A tremendous meeting of people with Alzheimer’s energizes efforts to better their world.
A remarkable conference of people experiencing Alzheimer’s energized efforts to improve their lives. Organized by Jay Smith and Richard Bozanich, two driven men in the early stages of Alzheimer’s, the October 27 event packed Los Angeles’ Skirball Cultural Center. Even the week-long drama of massive L.A. fires which caused the evacuation of over a million people did nothing to deter participants, and many were turned away because the seats sold out.
The Alzheimer’s Association was the conference’s backer, and Peter Braun, its Chapter President, opened by stating, “This is the largest gathering of people with dementia in our country.” He was followed by Smith and Bozanich, who drew a standing ovation as they called on Americans to hear the voice of early-stage Alzheimer’s.
They were followed by speakers calling for practical and immediate improvements to the current state of affairs: doctors to become better skilled at diagnosis, therapists to be better educated in ways to help them live well, and society at large to be better informed on how to relate to and be supportive of them. The conference received a lot of publicity. PBS and HBO crews were on-site, and the Alzheimer’s Association will be turning footage into a presentation they plan to take on the road nationwide.
All this publicity will get some very important messages out to the world. Here are a few.
The Message to Doctors: Get the Best Diagnostic Training
Clinical diagnosis in the early stages of Alzheimer’s requires experience and skill. No doctor wants to risk misdiagnosing ordinary aging, unrelated illnesses, or medicinal side-effects as Alzheimer’s. The result is intense caution by doctors about offering a diagnosis. When someone notices a symptom that might indicate Alzheimer’s, it could be a long road until the doctor makes a clear diagnosis.
Yet an early and accurate diagnosis means so much to people. People shared their journeys with this reality. (Paraphrased)
•“I was aware I was slipping at work. I could not contribute ideas at meetings anymore. I went into my office and just stood there, not knowing where to start, even though I knew there was a lot to do. I thought it was stress, so shifted to a simpler position but could not learn its tasks. I felt scared. One day I called in sick and never went back. From there it was a long and bumpy road to diagnosis.”
•“I had eight diagnoses in 18 months. Time after time, doctors said ‘It could be…,’ ‘It could develop into…,’ ‘You have a risk for…’ It was very difficult to live with this vague information.”
•“As long as I had a diagnosis of mild cognitive impairment, my doctor did not give me medications. I needed to be diagnosed with AD to get them.”
•“Compensating for my subtle impairments fatigued me so much, I ended up spending two days in bed after what used to be routine business trips. I had to retire and start a long search for diagnosis.”
These calls for doctors to be better educated in the latest diagnostic techniques and tools were significant moments. A formerly vague complaint has now crystallized into a firm voice.
The Message to Everyone with Alzheimer's: Choose to Live Life
Immense victories in the Alzheimer’s fight were brightly seen in stories people told about their lives after diagnosis.
•“I accepted it right away. I reassessed my life and priorities, began to plan and accommodate, and made some commitments about judgment.”
•“At first I was in a dark phase. Then advocacy became important. I met people in a similar situation who have become a family of sorts. I will not lead a stigmatized life.”
•“I joined a memory club, participate in research studies, took up ceramics, and put in a 600-gallon pond in our backyard. I take care of my mother, who has AD and lives with us. I try to focus on the positive and the beauty of each day.”
•“We moved into a smaller house. We simplified our life. I gave up handling our finances. I try to adopt routines of exercise and healthy living, and I found an unexpected spiritual gift in recognizing where I am in life and living fully what I have left.”
These are very different voices than those described from the past. In an interview, Bozanich noted, "My mom's uncle Irwin got this, and we never saw him again. I didn't want the same thing to happen to me, to be sequestered away like people are ashamed of me. I didn't want to go quietly." This conference was an affirmation that things are different today. The message: People with Alzheimer’s can do so much, both spiritually and physically. They are very alive and can make great choices about how to live. Says Smith, “There’s still a lot of good living to do.”
The Message to Family and Friends: Relating Right Requires a Little Learning
No less important were the simple tips of social queues to the broad circle of people close to those who have Alzheimer's.
•“People with early-stage dementia resent the term ‘caregiver’. We prefer ‘care partner’ because, for the most part, we can still take care of ourselves very well, thank you.”
•“Be patient. It makes a world of difference.”
•“Accept it. We go through a tunnel of denial at first. When we come out the other end and have found acceptance, accept along with us. Don’t make us insist and explain that we do have a problem.”
The reach of these messages promises to be truly great, what with so much media attending the conference, and the Alzheimer's Association videoing it for display across the country, .
Elyse Salend, a specialist on aging who works for the grant-giving Archstone Foundation, said, "I felt awed by them, by their courage. They're not hiding out. They're trying to make the world better for all of us."
Mr. Bozanich is leaving the success of this conference with a crystal clear mission. "As long as I'm able to talk about it," he said, "it's important to speak out about what it's like to live with this."
Wednesday, December 29, 2010
How to talk to your family member with Alzheimer's
Reading this article from Dementia Weekly, I am reminded that communication is EVERYTHING in Alzheimer care. Relating well to the person in a calm reassuring way can allay fears. So much of everyday life becomes confusing for them; they need us to tell them simply what is happening, what is expected now (not later, always stay in the present) and that you will keep them safe. Invite them to come with you; don't order them to come. "We're having dinner now. I'd like you to join us. Please come with me." There will be less resistance to care as the article below suggests.
Chicago - Adults with Alzheimer's in nursing homes who are talked to like children are more resistant to care, according to new research reported today at the 2008 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2008) in Chicago.
As effective pharmaceutical treatments and prevention for Alzheimer's remain elusive, some researchers are focusing their efforts on improving quality of life and care including communication. One study determined that there is a correlation between how nursing home staff communicates with residents who have dementia and the residents' subsequent resistance to care. Another investigated how families work to maintain normalcy and coherence during dinner time conversation when a family member with Alzheimer's is included.
"The style of communication that we use with people with Alzheimer's influences how they feel about themselves and how well they respond to those providing care," said Sam Fazio, PhD, Director, Medical and Scientific Relations at the Alzheimer's Association. "With the growing prevalence of Alzheimer's, it will be increasingly important for healthcare providers, caregivers and families to understand the effect Alzheimer's has on communication and, perhaps more importantly, the impact their communication may have on the individual's quality of life."
Chicago - Adults with Alzheimer's in nursing homes who are talked to like children are more resistant to care, according to new research reported today at the 2008 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2008) in Chicago.
As effective pharmaceutical treatments and prevention for Alzheimer's remain elusive, some researchers are focusing their efforts on improving quality of life and care including communication. One study determined that there is a correlation between how nursing home staff communicates with residents who have dementia and the residents' subsequent resistance to care. Another investigated how families work to maintain normalcy and coherence during dinner time conversation when a family member with Alzheimer's is included.
"The style of communication that we use with people with Alzheimer's influences how they feel about themselves and how well they respond to those providing care," said Sam Fazio, PhD, Director, Medical and Scientific Relations at the Alzheimer's Association. "With the growing prevalence of Alzheimer's, it will be increasingly important for healthcare providers, caregivers and families to understand the effect Alzheimer's has on communication and, perhaps more importantly, the impact their communication may have on the individual's quality of life."
