Archives for May 2013

On This Memorial Day: Caregiving and Veterans

(Family Caregiver Alliance) Whether it’s former “empty-nest” parents resuming a caregiving role for unmarried children returned home as injured veterans, or a spouse of a veteran who suffers from post-traumatic stress disorder (PTSD), the responsiblities of the veteran’s caregiver can become incredibly overwhelming—mentally, emotionally and physically. With today’s medical care system and technologies, we’re seeing more veterans living longer lives—but often accompanied by injuries, psychiatric issues and/or physical impairments.

We’ve compiled the resources on this page to provide answers and links to resources for those experiencing the situations above, as well as for veterans themselves. The most helpful may be the toll-free National Caregiver Support Line: 1-855-260-3274 (Monday through Friday 8 a.m. to 11 p.m., Saturdays 10:30 a.m. to 6 p.m. Eastern Time). The phone service provides licensed clinical social workers who will answer questions, listen to your concerns, and direct you to a VA Caregiver Support Coordinator in your local area.

Family Caregiver Alliance Fact Sheets

Related Articles & Publications

Other Resources for Veterans


People with Alzheimer’s at High Risk of Falls

(Fisher Center for Alzheimer’s Research Foundation) Falls are a leading cause of broken hips and other serious injuries in the elderly, and those with Alzheimer’s are at particularly high risk of falling. Problems with vision, perception and balance increase as Alzheimer’s advances, making the risk of a fall more likely.

A study from the medical journal Age and Ageing found that seniors with Alzheimer’s are three times more likely to suffer from hip fractures than those without the disease. A broken hip is very painful and requires surgery and hospitalization, which can lead to further disorientation and disability for the person with Alzheimer’s. A broken hip increases the chances that the person with Alzheimer’s may no longer be able to be cared for at home. Furthermore, the study showed, those with Alzheimer’s who suffer a broken hip are more likely to die than those without dementia.

It’s therefore important that persons with Alzheimer’s and those who care for them take measures to prevent falls. Extra attention must also be given to those with Alzheimer’s who are undergoing rehabilitation follow a fall and fracture. Fall prevention is important for caregivers as well, since those who care for a loved one with Alzheimer’s must remain mobile and healthy in order to provide optimal care.

The National Center for Injury Prevention and Control, part of the federal Centers for Disease Control and Prevention, recommends a number of measures to reduce the chance of falls. Since about half of all falls occur in the home, the center recommends a number of steps to make the home safer.

  • Remove things you can trip over, such as papers, books, clothes, and shoes, from stairs and places where you walk.
  • Remove small throw rugs or use double-sided tape to keep the rugs from slipping.
  • Keep items you use often in cabinets you can reach easily without using a step stool.
  • Have grab bars put in next to your toilet and in the tub or shower.
  • Use non-slip mats in the bathtub and on shower floors.
  • Improve the lighting in your home. As you get older, you need brighter lights to see well. Lamp shades or frosted bulbs can reduce glare.
  • Have handrails and lights put in on all staircases.
  • Wear shoes that give good support and have thin non-slip soles. Avoid wearing slippers and athletic shoes with deep treads.

People with Alzheimer’s are particularly likely to have vision or perception problems. Busy patterns, for example, may make it difficult for the person with Alzheimer’s to navigate about a room. Or similar-colored furniture, tables and carpets may be hard to distinguish for the person with Alzheimer’s.

Other steps to reduce the likelihood of falls include getting regular exercise, which can help to improve balance, strength and agility. The ancient martial art of tai chi, for example, has been shown to improve balance and reduce the risk of falls. Ask your doctor about the best type of exercise for you or for someone with Alzheimer’s.  Keep in mind, some people with dementia may have difficulty learning a new kind of exercise.

Many medications, including blood pressure medicines, can cause dizziness when standing, lightheadedness or other problems that increase the risk of falls. If side effects are a problem, ask your doctor about medication alternatives.

Finally, regular vision checks are important at all ages, and particularly in seniors. Eye problems like cataracts, for example, can make it difficult to see and increase the chance of falls, but are easily corrected.


By ALZinfo.orgReviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Source: Nicole L. Baker, Michael N. Cook, H. Michael Arrighi and Roger Bullock: Hip fracture risk and subsequent mortality among Alzheimer’s disease patients in the United Kingdom, 1988–2007 Age and Ageing (2010) doi: 10.1093/ageing/afq146 First published online: November 18, 2010.

© 2002 – 2013, The Fisher Center for Alzheimer’s Research Foundation


High Caloric Intake Associated with Increased Risk of Cognitive Impairment

J Alzheimers Dis. 2012;32(2):329-39. doi: 10.3233/JAD-2012-120862.

Relative intake of macronutrients impacts risk of mild cognitive impairment or dementia.

