Wednesday, May 8, 2013

A Tale of Two Women, Afraid of Alzheimer’s


Contrasting the lives of two senior women, both of which lost their own mother to Alzheimer’s. Their concerns about getting the disease are valid and each is handling her concerns differently.
            Lily’s Story
Lily’s mother died at age 86 in the mid 1980’s after several years of struggle with a form of Alzheimer’s that involved very difficult and troubling behaviors. Now that Lily has turned 70, her concerns of ending up like her mother have become very real.
What Lily is Doing Right
Lily has started trying to adjust her diet to better manage her Type 2 Diabetes and has begun to take more supplements to support her health, including fish oil and B-vitamins. She reads daily and usually talks on the phone often with good friends and relatives. Lily keeps up with regular check-ups at her Primary Care physician and a Naturopathic Physician. Lily gets on a computer daily and checks-in with family on Facebook and writes emails to them. Lily also speaks two different languages, her native Spanish and second language English, and uses both on a daily basis.
What Lily Could Improve Upon
Lily has not set up any advanced directives, a will, a trust nor has she designated either a power of attorney or healthcare representative to any of her children. Although Lily has saved up some money she would like to will to her children to prevent them any unnecessary burden, she has not set up a trust for them. Without these measures, if/when Lily develops Alzheimer’s, one of her children will need to seek a Guardianship in order to make proper care decisions as well as a Conservatorship to make financial decisions for her. Guardianship and Conservatorship are complicated and costly to process through the court system, which will end up being a burden on her family, which is exactly what she hopes to avoid. 
Lily could benefit by tying up the loose ends pertaining to her estate and final wishes now instead of leaving them undone. Lily could also improve her cognitive skills by playing more games like crossword puzzles and Sudoku. Lily could also focus on improving her psychological state, as she often seems to get depressed and emotional. Lily should also focus on more exercise (which she does not do), as it has proven beneficial for the health of the brain.
Violet’s Story
Violet’s mom died at age 92 after fighting Alzheimer’s for 15 years. Violet is now in her early 70’s. At the end, Violet’s mom did not remember her or her sister. Violet said her mom would simply stare off into space when she visited. Violet never understood how her mother could develop Alzheimer’s after being a bookkeeper for 40 years. Violet does not believe the research that points to keeping mentally fit to avoid Alzheimer’s because her mom kept her brain sharp with numbers, and President Reagan ran the country, and before that memorized lines as an actor, and he still got the disease.
 What Violet is Doing Right
Violet eats modestly and avoids sugars. She walks around her neighborhood daily and gets regular checkups at her Primary Care Physician. (Violet is fortunate to have no underlying diseases that require managing.) She takes part in hobbies she loves on a daily basis including scrap booking, reading the newspaper cover to cover and repairing antique items. She and her son eat dinner together frequently and usually take one or two vacations a year together. Violet meets up with friends on a semi-regular basis for coffee or lunch. Violet often goes to movie premiers to collect autographs. She follows politics and debates ideas with friends and family. She keeps abreast of all the current news and events. Violet also uses a computer frequently and emails friends.
Violet has already completed elaborate advanced directives and instructions for her son. She has inventoried all her collections with descriptions, names and values so he can sell things of value after she’s gone.
Conclusion
Clearly, Violet is better prepared for developing Alzheimer’s than Lily. Although both women are afraid of developing the disease and are close in age, they aren’t working to prevent it as fervently. It’s hard to say why Lily is less prepared than Violet. Perhaps the taboo surrounding open end-of-life discussions is at play. Perhaps making life changes at age 70 feels too overwhelming for Lily.  Nevertheless, Lily and others could all learn a lot from Violet’s choices. 
Does any one have a "Lily" in their life that needs a little guidance or support? 
How did you help?

Monday, May 6, 2013

Improve Memory & Cognitive Function for Dementia


If you're looking to improve memory and cognitive function for someone you love with dementia, here are a few tips.

