Triggering Moments of Lucidity in Dementia Patients w/ Dr. Stephen Post

>>Welcome to American Medicine today. I'm Kimberly Bonati alongside Ethan Youker. We have a jam packed show. Let's get right to it. A recent national prevalence study has estimated that up to 44% of dementia patients experience unexpected moments of lucidity. So how do we as caregivers help encourage them? Joining us to discuss is Dr. Steven Post, founding director of the Center for Medical Humanities Compassionate Care and Bioethics Center at Stony Brook University. >>Thank you for joining us, Doctor. >>You're welcome. Kimberly and Ethan, too. Nice to see you. >>So tell us more about this study. You surveyed nearly, what, 6000 caregivers for those with dementia. What were those findings? >>Well, we used the Gallup organization and we did, in fact, identify 6000 active primary caregivers. And our intent was to understand how they as caregivers responded to these wonderful moments of unexpected lucidity in their loved ones. Maybe they thought their loved one was completely gone, a husk, a shell, dead and so forth. But they come back into themselves. And sometimes it's stimulated by music, familiar music or art or the smell of something that they love from the kitchen. It could be a lot of different things. It could be the fall leaves. It could be the sound of the ocean. Who knows? But they can be stimulated. And it's quite dramatic at times. And then sometimes it's just sporadic. Sometimes it just happens. But it's very important because we wanted to know how the caregivers respond to that kind of moment. And it's actually quite positive. About 90% of them have very favorable responses and it gives them a sense of meaning and purpose and hope in what they're doing because they don't feel like they're just wasting their time. We're spinning their wheels. They feel like their grandma is still there and grandma still needs them. I personally have a have a family member who's I mean, he's not well, he's literally not there all the time. And so I think that's what sparked my interest when I saw this, that these moments of lucidity are possible because collectively, as a family, we all yearn for those moments where, you know, it's my father in law where he returns. Is there any indication how those are sparked? It's completely unknown. Do you know how long these moments typically last? >>Well, we surveyed all of those kinds of things. I think music is the most important intervention. So there's quite a lot of work going on around the country in the area of music and memory, particularly music that's familiar to the individual as he was or she was in life and developing. Maybe it was the Beatles, maybe it was Bing Crosby, who knows? But something that was meaningful to them. And usually it's more effective if it's applied with an iPod. It's something about being singular, about them, about the most important impression. And so they don't just sort things out with their background environment. But that's a long story. And it's also it stimulates them in terms of of who they are. I have a book called Dignity for Deeply Forgetful People. I don't much like the word dementia because it invites a lot of negative metaphors. Gone husks show all those kinds of things. I was mentioning. But deep forgetfulness is something that is more continuous. You know, I'm certainly one who has those experiences in the parking lot at night when I'm going home. Where did I park my car? So it's okay to forget where you parked in car. It's not okay to forget that you have a car. That's park. That's actually a pretty good diagnostic fiction. Yes, music is important, but. But art is important. We had a we had one case of a gentleman who would come into an art therapy class in the early mornings. He was quite severely forgetful, would say, for a long his dementia. But he would in fact sketch things out on a piece of white paper with a black crayon. And it was chaotic, but there was always this one line in the middle of the paper. It looked like a little bit of a street maybe, And we would ask him in the morning, So what is this? And he couldn't respond. But then one morning he'd volunteer and he said, This is a map so my daughter can find her way to my house. >Hmm. Wow. >And these are anecdotally true. Many, many people report them. In fact, the National Institute for Health is even funding research now, trying to wonder what's going on in the brains of people who have these moments of return to use the word Ethan. And I think it's it's really important. >>We're going to take a quick break. We'll be right back with Dr. Steven Post after this. You were watching American Medicine today. >>I went to Dr. Bonati and he went ahead and looked at my pictures. He told me, You have pain here. You have pain here. And I was like, Yeah, absolutely. I'd been to others, but he was a doctor that didn't want to fillet my back open like a fish and do like open spinal surgery because everybody else wanted to do that and I was not having it. The anesthesiologist who was working with me, I was like, how in a conversation with this guy? And then I was watching on the monitor as Dr. Bonati is fixing my back, I really felt like I was in good hands. >>Bonati succeeds where others fail. >>Welcome back to American Medicine Today, we're continuing our discussion on dementia and Alzheimer's with Dr. Steven Post. >>I think what I what I have personally encountered with my father in law is that it's almost like he he's I use the term locked in. He's locked inside his his mind, really, because we've found that he does hear and can process what you're saying. You know, you'll say something to him and hold his hand in yours and he'll kind of smile and might squeeze your fingers, but he can't communicate back. What are your thoughts and sort of that idea of being locked inside? >>I've been writing on that for 30 years and it's so important to learn to use language appropriately. So, for example, you never ask someone with dementia, What would you like for breakfast? You know why? Because you're putting pressure on them. You're forcing them to dig back and try to remember words that they may well have forgotten. But if you give them choices. So those are called closed ended questions. Would you like Post Toasties being named? Post? Of course. Post Toasties or Ham and Eggs? You'll be surprised that same individual who had no response before it was anxious because you ask the question, suddenly they'll say, Oh, ham and eggs, and they'll have a smile because you help them remember. By the way, you used language. >>My grandmother passed away from dementia, so this really hits home because we didn't know how to deal with it at the time. And then we had a great uncle whose wife was in a home with dementia, and he would visit her every single day. And there were times where she remembered him. And even when she didn't know that that was her husband, she said, I know your heart, your good heart. And so they had that loving kind of connection, even though it wasn't immediate