Improve the Psychological Well-Being of Dementia Patients and their Caregivers with Mindfulness

Improve the Psychological Well-Being of Dementia Patients and their Caregivers with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness training eases depression and improves sleep and quality of life for both people with early-stage dementia and their caregivers. . . . Mindfulness involves attentive awareness with acceptance for events in the present moment. You don’t have to be drawn into wishing things were different. Mindfulness training in this way takes advantage of people’s abilities rather than focusing on their difficulties.” – Marla Paul

 

Dementia is a progressive loss of mental function produced by degenerative diseases of the brain. Dementia patients require caregiving particularly in the later stages of the disease. Caregiving for dementia patients is a daunting intense experience that can go on for four to eight years with increasing responsibilities as the loved one deteriorates. This places tremendous psychological and financial stress on the caregiver. Hence, there is a need to both care for the dementia patients and also for the caregivers. Mindfulness practice for caregivers has been shown to help them cope with the physical and psychological demands of caregiving. In addition, mindfulness training has been found to help protect aging individuals from physical and cognitive declines.

 

In today’s Research News article “Mindfulness Training for People with Dementia and Their Caregivers: Rationale, Current Research, and Future Directions.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00982/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_686352_69_Psycho_20180626_arts_A ), Berk and colleagues review and summarize the published research on the application of mindfulness training for the treatment for dementia patients and their caregivers.

 

They find that the published research reports that mindfulness training improves the psychological well-being of caregivers for dementia patients. It significantly reduces depression and anxiety and improves self-efficacy. Studies of mindfulness training for the dementia patients themselves report improvements in attention, memory, cognition, and quality of life. When the patients and their caregivers were both trained in mindfulness there were significant improvements in stress responses and mood in both.

 

These are important findings that strongly suggests that mindfulness training is a safe and effective means to improve the psychological well-being of both the dementia patient and their caregiver. Given the great difficulty and stress produced by dementia on both the patient and caregiver, these improvements are very important to relieve or at least mitigate the suffering of both. This suggests that mindfulness training should be routinely provided for dementia patients and their caregivers.

 

So, improve the psychological well-being of dementia patients and their caregivers with mindfulness.

 

“The dementia journey is hugely challenging and provokes in us a great deal of frustration, fear and dread—understandably. But as much as dementia is described as a journey of loss, it can also become a journey of love and understanding. At times, love needs to be gritty and determined; at other times, it will be sweet. At all times it must be unconditional.” – Alice Ashwell

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Berk L, Warmenhoven F, van Os J and van Boxtel M (2018) Mindfulness Training for People With Dementia and Their Caregivers: Rationale, Current Research, and Future Directions. Front. Psychol. 9:982. doi: 10.3389/fpsyg.2018.00982

 

Abstract

The world population is aging and the prevalence of dementia is increasing. By 2050, those aged 60 years and older are expected to make up a quarter of the population. With that, the number of people with dementia is increasing. Unfortunately, there is no cure for dementia. The progression of symptoms with no hope of improvement is difficult to cope with, both for patients and their caregivers. New and evidence-based strategies are needed to support the well-being of both caregiver and patient. Mindfulness training is a body-mind intervention that has shown to improve psychological well-being in a variety of mental health conditions. Mindfulness, a non-judgmental attention to one’s experience in the present moment, is a skill that can be developed with a standard 8-week training. Research has shown preliminary but promising results for mindfulness-based interventions to benefit people with dementia and caregivers. The aim of this review is (a) to provide a rationale for the application of mindfulness in the context of dementia care by giving an overview of studies on mindfulness for people with dementia and/or their caregivers and (b) to provide suggestions for future projects on mindfulness in the context of dementia and to give recommendations for future research.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00982/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_686352_69_Psycho_20180626_arts_A

 

Improve Alzheimer’s Disease Risk Factors with Mindfulness

Improve Alzheimer’s Disease Risk Factors with Mindfulness

 

By John M. de Castro, Ph.D.

 

“MBSR may reduce hippocampal atrophy and improve functional connectivity in the same areas of the brain most affected by Alzheimer’s disease. MBSR is a relatively simple intervention, with very little downside that may provide real promise for these individuals who have very few treatment options.” – Rebecca Wells

 

In the course of normal aging, there is a slow decline in cognitive ability. But, for some the decline can be excessive producing dementia. Alzheimer’s disease is the most common form of dementia. It involves an irreversible progressive loss of mental function associated with brain degeneration. The early stages are typified by memory loss but as the disease progresses patients can lose the ability to carry on a conversation or carry on normal life functions, and eventually leads to death. In fact, Alzheimer’s disease is the sixth leading cause of death in the U.S. On average, this progression lasts about 8 years but can last as long as 20 years. Alzheimer’s typically first emerges after age 65, but can occur at younger ages.