Supplements to Start Using

·   Add Fish Oil – Fish oil has positive effects on cognitive functioning. There are possible benefits on the brain health and aging according to the researchers at Rhode Island Hospital’s Alzheimer’s Disease & Memory Disorders Center.

·   Add Acetylcholine supplements, or medications that slow the breakdown of this neurotransmitter. According to the National Institute of Mental Health, “a decrease in acetylcholine may be responsible for some of the cognition deficits in Alzheimer's disease” and “patients taking medications that slow the breakdown of this neurotransmitter have experienced improvements in memory.”

Supplements to Stop Using

·   Phosphatidylserine – According to Dr. Glen Smith at the Mayo Clinic, the early studies that showed health benefits with this supplement were only when the supplement was derived from the brain cells of cows. Mad cow disease concerns led to developing the supplements form soy or cabbage and the plant-based versions have not been researched enough to prove results.

·   Ginkgo Biloba – According to Dr. Brent Bauer at the Mayo Clinic, a 2009 issue “of the Journal of American Medical Association, found no evidence that ginkgo biloba prevents memory loss or slows the progression of cognitive decline in older adults.”

Therapeutic/Memory Triggering Activities

·   Decorate the place to resemble a past era, like Belfair Gardens did with a 1940s makeover to help Alzheimer's patients go for a walk down memory lane.

·   Play DVDs that focus on past eras, like the Living Memories Archive is making for fostering “The stimulation of the memories of dementia patients, which help to provide new topics for conversation.”

·   Add Music Therapy - According to research by Willamette University posted on the US National Library of Medicine, music therapy has a “possible beneficial effect on symptoms including social, emotional and cognitive skills and for decreasing behavioral problems of individuals with dementias.”

·   Add “training and practice in problem-solving skills, memory techniques, and other cognitive strategies” to help improve their abilities according to “Aging Concepts and Controversies” by Sasser and Moody (page 23).

·   Group people together to let others help “compensate for cognitive losses through a social process dubbed ‘interactive minds’ or ‘collaborative cognition’” (Sasser & Moody, p. 24.) whereby one person helps to fill in the gaps of another person’s memory when recalling things.

