Non-pharmacological therapy for Alzheimer’s disease and dementia

It is an exciting time for the science of neurology and brain study. I read recently that we have learned more about the brain in the last five years than in the five thousand years previous. Recent advances in brain-imaging technology have given us some incredible tools for studying this most complex structure in the known universe: tools like the fMRI, the EEG, SPECT scan, and CT scan and the PET scan. These special tools allow us to watch electrical activity and blood flow in the brain as it responds to different stimuli and situations. One thing we are learning is there is a special connection between music and the brain.

At a conference we attended recently we were able to spend some face time with Cindy and Darryl, creators of Serenity Babies. We had a really nice visit, as it has been a couple of years since we last saw them. They shared some tips for using dolls as therapy.

Snoezelen - Enriched Sensory Environment for Alzheimer's

The picture above is of a multi-sensory or enriched environment. More specifically the pictures is of a Snoezelen room. Snoezelen is a concept created by two Dutch therapists who were in the early 1970s working with people (mostly children) who had developmental disabilities. Snoezelen is a good example of  multisensory stimulation for Alzheimer’s disease or any dementia.

The two therapists who first came up with the concept (and coined the term “Snoezelen”) are Jan Hulsegge and Ad Verheul. The children they were working with were severely challenged. So was the institutional environment that was trying to treat these children. There was almost nothing there to stimulate the senses, the brains or the imaginations or those kids. The professionals on staff at the DeHartenburg Institute were not happy when Jan and Ad introduced their chaos of toys and crazy lights into the sterile “hospital atmosphere.” The positive results from these messy methods eventually won over the medical personnel, and sensory stimulation has become an accepted therapy.

What is multisensory stimulation for Alzheimer’s?

Snoezelen is a contraction of two Dutch words: ‘‘snuffelen’’, to sniff out or explore, and ‘‘doezelen’’, to doze or relax. Snoezelen incorporates all of the senses to create a true multisensory experience. The bubble tubes that are a part of so many Snoezelen rooms not only stimulate the eyes, but the bubbling action creates sound and vibration to stimulate ears and our feeling sense as well. Music is a big part of these multisensory environments, as are videos depicting nature. Typically, the individual undergoing therapy controls the experience. He or she controls what stimulation is active; its intensity, duration, etc. There is now an abundance of support for the contention that this client controlled “exploring while relaxing” actually reduces stress, anxiety and even pain as it reinforces self-image.

The concept of Snoezelen, the idea of providing soothing sensory stimulation, has recently been found to help people who have dementia, especially those who are in the later stages of their disease. Benefits include increased socialization and communication as well as a reduction in depression and anxiety and many of the other behavioral and psychological symptoms associated with this group of diseases.

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An environment for exploration and relaxation can be costly; one multisensory room in the UK cost $200,000 to build.

A garden is ideal multisensory stimulation for Alzheimer's

Many assisted living and memory care communities have gardens similar to this one. Unfortunately, I only rarely see anyone enjoying them.

But providing multisensory stimulation needn’t be expensive. A  video that shows nature in all of her splendor, especially on a big screen, can provide hours of enjoyable visual and auditory feedback. Tactile stimulation can come from something as simple as a squeezable ball, or some textured fabric. Pictured here is one of my favorite enriched environments. Many memory care communities have similar gardens. If it were up to me, it would be a required architectural element in any extended care community. A  garden is very stimulating visually — that is its purpose. But flowers add smells (olfactory stimulation). Birds singing their songs and calling their calls add an enjoyable auditory mix. A small fountain or waterfall would also add some natural audio ambiance. Other additions could add an almost infinite variety of sensory feedback while maintaining a natural theme…

…or bring the outdoors in. The collection of found objects in this box  (pictured) simulates a forest, and can provide a variety of stimulation to several of the senses. You might layer sand on the bottom and drop in seashells and starfish and weather-worn stones to conjure the seashore. A variety of stones in different shapes, colors, sizes and textures is another idea.

Enriched sensory environment for Alzheimer's | Sensory Box

An example of a sensory box that supplies some of the sensory stimulation that one might get from a walk in the woods.

We are inclined to over-protect children with developmental disabilities and special needs. (see the interview video with Ad Verheul and Jan Hulsegge to the right) We tend to shelter elderly people for whom we provide care, especially elderly people with dementia. Safety is critical. It is our first obligation as carers to provide a safe and secure environment. But experience and stimulation are also important. Being safe and secure and bored and uninspired and apathetic is certainly not an optimal situation.

See our complete line of sensory stimulation products, or be creative. Just remember, dementia takes a toll on the senses, as does aging. An older person with Alzheimer’s disease isn’t going to see or hear as well as he or she once did. Music will need to be a little louder to be appreciated — just be careful not to turn the volume up to dangerous levels.  Likewise, flavors and odors may need to be stronger to be tasted or to be smelled. Spices not only add strong flavors to food, but can be good for the brain.

But we use our senses all the time. You might ask, “Why go to so much trouble to provide multisensory stimulation for Alzheimer’s ?” Our senses are what connect us to our world. Our senses allow us to understand our environment, to manipulate it and to move about within it. As it turns out, sensory stimulation is brain stimulation. And the more we stimulate the brain of a person who has dementia, the better that person will function. The happier he or she will be.

But a “more is better” approach is not necessarily the best tactic. Sensory stimulation is therapy for anyone. There are ways to stimulate the senses that yield better results than just randomly providing stimulation. We will explore that idea in a later post,  How Sensory Input Affects the Brain. But coming next we will explore how our senses work –  Our Senses and Perception.