 

It is estimated that 5 million Americans have Alzheimer’s disease. Unfortunately, there are no known cures for Alzheimer’s disease. But, there are treatments that can help relieve the symptoms. These include drug treatments. Recently, mindfulness practices have been shown to improve the symptoms of age related dementia. It has been shown that chronic stress is a risk factor for the development of Alzheimer’s disease. Mindfulness-Based Stress Reduction (MBSR) is a mindfulness technique that was designed to reduce stress and its effects. So, it would seem reasonable to study the ability of MBSR to relieve the symptoms of Alzheimer’s disease.

 

In today’s Research News article “Plasma REST: a novel candidate biomarker of Alzheimer’s disease is modified by psychological intervention in an at-risk population.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537638/, Ashton and colleagues examined the association of a biomarker, repressor element 1-silencing transcription (REST), with Alzheimer’s disease and the ability of Mindfulness-Based Stress Reduction (MBSR) to alter REST and the early symptoms of Alzheimer’s disease. They recruited patients over 65 years of age with diagnosed Alzheimer’s disease and healthy elderly control participants. They scanned their brains with Magnetic Resonance Imaging (MRI) and collected blood samples to measure the plasma levels of REST. They also recruited individuals over 65 years of age with anxiety, depression, and mild cognitive impairment. They were randomly assigned to receive an 8-week program of either MBSR or health education. They measured memory, verbal fluency, executive function, anxiety, depression, worry, and collected blood samples to measure the plasma levels of REST.

 

They found that REST levels were significantly lower in Alzheimer’s disease patients than healthy control participants. Also, the lower the levels of REST the lower the brain volumes in these patients. In addition, the REST levels in participants with mild cognitive impairment who later expressed full blown Alzheimer’s disease were significantly lower than those participants who did not. MBSR produced a significant increase in REST and the greater the level of REST increase the greater the improvement in anxiety and depression.

 

These are very interesting and potentially important findings that suggest that levels of repressor element 1-silencing transcription (REST) in the blood may be a marker for Alzheimer’s disease. It is lower in patients with active Alzheimer’s disease and in people with mild cognitive impairment who would eventually develop Alzheimer’s disease and is associated with reduced brain volume. MBSR participation increases REST and the increase is associated with improved symptoms. This suggests that low REST levels identify Alzheimer’s disease patients and that mindfulness practice can increase REST levels.

 

Repressor element 1-silencing transcription (REST) promotes the development of neurons. So, low levels of REST may be a sign that neural development has slowed or stopped and this may be an important mechanism for the development of Alzheimer’s disease. Interestingly, mindfulness training may be able to reverse the decline in REST and could potentially restrain the development of the disease. It is not known how MBSR could affect REST, but it can be speculated that the ability of MBSR to reduce the physiological and psychological responses to stress may be involved.

 

So, improve Alzheimer’s disease risk factors with mindfulness.

 

“Perceived stress can be altered by mindfulness-based stress reduction, cognitive-behavioural therapies and stress-reducing drugs. These interventions may postpone or even prevent an individual’s cognitive decline.” – Mindy Katz

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Ashton, N. J., Hye, A., Leckey, C. A., Jones, A. R., Gardner, A., Elliott, C., … Marchant, N. L. (2017). Plasma REST: a novel candidate biomarker of Alzheimer’s disease is modified by psychological intervention in an at-risk population. Translational Psychiatry, 7(6), e1148–. http://doi.org/10.1038/tp.2017.113

 

Abstract

The repressor element 1-silencing transcription (REST) factor is a key regulator of the aging brain’s stress response. It is reduced in conditions of stress and Alzheimer’s disease (AD), which suggests that increasing REST may be neuroprotective. REST can be measured peripherally in blood plasma. Our study aimed to (1) examine plasma REST levels in relation to clinical and biological markers of neurodegeneration and (2) alter plasma REST levels through a stress-reduction intervention—mindfulness training. In study 1, REST levels were compared across the following four well-characterized groups: healthy elderly (n=65), mild cognitive impairment who remained stable (stable MCI, n=36), MCI who later converted to dementia (converter MCI, n=29) and AD (n=65) from the AddNeuroMed cohort. REST levels declined with increasing severity of risk and impairment (healthy elderly>stable MCI>converter MCI>AD, F=6.35, P<0.001). REST levels were also positively associated with magnetic resonance imaging-based hippocampal and entorhinal atrophy and other putative blood-based biomarkers of AD (Ps<0.05). In study 2, REST was measured in 81 older adults with psychiatric risk factors for AD before and after a mindfulness-based stress reduction intervention or an education-based placebo intervention. Mindfulness-based training caused an increase in REST compared with the placebo intervention (F=8.57, P=0.006), and increased REST was associated with a reduction in psychiatric symptoms associated with stress and AD risk (Ps<0.02). Our data confirm plasma REST associations with clinical severity and neurodegeneration, and originally, that REST is modifiable by a psychological intervention with clinical benefit.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537638/

Improve Dementia Patients and Their Caregivers with Mindfulness

Mindfulness dementia2 Paler

By John M. de Castro, Ph.D.

