Complex concerns come with determining when it’s time to hang up the keys: How can this topic be approached in a respectful way with loved ones? Can a plan be created for the future so that the person with dementia can continue to enjoy activities after they’ve decided to stop driving?

Dr. Mark Rapoport, geriatric psychiatrist, acting head of Geriatric Psychiatry at Sunnybrook, and one of the researchers behind a new Canadian online resource called the Driving and Dementia Roadmap shares insight into how individuals with dementia and those close to them can face this challenge together.

What is dementia?

Dr. Rapoport: Dementia occurs when a person experiences changes or a decline in memory, and the ability to think, problem solve, or make decisions, that are significant enough to affect their daily life and everyday activities. Although dementia is most common in older adults, it is not a ‘normal’ part of aging.

The Alzheimer Society of Canada says dementia impacts more than 600,000 people in Canada. It’s estimated that by 2030, one million Canadians will be living with dementia.

When is it time for a person with dementia to stop driving?

Dr. Rapoport: Some concerns around driving that are common with dementia can include forgetfulness or getting lost in familiar places. If a person is feeling unsure or anxious while driving or if there are any safety concerns expressed by family or friends about the individual’s driving abilities, it is important to seek information and the advice of a healthcare professional for next steps.

Some individuals with mild dementia may continue to drive safely and some may have to stop driving right away. It’s important to be aware that as the disease progresses, they will inevitably have to stop driving. It can be difficult to know exactly when driving has become or will become unsafe.

After receiving a dementia diagnosis, it is critical for the individual and their family to watch for changes in that person’s driving and consider whether they can continue to drive safely.

For people with moderate or severe dementia, driving is dangerous as the brain functions needed to react quickly and make rapid decisions for safe driving have deteriorated. By these stages, driving must stop.

What is the Driving and Dementia Roadmap?

Dr. Rapoport: The Driving and Dementia Roadmap or drivinganddementia.ca, is a free, online, and Canadian resource created to help older adults living with dementia, their family, friends, and healthcare teams, and provide them with information around the decision to stop driving.

The Driving and Dementia Roadmap was developed by researchers from Sunnybrook, Baycrest, and the Canadian Consortium of Neurodegeneration in Aging.

I have been working in the field of geriatric psychiatry for many years, and over time patients and families identified the need for easily accessible and credible information about driving and dementia and driving cessation. This is the first time that helpful materials have been curated into a one-stop-shop website that includes resources useful for all provinces and territories across the country.

The Driving and Dementia Roadmap website includes information, videos, worksheets, as well as strategies to help people living with dementia and their families navigate the challenging conversations, emotions, and planning that comes with the decision to stop driving.

Making a plan for the future

Driving cessation is a major life change for a person with dementia. There are often concerns about a loss of independence or identity.

It is important to include the individual with dementia in discussions about driving. This can help in creating a plan and making alternative transportation arrangements for when the person can no longer drive. The website provides strategies to ensure that the person with dementia continues to live a fulfilling life even after driving stops.

The Driving and Dementia Roadmap website doesn’t provide individuals with recommendations about their driving. It is for educational and informational purposes. Patients and families are strongly encouraged to reach out to a qualified healthcare provider with any concerns for their guidance, advice, and support as they navigate the driving and dementia journey.

Read the news release to learn more about the Driving and Dementia Roadmap.

For more information go to: drivinganddementia.ca

The post Driving and dementia: How to know when it is time to stop driving appeared first on Your Health Matters.

Despite the statistics, innovative research is underway at Sunnybrook to help bring hope to the fight against Alzheimer’s and dementia.

“We may be entering a new era with possible effective treatments for this disorder which affects whole families and is increasingly prevalent with populations aging,” says Dr. Sandra Black, director of the Dr. Sandra Black Centre for Brain Resilience and Recovery. “Continued research is critical as we aim to develop and discover meaningful treatments and prevention strategies for Alzheimer’s and dementia.”

Here are just some of the innovative ways that Sunnybrook clinicians and researchers are on the leading edge of research in the detection, prevention, and treatment of Alzheimer’s and dementia.

