Archives for November 2015

Improving Fitness May Counteract Brain Atrophy in Older Adults

(University of Maryland) Older adults that improved their fitness through a moderate intensity exercise program increased the thickness of their brain’s cortex, the outer layer of the brain that typically atrophies with Alzheimer’s disease, according to a new study from the University of Maryland School of Public Health.  These effects were found in both healthy older adults and those diagnosed with mild cognitive impairment (MCI), an early stage of Alzheimer’s disease.

“Exercise may help to reverse neurodegeneration and the trend of brain shrinkage that we see in those with MCI and Alzheimer’s,” says Dr. J. Carson Smith, associate professor of kinesiology and senior author of the study, published in the Journal of the International Neuropsychological Society on Nov. 19, 2015.

“Many people think it is too late to intervene with exercise once a person shows symptoms of memory loss, but our data suggest that exercise may have a benefit in this early stage of cognitive decline.”

The previously physically inactive participants (ages 61-88) were put on an exercise regimen that included moderate intensity walking on a treadmill four times a week over a twelve-week period. On average, cardiorespiratory fitness improved by about 8% as a result of the training in both the healthy and MCI participants.

The atrophy of the brain’s cortical layer is a marker of Alzheimer’s disease progression and correlates with symptoms including cognitive impairment. Dr. Smith and colleagues found that the study participants who showed the greatest improvements in fitness had the most growth in the cortical layer, including both the group diagnosed with MCI and the healthy elders.

While both groups showed strong associations between increased fitness and increased cortical thickness after the intervention, the MCI participants showed greater improvements compared to healthy group in the left insula and superior temporal gyrus, two brain regions that have been shown to exhibit accelerated neurodegeneration in Alzheimer’s disease.

Dr. Smith previously reported that the participants in this exercise intervention showed improvements in neural efficiency during memory recall, and these new data add to the evidence for the positive impact of exercise on cognitive function. Other research he has published has also shown that moderate intensity physical activity, such as walking for 30 minutes 3-4 days per week, may protect brain health by staving off shrinkage of the hippocampus in older adults.

This is the first study to show that exercise and improved fitness can impact cortical thickness in older adults diagnosed with mild cognitive impairment.  Dr. Smith plans future studies that include more participants engaging in a longer-term exercise intervention to see if greater improvements can be seen over time, and if the effects persist over the long term.

The key unanswered question is if regular moderate intensity physical activity could reverse or delay cognitive decline and help keep people out of nursing homes and enable them to maintain their independence as they age.

Improved Cardiorespiratory Fitness Is Associated with Increased Cortical Thickness in Mild Cognitive Impairment” was written by Katherine Reiter, Kristy A. Nielson  Theresa J. Smith,  Lauren R. Weiss, Alfonso J. Alfini and J. Carson Smith and published in the Journal of the International Neuropsychological Society. Link:

Related Links

Improved Cardiorespiratory Fitness Is Associated with Increased Cortical Thickness in Mild Cognitive Impairment

Semantic Memory fMRI and Cognitive Function After Exercise Intervention in Mild Cognitive Impairment

Physical activity reduces hippocampal atrophy in elders at genetic risk for Alzheimer’s disease

Citation

http://sph.umd.edu/news-item/improving-fitness-may-counteract-brain-atrophy-older-adults

Copyright University of Maryland School of Public Health

 

How Exercise May Energize Brain Cell Function

(Johns Hopkins Medicine) As we age or develop neurodegenerative diseases such as Alzheimer’s, our brain cells may not produce sufficient energy to remain fully functional.

Researchers discovered that an enzyme called SIRT3 that is located in mitochondria — the cell’s powerhouse — may protect mice brains against the kinds of stresses believed to contribute to energy loss. Furthermore, mice that ran on a wheel increased their levels of this protective enzyme.

Researchers led by Mark Mattson, Ph.D., of the National Institute on Aging Intramural Research Program and Johns Hopkins University School of Medicine, used a new animal model to investigate whether they could aid neurons in resisting the energy-depleting stress caused by neurotoxins and other factors. They found the following:

  • Mice models that did not produce SIRT3 became highly sensitive to stress when exposed to neurotoxins that cause neurodegeneration and epileptic seizures.
  • Running wheel exercise increased the amount of SIRT3 in neurons of normal mice and protected them against degeneration; in those lacking the enzyme, running failed to protect the neurons.
  • Neurons could be protected against stress through use of a gene therapy technology to increase levels of SIRT3 in neurons.

These findings suggest that bolstering mitochondrial function and stress resistance by increasing SIRT3 levels may offer a promising therapeutic target for protecting against age-related cognitive decline and brain diseases.  The research team report their findings online Nov. 19 in the journal Cell Metabolism.

Citation

http://www.hopkinsmedicine.org/news/media/releases/animal_study_shows_how_exercise_may_energize_brain_cell_function_

ARTICLE: Cheng, A. Mitochondrial SIRT3 mediates adaptive responses of neurons to exercise, and metabolic and excitatory challenges. Cell Metabolism. E-published Nov. 19, 2015.

