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What is ‘doll therapy’ for people with dementia? And is it backed by science?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> The way people living with dementia <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-changes-perception">experience the world</a> can change as the disease progresses. Their sense of reality or place in time can become distorted, which can cause <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/restlessness">agitation and distress</a>. One of the best ways to support people experiencing changes in perception and behaviour is to <a href="https://www.dementia.org.au/professionals/designing-dementia-friendly-care-environments">manage their environment</a>. This can have profound benefits including <a href="https://www.agedcarequality.gov.au/resource-library/reducing-use-sedatives-aged-care-video">reducing the need for sedatives</a>. One such strategy is the use of dolls as comfort aids. <h2>What is ‘doll therapy’?</h2> More appropriately referred to as “<a href="https://www.dementia.com.au/resource-hub/the-use-of-dolls-in-dementia-care">child representation</a>”, lifelike dolls (also known as empathy dolls) can provide comfort for some people with dementia. Memories from the <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/memory-loss#:%7E:text=Older%20memories%20%E2%80%93%20which%20have%20been,detailed%20memories%20from%20earlier%20life.">distant past</a> are often more salient than more recent events in dementia. This means that past experiences of parenthood and caring for young children may feel more “real” to a person with dementia than where they are now. <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/hallucinations#:%7E:text=Visual%20hallucinations%20are%20more%20common,hallucinating%20and%20how%20others%20respond.">Hallucinations or delusions</a> may also occur, where a person hears a baby crying or fears they have lost their baby. Providing a doll can be a tangible way of reducing distress without invalidating the experience of the person with dementia. <h2>Some people believe the doll is real</h2> A recent case involving <a href="https://www.theguardian.com/australia-news/2024/nov/06/deplorable-nurse-slammed-therapy-doll-dementia-patient-believed-was-real-baby-on-table-nsw-tribunal-hears">an aged care nurse mistreating a dementia patient’s therapy doll</a> highlights the importance of appropriate training and support for care workers in this area. For those who do become attached to a therapeutic doll, they will treat the doll as a real baby needing care and may therefore have a profound emotional response if the doll is mishandled. It’s important to be guided by the person with dementia and only act as if it’s a real baby if the person themselves believes that is the case. <h2>What does the evidence say about their use?</h2> Evidence shows the use of empathy dolls may help <a href="https://www.sciencedirect.com/science/article/pii/S0197457223002677">reduce agitation and anxiety</a> and <a href="https://www.mdpi.com/2039-4403/14/4/200">improve overall quality of life</a> in people living with dementia. Child representation therapy falls under the banner of <a href="https://www.sciencedirect.com/science/article/pii/S0149763423004761">non-pharmacological approaches to dementia care</a>. More specifically, the attachment to the doll may act as a form of <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6494367/">reminiscence therapy</a>, which involves using prompts to reconnect with past experiences. Interacting with the dolls may also act as a form of <a href="https://www.health.vic.gov.au/dementia-friendly-environments/sensory-stimulation">sensory stimulation</a>, where the person with dementia may gain comfort from touching and holding the doll. Sensory stimulation may <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.13169?casa_token=ro96fxe2VPoAAAAA%3AKOS10VkTdcrf0yTI_F9p6cI5Kpbj85ZTFq13PQ56YHxi0i3-5BOnFQfW1WFWqiCZ8-mk5sp_EGkGtKM">support emotional well-being and aid commnication</a>. However, not all people living with dementia will respond to an empathy doll. The <a href="https://www.alzheimerswa.org.au/wp-content/uploads/2017/07/2.00-Guidlines-for-Use-of-Dolls-and-Mechanized-Pets-as-a-Therapeutic-Tool-4-pages.pdf">introduction of a therapeutic doll</a> needs to be done in conjunction with careful observation and consideration of the person’s background. Empathy dolls may be inappropriate or less effective for those who have not previously cared for children or who may have experienced past birth trauma or the loss of a child. Be guided by the person with dementia and how they respond to the doll. <h2>Are there downsides?</h2> The approach has <a href="https://pubmed.ncbi.nlm.nih.gov/33125455/">attracted some controversy</a>. It has been suggested that child representation therapy “infantilises” people living with dementia and may increase negative stigma. Further, the attachment may become so strong that the person with dementia will <a href="https://www.dementiauk.org/information-and-support/living-with-dementia/doll-therapy/">become upset if someone else picks the doll up</a>. This may create some difficulties in the presence of grandchildren or when cleaning the doll. The introduction of child representation therapy may also require additional staff training and time. Non-pharmacological interventions such as child representation, however, have been shown to be <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10180718/">cost-effective</a>. <h2>Could robots be the future?</h2> The use of more <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8247474/#:%7E:text=Therefore%2C%20an%20interactive%20baby%20robot,mental%20support%20for%20older%20adults.">interactive empathy dolls</a> and <a href="https://journals.sagepub.com/doi/full/10.1177/14713012231155985">pet-like robots</a> is also gaining popularity. While robots have been shown to be <a href="https://www.sciencedirect.com/science/article/pii/S1568163722000757">feasible and acceptable in dementia care</a>, there remains some contention about their benefits. While some studies have shown <a href="https://academic.oup.com/innovateage/article/5/2/igab013/6249558?login=false">positive outcomes</a>, including reduced agitation, others show <a href="https://www.sciencedirect.com/science/article/pii/S1568163722000757">no improvement</a> in cognition, behaviour or quality of life among people with dementia. Advances in artificial intelligence are also being used to help support people living with dementia and <a href="https://journals.sagepub.com/doi/full/10.1177/1471301221998888">inform</a> the community. <a href="https://feel-lab.org/research_projects/ai-viv-and-friends/">Viv and Friends</a>, for example, are AI companions who appear on a screen and can interact with the person with dementia in real time. The AI character Viv has dementia and was co-created with women living with dementia using verbatim scripts of their words, insights and experiences. While Viv can share her experience of living with dementia, she can also be programmed to talk about common interests, such as gardening. These companions are currently being trialled in some residential aged care facilities and to help educate people on the lived experience of dementia. <h2>How should you respond to your loved one’s empathy doll?</h2> While child representation can be a useful adjunct in dementia care, it requires sensitivity and appropriate consideration of the person’s needs. People living with dementia <a href="https://pubmed.ncbi.nlm.nih.gov/38325063/">may not perceive the social world the same way</a> as a person without dementia. But a person living with dementia is not a child and should never be treated as one. Ensure all family, friends and care workers are <a href="https://www.alzheimerswa.org.au/wp-content/uploads/2017/07/2.00-Guidlines-for-Use-of-Dolls-and-Mechanized-Pets-as-a-Therapeutic-Tool-4-pages.pdf">informed about the attachment to the empathy doll</a> to help avoid unintentionally causing distress from inappropriate handling of the doll. If using an interactive doll, ensure spare batteries are on hand. Finally, it is important to reassess the attachment over time as the person’s response to the empathy doll may change.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/243589/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-doll-therapy-for-people-with-dementia-and-is-it-backed-by-science-243589">original article</a>. </div>

Mind

These 12 things can reduce your dementia risk – but many Australians don’t know them all

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/joyce-siette-1377445">Joyce Siette</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> and <a href="https://theconversation.com/profiles/laura-dodds-1378067">Laura Dodds</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Dementia is a <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/jan-may-2022">leading</a> cause of death in Australia. Although dementia mainly affects older people, it is an avoidable part of ageing. In fact, we all have the power to reduce our risk of developing dementia, no matter your age. Research shows your risk of developing dementia could be <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">reduced by up to 40%</a> (and even higher if you live in a <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30074-9/fulltext">low or middle-income country</a>) by addressing lifestyle factors such as healthy diet, exercise and alcohol consumption. But the first step to reducing population-wide dementia risk is to understand how well people understand the risk factors and the barriers they may face to making lifestyle changes. Our new <a href="https://www.mdpi.com/2673-9259/2/4/21/htm">paper</a>, published this week in the <a href="https://www.mdpi.com/2673-9259/2/4/21/htm">Journal of Ageing and Longevity</a>, found most older people are aware that dementia is a modifiable condition and that they have the power to change their dementia risk. We also found the key barrier to making brain healthy lifestyle choices was a lack of knowledge, which suggests a public awareness campaign is urgently needed. <h2>What we did</h2> We began by <a href="https://www.mdpi.com/2673-9259/2/4/21/htm">reviewing</a> the published research to identify 12 factors shown to reduce dementia risk. We surveyed 834 older Australians about their awareness of the 12 factors, which were: <ol> <li>having a mentally active lifestyle</li> <li>doing physical activity</li> <li>having a healthy diet</li> <li>having strong mental health</li> <li>not smoking</li> <li>not consuming alcohol</li> <li>controlling high blood pressure</li> <li>maintaining a healthy weight</li> <li>managing high cholesterol</li> <li>preventing heart disease</li> <li>not having kidney disease</li> <li>not having diabetes</li> </ol> <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">The Lancet</a> subsequently published its own list of factors that help reduce dementia risk, which covered much the same territory (but included a few others, such as reducing air pollution, treating hearing impairment and being socially engaged). Of course, there is no way to cut your dementia risk to zero. Some people do all the “right” things and still get dementia. But there is <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">good evidence</a> managing lifestyle factors help make it less likely you will get dementia over your lifetime. Our study shows many older Australians are quite aware, with over 75% able to correctly identify more than four of the factors in our list of 12. However, few were able to name the less well-known risk factors, such as preventing heart disease and health conditions like kidney disease. The good news is that close to half of the sample correctly identified more than six of the 12 protective factors, with mentally active lifestyle, physical activity and healthy diet in the top three spots. <h2>Two key issues</h2> Two things stood out as strongly linked with the ability to identify factors influencing dementia risk. Education was key. People who received more than 12 years of formal schooling were more likely to agree that dementia was a modifiable condition. We are first exposed to health management in our school years and thus more likely to form healthier habits. Age was the other key factor. Younger respondents (less than 75 years old) were able to accurately identify more protective factors compared to older respondents. This is why health promotion initiatives and public education efforts about dementia are vital (such as Dementia Awareness Month and <a href="https://www.memorywalk.com.au/">Memory, Walk and Jog initiatives</a>). <h2>How can these findings be used in practice?</h2> Our findings suggest we need to target education across the different age groups, from children to older Australians. This could involve a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ajag.13049">whole system approach</a>, from programs targeted at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858574/#:%7E:text=Family%20Coaching%20has%20specific%20goals,to%20problem%20solve%20challenging%20situations.">families</a>, to educational sessions for school-aged children, to involving GPs in awareness promotion. We also need to tackle barriers that hinder dementia risk reduction. This means doing activities that motivate you, finding programs that suit your needs and schedule, and are accessible. <h2>What does this mean for you?</h2> Reducing your dementia risk means recognising change starts with you. We are all familiar with the everyday challenges that stop us from starting an exercise program or sticking to a meal plan. There are simple and easy changes we can begin with. Our team has developed a program that can help. We are offering limited <a href="https://www.brainbootcamp.com.au/">free brain health boxes</a>, which include information resources and physical items such as a pedometer. These boxes aim to help rural Australians aged 55 years and over to adopt lifestyle changes that support healthy brain ageing. If you’re interested in signing up, visit our <a href="https://www.brainbootcamp.com.au">website</a>. Now is the time to think about your brain health. Let’s start now.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/191504/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/joyce-siette-1377445">Joyce Siette</a>, Research Theme Fellow, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> and <a href="https://theconversation.com/profiles/laura-dodds-1378067">Laura Dodds</a>, PhD Candidate, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/these-12-things-can-reduce-your-dementia-risk-but-many-australians-dont-know-them-all-191504">original article</a>. </div>

