Lynne Christensen, Author at University Health News University Health News partners with expert sources from some of America’s most respected medical schools, hospitals, and health centers. Thu, 19 May 2022 20:02:03 +0000 en-US hourly 1 Coronavirus: Don’t Run Out of Medications https://universityhealthnews.com/daily/general-health/coronavirus-dont-run-out-of-medications/ Tue, 17 Mar 2020 16:58:37 +0000 https://universityhealthnews.com/?p=130768 Take the time now to check the medications you take on a regular basis and make sure you have enough for at least two weeks longer than usual. If you or someone you live with comes down with COVID-19 you may not be able to leave your home for a few weeks. If there is […]

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Take the time now to check the medications you take on a regular basis and make sure you have enough for at least two weeks longer than usual. If you or someone you live with comes down with COVID-19 you may not be able to leave your home for a few weeks. If there is an outbreak in your community (meaning a large number of people suddenly get sick) you may need to stay at home even if you are not ill.

The novel coronavirus, which causes the disease COVID-19, has upended normal life for most Americans. The extraordinary measures being taken now by the government are meant to slow down transmission of this new virus. If we act and adhere to recommendations of the Centers for Disease Control and Prevention (CDC), most people will not be infected and become sick. In order to keep the numbers as low as possible and to protect those most vulnerable to serious health consequences and death from the virus, it’s important to take precautions.

According to the Centers for Disease Control and Prevention (CDC), older adults and people with underlying health conditions appear to be the most at risk for serious health problems with the virus. The CDC has a wealth of information on their website (https://www.cdc.gov/coronavirus/2019-ncov/index.html). In addition to avoiding unnecessary contact with other people, washing your hands often, and cleaning frequently touched surfaces every few hours, the CDC also advises keeping a two-week supply of medications, food and other essentials on hand.

Any medication you take for a chronic health condition should not be interrupted if at all possible. For many health conditions, including inflammatory forms of arthritis such as rheumatoid arthritis and psoriatic arthritis, stopping the drugs your doctor has prescribed or taking them less frequently can lead to a flare-up of symptoms.

If you are running out of medications that you take regularly, contact your doctor or pharmacist about getting more. Questions to ask your doctor include:

  • Can I get a prescription for a longer period of time, for example, three months? This often will depend on your insurance plan.
  • Are some medications more critical than others? Certain medications you take may be more essential than others. For example, it’s more critical to not interrupt a blood pressure medication than a nonsteroidal anti-inflammatory drug (NSAID).

Some pharmacies will deliver medications. If not, you can ask a young, healthy person to pick up your medications. Some pharmacies have a drive-through option. If you cannot get medications from the pharmacy, consider getting them from a mail-order pharmacy. This usually takes several weeks, however.

If you are low on medications, you may be tempted to borrow some from someone else. This is not recommended. Even if the person takes the same medication, it may be a different dose. Errors can occur.

Keep a list of all your medications in an easily accessible place, and make sure a family member or friend knows where it is. Make sure you have contact information for your doctor and pharmacist, as well as local and state public health departments. In case you are unable to reach your doctor or pharmacist or medication supplies are not available, local or state health officials should be able to help you.

Chad Deal, MD, Head of the Center for Osteoporosis and Metabolic Bone Disease at Cleveland Clinic, and Associate Editor of Arthritis Advisor, contributed to this report

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What Is Bariatric Surgery? https://universityhealthnews.com/daily/digestive-health/what-is-bariatric-surgery/ Sat, 07 Mar 2020 05:00:45 +0000 https://universityhealthnews.com/?p=131344 Bariatric surgery is an operation that shortens the digestive tract to prevent your body from absorbing all the calories you consume. Weight loss is the most obvious result—but bariatric surgery can do more than help people shed pounds.

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Bariatric surgery is an operation that shortens the digestive tract to prevent your body from absorbing all the calories you consume. Weight loss is the most obvious result—but bariatric surgery can do more than help people shed pounds. In fact, in many cases, bariatric surgery can reverse obesity-related medical conditions, such as type 2 diabetes, high blood pressure, and high cholesterol levels.

New research shows that bariatric surgery also can help combat other potentially serious health issues. For instance, one study review examined the effect of bariatric surgery on patients with nonalcoholic fatty liver disease and found that the procedure reduces deaths from all causes, as well as the diagnosis of cirrhosis. A 2017 study published in the journal Annals of Surgery found that bariatric surgery lowered overall cancer risk by one-third among severely obese people, with the greatest effect seen for obesity-associated cancers. Specifically, the risk of postmenopausal breast cancer dropped by 42 percent, endometrial cancer fell by 50 percent, colorectal cancer was reduced by 41 percent, and pancreatic cancer was lowered by 54 percent.

Bariatric surgery also may help you live longer. A 2018 study found that obese middle-aged people who have the surgery live almost twice as long over a 10-year period compared with people who receive traditional weight management treatment, such as counseling on dietary choices and behavior modification strategies.