Other authors on the paper are Aiwu Cheng, Ying Yang, Ye Zhou, Chinmoyee Maharana, Daoyuan Lu, Wei Peng, Yong Liu, Ruiqian Wan, Krisztina Marosi, Magdalena Misiak and Vilhelm A. Bohr, all of the National Institute on Aging Intramural Research Program.

This work was supported by the Intramural Research Program of the National Institute on Aging and the Glenn Foundation for Biomedical Research.

© The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. All rights reserved.

 

Mediterranean Diet Recipes from the Mayo Clinic

(Mayo Clinic) Experiment with eating the Mediterranean way with these healthy recipes. People who follow the Mediterranean diet have a longer life expectancy and lower rates of chronic diseases than do other adults. Indeed, the Dietary Guidelines for Americans point to the Mediterranean diet as an example of a healthy-eating plan.

The Mediterranean diet emphasizes plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts. It replaces butter with healthy fats, such as olive oil and canola oil, and uses herbs and spices instead of salt to flavor foods. Red meat is limited to no more than a few times a month, while fish should be on the menu twice a week.

The Mediterranean diet is also about enjoying delicious foods — as you’ll discover when you try these recipes.

Main Dishes

Salads and Sides

Healthy Desserts

Citation

http://www.mayoclinic.com/health/mediterranean-diet-recipes/MY02229

References

  1. Mediterranean Diet & Pyramid: Overview. Oldways Preservation Trust. http://www.oldwayspt.org/resources/heritage-pyramids/mediterranean-pyramid/overview. Accessed Sept. 6, 2012.
  2. Dietary Guidelines for Americans, 2010. U.S. Department of Health and Human Services. http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm. Accessed Sept. 6, 2012.
  3. Mediterranean diet tips for everyone. Oldways Preservation Trust. http://www.oldwayspt.org/what-can-you-do/consumers?page=5. Accessed Sept. 6, 2012.

© 1998-2015 Mayo Foundation for Medical Education and Research (MFMER).

 

Alzheimer’s Disease: Resources for Managing Family Stress

(BrightFocus Foundation) It is not at all unusual for families to find themselves feuding when confronted with all the decisions of caring for an elder with Alzheimer’s, or other long-term diseases of aging. Caregiver stress can run high and emotions can become frayed, but professional and objective guidance and resources are available for those who seek it. The resources mentioned in this article are good starting points for families who find themselves in this position.

Their widowed mother was now in her eighties and living alone. She was outliving most of her friends. Memory issues had been apparent. Home safety, driving, medication adherence, good nutrition, and socialization were concerns. Her nearest child was 20 miles away, and while very busy during the week with a growing family and work, he did visit on most weekends. The other children stayed in close phone contact, and visited at least once a year, but all lived out of state. Everyone agreed they needed to do “something.”

Mom’s dementia was progressing. Was it Alzheimer’s or another type of dementia? To this point, she had only been followed by a primary care physician for her medical care.

She had some help at home, but it was not enough, and the children were concerned about the cost of more caregiver hours. Whether to remain in her home or to move to a local retirement facility was one of the many questions. The children felt stuck in their indecision, and sometimes, in moments of frustration and helplessness, they lashed out at one another. Over time, the stress of worry and decision-making was fraying their family bonds.

When the issues are numerous, and the questions are overwhelming, there are options a family can consider to bring resolution to the problems, as well as to bring sanity and goodwill back to their family. The first question to ask is “What is best for a person experiencing symptoms of dementia?”

A Good First Step: The Neuropsychological Evaluation

If there has been no neurological evaluation yet, get one. A thorough neuropsychological evaluation will establish a baseline so that cognitive changes over time can be monitored to provide better treatment. With this info, a family can better understand their loved ones needs, and the information can provide the clarity needed to make medical and caregiving decisions. A loved one’s primary care physician can make the referral for the evaluation.

In the above example, dementia was clearly present, though before the evaluation, the kind of dementia was unknown. When it became clear in the evaluation that it was probable Alzheimer’s, her long-term needs were brought into focus.

Someone to Guide and Advocate

A family facing these caregiving issues for the very first time can struggle with identifying resources for their loved one. Increasingly, options for assistance are readily available. Two options are a Geriatric Care Manager (GCM) and/or the local Area Agency on Aging.

Geriatric Care Manager

A Geriatric Care Manager (GCM) is a human services professional, such as a nurse or social worker, who specializes in serving adults 65 and older, or an adult with a disability. A GCM often steps in when a family is in crisis, and helps the family find solutions to their caregiving problems, including in-home care, long term placement, and community resources. A GCM is hired privately by the family, and works on behalf of the elder.  A GCM can be a resource when there are differences of opinion, when the children are out of the area and cannot oversee the care, or when a nearby family needs someone to oversee and manage the care while they are working. To find a GCM in your area, go to www.caremanager.org.

