Author: DENT Neurologic Institute

What to Expect At Your Sleep Study

In a study from the Center for Disease Control and Prevention, 38 percent of adults living in New York reported getting less than the recommended seven hours of sleep per night. The CDC identifies daily sufficient sleep as one of the five key health behaviors for preventing chronic disease. 

“Poor sleep can lead to an increased risk for multiple medical issues, in addition to feeling poorly the next day. Depending on the cause, poor sleep can increase your risk for heart attack, stroke and other medical issues, just as much as untreated high blood pressure, elevated cholesterol and cigarette smoking,” said Director of the DENT Sleep Center, Dr. Marc Frost.

Insufficient sleep can be caused by a number of factors, many of which can be attributed to lifestyle habits such as late night electronic use or an inconsistent bedtime routine. However, in some instances poor sleep can be caused by a medical condition that must be diagnosed and treated by a medical professional. The first step in identifying if you have a sleep disorder is to consult with your primary care provider to decide if you should participate in a sleep study.

For many, a sleep study can seem overwhelming and intimidating. We asked Doug Lukaszewski, a sleep technician in the DENT Sleep Center, commonly asked questions about sleep studies, to clear up some of the common misconceptions surrounding the diagnostic test. 

1. Do I need a referral from my provider for a sleep study?

Yes, the DENT Sleep Center does require a referral from a physician. Once the DENT Sleep Center team has received the referral, they will seek authorization from the insurance company prior to scheduling.

2.  What Should I Bring to a Sleep Study? 

 All you need to bring to your sleep study are clothes to sleep in.

“Whether it is pajamas or shorts and a T-shirt, something you feel comfortable in will work best. Please do however, make sure whatever you bring to wear is appropriate,” said Lukaszewski.

Additionally, bring all medications that you usually take at night, none will be provided for you. Pillows and blankets are supplied, however you are welcome to bring one with you. 

It is important to remember to take everything you bring to the lab home with you. All the DENT Sleep Center rooms have a restroom that include a shower. If you intend to take a shower in the morning, towels, body wash, and shampoo are provided. Other toiletries are also provided (toothpaste, toothbrush, combs.) 

3. What time do sleep studies normally begin?

Patients are asked to arrive by 8:30 pm and upon arrival are escorted to their private rooms. After paperwork is completed, the sleep technician will apply all of the devices needed to monitor your bio information while sleeping, this process usually takes around 30 minutes. 

Patient should expect to be in bed anytime between 10:00-11:00 pm, and awakened at 5:30 am. 

4. Is there an alternative to having a sleep study done in the sleep lab or office?

The DENT Sleep Center does perform home sleep studies. At home sleep studies are very simple and utilize easy to use devices. Patients are taught how to use the device, to use for their sleep study that night. Information is stored on the device while you are sleeping and is downloaded by the technician. The information is then interpreted by a physician who specializes in sleep disorders. 

5. What are a few common conditions that would bring a person into the Sleep Center?

  • Obstructive sleep apnea
  • insomnia
  • narcolepsy
  • periodic limb movements
  • somnambulism (sleep walking)
  • REM behavioral disorder

6. What happens if you can’t fall asleep?

Although the vast majority of patients do get a sufficient sleep in the office, a very small amount do not sleep. In this case, the physician can order another study or the patient can try an at home sleep study.

“Keep in mind the home sleep study devices are intended to almost exclusively diagnose sleep apnea, so there are limitations as to what it can do,” added Lukaszweski. 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

Ease Up On Electronics Before Bed – Your Brain Will Thank You

For many, scrolling through Facebook or Twitter in bed is just part of the nightly routine. However, studies show these activities, especially social media use, can be disruptful to the recovery processes that occur during sleep. 

We sat down with Director of the DENT Sleep Center, Dr. Marc Frost, who discussed the importance of turning off electronics before bed, and shared best practices for getting a good night’s sleep. 

Why is it important to “power down” before bed?

Sleep is an important way for the brain to recover from a day of critical thinking and decision making. Electronics use before bed stimulates the brain, making it difficult to fall asleep, therefore delaying and disrupting the recovery process. 

“Winding down before bed gives the brain a chance to start decompressing from all the activities of the day,” said Dr. Marc Frost. “Electronics that require active involvement like Facebook or Instagram, are too stimulating and require too much attention to allow you and your brain to properly wind down.”

