Alzheimer’s disease: Causes, Symptoms, Treatment

End-of-Life Decisions for Alzheimer’s Patients

2012-01-28T01:00:00.000-08:00

For an individualwith Alzheimer’s disease, advance planning is essential to fulfillingend-of-life wishes. Physicians and other members of the health care team playan important role in initiating discussion with the individual and familyregarding these wishes.

Early discussion,when the individual’s cognitive and communication abilities are least impaired,will help to clarify the individual’s wishes. A person with Alzheimer’s maylack capacities to drive, handle financial affairs or live independently butstill may have the capacity to make independent decisions about his or hermedical care or place of residence.

Advance directives

Individuals have a moral and legal right to limit or forgo medical or life-sustaining treatment (including the use of artificial feeding, mechanical ventilators, cardiopulmonary resuscitation, antibiotics, dialysis and other invasive technologies).
Individuals who lack decision-making capacity have the right to have surrogates use advance directives to assure their right to limit or forgo medical or life-sustaining treatment.
The two common forms of advance directives are a living will and a durable power of attorney for health care:

A living will states the individual’s choices for future medical care decisions.
The durable power of attorney allows the individual to designate a surrogate, usually a trusted family member, to make specific treatment decisions for them. The surrogate should make decisions consistent with what they think the individual’s wishes would have been.

Every state nowlegislatively recognizes advance directives. Both the living will and durablepower of attorney for health care are authorized in most states and theDistrict of Columbia. However, issues within the statutes regarding the use orwithdrawal of artificial nutrition and hydration vary from state to state.

Treatment withdrawal/refusal

The Alzheimer’sAssociation Ethics Advisory Committee concluded that all efforts at lifeextension in the advanced stage of Alzheimer’s creates burdens and avoidablesuffering for patients who could otherwise live out the remainder of theirlives in greater comfort and peace.

Cardiopulmonary resuscitation, dialysis, tube feeding, and all other invasive technologies should be avoided.
The use of antibiotics usually does not prolong survival, and comfort can be maintained without antibiotic use for patients experiencing infections.
Care providers should work closely with the family or the proxy decision maker in cases where a substitute judgment must be made to interpret advance directives.
If necessary, the importance of respecting the individual’s wishes should be clarified for the family.
Clinical ethics consultants or an ethics committee may offer assistance in facilitating consensus.

Pain recognition and intervention

Pain is often difficult to evaluate in individuals who are unable to use words to express their needs. Signs that the person may be in pain are moaning, rocking, crying, resistance to care, refusal to eat, social withdrawal, motor restlessness or sleeping.
It is important to assess the person’s need for comfort measures including pain medication, since many persons with Alzheimer’s disease may be unable to verbally communicate their discomfort.

Artificial hydration and nutrition

When a patient cannot eat normally, a medical treatment option isartificial hydration and nutrition (AHN). With AHN, a chemically balanced mixof nutrients and fluids, is provided to the patient by placing a tube directlyinto the stomach, the intestine or a vein. AHN provides the nutrition andfluids that the patient needs but does not offer the sensory rewards andcomfort that come from the taste and texture of food and liquids. In addition,doctors and nurses, rather than patients themselves, control when and how muchwill be “eaten”. Finally, the social interaction that often accompanies eatingand drinking is not present.

Providing adequate food and fluids during the various stages can beespecially challenging to the family and the caregiver. Offering small mealsthat contain soft, sweet and cold foods seems to appeal to patients as thedisease progresses but in the final stages, swallowing difficulties may lead toaspiration pneumonia if you try to feed the patient.

Families become very distressed when their loved one refuses to eat. Ourinstincts tell us to provide nutrition to people who are ill. Food is symbolicof life and of love and of caring. But when a patient reaches the final stagesof dementia, the body can no longer metabolize food, and food can stay in thedigestive tract, causing nausea and vomiting. Certain food (especially meat)may not taste or smell good and may be difficult to chew. Ultimately, thepatient may prefer only liquids, and then nothing at all. When the patient isnearing the end of life, allowing him or her to refuse food is one of thehardest decisions facing families and clinicians, but it is the kindest thingwe can do.

Hospice care

During the finalstages of Alzheimer’s disease, hospice care can be particularly beneficial toindividuals with Alzheimer’s disease and their family members. Hospice, whichis normally offered to individuals who are expected to live less than sixmonths, includes comprehensive palliative care and support services, includingbereavement counseling for family members.

Despite theappropriateness and benefit for persons with advanced Alzheimer’s disease andtheir families, and their eligibility for the Medicare hospice benefit, veryfew receive hospice care. Physicians, care professionals and families canchange this by generating awareness of the importance of hospice to theindividual in the final stages of Alzheimer’s disease.

If an individual’s end-of-life wishes conflict with the care provider’spersonal beliefs, consideration should be given to the transfer of care toanother provider.

Eligibility for hospice for Alzheimers patients

There were developedofficial medical recommendations in determining whether a patient withend-stage dementia is appropriate for hospice care and/or eligible for theMedicare/Medicaid Hospice Benefit.

Functional Assessment Staging

Even severely demented patients may have a prognosis of up to two years. Survival time depends on variables such as the incidence of comorbidities and the comprehensiveness of care.
The patient should be at or beyond Stage 7 of the Functional Assessment Staging Scale. The factors listed below should be understood explicitly since many patients do not progress in an orderly fashion through the substages of Stage 7.

The patient should show all of the following characteristics:

Unable to ambulate without assistance.

This is acritical factor. Recent dataindicate that patients who retain the ability to ambulate independently do nottend to die within six months, even if all other criteria for advanced dementiaare present.

Unable to dress without assistance.
Unable to bathe properly.
Urinary and fecal incontinence.

Occasionally or more frequently, over the past weeks.
Reported by knowledgeable informant or caregiver.

Unable to speak or communicate meaningfully.

Ability to speak is limited to approximately a half dozen or fewer intelligible and different words, in the course of an average day or in the course of an intensive interview.

Presence of Medical Complications

The presence of medical comorbid conditions of sufficient severity to warrant medical treatment, documented within the past year, whether or not the decision was made to treat the condition, decrease survival in advanced dementia.
Comorbid conditions associated with dementia:

Aspiration pneumonia.
Pyelonephritis or other upper urinary tract infection.
Septicemia.
Decubitus ulcers, multiple, stage 3–4.
Fever recurrent after antibiotics.

Difficulty swallowing food or refusal to eat, sufficiently severe that patient cannot maintain sufficient fluid and calorie intake to sustain life, with patient or surrogate refusing tube feedings or parenteral nutritional.

1. Patientswho are receiving tube feedings must have documented impaired nutritionalstatus as indicated by:

a. Unintentional,progressive weight loss of greater than 10 percent over the prior six months.

b. Serumalbumin less than 2.5 gm/dl may be a helpful prognostic indicator, but shouldnot be used by itself.

Mortality Risk Index

One of the alternativeapproaches to determine the patient’s eligibility for hospice care is theMortality Risk Index (MRI), a composite score based on 12 risk factor criteriaobtained from using the MDS (Minimum Data Set), developed by Mitchell in 2004.

Risk factorsassessment (points):

Complete dependence with ADLs (1.9).
Male gender (1.9).
Cancer (1.7).
Congestive heart failure (1.6).
O2 therapy needed w/in 14 day (1.6).
Shortness of breath (1.5).
<25% of food eaten at most meals (1.5).
Unstable medical condition (1.5).
Bowel incontinence (1.5).
Bedfast (1.5).
Age > 83 y.o. (1.4).
Not awake most of the day (1.4).

Complete assessment and summarize the score. Refer to the table below forrisk estimate of death within 6 months (Score – Risk):

0 - 8.9%
1-2 - 10.8%
3-5 - 23.2%
6-8 - 40.4%
9-11 - 57.0%
= 12 - 70.0%

Sources and Additional Information:

http://www.alz.org/professionals_and_researchers_end_of_life.asp

http://www.geronguide.com/gg/Artificial+Hydration+and+Nutrition+in+Advanced+Alzheimers

http://www.jhasin.com/files/articlefiles/pdf/ASIN_3_10_p355_362.pdf

http://www.nap.edu/openbook.php?record_id=5801&page=402

http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_150.htm

SingFit by Musical Health Technologies for iPhone

2012-01-21T16:42:00.000-08:00

Singfit is a freeiPhone and iPad app, based on the concept music therapy, assisting a person tosing alone the specially preselected classical tunes to activate triggered bymusic brain performance. That helps to slow down and diminish the negativesigns of Alzheimer’s and other dementias, and to escalate recovery for theviral body functions as ability to speak, impaired by, for example, traumaticbrain injuries and strokes, traffic accidents and other substantial traumas.

The app providesusers with an eclectic assortment of sing-along selections, ranging fromFoghat’s “Slow Ride” to Bob Marley and the Wailers’ “Buffalo Soldier.”

Numerous studiessupport the fact that singing in general can have multiple health benefits.Professor Graham Welch, Chair of Music Education at the University of London,puts it like this:

“The health benefitsof singing are both physical and psychological. Singing has physical benefitsbecause it is an aerobic activity that increases oxygenation in the bloodstreamand exercises major muscle groups in the upper body, even when sitting. Singinghas psychological benefits because of its normally positive effect in reducingstress levels through the action of the endocrine system, which is linked toour sense of emotional well-being.”

While Dr. DanielLevitian, author of the New York Times’ bestseller This is Your Brainon Music sums it up like this: “Listening to, and even more so, singing orplaying music can alter our brain chemistry associated with well-being, stressreduction, and immune system fortitude.”

SingFit can helpbring the joyful, communication-enhancing act of singing to thepatient-caregiver relationship. Since the SingFit app and a collection ofpublic domain songs are free to download for iPhone, iPod Touch and iPad, it’seasy to try out the app for yourself. You’ll find that because one doesn’t needto be able to read or even see, SingFit is the perfect activity for seniors,people with neurological or physical impairments and those with developmentaldelays.

So, what is SingFitexactly? SingFit is easy-to-use software that utilizes spoken wordprompting to feed the words of a song to a singer, right before they need to besung. This means that a singer does not need to be able to read or even see tosing the words of the song perfectly. The lyrics are spoken to the singerduring SingFit’s specially selected and recorded songs. Note that SingFit isnot exactly a Karaoke application. In traditional karaoke a singer must readthe words of the song. For that reason, people with certain conditions likeAlzheimer’s, special needs or low vision typically have been excluded fromusing karaoke to sing. Plus, it is possible that being freed up from having toread the words of the song makes for a more spontaneous and enjoyableexperience.

Screenshots:

System Requirements: Compatible with iPhone, iPod touch, and iPad. RequiresiOS 4.3 or later.

Cost: SingFit is free to download and comes withfive FREE, fun-to-sing standards including When the Saints Go Marching In,House of the Rising Sun and Home on the Range. Look for the free songs on theFeatured screen of the SingFit song catalog. A $12.99 a month subscriptiongives unlimited access to SingFit’s catalog of hit songs from multiple eras& genres.

Rating: 5 out of5

List of availabletracks: http://www.musicalhealthtech.com/singfit-music-catalog/

Developers’ page:http://www.musicalhealthtech.com/singfit/

iTunes page: http://itunes.apple.com/us/app/singfit/id442827581?ls=1&mt=8

Video Presentation:

Check your Brain Health with BrainyApp for iPhone

2012-01-11T15:10:00.000-08:00

Developers of thissmart application are confident that it is the only one, developed for iPhone,which is capable of evaluating, rating, and tracking your brain health. Thisevidence-based app is claimed to be much more than just brain games! And as itis free to use, feel free to try it.

How brain-healthy do you think you are? BrainyApp will guide you on how to livea brain-healthy lifestyle and show you that what is good for your heart is alsogood for your brain.

As well as being important for good memory and thinking skills, being brainhealthy may also reduce your risk of developing dementia.

To get the most out of BrainyApp, start by taking the Brain Health Survey,which will give you your initial brain health score. You will be able to emailyourself your results and feedback on how you went.

You can then regularly add to your score by completing the suggested Activitiesin BrainyApp. If you’re not doing enough Activities, you’ll see yourbrain-heart health score decrease.

You can also earn extra points by sharing your score and BrainyApp Facts onFacebook.

BrainyApp has the following features:

Brain health survey – see what your brain health score is and get personalized recommendations on what you can do to improve your brain health.
Brain games – give your brain a work out.
Activities – add to your brain health points with a range of activities including exercise, eating well, getting health checks, keeping your mind active and managing your smoking and alcohol intake.
Monitor your Brain Health Points and track your progress over time.
Get a daily fact sent to you.
Share facts and your brain health scores with friends and family.

BrainyApp wasdeveloped by Alzheimer’s

Australia

and Bupa Health Foundation to raise community awareness of the risk factors forAlzheimer’s disease and other types of dementia and on how to live a brainhealthy lifestyle.

Screenshots:

System requirements:Compatible with iPhone, iPod touch and iPad. RequiresiOS 4.0 or later.

Rating: 4 out of 5

Cost: Free

iTunes site: http://itunes.apple.com/au/app/brainyapp/id473599106?ls=1&mt=8

Alzheimer's Apps for iPhone

2012-01-05T21:45:00.000-08:00

Technology makes impact on our daily life, andit may help to manage the Alzheimer’s symptoms better in some areas than anyother conventional tools and arrangements. Starting with this publication, weare going to present some applications, specifically developed for iPhone andother portable Apple devices, which will help in some areas of daily life. Someof them are specifically developed for Alzheimer’s and Dementia patients, whileothers have useful features, you may benefit from.

We will start this section, presentingcollection of small applications, developed by Healthful Apps.

With special Alzheimer’s Apps collection,consisting of 15 small utilities, the Alzheimer’s community has a potentiallypowerful tool at their disposal to help improve the quality of life for thosewith the disease as well as their caregivers. Alzheimer’s Apps identifies appsthat may improve the quality of life for those who have some form of dementiaby featuring apps that calm, engage, and/or lift spirits.

The goal is to leverage these app-inspired activities resulting in an improvedinteraction with caregivers and visitors. Grandchildren, for example, can findfamiliar music, games, or activities in apps that can be enjoyed togetherperhaps stimulating discussion by one who is normally less communicative.

The last apps listed can be tried with persons with advanced dementia, as appsthat are responsive to one's touch tend to generate interest.

ElderGadgetrecommends four such programs that may benefit seniors with Alzheimer’s anddementia.

Koi Pond - Koi Pond has to beexperienced to be believed. Once the app is opened and the volume up, you cansee and hear these peaceful, beautiful fish swimming. Be sure to put yourfinger in the “water” and watch the koi react.

Art Gallery- Ourlove and appreciation of art stays with us, even in dementia. Familiar artistsand styles can evoke the same feelings they did before, bringing a sense of joyor nostalgia to the user.

Serena - After creating aplaylist and choosing a song, download and open the Serena app, which willsearch for and display the lyrics to those songs. This may trigger familiarityamong the user.

PhotoLabeler – It’s an easy way to label family photos. The Photo Labeler is a handytool to have when sitting with visitors and caregivers.

Note that iPhone apps can be developed or recommended by virtuallyanyone, ranging from doctors who specialize in Alzheimer’s care to the averageteenager. These apps are not guaranteed to benefit an Alzheimer sufferer, butmay help trigger memories and familiar activities, especially for those in theearlier stages of dementia or any memory-loss disease.

Cost: $0.99

iTune Site: http://itunes.apple.com/us/app/alzheimers-apps/id351904904?mt=8

Chronic Stress as Risk Factor for Alzheimer’s Disease

2011-12-28T22:55:00.000-08:00

Stress is inherent in every human being. It is theway we respond to a real or imaginary threat. It is the fight-or-flightmechanism which enables our bodies to initiate the chain of biochemicalreactions in response to a hazard, whether real or perceived. While your mindand emotions develop through the learning experience of life, instincts weregiven to you as a survival protection tool.

What is stress?

Stress is a normal physical response to events thatmake you feel threatened or upset your balance in some way. When you sensedanger – whether it’s real or imagined – the body's defenses kick into highgear in a rapid, automatic process known as the “fight-or-flight” reaction, orthe stress response.

When you perceive a threat, your nervous systemresponds by releasing a flood of stress hormones, including adrenaline andcortisol. These hormones rouse the body for emergency action.

Your heart pounds faster, muscles tighten, bloodpressure rises, breath quickens, and your senses become sharper. These physicalchanges increase your strength and stamina, speed your reaction time, andenhance your focus – preparing you to either fight or flee from the danger athand.

The stress response is the body’s way of protectingyou. When working properly, it helps you stay focused, energetic, and alert. Inemergency situations, stress can save your life – giving you extra strength todefend yourself, for example, or spurring you to slam on the brakes to avoid anaccident.

The stress response also helps you rise to meetchallenges. Stress is what keeps you on your toes during a presentation atwork, sharpens your concentration when you’re attempting the game-winning freethrow, or drives you to study for an exam when you'd rather be watching TV.

But beyond a certain point, stress stops beinghelpful and starts causing major damage to your health, your mood, yourproductivity, your relationships, and your quality of life.

ChronicStress Danger

What happens with chronic stress then? If we arechronically stressed and experience chronic distress as a result, then we areconstantly releasing cortisol. Like red wine, too much of a good thing can bebad. Chronically high cortisol has been shown to cause brain cell dysfunction,to kill brain cells, and to cause atrophy of the brain.

With aging, something additional happens. Biologicalsystems become deregulated. Our ability to shut down biological systems oncethey are turned on becomes impaired with aging. Cortisol levels go up, but theystay up longer and go down slower. We become more prone to the psychological effectsof stress if we are distressed, and the effects last longer. More brain cellsmay dysfunction and more may be killed.

Over the course of a lifetime, the effects of chronic stress can accumulate andbecome a risk factor for cognitive decline and Alzheimer's disease. Severalstudies have shown that stress, and particularly one's individual way ofreacting to stress (the propensity to become distressed often found in neuroticpeople for example), increases the risk for Alzheimer's disease.

ClinicalResearch – Stress as Risk Factor for Alzheimer’s Disease

UCSan Diego Study, 2010

In 2010, a research group led by Mark Tuszynski atthe University of California, San Diego, performed a study on monkeys to seehow different environments affect the development of Alzheimer’s disease. Somemonkeys were put in very small cages when they were young, while others were inlarger cages. The monkeys in the small cages were unable to get enough exerciseand released larger amounts of stress hormones. These stress hormones canreduce the number of nerve synapses. Upon study of the monkeys’ brains, it wasconfirmed that monkeys raised in smaller cages had, on average, a higherdensity of plaques and lower number of synapses, the same brain pathology seenpostmortem in Alzheimer’s patients.

Universityof Houston, 2010

In another study in March, 2010, Karim Alkadhi atthe University of Houston led a research team to study the effects of stress onrodents in a water maze. Some rats were injected with amyloid peptides, whileother rats were subjected to stress by placing an intruder rat in their homecage. The rats were divided into 4 groups to see the effects of the amyloidproteins and stress singly and combined.

The study results showed that only one group ofstudents had difficulty learning the new task, reflecting substantial memoryimpairment - the animals that received both the amyloid dose and were regularlystressed out.”

UtahState University, 2010

Chronic psychological stress throughout a lifespanmight increase an individual's risk for Alzheimer's and dementia later in life,according to research from the Emma Eccles Jones College of Education and HumanServices at Utah State University.

The research, led by Maria Norton, Ph.D., built offthe recently completed 15-year Cache County Memory Study (CCMS) and used thatdata to focus on the role psychological stress has on dementia. The findingsare consistent with the hypothesis that chronic stress can expose an individualto long-term levels of stress-related hormones, which results in chronicallyhigh levels of glucocorticoids, a natural chemical, shown in both animal andhuman studies to increase the rate of neuronal cell death with long-termexposure.

"Using this objective data, such as deathrecords, medical information, and the cognitive evaluations from the CCMS, wewere able to see that people who experienced particularly stressful lifeevents, such as a parent's death during one's childhood, death of a child orspouse, or living with a spouse who is afflicted with dementia is associatedwith significantly higher rates of dementia later in life," Norton said.

Norton also found that there were some factors thatwere associated with lower rates of depression and stress, such as individualswho had high levels of religious involvement, thus indicating that the abilityto cope with psychological adversity might reduce the risk of Alzheimer's.

Universityof South California, 2011

While there were multiple studies, which confirmedthe causal relationship between chronic stress and Alzheimer’s Diseasedevelopment, scientists at the University of Southern California (USC) have nowfound an scientifically backed up mechanism: chronic stress (physical ormental) causes over expression of the RCAN1 gene, in turn leading toneurodegenerative disease.

The mechanism involves the following steps:

In a healthy person, the RCAN1 gene helps cells cope with stress. However, chronic overproduction of RCAN1 causes hyperphosphorylation of tau proteins in the brain.
Tau proteins stabilize microtubules, which are like scaffolding, used to build the brain’s neurons. Previous research has shown that when the tau protein binds too much phosphate (hyperphosphorylation), it forms snarls that prevent the brain’s signals from effectively traveling.
These neurofibrillary tangles eventually choke the life out of neurons, killing off brain function a tiny piece at a time in what is outwardly recognized as degenerative brain disease.

The researchers suggests that overexpression ofRCAN1 is also connected to Amyloid beta (overproduction of the Amyloid betapeptide), a competing theory of neurodegeneration.

Further supporting the RCAN1 role are observationsthat it has been also shown to be chronically overexpressed from birth in thebrains of patients with Down syndrome. These patients develop neurofibrillarytangles and typically start to experience the onset of Alzheimer’s diseasearound age 40.