Area Agency on Aging

While GCMs are hired privately, the local Area Agency on Aging is also a valuable community resource. The Area Agency on Aging can conduct in-home assessments, and identify and access local resources for which the elder may qualify. They too, can be a great resource for a family, and the cost is often covered by the locale in which the elder lives. To find your local Area Agency on Aging, go to http://www.n4a.org/.

About Those Family Feuds

It is not at all unusual for families to find themselves feuding when confronted with all the decisions of caring for an elder with Alzheimer’s, or other long-term diseases of aging. Caregiver stress can run high and emotions can become frayed, but professional and objective guidance and resources are available for those who seek it. The above resources are good starting points for families who find themselves in this position.

 

Aerobic Exercise May Reverse Aging Effects on the Brain

(8th Conference, Clinical Trials on Alzheimer’s Disease)  Aerobic exercise appears to improve brain function and reduce markers of neurodegeneration in older adults at risk of developing Alzheimer’s disease (AD), according to research being presented at the 8th International Conference on Clinical Trials for Alzheimer’s Disease (CTAD). Laura Baker, Ph.D., principal investigator of the study and a cognitive neuroscientist at Wake Forest Baptist Medical Center said these results suggest that aerobic exercise may represent a promising disease-modifying therapeutic intervention for people in the earliest stages of AD.

The study assessed levels of two proteins in the cerebrospinal fluid (CSF) – beta amyloid and tau. Previous studies have shown that in the presence of a neurodegenerative process such as AD, CSF levels of tau increase, while levels of beta amyloid decline as the amyloid protein is deposited as plaques in the brain. But aerobic exercise seems to reverse this trend, particularly in people who are older and start with higher levels of cognitive impairment.

“We don’t know yet if we are reversing the process, protecting the brain, or just buying some time,” said Baker.

To test the effects of aerobic exercise on the brain, Baker and colleagues enrolled adults between the ages of 55 and 89 with mild cognitive impairment (MCI) and prediabetes.

Participants were assigned randomly to take part in a structured exercise program involving either moderate-to-high intensity aerobics or stretching for 45-60 minutes, four times per week, for six months, under the supervision of a trainer.

CSF and blood were collected from participants at the beginning of the study and after completion of the exercise program. At both time points, participants also completed assessments of cognition, how long it took to walk 400 meters, body fat and glucose tolerance. Forty participants also underwent magnetic resonance imaging (MRI) scans.

Participants in the aerobic exercise group showed, in addition to higher cognitive scores, faster walk times, and improved glucose tolerance. Aerobic exercise also had beneficial effects on tau and beta amyloid levels in the CSF and led to significant increases in blood flow to certain areas of the brain, not when participants were exercising, but when they were at rest.

“Resting blood flow was increased in those areas of brain where blood flow is typically decreased with aging and with the onset and progression of MCI due to Alzheimer’s disease,” said Baker. The brain imaging group at Wake Forest is now analyzing these data further to learn more about how brain cells change their communication patterns in response to exercise.

“The question we are going to ask next is whether the increased blood flow reflects improved health of the vessels in specific regions of the brain, or increased volume of blood to these regions.”

The next phase of the study will extend the exercise program to 18 months and will be conducted, under the auspices of the Alzheimer’s Disease Cooperative Study (ADCS), at 14 sites around the country. For the first 12 months, participants will be supervised by a trainer at their local YMCA; followed by a six-month unsupervised period designed to test the sustainability of the intervention.

Baker said she is hopeful that the results of the study will help motivate people to think about exercise in a different way.

“We all know that exercise is good for us, but maybe seeing observable, objective brain changes will provide the impetus to get us out the door to exercise.”

Other researchers involved in this study included Suzanne Craft, Ph.D., Kaycee M. Sink, M.D., and Valerie M. Wilson, M.D., from the Wake Forest School of Medicine; Jeannine Skinner, Ph.D., from Vanderbilt School of Medicine; Brenna Cholerton, Ph.D., from University of Washington Health Sciences; and Maureen Callaghan, M.D., Angela Hanson, M.D., from the VA Puget Sound.

Citation

http://www.ctad-alzheimer.com/sites/ctad.prod/files/files/Aerobic%20Exercise%20press%20release.pdf

BARCELONE 2015 www.ctad-alzheimer.com

CTAD © 2015 All rights reserved.

 

Dementia and Alzheimer’s Care: Planning and Preparing for the Road Ahead

(HelpGuide.org) Alzheimer’s disease and other types of dementia can be a challenging journey, not only for the person diagnosed but also for their family members and loved ones. Caring for someone with Alzheimer’s or dementia can seem overwhelming at times, but the more information and support you have, the better you can navigate the demanding road ahead and determine the long-term care options that are best suited to you and your loved one.

Preparing for Alzheimer’s and Dementia Care

As you come to grips with an Alzheimer’s or other dementia diagnosis, you may be dealing with a whole range of emotions and concerns. You’ll no doubt be worried about how your loved one will change, how you’ll keep him or her comfortable, and how much your life will change. You’ll also likely be experiencing emotions such as anger, grief, and shock. Adjusting to this new reality is not easy. It’s important to give yourself some time and to reach out for help. The more support you have, the better you will be able to help your loved one.

