Spring Arbor Living Blog

Behavioral and neuro-psychiatric symptoms of dementia can be extremely challenging and distressing for patients and their caregivers. Antipsychotic medications may be the only option if the patient's behavior is potentially harmful to him- or herself or to others.

Antipsychotic medications are often prescribed for dementia patients in nursing homes to alleviate the agitation, aggression or psychotic behavior that is either distressing to the patient or makes the patient a danger, but the Food and Drug Administration (FDA) has not approved any drugs for the treatment of behavioral symptoms of dementia. What's more, antipsychotics carry an FDA black box warning that older patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death.

Drugs versus alternatives

There are ways to deal with difficult dementia patients that don't involve the use of drugs. Once a medical cause has been ruled out, the nursing and medical staff should look for environmental triggers that can be avoided or minimized.

• Changes in the environment might include increasing contact with caregivers, switching roommates, adjusting the temperature in the room or providing stimulating activities.
• Simply paying attention to a patient can often ease disruptive symptoms.
• In some cases, difficult behavior can be safely managed by reducing boredom -- providing intellectual and physical stimulation, exercise, calming music or pet therapy.

However, if someone is in psychological agony and nondrug approaches have failed, medication might help. The risks and benefits of prescribing antipsychotics to people with dementia need to be carefully considered. While dementia patients are difficult to care for, even when drugs are administered, the practice of overmedication to make patients "manageable" is certainly not acceptable. Advocating for your loved one with dementia

When someone with dementia is cared for in an Alzheimer's care facility, the support of family and friends is still critical, since the person can't adequately advocate on his or her own part. Family members must learn about the medications that are being dispensed, the reasons for their use, proper dosages and possible side effects.

If you notice that your loved one seems to be showing greater confusion after starting a drug, say something. Bring this to the attention of the doctor who prescribed the medication and discuss what steps can be taken to improve his or her quality of life. By maintaining this dialogue, you will be doing everything you can to ensure the best care for your loved one.

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A subscriber to the Johns Hopkins Memory Disorders Bulletin asked: “I recently read a newspaper interview with a famous neurologist who described the case of a musician who had completely lost his memory to dementia, yet was capable of playing piano concertos -- from memory at a professional level. Having cared for my mother, who died from Alzheimer's, I do not see how this is humanly possible. Can you please explain?”

Dr. Peter Rabins answers:  “I have also observed individuals who have advanced Alzheimer's disease but can still play bridge or music. There are several plausible explanations. Most likely, the retained ability is "highly developed," that is, something the person was especially good at. Usually, there is some deterioration from the very high level at which the person could once perform, but the remaining skills are still far above average. Often, what is retained is something learned a long time ago.

In Alzheimer's disease and most dementia, new information is lost first and information that was learned long ago is retained for a much longer period. As a result, the person with dementia can play a piece of music learned many years ago, but not learn a new piece of music. In vascular dementia, the deficits are described as "patchy" because some abilities are intact and others are impaired -- the difference depends on whether a particular area of the brain has been injured or not.”

Johns Hopkins Health Alert

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As you age, make time for games, puzzles, and handicrafts.  

A new study published in BMC Medicine shows that these activities reduce the risk, and help slow down the progress of dementia in healthy elderly people.

The study revealed that healthy older adults were able to improve specific skills, such as reasoning, memory, language and hand-eye coordination with cognitive training.

Estimates show that by 2050 the number of people over 65 years old will have increased to 1.1 billion worldwide, and that 37 million of these will have dementia.
 
Previous research has shown that mental activity can lower a person’s risk of dementia, but the effect of cognitive training on healthy people is less well understood. To investigate this further, researchers from China studied the use of cognitive training as protection against mental decline for healthy elderly people who live independently.

Study participants were between the ages of 65 and 75 years old. For 12 weeks, the training sessions were an hour long, twice a week, and the subjects were given homework.

Training included a multiple approach system that tested memory, reasoning, problem solving, map reading, handicrafts, health education and exercise, or focused on reasoning only. “Booster training” was also  provided six months later.

“Compared to the control group, who received no training, both levels of cognitive training improved mental ability, although the multifaceted training had more of a long term effect. The more detailed training also improved memory, even when measured a year later and booster training had an additional improvement on mental ability scores,” said research leaders Chunbo Li and Wenyuan Wu.

