Archives for December 2015

Deaths in the United States Among Persons with Alzheimer’s Disease (2010-2050)

Alzheimers Dement. 2014 Mar;10(2):e40-6. doi: 10.1016/j.jalz.2014.01.004.

Deaths in the United States among persons with Alzheimer’s disease (2010-2050).

Weuve J1, Hebert LE2, Scherr PA2, Evans DA2.



Alzheimer’s disease (AD) profoundly affects the end-of-life experience. Yet, counts of deaths attributable to AD understate this burden of AD in the population. Therefore, we estimated the annual number of deaths in the United States among older adults with AD from 2010 to 2050.


We calculated probabilities of AD incidence and mortality from a longitudinal population-based study of 10,802 participants. From this population, 1913 previously disease-free individuals, selected via stratified random sampling, underwent 2577 detailed clinical evaluations. Over the course of follow-up, 990 participants died. We computed age-, sex-, race-, and education-specific AD incidences and education-adjusted AD mortality proportions specific to age, sex, and race group. We then combined these probabilities with US-wide census, education, and mortality data.


In 2010, approximately 600,000 deaths occurred among individuals aged 65 years or older with AD, comprising 32% of all older adult deaths. By 2050, this number is projected to be 1.6 million, 43% of all older adult deaths.


Individuals with AD comprise a substantial number of older adult deaths in the United States, a number expected to rise considerably in coming decades.


Copyright © 2014 The Alzheimer’s Association. Published by Elsevier Inc. All rights reserved.


Cancer Drug Shows Promise in Parkinson’s Dementia

(MedScape) The tyrosine kinase inhibitor nilotinib (Tasigna, Novartis), approved in the United States for acute myelogenous leukemia (CML), has shown early promise in patients with Parkinson’s disease (PD) with dementia (PDD) and Lewy body dementia (LBD).

In an open-label phase 1 study, nilotinib, given at doses considerably lower than that used for CML, led to statistically significant changes in relevant biomarkers of neurodegeneration in cerebrospinal fluid.

The drug also produced marked improvement in cognition and motor function in 11 of 12 patients who completed the 6-month study, with 10 patients reporting meaningful clinical improvements, the researchers say.

Fernando Pagan, MD, associate professor of neurology at Georgetown University Medical Center (GUMC), and director of the Movement Disorders Program at MedStar Georgetown University Hospital, Washington, DC, presented the findings at the Society for Neuroscience (SfN) 2015 Annual Meeting.

“To my knowledge, this study represents the first time a therapy appears to reverse — to a greater or lesser degree depending on stage of disease — cognitive and motor decline in patients with these neurodegenerative disorders,” Dr Pagan said in a statement from the university.

“But it is critical to conduct larger and more comprehensive studies before determining the drug’s true impact,” he cautioned.

Novel Findings

The 12 patients had advanced PD, PDD, and LBD and no prolonged corrected QT interval, myelosuppression, or other medical conditions. They were treated with nilotinib starting at 150 mg/day and increasing to 300 mg/day over 6 months. (In patients with CML, nilotinib is given at a dose of 800 to 1200 mg/day).

Some patients saw dramatic improvement in symptoms; one individual who had to use a wheelchair was able to walk again, and three others who could not talk were able to hold conversations. Those with earlier-stage disease responded best, as did those diagnosed with LBD, the researchers say.

Treatment with nilotinib also led to significant declines in several cerebrospinal fluid (CSF) biomarkers of neurodegeneration, including tau, pTau, α-synuclein, and amyloid β, suggesting “clearance of toxic proteins in the brain,” Dr Pagan said. Nilotinib also increased CSF concentrations of several neurorestorative biomarkers.

“We are very pleased with the safety profile in this patient population, and it’s really exciting to see a disease-modifying effect,” Charbel Moussa, MD, PhD, who directs the GUMC Laboratory of Dementia and Parkinsonism, noted in an interview with Medscape Medical News.

“Nilotinib gets into the brain, has direct target engagement in the brain, and triggers autophagy, and that leads to degradation of intracellular proteins that we think are the main culprits in neurodegeneration, but also β-amyloid plaque, which is extracellular,” said Dr Moussa, who did the preclinical work that led to the phase 1 clinical study.

Nilotinib had good penetration in the CSF — 0.5% to 1.5% — which is higher than the penetration seen with dopamine drugs, the researchers note.

And “strikingly,” Dr Moussa said, “we see an increase in the neurotransmitter dopamine” during nilotinib treatment such that doses of L-dopa and other dopamine-sparing drugs had to be lowered or stopped.

However, stopping nilotinib led to cognitive and motor decline despite restarting L-dopa therapies. Patients in the study can continue taking nilotinib provided by Novartis as part of an expanded-access study.

Interpret Cautiously

The researchers urge caution in interpreting the phase 1 results because the study was designed to test safety, not efficacy, and lacked a control group. Also, nilotinib was not compared with a placebo or other medications used to treat PD in the study.

Constantino Iadecola, MD, director, Brain and Mind Research Institute at Weill Cornell Medical College in New York City, also urged caution in interpreting the results from this early study.

It’s “exciting” data, but from a “nonrandomized, nonblinded, non–placebo-controlled study that looked at 12 patients,” he noted in an interview with Medscape Medical News.

“The patients were selected very carefully, and we don’t know all the criteria for selection. More quantitative assessment of the data is needed. I would encourage the media not to blow it up out of proportion.”

