Depression and Dementia

with Melissa Smith-Wilkinson &
Padmaja Genesh
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Join us for this candid conversation with Padmaja Genesh of the Alzheimer Society of Calgary, where she is a Learning Specialist focusing on Supporting Learning & Excellence in Dementia Care since September 2012. Padmaja Genesh received her medical degree from Calicut University, India. She has worked as a family physician for several years in India and the Middle-East, before migrating to Canada. She received her Bachelor’s degree in Gerontology from Laurentian University, Sudbury, Ontario. Her passion for working in the field of Dementia stems from her experience with her father-in-law, who was diagnosed with Alzheimer’s disease in 1999

Website: Visit Alzheimer Society of Calgary 

Join Padmaja on the third Tuesday of every month for a live chat with an expert- Facebook live: Watch Here

Mental Health Concerns with Padmaja & Clinical Associate Professor of Psychiatry, Dr. Dallas Seitz: Watch Here

Melissa Smith

Welcome to Caregiver Wellness podcast, as usual, we're so glad that you joined us today to listen in and tap into this just a little bit over 30 minute conversation that we had with Padmaja of the Alzheimer's Society of Calgary. They've been a huge supporter of us Caregiver Wellness Retreat as we have done an in-person retreat with them for several years. And this year we'll be doing one virtually on May 28. So whether you're listening to this before then, you can go on to our website and register and really tap into a sense of community gathering and expert advice and support.

 

Melissa Smith

Right, right. On point and on topic that morning. Or if you're listening to it afterwards, you can catch it virtually on our website at CaregiverWellnessRetreat.com. We're really proud of everything that we offer caregivers in terms of wellness and support at no cost. So we're honored to be able to support you in your journey of caregiving. So join me today as I welcome Padmaja. And we talk about a pretty serious topic, but also I think one that is just incredibly important and valuable dementia and depression.

 

Melissa Smith

And we talk about what to look at in our person with dimension and also what to look at in ourselves as a caregiver. It is so easy to be burned out and to start to move into this spiral. So what do we need to look for and what are the things that we can do to combat these signs and symptoms that we see? So join me and tuning in and I look forward to exploring more of these topics with you in future podcasts.

 

Melissa Smith

So I'll introduce Padmaja. She she has received her medical degree from India and she said go ahead.

 

Padmaja Genesh

Yeah, that's right.

 

Melissa Smith

And she's also worked as a family physician for several years in India and in the Middle East before she migrated to Canada. She has her bachelor's degree in gerontology. And she also has an incredible passion in the field of dementia stemming from her own personal experience, where she was a long-Distance caregiver for her father in law who was diagnosed with Alzheimer's in 1999. She's a learning specialist for the Alzheimer's Society of Calgary and she's been with them since 2012. So that's the shorter version Padmaja. Is that okay?

Padmaja Genesh

Thank you. Absolutely.

 

Melissa Smith

I figured we could keep going, but

 

Padmaja Genesh

 

 I'm a short person. So the short version is what's best for me.

 

Melissa Smith

Yeah, absolutely. No problem. Well, I'm especially excited to chat with you on and really what is a bit of a serious topic. And I think we often don't talk about mental health, although in light of the pandemic, it's becoming less and less taboo, which is really exciting to me. And so I think a great place perhaps to start is maybe even just understanding a simple definition of depression. So how would you define it?

 

Padmaja Genesh

I would say that depression is a very common mood disorder that can affect us during our lifetime and affects our quality of life, it affects our thinking, it affects our behavior. It also significantly impacts our quality of life and ability to make decisions and function on a daily basis.

 

Melissa Smith

And and so just practically speaking, as someone who is trying to understand a little bit further, either the symptoms in myself or in the symptoms of my person with dementia. How do I know if, like, there's the clinically diagnosed depression, there's a mild depression, is it sadness? Is it a symptom of something else? How do you decipher between the different signs and symptoms?

