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Is it Dementia or Stress?

Blog Post by Oran Aviv



If you have been following my blog posts, you know that I have often explained that many behavioral changes in individuals living with dementia might not solely stem from their neurological condition. Instead, these changes could be tied to their chronic stress from coping with dementia. (Learn more: Stress and Dementia)


This is the reason reflexology can be so helpful for people who are living with dementia because it can reduce the stress that may be causing additional cognitive decline and confusion.


In recent weeks, I've personally experienced the impact of chronic stress on both my memory and behavior. The parallels I observed between my own experiences and the behaviors often associated with dementia further solidify the connection between stress and cognitive function for me.



How We Respond to Danger

When we are in danger, our body has a natural response system in place to protect us. It's called the "fight or flight" response, and it's like our body's superhero mode when faced with danger or stress.


Picture this: You're out in the wild, and suddenly, a big, growling bear appears. What happens next is your body gears up to either fight that bear or run away as fast as possible.


Your brain senses danger and shoots a quick message to your body, saying, "Hey, we've got a situation here!" This message acts like an emergency alert, setting off a chain reaction to give us the strength to run away or stand our ground and fight.



What Happens During Fight or Flight

When we are in danger, our body kicks into the Fight or Flight response to protect us, and here's what happens:


Our adrenal glands, which are like little stress managers on top of our kidneys, release a burst of adrenaline (also known as epinephrine). This is the energy boost that gets us ready for action.


Adrenaline makes our heart beat faster, pumping more blood to our muscles. This is like revving up the engine to give you the power to fight or run.


Our breathing speeds up, allowing more oxygen into our bloodstream. This helps our muscles work better because they need that oxygen to function at their best.


Blood flows to our major muscle groups, making them tense and ready. This is your body getting ready to fight that bear or sprint out of there like Usain Bolt.



How Stress Affects Us

The fight or flight response is our way of responding to danger, but in our modern lives, we sometimes trigger this superhero response even when there's no bear in sight. Imagine you're about to give a presentation, and you feel nervous. Your brain might interpret this as a threat (even though there's no bear), and the fight or flight response kicks in.


Normally, when the perceived danger has passed, our body returns to its normal relaxed state. However, when stress induces the fight or flight response, we may continue to respond as if we are still in danger.


When our body remains in this prolonged state of heightened stress response, it can lead to various physical and mental health issues. This prolonged activation of the stress response is often referred to as chronic stress, and it can have detrimental effects on the body and mind



I Forgot My Phone Number

Stress has become a constant companion, especially for those of us living through challenging times like a war. What's been particularly surprising is how my own stress has manifested in cognitive decline and confusion, mirroring behaviors often seen in people living with dementia.


A few weeks ago, I found myself at a store, ready to enjoy my membership discount. The cashier politely requested my phone number, and I rattled off the digits confidently. The problem? It wasn't right. I was convinced it was a cashier’s error, but when I tried again I stumbled. I knew some numbers but couldn't string them together correctly. I had forgotten my own phone number, a memory slip caused by the chronic stress I was under.


Fortunately, by the next day, my memory bounced back, and I had no trouble recalling my phone number. Since that one-time hiccup, I've had no issues remembering it. I even double-checked just now, and I know my phone number well in two languages. 😁


Stress can indeed mess with memory retrieval, leading to temporary forgetfulness or lapses. But what struck me is how, in the context of dementia, we often attribute increased memory loss solely to the condition itself, without considering that stress might play a significant role in these changes.



Stress and Sleep

In the initial weeks following the onset of the war, many of us dreaded the nighttime. Sleep became elusive, and once we managed to doze off, we would abruptly wake up in the wee hours with thoughts that refused to let us return to slumber. Our wake-ups were often accompanied by fear, anger, or even panic.


To cope, a friend on Facebook initiated a group for early risers. During those lonely hours of the night, we'd chime in, sharing our struggles with falling back asleep. It was oddly comforting to realize we weren't alone in this.


Stress can significantly impact sleep in various ways, leading to disruptions in both the quantity and quality of sleep.


According to the Mayo Clinic:

Sleep disturbances may affect up to 25% of people with mild to moderate dementia and 50% of those with severe dementia. These disturbances often worsen as dementia progresses.


Now, here's the twist. What if the stress of living with dementia is making sleep issues even worse? In our presentation for the Alzheimer’s Disease International Conference, we shared that caregivers reported improved sleep patterns in individuals with dementia when hand reflexology was applied.