The cost also has to be considered, as low-dose nilotinib would likely have to be taken daily and continuously for continued benefit in PD. “In Manhattan, a 150-mg pill is $93 per pill, which means $100 a day essentially. It’s not like in cancer, where you take it for a period of time and then stop,” Dr Iadecola noted.

Dr Moussa and colleagues are now planning a double-blind, placebo-controlled phase 2 clinical trial testing nilotinib in patients with PD and other neurodegenerative diseases, including Alzheimer’s disease. The study is likely to begin in 2016, he said.

The phase 1 study received philanthropic funding and was supported by the Georgetown-Howard Universities Center for Clinical and Translational Science. Dr Moussa is an inventor on a Georgetown University patent application for use of nilotinib and other tyrosine kinase inhibitors for the treatment of neurodegenerative disease. Dr Pagan has disclosed no relevant financial relationships.

Society for Neuroscience (SfN) 2015 Annual Meeting. Abstract 12.01. Presented October 18, 2015.


By Megan Brooks

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Alzheimer’s Disease: Potential Causes of Behavioral Symptoms

(Alzheimer’s Foundation of America) While the underlying cause of the behavioral symptoms of Alzheimer’s disease and related dementias is the illness itself—changes in the brain due to the death of brain cells, there are multiple other factors that may trigger the various behaviors and emotions that can unfold during the progression of the disease. Understanding the cause and effect can help family and professional caregivers better manage situations that may arise.

Reaction to Loss

We all rely on input from our environment to guide us in activities and relationships. An individual with dementia has lost both the benefit of such input and the ability to inform us of their internal world. This absence causes fear, insecurity and frustration, which may present in the form of aggression and agitated behavior.

Some Suggestions:

  • Provide reassurance.
  • Speak in a calm voice.
  • Promote a sense of security and comfort.

Inability to Meet Basic Needs

As a result of cognitive impairment and psychiatric symptoms, a person’s basic needs might not be met. The resulting hunger, dehydration, elimination problems and fatigue can produce behavioral changes. Individuals with dementia may stay hungry because of, for example, their inability to feed themselves, depression or loss of muscle coordination. They may show their discomfort through agitated and aggressive behavior.

Likewise, they may forget how to pour water into a cup or never ask for a drink due to their inability to communicate. Dehydration can lead to urinary tract infection, constipation and fever—putting individuals at a high risk for delirium and consequently more behavioral problems.

Similarly, individuals may forget where or what the bathroom is, and eventually may not recognize the internal cues for urination or a bowel movement. Elimination problems may prompt agitation, aggression,wandering, pacing, and incontinence. Compounding this, they may develop urinary tract infections or constipation which, left untreated, could result in delirium.

Lastly, people with dementia may get tired easily because of wandering, pacing and disruption of the sleep-wake cycle. Fatigue often leads to irritability and aggression.

Some Suggestions:

  • Offer verbal and physical assistance during meals.
  • Serve foods that the individual likes.
  • Provide adequate snacks and supplements.
  • Prevent distraction during meals by rearranging the environment
  • Serve pre-cut or finger food if using utensils becomes difficult.
  • Consult with a healthcare professional about swallowing problems.
  • Schedule fluid intake to ensure six to eight glasses of liquid per day.
  • Avoid coffee, tea beverages with caffeine that act as diuretics.
  • Establish a routine for using the toilet, such as assisting them to the bathroom every two hours.
  • A commode, obtained at any medical supply store, can be left in the bedroom at night for easy access.
  • Put up signs (with illustrations) to indicate the bathroom door.
  • Use easy-to-remove clothing, such as those with elastic waistbands.
  • Try soothing music or a massage to induce sleep.
  • Reduce environmental stimuli.
  • Encourage short periods of napping to prevent exhaustion.

Co-Existing Medical Problems

Pain and discomfort from a medical problem (i.e., dental pain, urinary tract infection) or medication side effects can go unnoticed because of the individual’s inability to report it due to poor memory and/or loss of verbal skills. In addition, caregivers may have difficulty gauging the individual’s pain because the person does not respond to questions. As a result, these individuals may not receive necessary medication or treatment. Those who are in pain and discomfort tend to exhibit verbal and physical aggression, restlessness, wandering and pacing.

Some Suggestions:

  • Become familiar with the person’s medical history.
  • Assess their non-verbal behavior to help identify the cause of distress.
  • Watch for signs of urinary tract infection and other medical conditions.
  • Monitor medications for side effects.

Co-Existing Psychiatric Disorders

Individuals with a previous diagnosis of psychiatric disorders, such as schizophrenia, depression or mania, and those with mental retardation are likely to exhibit more behavioral problems when they develop dementia than other individuals without psychiatric illnesses. Those with hallucinations or delusions and who are depressed or manic tend to exhibit more aggressive and agitated behavior.

Some Suggestions:

  • Consult with your physician about available medications, such as anti-depressants, anti-psychotics and other mood stabilizers, to control severe symptoms, if appropriate. Also discuss non-drug interventions, like behavioral modifications and environmental changes.
  • Provide reassurance.
  • Distract and redirect with other activities.

Environmental Factors

Excessive noise, poor or glaring lighting and cold temperature in the home or a long-term care facility, and overcrowding in a group setting can increase agitation, screaming and aggressive behavior. Any change in the environment or routines, such as bathing and eating, can cause frustration and agitation. As well, boredom that results from lack of activities, and conflicts among residents in a group setting can manifest in behavioral changes.

