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Thu, Oct 25 9:23am · Dementia-Friendly Communities in Living with Mild Cognitive Impairment (MCI)

You're correct in that these are different approaches to the central issue of how we can improve quality of life while also keeping folks safe when dementia enters the picture. Exciting stuff!

Tue, Oct 23 8:44am · Dementia-Friendly Communities in Living with Mild Cognitive Impairment (MCI)

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In recent years, the Dementia Friendly America organization has taken off, in which many US states have started initiatives to promote “dementia friendly” communities. The idea is that, rather than institutionalize people with dementia, a better quality of life might be possible if people are able to remain a part of the community, as independent as possible. To keep people in the community, it takes the collaborative effort of all aspects of the town or city, from the health care systems to banks, restaurants, and law enforcement. For example, one part of the initiative is to encourage dementia friendly businesses in the community, where employees are trained to recognize when a person has dementia, communicate with that person, and know how to find resources for the person with dementia if needed. You can find a list of state-by-state resources here http://www.dfamerica.org/dfa-communities/

While the Dementia Friendly America programs are a good start, a few European cities have been able to undertake a much bolder, all-encompassing approach. Instead of trying to find ways to accommodate persons with dementia into an existing community, an entire village is created – designed from the ground up with memory problems in mind.

Let’s take a closer look at an experimental village in southwest France. Set to open in 2019, this 12-acre facility is a scaled-down town, complete with things like a restaurant and grocery store as well as a garden and farm where residents can stay active with interesting, productive tasks. The facility will be secure as a whole, but will allow the kind of freedom of movement between home and the community that people are used to having. The village will incorporate research measures into the daily life to gauge the effectiveness of this living situation compared to a traditional nursing home. Check out these stories for more details:

Personally, I get really excited reading about these rather radical approaches to making not only a safe place to live, which is the main goal of a skilled nursing facility (aka nursing home), but also a rich, vibrant, fulfilling place to live, which is often lacking at these facilities. I will be anxious to see the results of this and other similar experimental memory villages. If successful, hopefully we will see these in the United States in the not so distant future, as well!

Chime in below, and let us know what you think of this concept.

Tue, Sep 11 8:12am · HABIT Returns to Rochester, MN! in Living with Mild Cognitive Impairment (MCI)

RST Team Photo 2018

After a hiatus of over 1 year, we are thrilled to announce that the HABIT Healthy Action to Benefit Independence & Thinking Program ® has returned to regularly scheduled sessions in Rochester, Minnesota. The team is a mix of staff who primarily work in the La Crosse, Wisconsin Mayo Clinic Health System location, and others who work in Rochester.

If you’re unfamiliar with the HABIT program for people with Mild Cognitive Impairment and their care partners, check out this page to learn all about it!

Our session included 8 wonderful couples/partnerships from around the country. The location was the scenic Assisi Heights conference center, and many patients and partners enjoyed being able to get outside for a stretch break and some fresh air. As is usually the case, patients and partners found a sense of community with one another, and left feeling motivated to continue working on their new HABITS!

Our next session will be in October, 2018, followed by 4 sessions in 2019. The goal is to make this “Rochester” HABIT a Midwest HABIT program, with offerings in La Crosse as well.

Thanks to the patients, partners, and staff who helped make this special session a success!

Photo of staff from left to right: Carolyn Isaak, M.S. (Yoga & Meditation Teacher), Jennifer Loepfe, B.A. (Cognitive Trainer), Angelina Polsinelli, Ph.D. (Neuropsychology Fellow), Anni Shandera-Ochsner, Ph.D., L.P. (HABIT MN Director), Joanne Nordeen, M.S. (Cognitive Trainer), Miranda Morris, M.S. (HABIT Enterprise-wide Coordinator), Alissa Butts, Ph.D., L.P. (Neuropsychologist).

 

Thu, Aug 2 9:43am · Planning for the Future: Advance Directives in Living with Mild Cognitive Impairment (MCI)

@bonniep, this is such a tough decision, and one I'm sure many others with a spouse diagnosed with MCI face. Often it does make sense to list someone other than your spouse as the surrogate decision-maker, given the uncertainty about what your spouse's cognitive capacity may be in the future. This can be a good topic to discuss as part of the larger "planning for the future" discussions you and your spouse have.

Tue, Jul 24 1:21pm · Planning for the Future: Advance Directives in Living with Mild Cognitive Impairment (MCI)

Hi Nancy, you certainly can start with an attorney. They should be knowledgeable about the requirements for such a document in your area. The other options listed above are alternatives that would not come with a legal fee. Nice to hear you are being proactive in getting this taken care of!

Tue, Jul 17 11:01am · Planning for the Future: Advance Directives in Living with Mild Cognitive Impairment (MCI)

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A diagnosis of mild cognitive impairment (MCI) comes with a lot of uncertainty. Shortly after your discussion with your doctor, you may have wondered what your diagnosis means for the future. Many people worry about being a “burden” on their loved ones in the future, especially if MCI turns into dementia.

While we cannot predict the future with certainty, we do know that having MCI increases the likelihood of dementia, which means that you may eventually need help making major decisions due to the thinking problems that come along with your condition.

This is tough to think about, and many people push this topic to the side, saving it for later. The problem is, families often find that “later” gets pushed out farther and farther away, right up until there is a crisis. By that point, the initial memory or other thinking problems may be much worse, and the person unable to fully participate in the decision making process. This is a stressful situation for other family members, who are left with the anxiety of not knowing exactly what their loved one would have wanted when faced with the issue at hand. No one wants to put their family in this position. Fortunately, there is a way to prevent this.

