ALZHEIMERS

|Resume | Daily CommentaryContact Us | Site Search  | Home Page | 

Alzheimers is the Death of the Mind Before the Death of the Body

STAGES OF ALZHEIMERS: (Caregiver's Guide) For the elderly over age 85, about 47% suffer from Alzheimers and is the commonest reason for someone to be admitted to a nursing home. The disease does not discriminate between races, but it appears to affect more women than men simply for the reason that they tend to live longer. There are three stages to Alzheimer's.
In the first stage, lasting two to four years, there are subtle changes- lack of "spark", lack of energy and a zest for life, lack of humor, decreased interest in family life, friends sports and other favorite pastimes. The personality change may become a caricature of the previous personality- the extrovert becomes a bombastic showoff; the introvert becomes reclusive. The first stage shows a loss of short term memory though past memories may remain unaffected. Toward the end of this stage, the person may not be able to hold a job, carry out most daily tasks or organize time and dates.
The middle stage may last several years and is characterized by extreme confusion and difficulty in coping with new situation since long term memory fails and is gradually erased from the mind. The patient will still recognize familiar faces and perhaps latch on to one or two in a last grasp to retain some sanity. Many functions must be given up- driving most obviously. The patients may babble since they lose track of not only other conversations, but their own. Wandering and getting lost are frequent. Sundowning, a phenomenon associated with extreme restlessness, agitation and wandering may become a daily occurrence at about four in the afternoon.
In the last stage, perhaps lasting only one or two years, the deterioration is virtually complete. The victim cannot remember faces- even his/her own. The overall nervous system regulating bodily functions is damaged so greatly that incontinence, difficulty in coordinating body movements and sometimes seizures results. The patient becomes emaciated to the point of a vegetative state.
Caregivers might be able to handle part of stage two, but beyond that one person will become both physically and mentally exhausted (see below).
(Insight) Here are nine issues to consider with an Alzheimer's patient and caregiver

1. Arguments are useless and in fact, make matters worse. Confusion memory loss and frustration are making the person behave irrationally and you can't "argue" them out of it.

2. Actions help when verbal communication may fail. Help the person by demonstrating what you mean or sometimes by starting him or her in the activity

3. Assume that people with Alzheimers may understand and hear what you say even if they are confused. Do not say things to others in front of them as if they were deaf

4. Appreciate good moments or good days, even though the person's ability is not going to remain that way.

5. Appropriate activities help people with Alzheimer's pass the time meaningfully and productively and reduce agitation, boredom , daytime sleeping and depression

6. Agitation can be alleviated when the caregiver remains calm, reassuring and respectful of the person's feelings

7. Adults with disabilities are still adults. Mental level is not always equal to social level.

8. Adapt the task to fit the ability of the patient. Break down the activity into separate steps or simplify the tasks by eliminating parts that could be frustrating

9. Assessment is ongoing. What is safe and effective for now may not be so at a later time. Keep watching and re-evaluating

ALZHEIMERS CAREGIVERS: It's not just the person that has Alzheimers that has all the health problems. Caregivers are under greater and greater stress in trying to take care of loved ones that need greater and greater care. Current estimates indicate that 4 million people have Alzheimers and 3 million of these are cared for at home. The Daily review article noted that "the hardship for caregivers is well documented in medical literature. "Alzheimers has two victims" said Doug McConnell, resource adviser for the San Francisco Bay Association of the Alzheimers Association. "The Alzheimer's patient can't change the course of his disease, but the caregivers must learn to take care of themselves". Several studies document that poorer health of caregivers. Caregivers had poorer immune systems and reported more days of infectious illness, consisting of upper respiratory tract infections. At the end of a 13 month study, 32% of the caregivers suffered from depression compared to only 6% of a control noncaregiver group. One professor noted that the stresses are a result of the demands of daily care, such as supervising a patient, restraining him or her from harmful actions, performing bodily maintenance tasks such as bathing, eating, dressing, etc. and instrumental tasks such as paying bills. Secondary stress may result from the result of family conflicts, economic hardships, restriction on social ties and leisure activities- feeling locked in an unwanted role. "Placement in a facility can be more than ridding yourself of a burdensome relative. It should often be looked upon as a rational, reasonable decision and it shouldn't represent failure or produce guilt". That said, it only reinforces the use of a good long term care policy.

ALZHEIMERS COST: This disease cost the U.S. $82 billion in 1993. Only heart disease and cancer cost more. Alzheimer's costs between $33,000 to $35,000 a year in 1991 and the total cost between diagnosis and death is estimated by two articles to be $174,000 to $213,000. It effects about 4 million according to the Alzheimer's Association. It is estimated that 47% of people who reach age 85 have the disease as do 18.7% of those between 75 and 84 and 3% for those age 65 to 74. By 2040, it is estimated that 14 million Americans will have Alzheimers. Half the current nursing home beds are occupied by those with the disease.

ALZHEIMER'S TEST: (1995) It was a small study covering only 58 people, but it had a 95% accuracy in testing for Alzheimer's. A drug called tropicamde is dropped in the eye. Those with Alzheimer's suffer a hypersensitivity and their pupils dilated markedly when tested. It won't be available for regular testing for perhaps two years.

ALZHEIMER'S: (1995) The disease affects about 4 million in the U.S. The number of victims is expected to increase to 14 million by 2050.

It is the fourth leading cause of death after heart disease, cancer and stroke.

One in 10 over age 65 and more than 25% over 80 have Alzheimers. Apparently it is also increasing for those as young as 40 or 50.

Care costs an estimated $80 to $100 billion annually. Annual cost is $174,000 per person

More than 70% are cared for in the home. Professional care costs about $12,500 per year- nearly all of it paid out by victims and the families because insurance normally doesn't cover for long term care. Basic long term nursing home care is at least $36,000 per year in California- and going up.

ALZHEIMER'S: 3/96 Very bad news. A new study indicated that Alzheimer's may solely be hereditary and may start at a very early age- as young as 20. 93 nuns, born before 1917, were studied. They made for a good control group since they all lived the same way, ate the same food, came from the same background, etc. The issue is that each was required to provide a detailed biography when they entered the order. Those who had grammatically complex sentences at age 20 were those that essentially escaped the ravages of Alzheimer's regardless of education. Those who had relatively simply sentences were demented six decades later. There was 90% accuracy. If proven accurate, it is similar to having blood tests to determine the predisposition to getting breast cancer, diabetes, etc. But this is worse since anyone with a reasonable education could simply look at a young persons's schoolwork, compare it against a control group and potentially show the predisposition to ending up like a vegetable at age 70 or so. That is NOT a pleasant thought to carry for your lifetime.

ESTROGEN: (12/96) On the plus side of the ledger is the fact that some doctors have had very good success in delaying the onset of Alzheimer's- or helped those that had it- by giving them doses of estrogen. The continued study of Alzheimer's seems to be providing insight into treatments of the disease.

DEMENTIA: (Journal of American Medical Association 1997) About 3 million in the U.S. are diagnosed with dementia but an additional 1.8 million more have not been diagnosed since family members don't recognize the symptoms or don't want to see a doctor.

But getting treatment early- while not eliminating the problem, can lessen the severity.

Another study by the National Institute of Aging said that risk of developing Alzheimers could be reduced by up to 60% by taking Ibuprofen frequently (statistics unknown as to what is the best dose). The risk was about 35% less for patients that had taken the drug for less than two years but increased to about 60% for those who had taken the drugs for longer than two years. They were not sure aspirin would do the same thing since it was not included in the study.

PROBLEM BEHAVIORS: (CRC 1997) It's sometimes the little things that make a difference in caring for someone with Alzheimers. For example, instead of saying would you like to sit over here and have a snack, just use "come here", "sit down" and "here's a snack". Using just one command or question at a time might make the task easier to comprehend to someone having difficulty in comprehension.

ALZHEIMERS: Nearly 35 million Americans are over the age of 65 and one in 10 of them has Alzheimer's disease. Patients are at greater risk for injuries due to lacerations, sprains, hypothermia and burns, and illnesses like pneumonia, urinary tract infections, and intestinal obstructions. Furthermore, these illnesses can run throughout the duration of the disease that could span three to twenty years. One article noted that Medicare is failing these people and, effectively, letting them get worse before care is provided. That is because it will "not pay for the low cost preventive and health maintenance services that keep people with the disease healthy, safe and out of hospitals and nursing homes." "Instead, Medicare pays after a health crisis forces a person with Alzheimer's disease into the hospital, the most expensive care in the system. People with Alzheimer's disease stay in the hospital twice as long as other geriatric patients, with costs as much as 75% higher."

I FORGET WHAT I WAS DOIN....: (1997) I have done this before regarding people who tend to forget things when they get older and are concerned about senile dementia. It's O.K to forget where your keys are, forget appointments, a name, etc. But those with dementia, including Alzheimer's, forget more things more often-and not remember them later.

For example, forgetting where you put your keys may be somewhat troublesome. But those with dementia forget what the keys are for.

You make part of a meal and forget to serve it. But an Alzheimers person might not even remember that they made the meal at all.

People with Alzheimer's disease may forget simple words or substitute inappropriate words, making his or her sentence incomprehensible.

They may be totally disoriented not knowing where they are nor how to get back to where they live. By the same token, they can forget the names and faces of loved ones.

Their judgement may become impaired. They may become combative and cause physical harm. They may exhibit rapid mood swings-from calm to tears to anger-for no apparent reason. Their personalities may change- but not the subtle changes associated with age. They may become extremely confused, suspicious, fearful.

And while all of use get tired or listless as times, the Alzheimers patients may become very passive and need cues and prompting to get involved. You will see further commentary in the future from the book, "When You Loved One Has Alzheimers" by David Carroll.

MORE ALZHEIMERS: (1997) A new technique called validation says that the best way to help some Alzheimers patients who may asking for someone long since dead is to simply say- "Oh, you miss your father (mother, sister, husband, etc.)" INSTEAD of saying that so and so is dead. The attempt is to put yourself in their current existence- as strange as it may seem- in an attempt to relieve the anxiety they may be feeling. Some say that their difficulties may be from unresolved conflicts that may go back as far as their childhood. Professional caregivers say it does work , at least in the limited study so far. But it may be difficult for a family member caring for a loved one at home because they are unaware of many new techniques or are so close to the situation that they can't make it work

ESTROGEN: (1997) A significant study noted that women that take extra Estrogen can reduce their risk of Alzheimers by up to 50%. This study is on the heels of others that noted the benefits of Vitamin E and Ibuprofen. In a short study, 12 elderly Alzheimers patients were given estrogen and within two months increased their memory three fold and doubled their concentration. Alzheimers kills about 100,000 people annually.

ALZHEIMERS: (1997) The Alzheimers Association suggests a checkup through these warning signs.

Memory Loss that Affects Job Skills- Occasionally forgetting something is O.K., but if you forget things more often and won't remember them later, there could be a problem

Difficulty Performing Familiar Tasks- Busy people can forget things- such as leaving food on the stove. But those with dementia might forget that they even cooked a meal.

Problems with Language- We all have problems finding the right words now and then, but those with Alzheimers might forget simple words or substitute inappropriate ones and make the sentence incomprehensible.

Disorientation of Time and Place- We all can forget the time of day or where we are going for just a minute. But those with dementia can forget all orientation with time and place.

Poor or Decreased Judgement- they noted that you might temporarily forget the child you are watching. However dementia victims might entirely forget the child. They may also dress inappropriately wearing several shirts or dresses.

Misplacing Things- We all can't find our keys at times. But not knowing you have a car is the real problem. They might also put the keys in the freezer, a wristwatch in the flour bowl.

Problems with Abstract Thinking- We might have problems balancing a checkbook, but those with Alzheimers might not even know what the numbers represent and also forget how to add and subtract.

Changes in Mood or Behavior- Those with Alzheimers can exhibit rapid mood swings for no apparent reason. They can get agitated, even violent.

