What if the stress of living with dementia causes more memory loss? If we can reduce this stress, there may be less cognitive decline. This does not change the condition that is causing dementia, but by reducing the stress, we may be able to reduce this additional cause of cognitive impairment.
Stress Affects Memory
All of us have experienced the effect of stress on our memory. How many times have we rushed out of the house to an important meeting, only to realize we can’t remember where we put our keys or phone? Others have studied non-stop for an exam only to go totally blank as they begin taking it.
This is part of the flight of flight response that shuts down systems in our body when we are under stress, including parts of our nervous system. When we can reduce the stress, our system returns to work as usual. So if you can’t find your keys or remember what you studied, just stop and breath to relax, so your brain will function better.
People living with dementia can experience much stress due to feeling confused, having difficulty expressing themselves or being overwhelmed by sensory stimuli that they are not able to filter out. These stress factors may cause additional cognitive impairment.
Although the mechanism is not clear, research shows that stress effects our memory and ability to learn.
Decline Due to Moving to a Facility
I have written before about how stressful change can be for someone living with dementia, especially the move to a new home or facility. We often hear people warn that a move can cause rapid cognitive decline. Well it may, but the reason for the decline may simply be stress. If we reduce the stress, we may stop the cognitive decline that it caused.
After his wife died, an 85-year-old man with minor cognitive impairment, decided to move to an independent living facility far from his home in order to be closer to his relatives who lived in the area. The move caused him great stress, depression and he became confused to such an extent that the facility felt he could no longer live independently and that they could no longer accept him.
After receiving a few sessions of reflexology, which had a very calming effect, the older man began feeling better and his mood and his cognitive ability improved. He was able to move into the independent living facility and function on his own. By reducing the stress caused by the move, he was able to return to his former self.
At a nursing home, a new resident who had dementia, would sit by herself on the side and would not talk or interact with anyone. The staff thought that this woman was not capable of speaking anymore.
One of the staff, who had learned ©Hands-on Dementia, began giving this new resident daily-2-minute hand reflexology sessions. The woman suddenly opened up and began to talk. Her adaption to her new home became much easier.
If someone who has cognitive decline or is living with dementia suffers a change in focus or memory after moving or experiencing a significant change, please do not accept it as part of a condition. It may just be due to stress. and stress can be relieved.
Morning Alertness, Afternoon Anxiety
Many people who are living with dementia often have more energy and can focus better when they first wake up in the morning, especially if they had a good night’s sleep.
On the other hand, many people who have memory loss may become more confused or agitated later in the day, a state that is often referred to as sundowning, because of the time it begins.
There is no scientific evidence to explain the reason for this change, but I think all of us can understand the cause. Imagine waking up in the morning feeling great, but as the day progresses you have to intently concentrate on many issues that need to be solved.
Those you work with aren't supporting you, so you have to work even harder. Your day becomes long, difficult, and frustrating and you feel like screaming. How would you feel at the end of a difficult day like this? I’m sure after a day of non-stop stress, you would be exhausted and most probably not in a very good mood.
For someone who is living with dementia, every day can be tiring, frustrating and difficult. It takes an incredible amount of energy to try to stay focused and by the end of the day this causes exhaustion.
Not being understood and/or not feeling yourself is very irritating and can certainly affect one’s mood. So of course someone living with dementia may be totally stressed, frustrated, and exhausted by the late afternoon. That a person living with dementia might be agitated seems totally normal – after such a stressful and difficult day.
Reducing Anxiety When Living with Dementia
If we can help someone living with dementia reduce their stress during the day, we can reduce the late afternoon anxiety.
One of the main principles behind Naomi Feil’s Validation Method is allowing a person to express themselves. When feelings are expressed to someone who listens, the person feels much better. By using validation we can help reduce that end of the day anxiety, also knows as Sundowning.
Another way to reduce anxiety that has built up all day is by reducing stress with hand reflexology. An older woman who lived with her foreign caregiver, was a regular visitor at our senior day care center. This woman had very severe anxiety for several hours every afternoon and it was very difficult for her caregiver to help her. This woman’s outbursts were so difficult, that her family paid a friend to come and visit every day during those hours to help calm this woman. The woman's caregiver learned hand reflexology in the ©Hands-on Dementia course we taught to caregivers at the Center. When the caregiver began giving a few minutes of hand reflexology every day, the woman stopped having her difficult anxieties in the late afternoon and the family no longer needed to have her friend come daily to calm her.
When someone is very anxious or stressed, it may not be a good time to touch or give them hand reflexology, but if you give hand reflexology regularly, it may reduce the stress and anxiety.
Bring Back a Feeling of Normality
When you feel out of place, not understood and not in full control of your life, that is stressful and can cause a decline in focus and memory. If we can help bring some normality back to the lives of people who are living with dementia, we may be able to reduce the stressfulness of living with this condition.
When someone feels they are not being understood, it causes exasperation and often humiliation. In this situation a person may prefer not to speak and even shut themselves off from others.
In Validation we have a technique called Ambiguity, where we can carry on a conversation with someone, even if we don’t understand most of what they are saying. We can understand their body language and the emotion of what they are trying to tell us and answer accordingly.
I had a client who had great difficulty finding the words to express what he wanted to say. The frustration and embarrassment of not being able to talk made him forget even more words. When I was able to use Ambiguity and he saw that I understood him, he was more open to try to express himself.
As this man felt more comfortable talking to me, the stress passed and suddenly he was able to express himself much better using words he hadn’t used for a long time. This most likely was due to a reduction in stress. His wife, who was present during this conversation, told me afterwards that she had not seen him so happy in months. The reason for his happiness, is that he felt normal again – simply being able to converse with someone who understood him.
The feeling of normality is different for each individual. For one person it may be sitting down in a café and having a cup of coffee like everyone else. Maybe even pointing to the menu to order a dessert. For others it may be doing something they have loved to do all their lives.
If you have not watched yet this 60-minute program about Tony Bennet, who has memory loss, please do. I think it shows how feeling normal can allow someone living with dementia to feel more like their pre-dementia selves.
In this clip we see that Tony has memory issues, but when he rehearses at the piano, he not only remembers the lyrics to all the songs, he even improvises new arrangements. Something we would not expect from someone who has memory loss.
When the curtain opens and Tony lifts his arms high when he sees the audience, his wife Susan said it was like he turned on a light switch. Tony felt at home on stage and gave an incredible performance, one that no one was sure he would be able to do with his memory loss.
The highlight for me of this evening, was when Tony remembers Lady Gaga’s name. Lady Gaga, a close friend and costar, was so shocked because Tony had not said her name in a year. The reason Tony could remember her name now was because he was in the place that made him feel normality, on stage singing as he had done most of his life. Tony was feeling great and he was able to remember Lady Gaga’s name.
Reducing stress can help reduce an added factor that may be causing confusion, lack of focus and cognitive decline. Don’t assume a change in any of these is only due to the condition that is causing memory loss. The change may just be from stress and there are ways of reducing stress. Allowing a person who is living with dementia to feel normality, can also reduce the stress of living with a condition that causes dementia.
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When Memory Loss Leads to Aggressive Behavior
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