Archives for August 2014

Legal Issues in Planning for Incapacity

(Family Caregiver Alliance) As you face aging and the need to make plans for your future, you face having to make legal decisions about many aspects of your lives. These legal decisions not only protect you from others doing things you might not like to you, they also protect family and loved ones by giving them guidance in the care that you would like to receive. After completing all the legal paperwork, the next step is to sit down and talk to family about the decisions you have made and why.

What are the Legal Documents Everyone Should Have?

Advanced Health Care Directive

  • Gives power to a person you designate to make health care decisions for you ONLY IF you can’t speak for yourself
  • Also called Living Will, Durable Power of Attorney for Healthcare
  • Each state has slightly different versions of the form, but a form from one state will be honored in another state
  • Hospitals and doctor’s offices have the forms
  • Everyone over 18 should have one
  • Must be completed while you are competent to know what you are signing, i.e. without dementia
  • Often used to decide on feeding tubes, ventilators and other treatments at the end of life or when someone is unconscious
  • Only needs to be witnessed; does not need to be notarized

What happens if you don’t have an Advanced Health Care Directive?

  • Doctors will do everything to treat your condition and keep you alive.
  • Family will be asked what to do.
  • If they don’t know what your wishes would be, there might be family conflict and guilt over making the wrong decision
  • Physician training, hospital and nursing home policies often dictate the use of “heroic means” to sustain life, “reviving” a very ill person after a stroke or using a respirator for someone deemed medically “brain dead” are standard procedures used in many hospitals.

POLST

Stands for Physicians Orders for Life Sustaining Treatment and replaces DNR—Do Not Resuscitate
Allows individuals with life threatening illnesses to decide with their doctors what treatment they would or wouldn’t want. Since it is a physician’s order, it is not open to the will of others
Is helpful if you do not want 911 Emergency Responders to perform CPR—Cardio-pulmonary Resuscitation and expands on other treatments you might or might not want.

What happens if you don’t have a POLST?

  • If 911 is called, EMTs are required to do everything possible to resuscitate a
  • person and keep him/her alive until they arrive at the hospital.

Will

Says how you want your estate (money and belongings) to be dispersed to family, friends, organizations, etc. after you die

  • Also called Last Will and Testament
  • Each state has different laws about estates, but most states will honor an out state will
  • Can be hand written or completed using on line forms, but necessary to be witnessed and/or notarized
  • If estate is complicated or over $100,000, it is best to have an attorney help you write the will or review what you wrote
  • Must be completed while you are competent to know what you are signing, i.e. without dementia
  • In a will, you appoint someone to be the executor or administrator who will pay your final bills and see that your wishes are carried out
  • Probate is the transferring of property when someone dies. The probate court oversees the executor to assure that the estate is divided as stated in the will.

What happens if you don’t have a will?
If you die without a will, the court will probate your estate, e.g. decide how your estate should be distributed

Durable Power of Attorney for Finance

Allows someone to access your finances, e.g checking account, investments, property in order to pay your bills

  • A Durable Power of Attorney is valid even if you are incapacitated
  • Must be completed while you are competent to know what you are signing, i.e. without dementia
  • Needs to be someone you trust as this person has a lot of control over your finances. If you don’t have someone you trust, you should consult a professional.
  • Spouses might not have access to all of your funds unless everything, including investments, is held as joint property

What happens if you don’t have a Power of Attorney for Finance?
If you don’t have a durable power of attorney for finance and you can’t manage your finances, a judge will have to appoint someone to do so. It may mean you will have to be conserved, e.g. someone appointed by the court will oversee your care and finances.

Final Arrangements

  • Decide whether you would like cremation or burial and let the family know. Also let loved ones know about your wishes regarding organ donation and other special arrangements.
  • Put your wishes in writing in a place family members can find them.
  • The more decisions you make beforehand, the fewer decisions family has to make during a difficult time when they are grieving

What happens if you don’t make your wishes known about final arrangements?

  • Family can often be in conflict about what you would have wanted.
  • The law can determine who has the power to make the decision if it is unclear or there is conflict.

What are the other things you might need?