Apathy and Agitation in Alzheimer’s

At Sunnybrook, clinical studies are underway on apathy and agitation in Alzheimer’s patients, where researchers are exploring ways to help decrease apathy in patients. This can help increase their interest in activities and their emotional responsiveness, which may help improve their quality of life, as well as their caregivers’.

Early on-set dementia

In a world-first study, a team of Sunnybrook scientists are trying to identify biomarkers, or biological clues in the brain, such as blood flow, that could demonstrate an early-onset frontotemporal dementia in people who have a genetic predisposition to the disease.

 

View this post on Instagram

 

A post shared by Sunnybrook Hospital (@sunnybrook)

Innovative technology

Researchers are also looking for innovative ways to deliver medicine or therapeutics directly to the areas of the brain involved in Alzheimer’s disease.

Preclinical research is exploring the delivery of gene therapy to treat Alzheimer’s and help improve memory and boost brain health.

One of those methods uses focused ultrasound technology, where ultrasound waves are precisely directed to a targeted area of the brain to help open the blood-brain barrier (BBB), which can allow potentially helpful medications to reach brain regions involved in Alzheimer’s and dementia, without having to use scalpels. Research teams have shown evidence that the BBB can be temporarily opened safely using focused ultrasound, an exciting first step in exploring a new way for therapeutics to be delivered to the brain.

Who will get Alzheimer’s disease?

Sunnybrook scientists are also using artificial intelligence and machine learning to try and detect early signs and symptoms of dementia to improve treatment and prevention of the disease.

Research is also underway to learn more about risk factors for dementia among diverse ethnic groups including individuals of South Asian and Chinese descent, as these groups are often under-represented in dementia studies.

The latest Sunnybrook research has also demonstrated that having poor vascular health may accelerate cognitive decline in patients with dementia and small vessel disease.

Preventing Alzheimer’s

Researchers are finding out how lifestyle can protect individuals from dementia.

While it is critical for cutting edge studies to continue in the search for new treatment and care for patients with Alzheimer’s and dementia, it can also be helpful for individuals to take action themselves to learn more about dementia and how activity can help boost brain health in more ways than one.

From prevention to diagnostics and potential treatment innovations, “We’re at the forefront of discovery for dementia and Alzheimer’s at Sunnybrook,” says Dr. Black. “There’s a lot to be optimistic about.”

The post Advancing Alzheimer’s research appeared first on Your Health Matters.

Dementia is an umbrella term used to describe a decline in thinking abilities that is severe enough to interfere with one’s day-to-day activities. While some degree of forgetfulness is completely normal as we age, the memory loss experienced in the context of dementia is much more severe.

AD is the most common cause of dementia, and is defined by the abnormal build-up of two proteins in the brain: amyloid plaques and tau tangles. The build of these proteins leads to the death of brain cells, which causes the brain to shrink and impacts memory and thinking abilities.

There are many risk factors for dementia. Some, like older age and genetics, can’t be changed. But recent research has shown that up to 40 per cent of dementia cases are linked to risk factors that people can control.

Vascular Risk Factors

Vascular Risk Factors (VRF) are conditions that affect the health of blood vessels that supply oxygen and nutrients to the brain. These include high blood pressure, high cholesterol, obesity, diabetes and smoking. Each of these conditions on their own can increase the risk of dementia, and when they present together, the risk is even higher.

The good news is that we know how to treat VRF. If you have been prescribed medication for high blood pressure, high cholesterol or diabetes, take it as directed and keep up with routine doctor visits. Eat a healthy diet and exercise regularly, as these lifestyle changes can reduce the risk of these conditions. There are also effective strategies to manage obesity and smoking, so don’t hesitate to reach out to your health care team. A good rule of thumb is that what’s good for the heart is good for the brain!

Cognitive Reserve

Cognitive reserve refers to your brain’s ability to cope and keep working, even in the face of damage from diseases like AD. Research has suggested that engaging in mentally stimulating activities throughout own’s life can help build up a high cognitive reserve, offering some protection from AD and other dementias.

Because of these findings, researchers now recommend keeping your mind active throughout your whole life, especially after you retire.