Types of Bariatric Surgery

Several different bariatric procedures are available, and all can be done laparoscopically, through several tiny incisions. Some also can be performed endoscopically, through the mouth and throat, which means no incisions at all. Compared with open surgery, minimally invasive procedures reduce pain and recovery time afterward, allowing people to return to their normal activities more quickly.

The optimal choice of bariatric procedure for an individual is selected by consultation between the patient and surgeon. Popular choices include gastric bypass surgery, gastric banding, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch.

Who Qualifies for Bariatric Surgery?

Because bariatric procedures have a significant impact on the body, candidates must meet certain requirements to be selected for surgery. In general, candidates must:

  • Be at least 100 pounds over their ideal weight
  • Have a body mass index (BMI) of 40 or greater Have a BMI of 35 or greater, plus an obesity-related disorder
  • Have undergone an intensive diet and exercise program that failed to produce significant weight loss
  • Undergo a mental health evaluation
  • Commit to following recommended diet and lifestyle changes that will be required after surgery.

After Bariatric Surgery

The complication rate from bariatric surgery is quite low. Patients are typically hospitalized for two days, and during this time they receive instructions on diet, medications, and resuming their normal activities.

For two years after bariatric surgery, people are expected to participate in frequent follow-up visits that may include blood tests to check for nutritional deficiencies. They need to be more mindful about maintaining their bone health to lower the possibility of fractures. They also should consider participating in support groups, which have been shown to help when it comes to managing expected lifestyle changes.

The good news is that the vast majority of people who undergo bariatric surgery feel better, look better, and live healthier lives with fewer chronic diseases and medications.

To learn more about bariatric surgery and other issues affecting your gut, buy Digestive Diseases and Disorders from University Health News.

Learn more about the different types of bariatric surgery.

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How To Diagnose Alzheimer’s Disease https://universityhealthnews.com/daily/memory/how-to-diagnose-alzheimers-disease/ Sat, 01 Feb 2020 05:00:58 +0000 https://universityhealthnews.com/?p=131404 For most individuals, an Alzheimer’s diagnosis will begin with a visit to your primary care provider. Your doctor will review your personal and family medical history, ask you about any symptoms you’ve experienced, review your medications, and give you a physical exam. He or she will likely administer a simple cognitive screening test, such as […]

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For most individuals, an Alzheimer’s diagnosis will begin with a visit to your primary care provider. Your doctor will review your personal and family medical history, ask you about any symptoms you’ve experienced, review your medications, and give you a physical exam. He or she will likely administer a simple cognitive screening test, such as the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Exam (MMSE), to look for formal evidence of cognitive decline.

You also may be referred to a neuropsychologist for tests that measure aspects of brain function such as memory, attention, executive functions (such as problem-solving abilities, calculation, and abstraction), language skills, and visuo-spatial abilities. Research reinforces the importance of cognitive testing in early disease detection.

Cognitive Function Tests

General diagnostic and cognitive function tests include:

General Practitioner Assessment of Cognition (GPCOG). This brief screening assessment incorporates both short-term recall and time/date orientation with a caregiver question list to highlight recent symptoms and changes in daily functioning. This test is typically used for the cognitive assessment that is now a part of the Medicare Annual Wellness visit.

Mini-Mental State Examination (MMSE). Your doctor will ask you a series of questions, such as the names of common objects, the date, the location of your doctor’s office, or to follow an instruction). The maximum score on the MMSE is 30 points. A score of 20 to 24 suggests mild dementia, 13 to 20 suggests moderate dementia, and less than 12 indicates severe dementia.

Montreal Cognitive Assessment Test (MoCA). The MoCA is a more sensitive test than the MMSE, especially for mild cognitive impairment (MCI) and mild or early-onset AD. Like the MMSE, it takes about 10 minutes to complete, and the maximum score is 30 points. MoCA is 100 percent sensitive at detecting mild AD, and 90 percent sensitive at detecting MCI.

Mini-Cog. This test asks you to remember the names of three common objects and then repeat them a few minutes later. You’ll also be asked to draw a clock showing a time your doctor specifies.

Computerized Tests. These tests offer an advantage over paper tests in that they are standardized, so they can be administered in exactly the same way each time they’re given. The U.S. Food & Drug Administration (FDA) has approved several computerized tests. These include CANTAB Mobile, a 10-minute memory test done using a touchscreen on a computer tablet or iPad; Cognivue, a computer-based test that creates a single brain health score; ANAM, a computer-based cognitive assessment program originally developed by the military for traumatic brain injury evaluation; and COGNIGRAM, another digital assessment tool that can be used on a one-time basis or for ongoing assessment.

Care Giver or Informant Testing. The 2011 diagnostic guidelines emphasized the importance of involving an “informant,” an individual who knows the patient well and who spends enough time with them to be able to comment on changes in cognition and behavior.

Behavioral Checklist. Current diagnostic tests focus on loss of memory and other cognitive abilities. Researchers are working on a different kind of checklist that might help identify people at risk for AD based on behavioral symptoms. The Mild Behavioral Impairment Checklist (MBI-C) looks at a collection of behaviors that can precede MCI— apathy/drive/motivation; mood/affect/anxiety; impulse control/agitation/reward; social appropriateness; and thoughts/perception. For a diagnosis of MCI, the symptoms must have continued for at least six months. The creators of the checklist say that once it has been refined, the scale may serve as a guide to researchers, as well as to family members of older adults at risk for dementia.

