In this episode of the Truth, Lies Alzheimer's podcast, host Lisa Skinner presents three recent research updates relevant to dementia caregivers. First, a large Canadian study of 500,000 nursing‑home residents found that antipsychotic drugs, often prescribed off‑label, significantly worsen behavioral symptoms (68% showed increased agitation) and accelerate cognitive decline; the segment emphasizes a shift toward person‑centered, non‑pharmacologic interventions such as music, art, exercise, and staff training. Second, a synthesis of 27 longitudinal papers by University College London, published in The Lancet Public Health, identifies cardiovascular risk factors—especially hypertension, obesity, and diabetes—as the dominant, modifiable contributors to dementia, noting that smoking and education have become less influential while obesity and diabetes are rising threats; the authors estimate that eliminating these factors could prevent up to 40% of cases. Third, a Neuroscience News study led by Marie‑Eve Picard and Pierre Rainville demonstrates that pain‑related facial expressions correspond to distinct brain activity patterns, enabling a machine‑learning model to predict pain from MRI data; the findings suggest facial expression analysis as an objective tool for assessing pain in non‑verbal dementia patients, with practical cues (furrowed brow, elevated cheeks, squinting, wrinkled nose, raised upper lip) for caregivers. Throughout, Lisa frames the information as actionable tools for reducing stress, improving care quality, and fostering a more compassionate relationship with loved ones, and invites listeners to join her Minding Dementia support group for further resources.
Chapters
Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.
Hi everybody, welcome to another new episode of the Truth, Lies Alzheimer's show. I'm Lisa Skinner, your host, and I have some really interesting updated information for everybody. I like to, you know, stay on top of the The research, things change on a dime when we're talking about Alzheimer's disease and dementia. It's actually hard to keep up with. So I'm doing the legwork for everybody because, first of all, I need to keep up with all this stuff myself. And I think it's important to keep everybody out there informed, especially as rapidly as things change. So I've got a couple of updates for you all today that I'd like to share. This one is telling us that antipsychotic medications worsen behavior in dementia patients. It was based on a study of 500,000 Canadian nursing home residents, and it found that antipsychotic medications significantly worsened behaviors. We're talking about the behaviors in patients with nearly 68% experienced increased behavioral issues. I find that pretty astonishing, to be honest with you. Antipsychotic medications are often prescribed off-label for dementia-related symptoms despite serious side effects like tremors and cognitive decline. They're talking about increased cognitive decline. So researchers advocate— here it is again— for person-centered approach to dementia care, emphasizing non-drug therapies like music, art, and exercise to address these behavioral issues. And training staff to reduce reliance on antipsychotics could improve the resident outcomes and their overall, um, quality of health, fostering less agitation and better quality of life. The findings call for a reevaluation of antipsychotic use in non-psychotic conditions. And here are some of the key facts based on this study. That minimizing or not using antipsychotics, 68% of residents on antipsychotics showed worsened behavior. Off-label use, 26% of nursing home residents received antipsychotics for unapproved purposes. And the studies did show that alternatives like music, exercise, and pain management improve outcomes without medication. Now, there's always going to be exceptions to that rule. There are a few brain diseases like frontotemporal lobe dementia, that they may have to continue to use behavioral management medications, but less than they perhaps do now, combined with person-centered approach to managing these behavioral issues. Oh, these are some of the comments. To this article. So this one person says, this important topic on antipsychotic drugs administered to a person living with dementia, when it is possible to effectively care for people with proper dementia care training. She says communities need to take time to train their workforce and avoid such pain. Even early death due to antipsychotic drugs. I 1000% agree with that comment. Here's another comment. Person-centered dementia care is key to creating the best quality of life for a person living with dementia. That's been my experience. And I agree with that statement. Another person emphasizes, there is no need for drug restraints in dementia care when the care providers are trained and coached properly. I agree with that, but from what I've seen to date, we have a long way to go. A lot of people don't even know about the person-centered approach to dementia care. They don't even know it exists. Let alone what it looks like. Another comment: Anyone who has worked in the field of dementia can attest to