Trusts

A trust creates a legal entity that holds your assets for you so that your estate does not have to go through probate when you die.

  • Also called a Living Trust
  • You name a trustee to oversee the trust both while you are alive and to distribute the trust to beneficiaries when you die
  • You may be the trustee of the trust while you are alive, in which case you name a successor trustee for the trust who will manage it after you die or become incapacitated.
  • A revocable trust allows you to control everything that happens in the trust while you are alive
  • An irrevocable trust cannot be changed without the beneficiary’s consent
  • There are many options for trusts for specific purposes, such as:
  • Special Needs Trusts—puts money aside to help someone who is disabled
  • Charitable Trust—money given to a charity
  • Bypass Trust—irrevocable trust passes assets to the spouse and then the children at death of second parent, limiting estate taxes
  • Life Insurance Trust—removes life insurance from estate and thus estate taxes
  • Generation Skipping Trust—allows grandchildren to directly inherit without paying taxes

What happens if you don’t have a trust?

  • Depending on the value of your assets, your estate will go through probate which can take several months and incur costs to the court

Beneficiary Forms

Bank accounts, investments, insurance, and retirement plans can be designated as “payable on death” to a named beneficiary, which means the funds don’t have to go through probate

  • Allows access to funds immediately, rather than waiting for probate to close

What happens if you don’t have fund “payable on death?”

  • Unless funds are in a trust, the estate must be probated through the court which can take several months (when the funds might not be available) and incur costs to the court

Where to Find my Important Papers

Have a central place to keep wills, trusts, powers of attorney, etc so that family members will know where to look for these documents.

What happens if you don’t have a central place?

Often, particularly in times of emergency and stress, we get confused and don’t know where something important might be. Having a place to go to will reduce the possibility of forms being
misplaced or lost. The legal forms are necessary to assure the care you or a loved one might want are carried out.

Conclusion

In a recent survey, 81% of the people said they think about these issues, however only 33% said they had completed the necessary forms. Although it is hard to talk about and think about, it is important to take care of these matters for your own sake and for the sake of your family.

Resources

Family Caregiver Alliance
785 Market Street, Suite 750
San Francisco, CA 94103
(415) 434-3388
(800) 445-8106
www.caregiver.org

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy.
FCA’s National Center on Caregiving offers information on current social, public policy and caregiving issues and provides assistance in the development of public and private programs for caregivers.
For residents of the greater San Francisco Bay Area, FCA provides direct family support services for caregivers of those with Alzheimer’s disease, stroke, ALS, head injury, Parkinson’s disease and other debilitating health conditions that strike adults.

American Bar Association (ABA)
Commission on Legal Problems of the Elderly
1050 Connecticut Ave. N.W., Suite 400
Washington, DC 20036
Phone: (202) 662-8690
www.americanbar.org

National Academy of Elder Law Attorneys
1577 Spring Hill Rd., Suite 220
Vienna, VA 22182
(703) 942-5711
www.naela.com

National Association of Area Agencies on Aging
1730 Rhode Island Ave, NW, Suite 1200
Washington, DC 20036
(202) 872-0888
www.n4a.org

National Senior Citizens Law Center
1444 Eye St., NW Suite 1100
Washington, DC 20005
(202) 289-6976
http://www.nsclc.org/index.php/consumers/

Compassion & Choices
PO Box 101810
Denver, CO 80250-1810
(800) 247-7421
www.compassionandchoices.org

National Hospice and Palliative Care Organization
1700 Diagonal Rd. Suite 625
Alexandria, VA 22314
(703) 837-1500
www.nhpco.org

Citation

https://caregiver.org/legal-planning-incapacity

Copyright © 2014 Family Caregiver Alliance. All rights reserved.

 

Electric Current to Brain Boosts Memory Discovery May Help Treat Memory Disorders Resulting from Stroke, Alzheimer’s, Brain Injury

(Northwestern University) Stimulating a particular region in the brain via non-invasive delivery of electrical current using magnetic pulses, called Transcranial Magnetic Stimulation, improves memory, reports a new Northwestern Medicine® study.