Mind

Music and dementia: researchers are still making discoveries about how songs can help sufferers

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/rebecca-atkinson-1288605">Rebecca Atkinson</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> and <a href="https://theconversation.com/profiles/ming-hung-hsu-2215063">Ming-Hung Hsu</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> Music is woven into the fabric of our everyday lives. Whether it’s lifting our spirits, pushing us to run faster or soothing us to sleep, we can all <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.713818/full">recognise its power</a>. So it’s no wonder it is increasingly being used in medical treatment. As well as proving very useful in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863265/">cancer treatment</a>, managing <a href="https://www.sciencedirect.com/science/article/pii/S1526590022000153">chronic pain</a> and even helping the brain <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2014.00245/full">recover after a stroke</a>, researchers have also been making great strides in using music to help patients with dementia. It reduces patients’ <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003477/full">anxiety and depression</a>, and <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00401-7/fulltext">improves wellbeing</a> both for them and their carers <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/individual-music-therapy-for-depression-randomised-controlled-trial/A1CD72904929CECCB956F4F3B09605AF">by enhancing</a> everyone’s ability to adapt and cope with adversity or stress. <a href="https://www.bamt.org">Music therapy</a> in the form of playing, singing or listening to music can also have a <a href="https://journals.sagepub.com/doi/abs/10.1177/1362361309105660">positive effect</a> on cognitive function – particularly for <a href="https://link.springer.com/article/10.1186/1472-6882-10-39">older adults</a> either with dementia or memory issues. So why does music appear to have such a powerful effect for people with dementia? <h2>Music and the brain</h2> About a decade ago, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1053811911013000">researchers discovered that</a> when people listened to music, multiple areas of the brain were involved in processing it. These included the limbic (which processes emotions and memory), cognitive (involved with perception, learning and reaction) and motor areas (responsible for voluntary movement). This challenged preconceptions that music was processed more narrowly in the brain – and helped explain why it has such a unique neurological impact. Not only that, research has shown that music might help <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306987708002880">regenerate the brain</a> and its connections. Many <a href="https://www.nhs.uk/conditions/dementia/about-dementia/causes/">causes of dementia</a> centre around cell death in the brain, raising the possibility that music could help people with dementia by mending or strengthening damaged neural connections and cells. It’s not just any music that has a regenerative effect on the brain, though. <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2016.00103/full">Familiar and favourite music</a> has been shown to have the biggest impact on the way we feel, and is closely linked with memory and emotions. This is because listening to our favourite songs <a href="https://www.nature.com/articles/nn.2726">releases feel-good hormones</a> that give us a sense of pleasure. Curated music playlists of favourite music could be the key in helping us deal with the <a href="https://journals.sagepub.com/doi/full/10.1177/10298649211030318">stress of everyday life</a>. This is relevant to Alzheimer’s and other forms of dementia because researchers have discovered that parts of the brain linked with <a href="https://academic.oup.com/brain/article/138/8/2438/330016">musical memories</a> are less affected by these conditions than other areas of the brain. This explains why memories and experiences that are linked to <a href="https://link.springer.com/article/10.14283/jpad.2018.19">favourite music</a> are often preserved for people with such conditions. Listening to music can also <a href="https://pubmed.ncbi.nlm.nih.gov/34346261/">help manage</a> their experiences of distress, agitation and “<a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/sundowning">sundowning</a>” – where a person is more confused in the afternoon and evening. In a <a href="https://www.sciencedirect.com/science/article/pii/S0197457224002209?utm_campaign=STMJ_219742_AUTH_SERV_PA&utm_medium=email&utm_acid=224973760&SIS_ID=&dgcid=STMJ_219742_AUTH_SERV_PA&CMX_ID=&utm_in=DM500444&utm_source=AC_">small study</a> conducted by us and our colleagues at the Cambridge Institute for Music Therapy Research, we showed just how great of an effect listening to music can have for people with dementia. We found that when people with dementia repeatedly listened to their favourite music, their heart rate and movements changed in direct response. This showed that people’s physical responses were affected by musical features like rhythm and arrangement. Their heart rate also changed when they sang along to music, or when they began reminiscing about old memories or stories while listening to a song or thinking about the music. These changes are important because they show how music affects movement, emotions and memory recall. Studies have also shown that during and after listening to music, people with dementia <a href="https://www.mdpi.com/2076-3425/13/7/1103">experienced less agitation</a>, aggression and anxiety, and their general mood was improved. They even needed less medication when they had regular music sessions. Other researchers have even begun testing the effects of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.4721?casa_token=VufeKQP7aNsAAAAA%3AMSOgiwUQYKqmmrLsUFv9glmSnc5BMxoqeMmmt3HX4BJX2Fs2UKeXjnN2850o1Umz0j1NvmrpQ3W3Pw">music training programmes</a> to support cognition for people with dementia. Results have been promising so far – with adults in the study showing improved executive functioning (problem solving, emotion regulation and attention) compared to those who took part in just physical exercise. So, music is likely to continue to be a useful medical treatment for people with dementia. But based on what we know so far, it’s important that it comes from the patient’s own music collection – and is used alongside other management techniques such as using drugs that can slow the progression of dementia or help manage symptoms to support self-care and wellbeing.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239446/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rebecca-atkinson-1288605">Rebecca Atkinson</a>, Researcher in Music Therapy, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> and <a href="https://theconversation.com/profiles/ming-hung-hsu-2215063">Ming-Hung Hsu</a>, Senior Research Fellow, Music Therapy, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/music-and-dementia-researchers-are-still-making-discoveries-about-how-songs-can-help-sufferers-239446">original article</a>. </div>

Mind

Demi Moore shares rare update on Bruce Willis' health

Demi Moore has shared a rare update on ex-husband Bruce Willis, as the actor battles frontotemporal dementia. The actress shared the update in an interview with Drew Barrymore on The Drew Barrymore Show, where she opened up about his health. She said she spends as much time as she can with Willis - who she was married to for 11 years and is the father of her three daughters - and his wife Emma Heming, with the blended family celebrating holidays and birthdays together. During the interview, Moore and Barrymore reminisced about their time working together on the 2003 film Charlie’s Angels: Full Throttle, where Willis made a special cameo. “When we did Charlie’s Angels, Bruce came and played on it, and he opens up the film,” Barrymore recalled, “And we got to work with him.” Barrymore went on to ask about his current health, noting she had known him for years, all the way back to his days as a barman. “I mean, I used to know him when he was a bartender at Cafe Central,” Barrymore said. “I’ve known him my whole life, too. How is he right now?” The actress provided a reassuring update: “Given the givens, he’s in a stable place.” Moore and Willis were married from 1987 to 2000 and share three daughters: Rumer, 36, Scout, 33, and Tallulah, 30. Moore also revealed details of how she supports their daughters as they cope with their father's health struggles. “What I say to my kids is you meet them where they’re at. You don’t hold on to who they were or what you want them to be, but who they are in this moment,” she explained. “And from that, there is such beauty and joy and loving and sweetness. “When I’m in LA, I go over every week, and I really treasure the time that we all share.” The Die Hard star was diagnosed with aphasia in March 2022 and almost a year later, his family shared that his condition had progressed to frontotemporal dementia. Image: Instagram

Caring

"I don't call that a life": Couple sign up to die in double suicide pod

Warning: This article contains sensitive content that some readers may find distressing. A couple from the UK has signed up to be the first to die in a double suicide pod, invented by an Australian doctor, after 46 years of marriage. Peter and Christine Scott, from Suffolk in England’s east, have shared their plans to travel to Switzerland to die together after Ms Scott, a former nurse, was diagnosed with early-stage vascular dementia. After meeting at a jazz club, the pair married 46 years ago, and shared that they have opted out of potentially years of hospital treatment and the crippling costs of care which could eat into their life savings. “We have had long, happy, healthy, fulfilled lives but here we are in old age and it does not do nice things to you,” Mr Scott, 86, told<a title="www.dailymail.co.uk" href="https://www.dailymail.co.uk/news/article-13825105/Former-RAF-engineer-nurse-wife-sign-British-couple-use-double-suicide-pod-Switzerland-dementia.html"> The Daily Mail</a>. “The idea of watching the slow degradation of Chris’s mental abilities in parallel to my own physical decline is horrific to me,” the former Royal Air Force pilot added. “Obviously I would care for her to the point I could not, but she has nursed enough people with dementia during her career to be adamant she wants to remain in control of herself and her life”. “I would not want to go on living without her,” he said of his 80-year-old wife. “I don’t want to go into care, to be lying in bed dribbling and incontinent – I don’t call that a life”. As English law does not allow for euthanasia, the couple have planned their trip to Switzerland for the procedure, where Ms Scott has planned out her final days with her husband. “I’d like to go walking with Peter in the Swiss Alps, by a river. I’d have a beautiful plate of fish for my last supper, and enjoy a great bottle of Merlot,” she said. “I’d make a playlist including Wild Cat Blues and The Young Ones by Cliff Richard and I’ve found a poem called Miss Me But Let Me Go, which sums up exactly how I feel”. The suicide pod, known as Sarco, can be turned on with a simple flick of a switch from inside the futuristic capsule that resembles a modern car. The machine was invented by Australian Dr Philip Nitschke, who has long been behind a number of initiatives to allow legal euthanasia in Australia. The 3D printed Sarco capsule ends the lives of those inside by pumping the pod with nitrogen which replaces the oxygen in the pod, which renders the occupants unconscious within about a minute without, its claimed, any panic or distress. With falling oxygen, the person eventually suffocates. Dr Nitschke said the machine is activated by a button from inside the pod. “The capsule for two people works exactly the same as the single Sarco but there is only one button so they will decide between them who will push it,” he told <a title="www.dailymail.co.uk" href="https://www.dailymail.co.uk/news/article-13825105/Former-RAF-engineer-nurse-wife-sign-British-couple-use-double-suicide-pod-Switzerland-dementia.html">The Daily Mail</a>. “Then they’ll be able to hold each other”. Image credits: Courtesy of Exit International

