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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Elaine Vlieger is making some concessions to Alzheimer's. She's cut back on her driving, frozen dinners replace elaborate cooking, and a son monitors her finances. But she lives alone and isn't ready to give up her house or her independence.
 
Some 800,000 people with Alzheimer's, roughly 1 in 7 Americans with the disease, live alone, according to data from the Alzheimer's Association. It's a different picture from the constant Alzheimer’s care giving that they'll eventually need.
 
Many cope on their own during early stages of dementia with support from family and friends who keep in close contact.
 
But with support or not, living alone with a disease that gradually strips people of the ability to know when they need help brings concerns, and loved ones agonize over when to step in.

There's no easy answer, and it's a challenge that will only grow. About 5.4 million people in the United States have Alzheimer's or similar dementias. That number is expected to reach up to 16 million by 2050 with the population aging so rapidly.

Most older people want to stay in their homes as long as possible, and developing cognitive impairment doesn't automatically mean they can't initially, says Beth Kallmyer of the Alzheimer's Association. The association's new analysis illustrates the balancing act between a patient's autonomy and safety. People with dementia who live alone can do so initially while they are less impaired, as the disease progresses dementia and Alzheimer’s patients need caregivers. Studies also show that those who live alone have a greater risk of injuries or accidental death than those who don't live alone.
 
The first National Alzheimer's Plan, due this month, may help. It aims to increase screening to catch dementia earlier and urges doctors to help plan for Alzheimer's care.

Do you have a loved one who needs constant Alzheimer's Care? Contact Spring Arbor.

Newsday

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Most people have heard that a diet rich in Omega-3s is good for you. But according to new research, eating foods such as chicken, fish and nuts may help lower blood levels of a protein strongly associated with Alzheimer's disease and memory problems.

In the Columbia University study, people who consumed diets rich in omega-3 fatty acids had significantly lower levels of a protein called beta-amyloid in their blood than those who did not consume as much of the nutrient.
 
According to the research, eating one more gram of omega-3s than average per week was associated with 20 to 30% lower levels of beta-amyloid.  One gram is approximately equal to half a fillet of salmon.

However, study author Dr. Nikolaos Scarmeas, a neurologist at Columbia University Medical Center recommended not focusing on eating particular quantities of omega-3s, but rather, incorporating as much of the nutrient into one’s diet as possible.

If two people consumed the same amount of omega-3s, one through food and the other through supplements, the person who consumed more omega-3 rich foods typically had lower blood levels of beta-amyloid.

It is believed that the build-up of beta-amyloid in the brain, not the blood, is a precursor for Alzheimer's.  However, past studies have indicated there may be a relationship between blood levels and brain levels of the protein.

“There is complex, conflicting literature; we do not understand very well biologically how levels of beta-amyloid in the blood, brain and spinal fluid are related exactly,” Scarmeas said. "In some studies, higher levels of beta-amyloid in the blood relate to higher levels of beta-amyloid in the brain.  Other studies have suggested the opposite."

Scarmeas added that his own lab had observed that people with higher blood levels of beta-amyloid were more likely to develop dementia, while people with lower levels tended not to.

The beneficial impact of omega-3 on brain health would fall in line with past studies of the nutrient.  Omega-3s have long been associated with positive benefits for memory and cognition.

Scarmeas speculated that omega-3s may be able to reduce oxidative stress on the brain and the resulting vascular damage, or even have some kind of impact on beta-amyloid in the brain. Though, there is not enough support yet to suggest the nutrient and protein are directly related.

"Previous studies have suggested that omega-3s and other aspects of diet may be related to brain function," he said. "Here we demonstrate one possible mechanism could be through amyloid, the main biological mechanism that relates to Alzheimer's disease. There have been animal studies suggesting omega-3s could relate to amyloid brain biology.  We've demonstrated this association may also be present in humans."

The study was published Wednesday in the journal Neurology.

Fox News

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A new study in laboratory animals suggests a promising new avenue for treating Alzheimer's Disease. They were given a medicine that's been around for decades.
Immune globulin, or gamma globulin, is made from purified blood plasma and is normally used to boost the immune system.

Recently, scientists have been exploring its potential as a treatment for Alzheimer's Disease.

The results of these immune globulin experiments have been inconsistent. Researchers from the Mount Sinai School of Medicine in New York thought these inconsistent results were due to variations in how the immune globulin was administered. So they gave their lab mice very small doses intravenously over four weeks.

Researchers say they saw a dramatic slowdown in the animals' cognitive deterioration.

The treatment increases certain immune system components, which may help restore plasticity, the ability of the brain to rewire itself as needed. It may also have a role in reducing the beta amyloid protein deposits in the brain that are characteristic of Alzheimer's Disease.

The results of the study were presented at a scientific meeting called Experimental Biology 2012 in San Diego, California.