While some of these tips are directed specifically at Alzheimer’s patients, they may equally apply to those with other types of dementia as well, including vascular and mixed dementia.

Early-stage Alzheimer’s Care Preparations

There are some Alzheimer’s care preparations that are best done sooner rather than later. It may be hard to consider these questions at first, as it means thinking about a time when your loved one is already well down the road of his or her Alzheimer’s journey. However, putting preparations in place early helps a smoother transition for everyone. Depending on the stage of diagnosis, include the person with Alzheimer’s in the decision-making process as much as possible. If their dementia is at a more advanced stage, at least try to act on what their wishes would be.

Questions to consider in preparing for Alzheimer’s and dementia care:

  • Who will make healthcare and/or financial decisions when the person is no longer able to do so? While a difficult topic to bring up, if your loved one is still lucid enough, getting their wishes down on paper means they’ll be preserved and respected by all members of the family. Consider meeting with an elder law attorney to best understand your options. You’ll want to consider power of attorney, both for finances and for healthcare. If the person has already lost capacity, you may need to apply for guardianship/conservatorship. More information can be found in the Resources section below.
  • How will care needs be met? Sometimes family members assume that a spouse or nearest family member can take on caregiving, but that is not always the case. Caregiving is a large commitment that gets bigger over time. The person with Alzheimer’s will eventually need round-the-clock care. Family members may have their own health issues, jobs, and responsibilities. Communication is essential to make sure that the needs of the Alzheimer’s patient are met, and that the caregiver has the support to meet those needs.
  • Where will the person live? Is his or her own home appropriate, or is it difficult to access or make safe for later? If the person is currently living alone, for example, or far from any family or other support, it may be necessary to relocate or consider a facility with more support.

Find out what assistance your medical team can provide in these areas. In some countries, you can also hire a care manager privately. Geriatric care managers can provide an initial assessment as well as assistance with managing your case, including crisis management, interviewing in-home help, or assisting with placement in an assisted living facility or nursing home.

Developing Day-to-day Routines

Having a general daily routine in Alzheimer’s and dementia care helps caregiving run smoothly. These routines won’t be set in stone, but they give a sense of consistency, which is beneficial to the Alzheimer’s patient even if they can’t communicate it.

While every family will have their own unique routine, you can get some great ideas from your medical team or Alzheimer’s support group, especially regarding establishing routines to handle the most challenging times of day, such as evenings.

  • Keep a sense of structure and familiarity. Try to keep consistent daily times for activities such as waking up, mealtimes, bathing, dressing, receiving visitors, and bedtime. Keeping these things at the same time and place can help orientate the person.
  • Let the person know what to expect even if you are not sure that he or she completely understands. You can use cues to establish the different times of day. For example, in the morning you can open the curtains to let sunlight in. In the evening, you can put on quiet music to indicate it’s bedtime.
  • Involve the person in daily activities as much as they are able. For example, a person may not be able to tie their shoes, but may be able to put clothes in the hamper. Clipping plants outside may not be safe, but the person may be able to weed, plant, or water. Use your best judgment as to what is safe and what the person can handle.

Communication Do’s and Don’ts

As your loved one’s Alzheimer’s progresses, you will notice changes in communication. Trouble finding words, increased hand gestures, easy confusion, even inappropriate outbursts are all normal. Here are some do’s and don’ts on communicating:

Do

  • Avoid becoming frustrated by empathizing and remembering the person can’t help their condition. Making the person feel safe rather than stressed will make communication easier. Take a short break if you feel your fuse getting short.
  • Keep communication short, simple, and clear. Give one direction or ask one question at a time.
  • Tell the person who you are if there appears to be any doubt.
  • Call the person by name.
  • Speak slowly. The person may take longer to process what’s being said.
  • Use closed-ended questions which can be answered “yes” or “no.” For example, ask, “Did you enjoy the beef at dinner?” instead of “What did you have for dinner?”
  • Find a different way to say the same thing if it wasn’t understood. Try a simpler statement with fewer words.
  • Use distraction or fibs if telling the whole truth will upset the person with dementia. For example, to answer the question, “Where is my mother?” it may be better to say, “She’s not here right now” instead of “She died 20 years ago.”
  • Use repetition as much as necessary. Be prepared to say the same things over and over as the person can’t recall them for more than a few minutes at a time.
  • Use techniques to attract and maintain the person’s attention. Smile, make eye contact, use gestures, touch, and other body language.

Don’t

  • Ever say things like: “Do you remember?” “Try to remember!” “Did you forget?” “How could you not know that?!”
  • Ask questions that challenge short-term memory such as “Do you remember what we did last night?” The answer will likely be “no,” which may be humiliating for the person with dementia.
  • Talk in paragraphs. Instead, offer one idea at a time.
  • Point out the person’s memory difficulty. Avoid remarks such as “I just told you that.” Instead, just repeat it over and over.
  • Talk in front of the person as if he or she were not present. Always include the person in any conversation when they are physically present.
  • Use lots of pronouns such as “there, that, those, him, her, it.” Use nouns instead. For example, instead of “sit there” say “sit in the blue chair.”
  • Use slang or unfamiliar words. The person may not understand the latest terms or phrases.
  • Use patronizing language or “baby talk.” A person with dementia will feel angry or hurt at being talked down to.
  • Use sarcasm or irony, even if meant humorously. Again, it can cause hurt or confusion.