Research for multisensory stimulation for Alzheimer’s

Baker, R., Bell, S., Baker, E., Holloway, J., Pearce, R., Dowling, Z., Thomas, P., Assey, J. and Wareing, L.-A. (2001), A randomized controlled trial of the effects of multisensory stimulation (MSS) for people with dementia. British Journal of Clinical Psychology, 40: 81–96. doi: 10.1348/014466501163508. Abstract

Julia C. M. van Weert, Alexandra M.,Dulmen, Peter M. M. Spreeuwenberg, Jozien M. Bensing and Miel W. Ribbe (2005). The effects of the implementation of Snoezelen on the quality of working life in psychogeriatric care. International Psychogeriatrics, 17, pp 407-427. doi:10.1017/S1041610205002176.  Full Paper

Bauer, Michael; Rayner, Jo-Anne; Koch, Susan; Chenco, Carol Gaye. (2014) The use of multisensory interventions to manage dementia-related behaviours in the residential aged care setting: A survey of one Australian state. Australian Centre for Evidence Based Aged Care, Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia. Journal of Clinical Nursing (Impact Factor: 1.26). 09/2012; 21(21-22):3061-9. DOI: 10.1111/j.1365-2702.2012.04306.x  Full Text

Meir Lotana* & Christian Goldb. (2009) Meta-analysis of the effectiveness of individual intervention in the controlled multisensory environment (Snoezelen®) for individuals with intellectual disability. Journal of Intellectual and Developmental Disability; Volume 34, Issue 3, pages 207-21. Abstract

Games and activities for Alzheimer's

Once we had a good start on the website, we began a search for games, puzzles, alarms, and other products that all of our research indicated would  benefit Bernice and others with Alzheimer’s disease.

That was not as easy as we thought it would be!

Fred Astaire and Cyd Charisse in a scene from The Band Wagon

That’s Entertainment

Entertainment for people with Alzheimer’s and other forms of dementia is not much different from entertainment for the rest of us. We work, we play, we take care of those pesky things like shopping and paying bills that are a part of everyday living. Sometimes we just want to forget about all that and relax.

An entertainment is something that distracts us or diverts us from the routine of daily life. It makes us for the time being forget our cares….
~ Sir Herbert Read

So we look for entertainment, for something to take us away from our everyday world and put us, for a while, into a fantasy world, into the world of nature, or directly into ourselves. That might mean reading a book, going to a concert or just listening to a symphony recording, taking a hike, going for a swim or a bike ride, taking in a movie…. The list goes on and on.

The category list of entertainment for a person with Alzheimer’s or dementia is very similar. It differs in the details. In the early stages, a dementia patient will likely enjoy the same forms of entertainment, the same movies and books, that he always did. As his disease progresses, the list gets shorter and the items change, but the need for entertainment remains. Make sure that the activities that you provide are stage-appropriate as well as age-appropriate.

Entertainment for Alzheimer’s Disease and Dementia

Entertainment media provide us with one of our biggest sources of reminiscence therapy. Old movies and television shows, recordings of old radio programs, live performances and recordings of songs and music from the 30s and 40s; any of these could inspire a memory. And the older movies are often better, not only because they are recognizable, but because they are simpler. More recent movies often have plots that are difficult to follow for anyone, let alone someone with cognitive challenges.

Movies and Documentaries

Feature movies are a first choice for many when it comes to finding a distraction from the routine of our daily life.  Musicals, comedies, and movies that feature dancing can provide entertainment without the need to follow a complex plot. What could be more iconic, or entertaining, than to watch Fred Astaire dancing on the silver screen, or even the TV screen, with any of his many partners. That’s Cyd Charisse with Fred in the picture at the top of this page in a scene from The Band Wagon. Many of these great old films are available at your local library in CD format.

Seasons: Spring & Summer | Ambient nature video from Best Alzheimer's ProductsNature at its best, accompanied by the sounds of nature or relaxing music.

BUY SEASONS SPRING & SUMMER

 

Nature documentaries are another entertaining option. Many rely heavily on the visual grandeur of their subject to tell the story. In our experience, people with Alzheimer’s disease and dementia enjoy these immensely. Award winning documentary films like The  Planet Earth, and March of the Penguins are also available at most public libraries.

Other Video Entertainment

Beyond the documentary are nature videos set to music or the sounds of nature. No plot, no story line, but still immensely entertaining, stimulating and relaxing. This category of movie is made to bring the world into your home. An undersea reef, the Amazon Jungle, majestic mountains, a Caribbean island; all can be enjoyed in the comfort of your living room. These can be thought of as music for the eyes, and provide a relaxing ambiance whenever they are playing; no annoying talking to get in the way.

We carry a series of DVDs called the “Ambient Collection,” and it is just that. Beautiful natural scenery and original inspirational music provide hours of viewing and listening enjoyment.We have all experienced the hypnotic effect of a fire, or of colorful fish swimming in an aquarium. These encounters usually leave us feeling quiet, peaceful, and content. That is exactly the effect that our selection of ambient videos has on everyone that watches them. These are perfect viewed at the end of the day, to relax and prepare the mind and body for sleep. They are also good at any other time that a respite is needed from the daily chores. They provide visual, auditory, and mental stimulation, all perfect for reducing the aggression and agitation that are often symptoms of dementia including Alzheimer’s.

See our entire collection, or view selected video clips.

A reminder when ordering video: Order the video format that corresponds with your equipment. Blue Ray and High Definition DVD provide a much better picture, but they won’t play on standard DVD players. On the other hand, Your DVDs will most likely play on your Blue Ray player.

SHOP NATURE DVDs

Old Radio

A family gathers around the old radio for an evening of listening.

Before television there was radio.

Talk about iconic images from our past.  This young family may be waiting for the broadcast of a Jack Benny or Fibber McGee And Molly episode. From the look on the little boys face he is more likely anticipating sharing an adventure with The Shadow or riding with The Lone Ranger. To you this may be a quaint image of Americana, but if the little boy in this picture is alive today, there is about a 25% chance that he has dementia. He grew up in a time before television. If he is living with dementia today, memories of radio are probably more real to him than are the TV shows he watched later.

So many of those classic radio shows are lost, but not all of them. Unfortunately, the quality of these recordings is not always what it could be. For people who likely don’t hear as well as they did when the shows were first broadcast, listening to these less than perfect restorations might be more frustrating than anything. We are not recommending anything specific in this genre for that reason. This is not to say we are not looking for quality restorations of these old programs. If you know of any, please pass it along. And don’t be afraid to try if you find something. The right recording for the right person might be hypnotic.