Roberts RORoberts LAGeda YECha RHPankratz VSO’Connor HMKnopman DSPetersen RC.

Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.


High caloric intake has been associated with an increased risk of cognitive impairment. Total caloric intake is determined by the calories derived from macronutrients.

The objective of the study was to investigate the association between percent of daily energy (calories) from macronutrients and incident mild cognitive impairment (MCI) or dementia.

Participants were a population-based prospective cohort of elderly persons who were followed over a median 3.7 years (interquartile range, 2.5-3.9) of follow-up.

At baseline and every 15 months, participants (median age, 79.5 years) were evaluated using the Clinical Dementia Rating scale, a neurological evaluation, and neuropsychological testing for a diagnosis of MCI, normal cognition, or dementia.

Participants also completed a 128-item food-frequency questionnaire at baseline; total daily caloric and macronutrient intakes were calculated using an established database. The percent of total daily energy from protein (% protein), carbohydrate (% carbohydrate), and total fat (% fat) was computed. Among 937 subjects who were cognitively normal at baseline, 200 developed incident MCI ordementia.

The risk of MCI or dementia (hazard ratio, [95% confidence interval]) was elevated in subjects with high % carbohydrate (upper quartile: 1.89 [1.17-3.06]; p for trend = 0.004), but was reduced in subjects with high % fat (upper quartile: 0.56 [0.34-0.91]; p for trend = 0.03), and high % protein (upper quartile 0.79 [0.52-1.20]; p for trend = 0.03) in the fully adjusted models.

A dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of MCI or dementia in elderly persons.


National Center for Biotechnology Information, U.S. National Library of Medicine


Mediterranean Diet May Lower Risk of Cognitive Impairment

Neurology. 2013 Apr 30;80(18):1684-92. doi: 10.1212/WNL.0b013e3182904f69.

Adherence to a Mediterranean diet and risk of incident cognitive impairment.

Tsivgoulis G1, Judd S, Letter AJ, Alexandrov AV, Howard G, Nahab F, Unverzagt FW, Moy C, Howard VJ, Kissela B, Wadley VG.



We sought to determine the relationship of greater adherence to Mediterranean diet (MeD) and likelihood of incident cognitive impairment (ICI) and evaluate the interaction of race and vascular risk factors.


A prospective, population-based, cohort of individuals enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003–2007, excluding participants with history of stroke, impaired cognitive status at baseline, and missing data on Food Frequency Questionnaires (FFQ), was evaluated. Adherence to a MeD (scored as 0–9) was computed from FFQ. Cognitive status was evaluated at baseline and annually during a mean follow-up period of 4.0 ± 1.5 years using Six-item-Screener.


ICI was identified in 1,248 (7%) out of 17,478 individuals fulfilling the inclusion criteria. Higher adherence to MeD was associated with lower likelihood of ICI before (odds ratio [lsqb]OR[rsqb] 0.89; 95% confidence interval [lsqb]CI[rsqb] 0.79–1.00) and after adjustment for potential confounders (OR 0.87; 95% CI 0.76–1.00) including demographic characteristics, environmental factors, vascular risk factors, depressive symptoms, and self-reported health status.

There was no interaction between race (p = 0.2928) and association of adherence to MeD with cognitive status. However, we identified a strong interaction of diabetes mellitus (p = 0.0134) on the relationship of adherence to MeD with ICI; high adherence to MeD was associated with a lower likelihood of ICI in nondiabetic participants (OR 0.81; 95% CI 0.70–0.94; p = 0.0066) but not in diabetic individuals (OR 1.27; 95% CI 0.95–1.71; p = 0.1063).


Higher adherence to MeD was associated with a lower likelihood of ICI independent of potential confounders. This association was moderated by presence of diabetes mellitus.



Alzheimer Disease and Risk of Stroke

Neurology. 2013 Feb 19;80(8):705-11. doi: 10.1212/WNL.0b013e31828250af. Epub 2013 Jan 9.

Alzheimer disease and risk of stroke: a population-based cohort study.

Chi NF1, Chien LN, Ku HL, Hu CJ, Chiou HY.



To investigate the risk of stroke in patients clinically diagnosed with Alzheimer disease (AD) compared with non-AD patients with similar vascular risk factors.


Using data obtained from Taiwan’s National Health Insurance Research Database, we evaluated the risk of ischemic stroke (IS) and intracerebral hemorrhage (ICH) in patients with AD (n = 980) who had no history of stroke, vascular dementia, or other cerebral degenerative diseases. Our evaluation period spanned from 2000 to 2010. We performed a 1:5 case-control matched analysis, in which cases were matched to controls according to their estimated propensity scores, which were based on demographics and existing vascular risk factors. This approach reduced selection bias. Cox proportional hazards regression analysis was then used to estimate the risk of IS and ICH in AD, conditional for matched pairs.