The discovery opens a new field of possibilities for treating memory impairments caused by conditions such as stroke, early-stage Alzheimer’s disease, traumatic brain injury, cardiac arrest and the memory problems that occur in healthy aging.

“We show for the first time that you can specifically change memory functions of the brain in adults without surgery or drugs, which have not proven effective,” said senior author Joel Voss, assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine.

“This noninvasive stimulation improves the ability to learn new things. It has tremendous potential for treating memory disorders.”

The study was published August 29 in Science.

The study also is the first to demonstrate that remembering events requires a collection of many brain regions to work in concert with a key memory structure called the hippocampus – similar to a symphony orchestra. The electrical stimulation is like giving the brain regions a more talented conductor so they play in closer synchrony.

“It’s like we replaced their normal conductor with Muti,” Voss said, referring to Riccardo Muti, the music director of the renowned Chicago Symphony Orchestra. “The brain regions played together better after the stimulation.”

The approach also has potential for treating mental disorders such as schizophrenia in which these brain regions and the hippocampus are out of sync with each other, affecting memory and cognition.

TMS Boosts Memory

The Northwestern study is the first to show TMS improves memory long after treatment. In the past, TMS has been used in a limited way to temporarily change brain function to improve performance during a test, for example, making someone push a button slightly faster while the brain is being stimulated. The study shows that TMS can be used to improve memory for events at least 24 hours after the stimulation is given.

Finding the Sweet Spot

It isn’t possible to directly stimulate the hippocampus with TMS because it’s too deep in the brain for the magnetic fields to penetrate. So, using an MRI scan, Voss and colleagues identified a superficial brain region a mere centimeter from the surface of the skull with high connectivity to the hippocampus. He wanted to see if directing the stimulation to this spot would in turn stimulate the hippocampus. It did.

“I was astonished to see that it worked so specifically,” Voss said.

When TMS was used to stimulate this spot, regions in the brain involved with the hippocampus became more synchronized with each other, as indicated by data taken while subjects were inside an MRI machine, which records the blood flow in the brain as an indirect measure of neuronal activity.

The more those regions worked together due to the stimulation, the better people were able to learn new information.

How the Study Worked

Scientists recruited 16 healthy adults ages 21 to 40. Each had a detailed anatomical image taken of his or her brain as well as 10 minutes of recording brain activity while lying quietly inside an MRI scanner. Doing this allowed the researchers to identify each person’s network of brain structures that are involved in memory and well connected to the hippocampus. The structures are slightly different in each person and may vary in location by as much as a few centimeters.

“To properly target the stimulation, we had to identify the structures in each person’s brain space because everyone’s brain is different,” Voss said.

Each participant then underwent a memory test, consisting of a set of arbitrary associations between faces and words that they were asked to learn and remember. After establishing their baseline ability to perform on this memory task, participants received brain stimulation 20 minutes a day for five consecutive days.

During the week they also received additional MRI scans and tests of their ability to remember new sets of arbitrary word and face parings to see how their memory changed as a result of the stimulation. Then, at least 24 hours after the final stimulation, they were tested again.

At least one week later, the same experiment was repeated but with a fake placebo stimulation. The order of real stimulation and placebo portions of the study was reversed for half of the participants, and they weren’t told which was which.

Both groups performed better on memory tests as a result of the brain stimulation. It took three days of stimulation before they improved.

“They remembered more face-word pairings after the stimulation than before, which means their learning ability improved,” Voss said. “That didn’t happen for the placebo condition or in another control experiment with additional subjects.”

In addition, the MRI showed the stimulation caused the brain regions to become more synchronized with each other and the hippocampus. The greater the improvement in the synchronicity or connectivity between specific parts of the network, the better the performance on the memory test.

“The more certain brain regions worked together because of the stimulation, the more people were able to learn face-word pairings, “ Voss said.

Using TMS to stimulate memory has multiple advantages, noted first author Jane Wang, a postdoctoral fellow in Voss’s lab at Feinberg. “No medication could be as specific as TMS for these memory networks,” Wang said. “There are a lot of different targets and it’s not easy to come up with any one receptor that’s involved in memory.”

