Editor's note: The below are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional. Yoga teachers should remain within their : This means not attempting to diagnose, treat, or offer medical advice to students.
In the United States alone, approximately 5.7 million people ages 65 and older are living with dementia. There is currently no cure for this condition, and most treatments revolve around symptom management. However, for those living with dementia, incorporating yoga as a complementary therapy may help: It has the potential to improve quality of life and even cognitive abilities by preserving them.
But before we explore how yoga can help and get to the practice, let’s take a closer look at the condition itself.
Dementia is a broad classification for a cognitive disorder with myriad symptoms that can vary drastically from person to person. The most common symptoms, however, include: memory loss, difficulty communicating thoughts, impaired visual and spatial abilities, impaired motor function, and difficulty reasoning.
It is important to note that dementia not only affects cognition but also psychological well-being. It can cause depression, anxiety, agitation, and paranoia, and decline in overall function. Dementia is progressive and irreversible.
Some causes of dementia are frontotemporal disorders such as Parkinsonism (a range of neurological conditions that create movement problems), Alzheimer’s disease, and vascular dementia-related obstruction of blood flow and oxygenation. The most common cause of dementia is Alzheimer's disease, the second is widely considered to be vascular dementia.
And it’s important to note that although dementia is incredibly common among people ages 65 and older, it is not a typical part of aging.
Medical professionals and scientists once believed that the brain was fixed and finite—that localization (the idea that there are specialized parts of the brain responsible for specific functions) was absolute, and that once the brain reached maturity, it was only downhill from there. However, while changes in cognition can come with aging—we may process information more slowly, have difficulty switching tasks, and our ability to evaluate and make judgments can weaken—it’s now understood that aging does not inherently result in memory loss and changes in cognition. Localization is not absolute—though areas of the brain are specialized—and we can compensate for damaged areas through training and attention. In short, our brains are more adaptable, flexible, and integrated than we previously imagined and we do have an impact on how our brain ages.
In fact, according to recent research reported at the 2019 Alzheimer's Association International Conference, adopting a variety of lifestyle choices—such as refraining from alcohol use and smoking, eating a balanced diet, exercising regularly, and choosing cognitively stimulating activities—may decrease the risk of cognitive decline and dementia by up to 60 percent. Pretty encouraging, right?
In a single-blind controlled study of the effects of yoga on elderly populations, researchers found that the group who practiced yoga “showed significant improvement in immediate and delayed recall of verbal and visual memory, attention and working memory, verbal fluency, executive function, and processing speed." The participants practiced together daily for one month, then three times per week for three months, and then on their own for six months (participants were encouraged to practice daily).
This study is one of only a few designed to test the efficacy of yoga in eldercare settings; however, there is a robust body of research on how breathing practices and meditation can benefit both brain and nervous system function. And from my own experience as a yoga therapist, I’ve noticed that yoga can provide a significant global improvement in mood, cognition, and memory for people living with dementia. For example, when I work with clients who have Alzheimer's disease I like to learn their favorite songs. I sing these songs back to them when they are upset or having problems focusing. Inevitably, they begin to sing along with me. It completely changes their mood and ability to be present. Singing, like the yogic breath in which the exhale is twice as long as the inhale, encourages a prolonged exhale, thus stimulating the body's relaxation response.
Furthermore, yoga teaches us to be in the present moment, and when living with memory loss associated with dementia, life is all about the moment.
Here are other potential benefits of practicing yoga with dementia:
• Increased circulation, respiration, and range of motion, helping to prevent falls and prolong mobility.
• Improved body awareness: increased interoception (awareness of signals happening within the body), proprioception (awareness of the body in space), and kinesthesia (movement awareness).
• Improved function of attention networks that help us stay alert and vigilant, prioritize sensory input, and exert executive control or (the ability to handle conflict and carry out goal-directed behavior).
• Greater ability to deal with pain.
• Increased focus on one's strengths and remaining abilities.
• Enhanced sense of well-being.
• Improved self-regulation and emotional regulation.
• Reduced reactivity of the amygdala, which correlates with reduced stress response.
• Improved hemispheric communication across the corpus callosum (a band of nerves connecting the right and left sides of the brain, allowing information to pass between them), which correlates with improved brain function.
• Increased telomerase, the rejuvenating enzyme that slows cell aging.
• The ability to reverse the effects of chronic stress.
Try this class format if you are working—whether as a yoga teacher or yoga therapist—with people 65 or older who have cognitive impairment. The following practices are only suggestions, so work within the context of your experience and comfort level. In my own experience with this population, I’ve found that these practices may ameliorate some of the worst symptoms of the disease, such as sudden and intense emotional outbursts, increased agitation as the sun goes down, and obsessive-compulsive behaviors. I’ve also included suggestions for both those still living independently in the early stages of the disease and those receiving 24-hour care.
First, some teaching tips to consider:
1. Learn what your students are still able to do and tap into their strengths.
2. Choose music that invites joy and sparks memories (if possible, find out what they liked to listen to in their youth).
3. Smile, speak clearly and slowly, make eye contact.
4. Always call your students by their names, and remember to introduce yourself (sometimes again and again).
5. Use sensory stimulation and sense meditation. Guide their attention and awareness to all five senses through imagery or through the use of sense objects such as sounds, scents, tastes, and visual and tactile objects.