Changes in Personality- we all adjust our personalities as we age, but those with Alzheimers can change drastically, becoming extremely confused, suspicious, fearful.

Loss of Initiative- We all tire of some tasks but normally rebound later. However, those with dementia may require prodding to become involved.

ALZHEIMERS: (Brookdale Center on Aging 1997) Alzheimers disease is a form of dementia, a global neurological impairment characterized by slowly progressive and irreversible deterioration of the cognitive functions- speech, abstract through, emotion, memory- and hence the ability to take care of oneself, to identify time and place, to relate socially to others, to think and speak and act in a clear and reasonable way.

If you are 65 years of age, you have a 10% probability of developing Alzheimers with the next year. At 75, the odds go to 40%. In your 80's, the odds increase to 50%.

The initial danger signs include

An inability to perform familiar tasks

Trouble organizing and sequencing familiar information; knowing where something goes, how it goes and why it goes there

Changes in habitual behavior patterns

Gradual memory loss

Sudden, dramatic lack of social inhibition

Diminution of reason and problem-solving abilities and an inability to adapt to simple change.

Increased suspiciousness and paranoia

Inability to control anger, rage and frustrations

Frequent catastrophic outbursts

Sudden and dramatic changes in the emotional persona.

And I'll repeat this every few months. Simply getting old and forgetting where you put the keys is NOT a sign of dementia or Alzheimers. It's when you forget what the keys are FOR is the real problem. Also don't confuse "simple" depression. One study stated that up to 20% of the elderly over age 65 suffer some degree of depression.

Much material in the next couple issues will be from When Your Loved One Has Alzheimers- A Caregivers Guide, David Carroll based on methods by the Brookdale Center on Aging.

ALZHEIMERS PHYSICIANS: (1998) Dr. David Kammet suggests you seek the following credentials/background when yo need someone to treat an Alzheimers patient.

They need academic affiliations, either board certified or on the staff of hospitals where they are obliged to be involved in teaching. Someone in contact with recent medical literature. Someone who knows the latest breaking developments in the field. Avoid doctors who are overly optimistic and promise the world; and avoid doctors who throw up their hands and tell you there's no hope, that it's all "fait accompli".

"And after the preliminary diagnosis is made, a good doctor should concentrate on the caregivers (emphasis mine). The doctor should see that their needs are met, both emotional and physical. The biggest thing here is encouragement. Letting the caregiver know that she is doing a good job. Also, caregivers need to vent. They need to get out their misplaced feelings and their guilts. Alzheimers patients lose their inhibitions and say the most terrible things to caregivers. Insults, nasty accusations, terrible stabs and slurs. This can make family members who are giving their all very depressed. The caregiver must consequently be reminded that the patient is sick and that it is Alzheimers that is speaking so antagonistically, not the person".

I included that excellent quote because caregivers have a terrible time keeping their own self worth, whether it be a patient for Alzheimers or other debilitating disease. If this isn't relevant to you directly, recognize your parents, friends, neighbors and other loved ones ARE impacted by this as you read this. Try to help them. If you are involved with an Alzheimers patient, try to find this book

ALZHEIMERS: (The Economic Burden of Alzheimer's Disease Care) (1998) "Informal care costs are almost three times the cost of formal care for persons with Alzheimer's disease in the community. Although these costs represent an imputed value rather than a dollar expenditure, if unpaid caregivers were not available, caregiving services would probably be purchased from paid providers, or else demented persons now cared for in the community would be placed in institutions. The changing nature of family composition and the increasing labor force participation of women will result in fewer available caregivers for elderly persons in the future. Therefore, more of these imputed costs may become actual expenditures."

ANGER: (Brookings 1998) Certain things are apt to set off a demented person

Difficulties in getting clothes on or off

Inability to comprehend what is being said.

Difficulty in manual dexterity- having problem dialing a phone, turning a faucet

Unable to perform previously routine functions- tying ones shoes, baking a cake,

Disturbing TV programs

A realization that something important has been forgotten

Confusion with a new environment, new people

Having to think of several things at once

An unexpected break in a regular day routine, for example, having to go to a doctor's appointment

Discovered incontinence

Being surrounded by angry or irritable people

Brookings suggests that when a patient gets unmanageable:

Distract the violent person. Perhaps bring an unexpected object into their view. Turn on the TV. Play a record. Go for a drive or walk.

Try physical tenderness. A hug, pat on the back or other tenderness might help. Rocking them gently in a rocking chair is said to work well.

If you cannot touch them (many don't like to be touched), try talking in a soothing tone. Your voice itself may calm them. Certainly don't yell- it will only the make the patient more excitable.

If nothing else seems to work, then do like some parents do with children- ignore them.

If the violent person is apt to cause injury to themselves or others, restrain them as necessary. Leave them alone until the episode ends. Be sure to talk with your doctor first since the restraints themselves could cause injury.

As a last resort, you may have to call for medical help. Brookings suggest that you do not call the police. Paramedics are much better trained to cope with such a patient than the police.

DELUSION: Brookings states that it is a waste of time to try and disagree with a delusional person. But they also state that one should never agree with a delusion either. Seems like a dichotomy but they suggest that you stand your ground and neither affirm nor deny what is being said and done. Instead, as noted elsewhere, try to distract them with something different and get their attention elsewhere. They suggest food is an excellent distraction

IF YOU ARGUE WITH AN ALZHEIMERS PATIENT, YOU GET EXACTLY WHAT YOU DESERVE

Anna Ortegara RN, MS

MEMORY LOSS: (1998) As identified previously, if you can't remember where your keys are when you get older, that's not necessarily a sign of anything. But not remembering what the keys are for is a problem.

Recent commentary indicates that stress can have a major impact on memory. Also it shows that genes probably play a part in memory retention- though that should be obvious since intelligence, looks and other factors are handed down from generation to generation. Some research shows that certain nontropic drugs may help memory retention- estrogen, vitamin E, B12, etc.

Regardless of our background, there are some things you can do to maintain intellectual power. People who are always intellectually challenged tend to retain more memory- and just about everything else. To me that is simply reading. In addition, it has been shown that physical exercise does wonders. People with high blood pressure in midlife were almost 2.5 times more likely to have poor cognitive function in old age. The Johns Hopkins Clinic noted that "putting people on a treadmill can improve mental abilities 20% to 30%.

ADULTS WHO KEEP READING, LEARNING AND INTERACTING WITH OTHERS ARE FAR LESS LIKELY TO LOSE THEIR MEMORY OR DECLINE INTO SENILITY THAT THOSE WHO RETREAT INTO THEMSELVES AS THEY AGE.

IT SEEMS THE MIND IS LIKE A MUSCLE THAT CAN BE BEST KEPT IN SHAPE THROUGH REGULAR EXERCISE.

ALZHEIMERS: I had the opportunity to attend a seminar by Anna Ortegara, RN, MS who works extensively with Alzheimers patients. Absolutely insightful. She noted the following- DON'T ARGUE WITH AN ALZHEIMERS PATIENT- It is a lose, lose proposition. They may have no recognition of the issue at all and are simply getting more agitated by the "conversation". Also- WHOSE PROBLEM IS IT? If a patient dresses themselves in layers of clothing, mismatched, etc. and it is not causing discomfort of any type- WHO CARES! Give them credit for dressing themselves in the first place. To make them go through the frustration, time, anxiety, agitation of changing simple to benefit YOU is not warranted.

Bathing such a patient is most difficult. In the middle or late stages of Alzheimers, they may have forgotten what water is and the reason for the bath itself and may become very afraid by the splashing, noise, etc. and become overwhelmed and confused. One way to conquer the is problem is to "take them to where they feel safe". If they have always talked comfortably about previous experiences of their mother, farm, vacation and so forth, get them into that same realm before the bath.

ALWAYS TALK TO THE PATIENT

If they feel safe then, maybe it will carry over to the bath (or other needed activity). But if there is too much agitation, DON"T BOTHER. Whatever it is can wait till another day when there is less trouble. This is the part where Anna stated that

CAREGIVERS MUST FOCUS ON THE PERSON, NOT THE TASK

To accomplish the task without recognizing the detrimental affects on the patient is illogical and self serving.

Roughly 3% of people between 65 and 74 get Alzheimers; 19% between 75 and 84 and 47.2% over the age of 85.

It is insidious in that the patient dies a little bit every day- that's why loved ones must say a little good bye every day. Do whatever you can to avoid the onset of this disease- reading and intense study have been shown to help. Yes, you will still end up getting the disease if you were predisposed to do so, but maybe you can forestall it and it might not happen till age 85 rather than 80. And if you are lucky, you'll be dead by then.

And more- simplify- SIMPLIFY- SIMPLIFY. For example, when preparing dinner for a patient, don't put the food in separate dishes and let them choose. It confuses them. Make up the full meal and put it in front of them.

Turn off all stimuli when doing something with a patient- including TV, radio, music and so on. Many patients cannot differentiate between background and foreground noise and they will get more agitated and confused. Also, play only PG13 TV. While they may not understand the violence per se, the extra action and noise can be confusing again.

I must add that music can soothe patients and can be used as a means to potentially calm a patient. But, again, make it simple. Don't play free form jazz- use structured music with standard beat. Again, you want to simplify wherever and whenever possible.

How insidious can this disease be? She spoke about one fellow who got Alzheimers but was blind. He forgot he was blind and kept getting up and falling down. And when looking into the mirror, they didn't know it was them. 40% of "us" who have mild changes in our function late in life end up getting Alzheimers.

Lastly, about 40% of patients in the past were retrained. Now it's far less at about 9% to 15%.

ALZHEIMERS: (1998) (Eldercare Journal) "Natural Wonders"- One of the goals for care givers is to provide a rewarding experience for anyone with Alzheimers or senile dementia. They may wish to consider a topic called "natural landscape". It is simply trying to get the demented person to focus on something in the landscape in front of them. But it is not necessary that they get the subject right. Caregivers can allow the patient to see what he or she sees regardless of their accuracy. For example the caregiver may draw attention to cloud. But if the patient mistakenly focuses on the street lamp, a tree your something else, the caregiver may follow them to this item remembering that what is important is their appreciation of an object- whatever it is- and not necessarily the accuracy or correctness in identifying what it is that the caregiver wanted to point out.

ADAPTING THE HOME FOR ALZHEIMER'S PATIENTS: 1998 (Chrisa DeNoia RNC) "The goal of a caregiver should be facilitating a low stimulus environment. It is not the time to move furniture around, paint the walls dramatic colors or re-decorate. Instead, restructure the room that the Alzheimers patient spends most of their time in to minimize unnecessary environmental stimuli. These particular rooms should not be a place where a phone rings and door bells are heard loudly and the television is played all at the same time. Such excess simulation may precipitate an anxious or agitated episode.

Mirrors may also confuse the Alzheimers patient. The patient is often perplexed by seeing their own reflection. You may wish to cover or remove all mirrors. In addition, bright, glaring lighting is also a potential source of agitation.

ALZHEIMERS: (1998) A new study by the Southwestern Vermont Medical Center memory clinic utilizes a eight minute word and picture test that supposedly is 90 % accurate in identifying patients with early Alzheimers. The exam uses four separate recall and thinking quizzes. Recognize that the problem with Alzheimers patients is the inability with short-term memory and the test asks for recall of objects the patient is shown. Further tests are being conducted now.

ADAPTING THE HOME FOR ALZHEIMER'S PATIENTS: 1998 (Chrisa DeNoia RNC) "The goal of a caregiver should be facilitating a low stimulus environment. It is not the time to move furniture around, paint the walls dramatic colors or re-decorate. Instead, restructure the room that the Alzheimers patient spends most of their time in to minimize unnecessary environmental stimuli. These particular rooms should not be a place where a phone rings and door bells are heard loudly and the television is played all at the same time. Such excess simulation may precipitate an anxious or agitated episode.