The Future

“This opens up a whole new area for treatment studies where we will try to see if we can improve function in people who really need it,“ Voss said.

His current study was with people who had normal memory, in whom he wouldn’t expect to see a big improvement because their brains are already working effectively.

“But for a person with brain damage or a memory disorder, those networks are disrupted so even a small change could translate into gains in their function,” Voss said.

In an upcoming trial, Voss will study the electrical stimulation’s effect on people with early-stage memory loss.

Voss cautioned that years of research are needed to determine whether this approach is safe or effective for patients with Alzheimer’s disease or similar disorders of memory.

Citation

by Marla Paul

http://www.northwestern.edu/newscenter/stories/2014/08/electric-current-to-brain-boosts-memory.html#sthash.Ch0W5ww1.dpuf

Other Northwestern authors on the paper include Lynn M. Rogers, Evan Z. Gross, Anthony J. Ryals, Mehmet E. Dokucu, Kelly L. Brandstatt and Molly S. Hermiller.

The research was supported by grants P50-MH094263 from the National Institute of Mental Health and F32-NS083340 from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health.

 

Marijuana Compound May Offer Treatment for Alzheimer’s Disease

(University of South Florida) Extremely low levels of the compound in marijuana known as delta-9-tetrahydrocannabinol, or THC, may slow or halt the progression of Alzheimer’s disease, a recent study from neuroscientists at the University of South Florida shows.

Findings from the experiments, using a cellular model of Alzheimer’s disease, were reported online in the Journal of Alzheimer’s Disease.

Researchers from the USF Health Byrd Alzheimer’s Institute showed that extremely low doses of THC reduce the production of amyloid beta, found in a soluble form in most aging brains, and prevent abnormal accumulation of this protein — a process considered one of the pathological hallmarks evident early in the memory-robbing disease. These low concentrations of THC also selectively enhanced mitochondrial function, which is needed to help supply energy, transmit signals, and maintain a healthy brain.

“THC is known to be a potent antioxidant with neuroprotective properties, but this is the first report that the compound directly affects Alzheimer’s pathology by decreasing amyloid beta levels, inhibiting its aggregation, and enhancing mitochondrial function,” said study lead author Chuanhai Cao, PhD and a neuroscientist at the Byrd Alzheimer’s Institute and the USF College of Pharmacy.

“Decreased levels of amyloid beta means less aggregation, which may protect against the progression of Alzheimer’s disease. Since THC is a natural and relatively safe amyloid inhibitor, THC or its analogs may help us develop an effective treatment in the future.”

The researchers point out that at the low doses studied, the therapeutic benefits of THC appear to prevail over the associated risks of THC toxicity and memory impairment.

Neel Nabar, a study co-author and MD/PhD candidate, recognized the rapidly changing political climate surrounding the debate over medical marijuana.

“While we are still far from a consensus, this study indicates that THC and THC-related compounds may be of therapeutic value in Alzheimer’s disease,” Nabar said. “Are we advocating that people use illicit drugs to prevent the disease? No. It’s important to keep in mind that just because a drug may be effective doesn’t mean it can be safely used by anyone. However, these findings may lead to the development of related compounds that are safe, legal, and useful in the treatment of Alzheimer’s disease.”

The body’s own system of cannabinoid receptors interacts with naturally-occurring cannabinoid molecules, and these molecules function similarly to the THC isolated from the cannabis (marijuana) plant.

Dr. Cao’s laboratory at the Byrd Alzheimer’s Institute is currently investigating the effects of a drug cocktail that includes THC, caffeine as well as other natural compounds in a cellular model of Alzheimer’s disease, and will advance to a genetically-engineered mouse model of Alzheimer’s shortly.

“The dose and target population are critically important for any drug, so careful monitoring and control of drug levels in the blood and system are very important for therapeutic use, especially for a compound such as THC,” Dr. Cao said.

Citation

http://hscweb3.hsc.usf.edu/blog/2014/08/27/marijuana-compound-may-offer-treatment-alzheimers-disease-usf-preclinical-study-finds/

Article citation:  Chuanhai Cao, Yaqiong Li, Hui Liu, Ge Bai, Jonathan May, Xiaoyang Lin, Kyle Sutherland,  Neel Nabar and Jianfeng Cai; “The Potential Therapeutic Effects of THC on Alzheimer’s Disease,” Journal of Alzheimer’s Disease, DOI: 10.3233/JAD-140093.