Saturday, May 4, 2013

Take It With A Grain


            As we understood it, our grandmother had Alzheimer’s for the last 10 years of her life (2002-2012). However, upon researching some of the symptoms of Alzheimer’s we now recall behaviors that fit the recognized symptoms of Alzheimer’s much earlier on. In the mid 1990’s our grandmother believed someone had stolen something out of her purse at the grocery store. (This was very uncharacteristic behavior.)
As far back as the mid 1990’s, marked grandmother’s dismissal of important discussions and events with short phrases (most commonly) “Take it with the grain.” Although her usage suggested, “dismiss it – it’s not important” the real meaning of the idiom according to the online dictionary is “to consider something to be not completely true or right.” So, at that point she was already mixing up idioms. Our belief was that her dismissals indicated apathy or lack of interest. However, in hindsight the improper idiom usage suggests something far more serious brewing. The idioms she used quickly ended conversations, and considering another symptom of Alzheimer’s is problems finding words and/or expressing oneself in conversations, it might have been the root cause for her to say such things.
Around the late 1990’s grandma nearly stopped driving. Although she never explained why she seldom went out alone, it seems likely that she was becoming fearful of getting lost in her own town.  When grandpa chose to move them both to San Diego in 2000, grandma never drove again. Considering how she was not confident enough to drive freely in a city she’d lived in for over 30 years, we can only imagine how fearful driving around an entirely new city would have made her.
When looked at through the filter of early-onset Alzheimer’s symptoms, we see that our grandmother’s development of the disease began much earlier than any of us realized.
Statistics on Alzheimer’s
It is estimated that around 18 million people worldwide have Alzheimer’s, according to the CDC’s webpage on World Alzheimer’s Day using numbers provided by the World Health Organization (WHO). The WHO estimates the number of people with Alzheimer’s to total 34 million by 2025. Some additional facts as highlighted by the CDC’s website on Alzheimer’s are:
·   2.6 million to 5.2 million Americans have Alzheimer’s.
·   Alzheimer’s is the 6th leading cause of death for adults over age 18.
·   Alzheimer’s is the 5th leading cause of death for adults over age 64.
·   Presently, healthcare costs for persons with Alzheimer’s are $183 billion in the US.
Diagnosing Alzheimer’s
According to the Alzheimer’s Association (ALZ.org), “there is no single clinical
test that can identify Alzheimer’s.” For diagnosing Alzheimer’s, ALZ.org explains that evaluation methods include “a complete health history, physical examination, neurological and mental status assessments, analysis of blood and urine, electrocardiogram, and possibly an imaging exam such as CT or MRI.” A 2011-2012 progress report by the National Institute on Aging explains advancements in detecting Alzheimer’s to include genetic markers, insulin resistance and brain glucose uptake; cerebrospinal fluid (CSF) biomarkers; imaging the living brain (looking for cortical thinning); combining genetics, CSF and Imaging Biomarkers; Sensory changes (like loss of smell) and Motor Changes (walking speed changes). [This last marker of gait speed predicting Alzheimer’s was researched by Portland’s very own Oregon Health and Sciences University and announced in July of 2012.]
Symptoms of Alzheimer’s
·   Memory (unknowingly repeating statements, forgetting appointments or conversations – and not remembering them later, misplacing items, forgetting names of loved ones or everyday items)
·   Disorientation & Misinterpreting Spatial Relationships (losing the sense of the day of the week or seasons of the year, “getting lost in familiar places”)
·   Speaking and Writing (trouble finding the right words to identify things or express oneself, trouble taking part in conversations)
·   Thinking and Reasoning (problems managing finances, balancing checking accounts, and keeping track of bills, usually attributed to difficulty recognizing and understanding numbers)
·   Making Judgments and Decisions (burning food on the stove, trouble driving)
·   Planning and Performing Familiar Tasks (familiar routines and tasks become a struggle, such as planning and cooking a meal or playing a game)
·   Changes in Personality and Behavior (some people with Alzheimer’s may experience: “depression, social withdrawal, mood swings, distrust in others, irritability and aggressiveness, changes in sleeping habits, wandering, loss of inhibitions, delusions, such as believing something has been stolen.”
Biological Causes of Alzheimer’s
The Mayo Clinic lists the causes of Alzheimer’s as resulting from “a combination of genetic, lifestyle and environmental factors that affect the brain over time.”  Alzheimer’s disease “damages and kills brain cells” and with fewer brain cells there are “fewer connections among surviving cells” of the brain leading to more cells dying and “significant brain shrinkage.” Two abnormalities of the disease have been noted, according to the Mayo Clinic as plaques (“clumps of a protein called beta-amyloid…interfering with cell-to-cell communication”) and tangles (the internal system of the brain carrying nutrients and other essential materials depends on a protein called “tau” and when tau protein twists into “abnormal tangles inside brain cells” this leads to “failure of the transport system” which causes “decline and death of brain cells.”)
Alzheimer’s Lifestyle Risk Factors
            According to the Mayo Clinic some Alzheimer’s disease lifestyle risks include: “lack of exercise, smoking, high blood pressure, high blood cholesterol, poorly controlled diabetes, a diet lacking in fruits and vegetables, and lack of social engagement.” Other factors may include previous trauma to the head, gender (more women than men develop Alzheimer’s), family history and genetics, and age (the risk increases after age 65 and “nearly half of those older than age 85 have Alzheimer’s” says the Mayo Clinic.
Please Share With Others & Add your Comments Below
Our hope is that by sharing and talking about Alzheimer’s experiences with others, we can help to inform those who are less aware so they may watch for symptoms in loved ones and have greater compassion and understanding for others facing the disease.