This just in!  Well, no, but I just found them while doing an edit on this page (6/27/2014). There are several online locations to listen to hours and hours of old-time radio programs. I recommend Internet Archive. According to Wikipedia, “The Internet Archive is a non-profit digital library with the stated mission of universal access to all knowledge. It provides permanent storage of and free public access to collections of digitized materials, including websites, music, moving images, and nearly three million public-domain books.” There is much more than old radio shows; there is music, historic news reports as well as more current reports, spiritual and religious lectures and recorded sermons, and even a 2009 radio science show about Alzheimer’s research that I will be tuning into sometime soon. There are other similar websites. Some require that you download their propriety software: I suggest you stay away from those. The Internet Archive will give you plenty to do….

Books

Novels, biographies, and all the other books that we read for our entertainment will eventually loose their appeal to a person with dementia. There are other books, however, that will retain their appeal. The so-called coffee table books fit this bill nicely, especially those that have a nostalgic, geographic, or natural theme. These can usually be found on the sales tables of the larger bookstores and appeal to many interests.

Another option is illustrated stories. These don’t have to be children’s books. Stories written or adapted for juvenile readers can be as engrossing as adult novels, and the illustrations that they often contain make them visually stimulating as well. Swan Lake is a marvelous example of this. It is the first book of a fairytale like trilogy, written by Mark Helprin, that I discovered when I was well into adulthood. I still recommend it to friends and anyone I think has the gift of childlike-ness and curiosity, the ability to find wonderment in simple and magical ideas.

MusicMan with Alzheimer's listening to music

Music provides wonderful reminiscences and is an indispensable part of a program of reminiscence therapy. To paraphrase a line from a modern movie classic: The one constant through all the years has been music. The movie was Field of Dreams. The constant in the movie was baseball, but the quote works even better for music. It’s something everyone has a deep connection to. Everyone has a favorite song, or several. Everyone has memories that are connected to one piece of music or another, some going back to childhood. Bing Crosby-America’s Favorite Entertainer More than that, music has the ability, like nothing else, to transport us to a different time or place, to brighten our mood, to relax or stimulate us. Many experts contend that music even has the power to heal. See our collection of American Masters CD’s that feature some of the most recognizable and loved songs from the 1920’s through the 1950’s, and at a very reasonable price.

But music is not just for listening: Encourage participation. People in later stages of dementia often remember the lyrics of songs that they may not have heard for years. A person with Alzheimer’s who has trouble putting a sentence together, who stumbles over words, might sing along with a familiar old song without hesitation or mistake. Not only is this enjoyable, it stimulates the memory. She’s not a singer? Maybe he plays piano or another musical instrument: Maybe not well, but that doesn’t matter; or hand him a tambourine or a pair of maracas or drumsticks, and let him keep the beat to recorded music. Merry music making can be done in groups or individually. In residential situations, bring in a leader who has a selection of rhythm and percussion instruments, and experience in encouraging participation.


Songs From Far Away & Long Ago

Songs From Far Away & Long Ago

Sentimental Sing-Along

Videos in the Sentimental Sing-Along Collection contain classic songs ideal for nursing homes, churches, senior centers, civic organizations, families and elder Americans everywhere. Each memory-stirring volume is 30 minutes in length and comes with a set of reproducible song sheets.

 

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Respite Video

The Video Respite® collection was designed to capture and maintain the attention of those with Alzheimer’s disease and other forms of dementia through music, light movement, and the recollection of fond memories. It is as if the loved one in your care is spending some time with a good friend. Here, Joyce talks about garden fresh vegetables.

The concept of the Video Respite series is to involve and entertain the person watching so that the carer can have some time to prepare a meal, clean, or just relax. There are thirteen videos in all, so you are sure to find one that is just perfect for the loved one you are caring for. These videos also work very well in a memory care community.

This is one of the best caregiver aids that we have found! (watch overview video)

 

Video Respite for Alzheimer's disease.Video Respite DVDs provide a respite for you the caregiver, a short time to yourself.

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Reminiscence Music

Familiar music might be the best way to trigger reminiscences. The effect that old old music has on us is the reason that oldies radio stations are as successful as they are. And it seems that no matter how long it has been since you last heard a favorite oldie you can still sing along and not miss a word. People who have dementia may not be able to learn the lyrics for a new song any longer, but they often remember old songs as well as anyone else. And reminiscing to their old favorites brings pleasure and can greatly increase quality of life.

Entertainment for Alzheimer's |Music is an ideal stimulation for reminiscenceMusic for Reminiscence

SHOP MUSIC

 

 

 

 

For the Alzheimer's Caregiver | Woman with Alzheimer's walking in a garden with her carer

Alzheimer’s Care and Dementia Care

Because Alzheimer’s disease and most other causes of dementia are progressive in nature, you will not be thrown suddenly into a situation in which another person is totally dependent upon you for their care and well-being. As an Alzheimer’s caregiver you will have some time, or you have had time, to adjust and to learn your new role. This knowledge does not make the prospect or the task easier, but it does give you time to prepare.

There are many reasons to care for a loved one with dementia at home for as long as possible. Once you have made the choice to do so, do everything you can to make yourself and your home ready so you can be be an effective, efficient carer. This website is designed to help you do just that. Use the information and the aids and the references available here to help you be the best caregiver you can.

Preparing for Caring

Educate yourself about the disease. The more you understand the effects that Alzheimer’s disease has and the ways that it affects the behavior and cognition of its victim, the better prepared you will be to help the person in your care. This knowledge will also help you to handle your own uncertainties and frustrations.

It’s one of the most beautiful compensations in life that no person can help another without helping themselves.

~ Ralph Waldo Emerson

Prepare the home. Before we provide appropriate activities and entertainment for our loved ones who have dementia, we must ensure their safety. People with most forms of dementia are prone to accidents and personal injury. While you are caring for a person with Alzheimer’s or dementia in your home, or in his home, it is important to be aware of the risks and know ways to lessen them. Open flames, obstructions that could cause tripping and falling, household cleaners that are poison, medications, and wandering are among the many things you should be aware of when preparing your home to care for a person with dementia.

Establish and maintain a daily routine. A predictable structure makes it easier for both caregiver and care-receiver, and ensures that those elements necessary to proper care do not get overlooked. Whenever possible the routine should include:

  • Activities of daily living — As the disease progresses, you will need to help more and more with the seemingly simple activities of daily living (ADLs), with hygiene and personal care, meals, toileting, and the other activities that make up this category. Help with these activities will almost certainly take up more of the day as the condition progresses.