The findings show that cognitive training may prevent mental decline in healthy older people and help them live independently as they continue to age.

Psych Central

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Deciding when an older adult is no longer fit to drive is a challenging issue with no clear answer. When it comes to dementia, the decision can be especially tricky. Here’s advice that may help you.
 
Caregivers are frequently the first line of defense when it comes to reporting unsafe driving in a person with dementia, and doctors should listen to what they have to say. “Caregivers are often proven correct when they report dangerous driving,” says Peter Rabins, M.D., M.P.H., director of the division of geriatric psychiatry at Johns Hopkins. “They are more likely than the patient to give a realistic assessment of the patient’s driving abilities.”

But the most reliable measure of a dementia sufferer’s driving ability is a driving test. If a doctor has doubts about a patient’s fitness to drive, he or she may refer the patient for an on-road driving test. Some states actually mandate behind-the-wheel road tests by the Department of Motor Vehicles for older drivers to renew their licenses, while other states allow occupational therapists trained to assess driving ability to evaluate patients. States also differ in physician requirements for reporting a driver who is too impaired by dementia to drive.

Often, enforcing a decision that a person with dementia is unfit to drive comes down to the patient’s family or caregiver. Dementia patients may forget they were told not to drive or not agree with the assessment that they are unfit to drive. It’s a very difficult topic to approach, but beginning discussions about driving with the person early on, reducing the need to drive and arranging alternative transportation can help make for a smoother transition to life after driving.
 
How can you tell if a driver with dementia may no longer have the skills needed behind the wheel? If someone shows one or more of the signs below, it’s time to have a serious conversation with the driver and his or her doctor:

• Stops in traffic for no reason or ignores traffic signs
• Fails to signal or signals inappropriately
• Drifts into other lanes of traffic or drives on the wrong side of the street
• Becomes lost on a familiar route
• Parks inappropriately
• Has difficulty seeing pedestrians or other vehicles
• Has difficulty making turns or changing lanes
• Gets drowsy or falls asleep while driving
• Lacks good judgment
• Has minor accidents or near misses

Johns Hopkins Health Alert

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When family members become caretakers of loved ones who suffer from Alzheimer's disease and dementia, they often study up on the condition.

"The more you can learn the better you're going to be and you better understand the disease."

Often used interchangeably, both dementia and Alzheimer's are forms of mental degradation. In many ways they seem the same but are actually two different medical terms.

"I tell people that it’s sort of like dementia is the team and Alzheimer's is one of the players," says Dr. Michael Raab, a geriatrician with Lee Memorial Health System.

Dementia covers a number of disorders; Alzheimer's is most common.

Alzheimer's has physical characteristics in the brain, which most other forms of dementia don't have.

"When you look at the brain, there are tangles and plaques. The Lewy Body dementias, the vascular dementias, the front dementias, none of them really have any plaques or tangles," says Dr. Raab.

What's more, Alzheimer's progression is gradual and can begin in middle age. General dementia is usually found in advanced years.

Finally, various conditions can affect different parts of the brain. Only a specialist can give you proper diagnosis.

"It takes very sophisticated testing which is what we do with our neuropsychologists, to try and differentiate the areas of thinking that have been lost," says Dr. Raab.
 
NBC2.com

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Even moderate exercise can increase the size of your brain. The best thing you can do to keep your brain healthy is to get off the couch go for a brisk walk. Just one year of walking three times a week can increase the size of the hippocampus, a part of the brain that's key to memory.

Scientists know that the hippocampus begins to shrink as we age, leading to impaired memory and an increased risk of dementia. Researchers have shown that aerobic exercise can reverse the shrinkage and improve memory, a finding that builds on past evidence pointing to a relationship between fitness and brain function.

"This important study goes well beyond saying that exercise is good for older people, a statement that often leads people to roll their eyes and say, 'Of course,' " says Columbia University neurologist Scott Small, M.D. "It links exercise specifically to a way in which aging affects the brain and clearly establishes a means to slow the onset of age-related memory loss."

For the study, researchers from the University of Pittsburgh, the University of Illinois, Rice University and Ohio State University recruited 120 sedentary older people without dementia.

The men and women, 55 to 80 years old who in the previous six months had participated in less than one weekly session of physical activity lasting at least 30 minutes.