Legal

Hollywood legend dies at age 94

The Notebook star Gena Rowlands has passed await the age of 94 after a lengthy battle with Alzheimer's. Her death was confirmed today by representatives for her son, filmmaker Nick Cassavetes, who told TMZ that Rowlands died on Wednesday afternoon at her home in Indian Wells, California, surrounded by family including her husband Robert and daughter Alexandra Cassavetes. While no official cause of death has been announced, Rowlands had been suffering from Alzheimer's for five years. In June, director of The Notebook and Rowland's son Nick Cassavetes was discussing the film's 20th anniversary when he shared <a href="https://oversixty.com.au/health/caring/hollywood-star-s-heartbreaking-health-update" target="_blank" rel="noopener">details</a> of his mother's diagnosis and how it was reminiscent of her character in the movie. “I got my mum to play older Allie, and we spent a lot of time talking about Alzheimer’s and wanting to be authentic with it, and now, for the last five years, she’s had Alzheimer’s,” Cassavetes told <a href="https://ew.com/the-notebook-star-gena-rowlands-has-alzheimers-8668642">Entertainment Weekly</a> of Rowlands’ character, who also had dementia. “She’s in full dementia. And it’s so crazy — we lived it, she acted it, and now it’s on us.” Gena’s mother, fellow actress Lady Rowlands, had also suffered from the same disease. While The Notebook was Rowlands’ most notable 21st century role, the acting veteran broke into the industry in the 1950s and earned two Academy Award nominations and multiple Golden Globe and Emmy Award wins throughout her career. She was known for her frequent collaborations with actor-director husband John Cassavetes in ten films, including 1974’s A Woman Under the Influence and 1980s Gloria. Image credits: New Line Cinema/Demmie Todd/Warner Bros/Spring Creek/Kobal/Shutterstock Editorial <div class="more-coverage-v2" style="box-sizing: inherit; margin-bottom: 0px; border-top-width: 1px; border-top-style: solid; border-top-color: #e0e1e2; float: right; margin-left: 16px; max-width: 40%; padding: 16px 0px;"> </div>

Caring

Is it OK to lie to someone with dementia?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> There was disagreement on social media recently after a story <a href="https://x.com/HammondCare/status/1817738312372691046">was published</a> about an aged care provider creating “fake-away” burgers that mimicked those from a fast-food chain, to a resident living with dementia. The man had such strict food preferences he was <a href="https://www.hammond.com.au/resource-hub/smart-thinking-about-hamburgers-improved-life-for-one-man-living-with-severe-dementia-symptoms?utm_content=301880186&utm_medium=social&utm_source=twitter&hss_channel=tw-252995959">refusing to eat</a> anything at meals except a burger from the franchise. This dementia symptom risks malnutrition and social isolation. But <a href="https://helloleaders.com.au/article/the-dementia-debate-ignited-by-a-whopper-burger">critics</a> of the fake burger approach labelled it trickery and deception of a vulnerable person with cognitive impairment. Dementia is an illness that <a href="https://www.alz.org/alzheimers-dementia/10_signs">progressively robs us of memories</a>. Although it has many forms, it is typical for short-term recall – the memory of something that happened in recent hours or days – to be lost first. As the illness progresses, people may come to increasingly “live in the past”, as distant recall gradually becomes the only memories accessible to the person. So a person in the middle or later stages of the disease may relate to the world as it once was, not how it is today. This can make ethical care very challenging. <h2>Is it wrong to lie?</h2> Ethical approaches <a href="https://www.britannica.com/topic/deontological-ethics">classically</a> hold that specific actions are moral certainties, regardless of the consequences. In line with this moral absolutism, it is always wrong to lie. But this ethical approach would require an elderly woman with dementia who continually approaches care staff looking for their long-deceased spouse to be informed their husband has passed – the objective truth. Distress is the likely outcome, possibly accompanied by behavioural disturbance that could endanger the person or others. The person’s memory has regressed to a point earlier in their life, when their partner was still alive. To inform such a person of the death of their spouse, however gently, is to traumatise them. And with the memory of what they have just been told likely to quickly fade, and the questioning may resume soon after. If the truth is offered again, the cycle of re-traumatisation continues. <h2>A different approach</h2> Most laws are examples of absolutist ethics. One must obey the law at all times. Driving above the speed limit is likely to result in punishment regardless of whether one is in a hurry to pick their child up from kindergarten or not. Pragmatic ethics <a href="https://philonotes.com/2022/05/pragmatic-ethics-meaning-nature-and-dynamics#google_vignette">rejects</a> the notion certain acts are always morally right or wrong. Instead, acts are evaluated in terms of their “usefulness” and social benefit, humanity, compassion or intent. The <a href="https://www.health.gov.au/topics/aged-care/about-aged-care/aged-care-laws-in-australia#aged-care-act">Aged Care Act</a> is a set of laws intended to guide the actions of aged care providers. It says, for example, <a href="https://www.agedcarequality.gov.au/resource-library/psychotropic-medications-used-australia-information-aged-care">psychotropic drugs</a> (medications that affect mind and mood) should be the “last resort” in managing the behaviours and psychological symptoms of dementia. Instead, “best practice” involves preventing behaviour before it occurs. If one can reasonably foresee a caregiver action is likely to result in behavioural disturbance, it flies in the face of best practice. <h2>What to say when you can’t avoid a lie?</h2> What then, becomes the best response when approached by the lady looking for her husband? Gentle inquiries may help uncover an underlying emotional need, and point caregivers in the right direction to meet that need. Perhaps she is feeling lonely or anxious and has become focused on her husband’s whereabouts? A skilled caregiver might tailor their response, connect with her, perhaps reminisce, and providing a sense of comfort in the process. This approach aligns with <a href="https://www.dementia.org.au/news/it-ever-okay-lie-someone-living-dementia">Dementia Australia guidance</a> that carers or loved ones can use four prompts in such scenarios: <ul> <li> acknowledge concern (“I can tell you’d like him to be here.”) </li> <li> suggest an alternative (“He can’t visit right now.”) </li> <li> provide reassurance (“I’m here and lots of people care about you.”) </li> <li> redirect focus (“Perhaps a walk outside or a cup of tea?”) </li> </ul> These things may or may not work. So, in the face of repeated questions and escalating distress, a mistruth, such as “Don’t worry, he’ll be back soon,” may be the most humane response in the circumstances. <h2>Different realities</h2> It is often said you can never win an argument with a person living with dementia. A lot of time, different realities are being discussed. So, providing someone who has dementia with a “pretend” burger may well satisfy their preferences, bring joy, mitigate the risk of malnutrition, improve social engagement, and prevent a behavioural disturbance without the use of medication. This seems like the correct approach in ethical terms. On occasion, the end justifies the means.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236229/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/is-it-ok-to-lie-to-someone-with-dementia-236229">original article</a>. </div>

Mind

Could the shingles vaccine lower your risk of dementia?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/ibrahim-javed-1552271">Ibrahim Javed</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> A <a href="https://www.nature.com/articles/s41591-024-03201-5">recent study</a> has suggested Shingrix, a relatively new vaccine given to protect older adults against shingles, may delay the onset of dementia. This might seem like a bizarre link, but actually, <a href="https://pubmed.ncbi.nlm.nih.gov/34697158/">research</a> has previously shown an older version of the shingles vaccine, Zostavax, reduced the risk of dementia. In this new study, published last week in the journal Nature Medicine, researchers from the United Kingdom found Shingrix delayed dementia onset by 17% compared with Zostavax. So how did the researchers work this out, and how could a shingles vaccine affect dementia risk? <h2>From Zostavax to Shingrix</h2> Shingles is a viral infection caused by the varicella-zoster virus. It causes <a href="https://www.healthdirect.gov.au/shingles">painful rashes</a>, and affects older people in particular. Previously, Zostavax was used to vaccinate against shingles. It was administered as a single shot and provided good protection for about <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/zoster-herpes-zoster">five years</a>. Shingrix has been developed based on a newer vaccine technology, and is thought to offer stronger and longer-lasting protection. Given in two doses, it’s now the preferred option for shingles vaccination in Australia and elsewhere. In November 2023, Shingrix replaced Zostavax on the <a href="https://www.health.gov.au/news/national-immunisation-program-changes-to-shingles-vaccination-from-1-november-2023">National Immunisation Program</a>, making it available for free to those at highest risk of complications from shingles. This includes all adults aged 65 and over, First Nations people aged 50 and older, and younger adults with certain medical conditions that affect their immune systems. <h2>What the study found</h2> Shingrix was approved by the US Food and Drugs Administration in <a href="https://www.drugs.com/history/shingrix.html">October 2017</a>. The researchers in the new study used the transition from Zostavax to Shingrix in the United States as an opportunity for research. They selected 103,837 people who received Zostavax (between October 2014 and September 2017) and compared them with 103,837 people who received Shingrix (between November 2017 and October 2020). By analysing data from electronic health records, they found people who received Shingrix had a 17% increase in “diagnosis-free time” during the follow-up period (up to six years after vaccination) compared with those who received Zostavax. This was equivalent to an average of 164 extra days without a dementia diagnosis. The researchers also compared the shingles vaccines to other vaccines: influenza, and a combined vaccine for tetanus, diphtheria and pertussis. Shingrix and Zostavax performed around 14–27% better in lowering the risk of a dementia diagnosis, with Shingrix associated with a greater improvement. The benefits of Shingrix in terms of dementia risk were significant for both sexes, but more pronounced for women. This is not entirely surprising, because we know women have <a href="https://www.alzheimers.org.uk/blog/why-dementia-different-women">a higher risk</a> of developing dementia due to interplay of biological factors. These include being more sensitive to certain genetic mutations associated with dementia and hormonal differences. <h2>Why the link?</h2> The idea that vaccination against viral infection can lower the risk of dementia has been around for more than two decades. Associations have been <a href="https://pubmed.ncbi.nlm.nih.gov/11762573/">observed</a> between vaccines, such as those for diphtheria, tetanus, polio and influenza, and subsequent dementia risk. Research has shown Zostavax vaccination can <a href="https://bmjopen.bmj.com/content/11/10/e045871">reduce the risk</a> of developing dementia by 20% compared with people who are unvaccinated. But it may not be that the vaccines themselves protect against dementia. Rather, it may be the resulting lack of viral infection creating this effect. Research indicates bacterial infections in the gut, as well as viral infections, are associated with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10169152/">higher risk of dementia</a>. Notably, untreated infections with herpes simplex (herpes) virus – closely related to the varicella-zoster virus that causes shingles – can <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/trc2.12119">significantly increase</a> the risk of developing dementia. Research has also shown shingles increases the risk of a later dementia diagnosis. The mechanism is not entirely clear. But there are two potential pathways which may help us understand why infections could increase the risk of dementia. First, certain molecules are produced when a baby is developing in the womb to help with the body’s development. These molecules have the potential to cause inflammation and accelerate ageing, so the production of these molecules is silenced around birth. However, viral infections such as shingles can <a href="https://doi.org/10.1016/j.virol.2018.07.011">reactivate</a> the production of these molecules in adult life which could <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717685/#:%7E:text=The%20disease%20mechanisms%20of%20AD,may%20lead%20to%20new%20therapies.">hypothetically lead to dementia</a>. Second, in Alzheimer’s disease, a specific protein called Amyloid-β go rogue and kill brain cells. Certain proteins produced by viruses <a href="https://www.biorxiv.org/content/10.1101/2024.05.16.594465v1">such as COVID</a> and <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/advs.202001299">bad gut bacteria</a> have the potential to support Amyloid-β in its toxic form. In laboratory conditions, these proteins have been shown to <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1003537">accelerate the onset</a> of dementia. <h2>What does this all mean?</h2> With an ageing population, the burden of dementia is only likely to become greater in the years to come. There’s a lot more we have to learn about the causes of the disease and what we can potentially do to prevent and treat it. This new study has some limitations. For example, time without a diagnosis doesn’t necessarily mean time without disease. Some people may have underlying disease with delayed diagnosis. This research indicates Shingrix could have a silent benefit, but it’s too early to suggest we can use antiviral vaccines to prevent dementia. Overall, we need more research exploring in greater detail how infections are linked with dementia. This will help us understand the root causes of dementia and design potential therapies.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/235597/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ibrahim-javed-1552271">Ibrahim Javed</a>, Enterprise and NHMRC Emerging Leadership Fellow, UniSA Clinical & Health Sciences, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/could-the-shingles-vaccine-lower-your-risk-of-dementia-235597">original article</a>. </div>