Some Suggestions:

  • Reduce excess stimuli, such as the TV or radio.
  • Elevate the room temperature.
  • Ensure adequate lighting.
  • Carefully and gradually introduce changes in routine or the environment.
  • Provide activities that are simple and creative.
  • In a group setting, staff should anticipate the characteristics of each resident and adjust the environment accordingly.

Sensory Impairment

Individuals with hearing or visual impairments tend to be more paranoid, hallucinate more, and feel more frightened and frustrated. For example, those with poor eyesight may not eat their food or they may be at risk for falls.

Some Suggestions:

  • Assess vision and hearing.
  • Ensure that individuals who wear glasses or hearing aids have them in place.
  • Evaluate problems such as cataracts, glaucoma or other eye diseases, and correct them with surgery, if feasible, or by creative environmental changes.

Factors Related to the Caregiver

A caregiver’s attitude and knowledge of dementia affect the care of individuals with the disease.  Individuals usually respond to a caregiver’s mood and cues accordingly.

Some Suggestions:

  • Become educated about the disease.
  • Stick to routines.
  • Learn effective communication techniques and how to cope with specific behavioral challenges.
  • Use a calm tone of voice combined with gentle touch to convey reassurance.
  • Validate the person’s feelings.
  • Speak slowly and simply.
  • Distract and redirect to positive activities.
  • Be patient and kind.
  • Remember that behavior problems result from the disease. Do not take things that the person says and does personally; it is the disease speaking.
  • Recall fond memories from the past, including ways in which your loved one cared for and supported you in the past.  This will increase your ability to be patient and understanding in difficult situations.
  • Reach out to friends and family for support, educate them about Alzheimer’s disease, and consider sharing with them the specific symptoms that your loved one is experiencing.  This way, they will be better able to both support you and interact positively with your loved one.
  • Acknowledge your own feelings, possibly sadness, anger or frustration, and consider joining a caregiver support group or attending individual counseling.
  • Remember to practice good self-care—physically and mentally.  Try to eat nutritious meals, get a good night’s sleep, exercise regularly, and make time for your own interests and friendships.  The better you take care of yourself, the better you can care for your loved one.

©2015 Alzheimer’s Foundation of America. All rights reserved.


Alzheimer’s Disease: Are We Close to Finding a Cure?

(MedicalNewsToday) First described in 1906 by Dr. Alois Alzheimer, Alzheimer’s disease is the most common form of dementia, accounting for around 60-80% of cases. It is characterized by problems with memory, thinking and behavior.

Onset is most common in individuals aged 65 and over, although people in their 40s and 50s can develop what is classed as early-onset Alzheimer’s.

Alzheimer’s is a progressive disease, meaning memory loss is mild in the beginning, but it worsens over time to the extent that individuals are unable to have conversations or respond to their surroundings.

There are treatments that have been approved by the US Food and Drug Administration (FDA) for Alzheimer’s. For example, cholinesterase inhibitors and memantine can help treat memory and thinking problems. But these drugs just help manage the symptoms; there is currently no cure for the disease.

In the US, around 5 million people aged 65 and over are living with Alzheimer’s, the majority of whom are women. This number is expected to almost triple to 16 million by 2050. Figures are similar worldwide; by 2050, more than 115 million people are expected to have the disease.

Current Alzheimer’s prevalence in the US makes it the 6th leading cause of death, killing more than half a million seniors every year. To put this in perspective, Alzheimer’s disease currently kills more people each year than prostate cancer and breast cancer combined.

Heather Snyder, PhD, director of medical and scientific operations at the Alzheimer’s Association, stated an interesting fact when talking to Medical News Today:

“As the 6th leading cause of death, Alzheimer’s disease is the only cause of death in the top 10 that we currently do not have a way to prevent, or to stop or slow its progression.”

This is certainly not through lack of trying. In the last month alone, we have reported how scientists restored memory and learning deficits in Alzheimer’s mouse models, how vitamin D deficiency could increase the risk of developing dementia, and how DNA methylation in the brain is linked to Alzheimer’s.

But what have these studies taught researchers about Alzheimer’s so far?

Preventing and Targeting Plaques and Tangles

As with all diseases, knowing exactly what causes Alzheimer’s is key to identifying ways to prevent and treat the condition.

Past research has indicated that Alzheimer’s occurs when two abnormal brain structures – plaques and tangles – damage and kill nerve cells, causing the memory, thinking and behavioral problems associated with the disease.

Plaques are fragments of a protein called beta-amyloid, which build up in areas between nerve cells. Tangles are twisted fibers of a protein called tau, which accumulate inside brain cells.

alzheimers amyloid plaques

Past research has indicated that Alzheimer’s occurs when two abnormal brain structures – plaques and tangles – damage and kill nerve cells.

Although the jury is still out on the exact roles plaques and tangles play in the development of Alzheimer’s, studies have suggested that build up of these proteins begins long before symptoms develop.

“Evidence suggests that the process of Alzheimer’s disease begins more than a decade before clinical symptoms appear, suggesting we may need to intervene earlier to have a major impact on the course of the disease, particularly when using therapies designed to prevent the development of abnormal protein structures – plaques and tangles – that are abundant in the brains of people with Alzheimer’s,” says Snyder.