Sourcesand Additional Information:

http://www.myinnerchi.com/health_managing_stress.html

http://helpguide.org/mental/stress_signs.htm

http://www.psychologytoday.com/blog/alzheimers-hope-the-horizon/201003/stress-the-brain-aging-and-alzheimers-disease

http://www.alzheimersreadingroom.com/2011/02/can-stress-cause-alzheimers-disease.html

http://www.kurzweilai.net/how-chronic-stress-causes-alzheimers-other-brain-diseases

http://www.news-medical.net/news/20110728/Chronic-psychological-stress-linked-to-increased-risk-of-Alzheimers.aspx

How to Find Adult Day Care Center for Alzheimers Patient?

2011-12-10T23:35:00.001-08:00

Choosing an Adult Day Care Center

Your first step in looking for right AdultDay Health Care Center (ADHC) starts from checking out of what is availablein your area. Start your search with a call to your local Area Agency on Agingor to a local chapter of the Alzheimer’s Association, which keeps an updatedlist of adult day care centers throughout the country.

In addition to this resource for information, you can also try:

Your family doctor.
Local social services or health department.
Mental health centers.
Local senior center.
Area Agency on Aging (Call 1-800-677-1116 for the AAA in your area).
Yellow Pages listings under Adult Day Care, Aging Services, Senior Citizens' Services, and similar categories.

In general, there are three types of adult day care centers:

A social center, where activities and socialization are offered.
A medical/health center, where nursing or rehabilitation services are available for people who have come out of a hospital or who have a disease that needs to be monitored, as well as activities.
A specialized center that serves a specific population such as people with Alzheimer’s or other forms of dementia.

Specialized centers may be the hardest to find, but that doesn’t meananother type of center won’t offer the services you need. According to a 2010report by the Alzheimer’s Association, people with Alzheimer’s and dementiawere accepted at 95 percent of adult day care centers in 2009. Some statesrequire centers to be licensed or certified, but the regulations vary fromstate to state.

What to Expect From Adult DayCare

In general, adult day care centers are open five days a week duringnormal business hours, but some provide evening and weekend services. Programsvary from center to center, with most offering activities, meals and snacks,and assistance with using the bathroom and other daily living activities.Different centers offer different programs. For example, some might have agardening program and others may focus on art activities.

Some centers will provide transportation; if not, be sure that your lovedone is brought inside to a staff member at the center rather than dropped offat the curb. Otherwise, someone with Alzheimer’s could wander off.

Questions to Ask to Help You Findthe Right Center

Before you start making decisions about adult care services, talk to yourloved one, if possible. Ask him or her, what are the preferences in a center. Wheneverthey can be part of the decision-making, they should be, if that is reasonableto expect feedback from a patient based on the stage of the illness.

Once you’ve narrowed down your search to centers that you’d like tovisit, make a list of questions to ask each director. The more specific your questionsare, the better you will be able to understand how the facilities and servicesfit your needs and requirements.

Spend a day at the adult day care center that sounds best to you, so thatyou can get a "feel" for the people and the environment. Also, checkout references. Talk to others who have used the adult day care center and askfor their opinions.

You may wish to try out different adult day care centers a few times eachto see whether your experience on different days confirms your initialimpressions. Be sure to bring the following site visit checklist with you eachtime.

Checklist for Choosing an AdultDay Care Facility

Location of facility

Is the facility accessible?
Can individual get to facility?
Is transportation to the facility available?
Is there an extra charge for transportation?

How long has the day care facility been in business?
What days and hours is the facility open?
Is the day care licensed by the state health department or department of social services?
Has the state health department received any substantiated complaints about the care provided in the facility?
What is the cost of care? Hourly, daily, or weekly? Must you commit to a minimum amount of service, i.e., at least 2 days/week? Are all activities included in the cost?
Does the facility accept individuals who:

Are incontinent?
Are in wheelchairs?
Have memory loss?
Have difficulties in speaking?
Wander?
Have special dietary requirements?
Have behavioral problems?

What is the participant to staff ratio? Does this ratio meet state standards? What professional staff is available to help with care planning and concerns?
What activities are provided?

Are there individual and group activities?
Are the activities stimulating? Exercise, music, crafts, memory sharing, etc.
Are individuals with dementia separated from other participants or included in activities?

Does the facility provide other conveniences/benefits such as blood pressure checks, annual immunizations, hair styling services, bathing, dental check-ups, etc.?
What is the policy concerning late arrival or late pick-up?
Are the meals well-balanced and enjoyed by participants? Are meals included in the cost?
Is staff willing to spend time finding out what you want and need? Were the programs and activities explained?
Is the day care facility clean, odorless, and pleasant to visit? Does the facility have comfortable furniture for activities and for relaxation?
Do participants interact with each other? Do they seem to enjoy their time at the facility?
Is the staff pleasant to the participants?
Can the facility accommodate the following special physical or medical requirements:

Dispense medicine?
Give reminders about taking pills?
Assist with toileting or handle incontinence?
Provide total access and participation to wheelchair-restricted clients?
Effectively communicate with hearing impaired participants?

Is financial assistance available? Is there a sliding scale, Medicare, Medicaid, or other funding available to help you pay the cost?
How do they insure safety? How are behavior problems handled? Are there specific behaviors or care needs which would require your loved one's withdrawal from the program?

Sourcesand Additional Information:

http://www.medicare.gov/longtermcare/static/communityservices.asp

http://www.everydayhealth.com/alzheimers/adult-day-care-for-alzheimers.aspx

http://helpguide.org/elder/adult_day_care_centers.htm

Adult Daycare for Alzheimer's Patients

2011-11-29T20:23:00.001-08:00

Adult daycare is a rapidly growing service thatprovides valuable respite to caregivers as well as important mental and socialstimulation to people with early and mid-stage Alzheimer's. Programs varywidely in terms of their offerings and fees.

What is adult daycare?

The primary purposeof the adult daycare centers are to: prevent premature or inappropriateinstitutional placement of persons with moderate to severe levels of impairmentdue to dementia; provide support and respite for caregivers; serve as models ofthe optimum type and level of day care services that are needed by persons withdementia; make training opportunities available to professionals and otherpersons providing care and treatment for this population; and increase publicawareness and knowledge about Alzheimer's disease and related disorders.

The centers provideservices that support the physical and psychosocial needs of persons withAlzheimer's disease or related dementia. Individual care plans are developedfor each program participant with activities scheduled in accordance with theseplans. The overall objective is to keep the participants as healthy and activeas possible by helping them maintain their highest level of functioning and toimprove the quality of their lives while providing respite to caregivers.

Thus, adult daycare centers provide structuredactivities and therapy in a safe, supportive environment to adults who needmental and social stimulation. Typical daycare clients have lost a degree ofindependence due to normal aging, a medical crisis, or a chronic condition suchas Alzheimer's disease or other dementias, but they live alone or with acaregiver. Half of all users have cognitive impairment. As the name suggests,it's a day service, not a housing option.

This increasingly available type of eldercare may beaffiliated with (or run by) medical centers, nursing homes, assistive-livingfacilities, or other organizations either on site or at another facility (suchas a community center or church). Some are established as"stand-alone" private businesses. There are more than 3,500 adult daycenters in the United States.

Why should I consider adult daycare formy parent?

Adult daycare is a form of respite care that'sprovided outside the home by professionals (as opposed to in-home respitecare). It's designed to benefit both the person using the services and,especially in the case of Alzheimer's disease, that person's caregiver.

For the elder with Alzheimer's, adult daycareoffers:

A chance to get out of the house
A break from being with the caregiver
Interactions with other people
Stimulating activities
Other therapies as needed (such as physical therapy or speech therapy)
Possibly a delay in cognitive decline, in the early stages
Prolonged independent living

For the Alzheimer's caregiver, adult daycareprovides:

Stress relief, lessened depression
Predictable hours of relief in order to attend to personal needs, run errands, and release stress
The ability to continue caring for a parent at home
Cost savings over more expensive in-home care
Reduced guilt because the parent's independence is supported
An improved mood in the patient, making care giving easier
Possible family counseling or training through the center, to help cope

Programs run from several hours to a full day.Participants may attend daily, a few times a week, weekly, or just for specialactivities. Weekend and evening care are less common, although this is changingas demand for adult daycare rises. (All options vary by center.)

How is it different from a seniorcenter?

Senior centers tend to cater to a healthier, moremobile, and more independent clientele. Adult daycare programs generally offerservices that are more intensive. Some specialize in Alzheimer's disease, andstaff members have special education and/or training in working with geriatricclients and in managing behaviors characteristic of a disease like Alzheimer's.

What happens at adult daycare?

Programs typically include organized and supervisedhands-on activities that may involve:

Stimulating recreation (such as crafts, group conversation)
Music therapy
Art therapy
Sensory stimulation
Physical therapy
Occupational therapy
Speech therapy
Access to a library
Entertainment (such as music, movies)
Outings to museums, parks, or other local attractions
Support groups and counseling
Socialization activities
Personal and nursing care (including help in keeping up with medications)
Meals (usually lunch) and snacks

Activities are usually customized to individualneeds and abilities, but at the same time, there's an emphasis on groupparticipation. The setting is often homelike and comforting.

Additionally, some programs offer medically orientedcare for patients who need it (administering medication; caring for basicmedical or personal needs, such as podiatry services). Some offer counselingand educational services to caregivers and families.

Some adult day programs are connected withchildren's daycare centers. An advantage to this arrangement is thatintergenerational connections that are made. A potential disadvantage that someresearchers have found is that the adults can feel that they're being treatedlike children themselves, if the activities are largely child-centered.

Does a parent with Alzheimer's need aspecial kind of program?

Any daycare provides caregiver respite. But theideal type features services tailored to people with Alzheimer's. Some adultdaycare programs specialize in people with dementias of all kinds and stages,while others specialize more narrowly in early-stage Alzheimer's. In thesedementia-specific programs, you're most likely to find tailored activities andstaff who are specially trained in the disease. A 1991 study found thatAlzheimer's-specific daycare tended to provide more support for families and agreater emphasis on therapeutic recreation (rather than on clinical or rehabservices) than general adult daycare. Be aware, however, that there's nospecial licensing required for a facility to call itself an"Alzheimer's/dementia daycare."

Adult daycare is especially useful in the earlystage of Alzheimer's, when the afflicted person retains some good cognitive andsocial skills and might find it easier to become acclimated to the center andpeople there. There's also evidence that early stimulation of the type providedby adult day centers can slow cognitive decline.

Daycare is also useful in the middle stages ofAlzheimer's disease, when the burden of care becomes greater and caregiverburnout is a strong risk. People in the final stage of the disease tend to beunable to manage daily care tasks without help and are often nonverbal; whenthe burden of 24/7 care completely overwhelms, it may be a nursing home ratherthan respite care that the caregiver really needs.

Can both of my parents attend?

Many day programs accommodate both the adult withdementia and a partner without, or a couple whose members each have some kindof disability. If it's a dementia-specific program, though, your healthy parentmay feel out of place. In such cases, look into whether she might be able tovolunteer there. What's possible depends on the individual program.

Bear in mind that a key purpose of adult dayprograms is to provide relief for the caregiver. (And many nonprofit programsdescribed as "respite" obtain funding because of this.) If your wellparent is the main caregiver, she's supposed to be taking a break while herpartner attends. Even if your parents prefer being together, limited separationthrough a day program can benefit both of them.

What does adult daycare for a parentwith Alzheimer's cost? Who pays?

Daily fees range from $60 to $150 dollars per daybut can vary widely depending on the services provided, where you live and theneeds of the individual, according to the National Adult Day ServicesAssociation (NADSA). Most programs are nonprofits, which may cost less thanfor-profit programs. Ask if a center offers a sliding scale of fees based onincome.

Some places charge a fee per session; others chargemonthly "tuition." Many centers charge an added fee fortransportation, while some offer it free.

Social model day care services are usually paid forprivately. Some private insurance plans may cover some of the cost; check withyour plan's administrator or the facility to find out.

Medical day care services, which are usuallyaffiliated with a nursing home or health care provider, may be covered byprivate insurance or by Medicaid, provided your state's Medicaid plan includesit, the person needing care is eligible, and the facility participates. Contactyour local Medicaid office to find out. A few programs also accept Medicare ifthe person requires rehabilitative surgery, such as from hospitalization, butMedicare does not generally cover adult day care services. Otherwise, medicalday care must be paid for privately.

Are there any reasons not to like adultdaycare?

Some people hear the phrase "daycare" and,associating it with children's daycare, imagine being talked down to andbabied. Getting past suspicions and resentment can be a challenge. Run throughthe many benefits. Suggest a no-strings trial run: "Let's just go once andsee what it's like, Mom." You could also avoid describing it as"adult daycare" and find terms more palatable to your parent, such as"a senior club" or "therapy for people with early Alzheimer'sdisease."

Most participants quickly come to enjoy the newfaces and varied activity. Some, however, refuse to participate and may evenbecome belligerent or disruptive; in such cases, they're usually not allowed toreturn.

Sources and AdditionalInformation:

http://health.msn.com/health-topics/alzheimers-disease/adult-daycare-for-a-parent-with-alzheimers-a-beginners-guide

http://www.aging.ca.gov/programs/adcrc.asp

http://www.alzinfo.org/08/treatment-care/adult-day-care

http://www.webmd.com/alzheimers/guide/caregiving-adult-day-care

Bacopa Preventing Alzheimer’s and Dementia

2011-11-19T23:50:00.001-08:00

What is Bacopa?

An extract of a little-known herb called Bacopa can dramaticallyincrease your brain function and memory — and may even help prevent dementiaand Alzheimer’s disease. Its therapeutic use has its origins from traditionalAyurvedic medicine in India, where it has been used for its adaptogenic,tranquilizing and antioxidant properties.

Bacopa is a creeping perennial herb that can be found in Nepal, China,India, Sri Lanka, Taiwan, Vietnam and some parts of the United States,including Hawaii, Florida and other Southern states. Bacopa (also called Bacopamonnieri or brahmi) thrives in wetlands, on muddy shores and around pondsor bog gardens. Be careful not to confuse brahmi (Bacopamonnieri) with gotu kola and other natural medicines that are also sometimescalled brahmi.

Used in India for thousands of years for both traditional and medicinalpurposes, Bacopa had a central role in religious consecration ceremonies forinfants: The botanical was believed to open a gateway to intelligence forchildren.

Bacopa herb contains many compounds including bacopasaponins such asbacoside A, bacopaside II, bacopaside I, bacopaside X, bacopasaponin,bacopaside N2 and minor components bacopasaponin F, bacopasaponin E, bacopasideN1 bacopaside III, bacopaside IV and bacopaside V. The total saponin content insamples, plant materials and extracts vary from 5 to 22%. Dammarane-typetriterpenoid saponins classified as pseudojujubogenin and jujubogeninglycosides are reported as some of active components in this plant.

Shamanic Memory

Researchers may first have been intrigued by Bacopa monnieribecause of the effect they believed it had on ancient shamans, who reportedlyused the herb to help them memorize epic poems. Researchers theorized thatperhaps the Bacopa plant enhanced the shamans’ brain function and improvedtheir memory, concentration and recall. It’s no wonder researchers suspected alink, since some of these epic poems — when they were finally written down —exceeded 900 pages, and the shamans could recite them word for word!

Mind Booster

Today, modern science is confirming traditional wisdom about Bacopa. Inresearch conducted in Australia and the United States, Bacopa improved studysubjects’ ability to retain new information — and it also helped them increasetheir visual processing speed in as little as three weeks.

Research into the benefits of Bacopa includes:

A study by the psychology department at the University of Wollongong in Australia that demonstrated Bacopa could increase memory and recall ability.
Research in 1996 presented at the International Brain Research Conference that showed that Bacopa reduced the time needed to learn new tasks by almost half. Participants taking Bacopa mastered mental exercises in as little as six days compared to 10 days for the control group.
An extensive 2001 rigorous, randomized double-blind, placebo-controlled experiment in Victoria, Australia confirmed the herb’s benefits for learning. After 12 weeks, those taking Bacopa scored significantly better on all higher order cognitive processing tests.

Bacopa monnieri has beenextensively tested and proven as a memory and concentration enhancer, but thebenefits of Bacopa extend to other mental and emotional functions, as well.
In many areas of the world, Bacopa is also used to treat:

Depression
Stress
Anxiety
Attention Deficit Disorder
Epilepsy
Alzheimer’s disease
Mental deficiency

Bacopa MayCombat Cognitive Decline

In addition to its short-term cognitive benefits, Bacopa may also preventlong-term cognitive decline. A study in the Journal of Alternative andComplementary Medicine showed that elderly participants who used 300 mg perday of Bacopa demonstrated improved mental functions in comparison to a placebogroup. Improvement was most profound in the areas of attention andverbal-information processing — and researchers concluded that Bacopa could beeffective in preventing cognitive decay.

Since research has shown a link between mild cognitive decline andeventual dementia and Alzheimer’s disease, preventing even mild memorydifficulties may play an important role in warding off those memory-relateddiseases that are so prevalent among baby boomers and elderly people.

News of the many health benefits of Bacopa recently seeped intomainstream news. In his TV show on May 30, 2011, Dr. Mehmet Oz (also known as“America’s Doctor”) recommended Bacopa for brain health. Dr. Oz said, “BacopaMonnieri will make you smarter, enhance your memory and help you focus better.”

Mechanism ofaction

Bacopa contains bacosides A and B, which enhance neuron repair and speed upinformation transfer between brain cells. This herb also has powerful antioxidantproperties which protect the brain cells from damage.

The mode of action of brain cell protective effects is due to theantioxidants that suppress neuronal oxidative stress and theacetylcholinesterase inhibitory activities. Treating patients with bacopaextract may be a way to treat neurodegenerative disorders associated withoxidative stress as well as perhaps Alzheimer's disease.

There is some evidence to suggest that itmight relax muscles in the blood vessels, airways, and the small intestine. Itmight also act as a tranquilizer to promote relaxation as well as a painreliever.

How to UseBacopa

Adults can use a dosage of Bacopa herb between 200 mg to 500 mg a fewtimes a week. Many preparations are in the form of extracts with variouspotencies. If you buy a bacopa extract product, your dosage would be less thanthat of the regular bacopa powder. How much less depends on how potent andconcentrated the extract.

A 225 mg tablet of Bacopa taken up to three times daily is recommendedby many health practitioners, although consultation with a qualified herbalistis advised to determine your ideal dosage.

To be most effective, Bacopa extract is usually taken in the recommendeddosage daily for 12 weeks. In low doses, Bacopa is mild and non-addictive.Although overdose is uncommon, Bacopa has been known to be toxic in very highdoses, so caution is advised. However, it is reported that any symptoms oftoxicity will immediately subside once Bacopa supplementation is discontinued.

Bacopa is relatively inexpensive and can be found at health food storesand through a variety of online retailers.

Precautions and SideEffects

Women who are pregnant or nursing should first talk to their doctorbefore taking. Bacopa also may cause sleepiness if taken in high doses.

Sources andAdditional Information:

http://www.easyhealthoptions.com/alternative-medicine/bacopa-may-help-prevent-alzheimers-and-dementia/

http://www.bacopa-monnieri.com/

http://www.holistic-herbalist.com/bacopa.html

http://www.herbslist.net/bacopa.html

http://www.webmd.com/vitamins-supplements/ingredientmono-761-BRAHMI.aspx

Validation Approach to Alzheimer’s Patients

2011-11-09T23:26:00.001-08:00

Basics

Validation is amethod of interacting with the dementia of people in the late stages ofAlzheimer's. People with Alzheimer's, especially on the late stages, frequentlyexhibit abnormal, sometimes even incomprehensible, behavior. For example, theymay think they are living in a different time or place or they may continuouslyrepeat a physical gesture. Many people - including professionals - feel thatcaregivers should handle this behavior by stopping it, ignoring it orcorrecting it.

According tovalidation method developer Naomi Feil, this unconventional behavior, whileillogical, is an attempt by the Alzheimer’s sufferer to communicate and expresstheir needs. The aim of the validation method is to understand and empathizewith the needs the person is trying to express. So, the theory behindvalidation is the belief that people with dementia do and say things for areason, and validating their words and actions is a way of encouraging them tokeep communication open with the rest of the world. Another foundationalprinciple of validation states, that older people are to be valued as is, andthose with dementia should not be changed.

Principles

Here are the keytenets of the Validation Method:

Validation is a method of communicating with and helping disoriented very old people. It is a practical approach that helps reduce stress, enhance dignity and increase happiness. Validation is built on an empathetic attitude and a holistic view of individuals. By stepping into the shoes of another human being and seeing the world through their eyes, caregivers can step into their world and better understand the meaning of their sometimes bizarre behavior.
Validation theory understands that these patients are often in the final stage of life and trying to resolve unfinished issues in order to die in peace. Validation techniques allow patients to have the opportunity to express what they wish to express verbally or non-verbally.
Validation practitioners are taught to be caring, non-judgmental and open to the feelings that patients expressed, believing that when patients can express the things that have often been suppressed for many years, the intensity of the feelings lessen, they communicate more and are less likely to withdraw into further stages of disorientation.

Effects

The way to validate a person that is suffering from dementia is to figureout why they do and say what they do in details, and to accept this behavior.Using validation methods of interaction is thought to prevent late stageAlzheimer's patients from shutting down further mentally, keeping theircognitive function active as much as possible. Validation encouragesAlzheimer's patients to forge a trust with their caregivers as a means toencouraging communication between the two.

By lending an understanding ear to someone with Alzheimer's to verbalize theirfrustrations, worries and fears, the negative emotions can diminish. This willcontribute to better cognitive functioning and behavior.

In her article “Communicating with the Confused Elderly Patient,” Naomi Feilgives practical examples of the how the validation method works to helpcommunication between patient and caregiver. The following material is anexcerpt from this article:

The following scenario, based on actual case experience, depicts a lesseffective way of responding to disorientation.