The participants were randomly assigned to one of two supervised groups, either an aerobic exercise program of walking around a track for 40 minutes a day, three days a week, or a program of yoga and toning with resistance bands. They provided blood samples, had MRI brain scans and took memory tests at the beginning of the one-year study, after six months and at the end.

After the study ended, brain scans showed that the hippocampus had increased in size by about 2% among the walking group, which effectively reversed age-related loss by one to two years, while it shrank by about 1.4% in the stretching group. The exercise group also showed improved performance on a memory test and increased levels of BDNF, a protein involved in learning and memory.

This is an inexpensive and painless way to improve memory and brain health. All you need is a good pair of shoes.

AARP

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While no one can promise a sure-fire treatment to prevent memory loss, there are strategies that can significantly improve your chances of keeping Alzheimer's at bay.

How to Protect Your Memory and Brain Health

8 Key Strategies Focused on Saving Your Memory

Dr. Peter V. Rabins, acclaimed author and geriatric psychiatrist at Johns Hopkins - and one of the nation's leading experts on the care and management of patients with Alzheimer's disease and other forms of dementia and memory care.

If someone told you there were eight straightforward steps you could take to dramatically enhance your quality of life and reduce or delay your chances for memory deterioration, what would you do?

Many experts believe that once you understand your various risk factors for cognitive decline, take control of them, and follow through with the evidence-based strategies detailed in How To Protect Your Memory and Brain Health, you'll be in a better position to keep your memory strong well into later life.

For example, do you know:

What's the best way to guard your memory and prevent dementia?

If you answered, stay heart healthy, you'd be right. And Dr. Rabins explains why with evidence from recent studies in the Archives of Internal Medicine. Controlling high blood pressure and cardiovascular disease are absolutely critical to cognitive function. Dr. Rabins explains how to take charge.

What are the effects of too little sleep on keeping your memory sharp?

Many of us have trouble sleeping at night. No big deal -- right? Now new studies show that getting adequate sleep plays an essential role in learning new information, relating to names, dates, faces, facts, specific events - in short forming memory.

What's so special about the Mediterranean diet?

For years the marketing and promotion of dietary supplements that claim to enhance memory have left many people confused and wary. Now recent evidence-based research reported in the Annals of Neurology suggests that people who closely follow the Mediterranean diet have a 40 percent lower risk of Alzheimer's disease. The take-away: The food you eat, not the pills, can prevent or slow the rate of cognitive decline.

How does regular physical activity protect memory and reduce the risk of Alzheimer's?

Studies investigating the exercise/memory/dementia link have shown positive outcomes in recent years. Dr. Rabins provides an in-depth look at a number of key studies to show you the benefits of regular exercise... and how to incorporate exercise into your schedule.

How does stress affect memory?

We all know that living a stress-filled life is unhealthy. It turns out that stress is worse for us than we thought. Johns Hopkins researchers have linked high levels of the stress hormone cortisol with poor cognitive performance in older adults. And another study, reported in the journal Neurology, found that depressed and anxious people are 40% more likely to develop mild cognitive impairment. In this fascinating section, Dr. Rabins provides key "stress erasers" - proactive steps you can take to reduce the stress in your life.

Every day, scientists are proving that diminished memory and mental capacity are NOT inevitable - and can be slowed, halted or even reversed through good nutrition, lifestyle habits and more. Even Alzheimer's disease is not something that suddenly occurs in old age. Rather, it's a continuum of illnesses that gets its start decades earlier without any symptoms.

So it makes sense that if we could find a way to keep our brains healthier and better able to counter the damage that occurs with age, we could better the odds of preserving memory and preventing or forestalling Alzheimer's and other dementias.

A recent report from the National Institutes of Health supports this view. It provides evidence that vascular disease risk factors - including mid-life hypertension, high cholesterol and diabetes - can all predispose someone to developing memory problems-even Alzheimer's.

While this may not sound like good news - it is.

Because it points the way to the importance of effective prevention strategies - strategies you can begin TODAY to keep your brain healthier, longer.

Original article – Johns Hopkins Health Alerts

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Right now there is no way to prevent Alzheimer's disease. The health of the body and brain depends on both lifestyle factors that are within your control.  It also depends on genetic factors.  However, new research reveals that lifestyle factors play an even more significant role in protecting the brain as we age.