 

Padmaja Genesh

Yeah, that's a very good question. At first, talk about some symptoms that you will experience yourself when you are going through depression. So basically having very low energy levels compared to previously, you feel like every little thing that you have to do, that everything that you did previously is now like a huge task. You don't have the energy to do it. So feeling that having very low energy levels, which is not very normal with the sadness you still have, the energy level is still there, but maybe the mood is not there for you to do. But here there is a significant lack of energy. You feel that and also the sad thoughts of feeling hopeless, feeling helpless, feeling out of control. You have lost all control, pessimism, lot of pessimism. You feel it's not going to nothing is going to work, that kind of feeling. So all those mood symptoms, irritability, becoming increasingly irritable, getting easily frustrated could be some of those things. And you notice that you're not able to enjoy the things that you used to enjoy before and the same kind of joy. You're not getting out of activities that used to give you enjoyment. Now you see that you're not getting the same amount of joy. You do not want to go out and meet people. You want to kind of retreat to yourself. No, the draw tendency to be draw and isolate oneself. You might notice sleep patterns just not getting good sleep or maybe waking up in the middle of the night with all the negative thoughts, you know, pessimism that all the negative thoughts, feelings of worthlessness, not wanting to continue to that effect on sleep patterns, you would see everyday changes, changes in your appetite, and that could be combined with that that might manifest as weight loss or weight gain.So these are some of the common things, common symptoms that one would notice. And you will see that this is not the same as how I used to be before something actually going on. It's just not to do with all the caregiving task. All that I'm experiencing now is something more is going on. And you feel that. And that is something when a person experiences that, it's very important to address that. Do not ignore it. Trust your gut feelings. And I know that this is not really normal and something more is going on, so I need to get some help.

Melissa Smith

Well, and I think it's interesting, though, my understanding is that the signs and the symptoms and kind of what a person feels really isn't much different than someone who has dementia and someone who doesn't have dementia. Are they pretty similar?

 

Padmaja Genesh

They are pretty similar, but what the caregiver would notice when that person with dementia is developing depression is that they will notice a significant change in their abilities and not just cognitive ability to remember or ability to do something, even the functional abilities, the ability to do things that they used to do before there was significant change in that decrease in those abilities, more dependance on the caregiver, not wanting to not wanting to engage in activities that they used to engage in before withdrawing, kind of withdrawing, keeping it to themselves.Tears, lots of crying. Some people you will see them in tears, crying, very sad, having sad thoughts, cognitive impairment. As I said, that would be their not wanting to and not concerned about any personal hygiene appearance. And you will see that in relationship, it affects the relationship to so not as warm. You know, you don't see the same kind of get the same kind of warmth from the other person that used to get before.

 

Padmaja Genesh

So those are some kind of changes that is very, very different from the normal way that the person used to be before. It's easy for caregivers to notice that that increased dependance, not wanting to do anything, that increased apathy, not wanting to do anything at all, that loss of interest in activities, things that they enjoyed before the drawing from all those. And these are things that you would notice. 
 

Melissa Smith

 

But if we're looking at. And so so so we're kind of almost dancing between two topics here, looking at the signs of depression in ourselves as a caregiver. But also a person with dementia. So let's focus for a moment on the person with dementia. How would those signs differ from just regular signs of dementia and cognitive decline? Because they sound incredibly similar to me.

Padmaja Genesh

It's just a change that you notice change from before, that's what tells you that something is going on. So as you said very correctly, the symptoms look very similar, right? Someone with just with dementia, without having any depression could have these very same symptoms. But the thing the what differentiates from just depression, dementia alone and depression added on to dementia is a change that you see from before. That's uncharacteristic for that person. What you've been taking care of that person for this many, for  some time, when we see that there's something else is going on, you know, maybe you feel that the medicine are working in some kind of thought. Even sleeping, you see more of sleep disturbances compared to before. More of mood says symptoms compared to before. So that's a change. It's not any new symptoms coming coming out. It's just a change in what you and the level of the person's functioning, their mental abilities, their sleep patterns, eating habits and activities, engagement and activities. You see that change. It's a change that tells us. But there's something else is going on.

