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Massage Today
August, 2013, Vol. 13, Issue 08

The Rewards of Working with Dementia Patients

By Ann Catlin, LMT, NCTMB, OTR

I'm a brain/behavior geek from way back. In college as an occupational therapy student in the 1970's, I added a semester just to take more psychology classes. An internship was spent living and working at a large state mental hospital in Wisconsin.

I loved it! My first jobs were in acute psychiatric units. I loved that, too. I spent ten years working in a rehabilitation center for people with traumatic brain injuries. I really loved that! Then I started working in nursing homes and began to learn about Alzheimer's disease and related dementias.

Fast forward to the present time and my favorite work is sessions with people with advanced dementia and teaching massage therapists and other professional caregivers how they do it, too. As our population ages, we will see greater numbers of people with cognitive impairment. Did you know that of people over the age of 85, about half have some degree of dementia? This is an issue that will affect almost all of us personally or professionally.

Geek that I am, I like finding a new piece to the puzzle of dementia and the inner world of people living with it. One piece I'd like to share with you is that not all dementia is the same. What follows is a description of the most common forms of dementia and the conditions that create it. Dementia is a general term meaning loss of memory and other intellectual abilities serious enough to interfere with daily life. It's important to understand that no two people are alike when it comes to dementia, even if the diagnosis is the same.

Alzheimer's disease (AD)

This is the most common type of dementia and accounts for about 60 percent of cases. AD is a progressive, degenerative disease that results in impaired memory, thinking and behavior reducing the ability to perform routine activities; common symptoms of dementia include memory loss, confusion, difficulty in communicating, disorientation in time and place, mood swings, restlessness, sleeplessness, behavioral disturbances, personality changes and perceptual motor problems. Abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells, leading to brain atrophy. Plaques and tangles are deposits of protein fragments that bind together over time. Experts believe they play a critical role in blocking communication among nerve cells and disrupting processes that cells need to survive.

It's the destruction of nerve cells that causes symptoms of Alzheimer's disease. If AD is diagnosed prior to age 65, it is considered early onset. The course of the disease is similar as described above. Researchers have identified a possible genetic or familial link in people who develop the disease in their 40's or 50's. Early onset AD is relatively uncommon.

Vascular dementia is the second most common. It's caused by decreased blood flow to parts of the brain, depriving cells of nutrients needed to live. Onset can be sudden following a cerebral vascular accident (stroke). In others, onset is more stepwise. This happens when the person has a series of small strokes, known as transient ischemic attacks. Unique symptoms may include emotional outbursts and weakness in one or more extremities.

Lewy body dementia (LBD) is progressive and caused by abnormal protein structures in the brain called Lewy bodies. Symptoms are similar to AD, except that visual hallucinations and paranoia is a unique feature. People with LBD have symptoms very much like Parkinson's Disease including muscle rigidity and tremors and stooped posture. LBD is the third most common form of dementia.

Frontotemporal dementia (FTD) is caused by cell degeneration and tissue shrinking in the brain's frontal or temporal lobes, which control functions of personality, behavior and language. Symptoms vary, depending upon the portion of the brain affected. Some people with FTD have dramatic personality changes and social behavior is inappropriate and impulsive while others lose language abilities. Most people diagnosed with FTD are in their 50's or 60's.

Dementia is a growing concern in healthcare, our communities and families. Sound information gives us a foundation from which to act and increases our comfort level to serve this special population. My next article will explore how focused touch and sensitive massage can improve the quality of life for both the person living with the disease and their care partners. Until then, take good care.

Want to learn more?

These links take you to brief videos.


  1. Alzheimer's Association 225 N. Michigan Ave., Fl. 17 Chicago, IL 60601
  2. Gitlin, L. (2005) Occupational Therapy and Dementia Care, American Occupational Therapy Association Bethesda, MD.
  3. Peterson, Ronald, The Mayo Clinic Guide to Alzheimer's Disease, (2007) Mayo Clinic 200 First Street S.W.Rochester, MN 55905
  4. National Institute on Aging
  5. Alzheimer's Society

Click here for previous articles by Ann Catlin, LMT, NCTMB, OTR.


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