Mirrors may also confuse the Alzheimers patient. The patient is often perplexed by seeing their own reflection. You may wish to cover or remove all mirrors. In addition, bright, glaring lighting is also a potential source of agitation.

ALZHEIMERS: 1998 A new study by the Southwestern Vermont Medical Center memory clinic utilizes a eight minute word and picture test that supposedly is 90 % accurate in identifying patients with early Alzheimers. The exam uses four separate recall and thinking quizzes. Recognize that the problem with Alzheimers patients is the inability with short-term memory and the test asks for recall of objects the patient is shown. Further tests are being conducted now.

ALZHEIMERS: (1998) Dementia doubles about every five years with about 5% affected at age 65 to about 35% at age 85. 60% to 70% of senile dementia is Alzheimers. People who go to school longer have less risk to Alzheimers. This "increased cultural reserve" simply forestalls the disease to a later age- perhaps by five years- at which point you may simply be dead. In the Netherlands, 22% of those diagnosed with Alzheimers elect assisted suicide. The two worst ways to die are AIDS and Alzheimers

ALZHEIMERS: (1998) The New Scientist magazine noted that children of older men may have an increased chance of developing Alzheimer's disease. It is suspected that DNA damage that builds up with age can be passed on from older fathers to their children which could raise their chances of developing the progressive degenerative brain disorder. Wonder what Clint Eastwood was thinking. Then again, I don't think he was thinking.

ALZHEIMERS: (1999) (Infobeat) "Alzheimer's, the "silent epidemic" that afflicts primarily elderly people, is causing increasing concern and spurring scientists to find the cause and a cure. There are now an estimated 18 million victims - some 5% of the world's elderly population - suffering from the progressive, degenerative disorder of the brain that affects memory, emotion and thought processes. Experts forecast that by 2020, Alzheimer's, which reduces victims to near vegetables before it takes their lives, will affect 30 million  people, with some 75% in developing countries in Asia and Latin America"

ALZHEIMERS IS THE DEATH OF THE MIND BEFORE THE DEATH OF THE BODY

ALZHEIMERS: (1999) A recent study in Rochester, Minnesota, the age specific rates of Alzheimers per 100,000 residents were: 60- 69 years of age- 51.3; 70- 79- 457.9; 80 and above, 1685.7. Late stage Alzheimers accounts for 85% of all cases.

ALZHEIMERS: (1999) Alzheimers is the 3rd most expensive disease after heart disease and cancer. Lifetime expenditures per patients is $174,000. About 10% of the elderly over 65 and about 50% over the age of 85 have Alzheimers. About 70% are cared for at home. 20% live alone. Half of all nursing home residents suffer from Alzheimers.

MORE ALZHEIMERS: (1999) One of the more offered comments about trying to ease the anxiety of the demented person is to provide all sorts of items, pictures, video tapes of friends and family. But an Alzheimer's expert indicated that that may be the worst thing to do. If the patient is frustrated at remembering, providing them with yet another "something" that they can't figure out can be very upsetting. You can try offering mementos- but if they don't work- lose them!

ALZHEIMERS SERVICES: In one metropolitan area, 65% covered were low income, 55% minorities, 70% female and 90% over the age of 65.

ALZHEIMERS: (1999) Anna Ortigara, RN, MS, Director, Residential Care Services, Rush Alzheimers Disease Center, Chicago was one of the featured speakers at an Alzheimers meeting. Truly enlightening- any Alzheimer organization anywhere in the U.S. would do its membership proud to have her speak on the subject of caring for an Alzheimer's patient. She had a couple pertinent comments that I will pass along.

TRY ANYTHING ONCE AT LEAST ONCE. IF IT DOESN'T WORK, LOSE IT!

And no matter what you do, even if you think you are being very patient-

GO SLOWER!!!!

TELL PATIENTS THAT THEY ARE DOING WELL BECAUSE THEY DO NOT KNOW IF THEY ARE DOING ANYTHING WELL.

ALZHEIMERS CARE: (1999) (National Alliance for Caregiving) They interviewed 1,509 caregivers and found that  22% were caring for a person who had Alzheimer's disease or mental confusion. They are twice as likely as other caregivers to be providing intense day to day care.

The survey data show that Alzheimer caregivers suffer higher levels of physical strain and emotional stress. Huge pressures are placed on their other family and work responsibilities. It is not just the amount of time they spend but the type of care they provide that makes their caregiving so intense. Alzheimer caregivers are: Twice as likely as other caregivers to be providing more than 40 hours of care each week. Nearly three-fourths have been providing  care for at least a year and almost 40 percent have been doing it for more than five years. They provide more help with activities of daily living and are more likely to be dealing with incontinence and with medication problems.

Three-fourths of Alzheimer caregivers are women, and one in three has children or grandchildren under the age of 18 living at home.

Seven in 10 are employed for at least some of the time they are caregivers. They miss time from work, cut back to part-time, turn down promotions, transfer to a less demanding job, choose early retirement or just have to quit work.

The 77.9 million Americans born in the baby boom years make up 29.3 percent of the nation. This aging of the population means an Alzheimer epidemic as an estimated 14 million Americans will have Alzheimer's disease by the middle of the next century, up from 4 million today.

Alzheimer caregivers are not wealthy people -- almost one in five has household income below $15,000 and only 11 percent have income of $75,000 or more, the report says, yet nonspouse caregivers who are living with and providing financial support for a person with Alzheimer's spend an average of $261 a month of their own money for prescription drugs, clothing and other daily needs.

ALZHEIMERS: (1999) An estimated 4 million people have the disease affecting about 10% of those between 65 and 85 and 40% of those over 85. Individual caregivers spend an AVERAGE of 69- 100 hours per week caring for the victims. Care givers are 46% more likely than non caregivers to visit doctors for their own health problems and are 71% more likely to use prescription drugs. More than 50% of caregivers are at risk for clinical depression.

The disease costs a minimum of $100 billion a year and about $26 billion directly to businesses thought lost employee productivity and absenteeism in trying to care for care for parents. About 2.3 million caregivers lose sleep, energy, work time and productivity due to caregiver stress.

Experts state that in 50 years, 1 in every 45 Americans will suffer from Alzheimers.

MEMORY STUDY: (1999) The National Institute on Aging is trying to get the word to people over age 55 that if they're getting abnormally forgetful, they should see a doctor. Scientists have just discovered that a memory problem called ''mild cognitive impairment'' can be an early warning sign of Alzheimer's - and they're beginning three huge studies to see if certain drugs could prevent those patients from ever getting Alzheimer's. Leon Thal, chairman of neurosciences at the University of California, San Diego, and Ronald Petersen, a Mayo Clinic neurologist, compared 76 MCI patients with 234 healthy subjects and 106 with mild Alzheimer's. The MCI patients progressed to Alzheimer's at a rate of 12% a year, compared with 1% or 2% of the healthy volunteers.

ROCKING CHAIRS AND ALZHEIMERS: (1999) While some of you "younger" readers may not have a direct interest in this, I suggest you read it closely since you may be required to take care of an invalid parent or other loved one in the near future and any insight to helping them- and therefore yourself- can be invaluable beyond money. A recent study by Kirkhaven nursing home showed that rocking chairs bring peace of mind to the elderly with dementia. "The son of one Alzheimers's patient felt rocking eased his mother's agitation. The study also found that rocking could even lessen the need for pain medication. It was speculated that prolonged rocking might cause the brain to release pain-relieving endorphins."

ALZHEIMERS AND EXERCISE: (1999) Recent studies by the American Academy of Neurology and the University of Cleveland indicate that people who exercise regularly during their lifetime may be at a lower risk of Alzheimers. "The findings agree with previous studies suggesting that staying active physically, mentally and socially helps protect against the disease."

And to repeat from the book: "How We Die". The two worst ways to die are from AIDS and Alzheimers. How you live today IS a direct factor on how you die later on.

ALZHEIMERS and CAREGIVING: (1999) The average lifetime with Alzheimers is 8 to 10 years. 75% of the caregivers are women. The emotional strain is enormous. Per the National Institute of Health, when someone falls ill, about 75% of the primary caregivers are females relatives. And while they are called upon to provide care for a dying person, when they die, they must significantly rely more on paid help (probably because fewer close relatives may still be alive- obviously including their husbands). About 15% who die from cancer have unmet needs versus about 23% that die from other causes.

The President of the National Family Caregivers Association said, "this is a wakeup call for doctors to address the needs of caregivers."

ALZHEIMERS DEATH: (2000) How do people with Alzheimers die? (SF Alzheimers Association) The most common cause is an opportunistic infection. Pneumonia and septicemia are the most common. The other major causes are eating and swallowing. Typically, the person gradually stops eating. This is normal as the body functions start to shut down.

In that regard, you might ask yourself, "What end of life choices might I face?" Decisions usually regard whether or not to resuscitate, administer antibiotic treatments for infections or use feeding tubes, respirators and/or trachea.

Alzheimers True Story: (2000)Bill had been in a nursing facility for about four weeks. May 18, at 3 am, he removed the stick that kept the window shut, removed the screen and went out the window fully dressed. He fell from the fourth floor to the roof of the first floor, fracturing nine ribs and his pelvic  bones. He said he was going to get money to pay the bills. He died yesterday of his injuries. He will be missed. Alzheimer's is a very bad thing.

Alzheimer's Disease (Risk Tutor 2000) is a progressive, neurological disorder that attacks the brain and results in cognitive problems, such as memory loss, impaired thinking and strange behavior.

Overview of Alzheimer's Disease:

Approximately 4 million Americans have Alzheimer's disease. One in 10 persons over 65, and nearly half of those over 85 have Alzheimer's disease. A person with Alzheimer's disease lives an average of 8 years and as many as 20 years or more from the onset of symptoms.

Alzheimer's disease is the 4th leading cause of death in the United States. More than 7 out of 10 people with Alzheimer's disease live at home. Half of all nursing home patients suffer from Alzheimer's disease or a related disorder.

Alzheimers:   (2000) The Mini-Mental State Examination (MMSE) is a widely used diagnostic tool for dementia. Its use as a predictive indicator of probable Alzheimer disease (AD) has not been established. In this study, the authors conclude that the MMSE is useful in predicting emergent AD in patients with positive test results. However, it is not recommended for use as a screening or diagnostic instrument since a negative test result did not rule out emergent AD. It is recommended as a tool to identify those needing closer monitoring.

Alzheimers (2000)

Mild Stage

Moderate Stage

Severe Stage

Alzheimers: (2000) Scientists say they have identified a long-sought enzyme suspected of playing a key role in Alzheimer's disease. In Alzheimer's disease, the brain develops deposits that are thought to kill brain cells. These deposits are created when a long, string-like protein is cut in two specific places. Scientists have long theorized the existence of a chemical scissors that makes one of these cuts. They called it gamma secretase, but they had never actually identified it.

Mental Elderly: (2000) "Elderly adults with psychiatric disorders are less likely to be diagnosed as having a mental disorder or to receive needed mental health treatment than younger adults. Investigators report in the Journal of the American Medical Association the results of a study of elderly persons conducted in public housing developments. Managers, social workers, janitors, groundskeepers, and other employees were trained to watch for mental disorders. Investigators concluded that such low-cost, moderate interventions were more effective than usual care in reducing psychiatric symptoms in the elderly.

So, what are the implications from long term care policies that include only senile dementia?

Alzheimers: (New England Journal of Medicine 2000) The brains of persons afflicted with Alzheimer's disease have to work harder, evidence of which researchers say can be detected by scanning. Although in recent years, researchers have pinpointed metabolic brain deficiencies and other early markers that may foretell Alzheimer's, this study, is the first time that researchers have identified brain differences in at-risk people while they perform assigned mental tasks.

Estrogen: Some might remember the suggestion that taking estrogen could hold off some of the impact of Alzheimers. A British study recently stated that a woman's ability to think may be less likely to decline in old age if they have a relatively high concentration of estrogen in their blood.