 

Melissa Smith

So what are what are some first steps that you would take? So let's focus on your person with dementia. And so I notice some of these, you know, these signs and symptoms of depression or maybe even mild depression. You can see a geriatric psychologist. Would you what would your next steps be?

 

Padmaja Genesh

The first step would be to kind of document what you're seeing and then bring it up with the person's physician, family doctor, bring it up with the person's family doctor and then have a conversation. I'm seeing all these changes for the last few days. It's kind of different from how he used to be before. It's not the same as how he or she used to be before. And I suspect that there's something else going on now, having initiating that conversation and not just ignoring that or kind of neglecting us. Maybe my person is having a bad day. Now, we tend to think that relate to this is having a bad day because all bad days, yeah, that's what happens. But then if the bad days are coming to three days together, that's not normal. You know, that's that's not usual. So that is where you think that this has been going on for the last past few days. And I just want to make sure that nothing else is going on. I suspect he said some depression could be associated. And that's very common because about 40 percent of people with dementia can experience depression. And all forms of dementia. Dementia, due to all course, it could be mild to moderate Alzheimer's disease, vascular dementia, Lewy body dementia, Parkinson's dementia. So all these different causes of dementia, they're all associated with, what, 40 percent of people you will see depression also coexisting with dementia.

Melissa Smith

So I know some of the treatments are similar to just anyone else having depression, for example. And my stepmom, who had early onset, she was on an antidepressant, some medication. And it it was life changing for my dad. So in her case, it worked. In other individual cases, you have to look at all the combinations of medicines and you have to absolutely absolute either whether it's right or not.

 

Melissa Smith

So what would you say are some non-pharmacological ideas or suggestions if they're suspecting something like that?

 

Padmaja Genesh

Yeah, so there are things like somatic therapies that have been suggested, this is simple things daily use, daily life. You can use like bright light. Use of bright light, it can actually reset the, you know, the connections between the mood regulating sensors and make them work better. So would be especially in places, if you are living in a place where you do not get much of sunlight much of bright light, have a new source of bright light in the room and sitting just sitting in front of the light for a couple of hours every day, that's it.

 

Padmaja Genesh

It's completely noninvasive. It's not anything being, you know, nothing invasive at all. But at the same time, it really helps to reset those connections between the regulating centers and control and even regulate the release of a mood controlling substances in the brain. 

 

Melissa Smith

 

It can be said that works for everyone, to everybody. And you do. Right. And not just in terms of a diagnosis for depression, but our bodies and chemical makeup and the circadian rhythm.

 

Melissa Smith

We have to be in the rhythm of the sunshine. And if we're not, it can be an incredible ripple effect into sleep. So that brings me to sleep. That's a huge yeah.

Padmaja Genesh

 

 Yeah, that's a huge one to. But the same thing, the same therapy works for people who care who have sleep problems as well. So being exposed to bright light, getting out if possible, and taking a walk out so that you get the natural sunshine during the day and cutting back on all the screen time at night.

That's very important to get a good night's sleep. The television, cell phones and all those kind of electronic gadgets. So all that blue light, no cutting back, all of that exposure to blue light, then keeping the bedroom cooler. And these are generally things that we advise everyone kind of winding down towards the end of the day, having a warm bath or a shower that might help listening to, you know, slow music, kind of gentle, soothing kind of music. Massage might help just having a massage for persons with dementia. There's been some research about using sleep kit. And sleep kit involves things like people can begin to decide what you want to put in the sleep kit and the contents of the sleep get wages for each person based on their temperament, their personality. Usual things to be included in the sleep kit are something like a hairbrush, then a mirror. So at the end of the night, spending that time with the person to brush their hair, hand lotion. So there's that physical contact playing some music, some soothing, relaxing music, reading a book or scripture for another person. It might be just scriptures. You know, they want to listen to that at the end of the day or reading to their their favorite book. All these are some things that are found to have significant effect because it's that ten, fifteen minutes of time you spend with the person at the end of the day and then tucking them in bed and kissing them good night. And that does make a difference. You know, that that person, the time that you devote it at the end of the day, if it helps a person sleep better through the night and we see that always running the hospitals, we see that dementia units, when the caregivers, when the staff, the members are taking the time, the nurse or calculated is taking the specific time, it really brought the person to sleep at night.