In addition to over stimulation, electronics emit blue light that promotes wakefulness, counteracting the natural transition to sleep. 

“The light involved with the electronics can potentially lead to a decrease in natural melatonin levels. Melatonin is produced by the brain in the evening as it starts getting darker, working with your circadian rhythms to help induce sleep,” said Dr. Frost. “Bright lights prevent this.”

Dr. Frost added that while many electronics do have some type of night mode which attempt to change light frequencies, it is not an ideal or long-term solution.

Best Practices For Unplugging Before Bed

1. Limit significant physical activity (including exercise,) too close to bedtime. Exercise can have an energizing effect, making it difficult to fall asleep if done too close to bedtime. 

2. Avoid caffeine within several hours of bedtime. Some people are sensitive enough that consuming caffeine after dinner time or even after lunch can have negative effects on their ability to fall asleep. 

3. Limit alcohol consumption. Alcohol can be very disruptive to the sleep cycle. 

5. Limit the use of video games before bed. Video games are very stimulating because they rely on active involvement.

6. Get into routine! Make a habit of doing relaxing activities before bedtime so the brain will learn a relaxing pattern that signifies bedtime. These activities may include taking a warm bath or reading a book. 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

DENT Study Finds Medical Cannabis May Alleviate Symptoms of Chronic Disease in the Elderly

Buffalo, NY – A recent study conducted by the DENT Cannabis Clinic finds that medical cannabis may alleviate symptoms associated with chronic conditions in the elderly.

The study, led by Dr. Laszlo Mechtler, focused on the effects of medical marijuana in seniors with chronic conditions. Of the 204 patients in the study, ranging in age from 75 to 102, 70 percent reported a significant increase in their quality of life and more than 30 percent were able to stop taking their opioid pain killers. 

The study found that a 1:1 ratio of THC to CBD, proved to wield the best results with the least amount of side effects. Dr. Mechtler and his team will be presenting their findings at the American Academy of Neurology Annual Meeting in Philadelphia this May. 

“Our findings are promising and can help fuel further research into medical marijuana as an additional option for this group of people who often have chronic conditions,” said Dr. Laszlo Mechtler, director of the DENT Cannabis Clinic.

Check out additional coverage of the study below. 

American Academy of Neurology – “Could Medical Marijuana Help Grandma and Grandpa with Their Ailments?”

WGRZ – DENT Studies Effects of Medical Marijuana on Seniors

 

Making the Most of Your Healthcare Visits – Facebook Live Recap

Preparing for healthcare appointments can seem daunting for both caregivers and patients. There are questions you want to ask and updates you want to give, but you may find that preparing for an appointment is an overwhelming task.

“Sometimes we have patients or family members who don’t necessarily understand the process, and it makes them feel like they don’t get the most out of their healthcare visit,” said Program Director for the DENT Integrative Center for Memory, Sarah Harlock. “However, there are steps that patients, family members and care partners can take to get the most out of appointments.”

Booking and Scheduling

After a dementia diagnosis, it can feel like there are appointments every other week. One day you may have an appointment with your physician, the next week you may need to get additional testing or imaging done. The frequency of appointments and testing can seem overwhelming at first. However, those initial tests are an important part of confirming your diagnosis and creating an appropriate treatment plan.

“Once a treatment plan has been made appointments will become less frequent. Some patients come once every three months, others every six. Depending upon your diagnosis and your needs, you and your physician will create an appointment schedule that works for you,” said Harlock.

Appointment Preparation

Reminders

The way patients diagnosed with memory disorders respond to appointment reminders is very individualized. Some patients enjoy keeping track of their appointments and want to be reminded in advance. Other patients may become very anxious or nervous when reminded. If as a care partner you notice that the person you’re caring for has increased anxiety leading up to an appointment, it’s okay to be sparing with reminders.

Time of day

Caregivers, try to schedule appointments that are at the patient’s best time of day.

“If person the person in your care is generally more confused and agitated in the afternoons, schedule a morning appointment,” said Harlock. “At appointments we will do in-office assessments and we want patients to feel relaxed and able to perform at their best.”

Allot enough time to get ready

“It is important that a patient is fully prepared for their appointment, so try to be mindful of that when scheduling,” said Harlock. “As a caregiver, if you know your loved takes 2 hours to get ready in the morning, maybe an 8 am appointment doesn’t make sense.”

