Namenda news from Alzheimersweekly.com

Namenda & Side-Effects

A team of investigators unraveled exactly how Namenda helps Alzheimer's patients without causing serious side effects.

Alzheimer's disease destroys brain cells and their connections (called synapses), causing memory loss and other cognitive problems that disrupt work, hobbies and daily life. Symptoms can be alleviated, in part, by the drug Namenda (marketed in some countries as Ebixa, generically known as memantine).

New research shows a unique advantage of Namenda. Researchers revealed a signaling process that normally helps a healthy brain to communicate. This process can destroy brain cells when it sends the wrong signal. It seems that Namenda can tell the difference between the two, allowing the process to do its job when signals work properly, while blocking it whenever signals will be destructive.

Namenda is currently FDA-approved to treat moderate-to-severe Alzheimer's disease. It was, in part, developed by Stuart A. Lipton, M.D., Ph.D., Director of the Del E. Web Center for Neuroscience, Aging and Stem Cell Research at Sanford-Burnham Medical Research Institute (Sanford-Burnham).

Namenda improves symptoms by blocking abnormal activity of glutamate, a chemical that transmits messages between nerve cells.

In a study appearing August 18 in The Journal of Neuroscience, a team of investigators at Sanford-Burnham led by Dr. Lipton unravel exactly how Namenda helps Alzheimer's patients without causing serious side effects.

"While Namenda is partially effective in treating Alzheimer's disease, one of its major advantages is how safe and well-tolerated it is clinically," said Dr. Lipton

In treating any disease, one of the most difficult parts of designing a new drug is finding ways to maximize its beneficial effect while minimizing harmful side effects. Namenda is a particularly safe treatment for Alzheimer's disease because it dampens excessive glutamate signaling that occurs away from synapses without blocking glutamate activity at the synapses. This is important because interfering with synaptic glutamate signaling would disrupt normal brain activity.

"We showed definitively for the first time that Namenda, the drug our group developed for Alzheimer's disease, works in a unique way," Dr. Lipton said.

"It inhibits a protein that binds glutamate called the NMDA receptor, but predominantly blocks NMDA receptors that signal molecularly to cause neuronal injury and death. It spares the synaptic receptors that mediate normal communication between nerve cells in the brain."

This finding helps explain why the drug is so well tolerated by Alzheimer's patients and might provide hints for the development of future therapies targeting the NMDA receptor and similar cellular machinery in other diseases.

Namenda is now available in an XR and a generic to save money and take fewer doses a day. Go to www.alzheimersweekly.com/treatment/namenda-&-side-effects-a804.html

Make Happiness Happen

I am on WATD tomorrow morning talking about how to bring happiness to someone with dementia. My column in the SS Senior News www.southshoresenior.com has the same ideas. I'm including it here for those of you who don't get the paper (you should; log on and read some good articles)

Make Happiness Happen

Believe it or not, August is Happiness Happens Month. Where do they come up with these titles for months anyway? How does one make happiness happen? One of my coaches, Susan, gave me a plaque that reads: ‘We don’t remember days; we only remember moments.’ That is true for all of us. We remember the joy in seeing our first born for the first time. We remember a moment on a vacation that brings a smile or a tear.
We hear a song and the feeling it evokes brings to remembrance who we were with and what we were doing. We are capable of pulling those special memories out of our head and enjoy them again.
Happiness for the person with Alzheimer’s however doesn’t just happen. Since often all the person with memory loss is aware of is this moment, caregivers need to find how to create as many happy moments throughout the day as possible. For each person this can be different. Does music bring a smile? One wife, unable to make her aphasic husband understand her invitation to come to the table to eat, recalled his happiness while ballroom dancing in years past. They had gone dancing weekly then. She decided to put on dance music each meal and invite him to dance which he willingly did. Then she danced him to the table with a smile. When he saw the visual cues of a meal on the table he was ready to sit and eat. She felt joy seeing the happiness on his face so she continued this dance routine three times a day.
A daughter taped the Judge Judy Show, seeing the enjoyment her mother got whenever she watched it. When her mother became restless or irritable, she popped in a Judge Judy tape. Voila; instant smiles and contentment!
So what makes your family member with Alzheimer’s smile? Is it old photos? Is it plants? Does he love the beach, sunsets, baseball games? Try offering those activities and see what feelings of happiness you can make happen for both of you.
Coach Beverly

Visit our website www.StilMee.com

StilMee's website is updated with all the services we offer. I am excited about the family forum trainings we'll offer in the fall and the StilMee Certification Training for professionals. 5 CEUs for social workers makes it a great way to expand your knowledge of working with folks with dementia. If you are in the healthcare field you will have contact with both those with dementia from various causes and their families. I guess I've always gravitated toward educating the caregivers in whatever healthcare field I was in at the time. I had an educational support group for families of mentally ill people at Deaconess Hospital in the late 70s and early 80s. It amazed me to find the lack of knowledge of the diagnosis a family member had. This is true today of families who muddle through caring for someone with dementia. There is no reason a person must 'muddle' through! There is valuable education from a coach, from support groups, from the Help Line at the Alzheimer's Association 800-272-3900, and books. I'm including a bibliography here that can start you on your way to confidence.