Copyright © 2011, University of South Florida. All rights reserved.

 

Know Stroke. Know the Signs. Act in Time.

(National Institute of Neurological Disorders and Stroke) Stroke is the third leading cause of death in the United States and a leading cause of serious, long-term disability in adults. About 600,000 new strokes are reported in the U.S. each year. The good news is that treatments are available that can greatly reduce the damage caused by a stroke. However, you need to recognize the symptoms of a stroke and get to a hospital quickly. Getting treatment within 60 minutes can prevent disability.

Know Stroke video. This eight-minute video features experts in the field of stroke discussing the symptoms of stroke and what to do, as well as stories from people who have successfully recovered from a stroke. This presentation requires the latest free version of RealPlayer.

What is a Stroke?

A stroke, sometimes called a “brain attack,” occurs when blood flow to the brain is interrupted. When a stroke occurs, brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function.

What Causes a Stroke?

There are two major kinds of stroke.

The first, called an ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel or artery in the brain. About 80 percent of all strokes are ischemic. The second, known as a hemorrhagic stroke, is caused by a blood vessel in the brain that breaks and bleeds into the brain. About 20 percent of strokes are hemorrhagic.

What Disabilities Can Result from a Stroke?

Although stroke is a disease of the brain, it can affect the entire body. The effects of a stroke range from mild to severe and can include paralysis, problems with thinking, problems with speaking, and emotional problems. Patients may also experience pain or numbness after a stroke.

Know the Signs

Because stroke injures the brain, you may not realize that you are having a stroke. To a bystander, someone having a stroke may just look unaware or confused. Stroke victims have the best chance if someone around them recognizes the symptoms and acts quickly.

What are the Symptoms of a Stroke?

The symptoms of stroke are distinct because they happen quickly:

  • Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
  • Sudden confusion, trouble speaking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

What Should a Bystander Do?

If you believe someone is having a stroke – if he or she suddenly loses the ability to speak, or move an arm or leg on one side, or experiences facial paralysis on one side – call 911 immediately.

Streetsign image with text: Trouble Walking Streetsign image with text: Weakness on one side Streetsign image with text: Trouble Seeing Streetsign image with text: Trouble Speaking

Act in Time

Stroke is a medical emergency. Every minute counts when someone is having a stroke. The longer blood flow is cut off to the brain, the greater the damage. Immediate treatment can save people’s lives and enhance their chances for successful recovery.

Why is There a Need to Act Fast?

Ischemic strokes, the most common type of strokes, can be treated with a drug called t-PA, that dissolves blood clots obstructing blood flow to the brain. The window of opportunity to start treating stroke patients is three hours, but to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes.

What is the Benefit of Treatment?

A five-year study by the National Institute of Neurological Disorders and Stroke (NINDS) found that some stroke patients who received t-PA within three hours of the start of stroke symptoms were at least 30 percent more likely to recover with little or no disability after three months.

What Can I Do to Prevent a Stroke?

The best treatment for stroke is prevention. There are several risk factors that increase your chances of having a stroke:

  • High blood pressure
  • Heart disease
  • Smoking
  • Diabetes
  • High cholesterol

If you smoke – quit. If you have high blood pressure, heart disease, diabetes, or high cholesterol, getting them under control – and keeping them under control – will greatly reduce your chances of having a stroke.

Citation

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov/disorders/stroke/knowstroke.htm

 

Increased Risk of Stroke in People with Cognitive Impairment

(Medical University of South Carolina Department of Neurology) People with cognitive impairment are significantly more likely to have a stroke than people with normal cognitive function, according to a new study published in the Canadian Medical Association Journal.

“Given the projected substantial rise in the number of older people around the world, prevalence rates of cognitive impairment and stroke are expected to soar over the next several decades, especially in high-income countries,” said study author Bruce Ovbiagele, M.D., Medical University of South Carolina (MUSC) Department of Neurology chairman.