Other research has suggested that targeting these abnormal structures could treat Alzheimer’s. Earlier this year, Medical News Today reported on a study by researchers from the University of California-Irvine, suggesting that increasing brain cell connections could reduce plaque accumulation.

“If amyloid accumulation is the driving cause of Alzheimer’s disease, then therapies that either decrease amyloid-beta production or increase its degradation could be beneficial, especially if they are started early enough,” says the first author of this study, Mathew Blurton-Jones.

Some studies claim that lifestyle factors may be a driver of plaques and tangles typical of Alzheimer’s. Research from Temple University in Philadelphia, PA, for example, suggests that chronic sleep deprivation may cause these abnormal brain structures. Another study suggests regular caffeine consumption could halt development of tangles, while research from the Icahn School of Medicine at Mount Sinai in New York, NY, claims eating grilled meat can increase the development of plaques.

Alzheimer’s and Genes

More recently, researchers have found evidence that genes play an important role in the development of Alzheimer’s.

Studies have shown that the majority of early onset Alzheimer’s cases are inherited – a form of the condition known as familial Alzheimer’s disease (FAD).

FAD can be caused by one of an array of gene mutations found on chromosomes 21, 14 and 1. Researchers have found that these gene mutations can lead to the development of abnormal proteins in the brain. For example, mutations on chromosome 21 can cause formation of abnormal amyloid precursor protein (APP).

According to the National Institute on Aging (NIA), such findings so far have helped researchers better understand how brain abnormalities form in early-onset Alzheimer’s. They have also led to the development of imaging tests that can show how abnormal proteins build up in the living brain.

When it comes to late-onset Alzheimer’s, studies have associated a gene called apolipoprotein E (APOE) to its development. One form of the gene in particular – APOE E4 – has been linked to an increased risk of the disease. Most recently, a study reported by Medical News Today claims that women with a variant of this gene are more likely to develop Alzheimer’s than men.

Last year, a study published in Nature Genetics revealed the discovery of 11 genes that may increase a person’s risk of Alzheimer’s, while another study found a variation in the ABCA7 gene that may increase the risk of Alzheimer’s in African-Americans.

Exactly how these genes increase Alzheimer’s risk is not yet understood. But every gene that is linked to Alzheimer’s can increase researchers’ understanding of how the disease develops, therefore raising the likelihood of finding ways to prevent and treat the condition.

Research Progress Provides ‘Reasons to be Hopeful’

It seems there is more focus on Alzheimer’s research than ever before, and a great deal of progress has been made as a result.

The last 20 years alone have seen the discovery of the role beta-amyloid and tau proteins play in Alzheimer’s, FDA approval of the first Alzheimer’s drug for memory and thinking symptoms, the first Alzheimer’s mouse model and the first potential blood test for Alzheimer’s.

As a result of Alzheimer’s research, there are an array of drugs in development that scientists believe have great potential to effectively treat the disease.

“Many researchers believe successful treatment will eventually involve a ‘cocktail’ of medications aimed at several targets, similar to current state-of-the-art treatments for many cancers and AIDS,” says Snyder.

Talking to Medical News Today, Dr. Laurie Ryan, of the Division of Neuroscience at the NIA, said that there are “reasons to be hopeful” when it comes to finding effective treatments for Alzheimer’s.

“Advances in imaging now allow us to ‘see’ Alzheimer’s pathology in the living brain, and over the past few years, genome-wide association studies have identified gene variants that appear to play a role in the disease and may be targeted for interventions,” she noted.

“We are testing a number of potentially promising interventions, from exercise, to hormones, to newly funded prevention trials.”

Lack of Research Funding and Volunteers ‘Hampers’ Progress

Although there has been good progress in the Alzheimer’s research field, organizations believe there is a lot more that needs to be done, particularly when it comes to funding.

James Pickett, head of research at the UK’s Alzheimer’s Society, told us:

“Dementia is the biggest health and social care challenge of our generation, but research into the condition has been hugely underfunded. This lack of funding has hampered progress and also restricted the number of scientists and clinicians working in the dementia field.”

He is not wrong. In the US, for example, Alzheimer’s research received $504 million in funding from the National Institutes of Health last year, while cancer received more than $5 billion. Breast cancer alone even received more funding than Alzheimer’s, at $674 million.

Snyder told Medical News Today that this lack of funding is something that needs to be overcome in order to develop new treatment and prevention strategies for Alzheimer’s.

“Other diseases have demonstrated that sustained investment in research can improve lives, reduce death rates and ultimately produce effective treatments and preventions,” she said.

“We have the tools and the talent to achieve breakthroughs in Alzheimer’s disease, but we need the resources to make this a reality.”

In addition, Snyder said a lack of volunteers for Alzheimer’s research is also a barrier to progression.

“Volunteering to participate in a research study is one of the greatest ways someone can help move Alzheimer’s research forward,” she noted.

Dr. Ryan agrees, telling us:

“With more than 150 Alzheimer’s-related clinical trials and studies actively recruiting in the US, the NIA and other research institutes face tremendous challenges in recruiting the thousands of volunteers needed. Increasing participation remains a challenge but one that must be overcome if we are to reach our goal of finding effective interventions.”

In an attempt to tackle this problem, Snyder said the Alzheimer’s Association have launched a clinical trials matching service called TrialMatch.

TrialMatch is a first-of-its-kind, confidential and free interactive tool that provides comprehensive clinical trial information and an individualized trial-matching service for people with dementia, family members and health volunteers,” she explained.