Advance Directives

An advance directive is a legal document that can be “activated” or put into effect in the event that you are unable to make your own healthcare decisions. A physician or psychologist must make this determination based on a thorough examination of you at the time your capacity (ability) to make decisions is in question. The document specifies:

  • Who you want to make decisions on your behalf. This is sometimes called a “surrogate decision maker” or “healthcare surrogate.” Usually you can designate a first choice and a second or even third choice.
  • Your wishes about the care you receive. For example, whether you want life support. Often, you can specify the situations in which you want certain interventions depending on your doctor’s opinion of whether you are expected to recover.
  • Essentially, this is your written “voice” to be used if there is a time when you cannot state your wishes or make your own decisions. This is a gift to your family in that they will not be put in the stressful situation of trying to guess what you would or would not want.

How to Get Started

You can fill out an advance directive well in advance of needing one. It’s a good idea for every adult to fill one out, regardless of whether you think you will need it in the future. Because the legal requirements for the document can vary from state to state, it’s important to use your local resources to help you get started.

  • Talk to your primary care provider/family doctor. He or she will likely be able to provide you with the form used in your area, and can talk with you about your wishes. At Mayo Clinic, your physician can help you meet with a social worker who can walk you through filling out the form and even witness your signature.
  • Or, you can contact your area agency on aging. Visit https://eldercare.acl.gov/Public/Index.aspx to find the agency in your zip code.

Once you’ve completed your advance directive form and had your signature witnessed, make time to do the following:

  • Give your healthcare facility or providers a copy of the completed form. It’s good for them to have a copy scanned into your medical record in the event it is needed.
  • Tell your family where the original document is filed at home.
  • Sit down and have a discussion with the person or people you have listed as your surrogate decision makers. Talk about your preferences for care in the future as outlined in your advance directives. It can help them to understand why you do or don’t want certain medical interventions.

Have you completed your advance directives yet? Any tips for others who are considering this?

 

 

 

Tue, May 8 9:22am · Can Computer Games Help My Memory? in Living with Mild Cognitive Impairment (MCI)

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Turn on the television or radio and chances are it won’t take long before you hear an advertisement for “brain training” computer game programs that are meant to give your brain a workout and prevent dementia. The claims made in the advertisements sound great – but can we really give our brains a workout by playing games on a computer or smartphone?

What does the research say?

    • There have only been a few randomized controlled studies (the gold standard in research) about the effects of specific computer based programs.
    • One such study, called the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) Study  was as multi-site study (Los Angeles, San Francisco, Rochester) led by researchers at Mayo Clinic. The goal of the study was to see whether older adults without evidence of cognitive or memory impairment who used the Brain Fitness program by Posit Science would show improvements on formal tests of memory and attention and in how they perceived their cognitive abilities in daily life.
      1. Participants used the program for one hour per day, 5 days per week, for 8-10 weeks.
      2. Another group of participants (the “control” group) did not use the program, but spent the same amount of time watching educational DVDs and taking paper and pencil quizzes to see what they remembered.
      3. Before and after the training period, both groups were given neuropsychological tests and questionnaires to see whether the training had an effect on memory and other thinking abilities and their perception of cognitive abilities.
      4. RESULTS: The group that did the Brain Fitness training improved (compared to the control group) on a test of memory, a test of thinking speed, and in their report of how good their memory in everyday life was.
      5. The catch: the benefits went away when people stopped doing the exercise.
    • A review of all of the studies on this topic from 1970-2007 found that overall, cognitive interventions, such as computer brain training programs lead to improvements in memory, but there is not good evidence that this is the ONLY way to get these benefits. In other words, computer based games seem to help, but so do other kinds of mental exercise.
    • A more recent publication by researchers at the University of Southern California, which combined results from multiple published studies, found that cognitive training improved thinking skills to the same extent as regular aerobic exercise.
    • The National Academies of Sciences was tasked by the National Institutes of Aging, the primary funding agency in the United States for aging related research, to evaluate the current state of the knowledge on interventions for preventing cognitive decline and dementia. In 2017, it published its report and one intervention they determined has “encouraging but inconclusive evidence” is cognitive training (in addition to physical exercise and controlling high blood pressure). It is important to note that they define cognitive training much more broadly than computer games. Cognitive exercise could be computer brain games, but could be other non computerized, cognitively challenging activities as well. They conclude that more research is needed to determine definitely the impact of these interventions, but that it is reasonable to expect cognitive exercise may help and for health care providers to recommend it.
    • Finally, in a recent review specific to Mild Cognitive Impairment and specific to computerized brain games, they found that brain games may modestly benefit aspects of cognition as well as mood in patients with MCI.

So, what’s the bottom line?

    • Cognitive exercise is likely beneficial. If you like computer-type games, give one of the “brain training” programs a try. One advantage of these programs is that they adapt to your skill level and get harder as you get better, therefore providing a consistent challenge.
    • But, you don’t have to spend money every month on a subscription to a computer program to see results. You can just as easily do something else to challenge your mind. Some examples are: learning to play a musical instrument, learning a new language, take up a new hobby or doing anything that really challenges your brain.
    • If you are already an expert at something (e.g., playing the guitar, crossword puzzles) you may need to try something new or make it more challenging (e.g., learning a new musical piece, trying harder crossword puzzles) to keep getting the cognitive exercise benefit.
    • The important thing is that you get in the habit of consistently doing something to keep your brain engaged!
  • Chime in! How do you keep your mind active?