Blood and Urine Tests. These tests can rule out conditions that cause memory loss, such as thyroid problems, kidney or liver dysfunction, and infections. Initial screening blood tests typically include thyroid stimulating hormone, vitamin B12, homocysteine, complete blood count, complete metabolic panel, erythryocyte sedimentation rate, and C-reactive protein.

Neurological Tests. Your doctor will check your coordination, strength and muscle tone, balance, eye movement, speech, and reflexes to look for other brain disorders, such as a stroke or ­Parkinson’s disease.

Brain Imaging. Your doctor may recommend brain imaging to help arrive at a diagnosis.

  • Computed tomography (CT) provides a three-dimensional view of your brain to help your doctor spot a stroke or bleeding in the brain.
  • Magnetic resonance imaging (MRI) identifies abnormalities in brain structure with sharper resolution than CT scans and can help doctors assess the structure of your brain.
  • PET scans are used to examine brain metabolism and look for areas with reduced metabolism that may be suggestive of lower brain activity. In addition, new PET tests can identify brain amyloid or tau, although these tests  may not be covered by insurance.

To learn more about conditions that affect your memory, purchase Combating Memory Loss at www.UniversityHealthNews.com.

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Alzheimer’s Warning Signs https://universityhealthnews.com/daily/memory/alzheimers-warning-signs/ Sat, 18 Jan 2020 14:00:52 +0000 https://universityhealthnews.com/?p=129367 To help recognize the warning signs of Alzheimer’s disease, and to distinguish them from normal memory lapses, the Alzheimer’s Association has developed a checklist of common symptoms, Here are three of them. Short-Term Memory Loss For most people, memory loss is the first noticeable sign of Alzheimer’s disease. Early in the course of the illness, […]

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To help recognize the warning signs of Alzheimer’s disease, and to distinguish them from normal memory lapses, the Alzheimer’s Association has developed a checklist of common symptoms, Here are three of them.

Short-Term Memory Loss

For most people, memory loss is the first noticeable sign of Alzheimer’s disease. Early in the course of the illness, a person with Alzheimer’s disease will tend to forget recent events and new information, while retaining memories of past events. Forgetting recent events may cause the person to ask the same questions repeatedly. This memory loss also causes the person to have difficulty learning new information. Eventually, the person may not remember the names or identities of family members or close friends, and long-term memory will be lost as well.

Memory is not one simple function, but a collection of several memory systems. For example, remembering how to drive a car involves a different memory system from that used to remember your wedding day, or from the one that allows you to do mental calculations.

With Alzheimer’s disease, recollection of facts and events (called “declarative” memory) tends to become impaired first, particularly with recently acquired memories. With this disruption, it’s easy to forget appointments and the content of conversations. A person with Alzheimer’s disease may ask a question, get an answer, and then ask the same question five minutes later. Often, people in the mild stage of Alzheimer’s disease will be confused about recent experiences, although they may have excellent recall of events that occurred 20 years ago. It may be easier to define vocabulary words than to supply recent autobiographical details (such as what the person did yesterday).

Memories of previously acquired skills and procedures, such as playing golf or mowing the lawn (called “procedural” memory), remain intact longer. These well-learned routines hold up for a while, and it may be possible to learn new routines that make use of the procedural memory system.

Alzheimer’s disease damages another system called “working memory.” Working memory allows you to mentally hold onto information while processing it. For example, arithmetic is performed in working memory. A person with Alzheimer’s disease may be able to remember a string of numbers for a short time, but be unable to add or subtract them. Working memory also helps us divide our attention. A person with normal memory can participate in a conversation while remembering that he has to turn off the oven in five minutes. A person with Alzheimer’s disease has increasing difficulty dividing his attention, so the oven stays on.

Trouble Finding Words

Language ability is divided into expression and comprehension. With Alzheimer’s disease, the ability to intelligibly express oneself with language tends to deteriorate faster than the ability to comprehend words and sentences. Most people with Alzheimer’s have trouble finding the right words to express what they want to say. For example, a person might want to refer to his watch but can’t remember the word “watch,” so he says, “the thing you tell time with.” A person with Alzheimer’s may also become confused and refer to her husband as her son or brother, mistaking one word for the other.

Confusion with Time and Place

Impaired orientation means that the person with Alzheimer’s becomes increasingly confused about time (date, day of the week, month, year, season) and place (residence, neighborhood).

Early on, people may become confused about the date or day of the week. Time relationships may be slightly impaired. For example, people may get ready for an appointment hours ahead of time. Also, while it may be easy enough to navigate familiar places, such as their own neighborhood, unfamiliar locations begin to present a problem.

In the moderate stage, time orientation worsens. A person in this stage may believe that he or she is living in another period of life, and may think that deceased relatives are still alive. Orientation to place also declines. People in this stage will increasingly have trouble finding their way around, even in familiar places. They may not recall where to put items, such as the dishes or towels, and will store them in inappropriate locations. It’s particularly important at this stage for people with Alzheimer’s to be supervised and to have identification in case they become lost.