“At each appointment, we want to make sure the patient is in the best frame of mind. Rushing them out the door to the appointment, creating stress is not a good way to achieve that optimal frame of mind,” added Harlock.

Caregivers, it is also important to be mindful of how much help your loved one needs. Is a telephone reminder enough, or has it become necessary to have someone helping them get ready for the appointment?

Preparing for the Healthcare Visit

There are many things you can do as a care partner to make the most of your loved ones healthcare visit.

Make sure the patient has their glasses, hearing aid, etc.,

“One major part of being prepared is making sure the patient has remembered their glasses or hearing aid, or anything vital to their communication. It is very difficult to assess patient if we cannot properly communicate with them,” said Harlock.

Bring an updated list of current medication

Another important piece of being prepared is having a current medication list. This list should include over the counter medicine and supplements. “

This is important, so that we know exactly what the patient is taking,” added Harlock. “The other piece to this is that caregivers are knowledgeable about how well the patient is taking their medication and there are ways to be respectful about this.”

One way you can respectfully check in with your loved one to measure how well they are taking their medicine is to say something along the lines of I’m sure you’re doing this right but just so I can answer the doctor, I need to know you are taking your mediation the way it is prescribed.’

“We have seen many patients whose family member thought they were taking their medication properly, then something happens as a result, and they realize they weren’t.” said Harlock.

Document any changes since last visit

The day before the appointment take a few moments to think about or write down the changes that have happened since the last visit. 

Documenting changes in a patient’s willingness to take shower, ability to handle finances or take medication, is vital information for a provider to be continually updated on.

“Mood is also an important thing to be taking notice of. If there is a big change in mood we would like to know about that,” added Harlock. “Additionally, if there is something you cannot say, or don’t feel comfortable saying in front of the patient, write us a note. Slip the note to the medical assistant or nurse and they will get the questions to the provider who will then make sure it is addressed during the visit.”

At the Appointment

Have your list of questions ready

It is easy to be distracted by rushing to the appointment, or hearing something the provider said. This list will help you focus and on the appointment and get your questions answered.

“Be knowledgeable and honest about what the patient is capable of. If you are the caregiver for a loved on it can be difficult to share, however it is important to be honest and accurate,” added Harlock.  

Take notes during the appointment so you can be mindful of what to keep an eye out for and what to mention in your next appointment.

“It is also helpful for caregivers to ask if there are any red flags to be watching for, especially with medication changes.”

Additional Tips

For caregivers

Caregivers, you are part of the healthcare team! Your insight is vital in maintaining and adjusting treatment plans.

In addition, please do not wait for the next appointment to tell us about a medication side effect, or that the patient is struggling with or has stopped taking a medication,” added Harlock.

For patients

Consider bringing someone to your appointment with you who knows you. Due to the changes that are happening in your brain, even at an early stage, your perspective may not be the same as your families or friend’s. You may not be an accurately communicating or understanding what your treating provider is saying. This is not meant to be an insult, but the reality of the a cognitive impairment diagnosis.

View the entire presentation below!

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

 

Care Partner Resolutions: Staying Healthy – Facebook Live Recap

According to the Alzheimer’s Association, more than 16 million Americans provide unpaid care for people with Alzheimer’s disease or other forms of dementia.  This care ranges from assistance with activities like bathing and dressing, to financial assistance, to coordinating care or providing emotional support. 

Different care responsibilities are important to note because although traditionally we may think of “hands on care,” as the primary role of a caregiver, there are many ways to be involved in managing a loved one’s diagnosis. 

“Many people are long-distance caregivers or care partners.  Adult children living out of the area often help by assisting with paying bills or helping coordinate care. Those responsibilities make you a care partner too,” said Sarah Harlock, program director for the DENT Integrative Center for Memory.

“I encourage caregivers and care partners to think of their own health and consider steps to put into play to ensure they are taking care of themselves,” said Harlock.

Importance of Prioritizing Your Health

“As the care partner to someone with Alzheimer’s or dementia, you yourself are at increased risk for higher levels of stress, depression, anxiety, negative physical health changes, or complications to existing health problems,” added Harlock. “Study after study shows that care partners have increased stress and depression scores over the general public.”

Often, with all the added responsibilities, caregivers will begin to neglect their own self-care. Many caregivers feel like they can’t find time to exercise or are too tired to prepare healthy meals for themselves. It is also common for caregivers to put off their own healthcare appointments or treatments.