“By volunteering for clinical trials, you are playing a more active role in your own health care, while also paving the way for better treatment options for people with Alzheimer’s and other dementias.”

To volunteer for a clinical trial, please visit the Alzheimer’s Association research center.

‘We can and will solve the Alzheimer’s disease epidemic’

Alzheimer’s and health care organizations admit there there are a lot of challenges to tackle before a cure for the disease is found.

But there is certainly a great deal of confidence that one day, Alzheimer’s will be eliminated from existence.

“It is impossible to predict whether this breakthrough is round the corner, but we are definitely making progress in the right direction,” said Pickett.

“We now understand much more about the progression of Alzheimer’s disease and researchers are finding ways to identify people in the earliest stages where they have the best of developing treatments that work.”

Snyder agreed, adding:

“At the Alzheimer’s Association, we are optimistic about the future, and our urgency continues to grow. We can and will solve the Alzheimer’s disease epidemic.”

To find out more about Alzheimer’s, please visit the Alzheimer’s Association website if in the US, or the Alzheimer’s Society website if in the UK.


MediLexicon International Ltd, Bexhill-on-Sea, UK

© 2004-2015 All rights reserved.


Stress Appears to Contribute to Alzheimer’s

( Feeling stressed increases the chance of older people developing mild cognitive impairment, which can be a forerunner to Alzheimer’s, according to a report published in Alzheimer Disease & Associated Disorders.

Each year, around 470,000 Americans are diagnosed with Alzheimer’s. For many, the first sign is mild cognitive impairment – a pre-dementia condition that significantly increases the risk of developing Alzheimer’s in the following months or years.

In the current study, researchers from Albert Einstein College of Medicine and Montefiore Health System – both in New York – looked at the connection between chronic stress and amnestic mild cognitive impairment (aMCI), which is the most common type of MCI, the main feature of which is memory loss.

The team studied data collected from 507 people enrolled in the Einstein Aging Study (EAS), a community-based cohort of older adults.

Participants Tested for Range of Cognitive Issues

Since 1993, the EAS has systematically recruited 507 adults aged 70 years and over who live in Bronx County, NY.

Participants undergo annual assessments that include clinical evaluations, neuropsychological tests, psychosocial measures, medical history, assessments of daily-living activities and reports of memory issues and other cognitive complaints by participants and their relatives or carers.

In 2005, the EAS began assessing stress using the Perceived Stress Scale (PSS).

The PSS is a widely used 14-item measure of psychological stress, designed to be sensitive to chronic stress. It measures stress perceived over the previous month due to ongoing life circumstances, possible future events and other causes. PSS scores range from 0-56, with higher scores indicating greater perceived stress.

The diagnosis of aMCI was based on standardized clinical criteria, including the results of recall tests and reports of forgetfulness from the participants or from others.

All the participants were free from aMCI or dementia at their first PSS assessment. They then attended at least one follow-up evaluation each year for an average of 3.6 years.

Stress Associated with Higher Incidence of  MCI

An aMCI diagnosis was made for 71 participants during the study. The higher the stress level, the greater the participants’ risk for developing aMCI. For every 5-point increase in PSS scores, the risk of developing aMCI increased by 30%.

Participants were then divided into five groups, or quintiles, based on their PSS scores, ranging from high stress in the top quintile to low stress in the bottom one.

Participants in the highest-stress quintile were nearly 2.5 times more likely to develop aMCI than those in the remaining four quintiles combined (low stress). Participants in the high-stress group were also more likely to be female, to have a lower education level and higher levels of depression.

To confirm the role of stress in elevating the risk for aMCI, the researchers then assessed whether depression might also have contributed. Depression is associated with stress, cognitive impairment and Alzheimer’s disease.

However, depression did not appear to affect the relationship observed between stress and the onset of aMCI significantly.

Similarly, stress appeared to have no impact on cognitive status in participants who had at least one e4 allele of the APOE gene. This gene increases their risk for developing late-onset Alzheimer’s.

First author Mindy Katz says:

“Perceived stress reflects the daily hassles we all experience, as well as the way we appraise and cope with these events. Perceived stress can be altered by mindfulness-based stress reduction, cognitive-behavioral therapies and stress-reducing drugs. These interventions may postpone or even prevent an individual’s cognitive decline.”

Since stress is treatable, the results suggest that detecting and treating stress in older people might help delay or even prevent the onset of Alzheimer’s.


Written by 

Influence of perceived stress on incident amnestic mild cognitive impairment: Results from the Einstein Aging Study, Mindy Katz et al., Alzheimer Disease & Associated Disorders, published 11 December 2015, abstract

Albert Einstein College of Medicine news release, accessed 11 December 2015 via Newswise.

MediLexicon International Ltd, Bexhill-on-Sea, UK

© 2004-2015 All rights reserved. MNT is the registered trade mark of MediLexicon International Limited.


Alzheimer’s Disease and Dealing with Memory Problems

(Alzheimer’s Society) People in the early stages of dementia, as well people without a diagnosis, may have mild memory problems. These pages look at common types of memory problems, and offer information to help you understand how your memory works. There are also lots of practical suggestions for living with these difficulties.

Understanding Your Memory

Memory is a very complex function. There are several different types. You use these different types of memory when you do different things. It can help to know a little about them.