Cognitive impairment and stroke are major contributors to disability and stroke is the second leading cause of death worldwide. Although stroke is linked to the development and worsening of cognitive impairment, it is not known whether the reverse is true. Previous studies that have looked at the link between cognitive impairment and subsequent stroke have been inconsistent in their findings.

Researchers analyzed data from 121,879 people with cognitive impairment, of whom 7,799 later had strokes. They observed a significantly higher rate of stroke in people with cognitive impairment than in people with normal cognitive function.

“We found that the risk of future stroke was 39 percent higher among patients with cognitive impairment at baseline than among those with normal cognitive function at baseline,” the authors said. “This risk increased to 64 percent when a broadly adopted definition of cognitive impairment was used.”

Blockage of blood vessels in the brain (brain infarcts), atherosclerosis, inflammation and other vascular conditions are associated with a higher risk of stroke and cognitive impairment and may contribute to the increased risk.

How to Recognize a Stroke

Ovbiagele said quick recognition that a person is having a stroke leads to earlier treatment and can dramatically affect a person’s outcome. He explains it from the head down, noting that virtually all stroke patients have at least one of these five symptoms. There are:

  • Head – A very severe headache – like the worst of your life
  • Eyes – A change in vision, either double or blurred vision
  • Mouth – difficulty speaking or slurred speech
  • Limbs – Numbness or paralysis in an arm or leg on one side
  • Legs – Difficulty walking as if a person were drunk

“The key is sudden onset. What separates stroke from virtually everything else is that it’s like a bolt out of the blue. One minute you’re totally fine, the next minute something changes. It’s always drastic. That blood vessel suddenly gets blocked or that blood vessel suddenly breaks and you have symptoms immediately. If you have one of those symptoms that comes out of the blue, you should call 911 immediately.”

Citation

http://academicdepartments.musc.edu/pr/newscenter/2014/strokestudy.html#.U_-RpWPp-So

© 2014  Medical University of South Carolina

 

Alzheimer’s Brain Benefits from Weight Loss Following Bariatric Surgery

(Endocrine Society) Researchers theorize procedure could reduce risk of Alzheimer’s in obese people.

Weight loss surgery can curb alterations in brain activity associated with obesity and improve cognitive function involved in planning, strategizing and organizing, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

Obesity can tax the brain as well as other organs. Obese individuals face a 35 percent higher risk of developing Alzheimer’s disease compared to normal weight people.

Bariatric surgery is used to help people who are dangerously obese lose weight. Bariatric surgery procedures are designed to restrict the amount of food you can eat before you feel full by reducing the stomach’s size or limit the absorption of nutrients by removing part of the small intestine from the path food takes through the digestive tract. Some procedures, such as Roux-en-Y gastric bypass (RYBG) surgery, use a combination of these methods. This study was the first to assess brain activity in women before and after bariatric surgery.

“When we studied obese women prior to bariatric surgery, we found some areas of their brains metabolized sugars at a higher rate than normal weight women,” said one of the study’s authors, Cintia Cercato, MD, PhD, of the University of São Paolo in São Paolo, Brazil.

“In particular, obesity led to altered activity in a part of the brain linked to the development of Alzheimer’s disease – the posterior cingulate gyrus. Since bariatric surgery reversed this activity, we suspect the procedure may contribute to a reduced risk of Alzheimer’s disease and other forms of dementia.”

The longitudinal study examined the effect of RYBG surgery on the brain function of 17 obese women. Researchers used positron emission tomography (PET) scans and neuropsychological tests to assess brain function and activity in the participants prior to surgery and six months after the procedure. The same tests also were run once on a control group of 16 lean women.

Before they underwent surgery, the obese women had higher rates of metabolism in certain areas of the brain, including the posterior cingulate gyrus. Following surgery, there was no evidence of this exacerbated brain activity. Their brain metabolism rates were comparable to the activity seen in normal weight women.

After surgery, the obese women also performed better on a test measuring executive function – the brain’s ability to connect past experience and present action – than they did before the procedures. Executive function is used in planning, organizing and strategizing. Five other neuropsychological tests measuring various aspects of memory and cognitive function showed no change following the surgery.