    SHOP ADLs

  • Sensory activities — Sensory stimulation is an important part of prolonging cognitive functioning. More…

    SHOP SENSORY ACTIVITIES

  • Cognitive stimulation — This can come in many forms, most of which are enjoyable and entertaining. Games, puzzles and toys are some of our favorite.  See more ideas in Alternative Therapy. Activities that stimulate the brain can slow down the progression of dementia a little, but a little is better than nothing. Such activities are also effective against apathy, aggression, anxiety and agitation that are common.

    SHOP ALTERNATIVE THERAPY

  • Social activity — Socialization is an important part of reality orientation. People with Alzheimer’s disease tend to become withdrawn. As they lose confidence, they avoid contact with others; provide as much opportunity for social interaction as possible.
  • Physical activity — Exercise is important to us all, especially as we grow older. To maintain our strength and flexibility, it is crucial to keep active. Incorporate walking, stretching, and light lifting into the daily routine. Pay particular attention to the hands. The longer the hands remain strong and flexible, the easier the routine activities of daily living will be for the person who has Alzheimer’s. Physical activity also increases blood flow throughout the body, and that can help to slow the effects of the disease on the brain. We have a good selection of exercise videos (DVD) that are created specifically for mobility impaired individuals; many of the exercises are done while sitting.

    SHOP EXERCISE VIDEOS

  • Relaxation and entertainment — It is important to schedule some time every day to do nothing in particular, to get away from the concerns of the day. This is true for both of you. Relaxation time might include a nap, especially if your loved one with dementia has trouble with sleeping, a common symptom. Music, movies, old classic television programs that they remember are all relaxing as well as stimulating.

A schedule that contains as much of the above list each day as possible will improve the quality of life for the one you are caring for, and in turn will provide a better quality of life for you.

Practice sympathy. As difficult as your role as Alzheimer’s caregiver will be at times, it is minor when compared to the obstacles and the uncertainties and the fears of the person for whom you are caring. Many who suffer from Alzheimer’s and dementia are aware that their faculties and abilities are slipping away. What they want most is to feel needed and to know that they can still be helpful and productive members of the family or community.

Communication is Key

One of the most trying aspects of dealing with Alzheimer’s and dementia is the breakdown of communication. Never stop communicating. As Alzheimer’s disease progresses it slowly erodes the ability to communicate verbally. One of the classic symptoms of Alzheimer’s is the difficulty of ‘finding the right word’. Another is the

impairment in structuring a logically sequenced sentence. These impairments are frustrating, as you can imagine, and likely have seen, but don’t stop communicating. Read more about communicating with a person who has dementia. Or see our post, 5 Excellent Articles on How to Communicate with Someone who has Alzheimer’s.

 

You are Caring for Two

As an Alzheimer’s caregiver, or as the care partner of someone with any other debilitating disease or condition, you are responsible for the health and well-being of two people. To do your best job of caring for another person, it is important that you maintain your own physical and emotional health. It is likely that the one you are caring for is your mother or father, or some other loved one. The emotional component of caring for another person, especially a loved one, makes the task even more challenging. You cannot do your best as a caregiver if you are exhausted, irritated, burned out.

If you are the primary caregiver for a person who has Alzheimer’s disease or another form of dementia, there are many people you can go to for help and support, including medical professionals, clergy or a spiritual advisor. You are likely to get the most meaningful and welcome support from your family and friends. There are also a number of respite care alternatives available to most people.

Respite Care

Professional respite care for Alzheimer’s comes in two basic flavors, in home respite care and adult day services. Both are designed, at least in part, to give you a respite from your daily responsibilities. Both of these services often provide bathing and other hygienic and personal services, help with Activities of Daily Living, as well as other specialized services. Respite care also gives your loved one a respite from you, a chance to be in a different setting with new people who understand her situation. Scheduling is also flexible. You can use the service every day of the week, or just one or two days.

  • In-Home Care
    There is a growing number of in home care providers; many of them are franchised, and this can be good for you. A franchiser should supply at least a modicum of training as well as provide a standard of care and hold the franchisee to that standard. It also makes qualified care easier to find. You should still do your homework. Try to get recommendations from others who have used the service. Talk to the supervisor and to the individual(s) who will be providing the care. Most importantly, everyone who will be interacting with your loved one should have a thorough understanding of the special needs of a person who has dementia.
  • Adult Day Services
    Formerly known as, and sometimes still referred to, by the less than agreeable term, “Adult Day Care”, Adult Day services provide a safe environment for adults who need special care, every now-and-then or on an ongoing or daily basis. According to national statistics, 70% to 80% of people enrolled in this type of respite care have dementia. The staff will be trained to care for people in this group, but you should talk to the administrator about any particular needs or quirks your loved one has. The more they know about him or her, the better able they will be to provide the best care.  The more you know about the center you are considering, the more likely you will be to make a good choice.
  • Residential Care
    Many extended care residences, assisted living, for example, offer an option of an overnight stay, or even one lasting several weeks. This option gives you an opportunity to spend a weekend with friends and family, catch up on some business or house work, or even to take a well-deserved vacation. The trained professional staff will ensure your loved one is well cared for. An extended stay in residential care may be a way to ease into a permanent move.
  • Other Respite Care
    Less formal respite care is also available for most of us. For example, other family members and friends can share your responsibilities from time to time. If someone ever offers this kind of help, remember that offer, and take them up on it from time to time!

Professional Residential Care

You may eventually have to find a residential facility for your loved one with Alzheimer’s or dementia. Professional residential care is the next step for you and your situation; it is not a failure on your part. (This is important and bears repeating) It is not a failure on your part! At this time, it is likely the best move for him, for his safety and well being. The professional care, the directed and personalized activities, and the social setting is more than most people can provide at home.
Failure comes in not visiting, frequently, your loved one once he or she is in a residential community. You wouldn’t be so neglectful, but some people are. One excuse we hear often is, “It’s not important. Mom doesn’t remember that I was there anyway.” If you hear anyone using this (or any) excuse for not visiting a friend or family member who is in an Alzheimer’s care facility, send them to this Website immediately!!! (And it wouldn’t hurt to scold them a little.) What is important is that your loved one is enjoying the moment, that he or she feels useful and cared about right now. I feel that a person afflicted with dementia, even if they cannot recall an event or an experience, does remember at some level.