Planning Activities and Visitors

As you develop daily routines, it’s important to include activities and visitors. You want to make sure that the Alzheimer’s patient is getting sensory experiences and socialization, but not to the point of getting overstimulated and stressed. Here are some suggestions for activities:

  • Start with the person’s interests. Ask family and friends for memories of interests the person used to have. You’ll want to tailor the interests to the current level of ability so the person doesn’t get frustrated.
  • Vary activities to stimulate different senses of sight, smell, hearing, and touch. For example, you can try singing songs, telling stories, movement such as dance, walking, or swimming, tactile activities such as painting, working with clay, gardening, or interacting with pets.
  • Planning time outdoors can be very therapeutic. You can go for a drive, visit a park, or take a short walk. Even sitting on a balcony or in the backyard can be relaxing.
  • Consider outside group activities designed for those with Alzheimer’s. Senior centers or community centers may host these types of activities. You can also look into adult day care programs, which are partial or full days at a facility catering to older adults and/or dementia patients.

Visitors and Social Events

Visitors can be a rich part of the day for a person with Alzheimer’s disease. It can also provide an opportunity for you as the caregiver to socialize or take a break. Plan visitors at a time of day when your loved one can best handle them. Brief visitors on communication tips if they are uncertain and suggest they bring memorabilia your loved one may like, such as a favorite old song or book. Family and social events may also be appropriate, as long as the Alzheimer’s patient is comfortable. Focus on events that won’t overwhelm the person; excessive activity or stimulation at the wrong time of day might be too much to handle.

Handling Challenges in Alzheimer’s and Dementia Care

One of the most painful parts of Alzheimer’s disease is watching a loved one display behavior you never would have thought possible. Alzheimer’s can cause substantial changes in how someone acts. This can range from the embarrassing, such as inappropriate outbursts, to wandering, hallucinations, and violent behavior. Everyday tasks like eating, bathing, and dressing can become major challenges.

Painful as some behaviors are, it’s critical not to blame yourself or try to handle all the changes in behavior alone. As challenging behavior progresses, you may find yourself too embarrassed to go out, for example, or to seek respite care. Unfortunately, difficult behavior is part and parcel of Alzheimer’s disease. Don’t isolate yourself. Ask for help from the medical team and reach out to caregiver groups for support. There are ways to modify or better accommodate problem behaviors. Both the environment you create at home and the way you communicate with your loved one can make a substantial difference.

Considering Long-term Alzheimer’s and Dementia Care

It’s the nature of Alzheimer’s disease to progressively get worse as memory deteriorates. In the advanced stages of Alzheimer’s, your loved one will likely need round-the-clock care. Thinking ahead to these possibilities can help make decisions easier. To find links to organizations in your area that may be able to help, see Resources and References below.

Care at Home

There are several options for extending care at home:

  • In-home help refers to caregivers that you can hire to provide assistance for your loved one. In-home help ranges from a few hours a week of assistance to live-in help, depending on your needs. You’ll want to evaluate what sort of tasks you’d like help with, how much you can afford to spend, and what hours you need. Getting help with basic tasks like housekeeping, shopping, or other errands can also help you provide more focused care for your loved one.
  • Day programs, also called adult day care, are programs that typically operate weekdays and offer a variety of activities and socialization opportunities. They also provide the chance for you as the caregiver to continue working or attend to other needs. There are some programs that specialize in dementia care.
  • Respite care. Respite care is short-term care where your loved one stays in a facility temporarily. This gives you a block of time to rest, travel, or attend to other things.

Is it Time to Move?

As Alzheimer’s progresses, the physical and mental demands on you as caregiver can gradually become overwhelming. Each day can bring more challenges. The patient may require total assistance with physical tasks like bathing, dressing, and toileting, as well as greater overall supervision. At some point, you won’t be able to leave your loved one alone. Nighttime behaviors may not allow you to sleep, and with some patients, belligerent or aggressive behaviors may exceed your ability to cope or feel safe.

Every situation is different. Sometimes the gap can be bridged by bringing in additional assistance, such as in-home help or other family members to share the caregiving burden. However, it is not a sign of weakness if moving to your loved one to a facility seems like the best plan of care. It’s never an easy decision to make, but when you’re overwhelmed by stress and fatigue, it’s difficult to maintain your caregiving standards. If the person with Alzheimer’s is living alone, or you as the primary caregiver have health problems, this option may need to be considered sooner rather than later.

When considering your caregiving options, it’s important to consider whether you are able to balance your other obligations, either financial or to other family members. Will you be able to afford appropriate in-home coverage if you can’t continue caregiving? Talk to your loved one’s medical care team for their perspective as well.