Mrs. K: “Doctor,I have to go home now to feed my children.”

Physician: “Mrs.K, you can’t go home. Your children are not there. You are 96 years old. Yourchildren are grown and live far away.”

Mrs. K.: “Oh,Doctor I know all that. That’s why I have to get out of here, right now. I haveto feed them. They’re coming home for lunch, and the door is locked. Get me outof here!”

The following response may be more appropriate, because it focusesinstead on the objective here and now and avoids asking why - a concept thatdisoriented older people may not wish or be able to deal with.

Mrs. K.: “Doctor,I have to go home now to feed my children.”

Physician: “Whatwill you feed them?”

Mrs. K.: “Oh,Doctor, I am a good mother.” (The patient here confuses present and past time.)“They love tuna. Do you think that’s good for them?”

Physician: “Ithas a lot of protein. Is that what you fed your children? Do your grandchildreneat tuna?”

Mrs. K.: “Theylove it. I brought them all up right!” (The patient now moves between pastfantasy and present reality. When her need to be a good mother is expressed,she can place herself in present time.)

Express the emotional need of the person aloud, thereby affirming theperson’s right to feel and to express feelings. Example:

Mrs. K.: “Doctor,I have to feed my children.”

Physician: “Youmust have been a good mother. You must miss your children.”

Mrs. K.: “You knowit. I always cared for them. Whatever they wanted, I gave them. You guessed it.But I get along all right now without them.”

Dimensions

As a caregiver, youhave been introduced to a new and different world - the world of dementia.People who inhabit the world of dementia are in a very different place thanthose of us who live in "Reality" (whatever that is).

Time. The first dimension in the Alzheimer’s Universe is Time. Time in the world of dementia operates completely differently than time does for the rest of us. First, time is not sequential in the dementia universe. Time can be present at one moment, past at another and future at another. Time has absolutely no continuity.

Memory. Memory is very different in the world of dementia. Past may be confused with present. Memory may be there one moment and gone the next. The mind plays hurtful tricks in the world of dementia - making a known and loved child or spouse into a stranger to be feared. Family may no longer be family. As much as we in the "Real" world know that this is our mother or wife or husband, the person in the dementia world does not know these "Realities". S/he only knows what they know at any given moment. It is so hard to accept their dementia world.

It is so different from what we know in the "Real" world. Yet,there is no successful alternative but to accept whatever the dementia personclaims as their reality - no matter how untrue it is to us. There is nosuccessful way to "force" a person with dementia to join the"Real" world. Usually, the most frustrated caregivers are the oneswho have not accepted this simple fact: the world of dementia is defined by thedementia victim. We in the "Real" world do not define it. We can onlyhope to live in it somewhat peacefully IF AND ONLY IF we accept this dementiaworld on the terms of the person with dementia. If they "see" arabbit on the couch, they see it. If you are not their spouse, you are not. Ifit is breakfast time, it is breakfast time (even at 6 p.m.).

Telling the dementia person that "I am too your wife" or"No, John, it IS NOT Friday. It is Sunday." Or saying, "Sally,you don't have any little babies. You are 85. Your babies are all grownup" - these kinds of statements from the "Real" world almostalways serve only to upset and distress the dementia person. However, if yousay something like, "If you say so, but I'd like to be your friend. .." or "It's your Friday, huh? What do you do on Fridays?" or"Sally, tell me about your babies."

Emotions. Emotions are also very different in the dementia universe. First, consider that the dementia person's reasoning abilities are very limited or perhaps gone completely. There are actual changes in the brain that affect a dementia person's ability to think. So, they are somewhat like a pre-schooler in their ability to assess, judge, make decisions, etc. Most dementia folks have some difficulty in understanding the spoken language. However, almost all dementia folks can easily pick up on the FEELINGS being expressed. It is very true that in the dementia universe, it is NOT so much what you say, but HOW you say it. When frustration, anger, and loudness creep into your voice, the dementia person is going to feel that much more strongly than the actual words being said.

Types

There are physical,mental and social aspects of validation. Some Alzheimer's validation techniquesinclude:

Centering. Centering is necessary in order to feel empathy for someone with dementia. To become centered, one must disregard personal feelings and thoughts in the mind.
Mirroring. Mirroring is adopting similar actions, tone, and volume of voice of someone. This technique is based on the human behavior theory that people like, trust and feel comfortable with people that are similar to them. Mirroring is not imitating or mocking. For example, if someone is leaning in close to speak to you with a calm and low voice, then you would also lean in close and use a low tone of voice.
Physical Touch. Physical touch is used to foster a relationship and trust with someone with Alzheimer's. This technique can be used in subtle ways over time to foster communication with someone that tends to withdraw.

Features

Alzheimer'svalidation is comprised of four parts:

The behavior of people with dementia is specific to their age. They are trying to tie up the loose ends of their life's issues before they die.
Validation puts the behavior of people with Alzheimer's into four stages:

Malorientation involves minimal forgetfulness and confusion;
Time confusion involves losing the ability to distinguish chronological time;
Repetitive motion--when Alzheimer's patients can't use their words, they resort to repetitive motion to solve problems;
Vegetation, or blocking out the rest of the world and ceasing to try to resolve their life issues.

Validation should employ techniques related to the mental, physical, emotional and social aspects of Alzheimer's.
Five to 10 people should make up the validation group with the goal of providing stimulation and communication with the person suffering from Alzheimer's.

Benefits

Employing validationtechniques has the following benefits for Alzheimer's patients:

Fewer incidents of lashing out physically;
Less of a need to be physically restrained;
Less of a need to be calmed down with medication or tranquilizers;
Improved communication;
The speed of Alzheimer's disease progression is slowed;
Increased self-esteem and value of self.

History

Naomi Feil, anexpert on Alzheimer's disease, is credited with founding validation therapy.She was born in Germany in 1932 and raised in a Cleveland, Ohio, home forthe elderly. Her mother worked in social services and her father was thedirector of the elderly home. She developed validation as an alternative totraditional methods of interaction with elderly people with dementia. TheValidation Method is a globally acclaimed protocol for care published in her1982 book, Validation: The Feil Method. Feil’s philosophy fordementia care is holistic and based in her understanding that unusual behaviorsexpressed by dementia sufferers are often due to a combination of cognitive,physical and social losses, and represent an attempt to express unresolvedfeelings and emotions.

Sources and Additional Reading:

http://www.ehow.com/about_4598311_alzheimers-validation.html

http://www.parentgiving.com/elder-care/alzheimers-caregiving-with-the-validation-method/

http://www.alzwell.com/validation.html

http://www.ec-online.net/community/Activists/difficultbehaviors.htm

http://www.alzheimersreadingroom.com/2007/07/alzheimers-validation-therapy-and.html

How to Manage hallucinations and suspicion in Alzheimer’s Patients?

2011-10-31T23:42:00.000-07:00

Alzheimer’s and Hallucinations

People withAlzheimer's disease may see, hear, smell, taste, or feel things that are notreally there. The most common hallucinations are those that involve sight orhearing. Some people with Alzheimer's disease develop strange ideas about whatis actually happening and may come to believe that other people want to harmthem. This kind of belief is called a delusion.

These symptomsare usually thought of as being caused by mental illness, but they are actuallyfairly common in Alzheimer's disease, especially in the middle stage, althoughthey can occur at other stages. There may be many causes mostly having to dowith the parts of the brain affected by the disease. In any case, it isimportant not to be frightened by what are irrational thoughts and experiencesand to know how to respond to them. Maintaining sameness and calmness inthe environment can help reduce hallucinations. Also, violent movies ortelevision can contribute to paranoia, so avoid letting the patient watchdisturbing programs.

A number ofsymptoms of Alzheimer’s disease are labeled as "psychotic,"hallucinations being one of them. Around 18 percent of people with Alzheimer’sdisease experience hallucinations, and they are more often reported in peoplewith a later disease onset. For the majority these are visual, for others theyare auditory, with some having both. Experiencing hallucinations normally lastsfrom one to two years and occurs in line with declining cognitive functions.

Some hallucinations are temporary, do not cause long-term difficulties, and areunrelated to mental illnesses. Sometimes, though, they can represent a majorproblem and specific treatment is needed. In addition to the dementia itself,there could be other causes for hallucinations including physical illness,fever and medications. In fact, many healthy people experience brief hallucinationsat some time in their lives. But since they can 'test reality' or solveproblems accurately, they are aware that these are not real, and as such, notworrying. People with dementia may not be able to do this accurately.

Monitor and analyzeany factors which may contribute in changes to the patient’s behaviors, suchas:

Sensory defects such as poor eyesight or poor hearing.
Side effects of some medications.
Psychiatric illness as part of multiple diagnoses.
Recently changed and unfamiliar environment.
Inadequate lighting, making visual clues less clear.
Physical conditions such as infections, fever, pain, constipation, anaemia, respiratory disease, malnutrition, dehydration.
New and unfamiliar caregivers.
Disruption of familiar routines.
Misinterpretation of environmental cues often a result of forgetting to use a hearing aid or glasses.
Sensory overload because of too many things going on at once.

Possible Reasons forHallucinations?

Lewy Bodies

Alzheimer’sdisease brains show disc-shaped plaques outside brain cells called neurons, andneurofibrillary tangles inside them. However, there is debate about whetherthese are the cause of hallucinations. There is better linkage betweenhallucinations and "Lewy Bodies," round masses inside neurons. DebbieTsuang, in the American Journal of Geriatric Psychiatry's April 2009 edition,found these in nearly 2/3 of patients with visual hallucinations. A review byAntony Harding in the February 2002 edition of Brain, detailed how Lewy Bodieswere shown in brain areas affected by Alzheimer’s disease, such as thehippocampus and amygdala, which are involved in emotional interpretation. LewyBodies are more often seen in Parkinson’s disease and dementia with LewyBodies--where hallucinations are one symptom. Harding suggests people withAlzheimer’s disease with hallucinations may also have one of these disorders.

The Occipital Lobe

The occurrence ofvisual hallucinations is not related to defects in the eyes or retinalconnections to the brain, although visual problems may exacerbatehallucinations. Shu-Han Lin discusses in the November-December 2006 edition ofClinical Imaging how instead hallucinations are associated with a decreasedoccipital lobe, which is involved in visual interpretation. This has led some,including Suzanne Holroyd in the Journal of Neuropsychiatry and ClinicalNeurosciences Winter 2000 edition to propose that hallucinations are due todamage to brain regions involved in vision and those that interpret visualsignals, including the occipital lobe, the amygdala and the hippocampus.

Genes

APOE4 is one formof the gene for the protein apolipoprotein E, normally involved in neuronalfunctioning. APOE4 is found in around 15 percent of people and causesfunctional problems with apolipoprotein E, leading to an eight-fold risk fordeveloping Alzheimer’s disease. Study results are mixed regarding whether APOE4is involved in the development of hallucinations. While the Tsuang study abovedidn’t find an association, another, by Kristina Zdanys inNeuropsychopharmacology's January 2006 edition, found APOE4 associated with anincreased risk of “visual disturbances.”

Another gene possibly involved in hallucinations is for the proteinbrain-derived neurotrophic factor, or BDNF, which is involved in dynamicneuronal changes. There are decreased amounts of BDNF in Alzheimer’s disease,in line with disease severity. One form of the BDNF gene was reported byKristina Zdanys in the Journal of Alzheimers Disease July 2009 edition to besignificantly linked to increased occurrences of hallucination.

A third gene is for one of the neuronal receptors for the brain neurochemicalserotonin, called 5HT2A. Stimulation of this receptor can cause hallucinations,and a study by Antonia Pritchard in Neurobiology of Aging's March 2008 editionfound a small association between hallucinations and one form of the 5HT2Areceptor.

How to Manage Hallucinations inAlzheimer’s Patients?

When hallucinations or illusions do occur:

It is essential that you do not tell the person who is seeing or hearing things that you know what he sees is not real because the things are real to the person.
Discuss the patient’s feelings relative to what they imagine they see.
Respond to the emotional content of what the person is saying, rather than to the factual/fictional content.
Reassure the person that you will keep him safe and try to understand the emotion behind the hallucination or delusion.
Physical contact may be reassuring as well, but be sure that the person is willing to accept this.
Hallucinations or false ideas may be harmless, and they are sometimes best ignored or accepted. If they don’t upset the person experiencing them, there may be no need for intervention. But be sure to report delusions and hallucinations to the person’s doctor to rule out physical or psychiatric illness.

This may beenough to enable the person to let go of these concerns, at least for themoment. If the hallucination is pleasant and the person is planning a birthdayparty, try to connect to her by joining in the fantasy. You do not need to saythat you see or hear the same things but you can accept that the person does. Seek professional advice if you are concerned about thisproblem, and you feel it goes out of proportions. Medications can sometimeshelp to reduce hallucinations, and managing the prescriptions my easy theproblem or even make it go away.

Alzheimer’s and Suspicion

People withAlzheimer's disease may also become suspicious and may accuse someone ofstealing from them when they cannot find something. When the person withdementia does not remember where he put something, the idea that it has beentaken by someone may appear to be a reasonable explanation for its beingmissing. Tell him you will help him look for it, and try not to mention thefact that he is the one who misplaced it. He may feel relieved when the objectis found.

Paranoia inpeople with Alzheimer's disease appears as unrealistic beliefs, usually ofsomeone seeking to do them harm. They may hoard or hide things because theybelieve someone is trying to take their possessions. These symptoms can be verydistressing both for the person with AD and for you. Remember, what the personis experiencing is very real to him. It is best not to argue or disagree.

Try not to take unjust accusations personally. In this situation it is best to offer to help the person to find the missing item. It will not be helpful to try to convince him that his explanation is wrong or based on his poor memory.

Offer a simple answer to any accusations, but don’t argue or try to convince them their suspicions are unfounded.
Distract the patient with another activity. Distractions which may help include music, exercise, activities, conversations with friends and looking at old photos.
If suspicions of theft are focused on a particular object that is frequently mislaid, such as a wallet for example, try keeping a duplicate item on hand to quickly allay the patient’s fears.
Keeping a diary may help to establish whether these behaviors occur at particular times of the day or with particular people. Identifying such causes may help you to be able to make changes to overcome the difficulties.

When thesebehaviors do not respond to supportive caregiving techniques it may benecessary to consider medication, especially if the person is very upset orputs himself or others in danger because of his symptoms. These symptoms aresometimes caused by depression, which often accompanies Alzheimer's disease.Consult with your physician, who may recommend an antidepressant medication.Other medications, called anti-psychotics, are frequently prescribed. Theyshould be used with caution and sensitivity.

Sources and AdditionalInformation:

http://helpguide.org/elder/alzheimers_behavior_problems.htm#hallucinations

http://www.caring.com/articles/alzheimers-disease-paranoia

http://203.89.197.244/services/hallucinations--false-ideas.aspx

http://www.dementiamanagementstrategy.com/Pages/ABC_of_behaviour_management/Management_strategies/Hallucinations__delusions_and_paranoia.aspx

http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=172

http://www.livestrong.com/article/161568-what-causes-hallucinations-in-alzheimers-patients/

Long-term Ecstasy use as Risk Factor for Alzheimer's

2011-10-23T21:06:00.000-07:00

What is Ecstasy?

The drug known as Ecstasy, X, or Adam has become arelatively common drug among adolescents today. Ecstasy is known as 3,4-methylenedioxymethamphetamine or MDMA for short. It is a synthetic drug thatcan act as both a stimulant and hallucinogenic drug that enhances sensoryprocessing, increases sexual sensations, and creates euphoric mood elevationsin the user. MDMA is known to cause major changes the level ofneurotransmitters in the brain, such as serotonin and dopamine, which controlour mood and behaviors.

Serotonin (5-Hydroxytrptanamine, 5HT) and dopamine arechemical mediators that are released in synaptic gaps of neurons. Theseneurotransmitters excite the post-synaptic membranes of neurons allow for themillions of neurons in the central nervous system to communicate with oneanother. Serotonin is a central neurotransmitter that is released from themid-brain region, where the cerebral hemispheres and thalamus-hypothalamus arebridged to the spinal cord. Serotonin receptors are present mostly in thesmooth muscle and central nervous system. The role of serotonin in the body isto regulate mood, sleep, and stimulate or inhibit the release of particularhormones in the body. Amphetamines such as MDMA cause the release of serotoninin the body, creating a heightened sensory experience for the drug user.

The drug came on my monitor last week, when I researched forthe potential link between Ecstasy and Depression, taking in accountthat there are multiple ongoing researches, trying to design a newEcstasy-based drug, which will be safe and efficient in treating PTSD(post-traumatic stress disorder). In this post, I would like to review thesuggestion, expressed by some medical professionals, that the long-term Ecstasyuse may cause the irreversible brain damage, which may potentially triggerAlzheimer’s Disease.

Brain Damage andAlzheimer’s Risk

A study fromVanderbilt University has found physical changes in the brains of Ecstasy usersthat suggest that their brains are not functioning as efficiently as they oncedid. These changes did not disappear after a year of abstinence fromEcstasy. Ecstasy use is associated with a loss of serotonin signaling, whichleads to hyper-excitability in the brain.

Ecstasy or MDMA (3-4-methylenedioxymethamphetamine), is aman-made drug. It is used as a recreational drug and known as a club drugbecause of its amphetamine-like and hallucinogenic properties. It is classifiedas a stimulant. Ecstasy produces changes in brain chemistry. But these may notbe the type of changes its users are after.

The Vanderbilt study found increased brain activation inthree brain areas associated with visual processing in subjects with thehighest lifetime Ecstasy use. The researchers interpret this as signs ofhyper-excitability in these regions of the brain — the need for more brain tobe used to perform a task, which means a loss of brain efficiency.

In discussing the Vanderbilt study, Dr. Ronald Cowan, whoheaded the Vanderbilt study, says that its results are what were expected,based on previous animal studies: Ecstasy use is associated with a loss of serotoninsignaling, which leads to hyper-excitability in the brain.

The study was of 20 long-term Ecstasy users, all of whomwere abstinent for at least two weeks before the study, and 20 non-users. Allunderwent fMRI (functional magnetic resonance imaging) scans during visualstimulation. The researchers looked at three brain areas: the visual systemlateral geniculate nucleus and Brodmann Areas (BA) 17 and 18.

The scans showed a direct, linear relationship betweenlifetime Ecstasy use and activation in all three brain regions — the moreEcstasy a subject had taken during their life, the greater was the activationseen in all three brain regions. The heaviest Ecstasy users also showed agreater spatial extent of activation (more of the region was active) in BA 17and BA 18.

Dr. Cowan interprets this increased activation as a sign ofa less functional brain. Cowan points out that this pattern ofhyper-excitability is similar to that seen in studies of individuals at riskfor or with early Alzheimer's disease. He says this does not mean that Ecstasyusers are at risk of dementia, but that there's a loss of brain efficiency inboth Ecstasy users and early Alzheimer's patients.

"We think this shift in cortical excitability may bechronic, long-lasting, and even permanent, which is a real worry," Cowansaid. The results of this study appeared in the May 2011 issue of Neuropsychopharmacology.

This comes on the heels of another study published in March 2011that found a definite brain drain in ten long-time Ecstasy users: theirhippocampus measured, on average, more than 10% smaller than that of non-users.That study was published in the Journal of Neurology, Neurosurgery andPsychiatry.

Several previous researches have suggested that people whouse ecstasy can develop serious memory problems, so a team of Dutch researchersdecided to investigate whether the drug caused structural changes in the brain.They used MRI scans to measure the volume of the hippocampus in 10 men in theirmid-20s who were long-term ecstasy users and seven men in the same age groupwho had never used the drug.

The hippocampus is the area of the brain responsible forlong-term memory. On average, the ecstasy users had not taken the drug for morethan two months before undergoing the MRI scans, but had taken an average of281 ecstasy tablets over the previous six and half years. The scans revealedthat ecstasy users had an average of 10.5 percent less hippocampal volume thannon-users. The users also had an average 4.6 percent lower overall proportionof grey matter in the brain, which suggests that the effects of ecstasy may notbe limited to the hippocampus.

"Taken together, these data provide preliminaryevidence suggesting that ecstasy users may be prone to incurring hippocampaldamage, following chronic use of this drug," the researchers wrote in ajournal news release. The researchers noted that atrophy of the hippocampus"is a hallmark for diseases of progressive cognitive impairment in olderpatients, such as Alzheimer's disease."

No Brain Damage fromEcstasy

In his presentation, Dr. Cowan expressed his concerned oversome recent media coverage of Ecstasy — pieces reporting on possibletherapeutic uses of Ecstasy in PTSD sufferers that suggest that some ofEcstasy's negative effects have been overstated.

"There's tension in the fields of psychiatry andpsychotherapy between those who think Ecstasy could be a valuable therapeuticthat's not being tested because of overblown fears, and those who are concernedabout the drug's potentially harmful effects," Cowan said in a universitypress release.

A new study led by Professor JohnHalpern of Harvard Medical School, one of the studies Dr. Cowan referred to,suggested that many previous researches made overarching conclusions frominsufficient data and exaggerated the drugs dangers. Professor David Halpernwas critical of previous investigations which had linked the use of ecstasy tobrain damage and said, "Too many studies have been carried out on smallpopulations, while overarching conclusions have been drawn from them".

He went on to say, "For a start,some previous research has studied users who were taken from a culturedominated by all-night dancing, which thus exposed these individuals to sleepand fluid deprivation – factors that are themselves known to producelong-lasting cognitive effects. Non-users were not selected from those from asimilar background, which therefore skewed results".

Halpern added, "In addition, paststudies have not taken sufficient account of the fact that ecstasy users takeother drugs or alcohol that could affect cognition or that they may havesuffered intellectual impairment before they started taking ecstasy".