An Analogy for Caregiver Health

Harlock likens the rules of maintaining caregiver health to the instructions given when flying on an airplane.

“I recently had the opportunity to travel by airplane and the safety instructions they provide haven’t changed much. They tell you to be cautious moving about the cabin, to keep your seatbelt on even when sitting, to put your own oxygen mask first before assisting others and so on,” said Harlock. “And I found it’s a pretty good analogy for caregiving.”

1. “Be mindful when moving around the cabin”

Be aware of your overall health. This includes your physical, mental and spiritual health. Being a caregiver to an individual with dementia can have a negative impact on your health.  Paying attention to changes in your own physical and mental health will keep you and the loved one in your care in healthier.

2. “Keep your seatbelt fastened, even when seated”

Memory disorders can bring a lot of change and you want to be prepared for when that change happens. As professionals, we can’t tell you exactly what changes you will see next or when you’re going to see them.  Gathering information and staying prepared can help you be prepared for when changes do arrive. Generally speaking people feel more at ease, more confident and less anxious when they have done some preparation.

3. “Be careful opening the overhead bins as contents may have shifted”

Be mindful that things are going to change. It’s important that you know what kinds of community resources are available to you. This informed and prepared approach will help increase confidence, decrease depression and decrease anxiety.

 4.  “Know where your emergency exits are”

Know how to give yourself a break. Know who you can call, for instance the neighbor who offers to stay with the person with dementia when needed, or know where you can turn to when you need assistance with your care partner roles. This plan could include some social programs that provide care partners some respite, or volunteers to come and visit, so you can take a break.

5.  “If there is a change in cabin pressure and the oxygen mask drops in front of you, put your mask on first before assisting others”

If you are not in good health it’s hard to give your all to the person you are caring for.  It is not selfish to care for yourself while you are providing care to others. You owe it to yourself AND the person you are caring for to care for yourself.

Questions to Ask Yourself

Try to look at each part of your health. First, look at your physical health. What is your doctor saying? Are you noticing any negative changes in your physical health? 

Also make sure to check in with your mental and emotional health.  Are you in a good mood most of the time or are people commenting that you don’t smile or laugh much anymore? Do you find yourself short tempered (more than before). Do you have healthy coping skills like exercise or coffee with friends? 

It is also important to be aware of your spiritual health. What brings you peace? Are you doing the things that being you peace or is there something else you can do that gives you that feeling?

After checking in with yourself act accordingly to work on any part that may be out of sync. 

With everything else going on, how do I make time?

“I think it’s important to set goals, then break those goals down into small manageable steps. Create an action plan,” said Harlock. “There is a great program out there called Powerful Tools for Caregivers which has its participants develop action plans.”

Sarah provided the following action plan as an example. 

“Let’s set the goal as wanting to lose 20 pounds.  Rather than looking at all 20 pounds at one time and all of the activities you have to accomplish to do that, break it down into manageable steps,” said Harlock. 

 Start by making the statement I will __________ fill in the blank with the healthy activity, on __________ fill-in the days of the week you will perform this action at __________ give a time.

The statement might read, “I will walk for 10 minutes Monday, Thursday and Friday at 4:30 pm.”

Look at the statement and decide how confident you are that you will be able to achieve this small step. On a scale of 1-10 (1 being not confident at all and 10 be extremely confident). If your confidence is lower than a seven you need to rethink this step.

For instance maybe three days a week that is not realistic, 4:30 may not be the best time to achieve that goal.  If at 4:30 pm your care recipient is typically engaged in an activity like a nap, then it might be the perfect time. However, if your loved one starts to get anxious, restless or more confused in the late afternoon, you may need to rethink the time. Adjust this statement until you feel confident you can accomplish it. 

“The point is you build on the success!  This week you may walk 10 minutes on Wednesday at 2:30 pm because you know that your husband will be having coffee with the guys. You see that you were able to do it and maybe next week you walk twice for 10 minutes. Now,  walking 10 minutes once a week is not going  to make you lose 20 pounds, but gradually those small steps will help you accomplish that larger goal of losing the 20 pounds and you keep building on your success. 

“The concept applies to other goals such as being a happier caregiver, feeling less stressed. You break it down into reasonable and manageable steps and you build on your success. If you don’t accomplish the task one week, look at why, adjust and try again,” said Harlock. 

