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With dementia, the person eventually loses all of the abilities they once possessed and the knowledge that they had acquired over time. Since using utensils and eating politely are acquired skills, they are lost in dementia. Using a fork and knife, for instance, takes practice and we are typically age 6, 7, or older by the time we have mastered all of the fine nuances of eating a meal and utilizing utensils properly. When we are young, we are fed by another person, then we learn how to drink from a bottle unassisted, then a cup or glass, then we learn how to use a spoon, then we master abilities that require more coordination and fine motor skills, such as cutting with a fork and knife or carving a turkey.

It is not surprising that as many as 80% of people with dementia have difficulty with eating and drinking. 50% are no longer able to feed themselves in the later stages of the disease (Ensell & Matheson, 2009). Furthermore, mealtime is an opportunity for individuals with dementia to socialize, feel useful, and embrace culture; if the mealtime experience is unenjoyable or challenging, this may prevent the person from engaging meaningfully with others and could lead to isolation or depression. See the tips below for providing help to individuals at different stages of dementia.




Tips for Early Stage

  • Provide reminders on when to eat.
  • If the person lives alone, clean out their refrigerator regularly. Make sure spoiled foods are not kept or consumed.
  • Drop off pre-made meals or utilize a Meals on Wheels service.
  • Be aware of safety concerns in the kitchen. Supervision may be required, even at an early stage.
  • Declutter the kitchen area. Too much clutter can cause confusion and agitation.
  • Consider assistive devices, such as a rocker knife, that might help the person to remain independent longer. Consult an Occupational Therapist for specific suggestions.
  • Be mindful of the person’s likes and dislikes and life-long habits related to eating.
  • Try to stick to a regular routine.

Tips for Middle Stage

  • Serve finger foods or serve the meal in the form of a sandwich
  • To avoid spilling, serve food in large bowls instead of plates or use plates with rims or protective edges.
  • Consult with an Occupational Therapist to help promote independence. Specific assistive devices may be recommended.
  • Consult with a Speech Therapist/Pathologist if there are chewing or swallowing challenges.
  • Avoid foods such as nuts, popcorn, and raw carrots, which may be hard to chew and swallow.
  • Serve soft foods such as applesauce, cottage cheese and scrambled eggs. Serve thicker liquids such as shakes, nectars, and thick juices. You may also purchase powders that can thicken liquids in order to assist with swallowing.
  • Try to stick to a regular routine.
  • Help the person maintain good oral hygiene.
  • Be alert for signs of choking. Learn the Heimlich maneuver in case of a choking incident.

Tips for Late Stage

  • Weight loss, malnutrition (Sharp & Shega, 2009) and loss of appetite are considered hallmark signs that the person is entering the last stages of the disease. In the Late Stage, the person may eat less and have difficulty swallowing.
  • Consult with a Speech Therapist/Pathologist if there are chewing or swallowing challenges.
  • Consult with an Occupational Therapist to help promote independence. Specific assistive devices may be recommended.
  • Gently place the person’s hand on or near an eating utensil.
  • Show the person how to eat by demonstrating.
  • Try hand-over-hand assistance.
  • Give the person plenty of time to eat. Keep in mind that it can take a person an hour or more to finish.
  • Be conscious of physical illnesses or disabilities that may affect their eating.
  • Help the person maintain good oral hygiene.



Ensell, C., & Matheson, N. (2009). Mealtime behaviours in people with dementia in the absence of dysphagia. Acquiring Knowledge In Speech, Language & Hearing11(2), 92-96.

Hansen, T. (2011). Measuring elderly dysphagic patients’ performance in eating – a review. Disability & Rehabilitation33(21), 1931-1940.

Logemann, J. A., Gensler, G., Robbins, J., Lindblad, A. S., Brandt, D., Hind, J. A., & … Gardner, P. (2008). A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson’s Disease. Journal Of Speech, Language & Hearing Research51(1), 173-183.

Sharp, H. M., & Shega, J. W. (2009). Feeding Tube Placement in Patients with Advanced Dementia: The Beliefs and Practice Patterns of Speech-Language Pathologists. American Journal Of Speech-Language Pathology18(3), 222-230.

