A Holistic Approach to Dementia
Updated: Nov 19, 2020
When I became a hospice nurse I went into it thinking that most of the people I would be caring for would have late-stage cancer, COPD, or cardiac conditions. I was alarmed to discover, however, that the majority of our patients have a primary hospice diagnosis of Alzheimer’s Disease or another form of dementia, which means that it is the condition that is expected to cause their death.
The statistics for dementia, specifically Alzheimer’s disease, are dismal; 1 in 3 seniors dies with some form of dementia, and Alzheimer’s is the 6th leading cause of death in the U.S. Even more alarming is the fact that there was an 89% increase in deaths due to Alzheimer’s Disease between 2000 and 2014. This steep increase in mortality over a 14-year period cannot be explained by genetic influences; therefore lifestyle and environmental factors must play a significant role and a more integrative approach to its management is called for.
In this post I wanted to share some information that I have learned from my personal experience, from working with dementia patients and their families, and through the research I have done on this topic. My goal with this is first and foremost to spread the word that there is hope for people dealing with dementia. Even when a full reversal of the disease is not possible, there are ways to either slow its progression or improve the quality of life of the person suffering with it. Of course, this article is not intended to constitute medical advice, and any changes to diet or treatment plans I recommend should be discussed with your trusted healthcare provider before implementing.
Diet
Historically, almost all forms of dementia have been deemed “incurable” by the experts. Recent testimonies like this one, however, have shown us that although it might not be a cure, diet reformation can have a significant impact on the course of the disease. As with most conditions, implementing diet changes as early as possible in the disease trajectory or even doing it prophylactically to help prevent it has the biggest impact. When people ask me what type of diet protocol to follow to prevent, reverse or slow down dementia, I recommend looking into the Bredesen Protocol. This article is a good summary of the science and logistics of the protocol and Dr. Bredesen also has a book called The End of Alzhemier’s which has the specifics. There are also practitioners who have been trained in the Bredesen Protocol, called Certified ReCODE practitioners , who can do the proper testing and interpretation and guide you through implementation. I also recommend looking into the Blood Type Diet, specifically seeing which foods to avoid for the person's type.
Since I typically work with people at the end of their dementia journey, I know that a major diet reformation is not logistically possible for many. Most of our hospice patients with dementia reside in memory care facilities and implementing a major diet change would involve the family bringing in almost all of their loved one’s food and in some cases having to feed it all to them. This is not realistic for both time and financial reasons for most people. I try to think of what I would do if it was my mother in this situation when I make recommendations, and the first thing I would do is to explore the feasibility of bringing her to my home and hiring a caregiver. Memory care facilities and private caregivers are both expensive, so many times families decide that paying for a caregiver is worth having more control over their loved one’s environment, including the food they eat.
If moving her home was not an option, I would try to determine which dietary additions would have the most impact and which foods I would specifically ask the facility NOT to give her. I would personally try to consult with a ReCODE practitioner to help me determine these factors if possible, but if I couldn’t, I would definitely instruct the facility to eliminate gluten/wheat products, dairy, foods with added sugar and any food on the blood type "avoid" list from the foods they offered her. Dementia patients tend to start preferring sweet foods as the disease progresses, so I would try to provide clean naturally sweeter foods such as nutrient-packed smoothies sweetened with fresh fruit, dried fruits like figs or dates, organic applesauce, or non-dairy pudding sweetened with honey or maple syrup.
In terms of supplements, after consulting with her healthcare provider, I would bring Vit D/K2, MCT oil, Magnesium glycinate, a B-complex, and RESTORE to the facility and instruct them on how to administer them to her. Facilities usually need to have a doctor’s order to administer any supplement, so I would call and consult with the doctor myself and ask them to give the order. These are not the only diet and supplement changes I would focus on, but they are where I would start. Diet changes should be the foundation of the treatment plan for any health condition, both physical and mental in nature.
Hydration
Whenever I visit a patient with dementia I make sure to offer them a glass of water. I learned the importance of this early on in hospice when one of my patients who lived in a memory care facility suddenly started having increased agitation and delirium, with an elevated heart rate. The facility nurse asked us to get an order from the doctor for more anti-anxiety medication for her, because she assumed these were symptoms of worsening dementia. During my visit I offered her a glass of water and she gulped it and then two more glasses down. Her symptoms significantly improved after that. People with dementia, even mild forms of it, may not be able to recognize when they need water and/or may not be able to get it for themselves or ask for it when they do. Many of them rely on others to keep them hydrated, and this can be challenging, especially if they are in a facility. My strategy for this would again be to ask for a doctor’s order to have the facility give my loved one structured water once a day and to offer them a glass of water at least every 4 hours during the day. This article has some additional helpful suggestions.