Monday, December 27, 2010
January's column
It is still blowing snow here in Boston and I've got to get to work on my column for January 2011. I'm calling it New Beginnings. I'll expand on the idea of looking at Alzheimer's progression as new beginnings rather than losses. We all experience losing abilities or opportunities throughout life; why look at the ones of Alzheimer's as catastrophic? Life is a learning experience; so is Alzheimer's. Noting changes in a family member should trigger the need to learn something new to help that person remain in charge of their life. I've met families who meet each new 'beginning' with courage and determination to normalize their family life to the extent possible. Although this disease is wrought with emotion, caregivers can turn it into a life journey. Life is full of hope and humor, which Bob Stern MD at BUAD Research Center says caregivers need (both) to thrive through Alzheimer's. People have accused me of being too positive about this caregiving thing. One blog reader was angry with me for this. Well, so be it. I found in being a caregiver for both my inlaws that I developed a heart for caregiving them. Finding humor in the often ridiculous happenings in a day of caregiving is essential. Try it.
Rosemary for Alzheimer's
This is an article from Dementia & Alzheimer Weekly, a great resource of information.
"Rosemary contains more than a dozen antioxidants and a half-dozen compounds reported to prevent the breakdown of acetylcholine. It's fabulous that the classical herb of remembrance has so many compounds that might help people suffering from Alzheimer’s."
These are the words of Dr. James Duke, former U.S. Department of Agriculture (USDA) Chief of Medicinal Plant Research. Dr. Duke is one of the world's leading authorities on medicinal plants. He helped build the USDA database that demonstrates how rosemary may slow the progress of Alzheimer's.
His strong advocacy of rosemary has to do with a chemical called acetylcholine. Anyone who has lived with Alzheimer’s in the past decade has heard of Aricept. Aricept is a medicine that does one thing: it inhibits acetylcholine.
So does rosemary.
Dr. Duke said that when he learned of the new medications that fought Alzheimer’s by inhibiting acetylcholine, “I probed my U.S. Department of Agriculture (USDA) database for herbs with phytochemical constituents that were also reported to prevent the breakdown of ACh (acetylcholine). Even though I myself had been the source of the overwhelming proportion of the data in the database for more than a decade, I was surprised at the output. The database yielded about a half dozen anti-AChE (acetylcholine) compounds, with Rosmarinus officinalis (rosemary) the proud winner in terms of their numbers and potencies.”
Monday, December 20, 2010
Richard Taylor PhD His thougts on being someone with Alzheimer's
ITEM OF INTEREST: ARTICLE
It is always startling to me when someone I know, even if only through some make-believe roles in make-believe movies, dies and has been prior to her/his death living with a diagnosis of Dementia - probably of this or that type.
Someone found the press release Mr. Heston read announcing his diagnosis - and I just read it. Reading Charleton Heston's announcement that he had been diagnosed with Alzheimer's disease reconfirms for me that many, too many individuals, even those diagnosed with the disease see the diagnosis as the start of a long good bye.
We announce and prepare ourselves and others for the fact that we have already started to fade away. It started the moment someone in a white coat told us "You have Dementia, probably of this or that type, and certainly with these features." I'm on my way out! It's all downhill from here! Don't look for me anymore; I'm going to be busy fading away and not being me.
We are seldom seen by others post-diagnosis. We seldom speak up or speak out post-diagnosis. After all, we are fading away. What could we have worthwhile to say? Could we possible grow as a human being after we have been diagnosed? We become someone we would be embarrassed to be, were we capable of appreciating who we had become!
Are we? Will be embarrassed for ourselves? Who is embarrassed for whom? How do you know I'm not accepting, perhaps even content with who I am today? Even if I'm sometimes frustrated. Even if I'm sometimes agitated. I'm still me!
Isn't it time others who don't live with the diagnosis focus their energies on understanding, appreciating, supporting, enabling those of us who do live with diagnosis? Don't concentrate on who we were. Don't try to convince us we should hang on to yesterday, or last year, or fifty years ago – when we are struggling to understand today!
Wouldn't it be easier to love someone we believed was a whole person, instead of someone half empty? Instead of someone who is literally a shell of who they were?
Is it any wonder people find us hard to love when they find us so hard to understand? To appreciate us for who we are? To accept our changes, our symptoms, our forgetting and confusion? Of course it is. Some people with dementia and many caregivers keep saying good-bye. I, and I honestly believe every other person living with and in dementia need to hear, feel, and be supported by saying "Hello!"
This is not an issue just for those in the late stage of the disease, nor just for those in the middle stage of the disease. It starts the day the diagnosis is pronounced. Collectively, and individually we need to find the courage, the support, the understanding to say "hello" to ourselves and each other.
Every day! Every day! It's that simple! It's that easy! Reduce stress, increase love you give and receive, enjoy and live in today.
"Hello,"
Richard
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It is always startling to me when someone I know, even if only through some make-believe roles in make-believe movies, dies and has been prior to her/his death living with a diagnosis of Dementia - probably of this or that type.
Someone found the press release Mr. Heston read announcing his diagnosis - and I just read it. Reading Charleton Heston's announcement that he had been diagnosed with Alzheimer's disease reconfirms for me that many, too many individuals, even those diagnosed with the disease see the diagnosis as the start of a long good bye.
We announce and prepare ourselves and others for the fact that we have already started to fade away. It started the moment someone in a white coat told us "You have Dementia, probably of this or that type, and certainly with these features." I'm on my way out! It's all downhill from here! Don't look for me anymore; I'm going to be busy fading away and not being me.
We are seldom seen by others post-diagnosis. We seldom speak up or speak out post-diagnosis. After all, we are fading away. What could we have worthwhile to say? Could we possible grow as a human being after we have been diagnosed? We become someone we would be embarrassed to be, were we capable of appreciating who we had become!
Are we? Will be embarrassed for ourselves? Who is embarrassed for whom? How do you know I'm not accepting, perhaps even content with who I am today? Even if I'm sometimes frustrated. Even if I'm sometimes agitated. I'm still me!
Isn't it time others who don't live with the diagnosis focus their energies on understanding, appreciating, supporting, enabling those of us who do live with diagnosis? Don't concentrate on who we were. Don't try to convince us we should hang on to yesterday, or last year, or fifty years ago – when we are struggling to understand today!
Wouldn't it be easier to love someone we believed was a whole person, instead of someone half empty? Instead of someone who is literally a shell of who they were?
Is it any wonder people find us hard to love when they find us so hard to understand? To appreciate us for who we are? To accept our changes, our symptoms, our forgetting and confusion? Of course it is. Some people with dementia and many caregivers keep saying good-bye. I, and I honestly believe every other person living with and in dementia need to hear, feel, and be supported by saying "Hello!"
This is not an issue just for those in the late stage of the disease, nor just for those in the middle stage of the disease. It starts the day the diagnosis is pronounced. Collectively, and individually we need to find the courage, the support, the understanding to say "hello" to ourselves and each other.
Every day! Every day! It's that simple! It's that easy! Reduce stress, increase love you give and receive, enjoy and live in today.
"Hello,"
Richard
--------------------------------------------------------------------------------
Saturday, December 18, 2010
More on Guardian and Conservator Responsibilities
After my last post I realized I had posted some information on this subject a few days or weeks ago. To add to your knowledge, here is what Attorney Leanna Hamill had to say in her newsletter.
On Guardian and Conservator Responsibilities
Attorney Leanna Hamill provides estate planning and related legal services to clients of all ages, with a focus on the needs of older individuals and their families.