Professor David Halpern explained thenew study outcomes: "Essentially compared one group of people who dancedand raved and took ecstasy with a similar group of individuals who danced andraved but who did not take ecstasy. When we did that, we found that there wasno difference in their cognitive abilities".

Summary

While the results of the studies on thepotential danger of Ecstasy use to the brain are quite controversial, I still wouldnot advocate it for medical and recreational purposes and for itsdecriminalization. The main reason is that for some people, MDMA can beaddictive. A survey of young adult and adolescent MDMA users found that 43percent of those who reported ecstasy use met the accepted diagnostic criteriafor dependence, as evidenced by continued use despite knowledge of physical orpsychological harm, withdrawal effects, and tolerance (or diminished response).These results are consistent with other studies that suggest a high rate ofMDMA dependence among users. MDMA abstinence-associated withdrawal symptomsinclude fatigue, loss of appetite, depressed feelings, and trouble concentrating.

Sources and AdditionalInformation:

http://serendip.brynmawr.edu/bb/neuro/neuro98/202s98-paper1/Kyin.html

http://www.thedoctorwillseeyounow.com/content/mind/art3317.html

http://www.19actionnews.com/story/14402184/long-term-ecstasy-users-at-risk-for-brain-damage-study-warns

http://www.mixmag.net/ecstasy-brain-damage

http://www.drugabuse.gov/infofacts/ecstasy.html

Kirtan Kryia Meditation to Prevent Alzheimer's Disease

2011-10-10T23:05:00.000-07:00

Meditation is one of the approaches, gradually getting widerecognition as a common way to improve mental and physical health and generalwellbeing. But is it effective in helping to prevent and combat disastrouseffects of Alzheimer’s disease to the human brain? Could meditation substantially increase brainactivity and improve memory and cognition in people who already haveAlzheimer’s disease? People who practice mediation will ultimately affirm itshealing effects. But is there are any scientific researches, which can confirmthe statement as way?

In this post, wewill review the result of several investigations on how Kirtan Kriya type ofmeditation can play a positive role in preventing, delaying, or even reversingAlzheimer’s disease.

What is meditation?

The word meditation is derived from two Latin words:meditari (to think, to dwell upon, to exercise the mind) and mederi (to heal).Its Sanskrit derivation 'medha' means wisdom.

Meditation is defined as an activity where one will "engagein contemplation or reflection; or to engage in mental exercise (asconcentration on one’s breathing or repetition of a mantra) for the purpose ofreaching a heightened level of spiritual awareness (Merriam-Webster,2009)." This definition is technical; a more personal definition ofmeditation is to let the mind empty and rest, with a following centeringexercise.

Meditation is not a technique but a way of life. Meditationmeans 'a cessation of the thought process’. It describes a state of consciousness,when the mind is free of scattered thoughts and various patterns. The observer(one who is doing meditation) realizes that all the activity of the mind isreduced to one.

Once, a Tibetan Lama was being monitored on a brain scanmachine by a scientist wishing to test physiological functions during deepmeditation. The scientist said - "Very good Sir. The machine shows thatyou are able to go very deep in brain relaxation, and that validates yourmeditation". "No", said the Lama, "This (pointing to his brain)validates the machine!”

What is Kirtan Kriya meditation?

Kirtan Kriya (pron. Keertun Kreea) is a type of meditationfrom the Kundalini yoga tradition, which has been practiced for thousands ofyears. This meditation is sometimes called a singing exercise, as it involvessinging the sounds, Saa Taa Naa Maa along with repetitive fingermovements, or mudras. This non-religious practice can be adapted toseveral lengths, but practicing it for just 12 minutes a day has been shown toreduce stress levels and increase activity in areas of the brain that arecentral to memory.

In Sanskrit, a kirtan is a song, and kriyarefers to a specific set of movements. In the Eastern tradition, kriyas areused to help bring the body, mind and emotions into balance to enable healing.

The mantra that is repeated while practicing Kirtan Kriya isdesigned to be uplifting.

Saa means birth or infinity
Taa means life
Naa means death or completion
Maa means rebirth

From an Eastern perspective, it isbelieved that the placement of the tongue on the roof of the mouth while makingthese sounds stimulates 84 acupuncture points on the upper palate. This causesa beneficial bio-chemical transformation in the brain. In addition, Westernresearch has revealed that utilizing the fingertip position in conjunction withthe sounds enhances blood flow to particular areas in the motor-sensory part ofthe brain.

Research findings: Kirtan Kriya meditation andAlzheimer’s

The recent decade of research has demonstrated the substantialpositive impact of Kirtan Kriya meditation on the brain. Following arehighlights from some of our recent and ongoing research:

The foundation conducted the first-ever study on the impact of meditation on people with memory loss, which was published in 2010 in the Journal of Alzheimer's Disease. The study found that Kirtan Kriya, performed 12 minutes a day for eight weeks, increased brain activity in areas central to memory and improved cognition and wellbeing in patients with memory loss.
Another study, which was published in 2009 in the journal Nuclear Medicine Communications, examined 11 healthy individuals in both a resting and meditative state. The study found that Kirtan Kriya causes significant increases in brain activity especially in the posterior cingulate gyrus (PCG) compared to baseline. Both of these areas of the brain are central to memory. The PCG is a critically important anatomical area, because it is the first part of the brain to decrease in function when a person develops Alzheimer's disease. Perhaps it's possible, therefore, that if everyone did Kirtan Kriya and activated their PCG on a regular basis, the number of people who develop Alzheimer's would diminish.
In the December 2010 issue of Consciousness and Cognition, a study was published comparing cerebral blood flow (CBF) in 12 advanced meditators with that of 14 non-meditators. The study findings support the notion that long-term meditation is associated with higher activity in the frontal areas of the brain, which help mediate attention, emotions and memory.
In the January 2011 issue of Psychiatry Research: Neuroimaging, another ground-breaking study was published. It revealed that different meditation practices actually changed brain blood flow in different brain areas. It was also the first study to show that there are blood flow changes correlated with the personal experience of the practitioner. This study highlighted that this practice can be used as meditation as medicine. This means that the study showed that different techniques may be prescribed for separate health conditions, from trauma to depression, to anxiety or depression.

In a groundbreaking study completed in January 2011, in collaboration with UCLA, we investigated the effects of meditation in caregivers of people with dementia. Results indicate that, compared to study participants who listened to relaxation tapes daily for eight weeks, those who practiced Kirtan Kriya improved significantly in measures of perceived support, physical suffering, energy, emotional well-being, cognitive tests of memory and executive function. Beyond that, this study revealed that Kirtan Kriya increased telomerase, an exquisite bio marker of health and longevity. In this study, we showed that mood, spirituality, and well-being; all markers of improved memory health and longevity, can be increased by Kirtan Kriya in only 12 minutes a day for 12 weeks.

How to practice Kirtan Kriya?

A good thing that the exercise is short, simple, and you cando at convenience of your home. Definitely, you may want to contact specialistsfirst, if you never practiced any kind of meditation before, to getunderstanding and feeling for the basic concepts and techniques. But then youcan do it yourself, which offers you the great flexibility and convenience.

Sit in an upright position on the floor or in a straight backed chair. Rest your hands on your knees with palms facing upwards.
Learn to chant. Put your index finger at the top of your head...the part called the crown. Now put another finger between your two eyes...the point that is sometimes called the Third Eye. Remember those two spots. Now imagine the Sound SA coming in at the crown of your head and then traveling down until it is opposite your 'third eye' and it makes a 90 degree turn and comes out the third eye point. It is sort of like a large L - It comes in at the crown and then makes a right angle out at the point between your eyes. As you chant each sound Sa, Ta, Na, Ma - see each of them coming in at the crown, travel down till opposite your 'third eye' make a 90 degree angle turn and exit at the point between your eyes. This step is important for beginners, but you will see that after a while, your body will perform the required actions with no mental efforts automatically.

Repeat the Saa Taa Naa Maa sounds (or mantra) while sitting with your spine straight. Your focus of concentration is the L form (as explained above), while your eyes are closed. With each syllable, imagine the sound flowing in through the top of your head and out the middle of your forehead (your third eye point).
For two minutes, sing in your normal voice.
For the next two minutes, sing in a whisper.
For the next four minutes, say the sound silently to yourself.
Then reverse the order, whispering for two minutes, and then out loud for two minutes, for a total of twelve minutes.
To come out of the exercise, inhale very deeply, stretch your hands above your head, and then bring them down slowly in a sweeping motion as you exhale.

The mudras, or finger positions, are very importantin this kriya (see illustration below).

On Saa, touch the index fingers of each hand to your thumbs.
On Taa, touch your middle fingers to your thumbs.
On Naa, touch your ring fingers to your thumbs.
On Maa, touch your little fingers to your thumbs.

The Jupiter finger brings in knowledge, expands our field ofpossibilities and releases us from limitations. The Saturn finger gives uspatience, wisdom and purity. The Sun finger gives us vitality and aliveness. TheMercury finger aids clear communication. Each time you close a mudra by joiningthe thumb with a finger, your ego "seals" its effect in yourconsciousness.

Visualize or feel each individual sound come in the crownchakra at the top of the head, down through the middle of the head and out toinfinity through the third eye. This is very important and must be done witheach sound. It is an essential part of the cleansing process. If this part ofthe meditation is not done, you may experience a headache.

While doing the meditation, you may experience pictures ofthe past come up like on a movie screen in your mind. Let them dance in frontof your eyes and release them with the mantra. This is part of the cleansing ofthe subconscious mind. If emotions come up, you can also incorporate them inthe chanting, i.e. if you feel anger then chant out the anger. Whatever youexperience is OK. Do not try to avoid or control your experiences. Simply bewith what is going on and go through it. It is all part of the cleansingprocess.

Video Presentation

To help you understand the technique, please review a briefvideo presentation:

Sources and AdditionalInformation:

http://lindsey-mason.suite101.com/what-is-meditation-a138668

http://www.healthandyoga.com/html/meditation.html

http://www.alzheimersprevention.org/

http://www.anti-aging-articles.com/Kirtan-Kryia-Meditation.html

http://www.kundaliniyoga.org/kyt15.html

How to deal with Aggressive Behavior in Alzheimer’s Patients?

2011-09-26T21:23:00.000-07:00

Understanding Alzheimer’s aggression

In order to understand the phenomenon known as “Alzheimer’s aggression”or “Elder Rage”, as author of the book with the same title Jacquelin Marcellcalls it, takes a bit of background information. For one thing, it is notnecessarily caused by a single factor. Yes, a patient may have been officiallydiagnosed with Alzheimer’s disease, but this does not mean that the damagesdone by the disease itself are what lead to aggression.

Consider that of the 4.5 million people diagnosed with Alzheimer’s eachyear; at least half of these folks will manifest some sort of Alzheimer’saggression. This can be something as simple as hostile or strange vocalizationsto full-blown hitting, biting, and punching. Clearly, there will usually be areason for this sort of behavior, but each person will be different.

Most medical professionals now understand that Alzheimer’s aggression canbe indicative of physical discomfort that results from common medications (forexample, many of the anti-anxiety medications often given to patients can causeheadaches and nausea), it might be caused by delusions and/or neuropsychiatricsymptoms, or it could be triggered by the return of memories or emotions thatwere from long before. In fact, Alzheimer’s aggression can be something assimple as frustration with an inability to communicate or remember something,and this leads to irritation and a “lashing out” at those around them. Often,this is particularly the case when an Alzheimer’s patient has lost the abilityto communicate easily or clearly.

So, the first real step in understanding Alzheimer’s aggression is toidentify the “trigger”. Interestingly enough, this often helps the caregiversto find a bit of peace and comfort because it helps to prove that the Alzheimer’saggression is not directed at them “personally”.

So often, an adult child or primary caregiver experiences enormousemotional pain when they feel that a person is physically attacking them ordirecting anger and rage at them. Simply, working at identifying the triggerfor Alzheimer’s aggression usually allows them to actually eliminate themselvesfrom the proverbial equation. Unfortunately, the process by which triggers areidentified can often take a substantial amount of time.

Dealing withAlzheimer’s aggression

Dealing withaggressive behavior is not easy, and there are no simple solutions to it.However, it is possible to make it less of a problem through a gradual processof identifying what triggers the aggression, and finding some effective ways todeal with it. It is important to remember that all behavior is a form ofcommunication. If we can establish quickly what the person is trying tocommunicate, it may prevent them from feeling frustrated and actingaggressively towards us.

The most importantadvice to caregiver is: Don’t take it personally. This is a hard thing to do,but you have to remember that you are dealing with a person who is manifestingthe symptoms of a disease. It isn’t personal to them either.

Any form ofaggression can be upsetting, but the most important thing to remember is thatthe person is not being aggressive deliberately. The behavior may appear to betargeted at you, but that is probably just because you are the one that isthere at that particular moment. The fact that the person is aggressive towardsyou doesn’t mean that their feelings towards you have changed − just that theirreactions have become different as the structure of their brain has changed.

So, what can someone do to help a loved one suffering from the conditionand also lashing out with Alzheimer’s aggression? There are currently someprescription medications given to patients with “dementia” but most are stillin the testing phases or considered questionable. They come in a range ofintensities and can reduce some incidents of Alzheimer’s aggression, but mostphysicians recommend that the “first line” of defense begins with individualpatient-oriented strategies.

For example, if Alzheimer’s aggression is triggered by anything fromhunger, fear or confusion, to actual anger or physical discomfort, it isnecessary to find ways to address and/or eliminate all of the possible issues.This might be through actual, physical methods or it can be through thought andpatience.

As you observe yourloved one, you may need to look for signs of a pattern or of side effects fromprescribed drugs. These observations will help the doctor to make a finaldiagnosis and plan a treatment routine. Your doctor may have questions orcomments pertaining to your case. As you care for your loved one, try toobserve him or her closely in order to answer the following questions:

Do you notice any pattern to the behavior?

Does the behavior occur at any set time of day?
Does it occur after your loved one takes a certain drug?
Does it occur when he or she is hungry or frustrated?
Does the behavior come out only when a certain person is present?

When you first noticed the problem, did you notice any other changes in the way your loved one was acting?
Were any big changes occurring in the home at that time?

Did you move?
Did anyone move in or out?
Did anyone in the family die or become ill?
Did you make any changes in care arrangements?

Has your loved one started any new drugs or changed drug dosage?
Has your loved one suffered a recent injury?

Be sure your doctorknows all the drugs that your loved one takes, even over-the-counter drugs.

General advices for those dealing with family or friends showing bouts ofAlzheimer’s aggression are to:

Learn diversionary tactics – if you suspect a “trigger”, such as a behavior (on your part) that seems to make them react, it is up to you as a caregiver to stop and step away from them in the most appropriate way possible. Never try to argue the point, just try to distract the patient from the issue and then get them into another or a new line of thought. For example, if the person seems to become upset when their clothing is removed, you cannot avoid bathing them, but you can speak the words such as “Here, let me get you ready for a warm bath,” and then move directly into the bathing process. Don’t quit at the first signs of trouble, but definitely bring the issue to a close if there is an escalation of aggression from them. Keep a written list of things he or she likes (such as going for a walk, listening to music, having a snack) and offer these as diversions.
Don’t forget signals – when your diversionary tactic is failing, it is a time to use the gentlest tones and the most reassuring touches you can. If you can put a sincere smile on your face, and try to convey that “all is well” through touches and expressions, it often calms a patient down at a remarkably hasty pace.
Consider communication – many Alzheimer’s patients lash out violently because they cannot remember something, they have forgotten where they are, or what a common item is for, or because they cannot communicate an idea clearly. If you make a point of putting labels and signs on everything with which they interact, you are going to greatly reduce the times when their lack of memory triggers a reaction. This can go so far as leaving lists of things “to do” in obvious places. For example, it is often a good idea to put a few words on a piece of paper tacked to the outside of the kitchen cabinets. These might be as simple as “Food and Snacks” that helps them to easily remember where they are and what they were doing.
Focus on the past – communicating with the patient, remember that Alzheimer’s strongly affects short-term memory. It’s often easier - and less stressful - for someone with Alzheimer’s disease to recall and talk about distant memories than it is for them to remember what they watched on TV the night before.
Stress factors - limit the amount of the generally recognized stress factors for the Alzheimer’s patients as loud noises, frenetic movement, and clutter. Remember that they may be easily frightened by a sudden noise, sharp voices, abrupt movements or a person approaching them from behind without warning.
Get into a routine – along with signs and notes, a solid routine is another fantastic way to help overcome moments of aggression. Not only does this reduce the opportunity for unexpected events, but it also ensures that hunger or bathroom related aggression is kept to a minimal level too.
Validation – when an Alzheimer’s patient is upset, angry, or severely frustrated, don’t argue with them about this. The last thing anyone wants to hear is “there’s no need to be so angry/sad/confused” when they don’t have any control over the issue or the environment. Instead, you MUST tell them that it is perfectly fine to feel as they do, and then work with them to get through the moment. Again, this is best done with reassuring words and gestures.
Try a bit of logic – if the patient has a relatively calm demeanor about a situation, you can actually ask them to think a bit about a situation to see if that helps resolve the issue. Try and stay calm, while also providing reassurance and support at all times. It is important the person understand you are not upset and you are there to help.
Safety - check the entire house and remove any object that your patient might use as a weapon. Stand out of range and, if you feel that your loved one may injure you, leave the room. Experts do not agree about physically restraining a person during a violent outburst. If you are strong enough to restrain your patient, you might try doing so. The danger is that you might frighten or further anger him or her, making the situation worse. If your patient struggles, there is the chance that one or both of you could be hurt.
Nothing is working? – the most common cures for the moments when a patient refuses to calm down include, ignoring them if they cannot do harm, trying to find a bit of humor in the moment, putting on a bit of soothing music, and making notes about the situation in order to help determine a better outcome for the next time that it occurs. If aggressive incidents are frequent or worrying, discuss them with a professional, such as a psychiatrist specializing in older people or a community psychiatric nurse. They may be able to offer support and suggest other ways of handling the situation.

Sources and Additional Information:

http://www.sharpseniors.com/a/understanding-alzheimers-aggression

http://thealzheimersdoc.com/?p=439

http://www.caregiverslibrary.org/Default.aspx?tabid=244

http://www.healthcentral.com/alzheimers/c/57548/50050/aggression

http://www.webmd.com/alzheimers/alzheimers-aggression

Watsu Therapy for Alzheimers Patients

2011-09-18T13:59:00.000-07:00

What is Watsu?

Watsu therapy is a very gentle and relaxing treatment thatis performed in warm water (which is at around 35C). When performed properlythen Watsu combines elements of massage (in particular shiatsu massage), joint mobilizationand stretching. The client receiving the treatment is continuously supportedwhilst being floated, cradled, stretched and rocked. The relaxing combinationof warm water with nurturing support creates a bodywork treatment that istherapeutic and healing on many levels.

Watsu began in Harbin Hot Springs, California, with American poet HaroldDull. In the Seventies, Dull becamefascinated with the Japanese acupressure therapy, shiatsu. He felt convinced itwould be even more powerful if combined with the healing properties of water. Thus,Harold Dull began developing it by floating his Zen Shiatsu students inwarm water applying its stretches and moves. Therefore, Watsu is also calledaquatic shiatsu, and the word 'Watsu' comes from the words Water and Shiatsu.

A typical Watsu session lasts around an hour. The therapist will outline thecourse of the session and be able to answer any questions you may have. A rangeof movement tests may be undertaken in cases of restricted mobility. Once inthe water, the therapist wrap floats around your legs to prevent them fromsinking during the session. Your head will be supported throughout the sessionby the therapist along with either low back or knees. You will be gently movedthrough the water in a continuous flowing motion, with the therapist addingstretches, point work and shiatsu massage where appropriate. Your ears will begenerally be under the water, nose and mouth above. Some drift off to sleep,others will remain aware of everything during a session, both are fine.

Therapeutic value ofWatsu

The therapeutic value of Watsu is based in the capacity toalleviate pain, strengthen the body and give back flexibility in patients who werelost the hope of movement for any reason. This type of massage is effective infront of problems like stress, the insomnia and the lack of energy, and also toimprove muscular and bony upheavals of the column and the joints. It canalleviate migraines and is useful against any painful upheaval that impliesrigidity and tension.

Underwater bodywork affects multiple levels (physical,emotional, and psychological) and gradually heals and corrects imbalances,leading to improved body/mind awareness and a general sense of wellbeing andpeace.

On a physical level, the sensation of warmth andweightlessness makes all unnecessary muscular activity stop, you just let go,which from a therapeutic point of view is an ideal way to restore health.

Therefore, the benefits of Watsu are not only physical, theygo further on. It acts in the psychic plane providing calmness and providingthe encounter with oneself therefore alleviating the ills that pronounces inthe body but that are originated in emotional aspects. In fact, during asession of Watsu is possible to produce liberation of not solved emotionalproblems. They can receive children and adults of any age and physical conditions,and not to know how to swim is not an impediment to benefit from all itsqualities.

The practice of slow movement techniques with diaphragmaticbreathing increases alpha electroencephalogram activity; produces righthemispheric activation; decreases sympathetic nervous system arousal andincreases awareness; decreases hypothalamic–pituitary–adrenal activation andimproves the psychological state associated with chronic diseases, anxiety anddepressive disorders, anger management, and stress-related dysrhythmias.

Watsu Benefits forAlzheimers Patients

Researchers attribute gains in brain function to the amount of oxygen that thebrain receives during movement. The brain uses the glucose that it receives(delivered by the oxygen) as fuel for thought. Movement increases production ofa brain chemical called brain-derived neurotrophic factor (BDNF), whichstimulates the growth of nerve cells in the brain and curbs the development ofAlzheimer’s disease as well as other age-related brain degeneration.