It’s not clear which activities may be most beneficial for the brain, so choose any challenging activity you enjoy. Some examples include playing chess, learning a new instrument or language, doing a puzzle or even socializing with family and friends.

Physical Activity

Several studies have shown that regular exercise can significantly reduce the risk of developing dementia. In our own research, we found that people who engaged in regular physical activity – even in older adults with Alzheimer’s changes in their brain – had less decline in their memory over time compared to those who were sedentary.

It doesn’t really matter what type of physical activity you engage in, as long as it elevates your heart rate. We know that people are more likely to exercise if they participate in activities they enjoy. Choosing social activities, like walking and dancing, can have the added benefit of exercising the body and the mind. Current guidelines suggest doing at least 150 minutes of moderate intensity activity per week, but remember that some movement is always going to be more beneficial than nothing.

Sleep

All of us know that a bad night’s sleep can impair our ability to think the following day. Research has also shown that getting too few hours of sleep may also increase the risk of  developing AD and dementia. It appears that sleep acts like a dishwasher, helping clear out harmful toxins – including amyloid –  from the brain.

To optimize quality sleep, try to go to bed at the same time each night and get up at the same time each morning. Make sure your bedroom is quiet, dark and at a comfortable temperature. Avoid using electronic devices two to three hours before going to sleep. Also, engaging in physically activity during the day can reduce the time it takes to fall asleep at night.

For people who gravitate towards naps, keep in mind that in some cases they can be a sign of a larger health issue or insufficient stimulation during waking hours. Generally, naps can be restorative, as long as they are limited and don’t interrupt your normal and healthy wake/sleep cycle.

The post How your lifestyle can protect you from dementia appeared first on Your Health Matters.

“Among the most vulnerable to COVID-19 are people living with dementia, stroke or other neurodegenerative diseases,” says Dr. Rick Swartz, neurologist. “With these conditions, changes in the brain leads to memory loss, difficulty with thinking, problem-solving, and/or movement. This could mean a person may not remember to do things like wash their hands, or they may not have the mobility they used to and require the help of a caregiver.”

» Learn more about caring for those living with dementia, stroke and neurodegenerative diseases during the COVID-19 pandemic by the Ontario Neurodegenerative Disease Research Initiative

» Find out about self-management and self-care during COVID-19 for people with stroke, heart conditions and vascular cognitive impairment from this Heart & Stroke webinar featuring Dr. Rick Swartz, Sunnybrook neurologist

Tips for hand hygiene help for a person with dementia

In a time when handwashing and taking precautions is paramount, it’s important to help those who are more vulnerable to illness during the COVID-19 pandemic, including those living with Alzheimer’s disease and other dementias. If you notice a person living with dementia is showing increased confusion, contact your health care team, as this may be a symptom of any illness.

• Explain: Give a simple description of how to wash hands to stay healthy.
• Show: Demonstrate proper hand-washing techniques, suggest humming part of a favourite tune so the individual with dementia washes their hands for an appropriate amount of time.
• Signs: Consider putting up signs near sinks as a visual reminder to wash hands. Using pictures and large font may be helpful to use in signage.
• Hand-sanitizer: If the person with dementia is not able to wash their hands easily, alcohol-based hand sanitizer with 60 per cent alcohol can be used as an alternative.

Plan ahead

From groceries to medication to alternate care, making plans in advance can help both the caregiver and the person with dementia.

• Virtual care: Talk to health care teams about the possibility of virtual care and having appointments done online or over the phone.
• Alternate care: Determine who can help provide care to the individual with dementia, if the primary caregiver becomes ill or is no longer able to assist.
• Limit trips to the pharmacy: Consider using a delivery service to fill prescriptions for medication.
• Grocery shopping options: Shopping for groceries and physical distancing is easier as many stores offer online shopping, pick-up and delivery options. Friends and family can also lend a hand by picking up groceries while at the store and dropping them off directly.
• Find resources: Learn more about resources that are available on a local, provincial and national level. Many credible organizations offer support and information online. For example, a service called 211 Ontario can help people in that province find programs and services in their community by dialing 2-1-1. There are also 211 Services outside of Ontario in some provinces and territories.