To learn more about AD, purchase Alzheimer’s Disease at www.UniversityHealthNews.com.

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Resources https://universityhealthnews.com/topics/memory-topics/resources-43/ Thu, 26 Dec 2019 16:17:34 +0000 https://universityhealthnews.com/?p=128120 For additional information, contact the following organizations: Administration for Community Living www.acl.gov 202-401-4634 Aging Life Care Association www.aginglifecare.org 520-881-8008 3275 W. Ina Rd., Suite 130 Tucson, AZ 85741-2198 Alzheimer’s Association www.alz.org 800-272-3900 (24/7 helpline) 312-335-8700 225 N. Michigan Ave. Chicago, IL 60611-7633 Alzheimer’s Disease Education & Referral Center www.nia.nih.gov/alzheimers 800-438-4380 Bldg 31, Rm 5C27 31 Center Dr., MSC […]

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For additional information, contact the following organizations:

Administration for Community Living
www.acl.gov
202-401-4634

Aging Life Care Association
www.aginglifecare.org
520-881-8008
3275 W. Ina Rd., Suite 130
Tucson, AZ 85741-2198

Alzheimer’s Association
www.alz.org
800-272-3900 (24/7 helpline)
312-335-8700
225 N. Michigan Ave.
Chicago, IL 60611-7633

Alzheimer’s Disease Education & Referral Center
www.nia.nih.gov/alzheimers
800-438-4380
Bldg 31, Rm 5C27
31 Center Dr., MSC 2292
Bethesda, MD 20892

Alzheimer’s Foundation  of America
www.alzfdn.org
866-232-8484
322 Eighth Ave., 16th Fl
New York, NY 10001

American Federation  for Aging Research
www.afar.org
888-582-2327 or 212-703-9977
55 W. 39th St., 16th Fl
New York, NY 10018

American Healthcare Association
www.ahcancal.org
202-842-4444
1201 L St. NW
Washington, DC 20005

Care2Caregivers
www.care2caregivers.com
800-424-2494
151 Centennial Ave.
Piscataway, NJ 08854

Caringkind
www.caringkindnyc.org
646-744-2900
360 Lexington Ave., 3rd Fl
New York, NY 10017

Caregiver Action Network
www.caregiveraction.org
202-454-3970
1150 Connecticut Ave., NW, Suite 501
Washington, DC 20036

Center for Applied Research in Dementia
www.cen4ard.com
330-631-9949
34194 Aurora Rd., #182
Solon, OH 44139

Eldercare Locator
www.eldercare.acl.gov
800-677-1116

ElderLawAnswers
www.ElderLawAnswers.com
866-267-0947
150 Chestnut St., 4th Fl, Box #15
Providence, RI 02903

National Association of Area Agencies
www.n4a.org
202-872-0888
1100 New Jersey Ave., SE, Suite 350
Washington D.C., 20003

National Association for Home Care & Hospice
www.nahc.org
202-547-7424
228 Seventh St., SE
Washington, DC 20003

National Hospice  & Palliative Care Organization
www.nhpco.org
703-837-1500
1731 King St.
Alexandria, VA 22314

National Institutes of Health
www.alzheimers.gov

Senior Center Directory
www.seniorcenterdirectory.com

U.S. Department of Veterans Affairs
www.va.gov
844-698-2311

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11. Ongoing Research https://universityhealthnews.com/topics/memory-topics/11-ongoing-research/ Thu, 26 Dec 2019 16:17:06 +0000 https://universityhealthnews.com/?p=128113 Scientists are looking for ways to stop the chain of events that underlie the destructive process of Alzheimer’s. The goal is to halt or slow the development of the disease. Many potential therapies have been created and tested. So far, none have panned out as hoped. News about failed drug studies can be disheartening. And […]

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Scientists are looking for ways to stop the chain of events that underlie the destructive process of Alzheimer’s. The goal is to halt or slow the development of the disease. Many potential therapies have been created and tested. So far, none have panned out as hoped.

News about failed drug studies can be disheartening. And it may feel as though no progress is being made. But research in Alzheimer’s disease is quite robust. Researchers are building on knowledge accumulated over the past several decades, and new approaches to treatment are being explored.

The biological changes in the brain may begin 15 to 20 years before diminished memory and other mental dysfunction are noticeable. Therefore, research on detecting the earliest changes in the brains of people with Alzheimer’s disease goes hand in hand with research on ways to treat it.

New tests are being created that detect the earlier changes (see Chapter 6). The large, ongoing Alzheimer’s Disease Neuroimaging Initiative (ADNI) is studying how changes in cognition, brain structure, and biomarkers correlate with the development of Alzheimer’s disease. The study continues to seek volunteers to join the study, including people with no memory problems and those with MCI or early Alzheimer’s dementia (www.adni3.org).

The failure of some experimental drugs to produce a dramatic improvement points to the likelihood that no single therapy will do the trick. The multifaceted nature of Alzheimer’s disease, and the fact that many people with the disease also have other causes of dementia, mean that a combination of treatments will most likely be required.

