Interview With Alzheimer’s Disease and Dementia Expert David Troxel


If you or a loved one is diagnosed with Alzheimer’s Disease or dementia, there’s likely one overriding question in your mind: “what next?”. It’s a stressful, emotional time.

We spoke to Alzheimer’s Disease and dementia expert David Troxel recently about a variety of topics around memory care. Keep reading for the interview:

What are some of the biggest indicators that should be worrisome to people that extend maybe beyond just sort of normal forgetfulness and are things that make you have to start to wonder if there is an Alzheimer’s or dementia component to what’s going on?

David Troxel: The Alzheimer’s Association has a very good handout on their website called the 10 Warning Signs of Dementia or Alzheimer’s. It reminds us that it’s more than just forgetfulness and memory loss; it’s personality change, confusion, apathy, a lot of things…So I always say that if you are having some forgetfulness or some lapses or some issues, don’t panic. Keep your sense of calm. But if it’s really disrupting your daily life, I think that’s when I get concerned.

Some sophisticated medical providers are looking at other things too, like maybe a first-time diagnosis of depression after the age of 65, because that can mimic Alzheimer’s. So I would say changes that are impactful, that people notice, that are causing some stress is when I would want to make sure someone goes to the neurologist and gets a good evaluation.”

Suppose the diagnosis does come back of Alzheimer’s or dementia. What should they do next?

DT: “Most dementias are slow and progressive, so it does give you time to get your affairs in order. It’s really important to get a power of attorney for health care or advanced directives, power of attorney for finances. It’s really important to talk to your person with dementia about their wishes and what their ideas are.

I think for the person with dementia, I would say that what we know is good for the brain is keeping an active life, exercising, the Mediterranean diet, socialization, music, time outdoors, time with family. Try to give yourself a sense of purpose. I think trying to have kind of a brain-friendly lifestyle is not necessarily going to stop the progression of dementia per se, but it will help you help you perform at your very best.”

You’ve worked with Prestige Senior Living for several years now; if a memory care community becomes the best option for some with cognitive decline, what makes Prestige’s Expressions wellness program so effective?

DT: “It’s a very rich program with physical, spiritual and emotional wellness, and even good food and friendship and company. I think it’s a very contemporary program…One thing I like about Expressions is that they keep it fresh and new. My mother had Alzheimer’s and she lived in memory care for three years in Sacramento. And she would sometimes say, ‘Things are kind of boring around here’. She would be looking for novelty, looking for innovation. And the fact that Prestige brings out new campaigns and music and new ideas and new games and new strategies, I think it’s very refreshing for people living with dementia.”

You and your research partner Virginia Bell pioneered The Best Friends Approach™, can you tell us about that?

DT: “Our books first came out about 25 years ago and we said, even though Alzheimer’s is a terrible thing, there’s a lot you can do to travel the journey and kind of be successful. And so The Best Friends Approach™ states that what a person with dementia really needs is a best friend; empathy, communication, affection, doing things together, forgiveness and understanding. And so this model of care, which sounds so simple, I think really struck a chord and is now in use all over the world…I’ve been really honored that the friends and colleagues at Prestige have been such early innovators in knowing the power of relationships and relationship-centered care and empowered activities. So I’ve been delighted to share my own expertise and journey with them as they’ve developed their program.”

As you look at how Alzheimer’s and dementia are treated now, what does the future look like?

DT: “I think we’re going to have better ways to screen people where you can diagnose Alzheimer’s much earlier because something like 60% of people with dementia are diagnosed very late in the game. It can’t be understated that our vision of these medicines that are under development is that we think they will work best if you start them earlier. So I think there’ll be a lot more around biomarkers, around genetic testing, about more sensitive kinds of behavioral and neuropsychological tests. I think we’re going to have greater ways that maybe instead of being pinged by your doctor’s healthcare system to do a cognitive test when you’re 65, and maybe when you’re 50 or 45, then that’s actually a good thing.

And I know it’s scary, the idea that you could probably have early, early, Alzheimer’s, but it will actually be a good thing for medical intervention. And the research pipeline certainly looks very robust, along with lots of different things in terms of caregiving models. I don’t know that I anticipate that we’re going to have that many changes about quality of life and what we know gives quality of life… I do think technology will play a much bigger role in terms of activities, engagement, home safety and wandering prevention; for all we know someone who’s 65 and they try to log into their iPhone too many times and get the wrong password, maybe that will trigger a neurological assessment or something.

So I would say technology might help people with dementia live in community longer. This whole idea of dementia-friendly communities making our broader community safe and sound for people with dementia is a huge trend right now.”