Alzheimer’s A Caregiver’s Guide and Sourcebook by Howard Gruetzner; John Wiley and Sons, Inc. New York, 1992.

Alzheimer’s Early Stages; first steps in caring and treatment by Daniel Kuhn, MSW; Hunter House Publishers, Inc., California 1998.

Care That Works; A Relationship Approach to Persons with Dementia by Jitka M. Zgola, Johns Hopkins University Press, Baltimore and London, 1999.

Learning to Speak Alzheimers by Joanne Koenig Coste, Houghton Mifflin Company, Boston and New York, 2003.

Matters of the Mind…and the Heart Meeting the challenges of Alzheimer care by Beverly Moore, Strategic Book Publishing, New York, New York 2009.

Rethinking Alzheimer’s Care by Sam Fazio, Dorothy Seman, & Jane Stansell, Heatlh Professions Press, Baltimore, London, Winnepeg & Sidney.

I'm Still Here by John Zeisel PhD, Penguin a division of Avery Publishing, NY, NY.

Driving and the elderly

Another good article in the most recent Right at Home Newsletter

While some people with dementia can still drive safely for a time, nearly all people with dementia will eventually have to give up driving," said lead guideline author Donald J. Iverson, MD, of the Humboldt Neurological Medical Group in Eurkeka, CA, who is a Fellow of the American Academy of Neurology.

Iverson adds, "It's important for doctors to discuss this with patients and caregivers soon after the diagnosis, since restricted driving will affect the patient's quality of life and may lead to other health concerns, such as depression."

The guideline recommends that doctors use the Clinical Dementia Rating (CDR) scale to identify people with dementia who are at an increased risk of unsafe driving. The CDR provides a tool for clinicians to integrate information from caregivers and from direct examination of the patient to develop a comprehensive view of the dementia severity.

Evidence shows that driving skills deteriorate with increasing dementia severity. "While patients with mild dementia, as a group, are higher-risk drivers, more recent studies report that as many as 76% are still able to pass an on-road driving test and can safely drive," said Iverson. "Faced with these facts, we needed to provide guidelines for doctors to identify those people at higher risk of unsafe driving, without unnecessarily restricting those who are safe drivers."

Family caregivers may be an accurate judge of loved one's driving abilities.

The guidelines also confirm that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.

Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:

Collisions;


Moving violations; and,


Aggressive or impulsive personality traits.
"It is important that the decision to stop driving be directed by a doctor who is trained and experienced in working with people with dementia and their families," Iverson said. "Doctors should be aware that assessing driving ability is a complex process. More than one source of information is needed to make a judgment. In some situations, a dementia specialist may be needed."

Doctors, patients and caregivers must also know their state laws, since some states require that doctors report any medical conditions that may impact a patient's ability to drive safely.

This guideline was published in a recent issue of Neurology, the medical journal of the American Academy of Neurology, which is dedicated to promoting the highest quality patient-centered neurologic care. Visit the AAN website for consumer information on dementia, Parkinson's disease, stroke, and other neurological disorders.

Marriage and Alzheimer's

An Alzheimer diagnosis of a spouse is a life crisis. Life is irrevocably altered. When one is sick, two need care. The healthy spouse is grieving the loss of his or her other half. Roles change, identity as a husband or wife changes, and there is more often than not a social change. People shy away from inviting you as a couple, perhaps fearing looking at the change, or embarrassed around the ill friend.
Sexuality changes; sometimes spouses withdraw from the diagnosed spouse and feel that sexual expression now is inappropriate or distasteful. There are hygiene issues, fear that the partner will forget who their partner is.
If a couple can preserve aspects of their sexual relationship, there is still a sense of 'couple'. Other times passion is relabeled compassion. There may be lonliness within the relationship; the relationship now defined by loyalty, not necessarily love. If less attracted to the mate, there is guilt around rejecting advances. Males may wonder if sex is still consentual, and don't make advances. Couples need help accepting the many losses in their marriage when a diagnosis of Alzheimer's is given. They must learn other ways of communicating caring.
The couples I've coached over the years mostly talk about the loss of relationship; little conversation or one sided, the well spouse carrying the conversation.
I'd love to hear from spouses and what you've discovered in your experience and how you've found solutions.

The Seasons of Caregiving

When I was very little my mother introduced me as her little nurse. Did that have anything to do with my choice of professions? I’ve focused my last 32 years in the mental health field. I thought about this question “Why that population; the mentally ill and now the cognitively impaired and their caregivers?”.