these facts. Holistic person-centered care can just about negate the need for antipsychotic medication. The second update I want to share with you that is recent, is that cardiovascular health is becoming— well, it has been for a while, but it's really being focused on— is becoming a major risk factor for dementia. And this was as of June 28th of this year, and the article states that in a shifting landscape in dementia risk factors. Cardiovascular health, which is the health of your heart and blood vessels, is now taking precedence. This is really, really important to know, and that's according to researchers from University College of London in the UK, who analyzed 27 papers about dementia that had collected data over more than 70 years. And this is what they've concluded by calculating what share of dementia cases were due to different risk factors. Their findings were recently published in The Lancet Public Health. So if you want to refer to that, you can and maybe read more about it. So the top risk factors for dementia over the years have been hypertension, obesity, diabetes, education, and smoking, according to a news release on these findings. But the prevalence of risk factors has changed over the decades. So this is the most updated information about the risk factors and how to minimize a person's risk of developing Alzheimer's disease later in life. Researchers said smoking and education have become less important risk factors because of population-level interventions such as stop smoking campaigns and compulsory public education. On the other hand, obesity and diabetes rates have increased amongst the population and have become bigger risk factors as a result. Hypertension, or blood pressure, still remains the greatest risk factor, even though doctors and public health groups are putting more emphasis on managing these conditions, the study says. Cardiovascular risk factors may have contributed more to dementia risk over time So these deserve more targeted action for future dementia prevention efforts, says Dr. Mukadam, an associate professor at UCL and the lead authority of this study. Eliminating modifiable risk factors could theoretically prevent 40% of dementia cases this study concluded. I thought that was really valuable information for everybody to know. And as I said before, and I say it pretty regularly because it's the absolute truth, this information changes to the extent that it's hard to keep up with. So I really think it's important that I stay on top of it and I keep all of you informed because this is really important information to know to help us all reduce our risk of developing Alzheimer's disease, especially when you see a percentage as high as up to 40%. That's, to me, is significant. Okay, and then the last update I have for you is a study in NeuroscienceNews.com where they say they have found that facial expressions of pain are linked to distinct brain activity. This is as of December 6th, 2024. So this is a very, very, very recently published article. And when I read this, I thought this would be such useful information for caregivers. Oh, for anybody, family members, but especially for people who have their boots on the ground and care for people with Alzheimer's disease and related dementia on a day-to-day basis. Because we know, and this was one of the most recent episodes of Truth, Lies Alzheimer's, I was sharing with you some of the triggers of the behaviors that we see, how to recognize them, and then how to kind of go through a process of elimination by trying to figure out— and it's totally a process of elimination— what triggered the behavior that you're seeing. The response that you're seeing. So when I saw this article, I thought this would be really useful because it talks about how to recognize facial expressions as it relates to a person's pain. So this is what the summary of this article says: Facial expressions triggered by pain are deeply tied to brain activity, revealing distinct neural mechanisms compared to verbal pain reports. And we all know, any of us who have lived in a dementia world, worked in a dementia world, been part of the dementia world, that our loved ones and the people we care for with dementia a lot of them lose their ability to articulate or verbalize that they're in pain. So this is going to help us all recognize these facial expressions and, and what the, the meaning might be, um, that they are in some kind of pain. So how they did this was researchers developed a neurobiological model using an MRI and machine learning to predict pain-induced facial expressions. These findings highlight the potential of facial expression as an objective tool for assessing a person's pain. So the bottom line is this research could actually pave the way for improved pain management especially in nonverbal or chronic pain patients, which apply to people living with Alzheimer's disease and dementia. So here are the key facts of this, of this study. A machine learning model predicts pain-induced facial expressions based on the person's brain activity. The brain mechanisms for pain-related facial expressions differ from verbal pain reports. Facial expression