recognition. But this is so difficult not only for the person who's going through it. And like you and Ethan said, they're kind of locked in for the family members. Do things like photographs help at all, or does that just make them more anxious? >>Oh, no, they help a great deal. In fact, most of the experienced caregivers that I know utilize photography quite adeptly. They'll typically have a book of photographs that is appropriate for the age cohort. Could be Mickey Mantle. It could be Joe DiMaggio, could be Marilyn Monroe. Who knows? But those kinds of things can be very stimulating. And so there's more there than meets the eye is what I like to say. And we're discovering some of the techniques that are very helpful in reconnecting with individuals and kind of freeing them from that, locked in, I'll use Ethan's language of that, locked in feeling. I think it's very important that we do so, because honestly, you know, the medications are, you know, let's hope they come along, become more and more successful. Right now, they're not too great, but you can bring someone back into themselves with the right use of these stimulants, the music, the art and so forth. And suddenly, you know, they're kind of there bit now. It may not last and the cynics may say, well, it's meaningless, but it's not it's not going to those individuals and certainly not to their caregivers, because their caregivers say, you know what, my life as a caregiver is meaningful. It also shields them somewhat from depression because there's a slightly higher depression rate globally among caregivers. That's why they need respite and so forth. If they are attentive and willing to notice and engage with these moments of lucidity, they tend to be happier and more relieved and find more meaning. You know, meaning is the key to life. If you just feel like you're wasting your time going through a kind of external routine that doesn't have any value at all, it's hard to be very fulfilled. But we find that when people are trained to notice these episodes, they feel more complete. >>I know to get back any time with your loved one, even if it's mere minutes, is worthwhile. Thank you so much for being on the program. Dr. Stephen Post. >>Thanks, doc. >>It's a pleasure. >>Take great care. That's all we have for this segment. We'll have more after the break. You were watching American Medicine today. If anyone deserves the number one Grandpa award it's Scott from Tampa, Florida. >>I have an office upstairs and I recruit nationwide in the oncology field engineers to fix the cancer treatment machines like variants. And for a hobby, I love to make cosplay outfits for my grandkids. I've made Ironman and Batman. I had pain in my lower back that it radiated down into my legs, through the sides of my legs, into the back of my legs. They were always really tight. And then there was the shooting pain that was like electricity right down my legs, the side of my legs and the front of my legs. And depending on what I was doing or how long I was on my feet. It could be incredibly strong shooting pains or just lightning. The car was not a friendly environment for me. You think I'm sitting? No, moving my foot back and forth. It was not a friendly environment and trying to get in and out of the car. Very difficult. Many, many times. I just had these these cramps in my legs while I'm driving and I had to pull over and stop. I had some struggles with the stairs in my house when I would wake up in the morning and I'd be ready to go down stairs, I would stand at the top of the stairs with both hands on both sides and just look at the stairs and go, I don't know what my legs are going to do. Gingerly, carefully put my leg down and make sure my legs were there. As I walked down with holding on for dear life going up, I had to bend over completely, you know, lean forward in my freezers full of ice packs. It's amazing. I went to a chiropractor who is a great guy. He was very helpful up until the last year or so. >>No matter what he did, the pain was still there. I have a sister who lives in Santa Barbara and she had back surgery ten years ago where they went in and did pins and screws and a fusion and, you know, cutting things out and all that stuff. She went through a year of recovery so that really gives me pause to think about that. And when I was making my decision of what to do. >>That's when he saw a commercial for the Bonati spine Institute and made the Call. >>The day of the consultation. Less than a minute somebody came out to get me, put me in the office, and I met with the doctor and it's, wow, that's like clockwork. That's not unusual. I've never had that happen before. I met with the doctor. He was very relaxed and interested in my experience up to this moment. Asked me about my symptoms. Asked me to explain where they radiate from, had me stand up, sit down, you know, do all these different things. And he looked at the MRI and then this is the avenue of concerns >>The Exclusive Bonati spine procedures are performed incrementally using conscious I.V. sedation. This keeps the patient alert and communicating with their surgeon to ensure the source of their pain is eliminated before they leave the operating table. >>And you're asking me some questions. Do you feel this? Do you feel that. It wasn't uncomfortable or anything. I think it was just information that they needed? Okay, great. That's what we needed to know. After the procedure, I went into the recovery room. So when I sat up knowing my my legs, you know, were just like leg day on work out day. Right. They were always real tight. I just reached back to my legs and I felt my legs and they weren't like tight as a drum. They were relaxed. So that's new. And so when I stood up, they said, You feel your pain. No, I don't. This was unusual. Everything was just gone. You know, all the all the symptoms were gone. I can't even describe you know, what that means or feels like, you know, to stand up and not have any pain. Your legs. I can go up and down the stairs. You know, I was feeling pretty good, actually. >>We sat down with Scott just three months after his procedures at the Bonati Spine Institute. He is already back to his routine and doing the things he loves most. >>Well, I've been walking. I've been lifting things. I've been doing things around the house. I've been going back to my normal activities I used to do two years ago. I am getting stronger and stronger. And, you know, you get out of shape when you don't do these things. And so getting back in shape, I am just a believer and I'm very thankful that I went through that and I'm living the dream right now. >>To see more stories of recovery just like this, Search for the Bonati Spine Institute on YouTube. Rumble Apple's App Store, Google's Play Store. Roku and Amazon's Fire TV. Well, this wraps up this edition of American Medicine today. Make sure to check out our show anytime, anywhere add us to your favorite streaming device. Search American medicine today. 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