I grew up hearing about my uncle Harold who was hospitalized when he was 27 for acting in a bizarre harmful way towards his mother. He spent the next 50 years in mental institutions. I visited him once when I was a student nurse on rotation at Medfield State Hospital and talked with a mild mannered pleasant man who looked just like his sister,my mother. I started to think how terrible for him to have had a psychotic break before the advent of psychotropic drugs. He missed out on 50 years of family life and perhaps years of pursuing and enjoying his dream of teaching. Today he would be treated with medications and probably released within a week or two….if his insurance company allowed that long.

The helper’s journey goes through seasons as I see it. First comes the spring; an awakening of a need of a person or population. There is the gathering of tools; information, education, and skill building.

As the skills needed to help are developed and refined, the summer brings confidence in oneself as helper. There may be a broadening or narrowing of the area in which we see we can best be effective. This may be grant writing, lobbying, directing, speaking,or teaching for the professional or hands on care. We find out what brings us satisfaction.

When I asked an audience in an assisted living residence to look at the satisfaction factor, we found some realized it in bringing comfort to the elder, others in teaching them easier ways of caring for themselves, others in advocating for services. The helper sees “This is how I can make a difference and feel satisfied doing it”

As caregiving continues there is a fall season in which there is ‘more of the same’, or little improvement in spite of our best efforts. There is a danger here of despair or burnout. This is the time when affirmation of what has been accomplished by our efforts becomes important. New ideas get generated as one reaches out to others for help in continuing.

Winter is a season of endings; perhaps that of a career, a program or an area of compassionate work. I underestimated the grief I felt 3 years ago when a program I developed and worked at for seven years waned as budget crunches emerged and finally ended for me when I was laid off. This is a time of new beginnings as well as endings.

And so we continue our individual journeys, learning about ourselves along the way, learning more about how to work with others in a team, and perhaps learning to let go when a caregiving area ends.

During all these seasons, the gift of appreciation and validation of work a person does cannot be overstated. We can each care for our team members who are helpers in their own unique way. An attitude of gratitude and appreciation among workers spreads like wildfire the same as an attitude of complaining and blaming can. We can choose the attitude of gratitude and carry on with our journey and support others in theirs.

A Matter of her mind...and my Heart

I'm beginning a new book about my Alzheimer caregiving journey, sometimes peaceful, sometimes not, with my mother in law, Bette. This is the opening paragraph. I'm hoping it helps others to read it as it did me to write it.

I should call this Confessions of an Alzheimer Coach. As I read back on the last 10 years of caring for Bette, I am aware of how much I’ve learned since the beginning, when I thought I knew a lot about Alzheimer care. It was after my father in law died of Alzheimer’s in 1996, that I realized Bette would require more attention. I didn’t know then just how much attention she would need and how little of what she needed she’d be wanting or accept. I confess I was a very reluctant caregiver, only agreeing to become primary caregiver to relieve my husband of a job he was ill-equipped to handle mainly because he loved her too much. His sister, although living nearby her mother, didn’t drive due to low vision and had limited knowledge of Alzheimer’s and the medical systems her mother would need. And so I accepted the position that would prove very challenging, frustrating, frightening in its impact on my marriage, my caring for my own mother and my feeling of emotional well being.
I’m writing this for one reason only; so caregivers can console themselves for the mistakes, the failures in care and the lack of heart for the job of caregiving. And, now one year after her death at 99 years of age, I can stand back and assess what kind of caregivers we were. As a professional, a nurse and owning a business coaching Alzheimer caregivers, I can adopt the professional stance when working with families. I often look very smart and an expert on Alzheimer’s. I have studied a great deal about the disease and caring with Habilitation Therapy approaches. I don’t really believe there are any experts on Alzheimer’s disease; just people who specialize in it. We learn very quickly there is no Alzheimer archetype to go by; no concrete model or typical patient. Each person is unique as he should be. A person expresses this crazy disease out of his experience coping with the world and its challenges. Whatever worked in the past to make a person feel as if they could relate in the world will be magnified in their response to the disease.
Probably the most difficult person to care for who has Alzheimer’s or any related dementia is the independent strong minded person who never felt they needed anybody. They handled life the way they saw it; they coped well, or perhaps sometimes not so well by others’ viewpoint, without adopting anyone else’s way but their own. I coached a man once whose wife had many difficult to manage behaviors. She resisted care, wandered, refused to wear protective underwear for her incontinence, and became belligerent when bathed or dressed. I asked him on our last coaching visit, “Is there anything in this that is positive for you?” “Oh, yes.” He exclaimed, “She needs me. She’s never needed me before, always so competent. It’s the first time in our 48 years of marriage that I feel essential. That feels good!”
My mother in law was such a woman.