Evaluating an Assisted-living Facility or Nursing Home

If the best choice is to move the Alzheimer’s patient to a facility, it doesn’t mean you will no longer be involved in their care. You can still visit regularly and ensure your loved one gets the care he or she needs. Even if you are not yet ready to make that step, doing some initial legwork might save a lot of heartache in the case of a crisis where you have to move quickly. The first step is finding the right place for your loved one.

Choosing a Facility

There are two main types of facilities that you will most likely have to evaluate for a loved one with Alzheimer’s: an assisted living facility or a nursing home.

Assisted Living

Assisted living is an option for those who need help with some activities of daily living. Some facilities provide minor help with medications as well. Staff is available twenty-four hours a day, but you will want to make sure they have experience handling residents with Alzheimer’s disease. Also be clear about what stage your loved may need to move to a higher level of care.

Nursing Homes

Nursing homes provide assistance in both activities of daily living and a high level of medical care. A licensed physician supervises each resident’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care providers and medical professionals such as occupational or physical therapists are also available.

How Eo I Choose a Facility?

Once you’ve determined the appropriate level of care, you’ll want to visit the facility—both announced and unannounced—to meet with the staff and otherwise evaluate the home. You will also want to evaluate the facility based on their experience with Alzheimer’s residents. Facilities that cater specifically for Alzheimer’s patients should have a designated area, often called a  special care unit in the U.S., for residents with dementia. Questions to ask such a facility include:

  • Policy and procedures – Does the unit mix Alzheimer’s patients with those with mental illness, which can be dangerous? Does the program require the family to supply a detailed social history of the resident (a good sign)?
  • Environment – Is the unit clean? Is the dining area large enough for all residents to use it comfortably? Are the doors alarmed or on a delayed opening system to prevent wandering? Is the unit too noisy?
  • Staffing – What is the ratio of residents to staff? (5 to 1 during the day, 9 to 1 at night is normal). What is staff turnover like? How do they handle meals and ensure adequate hydration, since the person can often forget to eat or drink? How do they assess unexpressed pain—if the Alzheimer’s resident has pain but cannot communicate it?
  • Staff training – What training for Alzheimer’s care do they have? Does the facility provide staff with monthly in-service training on Alzheimer’s care?
  • Activities – Is there an activity plan for each resident based on the person’s interests and remaining cognitive strengths? Are residents escorted outside on a daily basis? Are regular outings planned for residents?
  • Services – Does the unit provide hospice services? What were the findings in the most recent state survey?

What to Expect During a Transition

Moving is a big adjustment both for the person with Alzheimer’s and you as their caregiver. Your loved one is moving to a new home with new faces. You are adjusting from being the person providing hands-on care to being an advocate. Remember to give yourself and the Alzheimer’s patient time to adjust. If you’re expecting to move, try to have essentials packed and ready to go, and as many administrative details taken care of as possible, as sometimes beds can come up quickly. Work closely with staff regarding your loved one’s needs and preferences. An extra familiar face during moving day, such as another relative or close friend, can also help.

Each person adjusts differently to this transition. Depending on your loved one’s needs, you may either need to visit more frequently or give your loved one their own space to adjust. As the adjustment period eases, you can settle into the visiting pattern that is best for both of you.

More Help for Dementia and Alzheimer’s Caregivers

Alzheimer’s Disease and Dementia Help Center: Educate yourself about Alzheimer’s disease and dementia and make important decisions early to help you feel more in control.

Dementia and Alzheimer’s Caregivers Help

Self-help to Reduce Stress and Prevent Burnout

Resources and References

Finding Long-term Care for Alzheimer’s Patients

  • CareFinder by the Alzheimer’s Association provides information about different care options in the U.S., tips on communicating with providers, financial issues, and searching for care. Or call the 24/7 Helpline: 1-800-272-3900.
  • Eldercare Locator by the US Administration on Aging provides a search for a variety of older adult services across the U.S., or call 1-800-677-1116.
  • In the UK, the Alzheimer’s Society provides information on care services, or call 020 7423 3500.
  • In Canada, the Alzheimer Society offers information on care options, or call 1-800-616-8816.
  • For other countries, visit Alzheimer’s Disease International for a directory of worldwide Alzheimer’s associations.

Legal Issues – Defines some key issues in planning for care, including how to designate people to make healthcare and or financial decisions when the person with Alzheimer’s is no longer able. Provides further detailed resources and how to find elder law advice. (Alzheimer’s Association)

Money Matters – Detailed PDF booklet outlining financial considerations, from managing and handling bills to health insurance, government benefits and care coverage, and how to get them in order. (Alzheimer’s Association)

Legal and financial planning – Tailored towards those with Alzheimer’s, provides good general overviews of planning ahead for legal and financial issues, including powers of attorney, estate planning, trusts, and finding an elder law attorney. (Fisher Center for Alzheimer’s Research Foundation)

National Association of Geriatric Care Managers – Describes what a geriatric care manager is, qualifications and credentials, questions to ask, and how to find one. (NAPGCM)