» Find more tips for caregivers from the Memory Doctor

Ways to stay connected

Health experts say while physical distancing is important to maintain during this pandemic, it’s also very important to make sure people with dementia aren’t isolated and that friends and loved ones keep in touch in a variety of ways.

• Routine calls: Schedule some time each day to contact friends and family. Go beyond just texting. In a time of physical distancing, maintain human interaction by speaking with a person on the phone or seeing them in a video chat.
• Telephone: Picking up the phone is one of the easiest ways to connect with loved ones. More people can join in if you have a conference call feature.
• Smartphones: Contact friends and family with a call, by text or by using social media app. Sharing photos and videos can help everyone feel a little closer in these times.
• Video-calling: Technology can bring friends and family altogether in groups. Not only can you speak to one another, you can see how everyone’s doing and stay connected.

Planning ahead and getting creative with communication are just some of the things that can be helpful for people living with dementia and other neurodegenerative conditions. For those who are vulnerable during the COVID-19 pandemic, having friends and family pull together to support them, their caregivers, and each other will go a long way.

The post COVID-19: Tips for supporting people with dementia appeared first on Your Health Matters.

Answer: Possibly, but more likely he is displaying symptoms of apathy.

Apathetic behaviours are generally characterized by a lack of motivation and indifference. To the caregiver, the person with dementia and apathy can appear as showing less or no interest in previously enjoyed activities, lack of motivation to initiate activities (including self-care), lack of ability to persist with activities, withdrawal from social activities, and showing less emotional responses to daily events.

Normal, but still challenging

Apathetic behaviours are the most common “neuropsychiatric symptoms” associated with dementia, and occur in up to 90% of people with dementia at some point in their illness. These behaviours can cause significant stress for the caregiver, as these patients often require extra time and effort to provide care for. Even when a patient still retains the cognitive abilities to do self-care activities like bathing, dressing, grooming etc., they may not engage in these activities because of apathy. Apathetic behaviours can also be mistaken for other neuropsychiatric symptoms like depression or resistiveness to care, which require different forms of treatment.

Apathy has only recently become a focus of research. In fact, it was less than 10 years ago, that diagnostic criteria for apathy in Alzheimer’s disease and other dementias were first proposed. These criteria describe apathy as a loss or diminished motivation compared to the patient’s previous level of function, with the presence of symptoms in the following areas:

1. Goal-directed behaviours (e.g. starting and/or participating in conversations, doing activities of daily living, seeking social activities etc.),
2. Cognitive activities (e.g. loss of interest in news, personal, community or family affairs etc.),
3. Emotions (e.g. diminished or absent emotional responses to positive or negative events etc.).

These criteria have been used in a growing body of research studies which suggest that apathetic behaviours have a biological basis and arise from changes in brain chemicals and brain function as a result of the damage caused by the dementia.

But is it depression?

Apathy is frequently confused with depression. Many patients with depression will also display apathetic behaviours, but most dementia patients with apathy will not have other symptoms of depression such as sad mood, hopelessness, guilt, and suicidal thoughts. It is important for the doctor to distinguish apathy from depression, as many antidepressants will be ineffective for the treatment of apathy, and some may even worsen symptoms.

Navigating apathy

The good news is that apathy is potentially treatable. Treatment begins by attempting to enrich the environment and daily activities of the person with dementia. I generally prescribe “gentle nagging” for the caregiver, stopping short if the patient becomes agitated. Attempting to engage them in a variety of activities they previously enjoyed (keeping in mind diminished cognitive capacity) is key. At times, the patient may respond better to non-family caregivers when it comes to initiating and participating in activities. Attending community-based day programs is a great way to engage patients in a variety of social, cognitive and physical activities. I often recommend hiring a personal trainer to develop an exercise program, and then allowing the trainer to initiate and monitor the program, acting as the external motivating factor for the patient. Providing positive feedback and “rewards” for engaging in activities can often help to ensure sustainability of benefits. All these types of suggestions are readily accessible to caregivers from the Alzheimer’s Society education and support groups.

