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Early Interventions in Early Stage Dementia Part 1

Stress ball

“What can I do to keep this from getting worse?”

I hear this question all the time.  Someone who has noticed- or had a family member notice- changes in cognition has had his worst fears confirmed by the physician:  You have Alzheimer’s disease.

Shortly after hearing this news, they meet me.  It is such an emotionally charged time- filled with panic, and dread, and hopelessness.  There are countless doctor visits and tests, chronic googling and Web MD’ing. Bad news and more bad news.  By the time I come knocking on the door, there is little reason to be optimistic.

We chat for a while, mostly about me… and my pesky dog, my messy children, the weather, the traffic, the price of gas… the ruminations of normal life. For some reason, this disarms the double-edged tension in the room and we all forget the reason for my visit. Eventually, we roll around to the dubious nature of my call and wait for hope to poke its head out from behind the curtain of fear.  It finally asks, “What can I do to keep this from getting worse?”

At this time, there is little hard evidence supporting medications or therapies that slow Alzheimer’s progression.  Some medications have been shown to minimize the symptoms, but the disease itself tends to advance with little deterrence.  Unfortunately, I don’t have the kind of perfectly packaged answers they are looking for.

But there is anecdote-a-plenty for the non-pharmacology interventions that make very logical sense.  Whenever someone asks me that difficult and foreboding question, here is what I tell them:

1.  Relax.  Depression and anxiety ally with Alzheimer’s and together make very formidable enemies. Do not be tempted to pack it in, give up, head for the hills, pull the sheets up over your head… do not give depression a foothold.  Depression may be part of the organic disease process going on in the brain, but you must stay positive and optimistic to whatever extent you can.  Don’t put your foot in the grave just yet.  You have work to do.

2.  Get moving.  Tired of the same old, same old lecture from every single health expert for the last 50 years?  Well too bad.  Exercise really is the best thing you can do to promote brain health.  Cardiovascular exercise- sustained, heart pumping movement- washes the brain in oxygen-saturated blood and nutrients.  It also triggers other hormonal and chemical responses that improve mood and thinking skills.  Add in some strengthening to improve metabolism, and balance and vestibular exercises to improve coordination, concentration, and agility and you really will feel and think better. *Don’t let a physical issue be the excuse behind not exercising.  Got back pain or a bum knee?  Get some physical therapy on those muscles and joints to get you exercise-ready.

3.  Ditch the junk.  There are lots of buzz words and fad diets out there that distort the facts on nutrition and brain health, but there is some credibility behind many of them.  Does oxidative stress cause brain inflammation?  Does sugar cause Type 3 diabetes of the brain?  Are additives and pesticides and hormones and other villains of the food industry to blame for the younger onset and increased prevalence of AD?  No matter which side of the argument you stand on any of these popular discussions, you’re simply better off eating what the earth provides for you.  Changing eating habits- both quality and quantity- may sound impossible and even unfair given the extent to which your world has been turned on its head, but it’s really not that hard.  It’s a few tough days, a mediocre week or two, and presto- lifestyle changed. So eat well, friends.  Vegetables, fruits, oily fish, and a few meats and dairy items. Lots of water. A little wine and coffee for fun.  I’m telling you, this is a game changer.

4.  Use your noggin.  Challenge yourself, even if the challenges used to be quite easy.  If reading the newspaper or a book becomes difficult, don’t quit all together.  Read to fatigue.  Then rest.  Review what you’ve just read.  Reread it if you forgot.  Write down the key points.  Tell someone about it.  It will stick the more it’s rehearsed.  It will have meaning the more it is discussed.  Also, solve some problems… a puzzle, a map, math homework.  Follow a recipe.  Take something apart to see how it works.  Play language and memory games like Wheel of Fortune and Jeopardy.  Do not quit just because it is hard.  It’s supposed to be.  Just like lifting weights builds bigger muscles, sustained brain effort develops more neural connections.  But nothing improves without challenge.

5.  Be Social.  This is extremely important.  The tendency of most newly diagnosed people is to stop the social activities they once enjoyed.  Social interaction is one of the most complex, spontaneous, “lights on” brain activities you can participate in.  Attending a social function causes a firestorm of brain activity.  It especially recruits the work of the prefrontal cortex and temporal lobes- where emotion, planning, judgment, insight, and language live.  These areas tend to falter early in the Alzheimer’s disease process, much to the dismay of many spouses and family members, but are so vital to many basic brain functions like attention and memory.  Socialization is exercise, and it has been shown to be a big factor in the success of learning new information.

Lastly, combine each of these tips into one big habit and you will have a master plan that simply resembles a well-balanced picnic.  Pack a healthy lunch, put on your tennis shoes, grab a friend, and go to the park.  Laugh, engage, learn, sweat, move, eat, drink, think… and feed your diagnosis to the ducks.

Coming Soon- Part 2: Strategies for managing memory loss and the road ahead.

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  1. All great suggestions Sue! Most of the people with dementia that I have met, I have met via the internet. Many of them were diagnosed more than a decade ago but are still fighting back. They are advocating and staying active. I know in my heart that this has helped them stave off the disease. There are even new groups now such as DementiaMentors.com where people with dementia can get support from others with dementia. This support is invaluable. I’m looking forward to part 2.

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