For Bernice

Every single time we would have a ‘foot bath’, Bernice would chat about the ‘smart’ person who invented this machine. All the things happening at once; she was very taken just by ‘watching’ the water whirl around and the ‘hum’ of the machine. And every time, she not only enjoyed it, but it always relaxed her. Every time was a ‘new’ experience for her; she forgot that we had done it before; often stating “I wondered what ‘that thing’ was that sits in my bathroom! How wonderful!!!”

The above account was written by Kate, one of the admirable people who has cared for Bernice since the time she was diagnosed with Alzheimer’s disease. It is instructive on many levels. The ‘footbath‘ is a portable unit that mimics the more professional models used by pedicurists and podiatrists. It swirls and vibrates and massages the feet. That’s the “all the things happening at once” part.

BUY FOOT BATH

Watching all of this happen at the same time that it is massaging her feet makes it a multi-sensory experience, and a cognitive one as well, causing Bernice to think about how it works, and the things it is doing “all at once.” Perhaps most enlightening: Kate made a point to say that she didn’t remember from one time to the next that she had used this “machine,” but she always enjoyed it, and it relaxed her. It is the experience, not the memory of the experience that is crucial.

Older couple creating a memory book for Alzheimer's

Life Stories for Persons with Alzheimer’s Disease: Making a Memory Book †
Presented by: Connie Lucas, Program Specialist
Alzheimer’s Association, Greater Iowa Chapter
December 19, 2005

What is a Life Story Book?

  • A history of a person’s past life experiences
  • A book of prized memories
  • A treasury of family and friends
  • A bridge to the past
  • A connection to the present

Uses:

  • A distraction technique for refocusing during difficult symptoms
  • A security tool when person is taken to unfamiliar places such as the hospital
  • Promotes well-being, validation and celebration of a person
  • A bridge to the past
  • Provides opportunities for pride and enhanced self-esteem

How to Begin…. Ask:

  • Ask persons with Alzheimer’s what they feel proud of in their life.
  • Ask them what they want other people to know about them
  • Ask about their favorite memories
  • Ask other family and friends to share what they like and admire about them
  • If persons are not able to give you these answers, then try to answer them as you think they would

Suggestions for Topics:

Childhood.
Many recall their childhood better than more recent times, so include as much as possible.

  • Date and place of birth
  • Names of parents and their occupations — did they immigrate?
  • Names and birth order of siblings
  • Community they lived in — was it famous for something or major businesses?
  • Schools they attended — favorite subjects, teachers, pranks
  • How they spent their time as a child: hobbies, pets, sports, friends, church
  • Holidays and special events

Adolescence
One of the most influential life stages

  • Graduation and subjects liked and disliked in school
  • Dates, first kiss, great loves
  • Cars
  • First jobs
  • First time living on their own
  • Favorite foods

Young Adult

  • College and work — any awards?
  • Marriage – lots of wedding details
  • Military service
  • First home or apartment
  • Starting a family
  • Vacations and travel

Middle Age

  • Grandchildren
  • Hobbies
  • Community and club activities
  • Politics

Later Years

  • Achievements and Awards
  • Volunteering
  • Hobbies — new skills learned
  • Travel
  • Most important lesson learned from life

Enriching a Written Life Story

More questions to ask:

  • How did you enjoy spending New Year’s Eve or your vacation?
  • Do you have a favorite book, movie, song or color?
  • Are you more of a pessimist or optimist?
  • Did you hold on to the first dollar you ever made, or spend it immediately?
  • What 3 favorite things would you want on a deserted island?
  • Are you more comfortable in the company of men, women or pets?
  • What really makes you “sparkle” or happy?

What advice do you have for future generations

  • Politics and political parties
  • Getting along with others
  • Money • both cash and credit
  • Happiness
  • Religion
  • Raising kids
  • Coping with hard times
  • Love
  • Giving
  • Work
  • Marriages

If you had your life to live over, what one thing would you do differently?

Getting Started

  • Write information in the first person
  • The amount of decoration on each page would depend on what stage of the disease the person is in. Less is usually better than more. Too much decoration makes it harder to concentrate on the content.
  • Only have one picture per page. You can have the opposite page blank or use it for writing or journaling.
  • If at all possible have your family member write his/her name on one of the pages
  • Make copies of each completed page. This book needs to be out where it can be used but have back up pages if they should get lost or damaged
  • You do not have to do it all at once. Begin with a few pages. Ask family and friends to make a page as a gift.
  • If you are more comfortable writing a story, it does not have to be the whole story to begin with. Pictures do help job our memories but there are not always pictures for each event.
  • Write one page where you tell them what is so special to you about them.
  • Caption each page.
    • Early stage (stage 5) example: “Connie’s first day of kindergarten at Saylor school in Des Moines”
    • Middle Stage (Stage 6) example: “Connie’s first day at Saylor school.”
    • Late Stage (Stage 7) example: “Connie loved school”

All the elements of the life story provide important tools for improving communication, making activities meaningful, preventing boredom, honoring the person’s life and offering positive diversion.

“Paging through a book of old photos while wrapped in a familiar blanket and holding hands can give some of the comforts of home” (stated in the Mayo Clinic on Alzheimer’s Disease)

When families come together to create the life story book, it can be a healing tool and a celebration of their loved one’s life.

Bibliography:

Alzheimer’s Disease Activity Focused Care by Carly Helen
A Dignified Life • A Guide for Family Caregivers by Bell and Troxel
Creative Memories by Mark Mizen, PhD
Mayo Clinic on Alzheimer’s Disease by Ronald Petersen, M.D., PhD, Editor 2002

† Reprinted with permission from the author

twiddle muffs for alzheimers and dementia

The original Twiddle Muff was developed by Margaret Light for her grandmother, Lily. As she grew older, and her eyesight began to decline, Lilly couldn’t be as creative and productive with her hands as she had been all her life. “The Twiddle Muff satisfied her need to keep her hands warm and busy,” Margaret says. “She enjoyed it so much that it was on her lap constantly.”

CLICK HERE TO BUY TWIDDLE MUFF S
The success of the original Twiddle Muff spawned the creation of three more designs; the Pup and the Cat, both with adorable pet-faces and tails, and the Sport in a pretty plaid. The cat comes in two colors, cream and chocolate brown.