Care partner well-being is so important to you and to the person you are caring for!

To view the entire presentation, check out the video below. 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

DENT Welcomes Dr. Thomas Pfiffner

DENT Neurologic Institute is excited to announce that Dr. Thomas Pfiffner has joined DENT as director of the DENT Spine Center. Dr. Pfiffner brings a unique multidisciplinary approach to spine care. At the DENT Spine Center your initial evaluation will be conducted by Dr. Pffifner, who will then collaborate with experts across a number of specialties to create a comprehensive and effective treatment plan. Dr. Pfiffner has truly unique academic background, his board certifications include chiropractic medicine, chiropractic radiology, neurology, neuroimaging and neuro-oncology, and he is also certified in medical cannabis. 

At DENT, Dr.  Pfiffner will be focusing on spinal disorders, including, but not limited to:

  • Radiculopathy 
  • Disc Disease
  • Spinal Stenosis
     
  • Post Traumatic Spine Injuries
  • Spinal Tumors
  • Neuroimaging Evaluation of Spinal Disorders

Dr. Pfiffner completed his neurology residency at the University of Minnesota. He is Fellowship trained at DENT Neurologic Institute and Roswell Park Cancer Institute. Dr. Pfiffner has published and contributed to multiple articles focused on spinal pathology. He will be key in the development of a new multidisciplinary spine center partnering with UB Neurosurgery.

Dr. Pfiffner is looking forward to his return to western New York and using his extensive experience to help those with spinal injuries.  

5 Steps to Take After a Memory Disorder Diagnosis

A memory disorder diagnosis can seem overwhelming and intimidating. Whether you are living with a diagnosis, or caring for someone with a memory disorder, there are many variables to consider when planning for the future. 

Sarah Harlock, Program Director for the DENT Integrative Center for Memory, shared five important initials steps to take after receiving a memory disorder diagnosis. 

  1. Gather important documentation.

    • Power of Attorney

    • Health Care Proxy or MOLST (Medical Orders for Life Sustaining Treatment)

    • Veterans Discharge papers etc.,

  2. Get some information about the diagnosis. You do not need to learn everything about the illness but have a sense of the types of challenges you may be faced with.

  3. Learn more about supportive services that are available such as community based programs, health services, and levels of care. Gather information to determine costs and how one enrolls in these services. 

  4. Make a plan (nothing is written in stone,) just create an outline of services you think you might like to try when necessary.

  5. Breathe! You have to learn to live with this diagnosis, and there is a lot of living still to do

While there are many other steps to take and adjustments you may need to consider, completing these initial steps will help you and your care partner begin planning for challenges that may arise in the future. 

For more details about programs and services, questions about making a plan, or more information about cognitive changes, please contact Sarah Harlock, Program Director for the DENT Integrative Center for Memory, at 716-250-2000, ext. 1107. 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

Dementia and Communication – Facebook Live Recap

Dementia is an umbrella term used to describe a group of symptoms. Those symptoms can arise as any negative change related to thinking, including; difficulty with memory, language, reasoning or problem solving. Those symptoms, commonly referred to as cognitive changes, may affect the way a person communicates. 

Program Director for the DENT Integrative Center for Memory, Sarah Harlock, explained over Facebook Live why these communication breakdowns happen and techniques you can use to improve communication between you and the person in your care. 

Importance of Communication:

It is important to note that there are many types of dementia, including but not limited to; Alzheimer’s disease, Lewy Body dementia, and Frontotemporal dementia. That being said, it is important to understand that communicating with someone with Alzheimer’s disease may be different than communicating with someone with frontotemporal or vascular dementia. Approaches in communication may need to vary from person to person, dementia diagnosis to dementia diagnosis.  

“It’s helpful to think of dementia communication as a continuum. The person you’re caring for with Alzheimer’s may not be able to communicate the same way as the person sitting next to them who also has Alzheimer’s,” said Sarah Harlock, program director for the DENT Integrative Center for Memory.

“Communication, at its core, is about connecting with another person,” said Harlock. “Although, sometimes communication may be about giving an instruction or direction, try to remember that communication is about making emotional connections and that is what the person with dementia is trying to do.”

In the later stages, dementia can be accompanied by changes that may impact a person’s ability to communicate. 

 

Vision Changes:

Vision changes are a large part of a late stage dementia diagnosis. A person with late stage dementia may experience significantly diminished peripheral vision.