“Our findings suggest the brain is another organ that benefits from weight loss induced by surgery,” Cercato said. “The increased brain activity the obese women exhibited before undergoing surgery did not result in improved cognitive performance, which suggests obesity may force the brain to work harder to achieve the same level of cognition.”

Other authors of the study include: Emerson Leonildo Marques, Alfredo Halpern, Marcio Corrêa Mancini, Maria Edna de Melo, Nídia Celeste Horie, Carlos Alberto Buchpiguel, Artur Martins Novaes Coutinho, Carla Rachael Ono, Silvana Prando, Marco Aurélio Santo, Edécio Cunha-Neto and Daniel Fuentes of the University of São Paolo.The study, “Changes in Neuropsychological Tests and Brain Metabolism after Bariatric Surgery,” was published online, ahead of print.

# # #

Founded in 1916, the Endocrine Society is the world’s oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, the Endocrine Society’s membership consists of over 17,000 scientists, physicians, educators, nurses and students in more than 100 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Washington, DC. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org.

Citation

https://www.endocrine.org/news-room/current-press-releases/brain-benefits-from-weight-loss-following-bariatric-surgery

© 2014 Copyright Endocrine Society. All rights reserved.

 

Mindfulness Training: New Coping Strategy for the Memory Impaired and Their Caregivers

(Northwestern University Feinberg School of Medicine) Mindfulness training for individuals with early-stage dementia and their caregivers together in the same class was beneficial for both groups, easing depression and improving sleep and quality of life, reports new Northwestern Medicine study.

“The disease is challenging for the affected person, family members and caregivers,“ said study lead author Ken Paller, professor of psychology at Weinberg College of Arts and Sciences at Northwestern and a fellow of the Cognitive Neurology and Alzheimer’s Disease Center at Northwestern University Feinberg School of Medicine.

“Although they know things will likely get worse, they can learn to focus on the present, deriving enjoyment in the moment with acceptance and without excessive worry about the future. This is what was taught in the mindfulness program.”

The study was published August 25 in the American Journal of Alzheimer’s Disease and Other Dementias.

Neurodegenerative diseases such as Alzheimer’s are particularly hard on caregivers, who are often close family members. They tend to have an increased incidence of anxiety, depression, immune dysfunction and other health concerns as well as an increased mortality rate, according to prior studies.

This is the first study to show that the caregiver and the patient both benefit from undergoing mindfulness training together. This is important because caregivers often don’t have much time on their own for activities that could relieve their emotional burden.

The training also helps the patient and caregiver accept new ways of communicating, scientists said.

“One of the major difficulties that individuals with dementia and their family members encounter is that there is a need for new ways of communicating due to the memory loss and other changes in thinking and abilities,” noted study co-author Sandra Weintraub, a professor of psychiatry and behavioral sciences at Feinberg and a neuropsychologist at Northwestern Memorial Hospital.

“The practice of mindfulness places both participants in the present and focuses on positive features of the interaction, allowing for a type of connection that may substitute for the more complex ways of communicating in the past. It is a good way to address stress.”

The study included 37 participants including 29 individuals who were part of a patient-caregiver pair. Most of the patients were diagnosed with dementia due to Alzheimer’s disease or mild cognitive impairment, often a precursor to dementia. Others had memory loss due to strokes or frontotemporal dementia, which affects emotions as well as speaking and understanding speech. Caregivers included patients’ spouses, adult children, a daughter-in-law and a mother-in-law.

Although the individuals with Alzheimer’s had mild to severe memory loss, they still were able to use other cognitive functions to participate in the mindfulness training and to experience emotion and positive feelings, Weintraub noted.

The participants attended eight sessions designed specifically for the needs of patients with memory loss due to the terminal neurodegenerative illness (dementia) and for the needs of their caregivers. Both groups completed an assessment within two weeks of starting the program and within two weeks of completing it.

Paller had expected mindfulness to be helpful for dementia caregivers based on previous research in the field. But he was uncertain whether a program would be successful for patients with memory impairments and whether patients and their caregivers could be trained together.

