Tackling 3 common issues in people living with dementia with evidence-based tips

The Bottom Line

  • More than 55 million people cross the globe live with dementia.  
  • Sleep problems, depressive symptoms, and difficulty performing activities of daily living are common challenges that accompany dementia.
  • Cognitive rehabilitation and a variety of non-drug strategies appear to help people living with dementia tackle these challenges. 
  • Patients and caregivers should discuss difficulties with sleep, depression, and executing daily activities with their healthcare team, so a plan can be put in place to address them.   

Globally, over 55 million people live with dementia, with 10 million more diagnosed every year (1). Dementia can be accompanied by a variety of additional issues that impact mental health, functional abilities, cognition, safety, and quality of life (2-7). Sleep problems, depressive symptoms, and difficulty performing fundamental activities of daily living—such as bathing or feeding oneself—are three examples of common challenges in this population. But there is good news! Non-drug strategies are available supports to help address these challenges (2;3;6). Click on the links below to learn more.


1. Sleep problems  

Up to 40% of people living with dementia experience issues related to their sleep, like increasingly waking up at night (2;8). Research shows that compared to usual care, supports like physical activities, social activities, strategies that include carers, and multi-component strategies may help improve sleep in people living with dementia. These enhancements were shown to have a slight to moderate impact. More research on the topic is needed to increase our certainty in the findings (2).


2. Depressive symptoms 

Almost 50% of people living with dementia experience depressive symptoms. Some go on to receive a formal diagnosis of depression, but many do not (3;9;10). Research shows that compared to usual care, various non-drug strategies have the potential to reduce depressive symptoms in people living with dementia who are experiencing depressive symptoms but don’t have a formal diagnosis. These beneficial strategies include standalone cognitive stimulation, cognitive stimulation plus exercise and social interaction, massage and touch therapy, occupational therapy, multidisciplinary care, and reminiscence therapy (3).


3. Difficulty performing daily activities  

Around 28% of older adults living with dementia at home are largely or totally dependent on others to complete daily activities (11). Research shows that compared to usual care, cognitive rehabilitation can produce large improvements in everyday functioning in people living with mild‐to‐moderate dementia. These positive results are immediate and may last up to one year, but more research is needed to increase certainty in the findings (6).


Are you living with dementia or a caregiver for someone who is? Be sure to identify any changes and challenges related to sleep, mental health, and engaging in and completing daily activities independently. Discuss these issues with your healthcare team and what treatment options are feasible and promising additions to the management plan.

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References

  1. World Health Organization. Dementia. [Internet] 2023. [cited September 2024]. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia 
  2. Wilfling D, Calo S, Dichter MN, et al. Non-pharmacological interventions for sleep disturbances in people with dementia. Cochrane Database Syst Rev. 2023; 1:CD011881. doi: 10.1002/14651858.CD011881.pub2. 
  3. Watt JA, Goodarzi Z, Veroniki AA, et al. Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: Systematic review and network meta-analysis. BMJ. 2021; 372:n532.  
  4. Fauth EB, Gibbons A. Which behavioral and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms. Int J Geriatr Psychiatry. 2014; 29:263-271. doi:10.1002/gps.4002.
  5. Baharudin AD, Din NC, Subramaniam P, et al. The associations between behavioral-psychological symptoms of dementia (BPSD) and coping strategy, burden of care and personality style among low-income caregivers of patients with dementia. BMC Public Health. 2019; 19:447. doi:10.1186/s12889-019-6868-0.
  6. Kudlicka A, Martyr A, Bahar-Fuchs A, et al. Cognitive rehabilitation for people with mild to moderate dementia. Cochrane Database Syst Rev. 2023; 6:CD013388. doi:  10.1002/14651858.CD013388.pub2. 
  7. McLaughlin T, Feldman H, Fillit H, et al. Dependence as a unifying construct in defining Alzheimer's disease severity. Alzheimers Dement. 2010; 6(6):482-493. doi: 10.1016/j.jalz.2009.09.004.
  8. Wilfling D, Dichter MN, Trutschel D, et al. Sleep disturbances in German nursing home residents with dementia: A multicenter cross-sectional study. J Alzheimers Dis. 2019; 69:227-36.
  9. Goodarzi ZS, Mele BS, Roberts DJ, et al. Depression case finding in individuals with dementia: A systematic review and meta-analysis. J Am Geriatr Soc. 2017; 65:937-948. doi:10.1111/jgs.14713. 
  10. Asmer MS, Kirkham J, Newton H, et al. Meta-Analysis of the prevalence of major depressive disorder among older adults with dementia. J Clin Psychiatry. 2018; 79:17r11772. doi:10.4088/JCP.17r11772.  
  11. Canadian Institute for Health Information. Dementia in home and community care. Internet] n.d. [cited September 2024]. Available from: https://www.cihi.ca/en/dementia-in-canada/dementia-care-across-the-health-system/dementia-in-home-and-community-care  

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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