160 Old Derby St., Suite 456
Hingham, Ma 02043
Phone: 781-749-2284 begin_of_the_skype_highlighting 781-749-2284 end_of_the_skype_highlighting Fax: 866-573-6429
Leanna@HamillLawOffice.com
Responsibilities of a Guardian & Conservator
Written on December 6, 2010 in Guardianship
Have you thought about pursuing guardianship or conservatorship over an adult family member who you believe can no longer handle their affairs? A guardianship is a legal relationship created by a court between a guardian and her ward, usually an incapacitated adult. The guardian has a legal right and duty to care for the ward. A conservatorship is a like a guardianship but refers only to property.
After you are appointed by the Court, you have a lot of responsibilities to properly carry out your duties. Here are some of the ongoing responsibilities of a guardian and conservator:
•Filing a report with the Court at 60 days and annually outlining your plans for the ward, their care, and their property,
•Filing a yearly report with the Court outlining the ward’s living situation, medical condition, how often you’ve visited them, what services they are receiving and related issues.
•Caring for the ward – making health care decisions, living decisions and decisions about how to manage their property for their benefit,
•Involving the ward as much as possible taking into account their condition and circumstances,
•Filing Roger’s Monitor reports annually, if you are also appointed in that capacity,
•In the case of a Conservatorship, fileing annual accountings showing what has occured over the last year with the property you are managing,
•Responding to any requests from the Court for more frequent recording.
A guardian or conservator is always subject to the oversight of the Court and can be penalized for failing to properly account for funds and monitor their ward.
(The term “ward” is used here for convenience. The legal term for someone under a guardianship is “incapacitated person” and for someone under a conservatorship is “protected person.”)
________
Estate Planning, Probate and Trusts involve complex areas of law. Individual circumstances must be considered before any advice can be given. The general information above is not to be construed as legal advice, which can only be given after consideration of the unique facts of each matter. Please seek the advice or counsel of your attorney, financial advisor or CPA as it may be appropriate.
Posted by Coach Licensor Beverly at 12:33 PM 0 comments
Labels: From Leanna Hamill's blog
Friday, December 3, 2010
On Guardian and Conservator Responsibilities
Attorney Leanna Hamill provides estate planning and related legal services to clients of all ages, with a focus on the needs of older individuals and their families.
160 Old Derby St., Suite 456
Hingham, Ma 02043
Phone: 781-749-2284 begin_of_the_skype_highlighting 781-749-2284 end_of_the_skype_highlighting Fax: 866-573-6429
Leanna@HamillLawOffice.com
Responsibilities of a Guardian & Conservator
Written on December 6, 2010 in Guardianship
Have you thought about pursuing guardianship or conservatorship over an adult family member who you believe can no longer handle their affairs? A guardianship is a legal relationship created by a court between a guardian and her ward, usually an incapacitated adult. The guardian has a legal right and duty to care for the ward. A conservatorship is a like a guardianship but refers only to property.
After you are appointed by the Court, you have a lot of responsibilities to properly carry out your duties. Here are some of the ongoing responsibilities of a guardian and conservator:
•Filing a report with the Court at 60 days and annually outlining your plans for the ward, their care, and their property,
•Filing a yearly report with the Court outlining the ward’s living situation, medical condition, how often you’ve visited them, what services they are receiving and related issues.
•Caring for the ward – making health care decisions, living decisions and decisions about how to manage their property for their benefit,
•Involving the ward as much as possible taking into account their condition and circumstances,
•Filing Roger’s Monitor reports annually, if you are also appointed in that capacity,
•In the case of a Conservatorship, fileing annual accountings showing what has occured over the last year with the property you are managing,
•Responding to any requests from the Court for more frequent recording.
A guardian or conservator is always subject to the oversight of the Court and can be penalized for failing to properly account for funds and monitor their ward.
(The term “ward” is used here for convenience. The legal term for someone under a guardianship is “incapacitated person” and for someone under a conservatorship is “protected person.”)
________
Estate Planning, Probate and Trusts involve complex areas of law. Individual circumstances must be considered before any advice can be given. The general information above is not to be construed as legal advice, which can only be given after consideration of the unique facts of each matter. Please seek the advice or counsel of your attorney, financial advisor or CPA as it may be appropriate.
Posted by Coach Licensor Beverly at 12:33 PM 0 comments
Labels: From Leanna Hamill's blog
Friday, December 3, 2010
Today's radio interview
Greg Porell's show on WATD is worth an ear. If you're out of the area, log on to www.Southshoresenior.com and you can catch on. Judy Flynn Esq. was on talking about some of those legal jams people get themselves into due to lack of education. For example, if you are called on to be a guardian or conservator for someone, what is entailed? What are your responsibilities, your obligations legally? She mentioned a website that can help. It is www.massguardianship.org. There are explanations of guardianship and some downloads to take advantage of. She can be reached at www.thelegalcheckup.com for specific help. I mostly listened the first part of the show as I need to learn as well.
My part of the show is the segment once monthly called Matters of the Mind, the same title as my column, also available at www.southshoresenior.com. It is a fun show; Greg makes it so with his easy going nature. I spoke about New Beginnings; that in the course of Alzheimer's there are new beginnings as loss of function is recognized. It is a time for new learning to meet this new challenge. With every loss there is a new beginning; that is life. Probably in the Alzheimer caregiving journey it is more poignant as we are apt to think, I've never done it that way before. But do it a new way, you must, if you are to have an easier journey. The coach can help through all the new beginnings as can support groups. Our coaches run five support groups, so they are aware of the changes that take place in a person with Alzheimer's.
My part of the show is the segment once monthly called Matters of the Mind, the same title as my column, also available at www.southshoresenior.com. It is a fun show; Greg makes it so with his easy going nature. I spoke about New Beginnings; that in the course of Alzheimer's there are new beginnings as loss of function is recognized. It is a time for new learning to meet this new challenge. With every loss there is a new beginning; that is life. Probably in the Alzheimer caregiving journey it is more poignant as we are apt to think, I've never done it that way before. But do it a new way, you must, if you are to have an easier journey. The coach can help through all the new beginnings as can support groups. Our coaches run five support groups, so they are aware of the changes that take place in a person with Alzheimer's.
Monday, December 13, 2010
How is dementia and Alzheimer's alike or unalike?
Every time I present a talk on Alzheimer's disease, someone asks the question "What is the difference between dementia and Alzheimer's? Or are they the same?"
This is an exerpt from this week's Alzheimer and Dementia Weekly.
Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems such as agitation, delusions, and hallucinations. While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions - such as memory, language skills, perception, or cognitive skills including reasoning and judgment - are significantly impaired without loss of consciousness.
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This is an exerpt from this week's Alzheimer and Dementia Weekly.
Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems such as agitation, delusions, and hallucinations. While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions - such as memory, language skills, perception, or cognitive skills including reasoning and judgment - are significantly impaired without loss of consciousness.
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Saturday, December 11, 2010
www.healthcareinsights.com article on Omegas
THIS ARTICLE IS PART 2 of "Oh My...Omega's! and focuses on Food Sources and Supplements
Omega-3 fatty acids make up a major part of brain and body cells but can only be ingested, not made by our bodies. Omega-3s are important for building brain cell membranes, dendrites and synapses. They are also anti-inflammatory, and thus helpful for preventing or managing a variety of diseases. Choose fish (3 or more x a week!), seafood, fish oils, green leafy vegetables, walnuts, flax seeds, and purslane.