6. Create a safe environment. Some participants may be uncomfortable closing their eyes—encourage them to gaze down the tip of their nose instead. And be conscious not to touch them if their eyes are closed or without their consent.
7. Focus on helping each person reach their highest functional level. Consider what stage of dementia they are in, meet them where they are, and offer opportunities for success. For example, if they cannot perform nadi shodhana (alternate nostril breathing) perhaps they can perform chandra bhedana (left nostril breathing). Be flexible and offer your students plenty of options.
Purpose: To increase or maintain flexibility, muscle strength, and balance.
Benefits: Can help with fall and injury prevention.
Tips: Increase body awareness by bringing your student’s attention to anchor points, such as the palms of their hands, their belly, their heart. However, if this is difficult for them, you can guide their attention to a sound or an image instead.
1.Centering options: To open class, offer a suggestion that they close their eyes or look down the tip of their nose. Set a feel-good intention, or invite them to offer their practice to someone they love.
2. Mobility exercises: Offer joint warm-ups and movements of the spine in all directions. Focus on simple movements that coordinate with the breath.
3. Twist options: Encourage gentle twists like looking over the shoulder. These practices can increase vagal tone, which in turn strengthens the parasympathetic response.
4. Balance options: Offer simple balance postures in which clients lift one foot while holding on to a wall or a chair. Start with something achievable and build from there.
5. Encourage cross-lateral movement to stimulate communication between both hemispheres of the brain: Invite your students to tap the opposite shoulders with opposite hands, hit a balloon with alternating hands, or do the hokey pokey: To make this dance cross-lateral, when cueing movement (i.e., “Put your right leg [or foot] in”), guide your students to take their right arm or leg across their body. Make these practices playful and fun.
6. Close with forward folds: End your classes with gentle forward folds to downregulate the nervous system, such as paschimottanasana (seated forward fold). Adapt to the person’s ability; if they are in a wheelchair, for instance, they can rest their arms on a table; if they are at risk for falls, also seat them at a table to fold forward.
Purpose: To activate the parasympathetic response.
Benefits: Can improve sleep and mood regulation by balancing the nervous system.
Tips: I've found that postures are easier to adapt to all levels than breathing practices, which can be confusing. For this reason, it’s important to consider stages of dementia for pranayama practice.
Late Stage: Encourage a sigh. Sighing activates the phrenic nerve, which helps to relax the body and has lasting effects related to diminishing hyperarousal. Mirror this and invite them to follow you.
Purpose: To quiet and focus the mind.
Benefits: Can promote peacefulness, focus, and mental clarity.
Tips: The more you know about your student’s life and interests, the more effective your guided meditations can be. Discover all you can about them and incorporate your findings into your classes.
A possible practice:
Invite your student to find a relaxed, comfortable position. They can be lying down or sitting upright in a chair with their feet on the floor. Begin with a simple body scan or breath awareness practice. Guided imagery works well for this population as you can help them recreate memories of their favorite places.
I often recall doing this kind of guided practice with a former yoga student of mine—a brilliant man named Tom who was at the end-stage of Alzheimer’s disease. Tom was in a long-term care facility and was dearly loved by all the staff. He was in the process of dying and was in a great deal of pain. Every day around the same time, he would become increasingly confused and cry out for help. His family told us that he’d been an avid sailor, so I would sit with him and talk about the sea, guiding him to close his eyes and recall the sound of the waves, images of sailboats, seagulls, and warm ocean breezes. I created a yoga nidra practice that was simple enough for him to follow, and it wouldn’t take long before he would be resting peacefully. The power of imagery, body sensing, and a soft, loving presence was a gift to share.
Purpose: To get the students in touch with their inner teacher.
Benefits: Can be calming and—when chanting with others—build a sense of community.
Tips: Consider participants’ cultural backgrounds and life experiences when choosing a mantra.
Practice: mantra repetition
Early to Mid-Stage: Kirtan kriya as taught by the Alzheimer’s Research and Prevention Foundation.
Late Stage: Repeat aloud, for the student to hear, the mantra so hum (I am) or a single affirmation like “I am love.”
Purpose: To help students access states of joy or bliss.
Benefits: Can encourage the balancing of the nervous system, which can respond peacefully to life’s challenges and cultivate positive emotions.
Tips: Consider the environment you’re teaching in. For instance, if you’re in an eldercare setting, know that they tend to be noisy and you may have little control over the noise level. In addition, hearing aids may accentuate background noise. Encourage your students to turn their awareness inward or to focus on one sound. Props, such as weighted blankets, can help your students settle their bodies and quell any anxiety they may feel. And dimming or turning down the lights can also aid in relaxation.
Practice: Modified yoga nidra
Use a steady voice and speak slowly to ensure that your students can understand you. Even if they don’t, the gentle tone of your voice can support the relaxation process.
It is vitally important to find methods of care that optimize quality of life and provide meaningful experiences for those living with dementia. Yoga can facilitate this by offering moments of joy, success, consistency, relief, and rest. It can minimize stress, providing a safe environment that emphasizes trust and comfort, and opportunities for play. Most importantly, yoga can help everyone discover their innermost self, the part of us that is unchanging. On that note, I’ll close with one of my favorite quotes from the documentary Memory Bridge:
“People who suffer from dementia are still here, still reachable, at a depth of memory and presence beyond the ravages of Alzheimer’s disease and dementia. We are learning to listen and listening to learn. They are still able to love and to be loved.”