Mind

Major breakthrough holds the key to diagnosing Alzheimer's

A new study has found that a simple blood test could be key to diagnosing Alzheimer's more quickly and more accurately. The research, published on the Journal of the American Medical Association, was conducted by a team of scientists at Sweden’s Lund University, was based off 1213 patients there with the condition. They found that a blood test could correctly identify whether patients with memory problems had Alzheimer’s 90 per cent of the time – making it “significantly” more accurate than cognitive tests and CAT scans in diagnosing the condition. The test itself measures tau protein 217, which if there is an abnormal build up of both in and around brain cells, may be the cause of the disease. “Increases in p tau-217 concentrations in the blood are quite profound in Alzheimer’s disease,” study co-author, Lund University associate professor and senior consultant neurologist, Dr Sebastian Palmqvist, told CNN. “At the dementia stage of the disease, levels are more than eight times higher compared with elderly (people) without Alzheimer’s.” As part of the study, the p tau-217 test was combined with one testing for another blood biomarker for Alzheimer’s called the amyloid 42/40 ratio. Other doctors have shared their thoughts on the research findings, with Chief science officer of America’s Alzheimer’s Association, Dr Maria Carrillo, telling CNN that doctors would “love to have a blood test that can be used in a primary care physician’s office, functioning like a cholesterol test but for Alzheimer’s”. “The p tau-217 blood test is turning out to be the most specific for Alzheimer’s and the one with the most validity. It seems to be the frontrunner,” she added. Blood tests like this could “change the game in the speed in which we can conduct Alzheimer’s trials and get to the next new medication”. Dr Jason Karlawish, the co-director at the University of Pennsylvania’s Penn Memory Centre, said of the research: “Not too long ago measuring pathology in the brain of a living human was considered just impossible.” “This study adds to the revolution that has occurred in our ability to measure what’s going on in the brain of living humans.” Image: Shutterstock

Caring

What’s the difference between Alzheimer’s and dementia?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Changes in thinking and memory as we age can occur for a variety of reasons. These changes are <a href="https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/memory-problems-forgetfulness-and-aging#changes">not always cause for concern</a>. But when they begin to disrupt daily life, it could indicate the first signs of dementia. Another term that can crop up when we’re talking about dementia is Alzheimer’s disease, or Alzheimer’s for short. So what’s the difference? <h2>What is dementia?</h2> Dementia is an umbrella term used to describe a range of syndromes that result in changes in memory, thinking and/or behaviour due to degeneration in the brain. To meet the <a href="https://alz-journals.onlinelibrary.wiley.com/doi/epdf/10.1016/j.jalz.2011.03.005">criteria</a> for dementia these changes must be sufficiently pronounced to interfere with usual activities and are present in at least two different aspects of thinking or memory. For example, someone might have trouble remembering to pay bills and become lost in previously familiar areas. It’s less-well known that dementia can also occur in <a href="https://www.childhooddementia.org/what-is-childhood-dementia">children</a>. This is due to progressive brain damage associated with more than 100 rare genetic disorders. This can result in similar cognitive changes as we see in adults. <h2>So what’s Alzheimer’s then?</h2> <a href="https://www.alz.org/alzheimers-dementia/what-is-alzheimers">Alzheimer’s</a> is the most common type of dementia, accounting for <a href="https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12068">about 60-80%</a> of cases. So it’s not surprising many people use the terms dementia and Alzheimer’s interchangeably. Changes in memory are the most common sign of Alzheimer’s and it’s what the public <a href="https://alzres.biomedcentral.com/articles/10.1186/s13195-023-01219-4">most often</a> associates with it. For instance, someone with Alzheimer’s may have trouble recalling recent events or keeping track of what day or month it is. We still don’t know exactly what <a href="https://link.springer.com/article/10.1134/s002689332104004x">causes Alzheimer’s</a>. However, we do know it is associated with a build-up in the brain of two types of protein called <a href="https://www.dementiasplatform.uk/news-and-media/blog/amyloid-and-tau-the-proteins-involved-in-dementia">amyloid-β and tau</a>. While we all have some amyloid-β, when too much builds up in the brain it clumps together, forming plaques in the spaces between cells. These plaques cause damage (inflammation) to surrounding brain cells and leads to disruption in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468450/">tau</a>. Tau forms part of the structure of brain cells but in Alzheimer’s tau proteins become “tangled”. This is toxic to the cells, causing them to die. A <a href="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad180583">feedback loop</a> is then thought to occur, triggering production of more amyloid-β and more abnormal tau, perpetuating damage to brain cells. Alzheimer’s can also occur with other forms of dementia, such as <a href="https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793">vascular dementia</a>. This combination is the most common example of a <a href="https://www.dementiauk.org/information-and-support/types-of-dementia/mixed-dementia/">mixed dementia</a>. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" alt="" /></a><figcaption></figcaption></figure> <h2>Vascular dementia</h2> The second most common type of dementia is <a href="https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793">vascular dementia</a>. This results from disrupted blood flow to the brain. Because the changes in blood flow can occur throughout the brain, signs of vascular dementia can be more varied than the memory changes typically seen in Alzheimer’s. For example, vascular dementia may present as general confusion, slowed thinking, or difficulty organising thoughts and actions. Your <a href="https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793">risk of vascular dementia</a> is greater if you have heart disease or high blood pressure. <h2>Frontotemporal dementia</h2> Some people may not realise that dementia can also affect behaviour and/or language. We see this in different forms of frontotemporal dementia. The behavioural variant of <a href="https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.20090238#:%7E:text=The%20behavioral%20variant%20of%20frontotemporal,often%20delayed%20for%20several%20years.">frontotemporal dementia</a> is the second most common form (after Alzheimer’s disease) of <a href="https://www.healthdirect.gov.au/younger-onset-dementia">younger onset dementia</a> (dementia in people under 65). People living with this may have difficulties in interpreting and appropriately responding to social situations. For example, they may make uncharacteristically rude or offensive comments or invade people’s personal space. <a href="https://www.sciencedirect.com/topics/neuroscience/semantic-dementia">Semantic dementia</a> is also a type of frontotemporal dementia and results in difficulty with understanding the meaning of words and naming everyday objects. <h2>Dementia with Lewy bodies</h2> <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies">Dementia with Lewy bodies</a> results from dysregulation of a different type of protein known as α-synuclein. We often see this in people with Parkinson’s disease. So people with this type of dementia may have altered movement, such as a stooped posture, shuffling walk, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428504/">changes in handwriting</a>. Other symptoms include changes in alertness, visual hallucinations and significant <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029467/">disruption to sleep</a>. <h2>Do I have dementia and if so, which type?</h2> If you or someone close to you is concerned, the first thing to do is to <a href="https://cdpc.sydney.edu.au/research/clinical-guidelines-for-dementia/">speak to your GP</a>. They will likely ask you some questions about your medical history and what changes you have noticed. Sometimes it might not be clear if you have dementia when you first speak to your doctor. They may suggest you watch for changes or they may refer you to a specialist for <a href="https://www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis#diagnosis">further tests</a>. There is no single test to clearly show if you have dementia, or the type of dementia. A diagnosis comes after multiple tests, including brain scans, tests of memory and thinking, and consideration of how these changes impact your daily life. Not knowing what is happening can be a challenging time so it is important to speak to someone about how you are feeling or to reach out to <a href="https://www.dementia.org.au/get-support/national-dementia-helpline">support services</a>. <h2>Dementia is diverse</h2> As well as the different forms of dementia, everyone experiences dementia in different ways. For example, the speed dementia progresses varies a lot from person to person. Some people will continue to <a href="https://livingwellwithdementia.org.au">live well with dementia</a> for some time while others may decline more quickly. There is still significant <a href="https://academic.oup.com/gerontologist/article-abstract/64/5/gnad130/7281753">stigma</a> surrounding dementia. So by learning more about the various types of dementia and understanding differences in how dementia progresses we can all do our part to create a more <a href="https://www.dementiafriendly.org.au/">dementia-friendly community</a>. <hr /> The <a href="https://www.dementia.org.au/get-support/national-dementia-helpline">National Dementia Helpline</a> (1800 100 500) provides information and support for people living with dementia and their carers. To learn more about dementia, you can take this <a href="https://www.utas.edu.au/wicking/understanding-dementia">free online course</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225271/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-alzheimers-and-dementia-225271">original article</a>. </div>