analysis can enhance pain assessments in patients unable to verbalize their discomfort. So these key facts are likened to a person stubbing their toe on a table leg or even fracturing their wrist that will probably make them wince in pain or possibly curse. Which is a natural reaction. Facial expressions play an important role in communicating the unpleasant sensory and emotional experience of pain. And among other things, they signal to others, so caregivers, family members, that we're hurt and may need help. The neural processes associated with this form of nonverbal expression have received little attention to date. Although they are known to play an important role in the experience of pain. This woman, Marie-Eve Picard, who is a doctoral student in the laboratory of Pierre Rainville, a professor in the Faculty of Dentistry at the Université de Montréal and a researcher at the Montréal University Institute of Geriatrics Research Center, Center decided to investigate. So in a new study, Picard and Rainville show that facial expressions triggered by painful stimuli can be predicted from brain activity. Their findings reveal that the neural mechanisms underlying these expressions are largely distinct from those associated with other manifestations of pain, such as subjective verbal reports of perceived intensity. Picard and her colleagues developed a neurobiological model that predicts facial expressions elicited by painful stimuli using machine-learned algorithms trained on magnetic resonance brain imaging data, or MRIs, They created a facial expression pain signature. Healthy volunteers underwent painful thermal stimulation, and their facial expressions were measured using the Facial Action Coding System, a standardized tool that analyzes facial movements based on the activity of— excuse me— of several groups of facial muscles. Activation of each muscle group caused a specific change in the person's facial expression. For example, pain-related expressions often include furrowed brows, elevated cheeks, squinting, wrinkled nose, and a raised upper lip. So for all our loved ones and caregivers out there, and family members, anybody living in the world of a person with dementia. I'm going to repeat that. You can look for pain-related expressions, which include a furrowed brow, elevated cheeks, squinting, a wrinkled nose, and a raised upper lip are signs of pain. Now, towards more precise assessments in clinical settings, accurately assessing a patient's pain is obviously important for appropriate pain management. The importance of facial expression and pain assessment receives less attention than the role it plays in social interaction, said Picard. However, Our results suggest that this behavioral indicator of pain can be a valuable complement to verbal reports of perceived intensity, or in our case, in our world, when they cannot express their pain or discomfort. The study was informed by an understanding of pain as multidimensional meaning that considering its various manifestations can improve assessments of its severity. Picard's work shows the existence of brain signatures, or patterns of brain activity, that are predictive of pain-related facial responses. And I think that's really the important thing to understand. While these results advance our understanding of the brain mechanisms behind pain, and nonverbal communication. Further research will be needed to test their generalizability and determine their applicability to conditions such as chronic pain. But I think the takeaway from this information is that there's a definite correlation between facial expressions and that are generated naturally from the brain when a person is experiencing pain. And for us, we can start looking at these certain facial expressions as a means to identify a trigger for some of these behavioral responses that we see on a day-to-day basis. So hopefully all three of these updates and findings and studies have added to your arsenal of tools that you can use every day when caring for somebody or trying to have a stressless or stress-free or less stressed relationship with somebody you're caring for or your loved one, because we deal with this stuff every minute of every day. And these are all really important gems of information that can help make our worlds a little easier to cope with by trying to understand why we're seeing the responses and the behaviors that we see. It's not always easy. We have the tough job trying to figure these things out and understand what triggered a certain response or triggered a certain behavior. Not always easy to do, as I'm sure most of you already know. So that concludes this episode of The Truth Lies in Alzheimer's Show. I'm Lisa Skinner, your host, and we'll be back next week with another new informational episode. And in the meantime, I wish you all health and happiness, and I, as always, will look forward to you coming back next week to hear another value-filled informational episode of the Truth, Lies Alzheimer's show. Take care. See you next week.
Bye-bye. Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group, where a community of like-minded caregivers and we're here to help.