Numbers 2000: According to the Alzheimer's Association and the National Institute on Aging, about 4 million Americans suffer from Alzheimer's. It typically afflicts people over 60, but in rare cases people in their 40s and 50s can develop the disease. According to a large survey of retired people, about 3% of those aged 65 to 74 have Alzheimer's. The figure rises to 19% for those aged 75 to 84, and to 47% for those 85 and older. Since the elderly population is growing rapidly, some estimates say that, unless a cure or prevention is found, there will be 14 million sufferers in the U.S. alone by the middle of the next century.

Alzheimer's: 70% of Alzheimer's victims live at hone with care form family and friends. The average annual cost of paid care for such people is $12,500.

Alzheimer's: Medicare spent an average of $7,682 in 1995 on beneficiaries with alzheimers- 70% MORE than the average of $4,524 spent on those without cognitive impairments. This should also make clear why the cost of a nursing home for such a patients is far more expensive- particularly as the disease progresses. For example, these people cannot feed themselves- they may have already forgotten what a fork is. Therefore an attendant must feed them three times a day, every day for the rest of their lives. That is expensive.

Dementia: (2000) 66% of all persons with dementia live in developing countries.

Alzheimers: (LIAF 2000)  In 1996, Alzheimer's disease cost the nation more than $82 billion, making it the third most expensive U.S. health care problem. Four million Americans suffer from an Alzheimer's-type dementia and it is the fourth leading cause of death among adults in the U.S. By the year 2050, an estimated 14 million individuals will be affected by the disease, along with an estimated 14 to 28 million involved as caregivers. Alzheimer's disease can last as long as 2 to 20 years for some patients, with an average time period of 8 years.

Respite for the primary caregiver is very important during the middle stages of the disease. The need for round-the-clock caregiving increases -- and so do the stresses. Caregivers are at risk for health problems of their own. In many cases, financial concerns add to their burden. Home care may be an option, but may place a strain on the financial situation.

“Living With Alzheimer’s,” a trio of educational video programs. The program, a finalist for a “Telly” Award, provides caregivers and health professionals with a thorough and supportive look at coping with Alzheimer’s disease. $39.95, Long Island Alzheimers Association.

Alzheimers Treatment (2000) Snoezelen is part treatment, part philosophy and part interior design. The aim of snoezelen is to create a relaxed, "fun", non-threatening space that provides sensory stimulation. The concept of Snoezelen (pronounced "snooze-lin") was originally developed in the Netherlands in the 1970's for children with learning disabilities.

Alzheimers (2001) It affects about 4 million Americans. The average lifetime is 8 years but can go as long as 20 years. 10% of America over 65 will get Alzheimers.

Alzheimer's Disease Breakthrough Leads to Hope for a Cure: (2001) Scientists have developed a way to rid the brain of the deposits that are thought to cause Alzheimer's disease. They hope that successful  tests on mice could eventually lead to a treatment for the incurable degenerative condition. A team from Massachusetts General Hospital, used antibodies to destroy the deposits - known as amyloid plaques - that had been created in the brains of laboratory mice. The researchers say it is much too early to determine whether the treatment would work in humans.

Alzheimer's Disease Caused by Proteins Associated with Aging, Not Plaques: (2001) The irreversible brain disorder Alzheimer's Disease may be caused by inflammatory processes associated with aging and not -- as generally believed -- by plaque-like deposits in the brain. Researchers say that the blame for Alzheimer's is on a molecule called amyloid beta, but traces the basic cause of the disease to the formation of toxic proteins rather than the build-up of plaque and tangles inside nerve cells in the brain.

Scientists Develop 10-Minute Test for Alzheimer's Disease:       Scientists have developed a test which can detect the early stages of Alzheimer's disease in just ten minutes. The test can distinguish Alzheimer's sufferers from patients with depression and people without any neuropsychiatric disorder with 98% accuracy. Professor Trevor Robbins and Dr Barbara Sahakian developed the test, called the CANTAB Paired Associates Learning Test, at Addenbrooke's Hospital in Cambridge.

Memory Loss( American Academy of Neurology 2001.) People diagnosed with persistent short-term memory loss have an increased risk of developing Alzheimer's disease and should be aggressively monitored by their physicians. Between 10 percent and 15 percent of people diagnosed with mild cognitive impairment, or persistent memory loss, develop Alzheimer's each year, according to the guidelines. Only two percent or less of people who do not have the condition develop Alzheimer's.

ALZHEIMERS: (2001)Japanese scientists have discovered a substance that offers the best hope yet of a cure for Alzheimer's disease

ALZHEIMERS: (2001) Progress Report on Alzheimer's Disease, 2000, spotlights recent research conducted and supported by the National Institute on Aging (NIA) and eight other Institutes at the National Institutes of Health

The Nun Study (2001) How one scientist and 678 sisters are helping unlock the secrets of Alzheimer's

Ten Warning Signs of Alzheimer’s (2001)

1. Recent memory loss that affects job skills

2. Difficulty performing familiar tasks

3. Problems with language

4. Disorientation of time and place

5. Poor or decreased judgment

6. Problems with abstract thinking

7. Misplacing things

8. Changes in mood or behavior

9. Changes in personality

10. Loss of initiative

Alzheimers: (2001) Although Alzheimer’s disease seems to run in families, in fact only a minority of cases have a clear genetic cause. But it is likely that genes play a role in many more cases, in combination with environmental factors, many of which remain unknown. The study of Alzheimer’s genes is key to understanding of this disease and may, ultimately, lead to better therapies. In an update feature, Dr. Robert Griffith discusses science’s current understanding of the genetics of Alzheimer’s disease. Mutations in four different genes have been linked to the condition—three to the early-onset form of the disease, affecting those younger than 60, and one to the later-onset form of the illness. All four influence the rate of deposition of an abnormal protein in the brain called beta-amyloid, which is widely acknowledged to be the hallmark of Alzheimer’s.Source: Novartis HealthandAge.com (26 Oct 2001)

Helping Children Understand Alzheimer's

Communication with Persons Who Have Dementia, Christina T. Lesher, LSW, Elder Law Quarterly Winter 2001 issue by Wright & Associates

Communicating with persons who have dementia is a challenge for social workers and caregivers. By implementing simple techniques social workers can help improve the quality of life for caregivers and their loved ones. (2002)

Remind families to:

Don't yell. If the person has difficulty hearing, eliminate background noise and speak close to the person in a soothing voice.

Pay attention to non-verbal signs and body language. They may indicate pain or an emotion the person is trying to communicate.

Remember a person who has dementia is not a child, even though they may exhibit child-like behaviors. Remind families that their loved one is a person with a rich history.

Give the person time to respond.

Try not to ask open-ended questions. Ask questions that may be answered "yes" or "no", or a choice between two items.

Use a familiar phrase. For example, my grandfather responds well to the phrase, "up in Boston", where he spent most of his life.

Use touch to communicate. Families may find that their loved one has a favorite texture or piece of fabric that is comforting to them.

Be creative and try to communicate by using different techniques.

Begin conversations by making eye contact. Introduce yourself and give the person time to respond.

Take a break from the family member if communicating with them becomes too frustrating for the caregiver.

Assessment and Management of Alzheimer's Disease, Martha Sparks, PhD, RN, GCNS (2002)

Alzheimer's Disease in 2050 The number of people with Alzheimer's disease will at least double by 2050, even if there are major treatment breakthroughs, say researchers at the University of North Carolina. The incidence of Alzheimer's disease increases with age, being 14 times more common in the over 85 age group, compared to those aged 65 to 69. Given that the number of people over 85 is set to rise sharply as the population ages, there is bound to be a corresponding increase in the number with Alzheimer's disease. Using data on Parkinson's disease and heart failure, the researchers looked at how the development of new treatments impacted upon the patterns of disease. If there were no new Alzheimer's treatments, then there would be a four-fold increase in the number of cases by 2050. But it seems likely that research will produce genuine medical benefits in the area of Alzheimer's disease. In this case, onset of the condition will be delayed, and more of the cases will be of the mild, rather than severe, type. An optimistic estimate is that there will be a doubling of people with Alzheimer's over the next 50 years.

MRI May Detect Alzheimer's Disease, Decades Before Symptoms Appear MRI scans of the brain may detect Alzheimer's disease decades before the first clinical signs of dementia occur, researchers from the University of South Florida and the University of Kentucky report in the May 28, 2002, issue of the journal Neurology. Researchers found from magnetic resonance imaging tests that shrinkage of the hippocampus, a region of the brain showing some of the first signs of Alzheimer's disease, occurs very early in the disease process - long before the illness spreads to the cerebral cortex and results in cognitive and memory impairment. The research subjects are part of the "Nun Study" that began at the University of Kentucky in 1992. Headed by Dr. David Snowdon, who is also a co-author of the current paper, the team has been studying 678 Catholic nuns who began participating in the study when they were 75 to 102 years old. The nuns undergo annual mental and physical exams and donate their brains to research at death.

Dealing with Difficult Alzheimers Behavior

Alzheimer's Cost to Business Doubles Alzheimer's disease will cost corporate America $61 billion - almost twice as much as thought in 1998, according to a new study from the Alzheimer's Association. The report, "Alzheimer's Disease: The Cost to U.S. Businesses in 2002," says the disease will cost corporate America $36.5 billion this year for workers who take time off to care for Alzheimer's patients. That figure includes loss of productivity ($18 billion), absenteeism ($10 billion) and hiring temporary workers ($2 billion), among other costs. Healthcare business costs and research will require an additional $24.6 billion.

Activities For People With Dementia

Alzheimer's Disease Cases May Triple by 2050- Presenting the results of the latest research at the 8th International Conference on Alzheimer's Disease and Related Disorders, researchers calculate that by 2050 as many as 16 million Americans may be afflicted with Alzheimer's disease, three times as many as currently have the illness. Estimates from 10 years ago predicted 14 million Americans would have Alzheimer's disease in 2050.

Underwriting (tests used by clinicians) to evaluate dementia (i.e. Alzheimer's disease) (2002)

Training Improves Cognitive Abilities of Older Adults National Institute on Aging (2003)

Cognitive Training (Alice Dembner 2003) Mental decline may, in some cases, be reversible. Mental exercises can improve performance on memory, reasoning and understanding complex topics. A five week program involving computer and pencil and paper training was equivalent of reversing the typical decline over 7 to 14 years. . \Scientists suggest that anyone wanting to stay sharp can stretch the brain suing puzzles, classes in new subjects., etc.The brain does lose cells as people get older, but it also can grow new ones and add new connections.  Good nutrition also help as do multivitamins. Researchers say that about 40% of those 65 and older have some memory impairment due to age.  Two years after the initial training, 73% tested better on speed, 55% on reasoning and 40% on memory.

Emergency Room Hospital Ready Bag by the Long Island Alzheimers Association

List of all medications including over the counter meds and vitamins

All diagnoses

All physicians phone numbers

Recent hospitalizations or surgery with dates

Insurance information with copies of health insurance cards

Phone numbers of family or friends to contact to alert to ER visits and/or for assistance

copies of health care proxy and Living Will

Snacks and drinks for loved one

Adult briefs, if needed

Item of comfort or item to occupy your loved one (family photographs, magazines)

Sweater, jacket or lap blanket in case ER is chilly

The LIAF also has a free Safety Program Packet. "The packet contains a Safety Program Universal Symbol for your refrigerator door and a set of forms to be filled out with pertinent medical info on the patient and the caregiver. Should you, as the caregiver, become incapacitated, trained police and and other emergency personnel will recognize the symbol and contact the necessary individuals as designated by the forms. LIAF is a New York organization that may be contacted at 866 789-5423."

Human Gene Affects Memory (2003)

Alzheimers: (2003) Men are diagnosed about 6 months earlier than women. Women often spend 1.5 years with evidence of the disease before being diagnosed. The women were simply more observant of their husbands and got them to the doctor earlier. The men were late in acting upon their observations.