Overall, patients with AD had a higher risk of IS and ICH than those without AD. The incidence of IS in AD cases and non-AD controls was 37.8 and 23.2 per 1,000 person-years, with an adjusted hazard ratio of 1.66 (95% confidence interval, 1.37–2.01, p < 0.001). The incidence of ICH in AD cases and non-AD controls was 5.2 and 3.0 per 1,000 person-years, with an adjusted hazard ratio of 1.70 (95% confidence interval, 1.03–2.79, p = 0.037).


Clinical diagnosis of AD is associated with considerably increased risk of stroke development.


© 2013 American Academy of Neurology


Use of Nilotinib Cancer Drug for Treatment of Parkinson’s, Alzheimer’s, Dementia

Hum Mol Genet. 2013 Aug 15;22(16):3315-28. doi: 10.1093/hmg/ddt192. Epub 2013 May 10.

Nilotinib reverses loss of dopamine neurons and improves motor behavior via autophagic degradation of α-synuclein in Parkinson’s disease models.

Hebron ML1, Lonskaya I, Moussa CE.


Parkinson’s disease is a movement disorder characterized by death of dopaminergic substantia nigra (SN) neurons and brain accumulation of α-synuclein. The tyrosine kinase Abl is activated in neurodegeneration.Here, we show that lentiviral expression of α-synuclein in the mouse SN leads to Abl activation (phosphorylation) and lentiviral Abl expression increases α-synuclein levels, in agreement with Abl activation in PD brains.

Administration of the tyrosine kinase inhibitor nilotinib decreases Abl activity and ameliorates autophagic clearance of α-synuclein in transgenic and lentiviral gene transfer models. Subcellular fractionation shows accumulation of α-synuclein and hyper-phosphorylated Tau (p-Tau) in autophagic vacuoles in α-synuclein expressing brains, but nilotinib enhances protein deposition into the lysosomes.

Nilotinib is used for adult leukemia treatment and it enters the brain within US Food and Drug Administration approved doses, leading to autophagic degradation of α-synuclein, protection of SN neurons and amelioration of motor performance.

These data suggest that nilotinib may be a therapeutic strategy to degrade α-synuclein in PD and other α-synucleinopathies.



Promoting Independence with Alzheimer’s Care

(Fisher Center for Alzheimer’s Research Foundation) Independence can be an important part of living with Alzheimer’s disease. But some caregivers may be inadvertently undermining the independence of those they care for by underestimating their abilities to carry out everyday tasks.

Those are the findings of new research from the University of Alberta in Canada, where a study led by by psychologist Tiana Rust shows that making patients with Alzheimer’s too dependent on their caregivers may make them less likely to contribute to daily activities and, in the process, diminish their sense of self-worth.

Often caregivers are only trying to help by assuming many of the day-to-day tasks that the person with Alzheimer’s needs. But when the caregiver assumes too many duties, it can create a so-called “dependency support script,” Ms. Rust says, in which those with Alzheimer’s are not encouraged to do things for themselves. As a result, the person with Alzheimer’s may feel less inclined to get involved with tasks like helping out in the kitchen or getting dressed that they may well be capable of, particularly in the earlier stages of the disease.

“When we create this excess dependency that doesn’t need to be there, this is a problem,” Ms. Rust said.

“If we’re able to maintain and promote independence to the degree permissible by the disease, that’s important.”

For her study, she observed several caregivers and Alzheimer’s patients as they prepared a meal together. While many of the patients were clearly capable of helping out with some of these duties, she noted that some of the caregivers assumed they were not able to do them and did the tasks themselves.

One woman, for example, was surprised to learn that her husband did many tasks at the day-care center he attended. She had been doing these for him at home for months, unaware that he was capable of doing them.

“People with Alzheimer’s disease have varying abilities, so it’s important to base [caregiver] interactions on the actual abilities of the person,” she said.

“Observing the person and gauging what they’re capable of before jumping in and supporting the dependence of the person is definitely important.”

Another important strategy, she notes, is to assist the person by breaking up tasks into smaller, more manageable steps.

“The task we had given the caregivers and the residents to do was set the table, make grilled cheese sandwiches, mix juice and clean up afterwards. All of those tasks are quite big in themselves, but they can all be broken up into small activities,” she said.

“These are all small tasks that these people with Alzheimer’s disease were still capable of doing, even though they might not have been able to do the full task.

“It’s a hard role as a caregiver to try to gauge what the person can do, to know what the patient is capable of, how much they can break up these tasks. But these were all things that the caregivers mentioned in the interviews, so they’re definitely wanting to promote their independence.”


By, The Alzheimer’s Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Source: University of Alberta, Research Services.

© 2002 – 2012, The Fisher Center for Alzheimer’s Research Foundation


Alzheimer’s Treatments: What’s on the Horizon?