What are the Types of Omega-3's?
There are two major types of Omega-3 fatty acids:
alpha-linolenic acid (ALA), which is the plant form,
eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which is the marine or "sea" form. EPA and DHA are found in fish, algae and all seafoods and in grass fed and free range animals and poultry.
It is the marine form, DHA and EPA, that help make up our own brains and bodies cell membranes and other components, not ALA, the plant form.
Food Sources of Omega-3's
ALA is found in vegetable oils such soybean, canola (rapeseed), and flaxseed, pumpkin seed, hemp seed, and perilla seed oils. Other sources of ALA include flaxseeds, pumpkin seeds, chia seeds, wheat (especially wheat germ), hemp, soybeans, tofu, walnuts, kidney beans, purslane, and green vegetables such as kale, spinach, Swiss Chard, collard greens, Brussels sprouts, Chinese cabbage, bok choy, mustard greens (and all of the other types of Chinese green vegetables), grape leaves, cauliflower, and salad greens.
Most foods rich in ALA also contain vitamin E which is one of nature's primary ways of preventing oxidation of the delicate Omega 3's. It is vitamin E in its multiple forms that also helps protect from oxidation the Omega 3's in our brain cell membranes and dendrites! (see our website and previous article about Vitamin E).
Purslane, though considered an exotic weed in the US, is frequently eaten as a leaf vegetable in Europe, Asia, and Mexico. Not only is purslane a rich source of ALA (1 cup of fresh leaves contains about 300 to 400 mg), but it is also a source of Vitamin A, Vitamin C, some B vitamins, magnesium, calcium, potassium, and iron. Some types of purslane are now sold as flowering plants; these are also edible.
What are the fish and animal sources of Omega-3's?
EPA and DHA are found mostly in marine sources, especially in higher-fat, cold-water varieties of fish such as salmon, mackerel, albacore tuna, sardines, Atlantic herring, swordfish, and lake trout, as well as in algae and krill...so today they are referred to as "marine" Omega 3's.
Surprising to many, PASTURE-RAISED (Free Range or Grass-fed) beef, lamb, and other animals, poultry and free-range chicken's eggs are also rich sources of "marine" Omega 3's including DHA and EPA.
Sixty percent of the fat content of grass is ALA Omega-3 fatty acid. When animals consume grass and green leafy "weeds," their flesh contains both ALA and the "marine" forms of Omega 3's. Just like humans, cattle convert the ALA they consume into EPA and DHA forms of Omega-3's; an analysis of grass-fed beef shows that EPA is the most prevalent Omega 3. ALA is the second most prevalent Omega-3 in grass fed beef with DHA the least abundant. But when transferred to the feed lot to be fattened on grains, the Omega-3 content rapidly diminishes until after just a few months in the feed lots, it is mostly gone. Animals fed only grain have high levels of Omega 6's and very low levels of Omega 3's in their flesh... or milk or products made from animal milk.
Some varieties of eggs are Omega-3 enriched, with either ALA or DHA/EPA depending on what the chickens are fed, and whether they are free-range. Feeding chickens flaxseed and canola (rape) seed and greens increases mostly ALA content while feeding them algae and seaweed increases EPA and DHA content of the eggs.
Thus if you do eat animal foods, and you can afford it, go for the grass fed and free range beef and lamb, and free range chickens, and/or Omega-3 eggs, and milk and cheese from grass fed cows. This is especially important for meat lovers who are not eating enough vegetables!
How often should I eat fish and seafood?
The Memory Preservation Nutrition (MPN)® program recommends eating fish at least three times a week and ideally some fish, seafood and/or marine oil (from fish, cod liver, or calamari) every day of the week.
The MPN™ does not emphasize just oily or fatty fish, even though they are higher in Omega 3 fatty acids, for several reasons. The most important reason is that many non-oily fish also are relatively high in Omega-3's and other important nutrients, and it is key that people try to eat fish that they enjoy eating.
What about contaminants in fish?
Though some fish contain mercury and other toxins the USDA and nutritionists say it is still safe to eat as much as 12 oz/week of those with problems (i.e. some domestic salmon, and those with higher mercury levels such as tuna, swordfish, and shark). However, pregnant women and small children are, as of late 2008, still cautioned by the USDA to avoid these particular fish.
Even more important though, pregnant women and small children need to consume fish, seafood, and fish oil to foster adequate brain and nervous system development for the fetus and child. There is indication that inadequate Omega-3's in mother (during mother's pregnancy and lactation) and child can result in poorer cognitive performance in school would otherwise be the case. See http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fish/index.html for a discussion of how to achieve the benefits of fish while reducing any risks.
Benefits of Supplements
Omega-3 supplements are an important way to ensure that you are getting enough Omega-3 fatty acids for optimal brain and body health. The preferred form of supplementation is DHA and EPA from fish oils, cod liver oil, or calamari (squid) oil. Calamari oil is excellent form rich in DHA and EPA, especially for those with fish allergy concerns (or worried about sustainability of our fish supplies).
Typically the amount recommended depends on the primary reason you are taking the supplement. A general recommendation is to take enough of a supplement to ingest between 600 mg to 3g of combined DHA and EPA daily. Be sure to read the label as supplements have variable amounts of the "active ingredients" of DHA and EPA depending on the brand and type of oil or capsule. Thus to achieve these amounts you might need to take two to four or many more of 1000 mg (large!) soft gels, or 1-3 teaspoons of an oil a day. Be sure to let you doctor know if you are taking more than 3g of the active ingredients (DHA and EPA) because Omega-3's thin the blood (thinning the blood is generally a good thing but may interact with other medical regimens you are pursuing, e.g. coumadin). Also be sure to purchase brands known to provide contaminant-free oils; the better companies have lab analyses proving "no detectible levels" of mercury, pcbs and dozens of other possible contaminants; these companies also properly process and package oils and capsules to prevent oxidation and spoilage.
Vegetarian alternatives include algae derived DHA/EPA or 2 Flaxseed Oil 1000 mg softgels (which typically each contain 450 mg ALA Omega-3). However, this is less optimal than supplementing with oils of a marine source because flaxseed oil contains the shorter chain ALA Omega-3 that needs to be converted by the body to DHA or EPA, and this is done much less efficiently as we age.
How do I find out what is best for me?
Dr. Nancy Emerson Lombardo can be reached by e-mail or phone for inquiries about what supplements would be best for you personally, and which brands are best. She also offers preferred nutritional supplements including some Omega-3 products through her website or by phone or email.
www.healthcareinsights.com
Omega-3 fatty acids make up a major part of brain and body cells but can only be ingested, not made by our bodies. Omega-3s are important for building brain cell membranes, dendrites and synapses. They are also anti-inflammatory, and thus helpful for preventing or managing a variety of diseases. Choose fish (3 or more x a week!), seafood, fish oils, green leafy vegetables, walnuts, flax seeds, and purslane.
What are the Types of Omega-3's?
There are two major types of Omega-3 fatty acids:
alpha-linolenic acid (ALA), which is the plant form,
eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which is the marine or "sea" form. EPA and DHA are found in fish, algae and all seafoods and in grass fed and free range animals and poultry.
It is the marine form, DHA and EPA, that help make up our own brains and bodies cell membranes and other components, not ALA, the plant form.