Alzheimers and Traveling: (2003) Great info by the Long Island Alzheimer's Association. Their newsletter is highly recommended 

Alzheimers: (Elder Rage 2003) Alzheimer's is typically preceded by "Mild Cognitive Impairment" (MCI), which can last five to ten years. 90% will then progress to Stage One Alzheimer's, which lasts 2-4 years. Stage Two lasts 2-10 years (and requires full-time care), and Stage Three, the end, typically lasts 1-3 years.

"By the age of 65 one out of every ten persons has some form of dementia, and by the age of 85 one out of every two. Surprisingly, the fastest growing segment of our population is the 85+ group, and over 50 million Americans are struggling to provide care for aging family members and friends."

The Alzheimer's Association reports that by delaying the onset of AD for five years, we could save $50 billion in annual health care costs. Even a one-month delay in nursing home placement could save $1 billion a year.

"75% of dementia patients are being cared for at home, and sadly, elder abuse is rising dramatically because families are so unprepared for the frustrations of caring for their elders, who are living longer than ever.

Alzheimers: (2003) Two non-steroidal, anti-inflammatory drugs (NSAIDs) — rofecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, and naproxen, a non-selective NSAID, which researchers had hoped would help slow the rate of cognitive decline in people with mild to moderate Alzheimer's disease (AD) — have turned out to be a disappointment, a new clinical trial reveals. While the results do not eliminate the possibility of a very small beneficial effect, analysis indicates that it is highly unlikely that naproxen or rofecoxib treatment reduces the one-year rate of cognitive decline, even by as much as one-third.

Helping Children Understand Alzheimer's

BAD The number of Alzheimers will triple in the next decade. This will totally cripple Medicaid and Medicare. And caregivers.

Alzheimers: (2003) Even though 26% of Canadians have a family member who has been diagnosed with Alzheimer's disease and 20% have a friend or acquaintance who has been diagnosed, a recent poll indicates that 3% of respondents had never heard of the illness and 1 in 10 knew nothing about it. Another 15% said they knew a great deal.

Antibiotics May Temporarily Stave Off Alzheimer's Disease Symptoms By Maury M. Breecher, PhD, MPH

Use it or lose it: Participation in a variety of leisure activities during early and middle adult years appears to lower a risk of developing Alzheimer's disease.

In an analysis of 107 twin pairs, where one twin was diagnosed with some type of cognitive impairment while the other was cognitively intact, greater participation in leisure activities was found to reduce the risk of developing Alzheimer's disease and dementia.

When researchers compared data on men and women directly, they did not find significant differences. However, intellectual cultural activity was more protective for women than for men

Long Island Alzheimers Association: Subscribe to their newsletter.  

Wander Track for Alzheimers patients- WatchMate provides monitoring of a wanderer in the home. The system alerts the caregiver when the wanderer goes beyond a set range and provides tracking capability up to 1 mile so that the wanderer can be located and returned.

Leisure Exercise of Brain May Ward Off Alzheimer's (2003)

New Alzheimers drug: The Food and Drug Administration has approved Forest Laboratories' memantine and will sell it here under the brand name Namenda, for patients with moderate to severe Alzheimer's symptoms.

some patients given memantine have experienced improvements in memory and thinking skills. But for the vast majority the drug instead slows the pace of deterioration, letting patients maintain certain functions a little longer. For example, the drug helped some patients maintain the ability to go to the bathroom independently for six more months, a benefit caregivers called very important.

memantine is the first option for advanced stages of Alzheimer's. The nation's four other Alzheimer's medications -- Aricept, Exelon, Reminyl and Cognex -- work in early stages of the disease.

About 4 million Americans have Alzheimer's, and a million of them are believed to suffer severe symptoms.

Alzheimers and exercise: The Journal of the American Medical Association, looked at 153 Alzheimer's patients living in the Seattle area over several years. Some of the patients, whose symptoms of the disease varied in their severity, were randomly assigned to an exercise program that focused on strength, balance and flexibility training.

For about 30 minutes a day, the patients went for walks, stretched or used light hand weights for quick exercises that they could do at home. The people providing care, usually a spouse or son or daughter, were also taught a number of techniques to encourage and help with the exercise program and to make better responses to behavioral problems.

Compared with a control group that received "routine" care, the patients who exercised were in better physical shape and had lower rates of depression.

When they followed up two years later, the researchers discovered that the improvements had not dissipated; patients in the exercise group were still physically active, had more pleasant interactions with people caring for them and were less depressed.

At the very least, say some scientists, the new findings lend support to the notion that patients need as much physical and social stimulation as any other person.

Alzheimers: The Food and Drug Administration (FDA) today approved memantine (NAMENDA), for treatment of moderate to severe Alzheimer’s Disease. This is the first drug approved for the treatment of patients with this severity of disease. Previous treatments for Alzheimer’s Disease have been studied in less severely affected (mild to moderate) patients. Memantine’s mechanism of action is different from that of the drugs currently available for treating this disease.

Alzheimer’s Disease, which affects about 4.5 million Americans, is a degenerative condition affecting memory, judgment and the ability to reason. The new drug an -- N-methyl-D-asparate (NMDA) antagonist -- is thought to work by blocking the action of the chemical glutamate.

Although memantine helps treat the symptoms of Alzheimer’s Disease in some patients, there is no evidence that it modifies the underlying pathology of the disease.

First Study of Alzheimer's Caregivers and End-of-life Cites Both Remarkable Resilience, Need for Support National Institute on Aging

Dementia and the Hospital Stay by Elisa V. Enriquez, MSW Intern, Almost everyone who has ever had the experience of being a patient in a hospital knows that it can be frightening. Those who have never been in that position may have experienced this fear and anxiety vicariously, while visiting a friend or relative in the hospital. It is even scarier for persons with a dementia. Not being in your own room, not eating familiar foods, and not knowing the people taking care of you can be devastating when one is confused and disoriented. Confusion and disorientation affect how quickly and how well a patient recovers.

Someone with dementia may have difficulty understanding that an intravenous tube is there to supply food or pain medication. He or she will want to remove the "offending" tube. Another risk for hospitalized persons who have dementia is wandering, searching for home or something familiar. Other difficulties include being unable to communicate or having staff untrained in dementia care try to assist a resistive patient with bathing or medical procedures. Providing useful techniques for staff and family visitors can mitigate some of these problems. Some suggestions include:

 Have a caregiver advocate on behalf of the patient. If possible, a family member should remain with the patient at all times. This person can help distract and soothe the patient during medical procedures, alleviate distress  or a potential catastrophic reaction, and ease communication between the patient and staff.

 Use non-verbal techniques and simple language to communicate with the person. Gestures, facial expressions, pictures, and signs are all examples of non-verbal communication. These can be applied when cueing the patient to eat or bathe.

 Have a list of patient’s likes and dislikes. Favorite items the patient can hold may provide comfort and distraction. Knowing what the patient dislikes can help staff avoid negative reactions and minimize anxiety.

 Do not use physical restraints. Studies have shown that the use of restraints tends to increase injuries and causes distress for the patient. Staff and caregivers can use other methods to keep the patient safe such as distraction, soothing touch, music, or prayer.

 Be sure the patient is not over- or under-stimulated. Persons with dementia have more difficulty communicating when over-stimulated with television and multiple conversations. Conversely, insufficient stimulation may increase anxiety.

 Be aware of changes that may be occurring in the patient. Some patients won’t express pain or other feelings. Note any physical or mood changes, which may indicate a complication or new illness.

 Allow the patient to make as many decisions as he or she can. Guided choices provide some control and can limit distress. .

Alzheimers: (2004) According to survey results from phone interviews with 600 people over age 35, only 15 percent said that Alzheimer's was a serious disease they were concerned about. More than half said they were worried about cancer and heart disease. While 63 percent said they are making lifestyle changes to reduce risk of cancer and heart disease, only 13 percent said they altered their lifestyles to protect against Alzheimer's.

Alzheimer’s Disease: (2004) A study in the issue of the Annals of Internal Medicine found that individuals who are diagnosed with Alzheimer’s survive about half as long as those of similar age. Women tended to live longer than men, surviving about 6 years after diagnosis, compared to 4 years for men. The study is intended to help doctors better gauge the prognosis of a patient with  Alzheimer’s disease, and could help families make appropriate plans.

Diabetes linked to increased Alzheimer's risk Researchers calculated that diabetics faced a 65 percent increased risk of developing the mind-robbing disease.

There is a nice Q&A on Alzheimers at the site.

Helping Children Understand Alzheimer's, Michael Plontz  2004

Aricept and Alzheimers: (WSJ) Nearly 600 patients with mild to moderate Alzheimer's received long-term treatment with Aricept or a placebo.

The researchers found that Aricept led to small but significant improvements of patients' performance in standard tests of mental function over the first two years of treatment. But the drug therapy didn't affect the likelihood of patients being placed in nursing homes or becoming disabled at three years.

the results "are incompatible with many drug-company-sponsored observational studies and advertisements claiming remarkable effects for cholinesterase inhibitors." In particular, Dr. Schneider called "implausible" the claim that Aricept "stabilizes cognitive decline, or delays nursing-home placement by two to five years…"

Aricept has been the leading drug for patients and  am surprised to hear that it is not as effective as advertised.

Drug for Alzheimer's disease is of little benefit Debashis Singh (2004)

Androgen loss may lead to Alzheimer's: Like estrogen loss in older women, decreased levels of testosterone may put aging men at risk for Alzheimer's disease

Researchers Identify Brain Protein That Halts Progression of Alzheimer's, National Institute of Environmental Health Sciences

Researchers Find Protein That Makes Long-Term Memory Possible, National Institute of Child Health and Human Development

Early dementia: (Michael Plontz 2004

Early detection of Mild Cognitive Impairment is essential for both loved one and caregiver. A treatment program for any given condition or disease involves two potential avenues of approach: prevention of the disease and/or treatment of the disease. Obviously, prevention is the ideal since it eliminates the disease. Polio and smallpox vaccines are examples of this approach.

Unfortunately, no one has found a way to prevent the occurrence of MCI, which is believed to be a precursor to Alzheimer’s disease (AD). Any treatment to date only slows down the disease’s progression. Researchers believe that the beginning of the disease is the result of “dents and bruises” that cells experience in a lifetime. This sets off a waterfall of neurohormonal and neurophysiological processes that affect the complex architecture of the brain, eventually resulting in AD.

Your loved one’s doctor will do as much as he can for your loved one, but what can you, as a caregiver, do?

There are several advantages for a caregiver in the early diagnosis of MCI in a loved one. Most importantly, you and your loved one can actively plan their future whether it is financial, long-term care or end-of-life planning. You can improve your understanding of the changes that are—and will—take place in your loved one, and educate your family and friends. You can seek out community resources. You can improve your knowledge on safety issues and on preventative health. You can stay up-to-date on progress being made with possible treatment options. And you can increase your awareness of MCI in general, and of local and national research projects, including clinical trials.

Until a cure is found, planning ahead is essential. The first thing to do is gather important papers together, organize them, and put them in a safe place. Some of the papers that should be included are:

Bank accounts/safety deposit boxes (and account numbers)

Insurance information (health, long-term care, and life—and policy numbers)

Deeds and titles

Birth certificates

Social Security and Medicare numbers

An up-to-date will

Family attorney’s name and number

Military affiliations (including discharge papers)

At this early stage, your loved one can help plan for their long-term care also. Will they prefer an assisted living facility or a nursing home, for example. Legal issues should be discussed at this point as well. These usually take the form of advanced directives. The term, advanced directives is used to encompass all options that make your loved one’s wishes known. Telling a caregiver now gives them a voice in decisions that will affect both of you. Some of these include:

Durable Power of Attorney (POA)

Guardianship

Living Will

Trust

Representative payee ship

Although it is a difficult subject to talk about, your loved one’s end-of-life wishes should be discussed now. So many families never touch on this subject, and, then at the time of death, quick decisions must be made quickly through a veil of grief. Honor your loved one’s memory by finding out now what they want.