Medications may provide some benefits for apathy. The most commonly used Alzheimer’s medications, the cholinesterase inhibitors (e.g. donepezil, galantamine, and rivastigmine) have small but definite benefits for apathy. It is not uncommon for me to hear from caregivers, that patients started on these medications appear brighter, more engaging and more likely to initiate activities. Unfortunately, some patients will not respond to these medications or may have much more severe symptoms that are interfering with their care and quality of life.

At Sunnybrook, we have been studying the effect of methylphenidate (Ritalin®and others) on apathy in Alzheimer’s Disease. In two small studies we have shown preliminary data that suggest methylphenidate is effective at improving apathy, is well-tolerated, and may have some positive cognitive benefits. Along with colleagues in the US, we are currently running our third study which we hope will provide more definitive proof of safety and effectiveness.

In summary, as the title of this blog suggests, we should not be apathetic about apathetic behaviours in dementia. They are very common, they represent a significant source of disability to the patient and a source of stress to the caregiver, they are often confused with other neuropsychiatric symptoms, and they are potentially treatable with appropriate environmental, behavioral and medication therapies.

The post Loss of interest, motivation and emotion: Apathy in dementia appeared first on Your Health Matters.

Answer: In the final stages of dementia, usually around the time when patients are no longer able to communicate or walk, and become bed-bound, a number will also develop swallowing problems, and some will refuse to eat. The swallowing problems can lead to fluids and food entering the lungs instead of the digestive system which can cause “aspiration pneumonia”. This is an agonizing time for caregivers and families who not only recognize eating and drinking as essential for survival, but also as one of the few remaining pleasures that contribute to quality of life for the patient in the end stages of the disease. Support from the medical team, and a realistic review of all available options is essential at this stage.

Exploring the options

Nutritionists and dietitians can provide a variety of recommendations, depending on the severity of the swallowing difficulties. At times this will involve changing the consistency of the diet to make it easier to swallow, and/or thickening the fluids to ensure they end up in the stomach, rather than the lungs. Proper positioning of the patient during the meals will also be suggested. At this point, caregivers and family often begin to think ahead, and wonder whether a feeding tube will be necessary. Feeding tubes, also referred to as “percutaneous endoscopic gastrostomy” (PEG) tubes are inserted through the skin, into the stomach by a brief surgical procedure, allowing artificial liquid nutritional fluids to be given, thus avoiding the need to eat by mouth. While this might sound like an ideal proposition to families, there are no current medical or nutritional scientific societies who recommend this for these situations. Why is that?

A difficult decision

It is generally acknowledged that for patients with end-stage dementia, feeding tubes do not actually improve nutritional status, and they do not improve survival. In fact, there are numerous complications associated with feeding tubes including pain, agitation, and diarrhea. Feeding tubes may not even prevent the aspiration pneumonia they are used for! Some patients will be so uncomfortable with the tubes, that they attempt to pull them out, which can lead to acute medical emergencies. Most importantly, there is no evidence that feeding tubes improve quality of life for the patient.

When treatment teams recommend against the use of a feeding tube, families sometimes argue that they just cannot let their relative “starve to death”. The decision to use a feeding tube needs to be made with the caregiver and family, taking into account the patient’s culture, religion and previously expressed wishes. The team will likely review the information summarized above, and inform caregivers that in general, tube feeding is not recommended as the risks outweigh the benefits.

The best alternative to feeding tubes is “assisted oral feeding”, in which a caregiver helps the patient eat small amounts of food and fluids slowly and carefully. The benefit of this procedure is the close contact between patient and caregiver (the “human touch”), and the more natural form of nutrition. These likely go a longer way to improving quality of life for patients, than any form of nutrition provided through a feeding tube.

The post Tube feeding and end-stage dementia appeared first on Your Health Matters.

Answer: The studies on the effect of alcohol consumption and the risk of dementia are complicated, confusing, and conflicted. What is known for sure is that prolonged and excessive alcohol use can lead to dementia and other neurological complications. What is much less clear is whether light or moderate drinking might actually prevent dementia.