General Garegiving Strategies

Tips for Caregivers: Caring for a person with Alzheimers disease – Quick tips on a variety of caregiving issues, from handling meals to communication. (Wisconsin Alzheimer’s Institute)

Living with and caring for a person with dementia – Links to brief articles for many issues of care at home: maintaining dignity, establishing routines, supporting independence, avoiding confrontation, memory aids and more. (Alzheimer’s Disease International)

Caring for Someone with Alzheimer’s: Home Care – Tips for patient care including helping with daily activities and personal care. This includes several short explanatory video clips. (National Institute on Aging)

Caring for someone with dementia: Understanding and respecting the person with dementia – Helping the patient to feel respected and valued, with tips on how to make the person feel good about themselves. (Alzheimer’s Society of the U.K.)

The Dartmouth Memory Handbook – Digital copy of the 4th Edition edited by Robert B. Santulli, M.D. Includes chapters on dementia and Alzheimer’s care and selecting a nursing home. (Caldwell Law)

Therapeutic Techniques used in Alzheimer’s Caregiving

Music, Art, and Other Therapies – Gives tips on how to use music, art, and pets as therapy. (Alzheimer’s Association)

Communication Tips

Caring for someone with dementia: Communication – Discusses both sides of the communication with the person who has dementia: the patient’s and the caregiver’s. (Alzheimer’s Society of the UK)

Guidelines for Better Communication – Offers sensible suggestions for how to communicate better with a person who has Alzheimer’s. (Family Caregiver Alliance)

Long Term Care for Alzheimer’s

CareFinder – Provides information about different care options, tips on communicating with providers, financial issues and searching for care. (Alzheimer’s Association)

Residential Care Options – Discusses all aspects of moving to residential care, including deciding if it is right for your loved one, evaluating facilities, and easing the transition for both you and your loved one. (Alzheimer’s Association)

Alzheimer’s: Consider options for long term care – A brief overview of the different types of care options. (Mayo Clinic)

Moving to a Facility – Tips on making the adjustment, including helping the staff to get to know the person, easing the transition, and getting through the adjustment phase. (Alzheimer’s Association)

Citation

Authors: Doug Russell, L.C.S.W., Tina de Benedictis, Ph.D., and Joanna Saisan, M.S.W. Last updated: August 2015.http://www.helpguide.org/articles/alzheimers-dementia/dementia-and-alzheimers-care.htm

©Helpguide.org. All rights reserved.

 

Smoking Accelerates Brain Ageing, Research Shows

(Age UK) But giving up could help repair and recover damage to the brain, recent research suggests.

Giving up smoking – even in later life – could help reverse the harmful effects it has on the brain, according to recent research from the Disconnected Mind study at University of Edinburgh, funded by Age UK.

In the latest, largest study of its kind, scientists have found that smoking appears to accelerate the thinning of the outer layer of the brain (cortex), seen in normal brain ageing. This can jeopardise important thinking skills such as planning, decision-making and problem-solving.

The good news is those participants in the study who had given up smoking appeared to have a thicker cortex than more recent quitters, suggesting some degree of recovery. However the authors are keen to underline that more research is needed to confirm these results with larger numbers of current smokers, studied over long periods of time

The study’s authors suggest that avoiding smoking helps maintain the normal thickness of the cortex, protecting against age-related cognitive decline. The research adds yet more weight to existing evidence showing a strong connection between smoking, brain decline and an increased risk of dementia.

Age UK is highlighting the research ahead of its annual Later Life Conference on Wednesday 18 November, which will focus on brain ageing and dementia. It will showcase exciting and innovative new approaches in the prevention and treatment of age-related cognitive impairment, joined by some of the leading thinkers, policy makers and service providers working in the field.

To reflect Age UK’s increasing focus on protecting and improving brain health, the Charity, in partnership with AARP – the leading US not-for-profit organisation for people aged 50+ – has recently convened the Global Council on Brain Health (GCBH). This is an independent collaborative of scientists, doctors, scholars and policy experts who will be developing and communicating trusted information on the actions people can take to support their brain health. It will examine key priority issue areas to improve brain health such as physical exercise, mental engagement, stress levels, and medications and supplements4.

Professor James Goodwin, Head of Research at Age UK, said: “We all know smoking is bad for our lungs and heart, but it’s important we also understand just how bad it is for our brain. This study shows how smoking speeds up the decline of the important thinking skills we rely on – in a sense accelerating brain ageing – in addition to increasing the risk of dementia and many other illnesses.

“While avoiding smoking is the best way to reduce the risk of brain decline, dementia and other cognitive diseases, this study gives new hope that quitting smoking, even in mid-life, can bring important benefits to the brain, as well as the rest of the body.

“With research suggesting that older people’s fear of developing dementia outweighs that of cancer, it is important we inform people about the simple steps they can take to safeguard against this horrible and distressing disease.

Brain decline is not an inevitable part of ageing, it is something we can protect ourselves against by making changes to our lifestyle – with avoiding smoking being one of them.”