Twiddles are a reassuring addition to your caregiver resources, and provide a less-expensive, drug-free therapy option ideal for use in any setting.

Buttoned to the outside are three detachable, attention-getting gadgets:

Original Twiddle MuffTwiddle Original

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  • a sealed satin/buckskin crackle pouch
  • a strand of three long, satin ribbons
  • a loop of colorful wooden beads in various sizes

Additional features:

  • a Velcro® pull-tab for attachment to a walker, wheelchair or bed tray
  • a name tag for personilizing the Twiddle
  • Muff is machine-washable – gadgets should be hand-washed
  • safety-tested to meet U.S. & European standards – CE certified for sale in Europe

The detachable Twiddle gadgets allow the Muff to be machine cleaned. Many have been put through countless machine washing cycles in industrial machines and still look and work like new!

Twiddle SportTwiddle Sport

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Twiddle®Muff was created to give (my Grandmother’s) inquisitive hands something to keep them moving, active and warm and remind her how much she is loved……..even when I

couldn’t be with her.

~ Margaret: Creator of the Twiddle Muff

Twiddle Muffs for Vimeo

Twiddle PupTwiddle Pup

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Professional caregivers rave about the effectiveness of Twiddles®. Having something to hold and manipulate, something to “twiddle” or fidget with, has a calming effect on a person who has dementia. The textures, the gadgets, the warm coziness of the Twiddles® are all there for just that reason. The stimulation they provide truly adds to the individual’s quality of life.

What Others are Saying

According to Linda Goy, director of life enrichment at the Scottish Home, a residential living facility in West Suburban Chicago: “The resident will talk to the Twiddle Muff, particularly if it is the pup or cat. ‘I want to hug you; you are a good boy; you are so cute.’ I’ve also seen it prompt unexpected conversation between residents. One will ask the other, ‘May I hold your cat?'” This often stimulates conversation and social interaction among residents as well as among family members.

Twiddle Muff |Bernice with her Twiddle Cat. "When I look at the eyes and mouth it makes me think I'm okay. Where did I get this little pumpkin pie?" ~ Bernice

“When I look at the eyes and mouth it makes me think I’m okay. Where did I get this little pumpkin pie?”
~ Bernice

Another from Pat Benda, R.N.C., director of nursing at the Scottish Home. She adds, “We are all concerned about over using meds, but we want to minimize the agitation and anxiety our residents sometimes exhibit. The Twiddle®Muff is a welcome alternative. Of course, the medication needs of our patients vary from day to day, from person to person and from situation to situation. The muff doesn’t necessarily replace meds, but may allow us to reduce dosage, or give fewer doses a day.”

This observation is supported by Corie Larocque, Alzheimer’s coordinator for Brighton Gardens in Wheaton, IL. “(The Twiddle®Muff) immediately helps calm the resident, directing their focus and energy on one thing. In my experience, the muff does reduce the needs for meds.”

These are the original Twiddle®Muff s! designed especially for the person with Alzheimer’s. Twiddle®Muff is a registered trademark. Others have tried to copy it, but none can compare to the real Twiddle®Muff.

SUGGESTIONS FOR USING YOUR TWIDDLE MUFF

  • MAKING THE INTRODUCTION  Because everyone is different, consider the personality and individuality of your loved one when purchasing and presenting the Twiddle Muff. A person who likes animals will probably do well with the Pup or one of the Cats. An analytic personality might begin her connection by evaluating the Twiddle. A nurturer may be pleased to “look after” it for a while. This product does contain small parts, and it should only be used with supervision.

  • CHANGE-UP  Add some variety to the activity by moving the gadgets around. Try the beads inside the Muff and the ball on the outside. If certain attachments pose an accident risk, remove it, at least temporarily. Some people, for example, like to chew. The ball that comes attached to the interior of the Twiddle is relatively safe and can pacify this need. The string of beads, on the other hand, could pose a swallowing risk, and probably should be removed.

  • POCKET POTPOURRI  The pocket on the side of the Twiddle can hold any number of interesting objects, from a tissue or favorite photograph, to a prized keepsake. Or put some oil in a Tangle Aromatherapy and hide it in the pocket for some added therapeutic value. Change the pocket contents each day to add interest and an element of surprise!

Care Instructions

  • PERSONALIZE THE TWIDDLE MUFF  Each Twiddle comes with a name tag for identification. This can be especially helpful if your loved one is in a care community. Use an indelible marker to write his or her name on the tag. This can add pride-of-ownership to the long list of benefits that the Twiddle Muff can offer.

  • CARE INSTRUCTIONS  Depending on use, the Twiddle should be laundered periodically. All attachments can be removed for cleaning.  Machine wash and dry the Muff. Attachments should be hand washed. Not intended for children under three years of age.

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What Others Are Saying
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Twiddle Muff |Brown Twiddle CatTwiddle Cat

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Mama loves her new “puppy”. She named it Poo-Bah…I have no idea where that came from! The very best part was that she actually tied a perfect bow with the ribbons. She tied the little baggie of homemade cookies that we had also given her, to the puppy, using the ribbons. I took a great photograph of this event! The staff was amazed, and told me that now they have an idea what to suggest to other residents’ loved ones, for gifts. My Aunt’s son is also very interested in the puppy, as she too has Alzheimer’s. I have given your web site to them. I plan to revisit it as well, to find even more items for Mama and for the “memory care community” where she now lives. I’m so glad I put “gifts for Alzheimer’s” in the search engine. ~Marilyn

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This is the second one we have purchased. The first was the dog and she has worn that one out. She absolutely loves these. ~ Colleen

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In our last phone conversation, she gushed about it, and just hearing her enthusiastic about ANYTHING brought my heart all the warmth I had hoped for. It’s a bit pricey as far as stuffed animals go, but I have to admit it was well worthwhile. ~Chris

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I was having trouble with my mom tearing paper, picking at her skin, just nervous behavior. This muff is perfect for her. She has things to touch and seems to particularly like the fringe which she will touch all day long. I guess she just needed something to do with her hands. ~Suzanne

Doubters become Believers

Ok, I was as skeptical as most prudent folks would be, but I took a chance and bought this for my mother, who is suffering from a rapidly-advancing case of dementia. I’m currently over in Afghanistan, and speaking with her on the phone was heart-wrenching. Thankfully, she still knows I’m her son, but not what my name is.