Food Sources of Omega-3's
ALA is found in vegetable oils such soybean, canola (rapeseed), and flaxseed, pumpkin seed, hemp seed, and perilla seed oils. Other sources of ALA include flaxseeds, pumpkin seeds, chia seeds, wheat (especially wheat germ), hemp, soybeans, tofu, walnuts, kidney beans, purslane, and green vegetables such as kale, spinach, Swiss Chard, collard greens, Brussels sprouts, Chinese cabbage, bok choy, mustard greens (and all of the other types of Chinese green vegetables), grape leaves, cauliflower, and salad greens.
Most foods rich in ALA also contain vitamin E which is one of nature's primary ways of preventing oxidation of the delicate Omega 3's. It is vitamin E in its multiple forms that also helps protect from oxidation the Omega 3's in our brain cell membranes and dendrites! (see our website and previous article about Vitamin E).
Purslane, though considered an exotic weed in the US, is frequently eaten as a leaf vegetable in Europe, Asia, and Mexico. Not only is purslane a rich source of ALA (1 cup of fresh leaves contains about 300 to 400 mg), but it is also a source of Vitamin A, Vitamin C, some B vitamins, magnesium, calcium, potassium, and iron. Some types of purslane are now sold as flowering plants; these are also edible.
What are the fish and animal sources of Omega-3's?
EPA and DHA are found mostly in marine sources, especially in higher-fat, cold-water varieties of fish such as salmon, mackerel, albacore tuna, sardines, Atlantic herring, swordfish, and lake trout, as well as in algae and krill...so today they are referred to as "marine" Omega 3's.
Surprising to many, PASTURE-RAISED (Free Range or Grass-fed) beef, lamb, and other animals, poultry and free-range chicken's eggs are also rich sources of "marine" Omega 3's including DHA and EPA.
Sixty percent of the fat content of grass is ALA Omega-3 fatty acid. When animals consume grass and green leafy "weeds," their flesh contains both ALA and the "marine" forms of Omega 3's. Just like humans, cattle convert the ALA they consume into EPA and DHA forms of Omega-3's; an analysis of grass-fed beef shows that EPA is the most prevalent Omega 3. ALA is the second most prevalent Omega-3 in grass fed beef with DHA the least abundant. But when transferred to the feed lot to be fattened on grains, the Omega-3 content rapidly diminishes until after just a few months in the feed lots, it is mostly gone. Animals fed only grain have high levels of Omega 6's and very low levels of Omega 3's in their flesh... or milk or products made from animal milk.
Some varieties of eggs are Omega-3 enriched, with either ALA or DHA/EPA depending on what the chickens are fed, and whether they are free-range. Feeding chickens flaxseed and canola (rape) seed and greens increases mostly ALA content while feeding them algae and seaweed increases EPA and DHA content of the eggs.
Thus if you do eat animal foods, and you can afford it, go for the grass fed and free range beef and lamb, and free range chickens, and/or Omega-3 eggs, and milk and cheese from grass fed cows. This is especially important for meat lovers who are not eating enough vegetables!
How often should I eat fish and seafood?
The Memory Preservation Nutrition (MPN)® program recommends eating fish at least three times a week and ideally some fish, seafood and/or marine oil (from fish, cod liver, or calamari) every day of the week.
The MPN™ does not emphasize just oily or fatty fish, even though they are higher in Omega 3 fatty acids, for several reasons. The most important reason is that many non-oily fish also are relatively high in Omega-3's and other important nutrients, and it is key that people try to eat fish that they enjoy eating.
What about contaminants in fish?
Though some fish contain mercury and other toxins the USDA and nutritionists say it is still safe to eat as much as 12 oz/week of those with problems (i.e. some domestic salmon, and those with higher mercury levels such as tuna, swordfish, and shark). However, pregnant women and small children are, as of late 2008, still cautioned by the USDA to avoid these particular fish.
Even more important though, pregnant women and small children need to consume fish, seafood, and fish oil to foster adequate brain and nervous system development for the fetus and child. There is indication that inadequate Omega-3's in mother (during mother's pregnancy and lactation) and child can result in poorer cognitive performance in school would otherwise be the case. See http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fish/index.html for a discussion of how to achieve the benefits of fish while reducing any risks.
Benefits of Supplements
Omega-3 supplements are an important way to ensure that you are getting enough Omega-3 fatty acids for optimal brain and body health. The preferred form of supplementation is DHA and EPA from fish oils, cod liver oil, or calamari (squid) oil. Calamari oil is excellent form rich in DHA and EPA, especially for those with fish allergy concerns (or worried about sustainability of our fish supplies).
Typically the amount recommended depends on the primary reason you are taking the supplement. A general recommendation is to take enough of a supplement to ingest between 600 mg to 3g of combined DHA and EPA daily. Be sure to read the label as supplements have variable amounts of the "active ingredients" of DHA and EPA depending on the brand and type of oil or capsule. Thus to achieve these amounts you might need to take two to four or many more of 1000 mg (large!) soft gels, or 1-3 teaspoons of an oil a day. Be sure to let you doctor know if you are taking more than 3g of the active ingredients (DHA and EPA) because Omega-3's thin the blood (thinning the blood is generally a good thing but may interact with other medical regimens you are pursuing, e.g. coumadin). Also be sure to purchase brands known to provide contaminant-free oils; the better companies have lab analyses proving "no detectible levels" of mercury, pcbs and dozens of other possible contaminants; these companies also properly process and package oils and capsules to prevent oxidation and spoilage.
Vegetarian alternatives include algae derived DHA/EPA or 2 Flaxseed Oil 1000 mg softgels (which typically each contain 450 mg ALA Omega-3). However, this is less optimal than supplementing with oils of a marine source because flaxseed oil contains the shorter chain ALA Omega-3 that needs to be converted by the body to DHA or EPA, and this is done much less efficiently as we age.
How do I find out what is best for me?
Dr. Nancy Emerson Lombardo can be reached by e-mail or phone for inquiries about what supplements would be best for you personally, and which brands are best. She also offers preferred nutritional supplements including some Omega-3 products through her website or by phone or email.
www.healthcareinsights.com
Friday, December 10, 2010
Resources
Perhaps because I'm in the field, but I get several good resources about different kinds of dementia, their treatment and the research being done. One is John Hopkins newsletter; another is Alzheimer and Dementia Weekly. If anyone wants contact information, write me @ beverly.moore@stilmee.com.
An article on Lewy Body Dementia in Dementia Weekly
What is Dementia With Lewy Bodies?
Dementia with Lewy bodies (DLB) is one of the most common types of progressive dementia. The central feature of DLB is progressive cognitive decline, combined with three additional defining features:
1.Pronounced “fluctuations” in alertness and attention, such as frequent drowsiness, lethargy, lengthy periods of time spent staring into space, or disorganized speech;
2.Recurrent visual hallucinations, and
3.Parkinsonian motor symptoms, such as rigidity and the loss of spontaneous movement.
People may also suffer from depression.
