015-01-09T11:08:29Z2015-01-09T11:08:29ZWhat can beagles teach us about Alzheimer’s disease?<figure><img src="https://images.theconversation.com/files/68247/original/image-20150105-13839-12zmqb8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Keep your brain active.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-179734769/stock-photo-first-steps-in-internet-browsing.html?src=0-bNLaJjGiEjCLIXKY3cdg-3-74&ws=1">Dog via Soloviova Liudmyla/Shutterstock</a></span></figcaption></figure><p>Every 67 seconds someone in the United States is <a href="http://www.alz.org/alzheimers_disease_facts_and_figures.asp">diagnosed</a> with Alzheimer’s disease and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24598707">new estimates</a> suggest that it may be the third leading cause of death of older people. </p>
<p>Alzheimer’s disease is associated with losses in memory in older people that become severe enough over time to interfere with normal daily functions. Other <a href="http://www.alz.org/what-is-dementia.asp">signs</a> of Alzheimer’s include changes in the ability to communicate, losses in language, decreased ability to focus and to pay attention, impairments in judgment and other behavioral changes. </p>
<p>People with Alzheimer’s disease experience changes in their brains (which we can see in autopsies). Over the course of the disease, clumps of protein (called <a href="http://www.nia.nih.gov/alzheimers/topics/alzheimers-basics#what">senile plaques</a>) and tangles in neurons (called <a href="http://www.nia.nih.gov/alzheimers/topics/alzheimers-basics#what">neurofibrillary tangles</a>) accumulate. These plaques and tangles interfere with how the brain works and disrupt connections that are important for intact learning and memory ability.</p>
<p>The majority of studies to develop treatments for Alzheimer’s disease use mice that are genetically modified to produce human proteins with mutations. But these mutations are usually present <a href="http://www.alz.org/research/science/alzheimers_disease_causes.asp#genetics">in less than 5%</a> of people with Alzheimer’s disease. This limitation can make it difficult to translate benefits of a treatment tested in mouse studies to people. However, there are several animals that naturally develop human-like brain changes that look much like Alzheimer’s disease, including dogs.</p>
<h2>Old dogs, new research tricks</h2>
<p>Old dogs may teach us a great deal about aging. As dogs get older, some develop learning and memory problems, much like we do. And like people, not all old dogs become impaired. Indeed, some old dogs remain bright and able to learn just as well as younger dogs, although they may be a little slower in reaching high levels of performance.</p>
<p>When an older dog has cognitive problems, we may see them as changes in behavior that can be disruptive to the relationship between owners and pets. For example, an old dog with cognitive problems may forget to signal to go outside, may be up at night and sleep all day, or have trouble recognizing people or other pets in the family. This is similar to a person with Alzheimer’s disease who may have difficulty communicating, disrupted sleep/wake cycles and trouble remembering family and friends.</p>
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<img alt="" src="https://images.theconversation.com/files/68385/original/image-20150107-1995-17o24gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/68385/original/image-20150107-1995-17o24gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=880&fit=crop&dpr=1 600w, https://images.theconversation.com/files/68385/original/image-20150107-1995-17o24gn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=880&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/68385/original/image-20150107-1995-17o24gn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=880&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/68385/original/image-20150107-1995-17o24gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1106&fit=crop&dpr=1 754w, https://images.theconversation.com/files/68385/original/image-20150107-1995-17o24gn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1106&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/68385/original/image-20150107-1995-17o24gn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1106&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Staying sharp.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-208623184/stock-photo-nosy-beagle-in-glasses-near-laptop.html?src=xK-9_04QIeYOHDnTHyo9BQ-6-10&ws=1">Soloviova Liudmyla/Shutterstock</a></span>
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<p>When aged dogs show cognitive changes not caused by other systemic illnesses, they are related to brain changes that are strikingly similar to people. For example, old dogs develop senile plaques in their brains that are made of a protein that is identical to one that humans produce. This protein, called beta-amyloid, is toxic to cells in the brain. </p>
<p>Unlike mice and rats, old dogs naturally develop significant brain pathology like we see in people. In this way, aging dogs may resemble aging humans in a more natural or realistic way than mice with genetic mutations. </p>
<p>There are many other changes in the brains of people with Alzheimer’s disease that are similar in aging dogs. These include changes in the blood vessels of the brain, the accumulation of damaged proteins and losses in cells, and chemicals that support cells in the brain. These changes may be modified by lifestyle factors.</p>
<h2>Healthy living, healthy aging</h2>
<p>There are many reports of how our lifestyle can be good or bad for aging. The food we eat can be a potent contributor to how our brains age. For example, <a href="http://www.alz.org/we_can_help_adopt_a_brain_healthy_diet.asp">several studies</a> in people show that antioxidant-enriched diets (including lots of fruits and vegetables) and the <a href="http://www.alzforum.org/news/research-news/mediterranean-diet-slims-down-risk-ad">Mediterranean diet</a> are associated with healthier brain aging. </p>