Let Your Voice Be Heard!

As the Alzheimer’s Association, we advocate and give voice for those who can no longer speak for themselves. Your voice is the most powerful tool to fight this disease on Capital Hill.

In 2014, the National Institutes of Health (NIH) will spend about $5.4 billion on cancer research, nearly $3 billion on HIV/AIDS research; about $2 billion on cardiovascular disease research; and about $1 billion on diabetes research. Meanwhile, the NIH will spend just $566 million on Alzheimer’s research. We have made great strides in developing effective treatments for other chronic illnesses. Experts say Alzheimer’s disease will require a similar level of investment in order to help us find compelling interventions, and ultimately, a cure for this devastating disease.



NIH Research Funding 2014

What can you do?

  • Educate yourself about the issues at
  • Find and contact your local chapter at The Greater Michigan Chapter’s website is The Greater Michigan Chapter serves more than 60 counties in Michigan, including Wayne, Oakland, Macomb, St. Clair, Sanilac, and Huron.
  • Meet with your members of Congress locally to discuss legislative issues.



Be the catalyst that helps to propel us into a future without Alzheimer’s disease! Sign-up to become an advocate today!!




The Alzheimer’s Association 2014 Alzheimer’s Disease Facts and Figures report reveals that there are more than five million Americans living with Alzheimer’s disease, including 170,000 here in Michigan.


Additionally, there are 15.5 million Americans caring for someone with Alzheimer’s or another dementia. 505,000 of them are Michigan residents.


The Alzheimer’s Association Facts and Figures reveals that a woman’s estimated lifetime risk of developing Alzheimer’s at age 65 is 1 in 6, compared with nearly 1 in 11 for a man.

In addition to the human toll, Alzheimer’s Association Facts and Figures confirms that Alzheimer’s is the most expensive condition in the nation. Nearly one in every five dollars spent by Medicare is on people with Alzheimer’s or another dementia.


We have seen diseases like breast cancer, heart disease and HIV/AIDS make tremendous progress in prevention, early detection and treatment after the federal government made a significant investment. Comparable investments in Alzheimer’s are now needed to realize the same successes and save millions of lives.


If we could eliminate Alzheimer’s tomorrow, we could save half a million lives every year.




Want to learn more about this report? Check out the links below.

2014 Facts and Figures Full Report

2014 Facts and Figures Fact Sheet

2014 Facts and Figures Michigan Fact Sheet

2014 Facts and Figures Infographic

2014 Facts and Figures Chalk Infographic

Want to become an advocate for Alzheimer’s public policy? Click here.


We know that February is Black History Month. But did you know that African Americans are at a higher risk for developing Alzheimer’s disease or another dementia? Some experts say black elders are nearly two times more likely to develop Alzheimer’s disease than white elders.


What can you do today to manage your risk for Alzheimer’s disease? Unfortunately, there is no proven method for preventing this disease, but researchers and scientists do have some tips that might help

  • Get active: If it’s good for your heart, then it’s good for your brain. Since African Americans have a higher rate of vascular (stroke-related) disease — which may be a risk factor for cognitive impairment — it’s important to engage in physical activity to reduce your risk.
  • Watch your blood pressure numbers: Prevention or control of high blood pressure helps maintain a healthy brain and promotes overall health. Adopt a fitness routine, eat healthy foods, don’t smoke and work to maintain a healthy weight.
  • Manage your cholesterol levels: A healthy brain and heart depend on maintaining normal cholesterol levels. Engage in regular physical activity and eat a diet low in saturated fat and high in fiber.
  • Prevent or control diabetes: Take steps to reduce your risk for diabetes by maintaining a healthy weight and being physically active. Prevention or control of diabetes promotes a healthy brain.
  • Overall wellness: African Americans are at a greater risk than white Americans for high blood pressure, diabetes, and high cholesterol. Because brain and heart health are so closely linked, it’s important to take good care of both. In addition, stay socially and mentally active to make sure your brain and your body can perform at their best.

Want to learn more? Check out our webpage on African Americans and Alzheimer’s disease.