 

“One of the major difficulties that individuals with dementia and their family members encounter is that there is a need for new ways of communicating due to the memory loss and other changes in thinking and abilities. The practice of mindfulness places both participants in the present and focuses on positive features of the interaction, allowing for a type of connection that may substitute for the more complex ways of communicating in the past.” – Sandra Weintraub

 

Dementia is a progressive loss of mental function produced by degenerative diseases of the brain. Dementia patients require caregiving particularly in the later stages of the disease. Alzheimer’s disease is the most common type of dementia and accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. For Alzheimer’s disease alone, there are an estimated 10 million caregivers providing 9 billion hours of care at a value of over $100 Billion dollars.

 

Caregiving for dementia patients is a daunting and all too frequent task. It is an intense experience that can go on for four to eight years with increasing responsibilities as the loved one deteriorates. In the last year, 59% of the caregivers report that they are effectively on duty 24/7. Over time dementia will lead to loss of memory, loss of reasoning and judgment, personality and behavioral changes, physical decline, and death. The memory and personality changes in the patient may take away all those characteristics that make the loved one identifiable, unique, and endearing, producing psychological stress in the caregiver. The feelings of hopelessness can be overwhelming regarding the future of a patient with an irreversible terminal degenerative illness. In addition, caregivers often experience an anticipatory grief associated with a feeling of impending loss of their loved one. If this isn’t bad enough, a little appreciated consequence is that few insurance programs cover dementia care outside of the hospital. So, medical expenses can produce extra financial strain on top of the loss of income for the caregiver. It is sad that 72% of caregivers report relief when their loved one passes away.

 

Obviously, there is a need to both care for the dementia patients and also for the caregivers, for all types of caregiving but particularly for dementia. They play an essential and often irreplaceable role. So, finding ways to ease the burden is extremely important. Mindfulness practice for caregivers has been shown to help them cope with the physical and psychological demands of caregiving. In addition, mindfulness training has been found to help protect aging individuals from physical and cognitive declines. So, it would make sense to combine mindfulness training of the patients and caregivers as a pair.

 

In today’s Research News article “Benefits of Mindfulness Training for Patients with Progressive Cognitive Decline and their Caregivers.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1247548971935693/?type=3&theater

or below or view the full text of the study at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363074/

Paler and colleagues provided an 8-week mindfulness training program for Alzheimer’s Disease patients and their caregivers. They were also given homework exercises on CDs to be practiced for 30-60 minutes daily. They found that the training produced an increase in quality of life, improvement in cognitive executive function, and a decrease in depression and sleep problems for both the patients and caregivers. The vast majority of the participants were pleased with the program and felt that they were less stressed and better able to cope with stressful circumstances and their relationships had improved.

 

These results are outstanding and suggest that combined mindfulness training for both patients and caregivers is a safe and effective method to improve the emotional state, cognitive ability, quality of life, sleep, and stress management for both. The efficiency of training both at the same time is important as the feasibility of implementing the program increases as the demands on time decrease. Mindfulness training is known to improve emotion regulation and depression, cognitive processes, improve sleep, decrease the psychological and physical responses to stress, and improve relationships in normal people. It is important that this study established that this is also true for dementia patients and their caregivers.

 

It should be noted that there was no control or comparison condition. So, it is impossible to make a strong conclusion that the mindfulness program itself produced the improvements. A randomized Controlled Trial (RCT) is needed to confirm these results. Nevertheless, the results are exceptionally promising and provide the rationale to implement an RCT. The authors do note, however, that recruitment of patients and caregivers for a control group would likely be extremely difficult.

 

So, improve dementia patients and their caregivers with mindfulness.

 

“Mindfulness involves attentive awareness with acceptance for events in the present moment. You don’t have to be drawn into wishing things were different. Mindfulness training in this way takes advantage of people’s abilities rather than focusing on their difficulties.” – Ken Paler

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available  on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Paller, K. A., Creery, J. D., Florczak, S. M., Weintraub, S., Mesulam, M.-M., Reber, P. J., … Maslar, M. (2015). Benefits of Mindfulness Training for Patients with Progressive Cognitive Decline and their Caregivers. American Journal of Alzheimer’s Disease and Other Dementias, 30(3), 257–267. http://doi.org/10.1177/1533317514545377

 

Abstract

New strategies are needed to help people cope with the repercussions of neurodegenerative disorders such as Alzheimer’s disease. Patients and caregivers face different challenges, but here we investigated an intervention tailored for this combined population. The program focused on training skills such as attending to the present moment nonjudgmentally, which may help reduce maladaptive emotional responses. Patients participated together with caregivers in weekly group sessions over 8 weeks. An assessment battery was individually administered before and after the program. Pre-post analyses revealed several benefits, including increased quality-of-life ratings, fewer depressive symptoms, and better subjective sleep quality. In addition, participants indicated that they were grateful for the opportunity to learn to apply mindfulness skills and that they would recommend the program to others. In conclusion, mindfulness training can be beneficial for patients and their caregivers, it can be delivered at low-cost to combined groups, and it is worthy of further investigation.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363074/