The symptoms of DLB are caused by the build-up of Lewy bodies – accumulated bits of alpha-synuclein protein -- inside the nuclei of neurons in areas of the brain that control particular aspects of memory and motor control. Researchers don’t know exactly why alpha-synuclein accumulates into Lewy bodies or how Lewy bodies cause the symptoms of DLB, but they do know that alpha-synuclein accumulation is also linked to Parkinson's disease, multiple system atrophy, and several other disorders, which are referred to as the "synucleinopathies." The similarity of symptoms between DLB and Parkinson’s disease, and between DLB and Alzheimer’s disease, can often make it difficult for a doctor to make a definitive diagnosis. In addition, Lewy bodies are often also found in the brains of people with Parkinson's and Alzheimer’s diseases. These findings suggest that either DLB is related to these other causes of dementia or that an individual can have both diseases at the same time. DLB usually occurs sporadically, in people with no known family history of the disease. However, rare familial cases have occasionally been reported.
Is there any treatment?
There is no cure for DLB. Treatments are aimed at controlling the cognitive, psychiatric, and motor symptoms of the disorder. Acetylcholinesterase inhibitors, such as donepezil (Aricept) and rivastigmine (Exelon), are primarily used to treat the cognitive symptoms of DLB, but they may also be of some benefit in reducing the psychiatric and motor symptoms. Doctors tend to avoid prescribing antipsychotics for hallucinatory symptoms of DLB because of the risk that neuroleptic sensitivity could worsen the motor symptoms. Some individuals with DLB may benefit from the use of levodopa for their rigidity and loss of spontaneous movement.
What is the prognosis?
Like Alzheimer’s disease and Parkinson’s disease, DLB is a neurodegenerative disorder that results in progressive intellectual and functional deterioration. There are no known therapies to stop or slow the progression of DLB. Average survival after the time of diagnosis is similar to that in Alzheimer’s disease, about 8 years, with progressively increasing disability.
What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS) conducts research related to DLB in laboratories at the NIH and also supports additional research through grants to major medical institutions across the country. Much of this research focuses on searching for the genetic roots of DLB, exploring the molecular mechanisms of alpha-synuclein accumulation, and discovering how Lewy bodies cause the particular symptoms of DLB and the other synucleinopathies. The goal of NINDS research is to find better ways to prevent, treat, and ultimately cure disorders such as DLB.
--------------------------------------------------------------------------------
Dementia with Lewy bodies (DLB) is one of the most common types of progressive dementia. The central feature of DLB is progressive cognitive decline, combined with three additional defining features:
1.Pronounced “fluctuations” in alertness and attention, such as frequent drowsiness, lethargy, lengthy periods of time spent staring into space, or disorganized speech;
2.Recurrent visual hallucinations, and
3.Parkinsonian motor symptoms, such as rigidity and the loss of spontaneous movement.
People may also suffer from depression.
The symptoms of DLB are caused by the build-up of Lewy bodies – accumulated bits of alpha-synuclein protein -- inside the nuclei of neurons in areas of the brain that control particular aspects of memory and motor control. Researchers don’t know exactly why alpha-synuclein accumulates into Lewy bodies or how Lewy bodies cause the symptoms of DLB, but they do know that alpha-synuclein accumulation is also linked to Parkinson's disease, multiple system atrophy, and several other disorders, which are referred to as the "synucleinopathies." The similarity of symptoms between DLB and Parkinson’s disease, and between DLB and Alzheimer’s disease, can often make it difficult for a doctor to make a definitive diagnosis. In addition, Lewy bodies are often also found in the brains of people with Parkinson's and Alzheimer’s diseases. These findings suggest that either DLB is related to these other causes of dementia or that an individual can have both diseases at the same time. DLB usually occurs sporadically, in people with no known family history of the disease. However, rare familial cases have occasionally been reported.
Is there any treatment?
There is no cure for DLB. Treatments are aimed at controlling the cognitive, psychiatric, and motor symptoms of the disorder. Acetylcholinesterase inhibitors, such as donepezil (Aricept) and rivastigmine (Exelon), are primarily used to treat the cognitive symptoms of DLB, but they may also be of some benefit in reducing the psychiatric and motor symptoms. Doctors tend to avoid prescribing antipsychotics for hallucinatory symptoms of DLB because of the risk that neuroleptic sensitivity could worsen the motor symptoms. Some individuals with DLB may benefit from the use of levodopa for their rigidity and loss of spontaneous movement.
What is the prognosis?
Like Alzheimer’s disease and Parkinson’s disease, DLB is a neurodegenerative disorder that results in progressive intellectual and functional deterioration. There are no known therapies to stop or slow the progression of DLB. Average survival after the time of diagnosis is similar to that in Alzheimer’s disease, about 8 years, with progressively increasing disability.
What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS) conducts research related to DLB in laboratories at the NIH and also supports additional research through grants to major medical institutions across the country. Much of this research focuses on searching for the genetic roots of DLB, exploring the molecular mechanisms of alpha-synuclein accumulation, and discovering how Lewy bodies cause the particular symptoms of DLB and the other synucleinopathies. The goal of NINDS research is to find better ways to prevent, treat, and ultimately cure disorders such as DLB.
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Monday, December 6, 2010
My blog
I will be posting articles of interest to caregivers in addition to my own. I would appreciate your feedback on this decision. I'll also post some excerpts from my second book, untitled as yet. Comments on any or all entries is appreciated.
FTL Dementia update from Dementia Weekly
Frontotemporal dementias are a set of devastating, progressive diseases. They attack the parts of the brain responsible for judgment, empathy, and social behavior. People with FTD often develop personality changes, make ruinous financial decisions, become sexually inappropriate, or engage in compulsive behavior. Some patients with AD exhibit some of those behaviors, too; however, with FTDs they are front and center. Some forms of FTD rob people of normal speech, while others impair movement, similar to Parkinson’s disease and amyotrophic lateral sclerosis. FTD typically strikes at younger ages than does AD, often in a person’s late forties or fifties. It involves less memory loss than AD, but much worse behavior problems. Patients, in early stages of FTD, often seem indifferent to what would be a mortifying situation for a healthy person.
The disease is particularly devastating to families, said Susan Dickinson, who heads the Association for Frontotemporal Dementias, because it often goes unrecognized or misdiagnosed. Families, therefore, have no recourse if a spouse with FTD blows all his or her money on a sports car, or makes advances to a neighbor, since the spouse is not recognized as ill. Friends may withdraw because of the rude or disturbing behavior of the person with FTD. “Living with these diseases is incredibly isolating,” Dickinson said. “These families are losing their loved ones, and nobody will listen. We have a lot of people who get divorced.” Earlier diagnosis of the disease would help families to understand and cope with what is happening, Dickinson said. “As soon as there is a medical diagnosis, a lot of people get right back together to care for their spouse.”
FTDs are fairly rare. Scientists estimate as many as 20,000 Americans suffer from them, said David Knopman of the Mayo Clinic in Rochester, Minnesota, reviewing the findings of several recent papers. This is similar to the number of Americans with amyotrophic lateral sclerosis, but about 200-fold less than people with Alzheimer’s disease. FTD most often hits between 45 and 64 years old, and people typically survive six to nine years after diagnosis, Knopman said, similar to Alzheimer’s.
Frontotemporal dementia is an umbrella term that encompasses a large number of clinical syndromes and distinct pathologies. This includes a confusing lexicon of terms such as progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), primary progressive aphasia (PPA), behavioral variant FTD (bvFTD), and Pick’s disease. The distinctions among these syndromes are often hazy, and diagnosis can only be reliably made after death by examining brain tissue changes. Until quite recently, the fundamental biology at the root of many of these syndromes was a mystery.