“For example, if you put a cup of coffee on the side of their place-mat and they keep asking ‘where’s my coffee,’ you, as a care partner may be frustrated and keep saying ‘it’s right there, it’s right there’. It’s important to remember that they are not asking to annoy you, or be difficult, the loss of peripheral vision has made it so they really can’t see it,” added Harlock.  

Depth perception and the ability to discriminate colors can also diminish as a dementia diagnosis progresses.

 

Hearing/Auditory Changes:

As dementia progresses, hearing changes can occur making it difficult for a person with dementia to hear certain pitches, particularly higher pitches.

In addition, as the disease progresses it can be hard for a person to distinguish between background noise and foreground noise.

“Whereas our brains can tune out background nose and focus on the conversation at hand, that can become increasingly difficult for a person with dementia, making it hard for them to follow a conversation,” added Harlock.

Creating a quiet and calm environment can be helpful when trying to communicate with a person in that stage.

 

Sensory Perception:

The importance of sensory perception can often be overlooked. However, sensory perception can be very important for people with dementia. Often they can become too hot or cold, and even the feeling of clothing can be uncomfortable for the person, so try to be mindful of that.

 

Processing Time:

When having a conversation with someone we expect them to respond back in a timely manner or give us non-verbal clues that they are thinking about their answer. This processing time can change significantly for a person with dementia.

“Processing time for someone with moderate to late stage dementia can take up to 90 seconds,” said Harlock. “In that case, repeating what you said louder again and again won’t help, it will only frustrate the person. Slow it down and give them a chance to process the information,” said Harlock.  

 

Language:

“Many times, in the late stages,  a person with dementia may revert back to their primary language. For instance, if a person’s first language was Spanish, and they learned English later in life, it is not uncommon for a person to begin solely speaking Spanish,” added Harlock.

 

Emotion:

Emotion can play a large part in communication for someone with a memory or mood disorder.  For example, if a person is anxious it causes them to be distracted, which can affect their ability to retain information.

“It is important to recognize that a person’s emotional state will impact their ability to communicate,” said Harlock. 

 

Verbal vs. Non-Verbal Communication:

 

There are many things you can do as a care partner to make communication easier for you and the person you’re caring for, both verbally and non-verbally.

 

Verbal Communication:

 

Word Choice:

When speaking, avoid slang or jargon. Remember to slow it down, including both talking slower and allowing for a longer processing period.

 

Tone of Voice:

“If you want someone to do something, make sure you are saying it in a way that makes them want to cooperate with you. If you are gruff, unfriendly, or you’re stressed out, the person will pick up on that and be less likely to do what you are asking of them,” said Harlock. 

 

Non-Verbal Communication:

 

“Most communication that happens is non-verbal. Body language, facial expressions and eye contact, all play a big role in communication,” said Harlock.

 

Facial Expression:

Facial expression can play a huge role in communication with a person who has dementia. “If you looking for someone to do something, make sure you are making the correct facial expression that will get you the cooperation you need, “ said Harlock.

 

Body Language:

“If you are acting aggressive or assertive a person with dementia will pick up on that and think ‘Whatever he/she wants me to do doesn’t look like fun, so I’m not going to do that.’ So make sure your body language is really calming.” added Harlock.

 

Gestures:

“If understanding language has become very difficult, we can use gestures to get our point across,” said Harlock

 

Eye Contact:

“Due to the vision loss, make sure you are in their line of sight and engage them in conversation,” said Harlock.

 

Effective Techniques will vary from person to person and type of dementia to type of dementia, however generally these tips can be very useful for creating meaning and effective communication.

 

1.     Speak slowly and calmly

2.     One question or instruction at a time, keep it clear and simple.

3.     Allow time for a response. *remember it can take up to 90 seconds to process the information and respond

4.     Tell the person what you want them to do, not what you don’t want them to do.

5.     Be more positive in your communication. Avoid using the word no (unless safety is at risk, then use the words you need to

6.     Simplify questions, don’t make them too long, keep them clear and concise

 

Techniques:

 

There are a few additional techniques that can help have more positive and productive communication with the person in your care.

 

Validation:

Validation is a way of opening up communication lines.

If the person you are caring for keeps saying ‘I want to go home now’ rather than saying something terse, like ‘you are home’ over and over,  try a different approach like, ‘tell me about your home or what home are you thinking about.’