Mind

Bruce Willis' daughter shares rare update on star's health

Bruce Willis' daughter has opened up about her family life in her latest interview with Today's Hoda Kotb. The actor's eldest daughter Rumer Willis shared that the actor is in good spirits, saying that "he's so good," despite his dementia. She added that he continues to be a wonderful grandfather to her infant daughter Louetta, and that seeing her parents Bruce and ex-wife Demi Moore, as grandparents is "so nice". "Honestly seeing them with her it just it almost unlocks all of these childhood memories because being a grandparent I think is the best," she told Kotb. "They have all of the love and joy without any of the responsibility," she laughed before adding, "so they get to just spoil her." She then elaborated on the special bond that Bruce shares with his granddaughter Louetta, and the sweet moments that they shared during their last visit. "Lou is just starting to walk a little bit and she was walking over to him and it was so sweet," she explained. "It's so nice because I feel like my dad is just like he's a girl dad through and through." She added that "he's so sweet with her" and his relationship with Lou reminded her of how he was with her little sisters. Bruce has been battling frontotemporal dementia since 2022, but despite the challenges, the family is feeling the love, as Rumer revealed that a lot of people have stopped her in public to share their love for Bruce and the impact he's had on their lives. "It's such a testament to who he is," she said. "He's so beloved." "It really makes me a proud daughter to just see how much love he's getting." Images: Instagram

Caring

Want to reduce your dementia risk? Eat these 4 foods, says new study

If you are what you eat, this might make you hungrier for foods that are bright in every sense. Research has shown that living, vibrant foods can slow down aging at a cellular level; while fruit and vegetables in particular have been associated with lower incidence of cognitive decline as individuals age. However, research has been relatively lacking on just how much of these brain-healthy foods you really need and which fruit and vegetables are best for the job. In collaboration with public health experts at Harvard University, medical researchers at China’s Zhejiang University School of Medicine conducted a meta-analysis that’s slated to be published in the June 2024 issue of The Journal of Nutrition, Health, and Aging. They combined data from two large-scale population-representative studies that analysed the diets and cognitive function of more than 10,000 participants ages 55 and older from China and the US. <h2>What daily diets revealed</h2> The data included diet questionnaires that honed in on the average of participants’ total daily intake of several different types of foods, including fruit and vegetables, and also broke them down into sub-types like green leafy vegetables and berries. Over a period of five years, the participants also took part in activities designed to assess their cognitive function and the average rate of cognitive decline. Overall, participants who included the most fruit and vegetables in their daily diets performed best on the brain tests and maintained those results over time. This suggested that both fruit and vegetables had protective elements that slowed cognitive decline. <h2>Vegetables that help protect cognition</h2> Interestingly, certain types of vegetables appeared to be more beneficial than others—say the researchers: “Our findings support the potential beneficial roles of VF, especially cruciferous vegetables, green leafy vegetables, and red and yellow vegetables, in maintaining cognitive function and slowing cognitive decline in middle-aged and older adults.” The researchers pointed to several reasons these particular vegetables might have shown a substantial impact, including anti-inflammatory and antioxidation nutrients like flavonoids and various vitamins or even gut improvements that have been shown to help improve or protect cognition. While beans didn’t figure prominently in both studies, they showed a protective element in the US study, so they are also worth keeping on your plate. (Beans are also thought to be one of the top foods for longevity.) <h2>Fruit that pack a punch</h2> As for fruit, while some didn’t show as much of a protective effect across the board, berries and apples are two examples of fruit that experts have previously said provide major polyphenol and antioxidant effect. Participants whose brains maintained performance were shown to have eaten three or more servings of vegetables and two or more servings of fruit per day. This is on par with the five servings of vegetables and two servings of fruit recommended we eat every day. Image credits: Shutterstock This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/want-to-reduce-your-dementia-risk-eat-these-4-foods-says-new-study" target="_blank" rel="noopener">Reader's Digest</a>.

Mind

People with dementia aren’t currently eligible for voluntary assisted dying. Should they be?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/ben-white-15387">Ben White</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>; <a href="https://theconversation.com/profiles/casey-haining-1486290">Casey Haining</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>; <a href="https://theconversation.com/profiles/lindy-willmott-15386">Lindy Willmott</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>, and <a href="https://theconversation.com/profiles/rachel-feeney-140352">Rachel Feeney</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a> Dementia is the <a href="https://www.dementia.org.au/about-dementia">second leading cause of death</a> for Australians aged over 65. More than 421,000 Australians <a href="https://www.dementia.org.au/about-dementia">currently live with dementia</a> and this figure is expected to almost double in the next 30 years. There is ongoing public <a href="https://www.mja.com.au/journal/2024/220/9/should-voluntary-assisted-dying-victoria-be-extended-encompass-people-dementia">discussion</a> about whether dementia should be a qualifying illness under Australian voluntary assisted dying laws. Voluntary assisted dying is <a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2023/12/Issue-464-10-Waller-et-al.pdf">now lawful in all six states</a>, but is not available for a person living with dementia. The Australian Capital Territory has <a href="https://www.canberratimes.com.au/story/8631104/marisa-paterson-to-consult-on-voluntary-assisted-dying-amendments/?cs=14329">begun debating</a> its voluntary assisted dying bill in parliament but the government has <a href="https://www.legislation.act.gov.au/DownloadFile/es/db_68610/current/PDF/db_68610.PDF">ruled out</a> access for dementia. Its view is that a person should retain decision-making capacity throughout the process. But the bill includes a requirement to <a href="https://www.legislation.act.gov.au/b/db_68609/">revisit the issue</a> in three years. The Northern Territory is also considering reform and <a href="https://www.theaustralian.com.au/subscribe/news/1/?sourceCode=TAWEB_WRE170_a_GGL&dest=https%3A%2F%2Fwww.theaustralian.com.au%2Fnation%2Fpolitics%2Fconcerning-territory-nt-surveys-public-support-on-euthanasia-for-mentally-ill%2Fnews-story%2F4e45111bb293af4cf32ac3c6df058869&memtype=anonymous&mode=premium&v21=GROUPA-Segment-2-NOSCORE&V21spcbehaviour=append">has invited views</a> on access to voluntary assisted dying for dementia. Several public figures have also entered the debate. Most recently, former Australian Chief Scientist, Ian Chubb, <a href="https://www.abc.net.au/listen/programs/melbourne-drive/voluntary-assisted-dying-dementia-victoria/103467864">called for the law to be widened</a> to allow access. Others <a href="https://www.smh.com.au/national/voluntary-assisted-dying-should-not-be-available-to-dementia-patients-20230607-p5deqo.html">argue</a> permitting voluntary assisted dying for dementia would present unacceptable risks to this vulnerable group. <h2>Australian laws exclude access for dementia</h2> Current Australian voluntary assisted dying laws <a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2023/12/Issue-464-10-Waller-et-al.pdf">exclude access</a> for people who seek to qualify because they have dementia. In New South Wales, the <a href="https://legislation.nsw.gov.au/view/html/inforce/current/act-2022-017">law specifically states</a> this. In the other states, this occurs through a <a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2022/04/Issue-451-White-et-al.pdf">combination of the eligibility criteria</a>: a person whose dementia is so advanced that they are likely to die within the 12 month timeframe would be highly unlikely to retain the necessary decision-making capacity to request voluntary assisted dying. This does not mean people who have dementia cannot access voluntary assisted dying if they also have a terminal illness. For example, a person who retains decision-making capacity in the early stages of Alzheimer’s disease with terminal cancer may access voluntary assisted dying. <h2>What happens internationally?</h2> Voluntary assisted dying laws in some other countries allow access for people living with dementia. One mechanism, used in the Netherlands, is through <a href="https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.16692">advance directives or advance requests</a>. This means a person can specify in advance the conditions under which they would want to have voluntary assisted dying when they no longer have decision-making capacity. This approach depends on the person’s family identifying when those conditions have been satisfied, generally in consultation with the person’s doctor. Another approach to accessing voluntary assisted dying is to allow a person with dementia to choose to access it while they still have capacity. This involves regularly assessing capacity so that just before the person is predicted to lose the ability to make a decision about voluntary assisted dying, they can seek assistance to die. In Canada, this has been referred to as the “<a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2022/04/Issue-451-White-et-al.pdf">ten minutes to midnight</a>” approach. <h2>But these approaches have challenges</h2> International experience reveals these approaches have limitations. For advance directives, it can be difficult to specify the conditions for activating the advance directive accurately. It also requires a family member to initiate this with the doctor. Evidence also shows doctors are <a href="https://link.springer.com/article/10.1186/1472-6939-16-7">reluctant</a> to act on advance directives. Particularly challenging are <a href="https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-019-0401-y">scenarios</a> where a person with dementia who requested voluntary assisted dying in an advance directive later appears happy and content, or no longer expresses a desire to access voluntary assisted dying. Allowing access for people with dementia who retain decision-making capacity also has practical problems. Despite regular assessments, a person may lose capacity in between them, meaning they miss the window before midnight to choose voluntary assisted dying. These capacity assessments can also be very complex. Also, under this approach, a person is required to make such a decision at an early stage in their illness and may lose years of otherwise enjoyable life. Some also argue that regardless of the approach taken, allowing access to voluntary assisted dying would involve unacceptable risks to a vulnerable group. <h2>More thought is needed before changing our laws</h2> There is <a href="https://www.parliament.qld.gov.au/Documents/TableOffice/TabledPapers/2020/5620T490.pdf">public demand</a> to allow access to voluntary assisted dying for dementia in Australia. The mandatory reviews of voluntary assisted dying legislation <a href="https://www.publish.csiro.au/ah/pdf/AH23005">present an opportunity</a> to consider such reform. These reviews generally happen after three to five years, and in some states they will occur regularly. The scope of these reviews can vary and sometimes governments may not wish to consider changes to the legislation. But the Queensland review “<a href="https://www.legislation.qld.gov.au/view/pdf/asmade/act-2021-017">must include a review of the eligibility criteria</a>”. And the ACT bill requires the review to <a href="https://www.legislation.act.gov.au/b/db_68609/">consider</a> “advanced care planning”. Both reviews would require consideration of who is able to access voluntary assisted dying, which opens the door for people living with dementia. This is particularly so for the ACT review, as advance care planning means allowing people to request voluntary assisted dying in the future when they have lost capacity. This is a complex issue, and more thinking is needed about whether this public desire for voluntary assisted dying for dementia should be implemented. And, if so, how the practice could occur safely, and in a way that is acceptable to the health professionals who will be asked to provide it. This will require a careful review of existing international models and their practical implementation as well as what would be feasible and appropriate in Australia. Any future law reform should be <a href="https://www.publish.csiro.au/AH/AH19201">evidence-based</a> and draw on the views of people living with dementia, their family caregivers, and the health professionals who would be relied on to support these decisions.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224075/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ben-white-15387">Ben White</a>, Professor of End-of-Life Law and Regulation, Australian Centre for Health Law Research, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>; <a href="https://theconversation.com/profiles/casey-haining-1486290">Casey Haining</a>, Research Fellow, Australian Centre for Health Law Research, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>; <a href="https://theconversation.com/profiles/lindy-willmott-15386">Lindy Willmott</a>, Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>, and <a href="https://theconversation.com/profiles/rachel-feeney-140352">Rachel Feeney</a>, Postdoctoral research fellow, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/people-with-dementia-arent-currently-eligible-for-voluntary-assisted-dying-should-they-be-224075">original article</a>. </div>