While, it would be unreasonable to expect that the Watsuwill be a magic solution for stopping and reversing Alzheimer’s, it is anextremely effective weapon to attach the accompanying psychological conditions,which are the Alzheimer’s patients are suffering, as depression, anxiety,insomnia, emotional and physical distress and many others.

Sources and AdditionalInformation:

http://www.innerwestmassage.com.au/watsu-massage.php

http://www.scubadogs.net/ingles/water/watsu.html

http://hydrotherapy2u.blogspot.com/2009/06/researchers-positive-effects-of-ai-chi.html

http://www.telegraph.co.uk/health/alternativemedicine/4702645/Splash-out-on-healing-watsu.html

http://www.aquaticbodywork.co.za/questions.html

How to take care of Alzheimer’s Patient before, during, and after natural disasters?

2011-09-07T22:18:00.000-07:00

A seasoned caregiverhas most likely faced some kind of traumatic natural event at one time oranother. Be it a hurricane, tornado, flood, wildfire or other phenomena, mosteveryone knows that it pays to be prepared for the worst. It's not enough thatcaregivers stock food, create a disaster medical kit and make shelter plans.Family member carers, as well as paid caregivers, also have to know how toreduce the worry and stress for persons with special needs during a disaster.

Advance Warning Helps Targeted Hurricane Victims Prepare

People normallyexperience worry and anxiety in the face of a hurricane – the most dangerous ofall storms. Thanks to advance warnings from national and local weatherservices, residents in the projected strike zone have ample time to evacuate orcarry out last-minute details at home. Time to act reduces some of the anxietyand fear of being caught unprepared when a major storm hits.

When making ahurricane disaster plan, don't automatically rule out evacuation just becauseyou think it's too much trouble to pack up and leave. Keep in mind thatemergency medical crews may not be available for hours – or even days – after ahurricane strikes. Plenty of people will need help, but downed power wires,fallen trees and debris will slow rescue efforts.

Be sure to get readyto the potential natural disaster ahead of time by enrolling the patient inMedicAlert + Alzheimer’s Association Safe Return, a 24-hour nationwideemergency response service for individuals with dementia that wander or whohave a medical emergency (find more information at 1.888.572.8566 or visitwww.alz.org). If the patient is already enrolled in MedicAlert + Safe Return,make sure his /her information is up to date, especially in preparation forstorm season.

Caregivers and patients cope with sudden naturaldisasters

Tornadoes present adifferent set of problems; residents often have only minutes to seek safeshelter before the storm hits. Tornadoes can do monstrous amounts of damage ina very short amount of time. Homes may be lost and whole towns shattered.Stress, anxiety and raw emotions can run high for weeks and months after astorm. Caregivers can help by offering encouragement and compassion.Professional help services and support groups can also help both caregivers andpatients.

Earthquakes happensuddenly and occur with no warning. An earthquake along a coastal region canmean a possible tsunami, so extra precautions and planning are necessary.Earthquakes aren't defined by a season like hurricanes, so residents have tostay prepared. Living close to one of the Earth's many fault lines is enough tocause anyone anxiety. A caregiver can ease a patient's worry by keeping silentabout any news of a possible earthquake.

Forest fires canbreak out almost anywhere, but are prone to spread quickly in areas where thereis little rain. Evacuating at the first sign of trouble will help keep ease thestress. Extreme summer heat can present problems – especially for elderlypeople and young children. Caregivers should know beforehand what to do in anyof these situations. Paid caregivers should also have instructions from familymembers or other qualified source so they'll know what to do in the event asudden disaster strikes.

Tips for reducing patient stress and anxiety caused bynatural disasters

There are tipscaregivers can follow to reduce excessive worry in the wake of extreme weatheror other natural disaster. It's tough to stay composed, but the caregiver whokeeps her wits about her during a traumatic event will have a better chance ofsurviving, and so will her patient. In addition to the plans and preparationsthat everyone should automatically have in place, caregivers can use thefollowing suggestions:

Do your best to remain calm, as you set the tone for your loved one. Provide frequent reassurance.
Decide how much information to give the patient. It may be best to watch or listen to the news in another room if graphic pictures or reports might upset the individual. Avoid elaborate details. Provide information using concrete terms and follow brief explanations with reassurance.
Keep caregiver duties as close to routine as possible while staying alert to conditions. Make sure your loved one takes medications as scheduled. Be ready to act should the situation suddenly change and worsen.
Keep the patient's routine as close to normal as possible. Try to schedule regular meals and maintain a regular sleep schedule.
Find outlets for anxious energy-engage the person in simple tasks, distract/talk about memories, etc. Redirect the person’s attention if he or she becomes upset.
Avoid alcohol, drugs and excessive smoking. Alcohol and certain drugs can cloud or distort a caregiver's judgment. Avoid chain-smoking as a way to calm jumpy nerves.
Move the person to a safer or quieter place, if possible. Limit stimulation. This is one of the important reasons to consider special needs/emergency shelters an absolute last resort. A person with dementia may not do well in the crowded, chaotic environment.
Delegate jobs to other family members if possible.
Accept water, food and offers of help only from qualified sources (Red Cross, Salvation Army, military help and so forth).
Pay attention to cues that the person may be overwhelmed, such as fidgeting or pacing.
Remind the person that he or she is in the right place.

Tips for dealing with severe episode of agitation

Approach the person from the front and use his or her name.
Use calm, positive statements and a patient, low-pitched voice. Reassure.
Respond to the emotions being expressed rather than the content of the words, as the person may not be able to verbalize his/her true feelings.
Don’t argue with the person or try to correct perceptions. Instead, affirm his or her experience, reassure and try to divert attention.
Under no circumstances should a person with Alzheimer’s be left alone following a natural disaster. Do not count on the individual to stay in one place while you go to get help.

Get ready for evacuation

If there are reasonsto believe that you may need to evacuate someone with Alzheimer’s due to thenatural disaster, be ready and act carefully to minimize the risk for thepatients health:

Have an emergency kit prepared with items you may need. If the kit is not ready, quietly gather supplies (flashlight, wallets, water, power bars or crackers and peanut butter, blankets and pillows if you can) and don’t wait too long. It’s best to give yourself plenty of time and try not to rush. Know where you’re going—shelter, hotel, other family member’s house—and let others know you’re A, B, and C plans. Remember the anxiety and physical situation may bring on different needs for your loved one. You may need additional incontinence products, consider what comfort items might help, and talk to your loved one’s doctor beforehand about anxiety or behavioral concerns and needs. Make sure you bring contact information, brief medical history, copy of all insurance information –as well as house insurance since many times you can’t get back into the house to get policies.
Keep medications in grab and go containers for quick evacuation. Take it all–who knows when you’ll be able to get back to normal.

Evacuate early and be extra cautious. Being stuck in long traffic delays or feeling rushed is not good for your loved one with dementia.
Inform other family members or trusted friends. Keep a calm attitude and stay as upbeat as possible. If you cannot contact other family members before leaving the house write with a lipstick or sharpie marker on your front door who is with you and where you’ve gone—it’s awful to panic and worry that your loved ones can’t be found

People with dementia are especially vulnerable during chaotic times. They have a limited ability to understand what is happening. Be alert to potential reactions that may result from changes in routine, traveling or new environments.
When appropriate, inform others that your loved one has dementia and may not understand what is happening. Consider printing up some small cards that you can discretely hand to someone with a brief explanation.

BasicEmergency Supply Kit

• Water, one gallon of water per person per day for atleast three days, for drinking and sanitation.

• Food, at least a three-day supply of non-perishablefood.

• Battery-powered or hand crank radio and a NOAAWeather Radio with tone alert and extra batteries for both.

• Flashlight and extra batteries.

• First aid kit.

• Whistle to signal for help.

• Dust mask, to help filter contaminated air andplastic sheeting and duct tape to shelter-in-place.

• Moist towels, garbage bags, and plastic ties forpersonal sanitation.

• Wrench or pliers to turn off utilities.

• Can opener for food (if kit contains canned food).

• Local maps.

Stress after Natural Disaster

Family members mustface the possibility that paid caregivers won't be able to show up for workafter a disaster strikes. As a last resort, a critical-needs patient may haveto go to a local hospital for care. It may be days or weeks before paid workerscan get back on schedule again.

Relocating after adisaster is going to be stressful; there's no way around it. The added burdenof being responsible for mobility equipment, patient supplies, oxygen,medications and prosthetic devices can be exhausting and overwhelming. Homecaregivers can make it easier for family members by looking ahead to bettertimes. It may also help to talk about old memories and even to write them downin a journal.

Careful planning is akey to caregiver and patient survival in the event of a natural disaster. Keepa master list updated and handy to make sure nothing is forgotten. Have anescape plan ready to execute on the spur of the moment. Know where hospitals arelocated in neighboring towns. Disaster preparedness is a sure way to keepstress levels in check and keep anxiety to a minimum. Planning now will easethe fear and reduce the chances any unwelcome surprises.

Sources and Additional Information:
http://maryking.suite101.com/caregiver-tips-reduce-stress--anxiety-during-a-natural-disaster-a375330

http://www.easylivingfl.com/disaster-management-for-alzheimers-caregivers/

http://dementiastages.info/alzheimer-patients-caregivers-face-increased-risk-in-tornado-aftermath/

http://caroldodell.wordpress.com/2011/08/26/need-to-evacuate-your-elder-caregiving-tips-during-a-natural-disaster/

http://firstlighthomecareblog.com/2011/08/26/disaster-preparedness-for-older-adults/

Aricept (Donepezil) – Number One Prescription Drug against Alzheimer’s Disease

2011-08-27T12:13:00.000-07:00

About Aricept(Donepezil)

Aricept, which is claimed to be the #1 prescription drugagainst Alzheimer’s disease in the USA these days, belongs to the class ofchemical substances, called cholinesterase inhibitors. It could be thrilling tonote, that during World War II the representatives of this very group ofchemicals were mainly developed for warfare purposes: such terrifying anddeadly weapons as neuroparalytic gases sarin, soman, and VX also belong to theclass of cholinesterase inhibitors.

Happily, nowadays the properties of cholinesteraseinhibitors are used mainly for peaceful purposes; one of them is to help peopleconquer Alzheimer’sdisease - one of the most devastating mental illnesses of elderly people.

Today there are three substances of cholinesterase inhibitorsgroup, which are approved for medicinal use – donepezil, galantamine and rivastigmine.However, it is only donepezil or Aricept as the brand medication, which isapproved for the use in patients on all stages of Alzheimer’s disease (othersare used only for mild to moderate conditions). Donepezil is said to be themost potent among other representatives of cholinesterase inhibitors.

Aricept was developed by Eisai Inc. and approved by the FDAin 1996. It is currently co-promoted by Eisai Inc. and Pfizer Inc.

There is a preliminary research data claiming that combinationAricept and memantine,another anti-Alzheimer’s medication, may significantly increase theeffectiveness of the treatment.

Aricept as Alzheimer’sTreatment

As was mentionedearlier, Aricept is part of a group of drugs called acetycholinesteraseinhibitors used to treat mild to moderate cognitive symptoms ofAlzheimer’s. There is no clinical evidence that it can actually alter thecourse of the disease or help repair damaged brain cells.

It is believed that the chemical acetylcholine, whichtransmits messages between brain cells in the area responsible for memory andacquiring new information, is reduced in the brains of people with Alzheimer’sdisease.

Acetycholinesterase inhibitors, such as Aricept, helpprevent the breakdown of this important chemical, therefore helping to delaydeterioration. In some cases it has delayed symptoms by around 12 months.

In one study where some people received Aricept and othersreceived a placebo, those who took the drug were twice as likely to show someimprovement in thinking and understanding. For many it delayed their declinefor up to 12 months.

For some people the drug doesn’t have any effect at all or,if it does, their condition stays the same when it could have been expected todeteriorate.

And it doesn’t have any effect in the later stages ofAlzheimer’s because there are so few acetylcholine-producing cells left.

The drug is only available in prescription form and it’s upto a doctor to decide whether it’s suitable for the individual Alzheimer’ssufferer.

Dosage

Aricept is available in tablet form or an orallydisintegrating tablet form, and is commonly started at 5 mg a day. If it's welltolerated after 4 to 6 weeks, the dosage may be increased to 10 mg a day.

Aricept has beenapproved by the FDA in dosages of 5 to 10 milligrams for patients with mild tomoderate cases of Alzheimer's and in a dose of 10 to 23 milligrams for moresevere cases. There are ongoing efforts requesting FDA to ban the 23-mg versionof the drug and to warn patients and physicians against taking two 10-mg. pillsper day if the higher dosage is removed from the market.

Clinical trialsof Aricept submitted to the FDA for approval show no significant benefit fromthe 23-mg version compared to the 10-mg version. But the increased adverseeffects from the higher dosage include a slowed pulse rate, nausea, vomiting,diarrhea, urinary incontinence, fatigue, dizziness, agitation, confusion andanorexia. Vomiting, which occurred more than 3 1/2 times more frequently inthose taking the high dosage, is a particularly dangerous side effect forAlzheimer's patients, because it can lead to pneumonia, massivegastrointestinal bleeding, esophageal rupture and even death.

"With noevidence of an added advantage in benefit to patients, the clear increase inrisk should have been more than adequate grounds for denying approval,"said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group."It is inexcusable that FDA approved this higher dose. Its prompt removalwould belatedly fulfill the agency's mission to allow only drugs whose benefitsoutweigh their risks to be marketed."

Side Effects

While applied to the normal doses of the drug, side effectsof the drug are generally well-tolerated. Nausea, vomiting, diarrhea, loss ofappetite/weight loss, dizziness, drowsiness, weakness, trouble sleeping,shakiness (tremor), or muscle cramps may occur as your body adjusts to thedrug. These effects usually last 1-3 weeks and then lessen. If any of theseeffects persist or worsen, notify your doctor or pharmacist promptly. Rememberthat your doctor has prescribed this medication because he or she has judgedthat the benefit to you is greater than the risk of side effects.

Many people using this medication do not have serious sideeffects. Tell your doctor right away if any of these serious side effectsoccur: slow/irregular heartbeat, fainting, trouble urinating, severe stomach/abdominalpain, black stools, vomit that looks like coffee grounds, seizures. A very seriousallergic reaction to this drug is rare. However, get medical help right away ifyou notice any symptoms of a serious allergic reaction, including: rash, itching/swelling(especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If younotice other effects not listed above, contact your doctor or pharmacist.

Potential Interactions

Drugs withanti-cholinergic properties that can cross into the brain, such as atropine,benztropine (Cogentin), and trihexyphenidyl (Artane) counteract the effects ofdonepezil and should be avoided during therapy with donepezil.

Donepezil ismetabolized (eliminated) by enzymes in the liver. The rate of metabolism ofdonepezil may be increased by medications that increase the amounts of theseenzymes, such as carbamazepine (Tegretol), dexamethasone (Decadron),phenobarbital, phenytoin (Dilantin), and rifampin (Rifadin). By increasingelimination, these drugs may reduce the effects of donepezil.

Ketoconazole(Nizoral) has been shown to block the enzymes in the liver that metabolizedonepezil. Therefore, concurrent use of ketoconazole and donepezil may resultin increased concentrations of donepezil in the body and possibly lead todonepezil side effects. Quinidine (Quinidex, Quinaglute) also has been shown toinhibit the enzymes that metabolize donepezil and may cause donepezil sideeffects.

Non-steroidal anti-inflammatory drugs (NSAIDs), such asaspirin or ibuprofen, also should be used with caution while taking Aricept,due to the increased risk of stomach ulcers.

Sources and AdditionalInformation:

http://www.pillwatch.com/info/aricept---most-prescribed-for-alzheimer.html

http://www.guide4living.com/alzheimers/aricept.htm

http://alzheimers.about.com/od/treatmentofalzheimers/p/aricept.htm

http://articles.latimes.com/2011/may/18/news/la-heb-alzheimers-aricept-05182011

http://www.medicinenet.com/donepezil/article.htm

Phosphatidylserine Natural Supplement as Remedy for Alzheimer’s Disease

2011-08-17T23:23:00.000-07:00

What Is Phosphatidylserine?

Phosphatidylserine (PS) is one of the naturally-occurringmolecules present all through the body. Although the human body can producethis substance at its own, the majority of this nutrient can be attainedthrough the diet. However, because the diet which we follow today is unhealthyand lacks the essential nutrients, Phosphatidylserine is used in certaindietary supplements, and sometimes claimed to be useful for the below-mentioneduses:

Depression
Attention deficit hyperactivity disorder (ADHD)
Alzheimer’s disease
Age-related dementia or cognitive decline

Phosphatidylserine (PS) is an essential component in all ourcells; specifically, it is a major component of the cell membrane. The cellmembrane is a kind of "skin" that surrounds living cells. Besideskeeping cells intact, this membrane performs vital functions such as movingnutrients into cells and pumping waste products out of them. PS plays animportant role in many of these functions.

It is not yet known how exactly Phosphatidylserinesupplementation does work to treat Alzheimer’s disease or for some otheruses, although it is generally believed that its levels may reduce due to thegrowing age and with certain other medical complications like Alzheimer’s. Soto maintain those levels it is prescribed as a supplement with treatment.

It is widely used for this purpose in Italy, Scandinavia,and other parts of Europe. PS has also been marketed as a "brainbooster" for people of all ages, said to sharpen memory and increasethinking ability.

Effect of Phosphatidylserine onAlzheimer's Disease

Phosphatidylserine(PS), in studies of severe mental decline, appears to have been equallyeffective whether the cause was Alzheimer's disease or something entirelyunrelated, such as multiple small strokes. This certainly suggests that PS mayhave a positive impact on the brain that is not specific to any one condition.From this observation, it is not a great leap to suspect that it might beuseful for much less severe problems with memory and mental function, such asthose that seem to occur in nearly all of us who are older than 40. Indeed, onedouble-blind study did find that animal-source phosphatidylserine could improvemental function in individuals with relatively mild age-related memory loss.

Overall, theevidence for animal-source PS in dementia is fairly strong. Double-blindstudies involving a total of more than 1,000 people suggest thatphosphatidylserine is an effective treatment for Alzheimer's disease and otherforms of dementia. The largest of these studies followed 494 elderly subjectsin northeastern Italy over a course of 6 months. All suffered from moderate tosevere mental decline, as measured by standard tests. Treatment consisted ofeither 300 mg daily of PS or placebo. The group that took PS did significantlybetter in both behavior and mental function than the placebo group. Symptoms ofdepression also improved. These results agree with those of numerous othersmaller double-blind studies involving a total of more than 500 people withAlzheimer's and other types of age-related dementia.

And, finally, the promising study results were published in the November2010 issue of the "Journal of Clinical Biochemistry and Nutrition."Elderly study participants, all with mild cognitive impairment, took 100 or 300mg of phosphatidylserine per day for six months. Memory scores increased in allgroups, and those with the lowest starting scores improved the most.Improvements occurred mostly in delayed verbal recall, an aspect of memoryassociated with early stages of dementia. There were no adverse effects, andthe researchers concluded that phosphatidylserine is a safe and helpfulsupplement for improving memory for some people.

This line ofinvestigation substantially slowed down in the 1990s over concerns about madcow disease (bovine spongiform encephalopathy), a fatal brain disorder believedto be caused by consuming foods or other products from affected cattle.Supplements containing phosphatidylserine are now derived from soy extracts. Earlystudies, though promising, were based on cow-derived supplements. There arereasons to expect that plant-source PS should function very similarly to PSmade from cows' brains, and some animal studies suggest that it is indeedeffective. However, in preliminary trials, soy-based PS and cabbage-based PSfailed to prove beneficial and did not show the same level of effectiveness.

Are There Side Effects?

Phosphatidylserine is generally regarded as safe when usedat recommended dosages. Side effects are rare, and when they do occur theyusually consist of nothing much worse than mild gastrointestinal distress. However,the maximum safe dosages for young children, pregnant or nursing women, orthose with severe liver or kidney disease have not been established.

The known potential side effects are:

Upset stomach
Gas
Insomnia.

Drug Interactions

Even though Phosphatidylserine is one of the naturalsupplements, it may potentially interact with some of the medications and othernatural supplements. For example, PS is sometimes is taken with ginkgo becausethey both appear to enhance mental function. However, some caution might be inorder: Ginkgo is a "blood thinner," and PS might be one as well. PSis known to enhance the effect of heparin, a very strong prescription bloodthinner. It is possible that combined use of PS and any drug or supplement thatthins the blood could interfere with normal blood clotting enough to causeproblems.

Some medicines which may result in Phosphatidylserine druginteractions are:

Anticholinergic medicines, including, but not limited to:

o Atropine
o Belladonna (B&O Supprettes, Donnatal, Bellamine S)
o Clidinium (Librax)
o Benztropine (Cogentin)
o Darifenacin (Enablex)
o Clozapine (Clozaril)
o Dicyclomine (Bentyl)
o Diphenhydramine (Benadryl, Tylenol PM)
o Haloperidol (Haldol)
o Glycopyrrolate (Robinul)
o Hyoscyamine (Levsin)
o Homatropine (Hycodan)
o Tolterodine (Detrol)
o Ipratropium (Atrovent)
o Tiotropium (Spiriva)
o Scopolamine (Transderm Scop)

Drugs which have cholinergic effects (including acetylcholinesterase inhibitors), like

o Donepezil (Aricept)
o Ambenonium (Mytelase)
o Galantamine (Razadyne)
o Edrophonium (Enlon, Reversol)
o Bethanechol (Urecholine)
o Methacholine (Provocholine)
o Guanidine
o Succinylcholine (Anectine, Quelicin)
o Rivastigmine (Exelon)

This is not a complete list and some other drugs may alsointeract with Phosphatidylserine. Thus, inform your doctor about all sorts ofprescribed or non-prescribed medicines and health supplements you take.