Fighting Alzheimer’s disease depends on the willingness of large numbers of people to volunteer to participate in clinical trials. This includes not just people who have been diagnosed with dementia but also people who are at risk for it but do not have cognitiveproblems. There are several advantages to such participation. For example, the treatment being studied may prove effective, and you will have access to it before it becomes publicly available (See “Research Studies—Should You Participate?”). For information on clinical trials in your area, check the websites listed in the Resources section.

Developing Treatments

More than 130 drugs targeted at Alzheimer’s disease are currently being tested in clinical trials. Some of them are intended to enhance cognition or treat psychiatric and behavioral symptoms. About 100 of them aim to act on the underlying causes of the disease. These would be disease-modifying drugs, meaning they could halt the progression or even reverse the effects of the disease.

Most of the new therapies being tested have beta-amyloid plaques or tau tangles as the primary target. Scientists know that the brains of people with Alzheimer’s disease contain plaques and tangles (see Chapter 1). The accumulation of these substances in the brain causes brain cells to die. As more and more brain cells die, the characteristic memory and thinking problems of Alzheimer’s disease become apparent.

For years, the prevailing theory has been that accumulation of beta-amyloid in the brain is the trigger that sets off the chain of events that culminates in the disease. Beta-amyloid is the toxic protein that is the major component of the sticky plaques in the brains of people with Alzheimer’s disease (see “Beta-Amyloid Formation”). Starting in middle age, some as-yet-unknown trigger causes beta-amyloid to start forming in many people’s brains. It accumulates to a much greater degree in the brains of people who go on to develop Alzheimer’s disease.

It was thought that the excessive accumulation of beta-amyloid set in motion all the other processes, like the development of tau tangles. It is now known that toxic tau, which results in the tangles, also plays a prominent role in cognitive decline. Defeating plaques and tangles has been a major focus of research efforts. But it has also become clear that a complex interaction of processes is at work, and other avenues of research need to be explored as well.

Attacking Amyloid

If the accumulation of beta-amyloid triggers the brain changes in Alzheimer’s disease, then preventing beta-amyloid from forming in the brain or clearing the beta-amyloid already there would, theoretically, prevent or halt the disease. Many drugs and other therapies based on the beta-amyloid theory have been developed and tested. Some work by preventing beta-amyloid from forming, and others work by removing beta-amyloid that’s already there. Early efforts with these approaches have largely been disappointing, but the idea of targeting beta-amyloid hasn’t been completely abandoned. Many anti-amyloid drugs continue to be studied.

Clearing Beta-Amyloid from the Brain. One approach to clearing beta-amyloid from the brain harnesses the capability of the body’s natural defenses to eliminate it. The immune system recognizes excess beta-amyloid as a threat and makes antibodies against it. Antibodies launch attacks against detrimental substances in the body. Boosting the levels of anti-amyloid antibodies has shown some promise.

Scientists have singled out the antibody against beta-amyloid and turned it into a drug therapy. Several such drugs that bind to beta-amyloid and clear it away have been developed. Some of these drugs showed promise in early studies with small numbers of patients. But when they were tested in large studies of people with mild-to-moderate Alzheimer’s disease, they did not work. A few of the drugs continue to be studied in people in the mild stage of Alzheimer’s disease or even in people who don’t yet have symptoms. Several experts believe that to be effective, these drugs must be given very early in the course of the disease, possibly before any symptoms are apparent. Studies in people at high risk for Alzheimer’s disease, but who do not yet have symptoms are underway.

Studies of a drug that targets beta-amyloid, called gantenerumab, had disappointing results with all but the highest dose. Based on more encouraging results at the high dose a phase 3 trial using just that dose is underway.

Another drug, called BAN2401, attacks beta-amyloid, but it works a little earlier in the process of plaque formation than other anti-amyloid drugs. It attaches to the stringy fibrils that form before beta-amyloid starts to clump together into the amyloid plaques. Based on promising early results, a phase 3 trial is now underway.

Preventing Beta-Amyloid from Forming.
Getting rid of beta-amyloid that’s already formed in the brain is one option. Another strategy is to prevent the beta-amyloid from forming in the first place. As stated earlier, beta-amyloid is created from a larger protein called amyloid precursor protein (APP). APP is a normal protein that aids in the growth and maintenance of brain cells. The long strand of APP can be cut into smaller fragments. An enzyme acts like a pair of scissors cutting a long ribbon into shorter pieces. One of those pieces is beta-amyloid.

Scientists have identified the two enzymes that clip APP at just the right places to create beta-amyloid. A drug that blocks the snipping action of beta-secretase or gamma-secretase would prevent beta-amyloid from forming. Several drugs that block either beta-secretase or gamma-­secretase are being studied. At least one study is looking at combining a drug that clears amyloid plaques plus a drug that blocks beta-secretase, thus preventing plaques from forming. So far the studies with these agents have been disappointing.

Early-Stage Studies

Based on the belief that treatment for Alzheimer’s disease must be given very early, several studies are underway to test this theory and to find the right drug for effective early intervention.