 

Melissa Smith 

You know, I hear you say that. And I think, you know, at the end of the day, we are all so human and we need this attention. Connecting, we thrive that way? Absolutely no. To to expect us to thrive any other way or to to to be able to overcome something no matter your cognitive ability. It's impossible without a human connection. What I really appreciate you saying I love that idea of a sleep kit, but essentially that's just establishing a routine. 

 

Padmaja Genesh

 

Absolutely, Absolutely

Melissa Smith 

And and I would say we've kind of vacillated back and forth between your person in dementia who might have depression or stroke signs and symptoms to the to the caregiver. So I'd love to kind of focus a little bit more on the caregiver on this last half and I mean, in my personal opinion, everything you said is applies to the caregiver and absolute a thousand percent. If we are not caring for ourselves, there is nothing left to to be given. So what are what are some suggestions uou have for caregivers if they're starting to show some signs and symptoms.

Padmaja Genesh

 

Of depression, you mean? Yeah, again, and not to ignore and they said, you know, to talk to your physician about it, talk to someone, you know, whether they are seeing some changes in you, close friends or family members. Are you seeing I'm feeling this someone you can trust? You may not want to share your feelings with everyone, but whoever you can confide in a friend, a close friend or a family member, you can confide and have a chat with them and see and feel this, you know. Do you think you do you notice anything, any change in me? And maybe when you get that confirmation that to say that's a signal for you to talk about it with the doctor, you know, do not ignore it because you need that help. You are taking care of a person. And for you to be straight what you call a good, competent caregiver, you need to be in good physical and mental health and your physical and mental health.  If it's declining, it can affect the quality of life of the person with dementia that you are supporting. And lots of research has shown that when people are depressed, there is more irritability, there are more bad behavior symptoms in the person with dementia who they're supporting directly, and it's reflecting in the other person. So for you to be a strong advocate and to be a competent caregiver for the person with dementia, you need to take care of your own health. That's very important. And that brings us to the topic of self-care, right. Self-care. So very important. We always say it's not selfish to not think that, OK, do not have time to care for myself. You are as important as a person you're supporting, because if you are not healthy in mind and body, then there is no way you can support another person. So that's so very important to take care of yourself, physical and mental health. So I'm talking to the doctor about it is important and some nonmedical. Again, what we talked about that bright light, it looks for us with bright light. Then having a routine that helps us move on from one thing to the other is a routine that you follow and establish. Otherwise, the whole day will be gone and you may not have done anything at all when you are really depressed. That's what happens. But having your routine and sticking to that routine helps you move, get this task done and kind of put normalcy brings into your life. So sticking with that routine is important. Early morning, but as soon as you wake up, not as soon as you wake up in the morning if we can get some exercise that is good because it releases endorphins, feel-good hormones that can help to counter all the decrease in hormones that leads to depression. So it can help to counter that negative effects of depression. It will mitigate those effects. If you can get some exercise in them in the morning and have those endorphins running in your body, it really helps improve your mood. Again,  getting some sun, sunshine going out, if possible, going out or even in your room, open the blinds in the windows and let some sunlight in. You know, that really has a positive effect on our moods, finding time to do activities that you enjoy, some time for yourself and you have to schedule it in other ways. If not, get done, schedule that time for yourself, because in the midst of all the other responsibilities that you have, if you do not schedule it, it will not get done.But it's important to have that self temi. What if it's fifteen minutes you start saving 50 minutes, maybe when the person is having a nap. No, that's your time for yourself. Or if you can get someone else to have a chat with the person, engage them through a face time chatter or something like that, and that's a time for you to have your own time. That's, that's really important. Listening to your favorite music, engaging in artistic activities, because that's a really good channel to channel all that negative energy, put that into something creative and that boosts your mood.