“We saw lower depression scores and improved ratings on sleep quality and quality of life for both groups,” said Paller, director of the cognitive neuroscience program. “After eight sessions of this training we observed a positive difference in their lives.”

“Mindfulness involves attentive awareness with acceptance for events in the present moment,” Paller said. “You don’t have to be drawn into wishing things were different. Mindfulness training in this way takes advantage of people’s abilities rather than focusing on their difficulties.”

Developing mindfulness is about learning different habits and a person has to practice a new habit for it to stick, Paller noted.

Paller said he hoped the study findings would encourage caregivers to seek out resources for learning mindfulness for themselves and the individuals with illness.

The paper is titled: “Benefits of Mindfulness Training for Patients With Progressive Cognitive Decline and Their Caregivers.”

Other Northwestern authors include Jessica Creery, Susan Florczak, M. Marsel Mesulam, Paul Reber, Jessica Kiragu, Joshua Rooks, Adam Safron, Darby Morhardt, Mary O’Hara, Kathryn Gigler, John Molony and Michael Maslar.

The study was supported by grant P30 AG13854 from the National Institute of Aging/National Institutes of Health, the Retirement Research Foundation, the State of Illinois, and the Mind and Life Institute.

Citation

by Marla Paul

http://www.northwestern.edu/newscenter/stories/2014/08/new-coping-strategy-for-the-memory-impaired-and-their-caregivers.html

 

 

Lack of Naturally Occurring Protein Linked to Early Dementia

(University of Warwick) Scientists at the University of Warwick have provided the first evidence that the lack of a naturally occurring protein is linked to early signs of dementia.

Published in Nature Communications, the research found that the absence of the protein MK2/3 promotes structural and physiological changes to cells in the nervous system. These changes were shown to have a significant correlation with early signs of dementia, including restricted learning and memory formation capabilities.

An absence of MK2/3, in spite of the brain cells (neurons) having significant structural abnormalities, did not prevent memories being formed, but did prevent these memories from being altered.

The results have led the researchers to call for greater attention to be paid to studying MK2/3.

Lead researcher and author Dr Sonia Corrêa says that

“Understanding how the brain functions from the sub-cellular to systems level is vital if we are to be able to develop ways to counteract changes that occur with ageing.”

“By demonstrating for the first time that the MK2/3 protein, which is essential for neuron communication, is required to fine-tune memory formation this study provides new insight into how molecular mechanisms regulate cognition.”

Neurons can adapt memories and make them more relevant to current situations by changing the way they communicate with other cells.

Information in the brain is transferred between neurons at synapses using chemicals (neurotransmitters) released from one (presynaptic) neuron which then act on receptors in the next (postsynaptic) neuron in the chain.

MK2/3 regulates the shape of spines in properly functioning postsynaptic neurons. Postsynaptic neurons with MK2/3 feature wider, shorter spines than those without.

The researchers found that change, caused by MK2/3’s absence, in the spine’s shape restricts the ability of neurons to communicate with each other, leading to alterations in the ability to acquire new memories.

“Deterioration of brain function commonly occurs as we get older but, as result of dementia or other neurodegenerative diseases, it can occur earlier in people’s lives,”says Dr Corrêa.

“For those who develop the early signs of dementia it becomes more difficult for them to adapt to changes in their life, including performing routine tasks.”

“For example, washing the dishes; if you have washed them by hand your whole life and then buy a dishwasher it can be difficult for those people who are older or have dementia to acquire the new memories necessary to learn how to use the machine and mentally replace the old method of washing dishes with the new. The change in shape of the postsynaptic neuron due to absence of MK2/3 is strongly correlated with this inability to acquire the new memories.”

Dr Corrêa argues that “Given their vital role in memory formation, MK2/3 pathways are important potential pharmaceutical targets for the treatment of cognitive deficits associated with ageing and dementia.”

Citation

http://www2.warwick.ac.uk/newsandevents/pressreleases/focus_on_naturally/

The research was supported by the BBSRC.

The paper can be accessed here: http://www.nature.com/ncomms/2014/140819/ncomms5701/full/ncomms5701.html

University of Warwick, UK