Autosomal Dominant Alzheimer’s Disease Trial. One study is using the experimental drug crenezumab in people who have the gene that guarantees they will get Alzheimer’s disease, but do not yet have any symptoms. Only about 1 percent of people with Alzheimer’s disease have this genetically determined form of the disease, but the results from this study may apply to the more common form of the disease. The researchers are hoping to show that by giving a drug to people who are cognitively normal now but are sure to get the disease later, it may be possible to prevent it from happening or at least to delay the onset.

The 300 participants in the study come from an extended family in Colombia, South America, and many of them carry a genetic mutation that results in dementia by age 51. Participants will receive either crenezumab or placebo, and will undergo several tests of cognitive functioning and other biomarkers of Alzheimer’s disease.

DIAN TU. Another study is being conducted by the Dominantly Inherited Alzheimer’s Network Trials Unit (DIAN TU) at Washington University School of Medicine. The participants in this study also carry the gene for genetically-determined Alzheimer’s disease. This study is testing three drugs targeting beta-amyloid. The experimental drugs solanezumab and gantenerumab remove beta-amyloid plaques from the brain. The third drug blocks beta-secretase, which reduces the amount of beta-amyloid in the brain.

A4. The National Institutes of Health is funding a study called the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s disease (nicknamed A4). The participants in this study are not carriers of the genes for genetically determined Alzheimer’s disease. Instead, the 1,000 participants are men and women age 65 to 85 without obvious impairments in mental function as measured on tests of memory and thinking, but who have evidence of buildup of beta-amyloid plaques in the brain as measured on PET scans (see Chapter 6). This suggests that they may develop dementia. The study is testing whether the experimental drug solanezumab prevents or delays the onset of Alzheimer’s disease.

Targeting Tau and Tangles

Beta-amyloid plaques are one of two abnormalities found in the brains of people with Alzheimer’s disease. Many researchers are focusing their attention on the other one—neurofibrillary tangles. The tangles are caused by a protein called tau that has undergone detrimental changes. Cells use tau to construct microscopic tubes (microtubules) that allow movement of communication signals throughout the cell. In people with Alzheimer’s disease, the tau becomes misshapen and turns into disorderly twisted fibers called tangles. When this happens, the cell loses its ability to communicate with other cells, and has more difficulty taking care of and repairing itself.

It has been discovered that abnormal tau can spread from one neuron to neighboring neurons, thus causing a chain reaction that destroys millions of neurons. There is some evidence that the accumulation of plaques in the brain sets the stage for Alzheimer’s disease, but it’s the spread of abnormal tau that tips the scales toward Alzheimer’s disease. Scientists are investigating therapies to repair or prevent the tangles from forming or from spreading.

Inhaled Insulin

Another approach to treating Alzheimer’s disease involves the relationship between insulin and brain function. Insulin, which is produced in the pancreas, transports glucose (sugar) into cells, where it is used as a source of energy. Levels of insulin and glucose must be maintained at the proper balance for optimal function of cells, including brain cells. When the body does not produce enough insulin, or does not properly use it, the result is diabetes (see Chapter 4).

Insulin carries out many critical functions in the brain. It’s been found that people with Alzheimer’s disease, even those without diabetes, may have deficiencies in some of these insulin-related functions. For example, they may have insulin resistance, which means the body no longer responds sufficiently to the effects of insulin. Over time, insulin resistance can cause increased inflammation and the accumulation of beta-amyloid in the brain.

Given this possible connection, researchers hypothesized that delivering insulin to the brain may have a beneficial effect. In a recent study of older adults with mild cognitive impairment or mild-to-moderate Alzheimer’s disease, those who used inhaled insulin for 18 months had better scores on tests of mental function than those receiving placebo (see “Inhaled Insulin for Alzheimer’s Disease”). This continues to be studied.

Other Approaches

Researchers are attacking the disease from many other angles in addition to those discussed above. While the amyloid hypothesis and research on tau have received much of the research focus, other substances and processes in the brain are worth examining. For example, researchers are looking into ways to protect brain cells and reduce inflammation in the brain. Chronic inflammation in the brain can occur as the immune system goes into overdrive attempting to clear away plaques and tangles. The massive inflammatory response can itself become toxic and contribute to further death of brain cells. Therefore, new therapies are being tested to reduce inflammation in the brain. In addition, research is underway to understand the role of damaged blood vessels in the brain (from stroke, high blood pressure, clogged arteries, and other causes).

Some scientists have come up with new theories about the cause of Alzheimer’s disease. Intriguing research suggests that microbes, such as bacteria and viruses may be involved in the development or worsening of Alzheimer’s disease.

Researchers continue to look for factors that predict the development of Alzheimer’s disease and to determine which diagnostic tests are most accurate for detecting early changes.

Stem Cell Research

Curing diseases by replacing failing body systems with regenerated cells is perhaps the “Holy Grail” of scientific research. This could be possible through stem cell research. Alzheimer’s disease is just one of many conditions thought to potentially benefit from this approach. If it fulfills its promise, stem cell therapy could be used to create fresh nerve cells that would replace the ones depleted by Alzheimer’s disease.