This method will open the door and allowing for meaningful and productive communication.

 

Therapeutic Fibbing:

Described as a detour from the truth, this technique can be very helpful and very kind for the person with dementia. This technique is best used when telling the truth will be more hurtful than helpful.

“I once worked with a woman who had dementia and would get very upset that her mother didn’t know where she was. She would become agitated wanting to get in touch with her mother. Unfortunately, the woman’s mother had died many years ago, however, instead of saying ‘your mother passed away’ only creating further agitation. we would use therapeutic fibbing to say something like “Your mother called, she wants you to stay for dinner,” and immediately the woman would calm down and be so relieved that her mother was no longer worried,” said Harlock.

 

Watch the full presentation below:

 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

Caregiving Through the Holidays – Facebook Live Recap

Often, the holiday season can seem overwhelming for those caregiving for loved ones with memory disorders. Between navigating logistics and managing expectations for both family members and the individual in your care, it can feel like the holidays are filled with more stress than joy. 

Sarah Harlock, program director for the DENT Integrative Center for Memory, shared her tips for managing the stress of the holiday season, while also finding time to enjoy the company of loved ones. 

“It’s very important to recognize how the holidays impact people with cognitive impairment and how that can impact caregivers,” said Harlock. “Even though the holidays are joyful and something we look forward to, if your day is already filled with the activities necessary to care for a loved one, adding the events and expectations of the holiday season can seem overwhelming.”

Understanding the Diagnosis

“I think it’s always important to go back to understanding the diagnosis. Often we use the terms Alzheimer’s, dementia and memory loss interchangeably, but they are very different, and each one of those diagnoses has different stages, so it’s important to understand the person you’re caring for.”

Neurodegenerative disease like Alzheimer’s or dementia are progressive disorders, so understanding the stages people are at is important in understanding how they will be affected by the holiday season.

 Someone who is in an early stage of any of these conditions may have very little change in their holiday routine and may still enjoy the season very much.  However, someone in the later stages of this illness may struggle more with the non-stop action and changes to their routine.

Evaluate your Traditions, Beliefs and Expectations

“I think it’s important that people are evaluating their traditions and beliefs and looking at their expectations. Sometimes, we get caught up in the fancy wrapping, or perfectly decorated house, and while those may have been important before, it’s important to evaluate whether or not they are still important and whether they are really at the essence of the tradition,” said Harlock.  “So, I encourage people to take time to think about what these traditions are really about, and rarely are they about fancy wrapping and perfectly decorated houses. They’re about spiritual connections and growth with other people,” said Harlock.

Often, there is more than one way to honor a tradition or belief. Although you may have celebrated the holiday season a certain way for decades, now you may have to make some changes. It is important to evaluate your expectations as a care partner and prioritize the events that are the most enjoyable and most meaningful, and which ones will be too stressful for the person you are caring for.

“Try to look at what’s important versus what you’ve always done,” added Harlock.

Plan Ahead

Communicating changes is very important. If in the past you hosted the family event and that is no longer feasible, begin planning early for those changes.

All adjustments come down to communication. It’s okay to let loved ones know why you’re changing things up and what they can expect. Be open to family recommendations, but be realistic. If you need to stand your ground, stand your ground.

“Allow yourself and other people to be disappointed that you have to change your traditions. This is a loss, and it’s important to acknowledge that loss,” said Harlock. “However, while I encourage you to acknowledge that this is a loss, don’t get stuck in it, there are many ways to honor a tradition.”

Routine

People with dementia do best when they stick to a routine, so try to keep the routine consistent, even through the holiday season.

The non-stop activity can be tough for the caregiver and the person with a memory disorder, so do your best to keep the changes as minimal as possible. It is important to note that changes in environment, like holiday decorations, can be disturbing for people with dementia, so consider pulling back on some of the more extreme decorations.

Tips for Caregiving through the Holidays 

1.Wherever possible, include the person who has the diagnosis

If the person you are caring for is able to articulate what events they enjoy participating in during the holidays, and what they could give up, have that conversation.

2.Think about where the events will take place

Consider where the holiday events will take place. Take into account the routine changes and consider the environment (hot, noisy, and crowded) and plan accordingly.

3. How long is the event?

If the event is going to last 8 hours and you know that may be overwhelming for the person in your care, consider just going towards the end for coffee and deserts. It may be easier to break the holidays up into smaller events, over four or five days. 