Lost in Time For many of us, time has taken on a new dimension since the onset of the war. The familiar rhythm of days seems elusive; time neither races nor crawls—it's as if our sense of it has slipped away. A friend on Facebook posts what she calls "Public Service Messages," where she tells us what day of the week it is because otherwise, we really wouldn’t know.


Take my buckwheat bread adventure as an example. I need to let the blended buckwheat ferment for 15 hours. My daughter, who gave me the recipe, came to visit and saw that the dough was fermenting. She asked when I put it in and to my surprise, she made me realize that instead of letting the dough rest for 15 hours, 25 hours had already passed and I was planning to let it sit for another 3 hours!


Stress can throw our cognitive functions, like attention and working memory, for a loop. These functions are crucial for estimating time accurately. When stressed, judging time intervals accurately becomes a challenge, leading to errors in estimating durations.


One of the most recognizable changes that happens to someone with more advanced dementia, is their lost sense of time. Naomi Feil, the founder of The Validation Method, defined someone in this state as “time confused”. These individuals don’t know if they are living in the present or in the past. Have any of us considered that time confusion may also be caused by stress?


In my presentation at the International Conference of Reflexologists this year, I shared a case study of an older man with minimal cognitive changes, who became confused and depressed after moving to an independent living facility. He was so confused that the facility refused to accept him because he could no longer live independently.

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After just a few reflexology sessions, he reverted to his former self, allowing him to stay in the independent living community on his own.


So, sometimes, confusion might just be a side effect of stress, but the good news is, there are ways to tackle stress.



Change in Behavior In the initial weeks following the commencement of the war, most of my time was spent in a horizontal position. My attention span barely extended beyond short video clips of sitcoms from the 1960s and '70s—Bewitched, The Brady Bunch, and The Nanny became my escape from the harsh reality. Even as I started to function more, a single news article could send me back to that horizontal refuge for an entire day. I dealt with my difficult reality by withdrawing.


The days filled with active volunteering, be it offering hand reflexology to refugees or preparing meals for those stuck in their homes in the South, brought a surge of energy and better functionality.


Then came a day when I unexpectedly lashed out at a family member, something I'd never done before. The culmination of sleep deprivation and bottled-up emotions overflowed, leading me to verbally attack a loved one.


Fortunately, we talked it through, and I apologized, but it was a stark realization of how I had temporarily lost control over my words and actions.


Chronic stress has a knack for meddling with emotional regulation, making individuals more susceptible to mood swings, irritability, or anxiety. These emotional shifts can manifest in behavioral changes, like heightened agitation or withdrawal from social activities.


Withdrawal and aggressive behavior are also commonly associated with more advanced stages of dementia, but what if some of these behaviors could be attributed to stress? What if, before turning to medications, we could try alleviating the stress?


I also want to emphasize how much a sense of purpose impacted my own mood. It's crucial to support older adults, especially those with dementia, in finding reasons to get up each morning—something that makes them feel useful and needed.



Unable to Concentrate

Another incident that happened during the very stressful first weeks of the war, genuinely startled me because it reminded me of my mother's more advanced stages of dementia. This occurred one day when I struggled with concentration.


I had taken out a package of tofu and started cooking with it. I tasted it and it seemed a bit sour. I wanted to make sure it wasn’t off, so I went to check the date that was on the discarded packaging. However, when I went to look at the date, I folded the cardboard package and went back to cooking. I repeated this 3 or 4 times. I remembered that I wanted to check the date, took the package, folded it, and put it back without looking at the date. My focus simply did not last for more than a few seconds!


Stress can significantly impact cognitive functions, especially attention and concentration. It's crucial to consider whether a decline in concentration might be due to stress, particularly in individuals who already have cognitive impairment.


In Conclusion

Living with dementia is undeniably stressful, and this stress may contribute to memory loss and confusion.


Regrettably, when someone with dementia displays increased memory loss, confusion, disrupted sleep patterns, or behavioral changes, the default assumption is often that it's merely the natural progression of the condition.


However, these symptoms could also be manifestations of chronic stress, as I personally experienced in the past few weeks.


Reducing stress has the potential to alleviate memory loss and associated behaviors. In our work, we've found that reflexology is one effective method for reducing stress in individuals living with dementia. It has shown promise in reducing cognitive decline and confusion when they are causd by chronic stress. Always consider if it is dementia or stress.

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Special Thanks:

I want to express my heartfelt gratitude to the Georgia Reflexology Association, with whom I had the pleasure of presenting my work to this week. Their kindness and support played a significant role in pulling me out of a low point, reigniting the spark for my passion for assisting those living with dementia. Thanks to them, I was able to write my weekly blog post for the first time in two months.


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