The disease is particularly devastating to families, said Susan Dickinson, who heads the Association for Frontotemporal Dementias, because it often goes unrecognized or misdiagnosed. Families, therefore, have no recourse if a spouse with FTD blows all his or her money on a sports car, or makes advances to a neighbor, since the spouse is not recognized as ill. Friends may withdraw because of the rude or disturbing behavior of the person with FTD. “Living with these diseases is incredibly isolating,” Dickinson said. “These families are losing their loved ones, and nobody will listen. We have a lot of people who get divorced.” Earlier diagnosis of the disease would help families to understand and cope with what is happening, Dickinson said. “As soon as there is a medical diagnosis, a lot of people get right back together to care for their spouse.”
FTDs are fairly rare. Scientists estimate as many as 20,000 Americans suffer from them, said David Knopman of the Mayo Clinic in Rochester, Minnesota, reviewing the findings of several recent papers. This is similar to the number of Americans with amyotrophic lateral sclerosis, but about 200-fold less than people with Alzheimer’s disease. FTD most often hits between 45 and 64 years old, and people typically survive six to nine years after diagnosis, Knopman said, similar to Alzheimer’s.
Frontotemporal dementia is an umbrella term that encompasses a large number of clinical syndromes and distinct pathologies. This includes a confusing lexicon of terms such as progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), primary progressive aphasia (PPA), behavioral variant FTD (bvFTD), and Pick’s disease. The distinctions among these syndromes are often hazy, and diagnosis can only be reliably made after death by examining brain tissue changes. Until quite recently, the fundamental biology at the root of many of these syndromes was a mystery.
On Guardian and Conservator Responsibilities
Attorney Leanna Hamill provides estate planning and related legal services to clients of all ages, with a focus on the needs of older individuals and their families.
160 Old Derby St., Suite 456
Hingham, Ma 02043
Phone: 781-749-2284 Fax: 866-573-6429
Leanna@HamillLawOffice.com
Responsibilities of a Guardian & Conservator
Written on December 6, 2010 in Guardianship
Have you thought about pursuing guardianship or conservatorship over an adult family member who you believe can no longer handle their affairs? A guardianship is a legal relationship created by a court between a guardian and her ward, usually an incapacitated adult. The guardian has a legal right and duty to care for the ward. A conservatorship is a like a guardianship but refers only to property.
After you are appointed by the Court, you have a lot of responsibilities to properly carry out your duties. Here are some of the ongoing responsibilities of a guardian and conservator:
•Filing a report with the Court at 60 days and annually outlining your plans for the ward, their care, and their property,
•Filing a yearly report with the Court outlining the ward’s living situation, medical condition, how often you’ve visited them, what services they are receiving and related issues.
•Caring for the ward – making health care decisions, living decisions and decisions about how to manage their property for their benefit,
•Involving the ward as much as possible taking into account their condition and circumstances,
•Filing Roger’s Monitor reports annually, if you are also appointed in that capacity,
•In the case of a Conservatorship, fileing annual accountings showing what has occured over the last year with the property you are managing,
•Responding to any requests from the Court for more frequent recording.
A guardian or conservator is always subject to the oversight of the Court and can be penalized for failing to properly account for funds and monitor their ward.
(The term “ward” is used here for convenience. The legal term for someone under a guardianship is “incapacitated person” and for someone under a conservatorship is “protected person.”)
________
Estate Planning, Probate and Trusts involve complex areas of law. Individual circumstances must be considered before any advice can be given. The general information above is not to be construed as legal advice, which can only be given after consideration of the unique facts of each matter. Please seek the advice or counsel of your attorney, financial advisor or CPA as it may be appropriate.
160 Old Derby St., Suite 456
Hingham, Ma 02043
Phone: 781-749-2284 Fax: 866-573-6429
Leanna@HamillLawOffice.com
Responsibilities of a Guardian & Conservator
Written on December 6, 2010 in Guardianship
Have you thought about pursuing guardianship or conservatorship over an adult family member who you believe can no longer handle their affairs? A guardianship is a legal relationship created by a court between a guardian and her ward, usually an incapacitated adult. The guardian has a legal right and duty to care for the ward. A conservatorship is a like a guardianship but refers only to property.
After you are appointed by the Court, you have a lot of responsibilities to properly carry out your duties. Here are some of the ongoing responsibilities of a guardian and conservator:
•Filing a report with the Court at 60 days and annually outlining your plans for the ward, their care, and their property,
•Filing a yearly report with the Court outlining the ward’s living situation, medical condition, how often you’ve visited them, what services they are receiving and related issues.
•Caring for the ward – making health care decisions, living decisions and decisions about how to manage their property for their benefit,
•Involving the ward as much as possible taking into account their condition and circumstances,
•Filing Roger’s Monitor reports annually, if you are also appointed in that capacity,
•In the case of a Conservatorship, fileing annual accountings showing what has occured over the last year with the property you are managing,
•Responding to any requests from the Court for more frequent recording.
A guardian or conservator is always subject to the oversight of the Court and can be penalized for failing to properly account for funds and monitor their ward.
(The term “ward” is used here for convenience. The legal term for someone under a guardianship is “incapacitated person” and for someone under a conservatorship is “protected person.”)
________
Estate Planning, Probate and Trusts involve complex areas of law. Individual circumstances must be considered before any advice can be given. The general information above is not to be construed as legal advice, which can only be given after consideration of the unique facts of each matter. Please seek the advice or counsel of your attorney, financial advisor or CPA as it may be appropriate.
Friday, December 3, 2010
From Geriatrics@brookdaleseniorliving.com
MEMANTINE DISCONTINUATION AND THE HEALTH STATUS OF NURSING HOME RESIDENTS WITH ALZHEIMER'S DISEASE. Fillit HM, Hofbauer RK, et al: Journal of the American Medical Directors Association, 2010; 11 (November) 636-644
OBJECTIVE: To estimate the effect of memantine (Namenda®) discontinuation for a nonmedical reason (e.g., formulary restriction or family decision) on the health status of nursing home (NH) residents with Alzheimer's disease (AD).
DESIGN: Retrospective chart review.
RESULTS: Compared with continuous treatment, memantine discontinuation was associated with a significant increase in the Total AD Symptom Change Score (i.e., worsening) in all comparison pairs. The symptoms showing greatest worsening aggregated into two factors: cognition and mood.
CONCLUSIONS: Memantine discontinuation in NH residents with AD may be associated with declining health status, and should be considered with care. A randomized, placebo-controlled trial of treatment discontinuation is merited.
KEVIN’S COMMENTS: Memantine is indicated for the treatment of moderate to severe Alzheimer’s disease. Several clinical studies have demonstrated in such persons a favorable effect on cognition, behaviors such as agitation and aggression, and activities of daily living. However, we can expect that nonmedical reasons for discontinuing medications in nursing home residents will escalate as budgetary concerns and perceived lack of benefit surface. This study showed that sudden withdrawal of memantine in persons with moderate to advanced Alzheimer’s disease resulted in a decline in overall health status within 2-3 months, compared with continued memantine treatment.
OBJECTIVE: To estimate the effect of memantine (Namenda®) discontinuation for a nonmedical reason (e.g., formulary restriction or family decision) on the health status of nursing home (NH) residents with Alzheimer's disease (AD).
DESIGN: Retrospective chart review.