4.Time of the event

Historically, people with dementia struggle with increased anxiety and confusion in the late afternoon or evenings. Consider switching the event from a dinner to brunch. That way you are still honoring the tradition and getting together as a family, you’re just changing the timeline.

5.Try to set aside a quiet space for your loved one.  

People with dementia struggle with commotion, which the holiday season can be full of. To avoid overwhelming that person, consider having a quiet room to give the person with dementia a chance to break from the chaos. This is especially helpful if the person has trouble following a conversation with a group of people. This space will give your loved one a chance to have more meaningful one on one conversations.

6. Decorations can be overwhelming for a person with dementia.  

Try to minimize the distractions. Decorations can add stimulation that might be upsetting or overwhelming for the person you’re caring for.  

7.  Be realistic and flexible

Think about what the holidays mean to you and find ways to participate in and honor your traditions that are enjoyable for both you and the person you’re caring for. 

Check out the entire presentation below.

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

 

 

 

What is TMS Therapy?

Transcranial Magnetic Stimulation or TMS therapy, is an FDA approved treatment for depression that utilizes energy to stimulate the brain and facilitate improvements in depressive symptoms. The treatment utilizes short pulses of a focused magnetic field to stimulate nerve cells in the area of the brain thought to control mood. This brief and painless treatment is performed in a quiet, comfortable setting under the supervision of a psychiatrist and is administered while the patient is awake and alert.  

We sat down with Physician Assistant in the DENT Psychiatry Center, Michael Asbach, who explained how TMS works to treat depression. 

1. How does it work? 

“A 3 Tesla magnet, which is the same strength magnet used in an MRI, is placed over the area of the brain known as the dorsolateral prefrontal cortex. The powerful magnet sends pulses through the skull and causes depolarization of the neurons in the superficial cortex of the brain. Through neural pathways, the local stimulation causes functional changes in other brain regions and leads to improved cell communication and improvements in depressive symptoms,” said Asbach. “The electromagnetic coil is placed against the scalp and delivers pulses of magnetic field in 30 second intervals involving 40 pulses in a 4 second period with 26 seconds of rest. The magnetic pulses are not painful and feel/sound like a light tapping on the scalp.”

“I often describe the sensation to my patients as if someone were to lightly flick your head 4000 times in a 20 minute period. It may not be comfortable but it is not painful for most.”

2. How long does the treatment take? When can patients expect to see results? 

“The first TMS treatment is called a mapping. At this appointment a medical practitioner and TMS technician will use a computer algorithm to identify the best location on the scalp for treatment. As a result of the mapping, your first treatment session usually lasts about an hour. Subsequent treatments are quicker and last anywhere from 20-30 minutes,” said Asbach.

“Patients receive treatments 5 days a week for 6 weeks or a total of 30 sessions. Patients commonly will start to see improvements in their symptoms about half way through the sessions, however sometimes improvements are not observed until later in the treatment process. The reason being that TMS is causing changes in neuron functioning and communication through the repetitive and sustained exposure to magnetic impulses which stimulate the cells and “wake them up.” This does not occur in just one session and requires continued exposure to the magnetic pulses,” Asbach continued.  

3. What patient population does this therapy work best for?

The FDA has approved TMS for patients with treatment resistant depression. Treatment resistant depression is defined by the failure of two or more antidepressant therapies with adequate trial of dose and duration.

“TMS treatment of depression is covered by most insurance companies although some insurers require further medication failures and/or an adequate trial of counseling. TMS is not recommended for the treatment of depression within the context of Bipolar illness. Additionally, patients with a history of seizures are recommended to consult with their neurologist as TMS treatment has been reported in rare instances to increase the risk of seizure (in normal clinical use the estimated risk of seizure is 0.03% of treatments),” added Asbach. 
 

4. What are some common misconceptions surrounding TMS that may hold people back from trying it?

A common misconceptions surrounding TMS is that it is an invasive procedure. Patients think that anesthesia is required or drastic alterations to their medication regimen. However, TMS is a non-invasive treatment that is done in the office. Patients are able to drive to and from their TMS treatments and often come to the office to receive their TMS treatment on their lunch break or on their way to work. 

“If patients suffer from depression and have tried 2 or more medications without success, they may be good candidates to receive this innovative treatment,” said Asbach.

 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.