(Mayo Clinic) Alzheimer’s treatments currently work by temporarily improving symptoms of memory loss and problems with thinking and reasoning.

These Alzheimer’s treatments boost performance of chemicals in the brain that carry information from one brain cell to another. However, these treatments don’t stop the underlying decline and death of brain cells. As more cells die, Alzheimer’s continues to progress.

Experts are cautiously hopeful about developing Alzheimer’s treatments that can stop or significantly delay the progression of Alzheimer’s. A growing understanding of how the disease disrupts the brain has led to potential Alzheimer’s treatments that short-circuit fundamental disease processes.

Future Alzheimer’s treatments may focus on combinations of medications like those used for many cancers and AIDS rather than a single compound. The following treatment options are among the strategies currently being studied.

Taking Aim at Plaques

Some of the new Alzheimer’s treatments in development target microscopic clumps of the protein beta-amyloid (plaques). Plaques have long been considered a sign of Alzheimer’s disease.

Two strategies aimed at beta-amyloid include immunizing the body against it and blocking its production:

  • Immunization strategies may prevent beta-amyloid from clumping into plaques and help the body clear the beta-amyloid from the brain. An early Alzheimer’s vaccine to reach clinical trials mobilized a person’s own immune system to attack beta-amyloid.Researchers stopped this study ahead of time when some participants developed acute brain inflammation. Although the trial ended before researchers could fully assess the vaccine’s effectiveness, the study demonstrated that beta-amyloid immunization could have a powerful effect on the brain.Most current immunization studies focus on administering antibodies against beta-amyloid from outside sources instead of enhancing a person’s immune system.

    One large research effort is exploring the value of intravenous (IV) infusions of a product derived from donated blood. This product contains naturally occurring anti-amyloid antibodies from the donors. Other studies are investigating laboratory-engineered (monoclonal) antibodies.

  • Production blockers may reduce the amount of beta-amyloid formed in the brain. Research has shown that beta-amyloid is produced from a “parent protein” in two steps performed by two different enzymes. Several experimental drugs aim to block the activity of the two enzymes.

Keeping Tau from Tangling

A vital brain cell transport system collapses when a protein called tau twists into microscopic fibers called tangles, which are another common brain abnormality of Alzheimer’s. Researchers are looking at a way to prevent tau from forming tangles.

Reducing Inflammation

Alzheimer’s causes chronic, low-level brain cell inflammation. Researchers are studying ways to treat inflammatory processes at work in Alzheimer’s disease.

Studies in nonsteroidal anti-inflammatory drugs have had varying results, but haven’t confirmed that these drugs prevent or delay progress of Alzheimer’s.

Researching Insulin Resistance

Researchers are studying the effects of insulin on the brain and brain cell function, and insulin changes in the brain that may be related to Alzheimer’s. A trial is testing an insulin nasal spray to determine if it slows the progression of Alzheimer’s.

Studying the Heart-head Connection

Growing evidence suggests that brain health is closely linked to heart and blood vessel health. Your arteries nourish your brain. The risk of developing Alzheimer’s appears to increase as a result of many conditions that damage the heart or arteries. These include high blood pressure, heart disease, stroke, diabetes and high cholesterol.

In addition, a strong genetic Alzheimer’s risk factor is one form of a gene for a protein that carries cholesterol in the blood (apolipoprotein E).

A number of studies are exploring how best to build on this heart-head connection. Strategies under investigation include:

  • Current drugs for heart disease risk factors. Researchers are investigating whether drugs now used to treat high blood pressure, diabetes and high cholesterol may also help people with Alzheimer’s or reduce the risk of developing the disease.
  • Drugs aimed at new targets. Additional projects are looking more closely at how the connection between heart disease and Alzheimer’s works at the molecular level to find new drug targets.
  • Lifestyle choices. Researchers have explored whether lifestyle choices with known heart benefits, such as exercising on most days and eating a heart-healthy diet, may help prevent Alzheimer’s disease or delay its onset.

Researching Thinking and Social Activities

Studies research whether thinking (cognitive) activities, such as memory training, may help prevent or delay Alzheimer’s.

Researchers also are studying whether social interaction may positively affect cognitive function.

Speeding Treatment Development

Developing new medications is a slow and painstaking process. The pace can be especially frustrating for people with Alzheimer’s and their families who are waiting for new treatment options.

To help accelerate discovery, the Coalition Against Major Diseases (CAMD), an alliance of pharmaceutical companies, nonprofit foundations and government advisers, have forged a first-of-its-kind partnership to share data from Alzheimer’s clinical trials.

Researchers anticipate that sharing these data from more than 4,000 study participants will speed development of more-effective therapies.


© 1998-2013 Mayo Foundation for Medical Education and Research.