To answer the question about the possible effects of alcohol consumption on preventing Alzheimer’s disease, it’s important to understand how these studies were done. The studies looking at alcohol use are generally observational in nature. They pick a given population without dementia, ask them about their alcohol intake, and then follow them over time to see who develops dementia. As you might imagine, it can be challenging for researchers to characterize the amount of alcohol consumed, because subjects often underestimate (purposely or subconsciously) the amount they drink. Different subjects will vary in terms of the pattern of drinking (e.g. daily vs weekly binging) and the type of alcohol they drink (e.g. spirits vs wine vs beer). All of these could affect the relationship between alcohol and dementia risk.

Most importantly however, while these observational studies might suggest there is a link between modest alcohol consumption and a decreased risk of dementia, establishing a direct causal (cause and effect) link between the two is impossible. The reason for this is that alcohol consumption might be associated with other, perhaps more important factors that reduce the risk of dementia. For example, modest drinking is also likely associated with greater social contacts, and social stimulation itself likely protects against dementia.

There have been numerous studies over the past few decades investigating this association described above. When the results of these studies are combined, it appears that light-to-moderate alcohol consumption is associated with about a 25 per cent reduction in the risk of Alzheimer’s disease and other dementias compared to people who are non-drinkers. The risk of dementia then increases in those who are heavy drinkers. However, as an example of how conflicting the results of these studies can be, there are two studies, both published in 2015, and both using data from Norway, that come to different conclusions. In the first study of over 25,000 Norwegians followed for up to 17 years, the risk of dementia was significantly higher in abstainers. In the second study of over 40,000 Norwegians followed for up to 27 years, abstaining from alcohol was not found to increase the risk of dementia, though drinking frequently (defined as more than five times in the previous 14 days) was associated with an increased risk of developing Alzheimer’s disease or other dementias.

In terms of the type of alcohol that might be most likely to provide some protective benefit, red wine has received the most attention. Red wine contains a compound called resveratrol, that has been associated with numerous (though largely unsubstantiated) benefits including protecting against heart disease and even increasing longevity. A recent study of resveratrol for patients with Alzheimer’s disease however, failed to demonstrate any clear evidence of benefit and was actually associated with greater brain shrinkage.

While my primary clinical and research practice is devoted to Alzheimer’s disease and memory disorders, my training as a Psychiatrist has certainly coloured my opinions about alcohol use. For prevention purposes, I would clearly prefer that my patients avoid alcohol use, and engage in a “brain healthy lifestyle” which includes exercise, mentally stimulating activities and a Mediterranean type diet. When I’m asked specifically about alcohol intake, I generally recommend avoiding regular use, and certainly no more than one drink per day. Once I have diagnosed dementia, I stress the absolute need for abstinence given the harmful effects alcohol can have on the brain, memory and behaviour once dementia is present.

The post A drink to brain health? Don’t make mine a double! appeared first on Your Health Matters.

Answer: Most definitely. Optimizing hearing and vision for the person with dementia is a valuable and important contribution to care. It makes obvious sense that if a person cannot see, or struggles to hear, they are less likely to attend to information or understand it, and as a result they are less likely to remember. There is good research to suggest that hearing and vision problems are common sources of “excess disability” – a term meant to describe worse cognitive and functional impairment as a result of causes beyond the degree of dementia pathology per se.

Ensuring vision and audiology assessments have been completed is a simple and relatively painless process for most patients and caregivers. Wearing appropriate eye glasses is also a fairly simple intervention with good compliance. Arranging for cataract surgery, may be more challenging, but given the increasing simplicity and excellent tolerability of the surgery, mild to moderate dementia should definitely not be seen as a barrier to improving vision through this procedure. Dealing with hearing loss can be more problematic. Not all types of hearing loss can be improved by hearing aids, and hearing aids can be very difficult to use, or can be poorly tolerated for some people with dementia. While I always recommend consultation with an audiologist, for some patients however, use of a “pocket talker” can be a simple and inexpensive alternative that might be better tolerated than traditional hearing aids.