I would also provide them with either a supply of ground chia seeds to add to juice or chia seed fruit pouches like these. Homemade chia pudding is another great way to use chia seeds. Chia seeds provide structured water, also called gel water, which is the “fourth phase” of water and is more effective at hydrating than plain water. This article describes how an anthropologist solved her 90-year-old mother’s chronic dehydration problem by having her nursing home add ground chia seeds to her orange juice every morning. It states “Pollack’s work suggests that gel water is more hydrating than liquid water, because its unique electrical charge allows our systems to operate more efficiently, and its absorptive qualities help the body retain water. Some studies have indicated that liquid water alone is not sufficient for hydration—as evidenced by cases where subjects couldn’t achieve hydration despite over-drinking.” If the person does not tolerate chia seeds, structured water is also found in fresh fruit and vegetables and bone broth.
Medications
It is well-known among hospice providers that patients frequently have periods of significant improvement when they have a “medication vacation,” which is when many or most of the drugs they regularly take are discontinued to focus more on comfort care. I have recently seen two people with dementia “graduate” from hospice after the antipsychotic medications they were taking were discontinued and they had a significant improvement in their overall condition. Just this month a study found that “there were significant increases in risk [for dementia] associated with the use of antidepressants, antiparkinson drugs, antipsychotics, bladder antimuscarinics, and antiepileptic drugs.” Dementia has also been linked to other very common medications such as reflux medications called PPIs and cholesterol drugs called statins.
Seniors in particular are taking too many pharmaceuticals, the effects of which alone or in combination are not well known and usually lead to the prescription of more medications to treat side effects. Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, has been linked to cognitive impairment including dementia. I recommend working with the prescribing physician to safely discontinue as many medications as possible for someone with dementia. Whenever a new symptom develops, I would 1) make sure the root cause is not easily handled without more medication, as in the case of dehydration and 2) try to ascertain if the symptom might be the effect of a medication they are already taking. Some medications such as PPIs and antidepressants should be tapered off of and not abruptly stopped in order to avoid negative withdrawal or rebound effects. Another possibility to look into for non-pharmaceutical symptom management is medical cannabis and/or non-psychoactive CBD.
Aluminum
Aluminum exposure has been found to contribute to dementia, and scientists actually use aluminum to induce an Alzheimer’s-type condition in lab rats. Aluminum is found in medications such as antacids and some vaccines and is also common in cosmetics and body care products, specifically deodorant. It is also found in many kitchen utensils, pots and pans, and obviously aluminum foil. Dietary sources of aluminum include baking powder, anti-caking agents, processed cheese and infant formulas . I try to limit all of my family members’ exposure to aluminum, but I would be even more strict about it for anyone with any form of dementia. There are several theories about effective methods for eliminating aluminum from the body, but the one I feel most comfortable recommending is drinking silica-rich water such as the brands Fiji, Volvic or Spritzer.
Music Therapy, Art Therapy, and Therapeutic Touch
In my experience and according to the available literature, people with dementia benefit greatly from the complementary therapies of art, music and touch/massage. Many hospice companies like the one for which I work offer these services to their patients as part of a holistic approach to end-of-life care because they significantly enhance quality of life and are even effective non-pharmacological approaches to symptom management, especially for those with dementia. I have personally seen the calming and empowering effects of these therapies in the people I care for, and I would say they are as, if not more, beneficial for them than nursing care. Whenever I am visiting a patient with dementia I try to figure out what type of music they might enjoy if they can't tell me, and I play a mix of that type of music on my device using YouTube or another streaming video platform while I am doing my assessment, feeding them, etc. If my loved one with dementia did not have hospice services I would seek these therapies out on my own for them.
Dementia in all of its forms is a very frustrating condition to navigate, and I know it is easy for someone watching their loved one succumb to it to feel lost and alone. In addition to implementing some of these holistic strategies, I highly encourage caregivers to find a local or online support group to join. Supportive community connections are critical for all of us no matter what we are dealing with, but even more so for those who are grieving the full or partial "loss" of a loved one who is still living.
Please feel free to send us or comment below with any additional recommendations you have from your experience with or research into helping a loved one with dementia. It's important to share your story, because something about it is always helpful to someone else.