At this point in time, the potential of stem cell research exists (early experiments have shown it to be possible for at least some diseases), but the reality of translating research into actual treatments or cures is still a long way off. Specifically, stem cell research must overcome significant hurdles.

Put simply, stem cell research is based on the fact that some cells have the flexibility to become many different types of cells. The cells of the human body are mostly quite specialized. For example, there are skin cells, liver cells, blood cells and nerve cells. Stem cells are a type of cell with the potential to become any other type of cell.

The most versatile stem cells are embryonic stem cells. Stem cells also can be obtained from bone marrow, umbilical cords, and skin. Stem cells can be stimulated to become specific types of cells. This breakthrough has led to ongoing research to see if it’s possible to, for example, create insulin-producing cells for diabetics or nerve cells to replace faulty ones in the brains of people with Parkinson’s disease.

There are many factors that need to be considered in relation to stem cells and Alzheimer’s, such as which types of cells would be replicated, which specific areas of the brain would be targeted, and how to get the cells to make the complicated connections found in the brain. And scientists still have to work out how they would introduce the new cells into patients and how they would ensure that the cells don’t transform into an undesirable cell type—a cancer cell, for example.

Conclusion

Research is happening at many levels, from basic research conducted in laboratories in petri dishes to new drugs and therapies being tested in humans. Scientists are simultaneously figuring out how Alzheimer’s starts and progresses, how to test for it, how to treat it, and how to prevent it. Different researchers are coming at the problem from different angles. Someday soon, one or more of these approaches may open the door to a world where Alzheimer’s is treatable or possibly preventable.

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10. Planning Ahead: Legal, Financial, and Health-Care Needs https://universityhealthnews.com/topics/memory-topics/10-planning-ahead-legal-financial-and-health-care-needs/ Thu, 26 Dec 2019 16:16:52 +0000 https://universityhealthnews.com/?p=128109 In addition to helping a person with Alzheimer’s disease manage daily activities, caregivers must also think about legal, financial, and health-care issues and make plans for the future. Eventually, a person with Alzheimer’s disease will no longer be capable of handling their own financial or legal affairs. And decisions about health care will have to […]

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In addition to helping a person with Alzheimer’s disease manage daily activities, caregivers must also think about legal, financial, and health-care issues and make plans for the future. Eventually, a person with Alzheimer’s disease will no longer be capable of handling their own financial or legal affairs. And decisions about health care will have to be made by someone else as well.

The early stages of Alzheimer’s disease can be an emotionally difficult time for everyone involved. It’s important to take the time at this stage to make some practical arrangements. Making legal and financial decisions early allows the person to actively participate in the planning of his or her own future. The decisions must be set down in legal documents at a time when the person is still mentally competent enough to make decisions (see “Legal Documents You Should Draw Up—Before it’s Too Late” checklist). Having a diagnosis of Alzheimer’s disease does not, by itself, mean that a person is incapable of making fundamental decisions. But at some point decision-making abilities will end. And it’s best to be prepared.

If the proper legal documents are not set up before the person becomes mentally incompetent to sign them, it is necessary to go to court to have a judge appoint someone to act as guardian. The guardian then has the legal authority to make certain decisions on the patient’s behalf. This process is time-consuming and costly, and it involves a court proceeding before a judge. It can be avoided with some advance planning.

Legal Planning

Start by consulting a lawyer who is familiar with trusts, estates, and laws pertaining to Medicare/Medicaid. Ask for a referral to someone who is experienced in elder or geriatric law. Your local Alzheimer’s Association chapter may be able to help as well. Everyone needs to have a will and to establish procedures for how financial and health-care decisions will be made. Laws vary from state to state. If you’re helping a relative who lives in another state, retain a lawyer who has expertise in the laws of the state in which the person with Alzheimer’s lives.

Power of Attorney

Many people choose to grant “power of attorney” to a trusted family member or friend, who will take care of legal and financial transactions. However, a simple power of attorney is not enough because it becomes void when the person granting it is mentally incapable of making decisions. Therefore, the situation requires “durable power of attorney.” This authorizes the designated person to act on behalf of someone who is unable to make his or her own decisions. This person can make decisions regarding property and other financial matters.

You might also want to consider setting up a living trust. Assets, such as a house, stocks, and money, are put into a legal entity called a trust, and a trustee (an individual or bank) will be responsible for managing the trust when the individual is no longer able.

Advance Directives

When it comes to making arrangements for future medical decisions, you have basically two options: a health-care proxy (also called a power of attorney for health care) and a living will.

A health-care proxy is a person you designate to make decisions on your behalf if you can no longer speak for yourself—often the same person to whom you would give durable power of attorney. This includes making decisions about medical treatment and eventually end-of-life decisions, such as whether to prolong life with a respirator, feeding tube, or cardiopulmonary resuscitation to restart a stopped heart. When choosing a health-care proxy, make sure it is someone you trust, and that he or she is willing to accept the responsibility. Also, have a conversation with your proxy and family members about your wishes.