Also, watch this video clip below to learn even more.

Picture of The 36-Hour Day

A Book Review

The 36-Hour Day:A Family Guide to Caring for People Who have Alzheimer’s Disease, Related Dementia, and Memory Loss

Caregiving for a person with dementia is a daunting task. It requires the acquisition of new skills and knowledge, the mobilization of resources and family members, and it can leave the primary caregiver feeling burnt out or overwhelmed. On the other hand, caregiving can also produce moments of joy and happiness, a sense of pride, and meaningful connections with loved ones. This is the key message conveyed in The 36-Hour Day: A Family Guide to Caring for People Who have Alzheimer’s Disease, Related Dementia, and Memory Loss by Dr. Nancy Mace and Dr. Peter Rabins.  The book discusses the undeniable challenges associated with caregiving, while deftly outlining numerous tactics for addressing day-to-day and long range caregiving concerns.  It shows that dementia can be managed effectively with moments of delight along the way.


Each family’s story is unique, and that is reflected in the style of The 36-Hour Day.  The guide includes short vignettes and personal stories, which are derived from actual family members that have called or written in to share their experiences. The chapters can be read sequentially, or the reader can skip to sections that are most pertinent to their situation, a useful option for those caregivers and professionals who may have difficulty finding time to read a detailed book.


Don’t miss out on your opportunity to own this must-read. Call (248) 996-1053 to purchase your copy today!


Driving is a complex activity that requires quick thinking and reactions, as well as good perceptual abilities. For the person with Alzheimer’s disease, driving becomes a safety issue. While he or she may not recognize that changes in cognitive and sensory skills impair driving abilities, you and other family members will need to be firm, but sensitive, in your efforts to prevent the person from driving when the time comes.

How do you know when the time has come?

Signs of unsafe driving include:
• Forgetting how to locate familiar places
• Failing to observe traffic signs
• Making slow or poor decisions in traffic
• Driving at an inappropriate speed
• Becoming angry or confused while driving

Keep a written record of your observations to share with the person, family members and health care professionals.
Tips to limit driving
Once it’s clear the person with dementia can no longer drive safely, you’ll need to get him or her out from behind the wheel as soon as possible. If possible, involve the person with dementia in the decision to stop driving. Explain your concerns about his or her unsafe driving, giving specific examples, and ask the person to voluntarily stop driving. Assure the person that a ride will be available if he or she needs to go somewhere.

Other tips to discourage driving include:

• Transition driving responsibilities to others. Tell the person you can drive, arrange for someone else to drive, or arrange a taxi service or special transportation services for older adults.

• Find ways to reduce the person’s need to drive. Have prescription medicines, groceries or meals delivered.

• Ask a respected family authority figure or your attorney to reinforce the message about not driving.

• Experiment with ways to distract the person from driving.

What if the person won’t stop?
If the person insists on driving, take these steps as a last resort:
• Control access to the car keys. Designate one person who will do all the driving and give that individual exclusive access to the car keys.

• Disable the car.

• Consider selling the car. .

• Alert the department of motor vehicles.

Want to learn more about dementia and driving? Check out the Alzheimer’s Association’s Dementia and Driving Resource Center here. Take a peek at the video below which depicts a family making decision about driving.


The Alzheimer’s Association is available for you any time, day or night, for reliable information and support.

Our 24/7 Harry L. Nelson Helpline allows people with Alzheimer’s disease or dementia, caregivers, families and the public to:

  • Speak confidentially with our master’s-level care consultants for decision-making support, crisis assistance and education on issues families face every day.
  • Learn about the signs of Alzheimer’s and other dementia.
  • Find out about local programs and services for individuals with dementia, caregivers, family and friends.
  • Get general information about medications and other treatment options, and legal, financial, and care decisions.
  • Receive help in their preferred language through our translation service, which accommodates more than 170 languages and dialects.

To learn more about how the Alzheimer’s Association 24/7 Helpline can assist you, call us at


Prefer to check us out online? Click here.


Ever thought about how physicians arrive at a diagnosis of Alzheimer’s disease or other dementias?