<p>Physical exercise and good cardiovascular health also appear to be associated with a lower risk of developing Alzheimer’s disease and <a href="http://www.aans.org/patient%20information/conditions%20and%20treatments/cerebrovascular%20disease.aspx">cerebrovascular disease</a>, which is a cause of <a href="http://www.alz.org/dementia/vascular-dementia-symptoms.asp">dementia</a>. Keeping your brain active and challenged with puzzles, brain games and an engaging social life, are all linked to better memory and less risk of disease and <a href="http://www.alzforum.org/news/conference-coverage/healthy-lives-healthy-minds-it-really-true">studies</a> are ongoing in people to measure the effects systematically. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/68386/original/image-20150107-1999-br064e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/68386/original/image-20150107-1999-br064e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/68386/original/image-20150107-1999-br064e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/68386/original/image-20150107-1999-br064e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/68386/original/image-20150107-1999-br064e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/68386/original/image-20150107-1999-br064e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/68386/original/image-20150107-1999-br064e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Eat well.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/nickimm/14033676428">Nicki Mannix</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Beagles and the brain</h2>
<p>Dogs may be very well suited to help us understand how these lifestyle factors help our brains as we get older. Our lab initially began studying beagles in the early 1990s as there was interest in developing a drug to treat “dog dementia” based on pet owners observations of changes in behavior in their older dogs. At that time, little was known about learning and memory changes in aging dogs (beagles over eight years of age) and our earliest research was designed to find ways to systematically measure these changes. </p>
<p>The first step in doing this was to teach dogs to look at different objects (for example a Lego block or a toy truck) and learn that one of the two always hid a food reward. When we switched the food reward to the object that was previously not rewarded, older dogs kept choosing the wrong object. Young dogs very quickly switched over to the new object. </p>
<p>When we counted the number of errors dogs make to learn the problem, old dogs made many more errors overall. Interestingly, not all old dogs were impaired. Another subset of old dogs showed significant losses in their ability to remember information and some showed changes in their ability to be “flexible” in changing behaviors. </p>
<p>This is very similar to people. Not everyone ages in the same way – some people remain sharp as tacks well into their older years. After measuring learning and memory changes in dogs, we next studied the brain changes that were most strongly linked to these cognitive losses. We found that senile plaques in the brains of old dogs were more frequent in the animals that had learning and memory problems. In our more recent studies, we have been seeking ways to improve brain health in old dogs with the hope that these approaches can translate to healthy aging in people. </p>
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<img alt="" src="https://images.theconversation.com/files/68248/original/image-20150105-13848-domrhq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/68248/original/image-20150105-13848-domrhq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/68248/original/image-20150105-13848-domrhq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/68248/original/image-20150105-13848-domrhq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/68248/original/image-20150105-13848-domrhq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/68248/original/image-20150105-13848-domrhq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/68248/original/image-20150105-13848-domrhq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Keep running.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/marcobellucci/4211294942">Marco Bellucci</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>For instance, in <a href="http://www.ncbi.nlm.nih.gov/pubmed/19096165">several studies</a> of aging in beagles, we have found that a diet rich in antioxidants that includes vitamins E and C, and importantly, fruits and vegetables, can lead to wonderful benefits in learning and memory ability that can be maintained for years.</p>
<p>For example, dogs that had trouble remembering where they had seen a food reward (this is an example of spatial memory) showed significant improvements in their memory over time. Also, old dogs showed rapid improvements in their ability to modify their behaviors when the rules had changed in the task they were learning (an example of enhanced executive function). </p>
<p>In addition, providing dogs with physical exercise, social enrichment and “brain games” (like the food reward game) can also significantly improve cognition as they get older. </p>
<p>If we take these factors into account, we may be able to engage in strategies and lifestyle changes that will be good for both species. Exercise, social interaction, learning new tricks – participating in the same activities with our aged companion animals, the benefits will be twofold: for them and for us.</p><img src="https://counter.theconversation.com/content/35588/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Head receives funding from the National Institutes on Aging.</span></em></p>Every 67 seconds someone in the United States is diagnosed with Alzheimer’s disease and new estimates suggest that it may be the third leading cause of death of older people. Alzheimer’s disease is associated…Elizabeth Head, Associate Professor , University of KentuckyLicensed as Creative Commons – attribution, no derivatives.