Learning more about your loved one’s condition is easier than ever thanks to a little invention called the Internet. Although it may be difficult to find many web sites on the specific condition MCI, there are numerous web sites on Alzheimer’s disease and all of its stages. When you learn about your loved one’s condition and then pass on that information to your family and friends you become an advocate for your loved one and his or her condition. Advocates can affect changes in the quality of care and even legislature, and it is one of the most important things you can do for both of you. Somewhere along the path of your education, you will find out all you can about the treatments presently used for your loved one’s condition. Because MCI is a relatively new concept, doctors use the medications and treatments that have been designated for AD. There is no cure yet, but the medications used now can slow the progression for up to almost two years. This can keep your loved one at home for longer and give you more quality time together.

AD, of which MCI is a part, is one of the most researched diseases in the world. There are numerous local and national research projects in progress, and most of these include clinical trials. You might consider a clinical trial for your loved one for several reasons:

Active participation in your loved one’s health care

Getting your loved one the finest medical care at leading facilities

Your loved one being the first to benefit from treatments not yet available to the public

Helping others

Of course you and your loved one must give informed consent. But think of all the good you could do—not only for yourselves, but for future generations. Once again, it’s about taking charge and advocating for your loved one’s care.

Alzheimer's and the Holidays:  (2004)  

The activity and festivities of the holiday season pose special challenges for families coping with Alzheimer's disease. The hurried pace can be trying at times for just about anyone, but for someone coping with Alzheimer's disease, the change in routine can be especially disruptive. That's why it's important to take steps at holiday time to minimize disruptions and simplify the celebration.

A few steps can help to assure that anyone with Alzheimer's, and those who care for and love them, can have a safe and joyous holiday season.

• Simplify. The change in routine of the holiday season can be disconcerting and upsetting. A tree with blinking lights and loud singing, music, or a football game on the TV can be disorienting for someone with memory loss and confusion. Rethink your holiday traditions, and simplify. Pick and choose those traditions that are most important to you. Simplify the decorations, and avoid flashy lights and raucous noise. For safety's sake, avoid candles and artificial fruits, which may be mistaken for the real thing.

• Engage the person with Alzheimer's — but keep things at their usual pace. Someone with Alzheimer's might enjoy simple holiday tasks, such as decorating cookies or putting ornaments on the tree. Or, singing holiday songs and reading a beloved scripture or story at home may be a meaningful alternative to visiting a place of worship. Do not, however, force the person with Alzheimer's to participate if they resist. Stick to the same daily routine and schedule as much as possible.

• If a loved one with Alzheimer's lives in a nursing home or assisted-living facility, test the waters by bringing him or her home for a short visit beforehand. For many with Alzheimer's, being removed from familiar surroundings can be disorienting and upsetting. Even being around family members a person doesn't see often can make someone with dementia anxious or fearful. If a home visit seems too stressful, arrange for visits by small groups to the nursing home to minimize confusion and upset.

• Apprise family members and relatives who are coming from out of town about the status of a parent, sibling, or loved one with Alzheimer's ahead of time. That way, everyone will be better prepared during family gatherings.

• Delegate. Let family members and friends help with the chores, like writing cards, baking, or shopping for gifts. Let others watch a loved one while you take in a show or other holiday event.

• Rethink the presents. Someone caring for a person with Alzheimer's might enjoy a gift certificate for a day spa or massage, or an offer to fill in and provide a few hours of caregiving respite. For someone with Alzheimer's, a photo album might be far more meaningful than, say, a new sweater. Other gift ideas: A family heirloom; a "Safe Return" bracelet, worn in case an Alzheimer's patient wanders off; or a donation to an appropriate organization.

Spinal Tap:  (2005) An experimental test to detect early signs of Alzheimer's disease is moving closer to clinical use.

The test measures the presence of phosphate, a chemical combination of phosphorus and oxygen, on a particular spot of a brain protein associated with Alzheimer's. This protein, called tau by Alzheimer's specialists, is found in tangles that appear in the brains of Alzheimer's patients. Currently, those telltale tangles can be found only by autopsy. But small amounts of the protein can be measured in spinal fluid, which this test uses.

Bridging The Language Barrier (Jude Roberts)

As a caregiver for a loved one with Alzheimer’s, the difficulties of getting their attention and having them understand you and the professional members of the caregiving team can be a very real challenge. Along with these issues, what if there was also a communication gap caused not only by the disease, but by a language barrier? What if your loved one speaks another language other than English? Because of this, an experience with a doctor or professional caregiver can be very scary and frustrating for a loved one. The Alzheimer’s Association recognized the ever-emerging need for a translation service available to family caregivers, their loved ones, and the professional members of the caregiving team.

Cathy Sewell, Director of Client Services at the Alzheimer’s Association’s Headquarters in Chicago, says the “language line” was a natural progression created from a market study done in 1999. Cathy says the translation service came about “because of the Alzheimer’s Association’s diversity initiative to be culturally competent, reaching out to the under-serviced throughout the country.” Since the inception of the national “24-7” Contact Center 2-1/2 years ago, and with 150 different languages spoken throughout the country aside from English, Cathy went about the daunting task of creating an even more extensive translation service for family and professional caregivers. One of the requirements of the Alzheimer’s Association was to find a language service with the ability to translate the word “dementia” with compassion, and that this word needn’t mean “crazy” in any language.

The Alzheimer’s Association chose NetworkOmni Multilingual Communication as their partner. NetworkOmni is a global language solutions company with headquarters in California. NetworkOmni immediately made a great impression on the Alzheimer’s Association. “They weren’t only easy to work with, but they took a true interest in learning all about Alzheimer’s disease, wanting to know how they could help us better serve caregivers and the Alzheimer’s Community,” says Cathy, “and their personnel took the time and effort to inform their interpretive staff of all our concerns regarding the need for a compassionate translation service, along with the need for extreme sensitivity when dealing with caregivers and their loved ones.” The service is free to family and professional caregivers, with the Alzheimer’s Association absorbing the entire cost.

The “language line” works quite simply by organizing a three-way, conference call between the family or professional caregiver, a care consultant from the Alzheimer’s Association, and an interpreter from NetworkOmni. A caregiver calls the Alzheimer’s Association’s national Contact Center, speaks with a care consultant and requests the translation service, stating the specific language that is needed. The care consultant then calls NetworkOmni, with the caregiver still on the line, making sure that everyone is connected to one another.

One story that illustrates the “language line” concerns Alex Karski and his 86 year-old, Polish-speaking mother who was diagnosed with Alzheimer’s disease just last year. For the past 20 years, she’s enjoyed the independence of living alone in Chicago, and still wants to maintain her routine. In order for her to remain independent for as long as possible, her son hired a Polish-speaking caregiver to aide his mother with the daily tasks of bathing, dressing, food preparation, and keeping up with medications. However, since the caregiver had no formal training in Alzheimer’s or dementia care, she found the man’s mother more and more difficult to work with, and she was unsure of how to handle the increasing demands that the disease was placing upon her. Alex noticed that the caregiver was becoming frustrated and short-tempered when dealing with his mother. He called the Alzheimer’s Association. Between the care consultant and the interpreter, they were able to educate the caregiver on the symptoms of Alzheimer’s disease, giving her several suggestions and communication tips. It was exactly what the caregiver needed, and since knowing that she has a place to turn to at all times, it has made all the difference in her ability to better care for and understand someone with Alzheimer’s disease.

Many caregivers do not realize that the “24-7” Contact Center exists. During normal, weekday working hours, when someone calls the Alzheimer’s Association, the system automatically transfers them directly to the closest, local chapter. After hours and on weekends, when the national 800 number is contacted, headquarters in Chicago answers the call on behalf of the local chapters. There’s always someone accessible for caregivers to speak with, and the “language line” is available to them at all times. With over 500 calls coming in on a daily basis, the “24-7” Contact Center is able to, as Cathy Sewell puts it, “empower caregivers to do what they need to do, like attend support groups, receive respite care, obtain important information regarding the disease, or receive a listening ear when they so desperately need one.”

Another service that has been a huge success and has had a great impact for the Alzheimer’s Association is the “Safe Return” program. Started 10 years ago, the “Safe Return” program is designed to help caregivers locate missing loved ones who have wondered off. “At least 60% of all people with Alzheimer’s will wander at some point,” says Cathy, “with wondering occurring even in the early stages of Alzheimer’s.” When someone has been identified as having Alzheimer’s, their caregivers can have them enrolled in the national “Safe Return” program, which builds a composite for law enforcement agencies and authorities, enabling them to gain valuable information when searching for a missing loved one. The program provides loved ones with an ID bracelet which states that the person is part of the Alzheimer’s Association’s “Safe Return” program. The bracelet provides a telephone number that can be contacted immediately. The program also distributes important information to local law enforcement agencies in the area where a loved one may be reported as missing, providing them with a photograph along with important medical and contact information.

The Alzheimer’s Association has so much to offer both family and professional caregivers, and yet Cathy Sewell is concerned that many do not realize what’s available to them every day, around the clock, and at no cost. “The Alzheimer’s Association has a dual mission ... care and research ... we care about both deeply.” says Cathy.

Alzheimers: What's the connection between diet and exercise and Alzheimer's?

Answer:  The single factor in diet that has gotten the most attention is a diet rich in disease-fighting antioxidants like vitamin E. There are studies indicating that these factors may have a mild protective affect, but the effects have not been terribly dramatic.

One of the most consistent beneficial things one can do is to have an active and stimulating life. Consistent mental and cognitive exercise like reading, doing crossword puzzles, learning a musical instrument or foreign language -- what some call the "use it or lose it" theory of keeping your brain healthy -- seems to be a good idea. Regular exercise also seems to be important. Studies indicate very active lifestyles into late life offer substantial protection against Alzheimer's.

What is Dementia? (LIAF.org 2005) Dementia refers to a decline in mental ability significant enough to cause impairment in social/interpersonal and/or occupational functioning. The decline, which is related to changes in the brain, is much greater than what would be expected from normal aging. Loss of memory is necessary for the diagnosis, as well as reductions in other areas of neurocognitive functioning.

Dementia has many possible causes or etiologies. The disease, which accounts for approximately half of all cases of dementia. However, it is important to distinguish Alzheimer's from other dementia processes, such as Vascular Dementia, Lewy Body Dementia, Fronto-temporal Dementia, to name a few.

Making a correct diagnosis is well beyond an intellectual pursuit and can be critical. For example, in the case of Lewy Body Dementia, which is second to Alzheimer's disease as a cause of dementia, the pattern resemble Alzheimer's disease in some ways (memory deficits and language impairments) and Parkinson's disease in other ways (rigidity and gait impairment). Individuals with Lewy Body Dementia have a greater sensitivity to certain medications, particularly those used to manage behavioral and psychiatric symptoms of dementia, and treatment with some of the common antipsychotic medications can have irreversible and even fatal consequences.

There is a developing body of evidence that the pattern of impairments among the different dementias is distinct enough that neuropsychological testing has become a fundamental part of the array of diagnostic devices. One of the unique contributions of the field of neuropsychology is its value in providing assessment, utilizing a vari-ety of standardized measures with known reliability and specificity, of cognitive deficits associated with cerebral damage.

What is a Neuropsychological Evaluation?

A neuropsychological evaluation is a battery of cognitive tests administered by a specially trained psychologist called a neuropsychologist. The tests are arguably more sensitive than the Mini Mental State Exam, which is simply a screening device. The evaluation typically takes between two to eight hours to complete, depending upon the referral question. All of the tests used are well-standardized. Therefore, an individual's performances are a sensitive indicator or diagnostic of the presence of cognitive deficits. The information obtained from this in-depth evaluation is translated into a report which details cognitive assets and deficits, helps to answer diagnostic questions and provides practical treatment recommendations for the patient, family care-givers,and/or health careproviders.

What is Assessed?