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I took a leap of faith and ordered the Twiddle Pup after a friend’s recommendation and the seemingly incredible reviews. I was not disappointed. I don’t know the science behind it, but my mother instantly fell in love with it, gave it a name, and carries it with her wherever she goes. She says “Rusty” provides her with much comfort, companionship, and a way to keep her frail hands warm on cold autumn evenings. I’m sure she doesn’t realize that playing with the enclosed marbles helps her circulation, but that’s ok. All she needs to know is that it keeps her hands warm and working.

 

 

Gustatory Stimulation for Alzheimer’s and Dementia

Eat, drink, and be merry

Gustatory Stimulation – In many ways taste is the most pleasurable of our senses, depending on how much emphasis one puts on food and eating. Taste is very closely aligned with smell and can lead to reminiscences. A favorite meal or a particular dish one has not had for a long time often triggers a flood of recollections.

Unfortunately, our senses become less acute as we age. This is probably truer of taste than the other senses. Don’t take that to mean that our person with Alzheimer’s won’t profit from exposure to gustatory stimulation, but foods and beverages chosen for a strong flavor will be easier for him to taste than will a more bland selection. Keep a variety of herbal and flavored teas. Be creative in the kitchen to bring a diversity of tastes to the table. Spice, after all, is the variety of life!

Gustatory Stimulation for Alzheimer’s and Dementia

There are so many things in the kitchen that can be used to stimulate the taste buds, since taste is almost always connected to eating. Remember to look for strong (not to be confused with bad) flavors. The licorice herb, for example, has a stronger taste than parsley: sautéed mushrooms finished with red wine have more flavor than if simply sautéed in oil or butter. And there is evidence that a little wine now and then is good for the brain.

“Tea” has two meanings in today’s usage. Tea is traditionally a drink (hot or iced) made from the leaf of one of several varieties of the tea plant, Camellia Sinensis. The leaves are processed differently to yield white tea, green tea, oolong tea, and black tea. Kukicha is another option that is brewed from the twigs and stems of the tea plant. Each of these varieties has a distinct taste, and it may be fun to have a tasting to distinguish the varieties. A “tasting” could even be done in a small group for the added social interaction: as in “having tea.”

More recently, “tea” has come to mean any drink made by infusing plant parts in hot water. The plant parts could be leaves, bark, root, stem, fruit, berries, flowers, or a combination of these, and these herb teas can be served hot or cold. This gives us an almost unlimited diversity of flavors – and odors – to stimulate the senses; additionally, temperature is a tactile discrimination. There are medicinal properties attributed to many herbs and plants. Be careful, since some herbal medicine is strong, and some can react badly with other medications that the dementia patient may be taking. On the other hand, the herbal teas and tea mixtures that are sold in health food stores and supermarkets are most likely safe for general use.

Best Alzheimer’s Products does talk about the healing effects of certain plants in the Prevention section of this website, but we do not prescribe medication, natural or otherwise. Be sure to consult with your medical professional before trying herbal remedies, and see our disclaimer.

Spices and flavorings – Abundant in most kitchens, spices, herbs, and extracts (vanilla, peppermint, etc.) add interest and variety to the taste of food. Instead of pork chops, serve pork chops with rosemary and garlic. Sprinkle fresh or dried thyme on eggs, just to be different. Bake cookies and make candy that use mint and other strong flavorings; the process will also add aroma to the entire home (olfactory stimulation).spices-and-herbs-for-alzheimers

Another consideration is the health benefits that are increasingly being reported for various spices. Turmeric is available fresh (a root that looks a little like orange ginger) or in powder form; it is the main ingredient in most curries. Turmeric has been used as a flavoring in Indian cuisine for thousands of years, and also as a medicinal herb. Western medicine is only now catching up; many health benefits are being discovered for turmeric including a strong anti-inflammatory property. Chronic inflammation is thought to be  partly responsible for most Western diseases including heart disease, cancer, metabolic syndrome, and Alzheimer’s disease.

Turmeric has an slightly bitter, aromatic taste. Thus, in cooking, it is often used in combination with other spices. It is also very bright in color, and is often used as a food coloring. It can lend a pleasant visual component to foods that makes eating a more complete sensory experience.

Other foods and flavors that show promise as treatment or protection against Alzheimer’s disease include:

  • Coconut — pure, organic only
  • Cinnamon
  • Green and black tea
  • Green leafy vegetable, sprouts, and other fruits and vegetable high in
  • Berries — like blueberries and strawberries. Get organic whenever possible. Strawberries in particular will have a lot of chemical insecticides on and in them, and eating those may provide more harm than good.
  • Read more about eating to prevent Alzheimer’s disease.

So how, you might ask, do I get those foods in my diet? Here is a great recipe for a drink that includes many of them. I’ll try to include more recipes as I find them, here and in other places on this website.

The Ingredients

  • 1 cup coconut or almond milk
  • 1/2 cup frozen mango chunks
  • 1 fresh or frozen banana
  • 1 tablespoon coconut oil
  • 1/2 teaspoon turmeric powder or use fresh turmeric
  • 1/2 teaspoon cinnamon
  • 1/2 teaspoon ginger
  • A dash of sea salt
  • A little honey, maple syrup to sweeten (optional)

The Add-ons

  • 1-2 tablespoons chia seeds
  • 1/2 cup fresh or frozen pineapple chunks
  • 1/3 cup coconut shreds/flakes
  • 1 tablespoon maca

Show Time

Simply place all of the ingredients into your blender and blend away for around 30-45 seconds or until your desired consistency is achieved.

* Thanks to healthysmoothiehq.com for this smoothie recipe.

Food as flavor – There are many foods available to us that were unknown when your loved one with Alzheimer’s was younger. Tropical fruits like Kiwi and Star Fruit are not only deliciously sweet, but even look beautiful. Arugula, sometimes called rocket, has been used in Mediterranean cuisine for centuries but is relatively new in the United States. It spices up a salad with a strong peppery taste and is good with rare, lean beef (our recommendation).