Caring

Kick up your heels – ballroom dancing offers benefits to the aging brain and could help stave off dementia

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/helena-blumen-1231899">Helena Blumen</a>, <a href="https://theconversation.com/institutions/albert-einstein-college-of-medicine-3638">Albert Einstein College of Medicine</a> <h2>The big idea</h2> Social ballroom dancing can improve cognitive functions and reduce brain atrophy in older adults who are at increased risk for Alzheimer’s disease and other forms of dementia. That’s the key finding of my team’s <a href="https://doi.org/10.1123/japa.2022-0176">recently published study</a> in the Journal of Aging and Physical Activity. In our study, we enrolled 25 adults over 65 years of age in either six months of twice-weekly ballroom dancing classes or six months of twice-weekly treadmill walking classes. None of them were engaged in formal dancing or other exercise programs. The overall goal was to see how each experience affected cognitive function and brain health. While none of the study volunteers had a dementia diagnosis, all performed a bit lower than expected on at least one of our dementia screening tests. We found that older adults that completed six months of social dancing and those that completed six months of treadmill walking improved their executive functioning – an umbrella term for planning, reasoning and processing tasks that require attention. Dancing, however, generated significantly greater improvements than treadmill walking on one measure of executive function and on processing speed, which is the time it takes to respond to or process information. Compared with walking, dancing was also associated with reduced brain atrophy in the hippocampus – a brain region that is key to memory functioning and is particularly affected by Alzheimer’s disease. Researchers also know that this part of our brain can undergo neurogenesis – or grow new neurons – <a href="https://doi.org/10.1073/pnas.0611721104">in response to aerobic exercise</a>. <figure><iframe src="https://www.youtube.com/embed/unmbhUvnGow?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Research shows those who regularly dance with a partner have a more positive outlook on life.</figcaption></figure> While several previous studies suggest that dancing has beneficial effects <a href="https://doi.org/10.1093/ageing/afaa270">on cognitive function in older adults</a>, only a few studies have compared it directly with traditional exercises. Our study is the first to observe both better cognitive function and improved brain health following dancing than walking in older adults at risk for dementia. We think that social dancing may be more beneficial than walking because it is physically, socially and cognitively demanding – and therefore strengthens a wide network of brain regions. While dancing, you’re not only using brain regions that are important for physical movement. You’re also relying on brain regions that are important for interacting and adapting to the movements of your dancing partner, as well as those necessary for learning new dance steps or remembering those you’ve learned already. <h2>Why it matters</h2> Nearly 6 million older adults in the U.S. and 55 million worldwide <a href="https://doi.org/10.1016/j.jalz.2019.01.010">have Alzheimer’s disease</a> or a <a href="https://www.who.int/news-room/fact-sheets/detail/dementia">related dementia</a>, yet there is no cure. Sadly, the efficacy and ethics surrounding recently developed drug treatments <a href="https://doi.org/10.1080/21507740.2022.2129858">are still under debate</a>. The good news is that older adults can potentially <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">lower their risk for dementia</a> through lifestyle interventions, even later in life. These include reducing social isolation and physical inactivity. Social ballroom dancing targets both isolation and inactivity. In these later stages of the COVID-19 pandemic, a better understanding of the <a href="https://doi.org/10.1177/23337214211005223">indirect effects of COVID-19</a> – particularly those that increase dementia risk, such as social isolation – is urgently needed. In my view, early intervention is critical to prevent dementia from becoming the next pandemic. Social dancing could be a particularly timely way to overcome the adverse cognitive and brain effects associated with isolation and fewer social interactions during the pandemic. <h2>What still isn’t known</h2> Traditional aerobic exercise interventions such as treadmill-walking or running have been shown to lead to modest but reliable improvements in cognition – <a href="https://doi.org/10.1177/1745691617707316">particularly in executive function</a>. My team’s study builds on that research and provides preliminary evidence that not all exercise is equal when it comes to brain health. Yet our sample size was quite small, and larger studies are needed to confirm these initial findings. Additional studies are also needed to determine the optimal length, frequency and intensity of dancing classes that may result in positive changes. Lifestyle interventions like social ballroom dancing are a promising, noninvasive and cost-effective path toward staving off dementia as we – eventually – leave the COVID-19 pandemic behind.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/194969/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/helena-blumen-1231899">Helena Blumen</a>, Associate Professor of Medicine and Neurology, <a href="https://theconversation.com/institutions/albert-einstein-college-of-medicine-3638">Albert Einstein College of Medicine</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/kick-up-your-heels-ballroom-dancing-offers-benefits-to-the-aging-brain-and-could-help-stave-off-dementia-194969">original article</a>. </div>

Mind

Terminal lucidity: why do loved ones with dementia sometimes ‘come back’ before death?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/yen-ying-lim-355185">Yen Ying Lim</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/diny-thomson-1519736">Diny Thomson</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Dementia is often described as “the long goodbye”. Although the person is still alive, dementia slowly and irreversibly chips away at their memories and the qualities that make someone “them”. Dementia eventually takes away the person’s ability to communicate, eat and drink on their own, understand where they are, and recognise family members. Since as early as the <a href="https://pubmed.ncbi.nlm.nih.gov/21764150/">19th century</a>, stories from loved ones, caregivers and health-care workers have described some people with dementia suddenly becoming lucid. They have described the person engaging in meaningful conversation, sharing memories that were assumed to have been lost, making jokes, and even requesting meals. It is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/20010032/">43% of people</a> who experience this brief lucidity die within 24 hours, and 84% within a week. Why does this happen? <h2>Terminal lucidity or paradoxical lucidity?</h2> In 2009, researchers Michael Nahm and Bruce Greyson coined the term “<a href="https://pubmed.ncbi.nlm.nih.gov/21764150/">terminal lucidity</a>”, since these lucid episodes often occurred shortly before death. But not all lucid episodes indicate death is imminent. <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.13667">One study</a> found many people with advanced dementia will show brief glimmers of their old selves more than six months before death. Lucidity has also been <a href="https://www.sciencedirect.com/science/article/pii/S0167494311001865?via%3Dihub">reported</a> in other conditions that affect the brain or thinking skills, such as meningitis, schizophrenia, and in people with brain tumours or who have sustained a brain injury. Moments of lucidity that do not necessarily indicate death are sometimes called <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12579">paradoxical lucidity</a>. It is considered paradoxical as it defies the expected course of neurodegenerative diseases such as dementia. But it’s important to note these episodes of lucidity are temporary and sadly do not represent a reversal of neurodegenerative disease. <h2>Why does terminal lucidity happen?</h2> Scientists have struggled to explain why terminal lucidity happens. Some episodes of lucidity have been reported to occur in the presence of loved ones. Others have reported that <a href="https://psywb.springeropen.com/articles/10.1186/s13612-014-0024-5">music can sometimes improve lucidity</a>. But many episodes of lucidity do not have a distinct trigger. <a href="https://www.sciencedirect.com/science/article/pii/S0300957223002162">A research team from New York University</a> speculated that changes in brain activity before death may cause terminal lucidity. But this doesn’t fully explain why people suddenly recover abilities that were assumed to be lost. Paradoxical and terminal lucidity are also very difficult to study. Not everyone with advanced dementia will experience episodes of lucidity before death. Lucid episodes are also unpredictable and typically occur without a particular trigger. And as terminal lucidity can be a joyous time for those who witness the episode, it would be unethical for scientists to use that time to conduct their research. At the time of death, it’s also difficult for scientists to interview caregivers about any lucid moments that may have occurred. Explanations for terminal lucidity extend beyond science. These moments of mental clarity may be a way for the dying person to say final goodbyes, gain closure before death, and reconnect with family and friends. Some believe episodes of terminal lucidity are representative of the person connecting with an afterlife. <h2>Why is it important to know about terminal lucidity?</h2> People can have a variety of reactions to seeing terminal lucidity in a person with advanced dementia. While some will experience it as being peaceful and bittersweet, others may find it deeply confusing and upsetting. There may also be an urge to modify care plans and request lifesaving measures for the dying person. Being aware of terminal lucidity can help loved ones understand it is part of the dying process, acknowledge the person with dementia will not recover, and allow them to make the most of the time they have with the lucid person. For those who witness it, terminal lucidity can be a final, precious opportunity to reconnect with the person that existed before dementia took hold and the “long goodbye” began.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/202342/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/yen-ying-lim-355185">Yen Ying Lim</a>, Associate Professor, Turner Institute for Brain and Mental Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/diny-thomson-1519736">Diny Thomson</a>, PhD (Clinical Neuropsychology) Candidate and Provisional Psychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/terminal-lucidity-why-do-loved-ones-with-dementia-sometimes-come-back-before-death-202342">original article</a>. </div>