RESULTS: Compared with continuous treatment, memantine discontinuation was associated with a significant increase in the Total AD Symptom Change Score (i.e., worsening) in all comparison pairs. The symptoms showing greatest worsening aggregated into two factors: cognition and mood.
CONCLUSIONS: Memantine discontinuation in NH residents with AD may be associated with declining health status, and should be considered with care. A randomized, placebo-controlled trial of treatment discontinuation is merited.
KEVIN’S COMMENTS: Memantine is indicated for the treatment of moderate to severe Alzheimer’s disease. Several clinical studies have demonstrated in such persons a favorable effect on cognition, behaviors such as agitation and aggression, and activities of daily living. However, we can expect that nonmedical reasons for discontinuing medications in nursing home residents will escalate as budgetary concerns and perceived lack of benefit surface. This study showed that sudden withdrawal of memantine in persons with moderate to advanced Alzheimer’s disease resulted in a decline in overall health status within 2-3 months, compared with continued memantine treatment.
Prayer heals from Brookdale newsletter
SISTERS IN MOTION: A RANDOMIZED CONTROLLED TRIAL OF A FAITH-BASED PHYSICAL ACTIVITY INTERVENTION. Duru OK, Sarkisian CA, et al: Journal of the American Geriatrics Society, 2010:58 (October) 1863-1869.
BACKGROUND: We know that exercise benefits our health, but an effective exercise and health improvement program can be difficult to find. Elderly African-American women were the focus of this study because only a few of these programs have been utilized for this population.
OBJECTIVE: To show that a faith-based exercise intervention program has both utility and success in improving outcomes for elderly African-American women.
DESIGN: Randomized controlled trial.
METHODS: All of the participants were African-American women, who, at the beginning of the study, could not walk without a walker and walked less than 30minutes 3 times a week. After enrolling, baseline blood pressures, pain scores, and weights were recorded. Participants were given a pedometer to record the number of steps walked. Two groups were created, the intervention group and the control group. Both groups received 45 minutes of exercise as well as weekly lectures, but only the intervention group participated in the faith-based curriculum, which included 8 weeks of scripture reading, group prayer, weekly goal setting, teaching on overcoming barriers, and a prize for the most steps walked for each week. The women were followed monthly after the first 8 weeks.
PARTICIPANTS: 62 participants, 60 years of age and from3 different Los Angeles churches, were included.
RESULTS: At the 6-month follow-up point, the intervention group had increased their walking activity by 3 miles per week compared to the control group. They also had a significant decrease in their systolic blood pressure.
CONCLUSIONS: A faith-based exercise program that utilizes goal setting and teaches strategies to overcome barriers to physical activity improved physical activity and blood pressure control in elderly African-American women.
KEVIN’S COMMENTS: Wellness is not just the health of our bodies, but the health of our minds, hearts, and souls as well. This study demonstrated that spiritual support and cognitive stimulation, as well as incentives to enhance motivation, helped overcome barriers to participation and resulted in increased physical activity levels. Another benefit was a reduction in blood pressure. This study reinforces the health benefits of programs that support multiple dimensions of wellness.
BACKGROUND: We know that exercise benefits our health, but an effective exercise and health improvement program can be difficult to find. Elderly African-American women were the focus of this study because only a few of these programs have been utilized for this population.
OBJECTIVE: To show that a faith-based exercise intervention program has both utility and success in improving outcomes for elderly African-American women.
DESIGN: Randomized controlled trial.
METHODS: All of the participants were African-American women, who, at the beginning of the study, could not walk without a walker and walked less than 30minutes 3 times a week. After enrolling, baseline blood pressures, pain scores, and weights were recorded. Participants were given a pedometer to record the number of steps walked. Two groups were created, the intervention group and the control group. Both groups received 45 minutes of exercise as well as weekly lectures, but only the intervention group participated in the faith-based curriculum, which included 8 weeks of scripture reading, group prayer, weekly goal setting, teaching on overcoming barriers, and a prize for the most steps walked for each week. The women were followed monthly after the first 8 weeks.
PARTICIPANTS: 62 participants, 60 years of age and from3 different Los Angeles churches, were included.
RESULTS: At the 6-month follow-up point, the intervention group had increased their walking activity by 3 miles per week compared to the control group. They also had a significant decrease in their systolic blood pressure.
CONCLUSIONS: A faith-based exercise program that utilizes goal setting and teaches strategies to overcome barriers to physical activity improved physical activity and blood pressure control in elderly African-American women.
KEVIN’S COMMENTS: Wellness is not just the health of our bodies, but the health of our minds, hearts, and souls as well. This study demonstrated that spiritual support and cognitive stimulation, as well as incentives to enhance motivation, helped overcome barriers to participation and resulted in increased physical activity levels. Another benefit was a reduction in blood pressure. This study reinforces the health benefits of programs that support multiple dimensions of wellness.
My column for November in SS Senior News
Hello God, it’s Me; I need You
In a research poll asking caregivers where they get their support, sixty-six percent answered “God’. The remaining thirty-three percent said friends, books, groups and professionals. Being a caregiver is lonely and laden with emotion. A diagnosis of Alzheimer’s is a life-changing event for families, one that continues to change life. Emotions emerge that surprise, even shame the person feeling them. Grief and sorrow over the losses the person sees in their diagnosed family member may be more easily managed than the emotions of anger, resentment, persistent impatience, and thoughts of hatred. These emotions feel unnatural and are not usually revealed to friends or family members. The caregiver carries them alone, unless they feel the presence of God.
I often ask caregivers if their faith brings them comfort through the caregiving journey. If they answer ‘yes’ I know the emotional impact will be lessened. If their religious practices like prayer and worship are an integral part of life and bring comfort and meaning to life, the person feels less alone.
Old Testament verses in Proverbs 3: 3-6 reads, ‘Trust in the Lord with all your heart and lean not on your own understanding; in all your ways acknowledge Him, and He shall direct your paths.’ The person of faith looks to God to hear their concerns, to continue to love them and forgive their shameful responses to caregiving. Some pray for patience to endure the challenges caregiving brings. Others are comforted believing God will guide them and protect them. God is the best care partner a caregiver can want.
In a research poll asking caregivers where they get their support, sixty-six percent answered “God’. The remaining thirty-three percent said friends, books, groups and professionals. Being a caregiver is lonely and laden with emotion. A diagnosis of Alzheimer’s is a life-changing event for families, one that continues to change life. Emotions emerge that surprise, even shame the person feeling them. Grief and sorrow over the losses the person sees in their diagnosed family member may be more easily managed than the emotions of anger, resentment, persistent impatience, and thoughts of hatred. These emotions feel unnatural and are not usually revealed to friends or family members. The caregiver carries them alone, unless they feel the presence of God.
I often ask caregivers if their faith brings them comfort through the caregiving journey. If they answer ‘yes’ I know the emotional impact will be lessened. If their religious practices like prayer and worship are an integral part of life and bring comfort and meaning to life, the person feels less alone.
Old Testament verses in Proverbs 3: 3-6 reads, ‘Trust in the Lord with all your heart and lean not on your own understanding; in all your ways acknowledge Him, and He shall direct your paths.’ The person of faith looks to God to hear their concerns, to continue to love them and forgive their shameful responses to caregiving. Some pray for patience to endure the challenges caregiving brings. Others are comforted believing God will guide them and protect them. God is the best care partner a caregiver can want.
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