Is Phosphatidylserine Safe?

Some people may be more likely than others to experienceproblems due to phosphatidylserine. Therefore, you should talk with yourhealthcare provider before taking the supplements if you have:

Any serious or chronic health condition
Liver disease, such as liver failure, cirrhosis, or hepatitis
Kidney disease, such as kidney failure (renal failure)
Any allergies, including allergies to medications, foods, dyes, or preservatives.

Also, let your healthcare provider know if you are:

Pregnant or thinking of becoming pregnant
Breastfeeding

Make sure to tell your healthcare provider about all othermedicines you are taking, including prescription and non-prescriptionmedicines, vitamins, and herbal supplements.

Sources and AdditionalInformation:

http://alzheimers.emedtv.com/phosphatidylserine/phosphatidylserine.html

http://drugmega.com/drugs-65842453/phosphatidylserine-drug-review-phosphatidylserine-side-effects-and-dosage.html

http://www.foundhealth.com/alzheimer-s-disease/alzheimers-disease-and-phosphatidylserine

http://www.livestrong.com/article/409676-supplements-for-alzheimers-prevention/

http://www.mbmc.org/healthgate/GetHGContent.aspx?token=9c315661-83b7-472d-a7ab-bc8582171f86&chunkiid=21843

Cold Sores (Herpes Simplex Virus Type 1) – strong risk factor for Alzheimer's disease

2011-07-21T22:37:00.000-07:00

Viruses and Alzheimer’s

For almost twenty years, Dr. Ruth Itzhaki, Professor of Molecular Neurobiology at the University of Manchester in England, has been exploring possible links between viruses and Alzheimer’s. Viruses are tiny infectious particles that attach themselves to and penetrate cells, then use the capabilities of those cells to reproduce. They can cause diseases like colds, flu and AIDS, or they can just sit there, remaining dormant or latent for long periods of time. A latent virus can become active when triggered by stress, other infections or environmental factors.

For a virus to contribute to the development of Alzheimer’s, Dr. Itzhaki reasoned, it would have to be very common in humans. And because Alzheimer’s appears to develop over a long period of time, it would make sense to look for a virus that has long periods of latency, but could periodically be reactivated and cause damage.

One family of viruses fits her criteria: herpes. There are over 100 types of herpes, of which eight infect humans, causing diseases ranging from chickenpox and shingles to cold sores and mononucleosis. Most people have some type of herpes, even though they may have no symptoms.

We will review one type of herpes which is particularly suspected in having tight causal links with Alzheimer’s in more details.

About Herpes Simplex Virus1

Herpes Simplex Virus Type 1 (HSV1) is especially common in humans. It is also regularly referred to as cold sores, fever blisters, oral herpes or herpes labialis. It is a viral infection of the skin that may occur once or return again and again. This happens when the virus is cleared from the skin by the immune system it hides in the nerves and is never completely removed from the body. Herpes outbreak infections are very common. It is estimated that nine out of ten people have been exposed to herpes outbreaks and many of these don't even know they have it. Those who carry herpes can spread the disease without even knowing it.

Herpes simplex begins as a group of small red bumps that blister and preceded by itching and burning of the area. The blisters begin to dry up after a few days and form a yellow crust. The crust then falls off and the redness slowly goes away. The whole process takes about 10-14 days. Scars rarely form.

What causes Herpes Simplex Virus1?

Cold sores are generally contracted from skin to skin contact with an infected area.
People can catch HSV1 by sexual contact such as kissing a person with a cold sore or sharing a drinking glass or utensils
Family members should not share towels or linen with someone who has an outbreak of herpes on the genitalia or cold sores. Herpes outbreaks can spread from person to person even when an infected individual has no outbreak or symptoms.
Once infected with cold sores, the virus remains inside the body in a latent (sleeping) state. Throughout a person's life the virus can then become "activated" causing a cold sore recurrence.

What causes or "activates" a Cold sores or fever blisters recurrence?

If you've had cold sores before, it can be hard to tell what might make them come back. Below are some factors that may trigger it to return:

Stress
Sun (Exposure of the area to strong sunlight)
Incorrect diet
Fever
Menstruation Cycle
Fatigue (not getting enough rest)
Being run-down
Pregnancy
Drinking a lot of alcohol
Ultraviolet light
Skin irritation (such as sunburn)
Certain foods
Temperature extremes

Herpes Simplex Virus1 and Alzheimer’s

Whilst it is not the case that everyone with herpes will indeed develop Alzheimer's, there is a fairly strong linkage. It all comes down to a particular gene which appears to damage a key part of the nervous system which is responsible for keeping Alzheimer's at bay.

What this means is that whilst herpes does not directly cause Alzheimer's, it doesn't weaken the system which Alzheimer's attacks, and therefore leaves you more vulnerable than someone who does not have the HSV1 disease.

Over the past several years, compelling evidence has surfaced linking HSV1 to Alzheimer's disease. In 2008, Canadian researchers Luc Letenneur and Karine Peres demonstrated a dramatic increase in antibodies directed against HSV1 in Alzheimer's patients compared to age-matched individuals without the disease.

University of New Mexico (UNM), Brown University, and House Ear Institute (HEI) recent study supplied even more conclusive results to support the theory of this causal relationship. “It’s no longer a matter of determining whether HSV1 is involved in cognitive decline, but rather how significant this involvement is. We’ll need to investigate anti-viral drugs used for acute herpes treatment to determine their ability to slow or prevent cognitive decline,” comments Elaine Bearer, M.D., Ph.D., Harvey Family Professor and Vice Chair for Research, Department of Pathology, UNM School of Medicine.

Professor Ruth Itzhaki has explored the relationship of HSV1 to Alzheimer's disease in great depth. In her landmark article published in 2008 entitled "Herpes Simplex Virus Type 1 in Alzheimer's disease: The Enemy Within," Dr. Itzhaki revealed that HSV1 infects the brains of 90 percent of adults. If HSV1 causes Alzheimer's, this high rate of infection would be a necessary characteristic in light of the very high prevalence of Alzheimer's disease. Further, she points out, HSV1 can remain latent in the nervous system lifelong and may undergo periodic reactivation causing persistent brain inflammation. As an example, HSV1 is the cause of recurrent fever blisters that occur when the virus gets activated in the brain. Undoubtedly the most compelling evidence linking HSV1 to Alzheimer's disease comes from her recent discovery of HSV1 DNA actually located exactly within the beta amyloid plaque, the so-called "hallmark" of the disease.

So compelling are these findings that Dr. Itzhaki has concluded, "Our present data suggest that this virus is a major cause of amyloid plaques and hence probably a significant etiological factor in Alzheimer's disease. They point to the usage of antiviral agents to treat the disease and possibly of vaccination to prevent it."

How It Happens?

One of the theories of this relationship has to do with the way that the herpes virus interacts with the receptors of lipoproteins. In partnership with the gene – Allele, the system which is responsible for motor functions is gradually degraded – not to the point where it doesn't work, but instead to the point where it is left open to developing Alzheimer's more quickly.

Interestingly, when the Allele gene is not present, there is no effect of herpes on the development of Alzheimer's, meaning that obviously the two need to be in sync with each other to have any tangible effect.

Reviewing the possible causes for the devastating HSV1 role in Alzheimer’s, Dr. Itzhaki mentioned that the complete mechanism on how HSV1 might damage the brain is still unclear. It could be via inflammation and oxidation. Oxidation is when unstable molecules called oxygen free-radicals combine with other molecules. In the same way that rusting damages metal, oxidation can damage brain cells. Dr. Itzhaki says that oxidation has been found in HSV1 infected cells in the lab and in brain cells harboring latent HSV1.

“We think inflammation must be a major factor,” she says. She lays out the hypothesized chain of events: “When HSV1 is latent (i.e. in a dormant state) in the brain, it can be activated by inflammation of the brain. The latter can occur when somebody has an infection, or is stressed, or immunosuppressed. The virus then augments the inflammation there. So other viral or bacterial infections (not necessary in the brain) can cause indirect trouble.”

Herpes Simplex Virus1 Treatment

Currently, there are no cures or vaccines for the herpes simplex virus. However, avoiding precipitating factors, such as sunburn and stress, can help prevent additional outbreaks. There are established treatments available to help decrease healing time, reduce pain associated with the lesion, and in specific cases, suppress the recurrence of the virus.

Nondrug therapy

Frequent hand washing will help reduce the spread of the virus to other parts of the body or to other people. Also, applying cool, moist compresses to the lesion may decrease pain and keep the lesion from drying and cracking.

Some recommendations on how to minimize the risk:

- Replace your toothbrush because it can harbor the virus for days and re-infect you with another cold sore. Don't keep your toothbrush in the bathroom. The moisture in the bathroom prolongs the life of the virus causing cold sore in your toothbrush. In short, keep your toothbrush dry.

- Avoid excessive arginine-rich food such as chocolate, cola, peas, grain cereals, peanuts, gelatin, cashew and beer.

- Supplement your daily diets with good food sources of lysine such as dairy products, potatoes and brewer's yeast.

- Lemon has been used to stop fever blisters or cold sores over decades in Europe. You can cut a small slice of lemon and place it either on your cold sore and leave it there as long as you can. Change it as often as possible with a fresh slice.

- Apple cider vinegar is one of the oldest home remedies for cold sores, herpes and wounds. It should not be used pure on open sores because it can sting a lot. Pour a few drops on a cotton ball and apply it on your cold sore or blister. You can also mix it with lemon juice to increase its potential.

- Garlic is a broad-spectrum antibiotic, killing bacteria, fungus, yeast, viruses and parasites. A scientific study has confirmed that garlic can destroy several virus types on contact including herpes type 1.

- Ice cubes are a great way to ease the pain associated with a cold sore. Simply rub an ice cube directly onto the cold sore for a few minutes when it first begins to appear. Repeat this every 10 minutes for about an hour or so.

- The juice from an aloe plant can help ease the pain from a cold sore. Simply rub aloe juice directly onto the infected area for some fast relief. Aloe gels can also be used instead of fresh aloe juice.

- Use petroleum-based products all over the infected area. This will help prevent any secondary infection from bacteria as well as expedite healing.

- An effective remedy is to apply tea bags to the affected area. This facilitates the tannic acid in the tea to act against the virus and prevent its further development. Another effective method is to press a warm tea bag on the cold sore. A five-day application will make the sores disappear.

- If powered common salt is applied to the affected area by a moistened index finger, it’ll make cold sores disappear in two to three days.

- Herbs like herbal sage, tea tree oil and the herbal sedative violet have been used as treatments for cold sores. Sage leaf tea with a small ginger root piece or ginger powder is effective against this condition.

- Avoid physical contact with the cold sore area. Touching, rubbing, and scratching cold sores can not only increase bacterial infection but also unwittingly spread the virus to other areas of the face and possibly infect other persons.

- Clean the cold sore with a washcloth, soap, and warm water. This will minimize itching as well as prevent the virus from spreading.

- Avoid salty and acidic foods like lemon and potato chips as these will aggravate cold sores and become more painful.

- Use an anesthetic ointment to alleviate the pain.

- Recognize cold sore symptoms to prepare you for it, as well as be aware of the conditions that trigger your cold sore outbreak. Stress, weather extremes, the menstrual cycle. All these can cause an outbreak. Avoid too much exposure to direct sunlight, and use a good sunscreen.

- Get lots of rest. A well-rested person would have higher immunity against cold sores.

- Take vitamin supplements, especially those with a substantial amount of anti-oxidants and Vitamin B. Vitamin B deficiency has been found to have a direct link with cold sore outbreaks, and anti-oxidants are essential for a healthy body.

- Exercise. Not only does it bolster your immune system, it is an effective way to ward off stress, one of the common triggers of cold sores.

Over-the-counter (OTC) topical medications

Most topical OTC products provide symptomatic relief only; they do not decrease healing time. Using topical anesthetics that contain benzocaine (5%-20%), lidocaine (0.5%-4%), tetracaine (2%), or dibucaine (0.25%-1%) will help relieve burning, itching, and pain. The most commonly recommended products are Lipactin gel and Zilactin. It is important to keep in mind that these topical anesthetics have a short duration of action, usually only lasting 20-30 minutes. Skin protectants, such as allantoin, petrolatum, and dimethicone-containing products help keep the lesion moist and prevent cracking of the lesion. Sunscreen-containing lip balms may also help prevent additional outbreaks if the sun is a precipitating factor. For additional pain relief, using aspirin, ibuprofen (Advil), or acetaminophen (Tylenol) may be beneficial. These products should be used according to package directions.

Docosanol 10% cream (Abreva) is the only OTC topical product that is known to decrease healing time when applied at the first sign of recurrence (for example, the prodrome or tingling sensation). Docosanol is applied five times per day until the lesion is healed. Common side effects include rash and itching at the site of application.

Prescription-strength topical medications

Treatment with topical acyclovir (Zovirax 5% cream) or penciclovir (Denavir 1% cream) will reduce healing time by approximately half a day and decrease pain associated with the lesion. Topical treatment is limited in its effectiveness because it has poor penetration to the site of replication of the virus, and therefore is restricted in its healing ability. Acyclovir cream should be applied five times per day for four days, and penciclovir cream should be applied every two hours while awake for four days. In August 2009, the FDA approved a cream containing acyclovir and a topical steroid, which reduces healing time by approximately one day.

Oral prescription-strength medications

The current FDA-approved oral antiviral medications used in the treatment of herpes simplex virus in adults are acyclovir, valacyclovir (Valtrex), and famciclovir (Famvir). Famciclovir has not been tested in children with cold sores. These oral medications have been shown to decrease the duration of the outbreak, especially when started during the prodrome (symptom onset before the actual condition becomes fully evident). The medications are generally well tolerated with few side effects. Most common side effects include headache, nausea, and diarrhea. Treatment is only for one day with valacyclovir and famciclovir. Valacyclovir is given as 2 grams orally every 12 hours for one day, and famciclovir is given as 1,500 milligrams orally for one dose. Acyclovir is given as 400 mg orally five times per day for five days. Acyclovir, valacyclovir, and famciclovir are considered relatively safe and effective when used in pregnancy, although topical treatment would be preferred when appropriate. Acyclovir and valacyclovir have been used while breastfeeding. However, pregnant women and nursing mothers should contact their physician or pharmacist prior to using any medication.

People who have more than two outbreaks in four months, which significantly affect their daily lives, should consider chronic suppressive therapy. The FDA has approved the use of oral valacyclovir daily to prevent recurrence of the herpes simplex virus in people with normal immune systems and famciclovir in people with suppressed immune systems.

Sources and Additional Information:

http://www.tangledneuron.info/the_tangled_neuron/2007/04/herpes_simplex_.html

http://www.herpesdatingservices.org/herpes-alzheimer-disease.htm

http://www.antiherpes.com/oral_herpes.asp

http://neurosciencenews.com/researchers-link-herpes-virus-alzheimers-disease-cold-sores-hsv1/

http://www.huffingtonpost.com/dr-david-perlmutter-md/alzheimers-herpes-could-be-a-cause_b_814047.html

http://www.medicinenet.com/herpes_simplex_infections_non-genital/page6.htm

http://www.coldsorehomeremedieshelp.com/

4 Speedy Tests for Early Alzheimer’s Detection

2011-07-10T22:16:00.000-07:00

Researchers found that simple word-memory tests may accurately detect the earliest stages of Alzheimer's disease and thus improve chances for the prompt treatment of the disease.

Mild cognitive impairment -- subtle but measurable memory problems -- is the earliest clinical stage of Alzheimer's disease and related memory disorders and is typically followed by dementia. People who suffer from mild cognitive impairment have memory problems that are greater than normal for their age but otherwise show no symptoms of dementia.

During this stage, an individual's most complex abilities may be compromised, but activities of daily living, such as traveling, paying bills, and balancing a checkbook, are unaffected.

Spotting Alzheimer's disease at this early stage is important because there is an irreversible loss of function for every month that mild to moderate Alzheimer's disease goes untreated. But detecting mild dementia in its earliest stages is difficult because the person may not show any symptoms, and current methods are often not accurate enough.

Test 1: Animals Names

This is a simple word test that may help in the early diagnosis of Alzheimer’s. It deals with the way in which our brain saves and stores memories. Since some words are learned earlier in childhood and used more frequently in adulthood, certain words will be more difficult for the Alzheimer’s patient to recall. Word association tests such as this seem to work well in detecting early stage Alzheimer’s.

First ask the individual to name all the animals they can think of in one minute.

Then ask her/him to name all the types of fruit they can remember in one minute.

Researchers have found that people with early Alzheimer’s are able to list only 10 to 15 words in contrast to the 20 to 25 words from a healthy individual.

Test 2: Three-word Delayed Recall

Tell your patient to remember three words.
Give three common nouns, such as horse, pencil and rose, and ask the patient to repeat them.
About five minutes later, ask the patient to recall them.
Individuals without impairment should be able to remember all three words, especially with such prompts as, “The first word was the name of an animal.”
Remembering only one or two words indicates a need for further evaluation.

Test 3: 20-Questions Test

1. I am going to say 3 words. Please remember them. Those words are: boy, cat, pen. Repeat those words. Later on, I will ask you to recall and repeat them. Here they are again: boy, cat, pen.

2. What is your date of birth?

3. What year is it now?

4. What month is it now?

5. Do you know what day of the week it is now?

6. What is today’s date? (The date should be given within one day of the correct date.)

7. What city or town are you in right now?

8. Where are you right now? (The person must be clearly aware of the place, such as home, hospital, etc.)

9. Do you know the name of the current president or head of the country?

10. Do you know the name of the previous president or head of the country?

11. Repeat each sentence exactly as I say it:
a. Yesterday, I went shopping with my friend.
b. Tomorrow, I will be visiting my daughter.
(Both sentences must be repeated exactly as stated.)

12. Now tell me the three words I asked you to remember. (The person must be able to recall at least two of them.)

13. Has your memory caused you significant problems in the past few weeks?

14. Have family members said to you that you are getting much more forgetful?

15. Have friends or acquaintances said to you that you are getting much more forgetful?

16. If you have six apples and give two apples to David and two apples to Laura, how many apples do you have left?

17. Please count, starting at 7 and adding 7 each time: 7, 14, 21, go on...

18. An orange and an apple are both… (What?) A dog and a bird are both… (What?)

19. Has your memory interfered with your ability to take care of your chores around your house, or your job?

20. What food did you eat for your most recent meal?

Scoring: If the person screened missed five questions or more, it is a good idea to have him or her consult a physician and have some testing done.

Test 4: Counting Coins

Ask your patient, “If I give you a nickel, a quarter, a dime and a penny, how much money have I given you?”
When you avoid naming the coins in ascending or descending order of value, this task calls upon comprehension, working (or task completion) memory, planning and calculating skills.
Inability to arrive at the correct total of 41 cents may indicate a need for further evaluation.

Sources and Additional Information:

http://www.webmd.com/alzheimers/news/20050321/word-test-may-detect-early-alzheimers

http://free-alzheimers-support.com/wordpress/2010/09/a-few-mini-tests-to-do-at-home-for-alzheimers-diagnosis/

http://www.alz.org/professionals_and_researchers_14306.asp

http://www.way-of-the-mind.com/alzheimers-test.html

10 Scoring Approaches for Alzheimer's Clock Draw Test –Alzheimer's Early Detection

2011-07-03T18:10:00.000-07:00

Drawing a clock by hand is one of easiest to administer and one of the most popular screening tools that can help to detect mild cognitive impairment, dementia, or Alzheimer's among new patients. The test can be done anytime, anywhere, and can be self-administered as well.

There are numerous versions of the clock-drawing test. They all involve asking the patient to draw the face of a clock. Variations include providing a blank piece of paper or a paper with a pre-drawn (often 10 cm diameter) circle and asking the patient to draw the face of a clock. Further questions from the patients may be politely deferred by repeating the request to draw the face of a clock. Most variations of the test also include asking the patient to draw in the arms to denote certain time. Many times have been used including, 3:00, 3:40, 8:40, 2:45 and so on. They time 11:10 has been suggested as useful because of the distraction of "pull" of the numeral ten on the clock when setting a time. Generally there is no time limit to the test, but the test usually takes only one to two minutes.

If you administer the test to somebody else, in general, look first at symmetry of the numbers of the clock. This can indicate whether or not the patient was able to plan ahead. Leaving numbers out, repeating numbers, or continuing past the number 12 is also an indication of abnormality. Secondly, look at the hands. Deliberately choose a time from the offered list that is not straightforward because you are looking for disinhibition or “frontal pull.” The time ‘ten after eleven’ requires that the patient inhibit a reflex to put the hands at the numbers 10 and 11. This also requires abstract thinking to translate the concept of time into a drawing.

Test Description

Draw a clock by hand on a large piece of paper (about 10 cm in diameter).
Draw the face of a clock and put the numbers in the correct positions.
Then draw the hands to indicate 3:40 (time).

Standard Scoring

To score, assign the following points for each part of the drawing:

1 point for the clock circle.
1 point for all the numbers being in the correct order.
1 point for the numbers being in the proper special order.
1 point for the two hands of the clock.
1 point for the correct time.

Less points you get in the test, more you should worry about the potential symptoms of Alzheimer’s Disease. A normal score is four or five points out of five.

A simple similar results interpretation is offered by Stahelin:

· The number 12 must appear on top (3 points),

· There must be 12 numbers present (1 point),

· There must be two distinguishable hands (1 point),

· The time must be identified correctly (1 point) for full credit.

A score less than 4 (out of 6) is considered impaired.