In fact, a brain-healthy lifestyle, including regular exercise and a heart-healthy diet are critical elements for Alzheimer’s prevention.

Regular physical exercise reduces the risk of developing Alzheimer’s disease by 50%. Regular exercise can also slow deterioration in those who have already started to develop cognitive problems. Try for at least 30 minutes of aerobic exercise five or more times per week.

Additionally, moderate levels of weight training increase muscle mass and help maintain brain health. Combining aerobics and strength training is much better than either activity alone.

Falls and the resulting head injuries are more likely as people age, which increases the risk for Alzheimer’s disease and dementia, balance and coordination exercises like yoga and Tai Chi can help with agility and fall prevention.

Maintaining a healthy diet is important in preventing Alzheimer’s disease. A heart- and brain-healthy diet that is rich in fish, nuts, whole grains, olive oil, and lots fresh produce.

Evidence suggests that omega-3 fatty acids, such as those found in cold-water fish such as salmon, tuna, trout and sardines may help prevent Alzheimer’s disease and dementia. Fish oil supplements are also a good source for omega-3s. In addition, it’s best to reduce consumption of full-fat dairy products, red meat, fast food, fried foods, and both packaged and processed foods.

Original article - Empowerher

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Recently, researchers looking into cognitive decline and dementia have made encouraging findings. Although it was believed that the adult brain could not develop new neurons (or brain cells), scientists have learned in the past decade or so that the human brain is pliable and adaptive. The brain can actually add new neurons even late in life and continually form new connections among existing neurons -- a phenomenon known as neuroplasticity.

This means that while an aging brain may have signs of damage, initially it can often compensate for them. And engaging in mentally stimulating activities like reading, taking a class or playing board games is one way to bolster this process.

This compensation process depends on your "cognitive reserve," the extra, perhaps unused, amount of cognitive ability that can make up for the loss of brain functioning when your brain shows signs of dementia due to the death of cells and their replacement by beta-amyloid plaques. Genetics, early childhood stimulation and education level can influence cognitive reserve but are essentially immutable once you're an adult.
 
Fortunately, studies have found that you can also increase your cognitive reserve and delay the onset of dementia through a variety of intellectually stimulating leisure activities in middle and later life.

A study in the journal Neurology found that among 101 people who eventually developed dementia, those who frequently participated in one or more activities, such as reading, writing, doing crossword puzzles, playing card or board games, having group discussions or playing music experienced memory decline more than one year later than those who participated in these activities less often. These pursuits built cognitive reserve and delayed dementia as much as a higher education level did.

It's worth noting that researchers have discovered that watching television is a passive activity that doesn't really stimulate the mind at all; on the contrary, watching television is associated with an increased risk of cognitive decline. One study found that TV watchers were 10% more likely than non-watchers to experience cognitive impairments over a five-year period. A possible explanation: Time spent in front of the TV means less time for the mental, social and physical activities that can help delay dementia.

Original article – Johns Hopkins Health Alert

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Today, a growing number of adult children are taking care of their aging parents with Alzheimer's. While most families cope well with the added responsibility, the primary caregivers, usually the women, suffer from stress and often neglect their own health.

Many adult children feel as though they can take care of parents, and they don’t realize the difficulties and the stresses that are involved. They also don’t understand how challenging it will become over time.

Experts say the numbers of adult children taking care of their parents will increase as people live longer. According to a 2011 study by MetLife Mature Market Institute, there are nearly 10 million children over the age of 50 who care for their parents. That figure has more than tripled over the past 15 years.

According to the U.S. Department of Health and Human Services, the demand for informal caregivers - family, friends and neighbors - is expected to grow by more than 20% in the next 15 years as baby boomers age.

As life expectancy increases, it will increase the responsibility of caregivers.

Trying to meet the needs of kids and the patient with Alzheimer's is pretty challenging for caregivers with families. The difficulty for families is in finding a compromise that allows Alzheimer’s patients to remain on their own like they want, yet making sure that they are receiving proper care.

Adult children should prepare a care plan for their elderly parents' when it becomes apparent that the parents are beginning to have difficulty taking care of them.

If adult children don't have a plan for how to deal with those challenges, they are going to end up in a crisis situation. If they're able, older adult parents should have some say in the plan before Alzheimer’s or dementia gets too far along.

For information on Alzheimer’s care in your area, contact Spring Arbor Living.

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