Living with Dementia: How to Maintain Independence and Function

As we age, we may start noticing some mental slips – such as forgetfulness or difficulty focusing – happening more often than usual. While this might be worrisome, it’s a normal part of brain aging and not usually a cause for concern.

Dementia, on the other hand, is different from normal brain aging and it’s important to differentiate between the two, says Charles Duffy, MD, PhD, director of University Hospitals Neurological Institute’s Brain Health & Memory Center.

But whether you’re experiencing typical age-related memory problems or a more progressive type of dementia, there are things we can do to help slow the advancement of brain aging and maintain our independence.

Stages of Brain Aging

The first and most common stage of brain aging is age-associated memory impairment (AAMI). Individuals and family members may notice memory problems, but the issue will not show up on tests or scans. AAMI is considered a normal part of brain aging that most people will experience as they get older. It can include problems with recalling memories, especially for recent events, being too distractible, inability to sustain focus, and difficulty with previously routine multitasking.

Mild cognitive impairment (MCI) is the stage between typical brain aging and dementia. MCI can be confirmed by tests and can include problems with memory, language or judgment. People with MCI are at an increased risk for developing dementia, but many do not progress beyond MCI or may even see their symptoms improve over time.

Lastly, the third stage of brain aging is dementia. Dementia is defined as the loss of some previously established cognitive thinking capacity. Unlike the first two stages of brain aging, dementia tends to be progressive, multi-faceted, and debilitating, affecting everyday life. Dementia most notably affects memory, attention, and your ability to organize your actions and thoughts. Dr. Duffy notes that dementia doesn’t make these things impossible, it just may be harder and take longer – so we need to be patient with ourselves or our loved ones.

Types of Dementia

There are many types of dementia, and they can affect different areas of the brain and different cognitive functions. The main categories of dementias include:

• Movement disorder dementias: Affecting the middle part of the brain, this type of dementia is associated with movement disorders such as Parkinson’s disease. Symptoms can include problems with forgetfulness, attention, communication and problem-solving.
• Vascular dementias: Vascular dementia can affect any part of the brain and can be caused by stroke or other blood vessel diseases causing decreased blood flow to an area/areas of the brain. The resulting cognitive impairment can include memory, judgement and reasoning problems. Vascular dementia tends to affect men more frequently than women.
• Fronto-temporal dementias. This type of dementia affects the front and sides of the brain. Caused by accumulations of different kinds of proteins, this type of dementia affects language and self-control.
• Alzheimer’s disease: Alzheimer’s disease is actually not just one disease but a group of different syndromes originating in the back half of the brain. Symptoms include memory problems, confusion, and difficulty holding conversations, finding places and things, staying organized, and sustaining tasks.

  Alzheimer’s disease affects about 6 million people in the U.S., two-thirds of whom are women. Onset over the age of 65 is by far the most common, while early onset (under age 65) makes up less than 1 percent of the Alzheimer’s population. Early onset also most likely has a genetic component, while later onset can affect anyone regardless of family history.

Medications for Dementia

There are several medications that can be used to treat the symptoms of dementia. Though these drugs will not cure or stop the progress of dementia, they can slow down cognitive decline and stabilize some symptoms of dementia. Some common medications include donepezil (Aricept) and memantine (Namenda). Dr. Duffy says these two drugs specifically work well with each other to improve symptoms and are often prescribed together.

Plan for Safe Independence

It’s important for patients and family members to take steps to help a person with dementia maintain independence while also making sure they stay safe both at home and when out and about.

“We have to balance our independence with the safety of ourselves and safety of the community,” says Dr. Duffy. “It’s important to always keep that balance in mind.”

Driving. Because dementia can affect your attention and make you more easily distracted, it is important to be extremely cautious about driving. It should only be done under optimal conditions and should be avoided in unsafe conditions such as heavy rain, snow or ice. You may also want to consider being tested or screened to make sure you are able to drive safely.

Fire alarms. Make sure fire alarms are installed in each floor of your home. It is also important to adhere to safety practices when cooking and using appliances to prevent accidental fires.

Walking. Walking with a companion and sticking to well-marked, familiar paths can help you avoid getting lost or disoriented while on a walk.

Firearms. Patient with dementia are strongly encouraged to remove all firearms from their home as it can present a safety risk for themselves and others.

Ways to Keep Your Mind and Body Healthy

Dr. Duffy likes to tell his patients his favorite “four-letter words” for staying active, engaged and independent while living with dementia or other age-related cognitive decline:

• Walk: Walking and other safe physical activities have proven benefits in helping to maintain function and physical health. Dr. Duffy recommends aiming to walk for a total of an hour every day.
• Talk: The most stimulating thing for the human brain is another human brain, says Dr. Duffy. So try to have conversations with friends, family or neighbors as often as you can.
• Read: This can include anything from newspapers to magazines to books – anything that gets you to process words on a page can help with maintaining brain function.
• Rest: Rest is restorative for the body and the brain. Get a good night’s sleep and take naps to recharge.
• Diet: Studies have shown eating what is commonly referred to as the Mediterranean diet – made up of lean meat and fish, fruit and vegetables, nuts, whole grains, legumes and olive oil – can have a brain-boosting and disease-modifying effect.

Related Links

The specialized brain health and memory team at University Hospitals Neurology Institute offers comprehensive treatment for Alzheimer’s disease and other dementias.