Regardless of the difficulty involved in optimizing hearing and vision, these interventions are well worth the effort. For example, a recent study in elderly people suggested that wearing hearing aids improved performance on cognitive testing compared to people who didn’t wear hearing aids, even though the group who wore hearing aids had worse hearing. Sensory impairment has also been associated with emotional symptoms like depression in people with dementia. Perhaps even more surprising, psychotic symptoms such as visual hallucinations (seeing things that aren’t there) and auditory hallucinations (hearing imaginary voices) have been associated with vision and hearing problems in people with dementia. Most importantly, there are reports that some of these symptoms can be improved when hearing and vision are improved.

The post Senses and Sensibility: Optimizing hearing and vision for people with dementia appeared first on Your Health Matters.

Answer: If you are asking the question, it’s probably no longer safe.

This is another one of the questions that invariably come up over the course of the illness. Unfortunately, it can also be a life-changing event for spouses and child-caregivers who are still working. It’s also another one of those questions that cannot be answered definitively by a medical professional because it is so dependent on individual characteristics of the patient.

In general, once a patient enters the moderate phase of dementia (the phase in which they require some help with their basic activities of daily living like dressing, bathing and grooming), it is unsafe to leave them alone for even short periods of time. Caregivers often say to me, “but my wife is perfectly content to sit and watch TV for an hour or two!” To this I generally respond that while that may be the case, they need to assure themselves that their spouse is also capable of handling emergencies. What would happen if there was a fire in the home? How would they deal with a stranger who comes to the door? By the time patients are in the moderate stage of dementia, they will often no longer have the insight and judgement to deal with emergencies, nor will they have the communication skills necessary.

At times, even patients with mild dementia may not be safe to stay alone, especially if they have demonstrated anxious, agitated, or impulsive behaviours. Patients who have experienced paranoia, delusions (false fixed beliefs, usually of a persecutory nature) or hallucinations, are also probably unsafe to leave alone. Finally, patients who have wandered should not be left alone.

Because of the serious implications for caregivers, this is a stage that I begin to talk about very early in my care of the patient, and ask caregivers to begin to plan for this eventuality.  Some of this planning generally includes thinking about alternatives to the caregiver themselves providing the supervision. For example, are there friends or family who can provide some of the supervision? Are there community resources that can be used? Can home care through government service providers be utilized? Can the caregiver afford private care or even a full-time professional caregiver? Can a day program be used? While all these options will be helpful, in the end, the burden of care often falls on the spouse or one of the children, seriously affecting their work and social life. This is often a time when the caregiver might begin to think of institutionalization.

The post When is it no longer safe to be home alone with Alzheimer’s? appeared first on Your Health Matters.

Answer: This is always a difficult question for me to answer. For some patients with even mild dementia, changing locations can lead to an increase in disorientation and confusion. Caregivers have complained to me that at times, the person with dementia can even become incontinent because they cannot find the bathroom in their hotel room. Perhaps a bigger concern is whether an increase in confusion because of the unfamiliar location and environment will lead to agitation and anxiety. This is a particular problem for air travel, where the person is stuck in a noisy, crowded confusing environment where there is literally no escape for hours.

Unfortunately there are no clear predictors of who is likely to be able to tolerate travel and who will not. For instance, factors such as age, gender, type of dementia, and severity of cognitive impairment, are not particularly helpful, as the response is so individual. I typically inquire about how they have tolerated travel in the past, though given the progressive nature of the illness, even this is not totally reassuring. Sometimes it is worthwhile trying a “trial run” where the patient and the caregiver may stay overnight at friends or family nearby to judge what effect changing environments will have on the person.

I generally encourage families to travel in order to enrich the quality of life for the patient and their caregiver, and at times, travel will be unavoidable. In these instances, it is always useful to have a game plan which could include notifying the travel authorities, ensuring adequate health insurance, having help arranged to get you to the gate, and waiting for you when you arrive. You might speak to your doctor about the availability of medications to help with agitation in the event this is necessary, but there are risks associated with the use of these drugs and they should not be used for the first time if you have no idea how they affect the person with dementia (either positively or negatively).

Finally, given how different the environment will be, you will need to be especially careful about leaving the person with dementia unattended at any time during the trip.

The post Travelling with dementia appeared first on Your Health Matters.