Working memory

You use this to store information for short periods. For example, working memory is needed to remember the numbers when you do a sum in your head.

Episodic memory

This is needed to recall past events – recent or distant. You use episodic memory when you remember personal experiences, such as what you had for lunch or when you attended a family gathering. These memories often include recollections of emotions and sensations.

Semantic memory

You use this to remember the meanings of words or remember facts. You also use it to remember familiar faces or objects.

You may have difficulty finding the right words when you are talking to someone if you have a problem with your semantic memory.

Prospective memory

You use this to remember about an appointment, date or event that is due to happen in the future.

If you have a problem with your prospective memory you may forget to do something at a particular time. Or you may forget that you had planned something, such as visiting a friend.

Procedural memory

This involves activities that you learn and can then do automatically without having to think. You use procedural memory to complete a sequence of actions in a particular order – such as tying shoelaces or swimming. You rely on it when you adopt new habits. This might include learning to use new memory aids.

Memory Problems

Memory problems vary with each person. What you consider to be a problem depends partly on what you need or expect to be able to do.

Some very common memory problems include:

  • forgetting people’s names
  • struggling to remember day-to-day events or experiences
  • misplacing items (eg keys, glasses) around the house
  • struggling with the steps in a recipe
  • finding it hard to follow conversations
  • forgetting appointments or important dates (eg birthdays)
  • getting lost in a familiar place or on a familiar journey.

Reacting to memory problems

Everyone reacts differently to memory problems. Many people get frustrated or worried, or lose self-confidence. This is normal.

Talk to others around you. They might suggest more helpful ways of thinking, and you may be able to work together to find solutions. Be realistic and focus on memory problems that are having a real impact on your life.

Try to focus on what you can remember and can do. You may well have a good memory of events from many years ago. You can probably still do many things you learned a while back.

Living with memory problems

There are lots of things you can do to help you live well with memory problems.

Living Well with Memory Problems

Many people find the following approaches helpful. It can help to try out different approaches and discover which ones work best for you.

Build on the many skills you still have. For example, if you’ve always been an organiser and good at planning, make the most of this when facing new challenges.

Regular routine

Set up a regular daily routine. This will make it easier to remember what will happen over the course of the day. Include time to relax as part of the routine. But keep somevariety and stimulation, or you may get bored.

One thing at a time

Focus on trying to do only one thing at a time. For example, if you’re making a cup of tea, don’t make a phone call at the same time. For a new task – like using memory strategies – repeat it and give yourself time to learn it.

Small steps

Break tasks down into smaller steps. Then you can focus on just one step at a time. For example, if you’re cooking something, follow the stages in the recipe one at a time. Ask for help from others if you think you need it.

One place for everything

Try to keep important things such as your keys, glasses and wallet in the same place. This could be a large bowl somewhere obvious and visible. Then you can always find them easily.


If your environment is noisy or very busy, you will find it harder to remember things or concentrate. Your memory works much better with no distractions.


Try to do the most challenging things early in the day, when you have most energy and can concentrate best. Avoid them if you feel tired, anxious or unwell. Take your time.


Talk to friends and family about how you feel and how you can work together. They can support you to try out new techniques to help with your memory.

 Memory Aids

People with memory problems have suggested some of the aids in this section, to help remember things. You might think of them as different tools for tackling different problems. You may have already used some of them.

Look for aids that fit with the skills you have. For example, if you have never used a mobile phone with a calendar, you may find it difficult to start using one now. Easy-to-use mobile phones – which can only be used for calls and nothing else – are widely available.

An occupational therapist can offer practical advice. For more expensive items, you might be able to ‘try before you buy’ – perhaps from a local disability living centre (see Assist UK). Whatever you use, people around you can support you to use it.

Memory Strategies

There are some strategies you can use to help you remember things. Some of these strategies involve picturing things in your mindand some use words and rhymes. People remember things in different ways. This means some strategies will work better for some people. Try them out and see which ones work best for you. This may also change over time.

If you can, try using a problem-solving approach, with several steps. These steps are illustrated here with an example.

1.  Identify the problem

Example: I sometimes forget people’s names

2.  Decide how much it matters to you

Example: It happens a lot. It can be embarrassing.

(It may be that some things matter a great deal, like forgetting a close friend’s name. But will it really matter much if you forget the name of a celebrity who you’re unlikely to meet?)

3.  Think about how you might help yourself

Example: I could carry a small photo album with people’s names next to their photos. Or I could tell people I’m a bit forgetful, ask for their name, and then repeat it in conversation.

4.  Practice your strategies and see what works for you

Example: Rehearse your strategies with a close friend or partner. They can support you to learn. You will then feel more confident when you go out.

A Healthy Lifestyle

Looking after yourself can make a huge difference to your memory. Problems can seem worse if you are stressed, worried or ill. If you can keep physically, mentally and socially active it will help you maintain memory, skills and self-confidence.

A healthy lifestyle means thinking about the points listed below.

Physical health

  • Do you get enough exercise?
  • Is your diet healthy?
  • Do you get enough rest?
  • Do you have regular check-ups (eg eyes, ears)?

Mental health

  • Do you keep your brain active with puzzles and reading?
  • Do you feel emotionally well?
  • Are you able to relax?

Social life

Everyday activities

  • Do you manage your time well so you can get everything done?
  • Do you have regular interests or hobbies to enjoy and look forward to?