Mind

Legendary Aussie soap star dies just weeks before birthday

Brian Wenzel has died aged 94. The beloved Aussie actor, known for his role on A Country Practice, passed away peacefully in an Adelaide nursing home, just weeks away from his 95th birthday. “It is with great sadness that we remember the life of beloved Australian actor Brian Wenzel,” the soap star's agent, Jennifer Hennessy confirmed in a statement. “His iconic and revered performances spanned multiple Australian generations with his wit and humour shining through to the end. “A passionate family man and devoted Carlton supporter leaves an irreplaceable mark on the Australian film and television industry.” Born on the 24th of May in 1929, Wenzel began his acting career at the age of just 17. He became a popular figure on Aussie TV in the 60s and 70s, starring in shows like Homicide, Division 4, and Matlock Police. He then scored his most memorable role as Frank Gilroy, an old-fashioned and uptight sergeant who was the heart of A Country Practice for 12 years. The show ran from 1981 to 1993, with a whopping 1,058 episodes, and he also briefly appeared on Neighbours after the show ended. Wenzel's role as Gilroy earned him a Logie Award for Best Actor in 1981. His final role on-screen was in 2014 for John Doe: Vigilante. In 2018 the actor had suffered two mini strokes that made him unable to walk unaided. “It’s terrible to not be able to walk and I can’t sing anymore, which is terrible. I’m hoping against all hope that I can get it all back again," he said at the time. Four years later, he was marred by his tragic battle with dementia and entered nursing care which he shared with his beloved wife Linda. Image: news.com.au/ Michael Marschall

Caring

What is childhood dementia? And how could new research help?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/kim-hemsley-1529322">Kim Hemsley</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/nicholas-smith-1529324">Nicholas Smith</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>, and <a href="https://theconversation.com/profiles/siti-mubarokah-1529323">Siti Mubarokah</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> “Childhood” and “dementia” are two words we wish we didn’t have to use together. But sadly, around <a href="https://doi.org/10.1093/brain/awad242">1,400 Australian children and young people</a> live with currently untreatable childhood dementia. Broadly speaking, childhood dementia is caused by any one of <a href="https://www.childhooddementia.org/what-is-childhood-dementia#what">more than 100</a> rare genetic disorders. Although the causes differ from dementia acquired later in life, the progressive nature of the illness is the same. <a href="https://doi.org/10.1093/brain/awad242">Half</a> of infants and children diagnosed with childhood dementia will not reach their tenth birthday, and most will die <a href="https://www.childhooddementia.org/what-is-childhood-dementia#what">before turning 18</a>. Yet this devastating condition has lacked awareness, and importantly, the research attention needed to work towards treatments and a cure. <h2>More about the causes</h2> Most types of childhood dementia are <a href="https://academic.oup.com/brain/article/146/11/4446/7226999">caused</a> by <a href="https://www.genome.gov/genetics-glossary/Mutation">mutations</a> (or mistakes) in our <a href="https://www.genome.gov/genetics-glossary/Deoxyribonucleic-Acid">DNA</a>. These mistakes lead to a range of rare genetic disorders, which in turn cause childhood dementia. <a href="https://doi.org/10.1093/brain/awad242">Two-thirds</a> of childhood dementia disorders are caused by “<a href="https://www.ncbi.nlm.nih.gov/books/NBK459183/">inborn errors of metabolism</a>”. This means the metabolic pathways involved in the breakdown of carbohydrates, lipids, fatty acids and proteins in the body fail. As a result, nerve pathways fail to function, neurons (nerve cells that send messages around the body) die, and progressive cognitive decline occurs. <h2>What happens to children with childhood dementia?</h2> Most children initially appear unaffected. But after a period of apparently normal development, children with childhood dementia <a href="https://doi.org/10.1016/j.pediatrneurol.2023.09.006">progressively lose</a> all previously acquired skills and abilities, such as talking, walking, learning, remembering and reasoning. Childhood dementia also leads to significant changes in behaviour, such as aggression and hyperactivity. Severe sleep disturbance is common and vision and hearing can also be affected. Many children have seizures. The age when symptoms start can vary, depending partly on the particular genetic disorder causing the dementia, but the average is around <a href="https://doi.org/10.1093%2Fbrain%2Fawad242">two years old</a>. The symptoms are caused by significant, progressive brain damage. <h2>Are there any treatments available?</h2> Childhood dementia treatments currently <a href="https://www.childhooddementia.org/news/report-reveals-global-research-inequity">under evaluation</a> or approved are for a very limited number of disorders, and are only available in some parts of the world. These include gene replacement, <a href="https://doi.org/10.1002/jmd2.12378">gene-modified cell therapy</a> and protein or <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1712649">enzyme replacement therapy</a>. Enzyme replacement therapy is available in Australia for <a href="https://australianprescriber.tg.org.au/articles/cerliponase-alfa-for-neuronal-ceroid-lipofuscinosis-type-2-disease.html">one form of childhood dementia</a>. These therapies attempt to “fix” the problems causing the disease, and have shown promising results. Other experimental therapies include ones that <a href="https://doi.org/10.3390/life12050608">target</a> faulty protein production or <a href="https://doi.org/10.1056/nejmoa2310151">reduce inflammation</a> in the brain. <h2>Research attention is lacking</h2> Death rates for Australian children with cancer <a href="http://www.childhooddementia.org/getasset/2WX39O">nearly halved</a> between <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/cancer-incidence-survival">1997 and 2017</a> thanks to research that has enabled the development of multiple treatments. But over recent decades, <a href="http://www.childhooddementia.org/getasset/2WX39O">nothing has changed</a> for children with dementia. In 2017–2023, research for childhood cancer received over four times more funding per patient compared to funding for <a href="https://www.childhooddementia.org/getasset/2WX39O">childhood dementia</a>. This is despite childhood dementia causing a <a href="https://doi.org/10.1093/brain/awad242">similar number of deaths</a> each year as childhood cancer. The success <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/cancer-incidence-survival">for childhood cancer sufferers</a> in recent decades demonstrates how adequately funding medical research can lead to improvements in patient outcomes. Another bottleneck for childhood dementia patients in Australia is the lack of access to clinical trials. An <a href="https://www.childhooddementia.org/news/report-reveals-global-research-inequity">analysis</a> published in March this year showed that in December 2023, only two clinical trials were recruiting patients with childhood dementia in Australia. Worldwide however, 54 trials were recruiting, meaning Australian patients and their families are left watching patients in other parts of the world receive potentially lifesaving treatments, with no recourse themselves. That said, we’ve seen a slowing in the establishment of <a href="https://www.childhooddementia.org/news/report-reveals-global-research-inequity">clinical trials</a> for childhood dementia across the world in recent years. In addition, we know from <a href="https://www.childhooddementia.org/join-us/professionals/impacts">consultation with families</a> that current care and support systems <a href="https://www.childhooddementia.org/getasset/44MLP8">are not meeting the needs</a> of children with dementia and their families. <h2>New research</h2> Recently, we were awarded <a href="https://www.premier.sa.gov.au/media-releases/news-items/major-funding-boost-for-research-into-childhood-dementia">new funding</a> for <a href="https://www.flinders.edu.au/giving/our-donors/impact-of-giving/improving-the-lives-of-children-with-dementia">our research</a> on childhood dementia. This will help us continue and expand studies that seek to develop lifesaving treatments. More broadly, we need to see increased funding in Australia and around the world for research to develop and translate treatments for the broad spectrum of childhood dementia conditions. Dr Kristina Elvidge, head of research at the <a href="https://www.childhooddementia.org/our-people">Childhood Dementia Initiative</a>, and Megan Maack, director and CEO, contributed to this article.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228508/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kim-hemsley-1529322">Kim Hemsley</a>, Head, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/nicholas-smith-1529324">Nicholas Smith</a>, Head, Paediatric Neurodegenerative Diseases Research Group, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>, and <a href="https://theconversation.com/profiles/siti-mubarokah-1529323">Siti Mubarokah</a>, Research Associate, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-childhood-dementia-and-how-could-new-research-help-228508">original article</a>. </div>

Mind

Better sleep is a protective factor against dementia

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/andree-ann-baril-1494268">Andrée-Ann Baril</a>, <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a> and <a href="https://theconversation.com/profiles/matthew-pase-1494296">Matthew Pase</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Dementia is a progressive loss of cognitive abilities, such as memory, that is significant enough to have an impact on a person’s daily activities. It can be caused by a number of different diseases, including <a href="https://alzheimer.ca/en/about-dementia/what-alzheimers-disease">Alzheimer’s</a>, which is the most common form. Dementia is caused by a loss of neurons over a long period of time. Since, by the time symptoms appear, many changes in the brain have already occurred, many scientists are focusing on studying the risk and protective factors for dementia. A risk factor, or conversely, a protective factor, is a condition or behaviour that increases or reduces the risk of developing a disease, but does not guarantee either outcome. Some risk factors for Alzheimer’s disease and dementia, such as age or genetics, are not modifiable, but there are several other factors we can influence, <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">specifically lifestyle habits and their impact on our overall health</a>. These risk factors include depression, lack of physical activity, social isolation, high blood pressure, obesity, diabetes, excessive alcohol consumption and smoking, as well as poor sleep. We have been focusing our research on the question of sleep for over 10 years, particularly in the context of the <a href="https://www.nhlbi.nih.gov/science/framingham-heart-study-fhs">Framingham Heart Study</a>. In this large community-based cohort study, ongoing since the 1940s, the health of surviving participants has been monitored to the present day. As researchers in sleep medicine and epidemiology, we have expertise in researching the role of sleep and sleep disorders in cognitive and psychiatric brain aging. As part of our research, we monitored and analyzed the sleep of people aged 60 and over to see who did — or did not — develop dementia. <h2>Sleep as a risk or protective factor against dementia</h2> Sleep appears to play an essential role in a number of brain functions, such as memory. Good quality sleep <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2793873">could therefore play a vital role in preventing dementia</a>. Sleep is important for maintaining <a href="https://www.science.org/doi/10.1126/science.1241224">good connections in the brain</a>. Recently, research has revealed that sleep seems to have a function similar to that of a garbage truck for the brain: <a href="https://doi.org/10.1016/j.mad.2023.111899">deep sleep could be crucial for eliminating metabolic waste from the brain</a>, including clearing certain proteins, such as those known to accumulate in the brains of people with Alzheimer’s disease. However, the links between deep sleep and dementia still have to be clarified. <h2>What is deep sleep?</h2> During a night’s sleep, we go through several <a href="http://ceams-carsm.ca/en/a-propos-du-sommeil/">sleep stages</a> that succeed one another and are repeated. NREM sleep (non-rapid eye movement sleep) is divided into light NREM sleep (NREM1 stage), NREM sleep (NREM2 stage) and deep NREM sleep, also called slow-wave sleep (NREM3 stage). The latter is associated with several restorative functions. Next, REM sleep (rapid eye movement sleep) is the stage generally associated with the most vivid dreams. An adult generally spends around 15 to 20 per cent of each night in deep sleep, if we add up all the periods of NREM3 sleep. Several sleep changes are common in adults, such as going to bed and waking up earlier, sleeping for shorter periods of time and less deeply, and waking up more frequently during the night. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=279&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=279&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=279&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=350&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=350&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=350&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Sleep stages, and the role of deep sleep for brain health. (Andrée-Ann Baril)</figcaption></figure> <h2>Loss of deep sleep linked to dementia</h2> Participants in the <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2810957">Framingham Heart Study</a> were assessed using a sleep recording — known as polysomnography — on two occasions, approximately five years apart, in 1995-1998 and again in 2001-2003. Many people showed a reduction in their deep slow-wave sleep over the years, as is to be expected with aging. Conversely, the amount of deep sleep in some people remained stable or even increased. Our team of researchers from the Framingham Heart Study followed 346 participants aged 60 and over for a further 17 years to observe who developed dementia and who did not. Progressive loss of deep sleep over time was associated with an increased risk of dementia, whatever the cause, and particularly Alzheimer’s type dementia. These results were independent of many other risk factors for dementia. Although our results do not prove that loss of deep sleep causes dementia, they do suggest that it could be a risk factor in the elderly. Other aspects of sleep may also be important, such as its duration and quality. <h2>Strategies to improve deep sleep</h2> Knowing the impact of a lack of deep sleep on cognitive health, what strategies can be used to improve it? First and foremost, if you’re experiencing sleep problems, it’s worth talking to your doctor. Many sleep disorders are underdiagnosed and treatable, particularly through behavioural (i.e. non-medicinal) approaches. Adopting good sleep habits can help, such as going to bed and getting up at consistent times or avoiding bright or blue light in bed, like that of screens. You can also avoid caffeine, limit your alcohol intake, maintain a healthy weight, be physically active during the day, and sleep in a comfortable, dark and quiet environment. The role of deep sleep in preventing dementia remains to be explored and studied. Encouraging sleep with good lifestyle habits could have the potential to help us age in a healthier way.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222854/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andree-ann-baril-1494268">Andrée-Ann Baril</a>, Professeure-chercheure adjointe au Département de médecine, <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a> and <a href="https://theconversation.com/profiles/matthew-pase-1494296">Matthew Pase</a>, Associate Professor of Neurology and Epidemiology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/better-sleep-is-a-protective-factor-against-dementia-222854">original article</a>. </div>