• Attention/Concentration

• Processing Speed

• Sensory-Perceptual Processes

• Expressive and Receptive Language

• Visual-Spatial Abilities

• Praxis (ability to carry out purposeful movement)

• Verbal and Non-Verbal Memory

• Gross and Fine Motor Functions

• Executive Functions (e.g., planning, reasoning, judgment, awareness)

• General Intelligence (IQ)

• Behavioral Functioning (e.g., impulsivity, disinhibition, frustration intolerance) or Changes in Personality

• Affect/Mood and Emotional Functioning (e.g. depression or anxiety)

When Should a Neuropsychological Evaluation Be Performed?

When an individual, family, or caregiver becomes aware of decline in mental status that impairs their ability to function and/or perform routine tasks independently at home. It is important to obtain an evaluation when the problems are first suspected, in order to clarify the diagnosis. However, a neuropsy-chological evaluation is usually undertaken only after medical causes have been sufficiently ruled out.

Why a Neuropsychhological Evaluation is Helpful.

• To confirm or clarify the presence of brain damage;

• To diagnostically disentangle Alzheimer's disease from other dementia processes;

• To facilitate care and rehabilitation by making useful and functional recommendations for rehabilitative therapies (e.g., cognitive remediation, occupational therapy, speech therapy) and to clarify what compensatory strategies would help;

• To identify the presence of mild disturbances in cases where other diagnostic studies (e.g., neuroimaging) have produced equivocal results;

• To clarify between true dementia and depression. Depression in elders can produce symptoms that mimic dementia, but are reversible;

• To provide an accurate and unbiased assessment of a person's cognitive capacities and limitations;

• To establish a baseline against which future progress or decline can be compared (e.g., to document changes in functioning since prior examination, including effects of treatment);

• To assist in disability determination or for legal purposes (e.g., to establish competency/ guardianship);

• To help determine when changes in the level of care should be made (e.g., if home health care, assisted living, or nursing home placement is warranted).

Worry, worry: (2005) Researchers at Rush University Medical Center in Chicago examined 1,064 older men and women, all of them mentally sharp at the start of the study. The sample included a mix of whites and African-Americans. All were given psychological surveys to see how prone they were to stress, anxiety, and worry.

Three to six years later, the investigators conducted memory tests to look for signs of Alzheimer's disease. They found that those people most prone to worry were 2.4 times more likely to develop Alzheimer's than those least likely to become anxious and distressed. The effects of stress were particularly strong for whites compared to African-Americans.

Exercise: A Boost to Physical and Emotional Well-Being in People with Alzheimer's, Mayo Foundation for Medical Education and Research

Vitamin E doesn't slow progression to Alzheimer's disease David Spurgeon

Alzheimers: (2005) The race to prevent Alzheimer's has taken on an urgency as the number of Americans with the disease is expected to soar in the coming decades. If current rates hold, up to 16 million people will develop Alzheimer's by the middle of the century, according to the Alzheimer's Association.

Their care could push Medicare spending for the disease from about $91 billion in 2005 to more than $1 trillion by 2050.

But then there is this: Amy Borenstein of the University of South Florida College of Public Health studied more than 1,800 people and found that those who drank fruit or vegetable juice three times or more a week were four times less likely to develop Alzheimer's late in life than people who rarely or never drank juice.

Borenstein and her colleagues believe the protective power of juice comes from polyphenols, powerful antioxidants found in the skin and peel of fruits and vegetables. Polyphenols are concentrated in juice that is made by crushing the whole fruit

exercise can boost the number of new brain-cell connections that provide a mental edge in midlife and might offer a hedge against Alzheimer's. And men and women who reported drinking one to three alcoholic drinks a week also did slightly better on such tests.

Alzheimers: Elevated levels of insulin, the hormone that regulates blood sugar and is vital for normal body function, may lead to inflammation and play a role in the onset of Alzheimer's. Excess insulin may also be associated with high levels of beta amyloid, the toxic protein that builds up in the brains of those with the disease. Scientists hope that better understanding of the role of insulin in the development of Alzheimer's may lead to new therapies to control or even prevent the mind-ravaging disease.

But they also said it was aluminum, purely hereditary and more. Reminds me in the 50's and 60's when they said they were about to find a cure for cancer. Then, they found out that there were MANY types of cancer. Same situation her, I believe.

Signs of Alzheimer's May Be Present 10 Years Before Diagnosis: (2005) Elevated levels of insulin, the hormone that regulates blood sugar and is vital for normal body function, may lead to inflammation and play a role in the onset of Alzheimer's, researchers report. Excess insulin may also be associated with high levels of beta amyloid, the toxic protein that builds up in the brains of those with the disease. Scientists hope that better understanding of the role of insulin in the development of Alzheimer's may lead to new therapies to control or even prevent the mind-ravaging disease.

Alzheimers: (2005) Men and women who lose weight unexpectedly in their golden years may be at increased risk of Alzheimer's disease. The weight loss may occur well before the forgetfulness, personality changes, and other troubling symptoms of Alzheimer's become apparent. Shedding pounds does not appear to be a cause of Alzheimer's; rather, in some instances, it may be a sign that changes contributing to an increased risk of the disease may be taking place.

Alzheimer's And Incontinence: A Puzzling Combination Daniel L. Paris, MSW (2006)

Just when you thought it couldn't get any worse, your loved one with Alzheimer's develops incontinence. What do you do now? The following letter and its answer may help with this puzzling combination.

Q) My mother has had Alzheimer's for probably 8 years. She has just begun having accidents in her bed and clothes. My father has briefs for her, but we are wondering about a simple way to get her to wear them. Perhaps you have some suggestions. Also if she wet them and changed clothes she might to put the briefs in the toilet. Should we put a diaper pail in the bathroom? Any ideas you have would be very helpful and much appreciated. Mother is 78, as is my father.

Elizabeth Smith-Boivin of Mills View Adult Home in New York and Gladys Bunker of the Alzheimer's Association of the Greater Palm Beach Area in Florida, provided the following answer:

A) If it is environmental incontinence, related to Alzheimer's Disease she simply may be forgetting how to find the bathroom in a timely way. In that case, you may want to keep the bathroom door open and the light on, so the toilet is visible. Treat the protective undergarments as part of normal dressing and don't make a big deal over it. The more you make an issue of it, the more it becomes a battle. Your mother may be unwilling to wear adult protective undergarments because she finds them uncomfortable. There are a number of products available, from simple, thin undergarment liners that enable a person to continue wearing their own underpants to the full, protective undergarments that feel like underpants. There are disposable as well as reusable and washable products on the market today. Find the most comfortable and reasonable product for your mother and your situation. Protective bed sheets are also available. To the degree it is possible, involve your mother in the decision of which product to use, showing her all the available options. This will contribute to her sense of independence, which is very important to an individual with Alzheimer's Disease.

Using a diaper pail in the bathroom is an excellent idea. But remember, it will be difficult for your mother to learn a new task. It would be a good idea for someone to assist her so they can remind her not to throw the undergarments in the toilet. You could also try securing a plastic garbage bag around the toilet bowl and dispose of it later.

Twin study shows that genetic factors influence the development and timing of Alzheimer’s disease  (2006) Alzheimer’s disease was associated with genetic factors in 58% to 79% of cases. The variation was explained by non-shared environmental influences. After adjusting for age, the researchers found no significant differences between men and women in prevalence or heritability of Alzheimer’s disease.

Alzheimers: Genes account for 58% to 79% of a person's risk of developing late-onset Alzheimer's. Although genes might play a bigger role than lifestyle choices in the development of the disease, experts say late-onset Alzheimer's is a complex disease probably caused by an array of factors. That means even people with a strong history of the disease might be able to reduce their risk or delay the onset of the disease so they develop it at age 85 and not at 70.

Alzheimers: (2006) About 25% of participants in a Mayo study who had an eighth grade education or less had mild cognitive impairments, while the disease only showed up in only 8.5% of participants with more than a college degree.

Alzheimer’s Disease: (Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association 2006) controlling cardiovascular risk factors, such as high blood pressure, overweight, high cholesterol, smoking, and diabetes are critical in maintaining brain health. Another finding is the key role of physical activity in maintaining brain health, in that elders who exercise are less likely to experience cognitive decline. The report also discusses the evidence indicating that learning new things and staying socially connected are associated with maintaining brain health as we age.

ALZHEIMER'S MOSTLY CAUSED BY GENES A landmark new study finding that Alzheimer's disease has a genetic cause in up to 80 percent of cases will affect prevention, treatment and further research for years to come.

Published in the February 2006 issue of Archives of General Psychiatry, the study examined 12,000 pairs of twins. The findings raise doubts about the widely held view that Alzheimer's has two forms, the "familial," with genetic roots, and the "sporadic," with environmental causes. Although past estimates of Alzheimer's risk varied widely, this study confirms the highest estimates of genetic predisposition, even among people previously thought to have the sporadic form of the disease.

Alzheimers: (2006) Advocates of Positron Emission Tomography scans for the diagnosis of Alzheimer's say the scans significantly aid in the early and accurate diagnosis of the memory-robbing disease. Neurologists say PET is useful in distinguishing between Alzheimer's and a similar-acting dementia.

Alzheimers is believed to affect about 5% of adults age 65 to 74, and nearly half of those age 85 and older,

Event                     Frequency

Home fire                       1 out of every 88 homes

Serious auto accident      1 out of every 70 autos

Death                             1 out of every 106 people

Disability                          1 out of every 8 people

:Detection of Alzheimer's (2007)

Dementia itself is not a disease, but rather a set of symptoms that accompany specific diseases. Dementia is a general term for the loss of memory, language and recognition that is severe enough to interfere with everyday life. Researchers believe dementia may be caused by a combination of genetic and environmental factors. Some diseases that cause dementia are irreversible and include Huntington’s disease, Pick’s disease, Parkinson’s disease, Lewy body dementia, multi-infarct dementia and Alzheimer’s disease (AD), the most common form of dementia, accounting for 60-70% of the diagnosed cases.

An estimated 4.5 million people in the United States have dementia. On average, patients with AD live from 8 to 10 years after they are diagnosed, although the disease can last up to 20 years. The disease usually begins after age 60 and the risk increases with age. Younger people may get AD; however, it is much less common. Ten percent (10%) of Americans age 65 and older have AD and it affects fifty percent (50%) of Americans age 85 and older. AD is one of the most feared mental disorders because of its progressive and relentless attack on the brain. Despite its prevalence, dementia may go unrecognized or be misdiagnosed in the early stages of the disease.

According to the Alzheimer’s Association and current national studies, there are many reasons to support the early detection of AD. An early diagnosis is crucial because that is when the most can be done to slow the progression of symptoms. In addition, early treatment can have a considerable effect on maintaining a patient’s current level of functioning. An early and accurate diagnosis can also help to identify reversible conditions that may mimic dementia such as depression, medication side effects, substance abuse, vitamin deficiencies, dehydration, bladder infections or thyroid problems. An initial assessment can avoid the trauma of a diagnosis of dementia where it does not exist. It also prevents unnecessary and possibly harmful treatment resulting from misdiagnosis. Other reasons include:

Identifying the cause of dementia leads to proper care and allows patients a greater chance of benefiting from existing treatments

Early diagnosis can help resolve the anxiety that accompanies noticeable, yet unexplainable changes in behavior

Educating persons with dementia and their caregivers gives them time to develop advanced care planning

The quality of life for both the patient with AD and the family can be maximized.

The earlier the treatment, the better the chance of a favorable response to treatment, the longer the delay of progressive symptoms and the less financial cost overall. The early identification process, currently recommended by the Chronic Care Network for Alzheimer’s Disease, includes two key tools to identify people who may have dementia.

Tool 1: Education and Awareness Materials which recommend the use of triggers that signal possible dementia and include the Ten Warning Signs of Alzheimer’s Disease.

Tool 2: Family Questionnaire which aims to collect data from family members who are often the best historians and are more likely to be aware of the signs and symptoms (of possible dementia) that are not apparent to the medical staff.