Help from Others


You do not have to face memory difficulties on your own. Other people can work with you to support you to stay active and independent. They might be professionals orfriends and family. Help is available and it is alright to ask for it.

Many professionals can help you live well with memory difficulties. Ask your GP if you think you need to see one of them, especially if memory problems are affecting your daily life.

Occupational therapists can work with you to help you with daily life and personal care. They can support you to continue with hobbies and interests. An occupational therapist can give advice on memory aids and coping strategies.

Psychologists can help you with depression or anxiety and with adjustments to loss or life-changing events. Counsellors can help you come to terms with memory loss or adiagnosis of dementia. Talking to a trained professional may help you feel less stressed or unhappy.

Speech and language therapists can help you and your relatives communicate better if you are having difficulty using or understanding words. They can also help you withmemory aids and strategies that use language.

Your local Alzheimer’s Society can often help put you in touch with dementia advisers,dementia support workers, Dementia Cafésand support groups. They will all give you helpful practical advice. Find out more or by calling theNational Dementia Helpline on 0300 222 1122.

Speak to your local pharmacist if you need help to remember to take your drugs. If you have a local disability living centre (or similar) ask them for advice. You should be able to try things out and maybe even borrow some items for a while.

Structured approaches

There are some structured approaches that can help people with memory loss anddementia. Ask professionals whether you can get these in your area. Your GP, local Alzheimer’s Society staff, memory service or community mental health team can help.

In cognitive rehabilitation you set your own practical goals. You then work with a therapist (eg a psychologist or occupational therapist) individually to achieve these. You could use some of the memory strategies in this handbook.

In cognitive stimulation you do stimulating activities and exercises in a group. These include games, songs and discussing current affairs. People find this helps memory and communication.

In life story work you work with someone over time to make a personal record of important experiences, people and places in your life. This could be in a book or photo album, or on a computer. Many people find life story workenjoyable and it may help with memory problems. Any professional carers who support you will also understand you better.

In reminiscence you are encouraged to talk about a period or subject from your past, usually in a group but sometimes one-to-one.Reminiscence often includes use of general prompts such as photos, objects or music from that time. It could help your mood as well as your memory.

Other Resources

United States

Do you have questions or concerns about your loved one’s changing behavior? The Alzheimer’s Association is here to help.

Read more:


All content © 2015 Alzheimer’s Society.


Caregiver Depression: A Silent Health Crisis

(Family Caregiver Alliance) One of today’s all-too silent health crises is caregiver depression. A conservative estimate reports that 20% of family caregivers suffer from depression, twice the rate of the general population. Of clients of California’s Caregiver Resource Centers, nearly 60% show clinical signs of depression. And former caregivers may not escape the tentacles of this condition after caregiving ends.

A recent study found that 41% of former caregivers of a spouse with Alzheimer’s disease or another form of dementia experienced mild to severe depression up to three years after their spouse had died. In general, women caregivers experience depression at a higher rate than men.

Caregiving does not cause depression, nor will everyone who provides care experience the negative feelings that go with depression. But in an effort to provide the best possible care for a family member or friend, caregivers often sacrifice their own physical and emotional needs and the emotional and physical experiences involved with providing care can strain even the most capable person. The resulting feelings of anger, anxiety, sadness, isolation, exhaustion—and then guilt for having these feelings—can exact a heavy toll.

Unfortunately, feelings of depression are often seen as a sign of weakness rather than a sign that something is out of balance. Comments such as “snap out of it” or “it’s all in your head” are not helpful, and reflect a belief that mental health concerns are not real. Ignoring or denying your feelings will not make them go away.

People experience depression in different ways; the type and degree of symptoms vary by individual and can change over time. The following symptoms, if experienced for more than two consecutive weeks, may indicate depression:

  • A change in sleep patterns—too much sleep or not enough;
  • Feeling tired all the time;
  • A loss of interest in people and/or activities that once brought you pleasure;
  • Becoming easily agitated or angered;
  • Feeling that nothing you do is good enough;
  • Thoughts of death or suicide, or attempting suicide;
  • Ongoing physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain.

Early attention to symptoms of depression may help to prevent the development of a more serious depression over time.

The National Institute of Mental Health offers the following recommendations:

  • Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities, and do what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Participate in activities that may make you feel better, such as mild exercise, going to a movie or ballgame, or attending a religious, social or community event.
  • Expect your mood to improve gradually, not immediately. Feeling better takes time.
  • It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition—change jobs, get married or divorced—discuss it with others who know you well and have a more objective view of your situation.
  • People rarely “snap out of” a depression. But they can feel a little better day by day.
  • Remember, positive thinking will replace the negative thinking that is part of the depression. The negative thinking will be reduced as your depression responds to treatment.
  • Let your family and friends help you.

The most frequent treatment for depressive symptoms that have progressed beyond the mild stage is antidepressant medication such as Prozac or Zoloft, which provides relatively quick symptom relief, in conjunction with ongoing psychotherapy, which offers new strategies for a more satisfying life. A mental health professional such as a psychologist or psychiatrist can assess your condition and arrive at the treatment most appropriate for you.

Respite care relief, positive feedback from others, positive self-talk, and recreational activities are helpful in avoiding depression. Look for classes and support groups available through caregiver support organizations to help you learn or practice effective problem-solving and coping strategies needed for caregiving. For your health and the health of those around you, take some time to care for yourself.