Advanced Scoring

While the test itself is very easy and fast to administer or self-administer, and standard scoring process is equally easy and fast to obtain results, there are a number of variations on advanced scoring the clock, more than variations in administering the test itself. Most scoring systems are highly correlated with well-established measures including the MMSE, Dementia Rating Scale and the Global Deterioration Scale. Let’s briefly review the main advanced scoring approaches:

Mendez et al. 1992. Clock Drawing Interpretation Scale (CDIS) with the time "ten minutes past eleven." Each positive result earns a score 1.

1. There is an attempt to indicate a time in any way.

2. All marks or items can be classified as either part of a closure figure, a hand or a symbol for clock numbers.

3. There is a totally closed figure without gaps ("the closure figure"). Score only if symbols for clock numbers are present.

4. A "2" is present and pointed out in some way for the time.

5. Most symbols are distributed as a circle without major gaps.

6. Three or more clock quadrants have one or more appropriate numbers per respective quadrant.

7. Most symbols are ordered in a clockwise fashion.

8. All symbols are totally within a closure figure.

9. An "11" is present and is pointed out in some way for time.

10. All numbers 1 to 12 are present.

11. There are no repeated or duplicated number symbols.

12. There are no substitutions for Arabic or Roman numerals.

13. The numbers do not go beyond the number 12.

14. All symbols lie about equally adjacent to a closure figure edge.

15. Seven or more of the same symbol type are ordered sequentially. Score only if one or more hands are present.

16. All hands radiate from the direction of a closure figure's center.

17. One hand is visibly longer than another hand.

18. There are two distinct and separable hands.

19. All hands are totally within a closure figure.

20. There is an attempt to indicate a time with one or more hands.

Lam et al. 1998. Scoring criteria for clock drawing test. Chose score by description of the produced clock. Lower score you get – smaller signs of Alzheimer’s.

0 - Correct time shown with normal spacing.
1 - Slight impairment in spacing of lines or numbers.
2 - Noticeable impairment in line spacing.
3 - Incorrect spacing between numbers with subsequent inappropriate denotation of time.
4 - Obvious errors in time denotation (arms misplaced, numbers in wrong place)
5 - Abnormal clock-face drawing with inaccurate time denotation (e.g. reversal of numbers, perseveration beyond twelve, misplaced numbers, drawing only to one side, omitting most numbers)
6 - Abnormal clock face drawing with inaccurate time denotation (e.g. reversal of numbers, perseveration beyond twelve, misplaced numbers and drawing to one side and omitting most numbers).
7 - A recognizable attempt to draw a clock face but no clear denotation of time.
8 - Some evidence that a clock face is drawn.
9 - Minimal evidence that a clock face is drawn.
10 - No reasonable attempt to drawing a clock face (exclude gross visual disturbance, hemiplegia and severe psychotics state).

Wolf-Klein et al. 1989. Scoring criteria for clock drawing test. Chose score by description of the produced clock. Higher score you get – smaller signs of Alzheimer’s.

· X - Normal

· IX - almost normal except for number

· VIII - almost normal except for spacing

· VII - very inappropriate spacing

· VI - perseveration

· V - absence of numbers

· IV - counter clockwise rotation

· III - other

· II - irrelevant spatial arrangement

· I - irrelevant figures

Shua-Haim et al. 1996. Simple scoring system. Award one point for each of the following:

Approximate drawing of the clock face.
Presence of numbers in sequence.
Correct spacial arrangement of numbers
Presence of clock hands
Hands showing approximately the correct time
Hands depicting the exact time

Shulman et al. 1986. Classification of clock errors with the time

1. Visual spatial

a. Mildly impaired spacing of times

b. Draws lines outside of circle

c. Turns page while writing numbers so that some numbers appear upside down

d. Draws in lines to orient spacing.

2. Error in denoting time as 3 o'clock

a. Omits minute hand

b. Draws single line from 3 to 12

c. Writes words 3 o'clock

d. Writes number three again

e. Circles or underlines 3

f. Unable to indicate 3 o'clock

3. Visual spatial

a. Moderately impaired spacing of lines

b. Omits number

c. Perseveration

i. Repeats circle

ii. Continues on past 12 to 13, 14, 15 etc

iii. Counter-clockwise

iv. Dysgraphia

4. 4. Severely disorganized spacing

a. Confused time, writes in minutes, times of day, months or seasons

b. Draws picture of human face

c. Writes words "clock"

5. Unable to make reasonable attempt at clock

a. Exclude severe depression or psychotic state.

Sunderland et al. 1983. This is one of the most popular scoring systems for evaluating clock drawings. Higher the score – better the patient mental state. This method usually involves giving patients a pre-drawn circle.

· 10-6 - Drawing of clock face with number and circle generally intact

o 10 - Hands in correct position (i.e. Hours hand approaching 3 o'clock)

o 9 - Slight errors in placement of hands.

o 8 - More noticeable errors in placement of hour and minute hands

o 7 - Placement of hands is significantly off course

o 6 - Inappropriate use of clock hands (i.e. use of digital display or circling numbers despite repeated instructions).

· 5-1 -Drawing of clock face with circle and numbers is NOT intact

o 5 - Crowding of numbers at one end of the clock or reversal of numbers. Hands may still be present in some fashion.

o 4 - Further distortion of number sequence. Integrity of clock face is now gone (i.e. numbers missing or placed outside of boundaries of the clock face)

o 3 - Numbers and clock face no longer obviously connected in the clock drawing. Hands are not present.

o 2 - Drawing reveals some evidence of instructions being received but only vague representation of a clock.

o 1 - Either no attempt or an uninterpretable effort is made.

SHULMAN scoring system, 1993. Scoring criteria is presented below, while lower score gives higher warnings.

0 - No reasonable representation of a clock

—No attempts at all

—No semblance of a clock at all

—Writes a word or name

1- Severe level of disorganization as described in 2
2 - Moderate visio-spatial disorganization of times such that accurate denotation of 10 after 11 is impossible

—Moderately poor spacing

—Omits numbers

—Perseveration—repeats circle or continues on past 12 to 13, 14, 15 etc.

—Right-left reversal—numbers drawn counterclockwise

—Dysgraphia—unable to write numbers accurately

3- Inaccurate representation of 10 after 11 when visio-spatial organization is perfect or shows only minor deviations

—Minute hand points to 10

—Writes ‘10 after 11’

—Unable to make any denotation of time

4 - Minor visio-spatial errors

—A mildly impaired spacing of times

—Draws times outside circle

—Turns page while writing numbers so that some numbers appear upside down

—Draws in lines (spokes) to orient spacing

5 - Perfect clock

Watson Scoring System. The Watson method of scoring the CDT divides the clock into four quadrants. This technique does not score the hands, but focuses exclusively on the placement of numbers or symbols within each quadrant.

Scoring is performed through the following approach:

Draw one line through the center of the circle and the number 12 or mark that best corresponds to the number 12. Draw another line perpendicular to this line also through the middle of the circle. This will divide the clock into four segments.
Moving in a clockwise fashion, count the number of digits in each quadrant beginning with the number 12. If a digit falls on one of the quadrant lines, it is included in the quadrant preceding the line. A total of 3 digits in one quadrant is considered correct.
If there is an error in numbers of digits in the first three quadrants (spanning numbers 12 through 9), assign a score of 1. For any error in the number of digits in the last quadrant, assign a score of 4.
The sum of the scores for each quadrant is the total score for the clock.
Normal range of scores is 0 to 3. Abnormal range of scores is 4 to 7.

If you administer the test on your own and find the results either disconcerting or suspicious, schedule an appointment with your personal care physician. Take the copy of the clock test with you to the doctor appointment, and show the test to the doctor. Insist on a referral to a memory specialist for testing.

There are many diseases that can present as dementia or Alzheimer's. Getting the correct diagnosis is difficult under any and all circumstances. You need to be sure all the proper tests are administered.

Sources and Additional Information:

http://www.alzheimersreadingroom.com/2009/12/alzheimers-clock-draw-test-detect-signs.html

http://www.neurosurvival.ca/ClinicalAssistant/scales/clock_drawing_test.htm

http://www.aging.ufl.edu/files/pdf/tools/clockanalysis.pdf

http://alzheimers.about.com/od/diagnosisissues/a/clock_test.htm

http://www.mumj.org/Issues/v3_i1_march_2006/articles/MUMJ%2016-21%20Clock%20Drawing%20Clinical%20Research.pdf

Low linguistic ability in early life linked to Alzheimer’s later on

2011-06-20T16:32:00.000-07:00

Nun Study as unique source for the long-term Alzheimer’s research

In 1991, David A. Snowdon, Ph.D., Professor at Sanders-Brown Center on Aging College of Medicine, University of Kentucky, Lexington, began what has come to be known as the Nun Study. Participants in this study are 678 American members of the School Sisters of Notre Dame religious congregation. The nuns in the study are age 75 to 106.

The Nun Study is an ongoing, one-of-a-kind resource for the study of brain diseases in the elderly. It is expected that data, tissue, and genetic material collected in this study will be used by scientists for decades into the future.

Each of the 678 participants in the Nun Study agreed to participate in annual assessments of their cognitive and physical function, medical exams, blood drawing for genetic and nutritional studies, and brain donation at death for neuropathologic studies. The Nun Study represents the largest brain donor population in the world. In addition, the sisters have given investigators full access to their convent and medical records. The convent archives are particularly useful in our study of Alzheimer's disease because they contain accurate risk factor data spanning the entire lifespan of the participants. Accurate information on early and mid-life risk factors is difficult or impossible to obtain in most other studies on Alzheimer's disease because individuals with this memory disorder cannot accurately recall their history. The convent archives contain a wealth of information including baptismal records, birth certificates, socioeconomic characteristics of the family, education documentation, autobiographies written in early, mid, and late life, as well as residential, social, and occupational data describing their mid and late lives.

Many factors that confound (or confuse) the findings of other studies are either eliminated or minimized because of the relatively homogeneous adult lifestyles and environments of these women. Participants in this study are non-smokers, drink little if any alcohol, have the same marital status and reproductive history, have lived in similar housing, held similar jobs, and had similar access to preventive and medical care.

Findings from Nun Study

Some of the findings received from the Nun Study confirm the results, received from other researches, but there are some absolutely new insights obtained for the additional risk factors and causal relationship between personal characteristics and traits to the chance of the Alzheimer’s development at some moment in life.

Among the findings were:

1. Those, who had revealed better linguistic abilities in early life, were less likely to have dementia later.

2. Those, who demonstrated set of positive emotions in early life, had greater longevity.

3. Low linguistic ability in early life was associated both with dementia in later life and less longevity.

4. Those with low serum folate levels were more likely to have Alzheimer's disease of other dementia.

5. There was no significant relationship found between dental amalgams (silver fillings) and dementia.

6. Those with brain infarcts had poorer cognitive function and a higher prevalence of dementia.

7. Dementia was unrecognized by nursing staff in a number of cases.

8. Higher education in early life was associated with less cognitive decline in later life.

The study has confirmed, for example, that a history of stroke and head trauma can boost your chances of coming down with debilitating symptoms of Alzheimer's later in life; and that a college education and an active intellectual life, on the other hand, may actually protect you from the effects of the disease.

One of the most surprising results of the Nun Study, however, is the discovery that the way we express ourselves in language, even at an early age, can foretell how long we'll live and how vulnerable we'll be to Alzheimer's decades down the line. After analyzing short autobiographies of almost 200 nuns, written when they first took holy orders, he found that the sisters who had expressed the most positive emotions in their writing and who expressed the better linguistic abilities as girls ended up living longest, and that those on the road to Alzheimer's expressed fewer and fewer positive emotions as their mental functions declined.

So, the study found that low idea density shown in the writings of the young women was strongly linked with low cognitive test scores and the presence of Alzheimer's disease in late life. For example, the nuns with low idea density scores were 30 times more likely to do poorly on a standard measure of cognitive function, the Mini-Mental State Exam, than those with more complex writings. An even more dramatic difference was observed when cognitive ability and characteristics of brain tissue were compared in the nuns who died. Neurofibrillary tangles of Alzheimer's disease appeared in about 90 percent of those nuns who had low linguistic ability in early life.

Among other findings there are some, which still do not have the valid scientific explanation, as why there is not always the direct correlation between the medical evidence for the Alzheimer’s disease appearance in the brain and the actual behavioral symptoms doctors can see on these patients.

"Most of the brains neatly fit our expectations, with little or no evidence of disease in a tack-sharp sister and abundant damage seen in a sister who had dementia," Dr. Snowdon wrote. "But sometimes (Dr. Bill) Markesbery (the neurologist who did the autopsies) finds little evidence of Alzheimer's in a sister who had the classic symptoms of the disease. And sometimes brains from other sisters who appeared mentally intact when alive show extensive evidence of the disease."

This surprising information wasn't a set-up by the researchers. In fact, Dr. Snowdon noted that Dr. Markesbery was not informed prior to conducting the autopsy about the mental status of that particular sister. After the autopsy, Dr. Markesbery met with Dr. Snowdon and the study's neuropsychologist, Dr. Kathryn Riley, to compare notes.

In one case - that of Sister Maria - Dr. Markesbery found that the nun had some plaques and tangles, but the number was not large. The nun's brain itself weighed within the normal range (most Alzheimer's brains have lower weights). Furthermore, the sister's brain rated Stage II on the Braak scale. (The Braak scale defines six distinct stages of the disease based on an autopsy. Stage 0 indicates the general absence of tangles. Stages 1-VI described the increasing range of the number and spread of the tangles throughout the brain.)

Following Dr. Markesbery's report, Dr. Riley shared Sister Maria's scores on three evaluations conducted prior to her death. These evaluations showed that Sister Maria had suffered progressive loss of her mental, physical and social functions in a way that was consistent with Alzheimer's disease.

Yet the reverse can happen as well. For instance, Dr. Markesbery's autopsy of Sister Bernadette's brain yielded the findings that she had Braak Stage VI, which indicates the most severe presence of Alzheimer's. However, Dr. Riley's report on the cognitive evaluations conducted in the years prior to Sister Bernadette's death showed that the nun was mentally sharp.

"The Nun Study's real eye-opening findings...are the ones that add to the evidence that Alzheimer's is not a yes/no disease," Dr. Snowdon wrote. "Rather it is a process - one that evolves over decades and interacts with many other factors." Using the data from the Nun's Study, Dr. Snowdon pointed out, "Of sisters in stages I or II, only 22 percent had evidence of dementia. For stages III and IV, that jumped to 43 percent. And by stages V and VI, 70 percent of the sisters had dementia."

While there is no magical cure for Alzheimer’s so far, the findings from Nun Study may give a hope that even you may not be able to eliminate the negative neurochemical changes in your brain, you still can fight the symptoms actual appearance by filling your life with regular physical and mental exercises, healthy diet, lowering stress, attempting to happy and present, etc. This way, you can be proactive in altering how this disease may affect you at some point, if you have predisposition, and follow in Sister Bernadette's footsteps, living a long and vital life.

Sources and Additional Information:

http://www.suite101.com/article.cfm/alzheimers_disease/90363

http://www.healthstudies.umn.edu/nunstudy/faq.jsp

http://defoore.com/theNunStudy.htm

http://www.nia.nih.gov/Alzheimers/ResearchInformation/NewsReleases/Archives/PR1996/PR19960220nunstudy.htm

http://www.healthcentral.com/alzheimers/c/42/88723/nun-contradictions/

Antioxidants' Benefits for Alzheimer’s Disease Patients

2011-06-09T22:42:00.000-07:00

Oxidative stress may lead to neuronal damage and apoptosis. beta-amyloid neurotoxicity may be mediated in part by free radicals. Antioxidants may act as free radical scavengers, minimizing damage from lipid peroxidation and apoptosis. The brain is vulnerable to oxidative stress from many fronts. There is a demand for oxygen, an abundance of catecholamines and the possibility of auto-oxidation. Additionally, monoamine oxidase (MAO) formation of hydrogen peroxide (an oxidative compound), an abundance of iron (present in oxidative reactions) and relatively low concentration ofantioxidative enzymes (superoxide dismutase (SOD), catalase, glutathione peroxidase, glutathione reductase) place the brain in a susceptible position for oxidative damage.

Vitamin E

Several reviews have examined the role of vitamin E in AD. Basic evidence supports the role of vitamin E in protecting cell cultures from the toxic effects of beta-amyloid. The absorption of vitamin E is variable by the oral route. Bile is necessary for absorption and fat enhances absorption. Vitamin E is distributed to all tissues, although adipose tissue is the major storage site. It is hepatically metabolized, 70±80% in 1 week.

The major clinical study examining vitamin E in AD was a 2-year double-blind placebo-controlled trial in moderate to severe AD patients comparing vitamin E (2000 IU/day), selegeline (10 mg/day), the combination of the vitamin E and selegiline, and placebo. The outcome measures were nursing home placement, time to death, decline in well-defined ADL level and cognitive function. Neither selegiline nor vitamin E improved cognition compared to placebo. Although the trial was randomized, groups differed significantly in baseline cognition, as measured by MMSE. No difference between groups was found unless the baseline cognition was co-varied in the analysis. When this statistical manipulation was performed, the treatment groups all demonstrated benefits compared to placebo in some of the outcome measures (except cognition). There was no additive effect in the combination selegiline/vitamin E group.

Safety

Initial signs of toxicity are fatigue and weakness. Hepatotoxicity and ascites have been associated with vitamin E in infants. In adults, the risk of thrombophlebitis has been reported. In one study, 46 patients with an average age of 60 years had suspected or confirmed thrombophlebitis after vitamin E ingestion. The dose was less than 400 IU for two patients, 400±800 IU for 26 patients, 800 IU for 13 patients and not reported for five patients. Some patients developed thrombophlebitis again when rechallenged with vitamin E. Many of the patients had medical comorbidities that may have predisposed them to thrombophlebitis. There was no comparison group.

Coagulopathy is another potential adverse effect from vitamin E. The mechanism of this potential effect may be related to vitamin E's enhanced effects on oral anticoagulants, possibly secondary to interference with the effects of vitamin K on coagulation factor synthesis. Patients on oral anticoagulants with a dosage change of vitamin E greater than 300 IU/day should have prothrombin time (PT) or international normalized ratio (INR) closely monitored. Dosages greater than 300 mg/day may prolong PT. A case report described a 55-year old man who developed bleeding with warfarin and 1200 IU vitamin E per day for 2 months. The symptoms resolved after vitamin E was stopped, but returned after he was rechallenged with vitamin E 800 IU for 4 weeks. Additional support for potential coagulopathy is based on a possible hemorrhagic stroke in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study.

Prescription guidelines

Our practice is to prescribe vitamin E 1000 IU b.i.d to AD patients. Although the level of impairment of AD patients in the Sano study was moderate to severe, we empirically start vitamin E in the mild and moderate AD patients, believing that the potential benefit outweighs the risk. For patients on anticoagulants, we start on lower doses and titrate upward, closely monitoring the INR. Quality control is not similar for vitamin E preparations as FDA approved prescription drugs. This creates the potential risk of contamination, not knowing the actual ingredients in the preparation, and other unknown risks inherent in the manufacturing process of the compound. We advise our patients to use preparations that are listed in the United States Pharmacopeia. In the Sano study, the vitamin E preparation was made exclusively for the double-blind study and is not commercially available.

Selegiline

Selegiline is a MAO inhibitor that selectively inhibits MAO-B. Hepatic metabolism of the compound results in the production of desmethylselegiline, amphetamine and methamphetamine. Selegiline blocks free radical activity from oxidative species. Desmethylselegiline upregulates antiapoptotic molecules, glutathione and superoxide dismutase, providing additional protection.

In addition to having utility as an antidepressant agent, selegiline has demonstrated the ability to prevent animals from developing a parkinsonian syndrome induced by 1-methyl-4-phenyl-1, 2, 5, 6-tetrahydropyridine (MPTP). In humans, selegiline dosed at 10 mg/day may delay the emergence of disability or signs and symptoms of Parkinson's disease.

Effectiveness and safety

In AD, selegiline was found to be superior to placebo in delaying time to death, and decline in ADLs. There was no benefit to cognition, no significant effect on institutionalization and no additive effect with vitamin E. In this clinical trial with AD patients, falls, dental events (an event that led to dental treatment) and syncope were the only categories of adverse events that differed between treatment group and placebo. In routine clinical use, CNS side effects associated with selegiline may include sleep disturbance, psychosis, agitation, confusion, hypotension, anorexia and dyskinesias. Additionally, selegiline has the potential to interact with other drugs. Concurrent use of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), or miperidine should be avoided, as fatalities have been reported with these medication combinations. Combining selegiline with bupropion has resulted in bupropion toxicity in animals, and the combination should be avoided. In addition, combining selegiline and buspirone should be avoided because of the risk of hypertensive crisis.

Prescription guidelines

Selegiline is not a first-line agent for the treatment of AD. It is more costly and has a more malignant side effect profile than vitamin E. Selegiline may be offered to patients who are unable to take vitamin E because of allergy, sensitivity or coagulopathy risk, but they should be well informed that selegiline is not a standard of care for AD.

Source: Dementia by Mario Maj and Norman Sartorius

SAGE test for Mild Cognitive Impairment and Early Dementia

2011-06-02T23:13:00.000-07:00

SAGE is a brief self-administered cognitive screening instrument to identify Mild Cognitive Impairment (MCI) and early dementia. It was developed by the Ohio State University Medical Center to provides the self-tested preliminary guidance for the early signs of dementia.

Average time to complete the test is 10 to 15 minutes. The total possible points are 22.

Administration

The test is self-administered. There are four forms of the SAGE test. Only one test form should be given. It does not matter which form is taken, as they are all interchangeable.