Professor Ian Deary, Director of the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh, who led the research project, said:

“It is important to know what is associated with brain health in older age and our study shows that the rate of smoking-related thinning to the brain is approximately twice the rate observed in previous, smaller studies. However, at the same time, our study also suggests that stopping smoking might allow the brain’s cortex to recover some of its thickness, though we need to conduct further studies to test this.”

Citation

http://www.ageuk.org.uk/latest-press/smoking-accelerates-brain-ageing/

© Age UK Group and/or its National Partners (Age NI, Age Scotland and Age Cymru) 2015. All Rights Reserved

 

Experimental Drug Targeting Alzheimer’s Disease Shows Anti-aging Effects

(Salk Institute for Biological Studies) Salk team finds molecule that slows the clock on key aspects of aging in animals.

Salk Institute researchers have found that an experimental drug candidate aimed at combating Alzheimer’s disease has a host of unexpected anti-aging effects in animals.

The Salk team expanded upon their previous development of a drug candidate, called J147, which takes a different tack by targeting Alzheimer’s major risk factor–old age. In the new work, the team showed that the drug candidate worked well in a mouse model of aging not typically used in Alzheimer’s research. When these mice were treated with J147, they had better memory and cognition, healthier blood vessels in the brain and other improved physiological features, as detailed November 12, 2015 in the journal Aging.

“Initially, the impetus was to test this drug in a novel animal model that was more similar to 99 percent of Alzheimer’s cases,” says Antonio Currais, the lead author and a member of Professor David Schubert’s Cellular Neurobiology Laboratory at Salk.

“We did not predict we’d see this sort of anti-aging effect, but J147 made old mice look like they were young, based upon a number of physiological parameters.”

Alzheimer’s disease is a progressive brain disorder, recently ranked as the third leading cause of death in the United States and affecting more than five million Americans. It is also the most common cause of dementia in older adults, according to the National Institutes of Health. While most drugs developed in the past 20 years target the amyloid plaque deposits in the brain (which are a hallmark of the disease), few have proven effective in the clinic.

“While most drugs developed in the past 20 years target the amyloid plaque deposits in the brain (which are a hallmark of the disease), none have proven effective in the clinic,” says Schubert, senior author of the study.

Several years ago, Schubert and his colleagues began to approach the treatment of the disease from a new angle. Rather than target amyloid, the lab decided to zero in on the major risk factor for the disease–old age. Using cell-based screens against old age-associated brain toxicities, they synthesized J147.

Previously, the team found that J147 could prevent and even reverse memory loss and Alzheimer’s pathology in mice that have a version of the inherited form of Alzheimer’s, the most commonly used mouse model. However, this form of the disease comprises only about 1 percent of Alzheimer’s cases. For everyone else, old age is the primary risk factor, says Schubert. The team wanted to explore the effects of the drug candidate on a breed of mice that age rapidly and experience a version of dementia that more closely resembles the age-related human disorder.

In this latest work, the researchers used a comprehensive set of assays to measure the expression of all genes in the brain, as well as over 500 small molecules involved with metabolism in the brains and blood of three groups of the rapidly aging mice. The three groups of rapidly aging mice included one set that was young, one set that was old and one set that was old but fed J147 as they aged.

The old mice that received J147 performed better on memory and other tests for cognition and also displayed more robust motor movements. The mice treated with J147 also had fewer pathological signs of Alzheimer’s in their brains. Importantly, because of the large amount of data collected on the three groups of mice, it was possible to demonstrate that many aspects of gene expression and metabolism in the old mice fed J147 were very similar to those of young animals. These included markers for increased energy metabolism, reduced brain inflammation and reduced levels of oxidized fatty acids in the brain.

Another notable effect was that J147 prevented the leakage of blood from the microvessels in the brains of old mice.

“Damaged blood vessels are a common feature of aging in general, and in Alzheimer’s, it is frequently much worse,” says Currais.

Currais and Schubert note that while these studies represent a new and exciting approach to Alzheimer’s drug discovery and animal testing in the context of aging, the only way to demonstrate the clinical relevance of the work is to move J147 into human clinical trials for Alzheimer’s disease.

“If proven safe and effective for Alzheimer’s, the apparent anti-aging effect of J147 would be a welcome benefit,” adds Schubert. The team aims to begin human trials next year.

Other authors on the paper include Oswald Quehenberger of the University of California, San Diego; and Joshua Goldberg, Catherine Farrokhi, Max Chang, Marguerite Prior, Richard Dargusch, Daniel Daugherty and Pamela Maher of the Salk Institute.

This study was supported by the Salk Institute Pioneer Fund Postdoctoral Scholar Award and the Salk Nomis Fellowship Award, fellowships from the Hewitt Foundation and Bundy Foundation, and grants from the Burns Foundation and NIH.

Salk has an issued patent on J147 licensed to Abrexa Pharmaceuticals.

Citation

http://www.salk.edu/news-release/experimental-drug-targeting-alzheimers-disease-shows-anti-aging-effects/

Copyright 2015 Salk Institute for Biological Studies