Finding Alzheimer’s disease (AD) is often a game of ruling out other causes — are the memory problems due to AD or is it something else? Is it caused by depression, vitamin deficiency, stress, sleep disturbances, infection, etc., etc.? Or are the memory problems in fact being caused by Alzheimer’s disease? Unfortunately there is no pass/fail test that will tell us immediately whether or not the person has a diagnosis. Because of the uncertainty with diagnosis, even experienced physicians can make mistakes and mis-diagnosis is not unheard of.

Comprehensive Diagnosis

  • Subjective complaints
  • Cognitive Testing200400104-001
  • Medical History
  • Medical Tests (i.e. blood work and brain imaging)

Rule out

  • Disturbed sleep
  • Emotional disorders
  • Metabolic disorders
  • Eye and ear impairments
  • Nutritional deficiency
  • Tumors
  • Infections
  • Alcohol, drugs, or medication interactions

It used to be that brain autopsy was the only way to receive a definitive diagnosis of Alzheimer’s disease, but with improved testing this is no longer the case. Experienced clinicians have a 95% accuracy rate in diagnosis. Furthermore, physicians can now administer tests that measure specific biomarkers in the brain that help them to determine a diagnosis.

The formation of plaques and tangles in the brain are the two hallmarks of Alzheimer’s disease (AD). Plagues are composed of a protein, beta-amyloid, that abnormally clumps together in AD. Many nerve cells, also called neurons, die as the damage of AD spreads. Dead and dying nerve cells contain tangles, which are made up of a protein called tau. The tangles destroy a vital cell transport system in the brain.

Advances in research have produced certain diagnostic tools that measure levels of tau and beta-amyloid. For instance a clinician may analyze a patient’s cerebrospinal fluid (CSF) to look for these important biomarkers. CSF is a clear fluid that bathes and cushions the brain and spinal cord. Adults have about 1 pint of CSF, which physicians can sample through a minimally invasive procedure called a lumbar puncture, or spinal tap. Research suggests that Alzheimer’s disease in its earliest stages may cause changes in CSF.

Beta-amyloid is under significant scientific scrutiny, and amyloid-plaque formations can be found in all patients with AD. Progress in Alzheimer’s disease research and imaging has made it possible to detect beta-amyloid in the human brain using radioactive tracers and positron emission tomography (PET). See the picture of a PET scan below.

pet scan

Amyloid PET Imaging

Despite these noteworthy advances, bear in mind that spinal taps and PET scans are not a definitive diagnosis! They are simply tools designed to increase the clinical certainty of the physician’s conclusion. Also note, that these tests are often expensive and not covered by most health insurances. Furthermore, amyloid imaging is usually only conducted in limited situations when the patient’s symptoms are atypical (e.g. young age of disease onset, symptoms do not satisfy criteria for AD, etc.).

Learn more about the steps involved in a diagnosis here, or call our 24/7 Harry L. Nelson Helpline to speak to a live representative.

Mentally Fit


Do computerized brain-training programs really work? Will doing Sudoku or crossword puzzles help to ward off cognitive decline?

As we age, our brain (like the rest of our body) loses some of the agility it once had. Normal aging is associated with a slower processing speed and less efficient working memory in the brain. These age-related changes, however, are modest; they are very different than neurological disorders such as Alzheimer’s disease. Furthermore, scientists now know that our brains are able to adapt, change, and re-organize throughout our entire lives — a phenomenon known as “neuroplasticity”. This means our neurons (nerve cells) have the capacity to learn and re-wire, even into old age. An old brain can learn new tricks!

So maybe you’re still asking — will ‘brain training’ help to promote brain health? Buyer beware. The research on such programs is preliminary and should be considered with caution. The games and exercises designed to improve brain performance aim to use neuroplasticity to improve core cognitive abilities; however, it is unclear whether these effects translate to real-life performance or whether these interventions have any appreciable effect on preventing neurological diseases.