VOA News

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Johns Hopkins is now presenting a quarterly in-depth report on the latest scientific breakthroughs, research findings and medical discoveries to help you safeguard your brain against aging and memory loss.

There are many exciting developments in the fields of Alzheimer's and memory research, and there's no better way to access this information than a subscription to the Johns Hopkins Memory Disorders Bulletin. Each quarterly issue brings critical information for patients and caregivers on Alzheimer's disease, dementia, Lewy body dementia, vascular dementia and other memory conditions. Edited by Dr. Peter V. Rabins, director of the division of Geriatric and Neuropsychiatry at the Johns Hopkins School of Medicine and author of the widely read book The 36-Hour Day, the Johns Hopkins Memory Disorders Bulletin contains the latest scientific breakthroughs, research findings from the world's foremost medical journals and conferences, news of medications and caregiver support, plus medical discoveries for safeguarding your brain against aging and memory loss. When you subscribe today, you'll get four FREE Special Reports to download instantly.

Order here. 

Johns Hopkins Health Alert

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Research is changing what we know about our Grey Matter. Our brains continue to produce brain cells into our 70’s. Because of changes in technology, science is making progress in cognitive science. Cognitive loss and forgetfulness is largely preventable.

According to a study, baby boomers now fear Alzheimer’s more than any other illness. The biggest question in age related memory decline is: how much it affects your daily life. The other is:  is memory decline getting gradually worse?

Those over 50 naturally experience age related memory decline.

How can you tell the difference between natural forgetfulness and Alzheimer's, and how can you prevent it?  The brain is resilient and recent science shows how the brain can change and grow even while aging. Watch the following video.

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Cases of dementia — and the heavy social and financial burdens associated with them — are set to soar in the coming decades as life expectancy and medical care improve in poorer countries, the World Health Organization says.

Some 35.6 million people were living with dementia in 2010, but that figure is set to double to 65.7 million by 2030, the U.N. health agency said Wednesday. In 2050, it expects the number of dementia cases to triple to 115.4 million.

Most dementia patients are cared for by relatives, who shoulder the bulk of the current estimated annual cost of $604 billion, WHO said.

"The catastrophic cost drives millions of households below the poverty line," warned the agency's director-general, Margaret Chan.

Dementia, a brain illness that affects memory, behavior and the ability to perform common tasks, affects mostly older people. About 70% of cases are believed to be caused by Alzheimer's.

In the last few decades dementia has become a major public health issue in rich countries. But with populations in poor and middle-income countries projected to grow and age rapidly over the coming decades, the agency appealed for greater public awareness and better support programs everywhere.

The share of cases in poor and middle-income countries is expected to rise from just under 60% today, to over 70% by 2050.

So far, only eight countries — including Britain, France and Japan — have national programs to address dementia, WHO said. Several others, such as the United States, have plans at the state level.

WHO said a lack of proper diagnosis is one of the obstacles to better dementia treatment. Even in rich countries more than half of dementia cases are overlooked until the disease has reached a late stage.

USA Today

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A much-anticipated test developed by Eli Lilly that detects the presence of proteins in the brain that are related to Alzheimer's disease was approved by the US Food and Drug Administration.

This test could enable clinicians to detect Alzheimer's earlier and more accurately in patients at the earliest sign of memory problems -- a potential boon to treatment and developing drugs against the disease.

The test uses a chemical known by the brand name Amyvid, a radioactive agent that tags clumps of a sticky substance called an amyloid. Amyloid proteins are hallmarks of Alzheimer's disease. The chemical is then detected using a brain imaging technique called positron emission tomography, known as PET scans.

For patients who already have some symptoms of cognitive decline, a positive scan suggests that moderate to frequent amyloid plaques are present in the brain, which is consistent with Alzheimer's disease.

If the scan is negative, indicating no clumps or few clumps of amyloid, "that gives the clinician a clue that Alzheimer's is less likely to be the cause of those symptoms," according to Daniel Skovronsky, who developed the agent at Lilly. For those patients, doctors can look for other potential causes of the memory decline, which may have another prognosis or be treated differentially than Alzheimer's.

The imaging agent cannot be used to diagnose someone with Alzheimer's disease if the individual does not experience memory impairment because the presence of amyloid in the brain does not alone suggest that someone has Alzheimer's.

Before the development of imaging agents, amyloid plaques could be determined only after death, by examining the brain during an autopsy.

Some 20% of cognitively healthy older adults have been found during autopsies to have large quantities of amyloid in the brain.

"It is likely to play an important role in learning both how to diagnose and treat the disease, but it's still an open question at this point for asymptomatic people," according to Park, a behavioral and brain-sciences professor who uses Amyvid in her research on aging of healthy older adults.

Amyvid will be available in limited quantities starting in June after being approved Friday, Lilly said.

Wall Street Journal

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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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