Experiment with new foods and new recipes, and new drinks, as you would with young children. Your loved one will not like everything you make, just like children, (just like your spouse) but you will probably find some new favorites for everyone.

The kitchen is the obvious place to look for flavors. Remember that herbs and spices, and teas lose flavor and strength if they get too old.


Food for Thought

There is little formal research investigating the effects of gustatory stimulation on people with Alzheimer’s disease. On the other hand, we all know how important tasting and eating are to quality of life.

There is evidence that even bad tastes stimulate the brain. A study reported in Brain used a saline solution as an “aversive gustatory stimulation,” and measured increased activity in several areas in the healthy brain, and brain stimulation is a part of what we are trying to achieve.

Music therapy for Alzheimers and demantia

Music is everywhere!

Auditory Stimulation – Our ears probably provide us with our second most vibrant source of sensory stimulation. Our eyes allow us to enjoy the paintings of Rembrandt and the sculpture of Michelangelo. Our ears allow us to share in the genius of Mozart and Beethoven; to wake up to a symphony of birds on a spring morning.

Auditory stimulation for people with Alzheimer’s and dementia is effective for mood enhancement, relaxation, and cognition; just as it is for everyone else. The calming effects of music are well known. Farmers play music to their cows, and the cows produce more and better milk. Music makes plants grow larger and healthier; at least according to some studies. Music is good for living things including people. In fact, Music Therapy is proving to be an effective Alternative Therapy for people with Alzheimer’s disease.

And it’s not just music that benefits dementia patients (and everyone else, as well). The sound of water, from a babbling brook or an artificial waterfall, is to the ear what a camp fire is to the eye. Bird songs are being studied to determine just how positively they effect the human brain.

SHOP MUSIC THERAPY

Sounds for the mind and the brain

Natural sounds are probably the best for mood and meditation. A gentle rain, or the wind blowing through pine trees, can work magic. To stimulate cognition, a Mozart symphony is probably better. And the music that the Alzheimer’s patient enjoyed when he or she was younger is best to stimulate reminiscence. Therefore, a variety of sound stimulation is important.

Sound does not have to be pleasing or melodic to be effective. Rattles and other percussion musical instruments are also good, especially if the person with dementia is playing them. The physical activity and the stimulation of listening to and following a rhythm both add to the benefits of the passive auditory stimulation. Even “white noise” has been shown to improve memory in Alzheimer’s patients.

Auditory Stimulation & Alzheimer’s Disease

Sound stimulation can be used in various ways and with various effects, and can augment other fun and beneficial activities.

  • Reminiscence Music Therapy – An “oldie” comes on the radio – something you listened to in high school, and suddenly you’re back, cruising with your teenage sweetheart; maybe you’re on the way to the Friday night sock-hop, or  the football game. Life is good, as it so often is in reminiscences. Anyway, you know what it is like to have your memory jogged by an old song. It’s the same with people with Alzheimer’s. Familiar music is stimulating on several levels and is a strong and important component of a comprehensive reminiscence therapy routine.
  • Participatory Music and Rhythm – If the patient plays a musical instrument, help them to enjoy doing that as long as possible. Sounds produced on an electronic keyboard can be pleasing to them even if those sounds do not come together in recognizable tunes. Sing-alongs are fun and can stimulate memory (see the letter in the box below). Sing-alongs are fun when done with a leader, but can work with recorded music also. Rhythm sessions using drums, rattles, bells, washboards, sticks, etc. can accompany a sing-along, recorded music, or follow a leader. These percussion instruments can be found or made from things around the house. A water bottle filled with beans or gravel is a rattle. A coffee can is a drum. An oatmeal box is a drum with a different sound.
  • Sing-Alongs – Most memory care communities will have professional and semi-professional musicians visit periodically to lead the residents in familiar songs. Many people who have Alzheimer’s disease will remember song lyrics and enjoy singing them long after other communication skills and memories are gone. The stories in the Music and Memory text box at the bottom of this page provide two examples of this very common phenomenon. Each of the DVDs in the Video Respite series features a personality who will get viewers to sing along with a variety of old songs.
  • Background Sounds and White Noise – Stimulating sound or music playing in the background while other activities are going on improves the mood, and even the memory, of people with all forms of dementia. This background sound can be reminiscence music, classical music, recorded sounds of nature, or a table top fountain or waterfall. Many recordings of natural sounds are available; recordings of ocean waves, waterfalls, bird songs, or rain. These recordings of ambient sounds are also very good sleep and relaxation aids.
  • Exercise to Music – Use music to accompany exercise or movement as you would in an aerobic class, or to encourage patients to dance. In a group, dancing is a social activity that is also exercise and can involve touching (tactile stimulation). Physical exercise and reminiscence are two powerful tools for the management of Alzheimer’s, and combing the two will undoubtedly result in an enjoyable activity. Big band tunes, many of the old jazz standards, and even early rock-and-roll will be recognized, and the beat will inspire motion. This natural connection between music and motion is the reason that most exercise videos have music tracks to accompany the exercise. See our collection of exercise videos that we have put together specifically for our friends who are no longer running marathons or pumping iron.

Music and Memory

In her column, Your Health, in USA Today, Kim Painter shared a letter written to her by one of her readers:

She wrote: “A volunteer would come to Dad’s nursing home, attired in a straw hat and suspenders, with a banjo, to engage the residents in a sing-along session. My dad always sang the loudest, with great gusto, and despite his memory deficits, he knew the lyrics almost perfectly to the old-time popular songs of the ’30s and ’40s. … My dad was happy then. … It was as if this music brought him back to a realm of cognitive lucidity and anchored him in a firm time and place.”

Kim Painter, USA Today, 7/24/2006

It’s almost as if Ms. Tomaino was watching that woman’s father when she wrote:

It is always remarkable to watch a person completely removed from the “present” due to a disease such as Alzheimer’s.. come to life when a familiar song is played. The person’s response may vary from a change in posture to animated movement: from a sound to verbal response. But usually there is a response, an interaction. Many times these seemingly disparate responses can reveal much about the preservation of self and the intact personal stories that may still remain.(Tomaino 2000, p. 195)

Tomaino, C. M. Working with images and recollection with elderly patients. In Music Therapy in Dementia Care (pp. 195-211). D. Aldridge (Ed.). London: Jessica Kingsley Publishers