In reality, there are many far more compelling interventions that may help to stave off cognitive decline than brain games or mind teasers. For example, brain-derived neurotrophic factor (BDNF) is a key component of neuroplasticity. Physical exercise and low-fat diets have been linked to increased production of BDNF and aid in neuroplasticity (Gomez-Pinilla, 2011). Want the most bang for your buck when it comes to brain health? Consider adopting a lifetsyle that incorporates regular physical exercise and a healthy, balanced diet.

Caution: There is still no proven method for preventing or delaying cognitive decline.


Gomez-Pinilla, F. G. (2011). Exercise impacts brain-derived neurotrophic factor plasticity by engaging mechanisms of epigenetic regulation.European Journal Of Neuroscience33(3), 383-390.

Smith, G. M. (2009). A Cognitive Training Program Based on Principles of Brain Plasticity: Results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) Study. Journal Of The American Geriatrics Society57(4), 594-603.

Zelinski, E. M., Spina, L. M., Yaffe, K., Ruff, R., Kennison, R. F., Mahncke, H. W., & Smith, G. E. (2011). Improvement in memory with plasticity-based adaptive cognitive training: results of the 3-month follow-up. Journal Of The American Geriatrics Society59(2), 258-265. doi:10.1111/j.1532-5415.2010.03277.x

i love sleeping

Unfortunately for the 15 million caregivers and 5.2 million living with Alzheimer’s disease (AD), sleep disturbances are a common occurrence among those with dementia. These disturbances can diminish the caregiver’s and care recipient’s quality of life. Research indicates that nearly half of those diagnosed with Alzheimer’s will exhibit disrupted sleep (Salami, Lyketsos, & Rao, 2011) at some point during their illness.  In AD, sleep disturbances are typically characterized by waking up throughout the night, daytime napping, and daytime drowsiness (Salami, Lyketsos, & Rao, 2011). Lack of sleep or poor sleep quality can also cause disorientation, confusion, and disordered thinking during the day, compounding the cognitive symptoms the person may already be experiencing. Furthermore, sleep disturbances, “increase the risk of physical and psychological morbidity in the persons with dementia and their caregivers” (McCurry et. al., 2011, p.1393) and increase the likelihood of institutionalization.

Sleep is clearly a prevalent issue in AD, but how do we overcome these challenges? More research is needed to effectively answer this question, but below are some evidence-based recommendations that might assist in promoting regular, good quality sleep.

Non-Drug Interventions

  • Maintain regular times for getting to bed and arising.
  • Establish a comfortable, secure sleeping environment — reduce noise or other stimuli, make sure bedding and room temperature are comfortable, provide nightlights and/or security objects.
  • Discourage staying in bed while awake or watching television while in bed; use the bedroom only for sleep.
  • Increase sunlight exposure during the day.
  • Have the person avoid excessive evening fluid intake and empty the bladder before going to bed.
  • Avoid daytime naps if the person is having trouble sleeping at night.
  • Treat any pain symptoms.
  • Engage in regular daily exercise, but no later than 4 hours before bedtime.
  • If the person is taking cholinesterase inhibitors (e.g. Exelon, Aricept) avoid giving the medicine right before bed


Final Thought

If you notice disturbed sleep in the person with dementia, it may be helpful to have a physician, such as a neurologist, give his opinion. Medication side effects, chronic illnesses, mood disorders, etc., could be contributing to the problem, and a medical doctor is best to address these issues.


Cole, C., & Richards, K. (2005). Sleep and cognition in people with Alzheimer’s disease. Issues In Mental Health Nursing26(7), 687-698.

McCurry, S. M., Pike, K. C., Vitiello, M. V., Logsdon, R. G., Larson, E. B., & Teri, L. (2011). Increasing Walking and Bright Light Exposure to Improve Sleep in Community-Dwelling Persons with Alzheimer’s Disease: Results of a Randomized, Controlled Trial. Journal Of The American Geriatrics Society59(8), 1393-1402. doi:10.1111/j.1532-5415.2011.03519.x

Salami, O., Lyketsos, C., & Rao, V. (2011). Treatment of sleep disturbance in Alzheimer’s dementia. International Journal Of Geriatric Psychiatry,26(8), 771-782. doi:10.1002/gps.2609


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