Mind

New studies suggest millions with mild cognitive impairment go undiagnosed, often until it’s too late

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/soeren-mattke-1484707">Soeren Mattke</a>, <a href="https://theconversation.com/institutions/university-of-southern-california-1265">University of Southern California</a> and <a href="https://theconversation.com/profiles/ying-liu-1221170">Ying Liu</a>, <a href="https://theconversation.com/institutions/usc-dornsife-college-of-letters-arts-and-sciences-2669">USC Dornsife College of Letters, Arts and Sciences</a> Mild cognitive impairment – an early stage of dementia – is widely underdiagnosed in people 65 and older. That is the key takeaway of two recent studies from our team. In the first study, we used Medicare data for about 40 million beneficiaries age 65 and older from 2015 to 2019 to estimate the prevalence of mild cognitive impairment in that population and to identify what proportion of them had actually been diagnosed. Our <a href="https://doi.org/10.1186/s13195-023-01272-z">finding was sobering</a>: A mere 8% of the number of cases with mild cognitive impairment that we expected based on a statistical model had actually been diagnosed. Scaled up to the general population 65 and older, this means that approximately 7.4 million cases across the country remain undiagnosed. In the second study, we analyzed data for 226,756 primary care clinicians and found that <a href="https://doi.org/10.14283/jpad.2023.131">over 99% of them underdiagnosed mild cognitive impairment</a> in this population. <h2>Why it matters</h2> Mild cognitive impairment is an early symptom of Alzheimer’s disease in <a href="https://doi.org/10.1001/jama.2019.2000">about half of cases</a> and progresses to dementia <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment">at a rate of 10% to 15% per year</a>. It includes symptoms such as losing the ability to remember recent events and appointments, make sound decisions and master complex tasks. Failure to detect it might deprive patients of an opportunity to get treated and to slow down disease progression. Mild cognitive impairment can sometimes be caused by easily addressable factors, such as medication side effects, thyroid dysfunction or <a href="https://theconversation.com/vitamin-b12-deficiency-is-a-common-health-problem-that-can-have-serious-consequences-but-doctors-often-overlook-it-192714">vitamin B12 deficiency</a>. Since mild cognitive impairment has <a href="https://doi.org/10.1016/j.amjopharm.2008.06.004">the same risk factors as cardiovascular disease</a>, such as high blood pressure and cholesterol, medication management of these risks combined with diet and exercise <a href="https://doi.org/10.1016/S0140-6736(15)60461-5">can reduce the risk of progression</a>. In 2023, the Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval">approved the drug lecanemab</a> as the <a href="https://theconversation.com/what-the-fdas-accelerated-approval-of-a-new-alzheimers-drug-could-mean-for-those-with-the-disease-5-questions-answered-about-lecanemab-197460">first disease-modifying treatment</a> <a href="https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/what-happens-brain-alzheimers-disease">for Alzheimer’s disease</a>, the most common cause of mild cognitive impairment. In contrast to previous drugs, which can temporarily improve symptoms of the disease, such as memory loss and agitation, this new treatment addresses the underlying cause of the disease. Lecanemab, a monoclonal antibody, <a href="https://www.news-medical.net/health/What-are-Amyloid-Plaques.aspx">reduces amyloid plaques</a> in the brain, which are toxic protein clumps that are believed to contribute to the progression of the disease. In a large clinical trial, lecanemab was able to <a href="https://doi.org/10.1056/NEJMoa2212948">reduce the progression</a> of early-stage Alzheimer’s disease. A similar drug, donanemab, also <a href="https://doi.org/10.1001/jama.2023.13239">succeeded in a clinical trial</a> and is expected to be <a href="https://www.medicalnewstoday.com/articles/fda-delays-approval-of-alzheimers-drug-donanemab-what-experts-think">approved sometime in 2024</a>. However, these drugs must be used in the early stages of Alzheimer’s disease, ideally when a patient has only mild cognitive impairment, as there is <a href="https://www.alz.org/alzheimers-dementia/treatments/lecanemab-leqembi">no evidence that they are effective in advanced stages</a>. <figure><iframe src="https://www.youtube.com/embed/w3IbAscNjsQ?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>An earlier diagnosis leads to early treatment and better outcomes.</figcaption></figure> <h2>What still isn’t known</h2> Many factors contribute to the <a href="https://doi.org/10.1002/alz.13051">lack of timely detection</a>. But researchers don’t have a good understanding of the relative importance of those individual factors or how to reduce the high rate of underdiagnosis. While distinct, symptoms are subtle and their slow progression means that they can be overlooked or misinterpreted as normal aging. A neurologist in China told our research team that diagnosis rates spike in China after the New Year’s holiday, when children who haven’t seen their parents for a year notice changes that are harder to pick up when interacting with someone daily. Doctors also commonly discount memory concerns as normal aging and doubt that much can be done about it. While cognitive tests to distinguish mild cognitive impairment from pathologic decline do exist, they take about 15 minutes, which can be hard to come by during the limited time of a doctor’s visit and may require a follow-up appointment. <h2>What’s next</h2> People, particularly those in their 60s and beyond, as well as their families and friends need to be vigilant about cognitive decline, bring it up during doctor’s appointments and insist on a formal assessment. The <a href="https://www.medicare.gov/coverage/yearly-wellness-visits">Medicare yearly “wellness” visit</a> is an opportunity to explore such concerns, but only about half of beneficiaries <a href="https://doi.org/10.1377/hlthaff.2019.01795">take advantage of it</a>. Just as physicians ask patients about unexplained weight loss and take those concerns seriously, we believe questions that explore a patient’s cognitive state need to become the norm. The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/216892/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/soeren-mattke-1484707">Soeren Mattke</a>, Director of the USC Dornsife Brain Health Observatory, <a href="https://theconversation.com/institutions/university-of-southern-california-1265">University of Southern California</a> and <a href="https://theconversation.com/profiles/ying-liu-1221170">Ying Liu</a>, Research Scientist, Center for Economic and Social Research, <a href="https://theconversation.com/institutions/usc-dornsife-college-of-letters-arts-and-sciences-2669">USC Dornsife College of Letters, Arts and Sciences</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/new-studies-suggest-millions-with-mild-cognitive-impairment-go-undiagnosed-often-until-its-too-late-216892">original article</a>. </div>

Mind

How music is changing the way dementia patients think

New research has proven that music truly is the universal language, with experts discovering how the power of music is helping those suffering with dementia. Music therapists have shown that music brings dementia patients back to the present, with some even finding their voice thanks to the nostalgic memories of the past. According to Registered Music Therapist and Managing Director of music therapy company Music Beat, Dr Vicky Abad, the power of music is not to be overlooked when it comes to degenerative diseases. “Music is a window into people’s pasts,” she said. “It builds on strengths and abilities against a disease that can strip a person of their dignity, abilities and quality of life.” The team at <a href="https://www.tricare.com.au/">TriCare Aged Care and Retirement</a>, who see the devastating impact of dementia each and every day, also experience first-hand the impact music has on residents, with many noticing “unrecognisable” changes in personality when a nostalgic tune is played. Louis Rose, an 80-year-old dementia patient and TriCare resident, was diagnosed with dementia six years ago, and requires assistance with many aspects of day to day life. However, listening to music is one thing he can enjoy on his own. “I grew up in Mauritius and while we didn’t have a lot, we certainly had music. Listening to music has always been an escape for me and a way to relax,” Mr Rose said. “When your brain starts to slow down and you find yourself forgetting things, it can be quite frustrating and confusing. Listening to music has been a way to distract myself from what’s going on in my head, it has helped me so much.” Tamsin Sutherland is a regular live music performer at TriCare facilities across Queensland, and has been able to witness incredible moments with the residents as they come alive as soon as she starts to play. “Watching residents who are often non-verbal sing along to the words is incredible,” she said “It really is like they are coming back to life and reconnecting with who they once were. To be part of that is quite emotional for me.” According to Dr Abad, music can help prevent the restless behaviour that often leads to pacing and wandering, especially in the evenings, which are often difficult times for those battling the disease. “Sundowning usually occurs in the late afternoon as dusk approaches, a time that is also associated with what used to be a busy time period in people’s lives,” she noted. “Personalised music is a simple and effective tool to help residents feel validated in their emotions during this time and provides them an opportunity to experience a calmer state of mind”. Image credits: Getty Images

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