Melissa Smith 

So this is something I hear all of these really creative ideas. And I would venture to say everyone listening to us could resonate almost with one thing that you've said, whether it's nontraditional therapies like our music or even just being outside in nature and going for a walk. And Sharon even expressed some really great ideas in the comments here. And I think I really like to hone in on this. One of the biggest things I think we we tend to do is caregivers is focus on the guilt. I don't have time or I can't or know sort of the aspect of it's almost impossible and and having a sense of self compassion and sympathy. And so there's no guilt in one thing that really, really struck me and I remember from my dad caring for his wife is how disrupted his sleep was, because because of her sundowning and because she ended up in the middle of the night or yet you felt like it was solely his responsibility to make sure 24/7 that her needs were taken care of. And so sleep was just so erratic. And so I think. There's no there's this idea that we can't ask for help or and we don't even begin to recognize the symptoms and things that kind of pile up. So there's no guilt in asking for somebody to come in and let you get a good night's sleep, huh?

 

Padmaja Genesh

Yeah. Yeah, absolutely. You need to get that help. 

 

Melissa Smith 

Can you identify a person that will be willing to do that? I imagine. And I hope there is someone in your life who can do that. But when I tried to get back on schedule or routine, I think it is so important to recognize.

 

Padmaja Genesh

And the thing is, many people want help. Some people might want to help, but they may not know how exactly they can help. So giving them something specific to do that, that that helps them, OK, I can do this, but no, I can do this. But so you might get people to agree to do take care of one aspect and that gives you some time for yourself. Catch up on your sleep. Yeah. It's so very important for caregivers.

Sleep is important. Health is important. Absolutely. That's important.

 

Melissa Smith

Yeah, absolutely. You know, the things I always go to is I think about when my kids were little, I'm like, OK, what is going on here? You had enough water, food and sleep and all that, a little bit of movement. So kind of all of those just really basic needs. And also that connection you talked about that sense of love and connection. You know, I see your comment here about CBT and mindfulness. And I think I think that's so interesting and important to that.

Padmaja Genesh

 

And now I wanted to add a few points more, please. So, yeah, I still one is about being mindful and taking that for when you get the negative feelings, being mindful of what's happening to you and try to, if possible, try to challenge those negative thoughts, then you would journaling that. That seems to help caregivers journaling at the end of the day, looking for at least three things or three persons that you are grateful for at the end of the day. And the more we focus on that, you might be you might be able to find out something like that and had such a bad day. But then at the end of the day, when you really put your mind to it, you recognize that there will be some people or some things have happened that have been really good. So having maintaining that journal and journaling and gratitude daily, that really helps. Yeah, and meditation helps. So different things work for different people. So whatever works for you is something that you need to find. And as we see in the books, the psychotherapy, it's really, really helpful. Cognitive behavioral therapy, Problem-Solving therapy, all these are very, very good. Mindfulness based cognitive behavioral therapy helps you recognize your wrong thoughts, distorted thoughts and replace them with positive thoughts, you know, and problem-solving strategy. So all these there's lots of evidence for it, for these psychotherapies. And combined with medications, it works great. And when those don't work, that's when we try we try to think about some other things, you know, going for the stronger medications and things like that. So in general, two-thirds of people will respond to either psychotherapy or medications. And about 50 percent improvement in symptoms can be expected with the first medication itself, but for some people, the first medication may not work and you might have to go through a few medications to find the right medication and the right dose. But a combination of psychotherapy and medications really helps. And in cases where those don't work, then you can think of other therapies, as I told you, about. The bright light can always be used any time. And it's also another interesting thing coming up, which is called the Veillette. You know, it's called transcranial photobiomodulation. That's using again, using light infrared light to stimulate the mood, controlling regions of the brain. And Relaid Canada is a company that is there doing some studies also for caregivers who can sign up for the study and you'll get the equipment, you'll get the, you know, the gadget and you can try and see if it's benefiting you. If it's not, then 80% of refund policies that after six months you can return it if it's not helping you. But it's sure to benefit persons with dementia without dementia. So it's all lots of other things that are also there. Yeah.

