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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 43 of skeletal muscles is an early symptom. In addition, LBD can involve a decline in motor/spatial skills, hallucinations, and delusions. Memory loss can occur, but this tends to happen in late-stage disease, which is different from the typical Alzheimer's disease pattern. LBD, like Alzheimer's disease, is progressive and ultimately fatal. TREATMENT Alzheimer's disease and other dementing diseases are difficult to treat, and no single approach works well for the majority of people who are affected by them. Treatment must be customized to the individual, of course. Some patients find that drugs that increase the availability of acetylcholine in the brain—called cholinesterase inhibitors—seem to slow the progression of these diseases. These drugs are not appropriate for vascular dementia, however, which is treated with antiplatelet drugs and other strategies to improve vascular health. Nonsteroidal anti-inflammatory drugs, not including aspirin and acetaminophen, may help to limit the inflammation associated with plaque formation. Some PATHOLOGY PERSPECTIVES people with dementia experience great agitation and paranoia; they could benefit from tranquilizers or antipsychotic drugs. Depression is almost an inevitable part of any progressive degenerative disorder. It tends to be especially severe with LBD. Addressing this problem may make other interventions more successful. IMPLICATIONS FOR MASSAGE Massage therapy has some benefits for people with dementia, but this has to be offered with some very specific cautions. Many practitioners working with elders who have frail health find that doing massage in a seated position at the person's home or care facility may be more practical than trying to do full-body table massage. It is also important to remember that diseases and conditions don't happen just one at a time. An older person with Alzheimer's disease or other dementing diseases may have any number of other age-related conditions that require some adjustments. These could include a history of stroke, diabetes, or osteoporosis—each of these requires special accommodations for massage, and that's just the short list. Another important thing to remember when we are working with someone who has limited means of communication is that we need to be watchful and sensitive about nonverbal signals. Our client may begin Resources Alzheimer's Association. "10 Early Signs and Symptoms of Alzheimer's." Accessed March 2017. www.alz.org/10-signs-symptoms-alzheimers-dementia.asp. National Institute on Aging. "Lewy Body Dementia: Information for Patients, Families, and Professionals." Last updated July 29, 2016. Accessed March 2017. www.nia.nih.gov/alzheimers/publication/lewy-body-dementia/basics-lewy-body-dementia. WebMD. Alagiakrishnan, K. "Vascular Dementia." Accessed March 2017. http://emedicine.medscape.com/article/292105-overview. WebMD. Crystal, H. "Dementia with Lewy Bodies." Accessed March 2017. http://emedicine.medscape.com/article/1135041-overview. World Health Organization. "Dementia Fact Sheet." Accessed March 2017. www.who.int/mediacentre/factsheets/fs362/en/. the session feeling safe and secure, but we don't know what triggers might lead to a change in that status. It is our responsibility to make sure our work is perceived as safe and welcomed every minute. Massage is unlikely to rebuild someone's lost memories or to restore lost function, but it may help with mood, pain, and anxiety. If we can add just a little improvement to the life of someone who lives with these conditions, then we are having a positive impact not just on the client, but also on their loved ones and caregivers. There's only a limited amount of research on massage therapy for patients with dementia, but what has been done suggests that those who receive massage are less combative, less restless, and better oriented after their sessions. This alone makes massage therapy look like a helpful intervention for this population. Progressive, degenerative, dementing diseases are not pleasant to think about. Often, when we think about massage in this context, it's as a comfort measure, not as a strategy toward getting better. But let's not minimize the value of comfort measures. Offering temporary well- being through healthy, welcomed touch is a noble calling, and we can be proud to be a part of that tradition. Ruth Werner, BCTMB, is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2016), now in its sixth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com.