All forms are in Adobe Portable Document (PDF) Format and require Adobe Reader. SAGE should be filled out in ink without the assistance of others. Inform the examinee that there are four pages to complete. Calendars and clocks should not be available during the testing. Do not answer specific questions. Just say, "Do the best that you can."

Questionnaires

Download SAGE test form 1

Download SAGE test form 2

Download SAGE test form 3

Download SAGE test form 4

Scoring

Average time to complete the test is 15 minutes. The maximum score is 22. A score of 17 and above is considered normal.

Download Scoring Instructions

Interpretation

Please note that SAGE screening is not a diagnostic test of any condition. Research has shown that SAGE can often, but not always, indicate whether individuals fall into the normal range, have mild memory or thinking impairments, or have a more severe memory or thinking condition. Please see the table below.

17 to 22 - Individuals with these scores are very likely to be normal.

15 and 16 - Individuals with these scores are likely to have mild memory or thinking impairments. Further evaluation by a physician is recommended.

14 and below - Individuals with these scores are likely to have a more severe memory or thinking condition. Further evaluation by a physician is recommended.

About SAGE Test

Dr. Douglas Scharre, a neurologist at the Ohio State University Medical Center, developed the Self-Administered Gerocognitive Examination (SAGE) to help identify individuals with mild thinking and memory impairments at an early stage. The research shows four out of five people (80 percent) with mild thinking and memory (cognitive) issues will be detected by this test, and 95% of people who are normal thinking will have normal SAGE scores.

Scharre, who specializes in treating Alzheimer’s disease, said treatments for Alzheimer’s and dementia are more effective when they are introduced in the earliest stage of the disease. Unfortunately, he said he often sees patients more than three to four years after the first symptoms of a cognitive impairment began to appear.

“It’s a recurring problem,” said Scharre. “People don’t come in early enough for a diagnosis, or families generally resist making the appointment because they don’t want confirmation of their worst fears. Whatever the reason, it’s unfortunate because the drugs we’re using now work better the earlier they are started.”

Many of the assessment tools for cognitive disorders being used today, while accurate, have aspects that deter their use. “Seldom are physicians reimbursed for the time and effort it takes to give such tests, or they tie up personnel to physically administer the test,” said Scharre, who advocates the use of routine screening for cognitive disorders in the primary care setting. Other diagnostic tests require the patient to use a computer, which can add heightened anxiety to some older adults who may be infrequent users of technology.

It only takes a paper, pen and a few minutes to take the test and because it’s self-administered, it doesn’t necessarily take time away from the appointment. “They can take the test in the waiting room while waiting for the doctor,” said Scharre.

Missing six or more points on the 22-point SAGE test usually warrants additional follow-up by the physician. Abnormal results can also prompt an early search for reversible and treatable conditions that may be causing the patient’s thinking and memory impairment. Many conditions besides Alzheimer’s disease, such as strokes and some thyroid conditions, can also impact memory, according to Scharre.

Scharre said there are potential cost savings to using the tests in a primary care setting. He reasons that a person who fares poorly on the self-exam will likely be less compliant taking medications on time, taking them in the proper dosages or following other recommendations such as maintaining healthy diets.

“Abnormal test results can serve as an early warning to the patient’s family,” added Scharre. “The results can be a signal that caregivers may need to begin closer monitoring of the patient to ensure their safety and good health is not compromised and that they are protected from financial predators.” Results of the new test compare favorably with current standard cognitive assessments that are not self-administered.

To validate the exam’s findings and accuracy, Scharre and other researchers at Ohio State evaluated study participants using SAGE, and then evaluated the same subjects with a battery of other established and well-documented assessment tools.

The study involved 254 study participants, 59 years of age or older, who took the SAGE self-assessment. Sixty-three (63) individuals were randomly selected to have a one-day clinical evaluation utilizing a battery of physical, neurological and cognitive tests.

SAGE scores compared favorably with the mini-mental state examination (MMSE), a brief questionnaire test that is commonly used in medicine to screen for cognitive impairments and dementia.

Both tests were able to differentiate clinically defined normal and mild cognitive improvement from subjects with dementia. However, SAGE, but not MMSE, was also able to distinguish between clinically defined normal from the mild cognitive improvement group.

Physical Exercises may Delay or even Reverse Alzheimer’s Disease Symptoms

2011-05-26T22:05:00.000-07:00

Scientists have discovered an interesting link between fitness exercises bring ultimately positive impact on the well-being of the Alzheimer’s patient, being able to slow down and even slightly reverse the symptoms severity. Keeping your body fit causes multiple positive changes to your physical, emotional, and mental health, so there is an overwhelming reasons to include the daily routine in your action plan to fight Alzheimer’s disease.

Patients with early Alzheimer's disease who exercised regularly saw less deterioration in areas of the brain that control memory, according to a study released at the 2008 International Conference on Alzheimer's Disease.

Mild Alzheimer's disease patients with higher physical fitness had larger brains compared to mild Alzheimer's patients with lower physical fitness, according to a study published in the July 15, 2008, issue of Neurology, the medical journal of the American Academy of Neurology.

For the Alzheimers and exercise study, 121 people age 60 and older underwent fitness tests using a treadmill as well as brain scans to measure the white matter, gray matter and total volume of their brains. Of the group, 57 were in the early stages of Alzheimer's disease while the rest of the group did not have dementia.

"People with early Alzheimer's disease who were less physically fit had four times more brain shrinkage when compared to normal older adults than those who were more physically fit, suggesting less brain shrinkage related to the Alzheimer's disease process in those with higher fitness levels," said study author Jeffrey M. Burns, MD, of the University of Kansas School of Medicine in Kansas City and member of the American Academy of Neurology.

The results of this Alzheimers and exercise study remained the same regardless of age, gender, and severity of dementia, physical activity and frailty.

"People with early Alzheimer's disease may be able to preserve their brain function for a longer period of time by exercising regularly and potentially reducing the amount of brain volume lost.

Evidence shows decreasing brain volume is tied to poorer cognitive performance, so preserving more brain volume may translate into better cognitive performance," Burns said. "This is one of the first studies to explore the relationship between Alzheimers and exercise (cardio respiratory fitness)”.

The positive message from researchers is that in order to benefit mental activity, physical activity does not necessarily need to be extremely strenuous or constitute a big time commitment. The major point is that although moderate exercise can benefit mental capacity, it is necessary that it be done on a consistent basis.

By strengthening the heart, exercise increases blood flow to the brain, which increases tolerance to exercise, prunes body weight, and lowers blood pressure. In addition, exercise lowers the bad cholesterol (LDL) and raises good cholesterol (HDL) with the added benefit of increasing sensitivity to insulin, which reduces likelihood of developing a disease that could negatively affect brain function.

Older adults exhibiting early signs of Alzheimer's disease can help prevent mental decline through high-intensity aerobic exercise, according to another study published in the Jan. 11, 2010 edition of the journal "Archives of Neurology." A team led by Laura Baker observed the effects of aerobic training on 33 older adults diagnosed with mild-cognitive impairment. For six months, subjects either participated in high-intensity aerobic exercises or completed stretching activities. The aerobic group demonstrated significant gains in mental agility, when compared to the stretching group, which continued to decline. Baker reports that aerobic exercise likely protects the brain by building heart and artery resilience --- increasing blood flow to the brain.

Mild Exercise Probed as a Means to Counter Dementia

Modest physical activity, which ranges from around thirty minutes a day, is recommended. If there are any health issues or concerns, then it is highly recommended that a professional health care advocate be consulted prior to beginning any new exercise regimen.

Need help with the arrangements – involve your caregiver or family member. Be consistent, and you will see positive results for your overall well-being soon.

So what types of activities are recommended?

Walking is the number one recommended activity. It is a low impact activity that can be started slowly and gradually increased to achieve greater intensity and longer durations. Daily changes can be made in an outdoor or indoor walking routine (e.g., many people vigorously walk in malls during inclement weather) to keep interest high (which assists in maintaining motivational levels).

Light strength training can be performed from a wheelchair. Studies have shown that individuals who perform strength training will also improve bone density. Tai chi is an excellent activity for strength, balance and coordination.

Aerobic exercises that have low impact are highly recommended. These include swimming (even walking in waist deep water will build strength, as will walking in deep sand) and bicycling.
Gentle forms of yoga emphasizing mild stretching exercises improve circulation, digestion and focus.

Note that exercise is natural and lacks the unpleasant and dangerous side effects associated with most, if not all, prescription drugs.

Sample of the Physical Fitness Training Protocol

Weigh in. Note your weight at the beginning of the training session.
Check Pulse. This is obtained after several minutes of sitting quietly after arriving to the Fitness Center. Do not proceed if your resting pulse is higher than 90.
Warm-up Walk. Walk on spot for several minutes to warm up.
Stretches. Perform a series of stretches, most of which are done sitting down: Neck stretch, (right, left, forward); arm across chest (r & l); hamstring stretch: sit, extend legs, one bent, one straight. Slide arms down straight leg, head looking forward, then switch. calf stretch (r & l). Do each stretch twice. Hold for 16 seconds.
Calf raise. Up on tip toes and down, holding lightly onto bar. Repeat 15 times.
Step up on Reebok step aerobics box and down (without bringing other leg to rest on box) – right, then left. One set per side. Add 2 reps per week.
Balance practice: Stand on box on right foot, holding onto bar lightly. Signal to the instructor when ready to let go and count seconds held; do 3 times for each foot and record longest time.
Wrist roll-ups. Perform two sets (each set = one rolling up of rope and one unrolling).
Treadmill. Fasten safety clip. Set elevation at 0 and rate at 1.0 or more, depending on your physical abilities.

You should be at 15-20 minutes from the beginning of exercises by now.

Bike. Adjust seat height and position to be comfortable. Enter weight. Use up and down arrows to set weight and time. Hit start.
Weight training. Perform 2 sets of 10-12 reps on 5 different machines that work large muscle groups. Rest for at least 30 seconds after each set. After two successful workouts of 2 sets of 10 at a given weight, increase to 12 reps. Then increase weight – 2-6 pounds, as tolerated, for upper body machine; 10-20 pounds for leg press. If you feel you are working too hard, drop back.
Leg Press. Strengthens muscles of the legs and buttocks. Back should be in most upright position possible. Shoulder pads should just touch shoulders. Legs, when on plate, should be at about 6 inches apart and at 90 degree angle (slightly greater than 90 for subjects with knee problems.
Chest Press. Strengthens muscles of the chest and shoulders. Two adjustments: back and seat. Back should be so that vertical sidebar is parallel to your shoulder and upper arm when you are leaning back. Seat height should be so that crook of arm handle is at armpit level. Ankles should be crossed.
Row: Strengthens muscles of the arm shoulder, and upper torso. One adjustment. Adjust seat so that center padded column is against your stomach, but you are sitting up straight, not slouched over the pad. Move yourself as close to hand grips as possible.
Torso Arm: Strengthens muscles of the arm, shoulder, and upper torso. Back in upright position, adjustable seat height. Seat is raised in order for you to reach hand grips. If uncomfortable high off the ground, grips can be lowered. Use seat belt.
Overhead Press: Strengthens chest and shoulder muscles. Adjust seat so that your shoulder is at the crook of the hand grip. Ankles should be crossed. Use seat belt.

You should be at 30-40 minutes from the beginning of exercises by now. Some general notes:

Drink plenty of water through the exercise.
Accept help from your family member or personal trainer to supervise your activity and monitor your vitals.
Be reasonable. You have a life marathon to run, do not get yourself exhausted on the first mile.
Be patient, do not expect magic improvements overnight.
Reward yourself for being consistent.

Sources and Additional Information:

http://www.brainbequick.com/alzheimers-and-exercise.html

http://www.healthsciencenews.com/2008/07/15/exercise-health-benefit-for-alzheimers

http://www.u.arizona.edu/~sarkin/elderrehab.html

http://www.livestrong.com/article/347048-exercise-alzheimers/

http://www.ultrafitnessdynamics.com/467/exercise-new-hope-for-alzheimers-sufferers/

Copper and Alzheimer’s Relationship: Enemy or Friend?

2011-05-17T21:57:00.000-07:00

Enemy

A recent study conducted by researchers from the University of Michigan reveals that copper pipes should not be used for supplying drinking water, as a building up of the metal in the body increases the risk of Alzheimer’s, heart diseases and diabetes in people over the age of 50.

According to the study published in the American Chemical Society’s Toxicology journal, traces of copper from the pipes mixes with the tap water consumed by people, and since our bodies are unable to process the metal, it simply accumulates over time resulting in major health problems, such as, Alzheimer’s in later age.

George J Brewer, who led the study points out that Alzheimer’s and heart diseases are only worsened by excess copper and iron, with such toxicities posing a looming public health problem in the ageing process, including ageing diseases.

As well, Brewer also warns people with a high intake of copper lose their brain function at over thrice the normal rate, if their diet comprises of a relatively high fat diet. The researchers also advise people over 50-years to refrain from taking vitamin and mineral pills containing cooper and iron, including reducing their meat consumption, as also avoiding drinking water from copper pipes.

The similar results were received by the researches, made by Larry Sparks, at the Sun Health Institute in Sun City, Arizona, and Bernard Schreurs, at West Virginia University. They confirmed that copper may increase the growth of the protein clumps in the brain that are a trademark of Alzheimer's disease.

Doing their research on rabbits, researchers first noticed that the rabbits they use to model Alzheimer's disease developed fewer plaques in their brains when they drank distilled water rather than tap water. These insoluble plaques, generated in the rabbits via a high-cholesterol diet, are a trademark of the degenerative illness. The copper drinking rabbits also suffered dramatically poorer memories in complex tests.

Not an Enemy, Not a Friend

Researchers in Germany, led by Drs. Thomas Bayer and Gerd Multhaup, prominent neuroscientists, have shown in their recent study that patients with mild AD who were given daily oral doses of copper for 12 months displayed no significant differences in their condition. That is, the patients who took the copper supplementation, up to 8 mg daily, showed neither improvement nor progression of AD. It should be noted that the US adult recommended daily allowance (RDA) for copper is 0.9 mg/day.

The clinical trial contained 68 patients, both male and female, with an average onset age of AD of 67. The phase II double-blind clinical trial divided the group into those receiving the copper supplementation and those receiving a placebo. The study demonstrates that the copper was well-tolerated. Both groups of patients displayed no clinically significant differences in vital signs, physical examination, blood tests, or biochemical analyses.

The important conclusions of this clinical trial, for copper and AD, are that

1) The long-term oral intake of 8 mg copper can be excluded as a risk factor for AD;

2) The long-term oral intake of copper is well-tolerated by AD patients; and

3) Copper intake has no effect on the progression of the AD.

Friend

Based on the researches, some of which were presented earlier, copper was postulated to be a possible risk factor in the development of Alzheimer's disease. However, other studies have completely opposite results, concluding that copper may reduce significantly the development of the disease.

Two recent studies, one by Exley and another by Jiang, both seem to point to the conclusion that copper reduces plaque build-up in the brain. This plaque is more specifically a clumping of the amyloid beta, a peptide present in the brains of Alzheimer’s patients. An earlier study from the Department of Psychiatry at the Saarland University Medical Center found lower levels of copper in post-mortem Alzheimer’s patients. Another study, by Bayer and Multhaup, found a positive correlation between copper levels and scores on an Alzheimer’s specific cognitive processing test. The results support the notion of a mild copper deficiency in AD patients. All these data might suggest that there is a relationship between copper deficiency and Alzheimer’s disease, but it is too soon to jump to that conclusion. It is possible that an increased uptake of dietary copper may therefore be therapeutically relevant.

Conclusion

You may be confused by this post the same way I was confused by reviewing all information available for the causal relationship between Copper and Alzheimer’s. Let’s say, that the research data is still not conclusive at the moment, so the wait-and-see approach should be applied to get better scientific confirmation for one or another theory.

Sources and Additional Information:

http://visitbulgaria.info/12439-copper-causes-alzheimer-s

http://www.newscientist.com/article/dn4045-copper-link-to-alzheimers-disease.html

http://www.copperinfo.com/health/pdf/alzheimers.pdf

http://www.urmc.rochester.edu/news/story/index.cfm?id=1718

http://intro2psych.wordpress.com/2010/03/26/alzheimers-sleep-and-copper/

http://www.sciencedaily.com/releases/2005/10/051004084327.htm

Eating Fresh Apples May Protect from Alzheimer’s

2011-05-08T22:35:00.000-07:00

Fresh apples -- the peel in particular -- have some of the highest levels of quercetin (also found in onions, broccoli, kale, blueberries, cranberries and red grapes). Some of the most lab exciting studies on this flavonol suggest it may help fight Alzheimer's disease by protecting brain cells against oxidative stress. In an animal study at Cornell University, quercetin proved more powerful than the antioxidant vitamin C in neutralizing the kind of neural damage done by free radicals. "Fresh apples have some of the highest levels of quercetin ... and may be among the best food choices for fighting Alzheimer's," said study author C.Y. Lee.

What is Quercetin?

Quercetin belongs to a group of plant pigments called flavonoids that give many fruits, flowers, and vegetables their color.

Flavonoids such as quercetin are antioxidants -- they scavenge damaging particles in the body known as free radicals, which damage cell membranes, tamper with DNA, and even cause cell death. Antioxidants can neutralize free radicals and may reduce or even help prevent some of the damage they cause. They also help keep LDL ("bad") cholesterol from being damaged, which scientists think may contribute to heart disease. In test tubes, quercetin has strong antioxidant properties, but researchers aren't sure whether taking quercetin (and many other antioxidants) has the same effects inside the body.

Quercetin acts like an antihistamine and an anti-inflammatory, and may help protect against Alzhemier’s disease, heart disease, and cancer.

Cornell University Study

In this latest research, Lee and his colleagues exposed rat brain cells to varying amounts of quercetin or vitamin C, a well-established antioxidant and disease fighter. The brain cells were then exposed to hydrogen peroxide, a substance that can mimic some of the kinds of cell damage that occurs in the brains of those with Alzheimer’s disease. The cells that had been treated with quercetin showed significantly less damage than the vitamin-C treated cells or brain cells that did not get any antioxidant protection. Quercetin also protected nerve cell membranes more than did vitamin C. This is significant because the researchers believe that loss of cell membrane integrity contributes to neurotoxicity. Larger doses of quercetin or vitamin C conferred greater protection from oxidative stress.

Scientists are not sure exactly how the quercetin in apples protects brain cells in the lab, although its antioxidant effects are thought to neutralize cell-damaging compounds called free radicals. Other foods that are rich in quercetin, such as onions, blueberries, cranberries, and tea, may also afford protection against Alzheimer’s. Quercetin is also sold in nutritional supplements. The apple, however, remains at the top of the list when it comes to natural sources for disease-fighting quercetin.

“People should eat more apples, especially fresh ones,” says study leader C.Y. Lee, Ph.D., professor and chairman of the Department of Food Science & Technology at Cornell University in Geneva, N.Y. He cautions that protection against Alzheimer’s using any food product is currently theoretical and adds that genetics and environment are also believed to play a role in the disease. Despite these caveats, the researcher predicts that “eating at least one fresh apple a day might help.” But Lee also points out that results so far are limited to cell studies and that more advanced research, particularly in animals, is still needed to confirm the findings.

Querecetin Natural Sources

Even though quercetin is relatively stable during cooking, fresh apples are better sources of quercetin than cooked or processed apple products because the compound is mainly concentrated in the skin of apples rather than the flesh, Lee says. Products such as apple juice and apple sauce do not contain significant amounts of skin. In general, red apples tend to have more of the antioxidant than green or yellow ones, although any apple variety is a good source of quercetin.

For those who don’t like apples or may have difficulty eating the whole fruit, there are some promising alternatives, Lee suggests. Other foods containing high levels of quercetin include onions, which have some of the highest levels of quercetin among vegetables, as well as berries, particularly blueberries and cranberries. Like other antioxidants, quercetin has been associated with an increasing number of potential health benefits, including protection against cancer.

How to Take Quercetin?

Recommended adult dosages of quercetin vary depending on the condition being treated. The recommendations for the general supplementation are 100 - 250 mg 3 times per day.

Precautions

Quercetin is generally considered safe. Side effects may include headache and upset stomach. Preliminary evidence suggests that a byproduct of quercetin can lead to a loss of protein function.

Pregnant and breastfeeding women and people with kidney disease should avoid quercetin.

At high doses (greater than 1 g per day), there are some reports of damage to the kidneys.

Possible Drug Interactions

If you are being treated with any of the following medications, you should not use quercetin supplements without first talking to your health care provider.

Anticoagulants (blood thinners) -- Quercetin may enhance the effect of these drugs, increasing your risk for bleeding:

Warfarin (Coumadin)
Clopidogrel (Plavix)
Aspirin

Chemotherapy -- Test tube and animal studies suggest that quercetin may enhance the effects of doxorubicin and cisplatin, two chemotherapy medications used to treat cancer. In addition, some doctors believe taking antioxidants at the same time as chemotherapy can be harmful, while others believe it can be helpful. Talk to your oncologist before taking any supplements if you are undergoing chemotherapy.

Corticosteroids -- Quercetin may cause these drugs to stay in the body longer.

Cyclosporine -- Quercetin may interfere with the body's absorption of this drug, which is used to suppress the immune system.

Sources and Additional Information:

http://www.dole.com/NutritionInstituteLanding/NI_Articles/NI_NutritionNewsDesk/NI_NutritionNewsDesk_Details/tabid/990/Default.aspx?contentid=8938

http://www.umm.edu/altmed/articles/quercetin-000322.htm

http://www.alzinfo.org/01/articles/prevention-and-wellness-109

http://www.nootropics.com/quercetin/index.html

http://seniorjournal.com/NEWS/Alzheimers/4-11-16Apples.htm