The Ten Warning Signs of Alzheimer’s Disease

Memory Loss

Difficulty Performing Familiar Tasks

Problems with Language

Disorientation to Time and Place

Poor or Decreased Judgment

Problems with Abstract Thinking

Misplacing Things

Changes in Mood or Behavior

Changes in Personality

Loss of Initiative/Motivation

If you recognize any warning signs in yourself or a loved one, the Alzheimer’s Association recommends consulting a physician for a complete assessment. Early diagnosis of Alzheimer’s disease or other disorders causing dementia is an important step to getting appropriate treatment, care and support services.

The Family Questionnaire is designed to help identify patients with memory problems that might go unnoticed by clinicians. It consists of five simple questions:

In your opinion, does your loved one have problems with any of the following challenges and how often?

Repeating or asking the same thing over and over?

Remembering appointments, family occasions, holidays?

Writing checks, paying bills, and balancing the checkbook?

Deciding what groceries or clothes to buy?

Taking medications according to instructions?

The information collected from these tools can be shared with the patient’s primary care physician and then a determination of need for further testing or a referral to a specialist can be made at that time.

Testing:

There is no single diagnostic test to detect whether a person has Alzheimer’s disease. However, diagnostic tools and criteria have been developed in recent years to make a clinical diagnosis of AD with an accuracy rate of 85-90%. The factors used to complete a diagnosis include:

Medical History

Mental Status Evaluation

Physical Examination

Neurological Examination

Neuropsychological Evaluation

Brain Scans

Laboratory Tests

The assessment of AD might begin with a memory screening test in the primary care physician’s office and then the patient may be referred to a neurologist, neuropsychologist, a geriatric psychiatrist or other specialist trained in the diagnosis of AD for further testing. Caregivers and family members are essential to the process of diagnosing early-stage Alzheimer’s disease. They may be able to supply valuable information and validate or deny the patient’s own reports.

A diagnosis of Alzheimer’s disease usually falls into one of three categories:

Probable Alzheimer’s— indicates a physician has ruled out all other disorders that may be causing the dementia.

Possible Alzheimer’s— indicates the presence of another disorder that could be affecting the understood progression of Alzheimer’s. The disease process appears different than what is normally seen; yet Alzheimer’s disease is still considered the primary cause of dementia symptoms.

Definite Alzheimer’s— this diagnosis can only be made at the time of an autopsy because it requires examination of actual brain tissue. An autopsy can confirm the presence of senile plaques and neurofibrillary tangles in the brain, which are the characteristic lesions of Alzheimer’s, to diagnose the disease with 100% accuracy.

Delay of Diagnosis:

Amazingly enough, there is a significant percentage of caregivers who are told, upon bringing their spouse or relative to the physician, that their decline is due to ‘normal aging.’ We now know that dementia is not a normal part of the aging process.

It is strongly recommended that persons experiencing any dementia-type symptoms should undergo diagnostic testing as soon as possible. A delay in diagnosis allows for a missed opportunity for treating the patient and also increases the chances for other problems and demands to multiply for the caregiver. For example, since AD affects memory, patients are at risk of not complying with the treatments that are necessary for problems such as diabetes, high blood pressure, mental health disorders and infections. A health crisis can then develop, compound the effects of dementia and lead to emergency care or hospitalization.

Caregivers may initially hesitate to bring a loved one with dementia to the physician. Researchers at the University of Portland found that it takes an average of 30 months from the time family members notice the first changes and symptoms of dementia for the person to be diagnosed with AD. Reasons cited by caregivers were: lack of knowledge about AD, they did not imagine that the changing behavior was part of an illness, they were unsure what type of doctor to see or how to describe symptoms, they felt overwhelmed with the burden of caregiving or they feared that the illness was truly AD. Many caregivers have reported that prior to the diagnosis, they were nearly overcome with anxiety as they watched their loved one deteriorate. Once the diagnosis was made, they felt a great sense of relief and were finally able to name the disease and move forward toward a plan of care.

There are several other reasons that contribute to a delayed diagnosis of AD. Early symptoms are often disregarded, mistakenly attributed to aging or even misdiagnosed. Sometimes people with dementia are unwilling to have their mental abilities evaluated, are defensive, or in denial of the changes that are occurring in their lives. Physicians may not feel comfortable dealing with memory loss issues, may not be trained to administer cognitive tests or are reluctant to place a patient in an uncomfortable testing situation. Patients with high intelligence may be able to score above average on screening tests (despite cognitive decline) and compensate for or even mask their symptoms during the office examination, thus leaving the physician without sufficient evidence to provide a diagnosis. This is the point where caregivers play an important role and can provide the most valuable data to support the possible diagnosis of Alzheimer’s disease.

Alzheimers It impacts only 1% of the population between ages 64- 69; 2% between 70 and 74; 5% between 75 and 79; 9% between 80 to 84 and 18% between 85 to 89.

Past 100 years of Alzheimers. (2007) This is the newsletter of the Long Island Alzheimers Organization. Exceptional material

Alzheimers study- (2007) the researchers assessed the occurrence of mild cognitive impairment in 1445 subjects and the progression to dementia in 121 patients with mild cognitive impairment.

The participants were between 65 and 84 years of age at the start of the study, and they were followed for 3.5 years. Alcohol use was assessed starting the year before the survey.

Drinking was not associated the development of mild cognitive impairment, according to the report. However, once mild impairment occurred, subjects who had up to one drink per day of alcohol had an 85 percent reduced risk of dementia compared with those who abstained.

The benefit was seen with both alcohol in general and with wine in particular.

Having more than one drink a day, however, offered no protection against dementia compared with abstaining,

Alzheimers: (2007) About five million people in the United States are living with Alzheimer’s, . Without a cure or new treatments, the number of those with the disease could grow to 13.2 million by 2050, the National Institute on Aging estimates.

The four Alzheimer’s treatments now on the market work by regulating the action of chemical neurotransmitters in the brain. The drugs — Aricept by Eisai and Pfizer, Exelon by Novartis, Razadyne by Johnson & Johnson and Namenda by Forest Laboratories — have shown mixed results treating Alzheimer’s symptoms and do nothing to stop the disease’s progress.

Estimates of its frequency vary, but it strikes one out of every 5 people between ages 75 and 84 and 42 percent of those over age 85, according to the Alzheimer’s Association. The organization estimates the current direct and indirect costs of the disease at nearly $150 billion a year

Alzheimers: (2007) The value of "free" services provided by informal family caregivers to their chronically ill, disabled or aged loved ones jumped to $306 billion, a 19 percent increase over four years. That's according to a state-by-state analysis of the number of family caregivers, hours of service and estimated market value conducted for the National Family Caregivers Association and the Family Caregiver Alliance. New York is the third-largest caregiving state with services provided valued at $20 billion, behind California and Texas.

Although we know that depression is a major factor in most caregiving, according to a Yale study, 30 percent of the respondents with loved ones in hospice care experienced what could be described as a major depressive disorder.

According to a Stanford University study, 40 percent of Alzheimer's caregivers will die from stress-related disorders before the loved ones for whom we care.

Alzheimers- More than 5 million Americans are living with Alzheimer's disease, a 10 percent increase since the last Alzheimer's Association estimate five years ago. Age is the biggest risk factor. Already, one in eight people 65 and older have the mind-destroying illness, and nearly one in two people over 85.

Unless scientists discover a way to delay Alzheimer's brain attack, some 7.7 million people are expected to have the disease by 2030. By 2050, that toll could reach 16 million.

About 10 years ago I attended a meeting of the Bay area Alzheimers Association where a leading physician indicated that they would find a cure in five years. I likened that to the 50s and 60s where articles said they had found the "link" to cancer and it would be cured in just a few years. It just may be that the human brain was never intended to last that long.

Because it complicates treatment for every other illness, the new report shows Medicare spends nearly three times as much for dementia patients' care as for the average beneficiary _ $13,207 a year vs. $4,454. Medicare's spending on dementia-related care is projected to double to more than $189 million by 2015.

That doesn't include the value of the unpaid round-the-clock care that families and friends provide the vast majority of Alzheimer's patients who live at home _ a tab the new report calculates at almost $83 billion_ or nursing home costs.

Also, Between 200,000 and half a million people under age 65 have either early-onset Alzheimer's or another form of dementia. I have a friend whose wife got it in her early 50s. She is pretty much 'gone' now. My mother has been institutionalized for over 10 years. Both my uncles had it. I think my sister will get it.

ALZHEIMER'S REPORT - The Alzheimer's Association reports that an estimated 5.1 million Americans have Alzheimer's disease and predicts that there will be 454,000 new cases of Alzheimer's by 2010 with the numbers increasing each year thereafter. "The number of Americans surviving into their 80s and 90s is expected to grow because of national demographics as well as advances in medicine, medical technology and other social and environmental improvements," the report states. "Since the incidence and prevalence of Alzheimer's disease increase with advancing age, the number of persons with the disease is expected to grow as a proportion of this larger older population."

Alzheimer's: Planning for the holidays Alzheimer's disease affects every aspect of your family and community life. Your holiday observances are no exception. Holiday memories from before your loved one developed Alzheimer's may darken what usually is a joyful season. And worries about how your loved one's condition may disrupt your family's plans can overshadow the simple pleasure of being together.

Rather than dwell on how much things have changed or worry about what might go wrong, focus on making the holidays as enjoyable as possible. Consider your loved one's needs, but don't forget about yourself.

When your loved one lives with you (2008)

If you're caring for a loved one with Alzheimer's at home:

Make preparations together. If you bake, your loved one may be able to participate by measuring flour, stirring batter, rolling dough or whatever tasks match their current retained skills. You may find it meaningful to open holiday cards or wrap gifts together. In the end, a perfectly wrapped gift or an award-winning pie may not be the outcome, but a pleasurable activity nonetheless is very possible.

Tone down your decorations. Blinking lights and large decorative displays can cause disorientation. Avoid lighted candles and decorations such as artificial fruits that could be mistaken for edible treats.

Host quiet, slow-paced gatherings. Television, conversation and meal preparation all add to the noise and stimulation of an event. A calm quiet environment usually is best. Keep daily routines in place as much as possible and, as needed, provide your loved one a place to rest during family get-togethers.

If your loved one is in a nursing home

If your spouse, parent or other close companion is in an assisted living facility or a nursing home, consider these tips:

Celebrate in the most familiar setting. For many people with Alzheimer's, a change of environment — even a visit home — causes anxiety. Instead of creating that disruption, consider holding a small family celebration at the facility. Find out what holiday activities are planned for the residents, and consider participating with your loved one there.

Keep the visitor traffic to a minimum. Arrange for a few family members to drop in on different days. Even if your loved one isn't sure who's who, two or three familiar faces are likely to be welcome, while nine or 10 may be overwhelming.

Schedule visits at your loved one's best time of day. People with Alzheimer's tire easily, particularly as they approach the late stage of the disease. Your loved one may appreciate morning and lunchtime visitors more than those in the afternoon or evening.

Care for yourself

Consider your needs, as well as those of your loved one. Here are some tips to help you manage your expectations of yourself:

Pick and choose. Decide which holiday activities and traditions are most important. Remember that you can't do it all. Focus on what you enjoy.

Simplify. Bake fewer cookies. Ask others to provide portions of holiday meals, and use disposable plates and utensils. Write a holiday letter and send a copy to family and friends instead of sending handwritten cards.

Delegate. Remember family members and friends who have offered their assistance. Let them help with cleaning, writing cards and shopping for gifts. Ask if one of your children or a close friend could stay with your loved one while you go to a holiday party.

Trust your instincts

Caregivers know best what their loved ones with Alzheimer's disease are capable of doing — and what agitates and upsets them. Resist pressure to celebrate the way others may expect you to. You can't control the progress of Alzheimer's or protect your loved one from all distress. But by planning and setting firm boundaries, you can avoid needless holiday stress and enjoy the warmth of the season.