 

Melissa Smith

I you know, in thinking about all of these different things, I mean, it's a lot there is so much you can do and I can almost feel or seem a little bit overwhelming and I would encourage those that are listening to us to just maybe even pause for a moment and maybe we can all do this together and just notice if your jaw could be softened. If your shoulders can drop right where you are, so even just this active, just it took us, what, two seconds to notice that.

 

Melissa Smith

Just that moment of starting to become aware. Is the beginning of taking some actionable steps toward even recognizing spending time with yourself, you know, pausing to notice those subtle changes in your loved one so that that would be where I would start because sometimes the rest can feel really overwhelming. But I can take just one quick pause to relax my jaw and my shoulders and notice that the sun is going to shine no matter how I respond to whatever's happening in front of me. So it's the days are just going to keep going.

Padmaja Genesh

Take a few deep breaths, you know, deep breathing.

 

Melissa Smith

Yeah. Yeah. I'll circle back to just one one less comment in terms we've talked a lot about psychotherapy and seeing your family physician and some medicated alternatives. Sometimes there is a little bit of a stigma with that. And I will say to whoever is listening in this regard that they're that that while some family members or some communities might have a certain idea or perception of that, but not to rule anything out, to truly seek counsel and seek what you feel might be best for yourself and and, of course, your person with dementia, because it may may take a big shift in your current thinking or current culture that you're involved in you little world. And it's important to really just take stock of what's best for your family and what's best for you, and then it's not going to be the same for everyone.

 

Padmaja Genesh

So that's a great point. That's a great point, Melissa, because, you know, when you look at the prevalence, the statistics about the problems of dementia in the community, the numbers are so small, the estimated numbers are so small and we know that that's not true. Said that about five percent of community people in the community, all of that is living in the community and about 15 percent of all the veterans in Long-Term Care. But in reality, it's that's not true. That's not true. Again, as you said, there is some stigma attached to that. And but people feel that it's a sign of some people feel it's a sign of weakness to talk about their feelings and to discuss with someone. It's a sign of weakness. But that's something that's not true. Again, it's not a sign of weakness. It takes courage. It's a sign of strength. I'm just asking that you are recognizing what you're feeling. So, again, that going back to the basics, asking yourself, checking in with yourself every day, how am I feeling? When people ask us that question? We always say I'm glad you don't post about me. I see how are feeling. But this very sincerely ask yourself probably my feeling today at this moment, checking yourself. Yeah. That awareness, as you said, is great. Yeah. You need to have the debate. That's a first step.

Melissa Smith

Yeah, absolutely. Well, I would just like to close this part of our conversation to invite anyone that's listening to listen to Padmaja on her regular Facebook lives. In fact, I listened to one recently where you interviewed a medical professional who talked about just mental health in general. And it was excellent. It was such a really valuable talk. And in fact, well, we'll post that in the chat and as well as on our Facebook and our website as well. So you can find that chat. That's great. Thank you. It was really fantastic and very, very informative to me. So I appreciate that so much. And I will give a little bit of a plug here. You all are partnering with us on May 28th to do a morning of Caregiver Wellness Retreat focused on live from Calgary. So it will be virtual, but you all will be represented, Padmaja and the staff there for the Alzheimer Society of Calgary.

 

Melissa Smith

We're so glad that you joined us today on Caregiver Wellness podcast, such an incredible conversation happened even after this recording. So if you ever want to join us for our community gathering live, just sign up for our newsletters and you'll get personal special invitations for those that are in our community to join us live. And we actually turn off the cameras and the recording and we just have conversations about your questions with our experts. And we have some incredible experts coming up in the next few episodes. Thank you so much for joining us. And we're honored to be walking in this path. A journey with you.