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Tuesday, September 18, 2012
Dear Dr. Camardi:
When I brought Mother in to see you for our dementia visit you asked me if we still did the “brain training” exercises you taught Mom .
Well, I hate to say it but with all that’s happened lately we haven’t kept up with them. I really do think they helped her when we did them consistently but it got to be tough when Dad passed and we kind of lost our routine.
The best idea you gave us was getting Mom back to cooking , doing all the measurements herself and planning out each step because Mom loves to cook and it gave her back a sense of accomplishment. She would prepare all the steps and get it ready , but we would cook it. Then we lost Dad and we lost our stability and we need to get back to it again.
I know it would help us if you would just go over it again .
The diagnosis of early dementia is the start of a race — a race against time to preserve as much brain function as we can. Until we have a cure, the best we can do is to stimulate and nurture cognitive functions to preserve mental faculties.
The goal is to preserve the blood supply to the brain (through exercise, blood pressure control, diabetic control, cholesterol control and weight loss) as well as cognitive function .
This involves doing some directed mental acts that draw on verbal, mathematical, reasoning, analytical and memory function every hour .
Key to this is discovering which things the patient enjoyed the most before dementia and then structuring daily activities that the patient is motivated to do because they are pleasurable.
In your mom’s case, cooking is an excellent way to combine verbal, mathematical and executive functioning skills (formulating a plan and seeing it through) in a manner that is gratifying for the patient both intellectually and socially.
I have also found that the vast majority of my “demented” patients are simply not mentally stimulated enough and, by default, many of them regress into what I call “functional dementia,” where life has been “dumbed-down,” instead of organic dementia where they do not have actual mental loss that can’t be reclaimed by working the brain (the “use it or lose it” concept])
As you can see this is a very complex issue but one I see far too much of in retirees.
Unstructured retirement without intellectual stimulation invites cognitive wastage. Too many of us stop thinking creatively when we stop working. But this does not have to be if we look upon it as a duty to ourselves and our loved ones to stay mentally engaged, so as to preserve and protect higher mental functions . Patients need the assistance of their caregivers and family to help in this process.
A “brain training” program takes a lot of planning, patience, discipline, focus and determination . Without being too technical, the goal is to stimulate the major cognitive centers of the brain with each session. Here’s my secret weapon: the newspaper.
Start with turning off the TV in the morning and reading the newspaper for current events and then discussing them. This will “warm up” the mind for active mental integration of short- and long-term memory , while watching TV is a passive act .
Then we can segue to the word games, puzzles and number games later on .
The middle of the day can be devoted to physical activities such as walking, gardening and even house cleaning .
In the background there should be the best and most natural antidepressant I have found: music. Playing the patient’s favorite music softly in the background has been shown to have beneficial effects .
Allow the person to discuss the feelings that music brings out; this can be cathartic. Having a flow or pattern to the day can be very uplifting , as the patient looks forward to various activities.
This outline of activities can bring a lot of joy to both patient and family . More importantly, it will preserve reasoning, analysis and recall longer than sitting there and watcheing the seasons pass. There is no reason why the “golden years” should be empty years.
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging and an assistant professor of medicine of the Virginia Tech Carilion School of Medicine. His column runs monthly in Extra.
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