The FCA Fact Sheet Caregiving and Depression offers a more in-depth discussion of this issue. The Fact Sheet is available in both English and Spanish on the FCA website or by sending $1 to Family Caregiver Alliance, 180 Montgomery Street, Suite 1100, San Francisco, CA 94104.

Related Health or Illness Resources


Copyright © 2015 Family Caregiver Alliance. All rights reserved.


Is It Time to Take Away The Car Keys?

( At some time you will feel concern or even fear that your parents should no longer drive an automobile.

This is one of the most important deliberations, considerations and possible actions you will probably face as the family caregiver.

A person’s age is not and should not be the reason for taking away the car keys. There are people in their 80s and 90s who hold licenses and drive actively and safely, while there are others in their 50s and 60s who are dangers to themselves and others when behind the wheel. The most driving-accident-prone Americans are those aged 15 through 19.

Physical and mental condition and ability are the first factors to consider.

Vision: Conditions such as cataracts, macular degeneration, glaucoma and diabetic retinopathy can hamper driving ability. Your parent’s optometrist or ophthalmologist can identify vision problems, limitations, concerns and cautions. It is possible that some limitation in vision can be accommodated by not driving at dusk or night. Some conditions, such as cataracts and glaucoma, can be corrected surgically. If your mom or dad wears glasses, schedule an annual eye and vision examination.

Physical ability: Driving takes dexterity, ability and strength in both arms and legs/feet to control the vehicle at all times. Consider any physical limitations. Consider, too, if he or she has shrunk a bit in physical size, where the solution may be to move the driver’s seat forward and upward for both better control and vision over the hood of the car, and/or adding a pillow.

Physical activity: Mature adult drivers die in auto accidents at a rate higher than other age bracket because, at home, many do little or no exercise, not even a daily walk outside. Therefore, if your parent currently does no physical activity to maintain or build strength, agility and aerobic ability, this should be a concern. Importantly, it is probably correctable by introducing him or her to less television time and more physical activity.

Diseases: Patients with Alzheimer’s disease can become disoriented almost anywhere, and a severe diabetic may fall into a coma. The parent’s physician can advise of such possible problems and risks. But, don’t assume that your parent has Alzheimer’s if he or she forgets momentarily the location of a wallet, purse or newspaper.

Medications: Prescription drugs are chemicals designed to produce specific and desired changes or functions within the body. But, as in the law of physics, for every action there is a reaction. That reaction may be drowsiness and/or a slowing of the person’s reaction time. In the field of medicine these are identified as side effects and may effect, even seriously, a person’s ability to drive.

A patient taking several different prescription drugs, particularly if they are prescribed by different doctors who don’t have updated knowledge of other drugs being taken, may have even more serious side effects as each of the drugs creates its own side effects plus conflict with other drugs to cause even worse reactions. The latter is identified as polypharmacy.

Your parent’s physician(s) can advise of the side effects of each drug plus the added conflicts through polypharmacy. You may also take all the prescription containers to a friendly pharmacist who can quickly do a computer-based analysis.

The American Medical Association has published a detailed report and recommendation to all of its physician members that they assist caregivers, answer their questions, and present their recommendations regarding the elder’s physical and medical conditions. The report also recommends that the physician be actively involved in counseling the patient to hang up the car keys.

Here are some hints for determining your mom or dad’s ability to drive:

Ride along: Take a ride or three with your parent and observe his or her physical ability in controlling the vehicle, staying within the lane, how turns are handled, the driving speed, ability to scan from left to right, any visual susceptibility to glare, and for any possible confusion in traffic. Do your observations simply, without nagging or distraction. Make notes upon return, for you may need to share them with an expert.

Check the vehicle: Periodically and without fanfare, check the outside of the car for any possible dents or scrapes.

Accompany your parent at least once to every medical specialist and service or treatment center and, and have him or her sign a release of confidentiality form naming you as a relative with whom they can share any and all medical and mental information without their violating federal confidentiality laws. If your relative is on Medicare, you can check the Explanation of Benefits (EOB) statements he or she receives after each medical visit or payment. This will ensure that you are aware of every one and service involved medically. These steps will guarantee that you can ask questions and express concerns privately as well as invoke professional assistance.

Research other available transportation for if and when mom or dad must quit driving. A call to the local Area Agency on Aging can learn about Dial-A-Ride, public transit, specialized transit (door-to-door service typically by minibuses) and even volunteers who provide chauffeur service. And talk to your siblings, children and other relatives to be volunteer drivers when in need.

If you determine that mom or dad is still capable of driving, suggest they enroll in a Mature Driving course. Such enrollment may even qualify your parent for a discount on auto insurance.

Here is why you should not jump to a decision or conclusion that mom or dad should no longer drive.

Taking the car keys removes the parent’s independence, the ability to drive to the market or to meet friends for coffee, to church and the senior center, the library or to visit friends. The experience can be traumatic.

As the caregiver, you may also have to deal with other relatives who may be too quickly judgmental and even emphatic that the keys must be taken.

Involve mom or dad in the consideration and decision. You may find a positive reaction when talking candidly with them, and they will understand your care and concern for their safety.

If you feel that it is time for them to hand over the keys, recognize that you may run into resistance. This is understandable. However, if that is the case, there are several ways to legally revoke your loved one’s license. You just have to find a tactful, loving way to approach this topic.


By Marlo Sollitto

©2015 AgingCare, LLC. All rights reserved.