Written By: Dr. Melinda Butler, OTR/L, OTD, BCPA



On the heels of the long Memorial Day Weekend, the unofficial start to summer, Americans everywhere are enjoying fun in the hot summer sun. In preparation for shedding those extra clothing layers and engaging in summertime activities, many have been hitting the gym to tighten, tone, and shape their bodies. There are over one hundred thousand health and fitness clubs in the US that millions of Americans frequent to achieve their physical fitness goals. But how often do we consider how these efforts also enhance our brain health and possibly aid in the prevention of Alzheimer’s Disease? While the brain is technically not a muscle, it is highly vascular. So cardiovascular activity (exercise), significantly increases blood flow, allowing nutrient-rich blood to nourish the brain; which improves cognitive function.


Passive activities like watching television have little cognitive benefit. However, just as we challenge our muscles during weight lifting by increasing resistance, and challenge our hearts during running, by increasing time and distance, so can we challenge our brains by increasing cognitive challenge. A 2018 study highlights the effects of retirement on cognitive function and indicates that the lack of cognitive challenge may be the blame. Therefore, it’s befitting to highlight some strategies for promoting optimal brain function. Here are some activities to add to your summer physical fitness regimen.

Teach Someone a New Skill
This forces you to gain a deeper level of comprehension of a concept and requires creative discovery of teaching methods and/or demonstration.

Use Your Non-dominant Hand
Do this during activities like eating, writing, or meal prep. It requires concentration and focus.

Memorize Phone Numbers
Now I realize that this seems quite archaic but some of us are old enough to remember having to actually commit frequently used phone numbers to memory and key them in or even spin the rotary! Memorization was necessary because back then if you lost your address book, there was actually no cloud backup! But despite having the cloud, you can still master this long, lost art if you tap deep into your cognitive database.



While an ounce of prevention is worth a pound of cure, the fact still remains that every 65 seconds someone develops Alzheimer’s Disease in America. Therefore, caregiver education and coping skills are essential for the effective management of this disease. The rate progression of the disease will vary from person to person. However, the stages are very typical. Understanding the stages will help to manage symptoms and behavioral manifestations at each stage.


Global Deterioration Scale

Level I –

No cognitive Decline

No memory deficits noted n/a

Level 2 –

Mild, age related impairment

Forget where regularly used items are; occasionally forget names of known people or objects, forgetting appointments Post-it notes, alarms, typical memory aids are effective

Level 3 –

Mild cognitive impairment

Deficits appear upon testing; co-workers aware of performance issues, may become anxious in new situations, new places Compensatory techniques (notes, written instructions), extra time for new learning, repetition

Level 4 –

Moderate cognitive decline

(Mild Dementia)

Difficulty with executive functions, finances, meal prep, orientation to familiar places; may become socially withdrawn Signs, notes, pill box, reminders; may still live alone with intermittent supervision

Level 5 –

Moderately severe cognitive decline

(Moderate Dementia)

Can no longer manage daily activities without assistance; oriented to person only (place, time and situation diminishes through stage); remembers spouse and maybe children but not grandchildren; may begin to wander, hoard; no longer oriented to reality Caregivers in the home, ALF, or memory care needed; redirection needed; supervision with activities of daily living; ask them to help you; therapeutic fib to redirect (don’t try to orient to reality; establish routines; simple signs/labels; offer 2 acceptable options (don’t give commands or say “you have to”); repeat (don’t say “I told you”)

Level 6 –

Severe cognitive decline

(Moderately Severe Dementia)

May begin to forget spouse; largely unaware of recent events; some knowledge of past remains; oriented to self only; counting backwards from 10 is challenging (then forward later in the stage); may become incontinent; shuffling gait develops; 45 ˚ downward gaze; difficulty following instruction Continue with routines; smiling and gentle touch to engage; simple one step instructions; hand over hand assist; do things with them not to them (they will mimic); ask don’t command; smile; approach at eye level; generational music is helpful; use nostalgia – old photos, shadow box; use past profession or lifestyle to engage (dolls, tools, arts and crafts)

Stage 7 –

Very severe cognitive decline

(Severe Dementia)

End stage Dementia; verbal abilities diminish within this stage; incontinence; total assistance with daily activities including feeding; becomes wheelchair or bedbound; neurologic reflexes present; may begin to develop contractures Speak in simple phrases (especially during care); smile and hand holding is helpful; ensure comfort with range of motion; splinting and pain management; emphasis on dignity and comfort;


For more information, tips, and management strategies, check out these amazing resources:

Positive Approach to Care®

TEEPA SNOW, MS, OTR is one of the leading expert advisors on Dementia care and education. She is the founder of Positive Approach to Care, PAC. The vision of PAC is to enhance life and relationships of those living with brain change by fostering an inclusive global community.
CLICK HERE to experience Teepa’s insightful website and story

IATB Dementia Care®
LANNY BUTLER, MS, OTR, CDP, CPAM is founder and President of IATB Dementia Care, a private consulting group on Dementia Possible Care giving. He lectures throughout the United States on Dementia Possible Care, and is author of My Past Is Now My Future: a Practical Guide to Dementia Possible Care.
CLICK HERE to see Lanny describe the stages of Dementia in this brief, 6-minute video


Explore online continuing education courses from Melinda below:

Rehabilitation for the Frail or Cognitively Impaired Older Adult: Part I

Rehabilitation for the Frail or Cognitively Impaired Older Adult: Part II

Creating Value-Based Treatment

Telehealth in the Skilled Nursing Facility

Practical DME and Home Modifications for Aging Adults

Functional Geriatrics

Medicare Documentation: Practical Strategies for Justifying Therapy Services

Current Ethical Trends in Occupational Therapy

Coding and Billing for the PDPM and PDGM

Visit summit-education.com for more information.




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Mosca, I., & Wright, R. E. (2018). Effect of retirement on cognition: Evidence from the irish marriage bar. Demography, 55(4), 1317-1341. doi:https://doi.org/10.1007/s13524-018-0682-7