A living will enables you to state your wishes about medical care in advance, in the event that you later become unable to communicate. This is more limited than naming a health-care proxy, because it is very difficult to anticipate specific health problems in advance. But a living will may be used to make your wishes clear about the use of artificial life support systems. The laws about living wills vary from state to state, so check with your lawyer to determine how best to express your wishes for future medical care.

Financial Planning

Once Alzheimer’s disease worsens, the ability to handle finances deteriorates. Additionally, providing care for a person with Alzheimer’s disease is often costly. When considering the management of your financial affairs and the payment for your care, you should discuss the options with an attorney, a financial planner or an accountant—someone well versed in Medicare and Medicaid rules and regulations.

Begin with an assessment of your personal assets, including your financial resources and sources of income. Resources include bank and credit union accounts, investments (stocks and bonds), life insurance, health insurance, and real estate. Sources of income may be from salary, retirement benefits, Social Security, veterans’ benefits, rental income, interest, and dividends. Next, list any financial liabilities, such as loans, credit card debt, home mortgage, and property and income taxes.

You may want to arrange for the direct deposit into your savings or checking account of as many income sources as possible. To arrange for direct deposit of government funds (for example, Social Security and veterans’ benefits), file an authorization form, which you can do online.

A joint bank account in the names of both the person with Alzheimer’s and the person who will be handling the finances is one way to simplify matters. However, there is a potential drawback. Although a joint account is a useful way to access another person’s resources, it may cause complications if you apply for Medicaid or other benefits. Government programs assume that all money in a joint account belongs to the person applying for the benefit.

The durable power of attorney, described earlier, is probably the best option for turning over the management of financial affairs. The agent, who acts on behalf of the person with Alzheimer’s disease, is authorized to deal with a wide range of financial matters, from managing bank accounts to selling assets.

To ease some of the financial burden, a few tax breaks exist for people with Alzheimer’s and their caregivers. An accountant can help you figure out your eligibility. For example, you may be entitled to a tax credit for part of the cost of a home attendant. If you claim the person with Alzheimer’s disease as a dependent, you may be able to deduct some medical expenses from your income tax.

Paying for Health Care

The costs of caring for a person with Alzheimer’s disease are often high. There are some potential resources to help defray costs. These include Medicare, Medicaid, and private insurance.

Medicare

Medicare covers all people 65 and older who are receiving Social Security retirement benefits. It pays for hospital care, a portion of doctor’s fees, some prescription drug costs, and some other medical expenses. For example, it covers physical and speech therapy and part of the cost of mental health care.

For dementia patients, Medicare will pay for physical, occupational, and speech therapy if the person’s doctor deems these services necessary. Medicare also will cover psychotherapy or behavior management therapy provided by a mental health professional if this type of therapy is deemed to be reasonable and helpful.

Medicare does not cover adult day care, 24-hour personal care in the home, or room and board in an assisted-living facility or nursing home. The exception is care received after a hospital stay of three or more days. In this case, Medicare will pay for home care or care in a skilled nursing facility, but only for a limited time.

Medicare prescription drug coverage is provided by private insurance companies. Medicare beneficiaries must choose a plan and pay a monthly premium. All Medicare drug plans cover the costs for cholinesterase inhibitor drugs (donepezil, rivastigmine, galantamine) and (memantine), in addition to antidepressants, antipsychotics, and anticonvulsants.

Medicaid

Medicare presently covers the cost of long-term care for a person with Alzheimer’s disease who meets the requirements. The laws are different, depending on the state in which you live, but benefits can include adult day care, respite care, home care, hospital care, and nursing home care.

Because it is a welfare program, the person with Alzheimer’s disease must have minimal income and assets to qualify. Some people divest themselves of their assets to qualify for Medicaid. If you choose to do this, there will be a period of time (up to three years) during which Medicaid will not pay for your nursing home care. Before divesting your assets, consult with an attorney or financial planner who understands the Medicaid laws in your state.

Other Financial Help

Veterans and their spouses, widows, children, or parents may be eligible for some medical benefits from the Department of Veterans Affairs. These benefits can include adult day care, home care, outpatient care, hospital care, and nursing home care. Contact the U.S. Department of Veterans Affairs (800-827-1000) for more information.

It’s possible to purchase long-term care insurance (nursing home insurance) from many insurance companies. These policies differ, but many are set up to pay a predetermined amount of money for each day a person is cared for in a long-term care facility. There can be deductibles, waiting periods, benefit time limits, and exclusions. Review several different plans before selecting one, and read the policy carefully before signing up. You typically must purchase long-term care insurance in advance of a disability. Once a person is diagnosed with Alzheimer’s, obtaining long-term care insurance is difficult, because the disease is considered a pre-existing condition, and the policy probably won’t cover it.

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9. Caregivers: Take Care of Yourselves https://universityhealthnews.com/topics/memory-topics/9-caregivers-take-care-of-yourselves/ Thu, 26 Dec 2019 16:16:12 +0000 https://universityhealthnews.com/?p=128105 Caring for a person with Alzheimer’s disease can be a difficult job. Caregivers will likely have many new responsibilities. The person with dementia will be the focus of attention as decisions must be made about living arrangements, caregiving, and financial and legal matters. While it’s certainly important to do everything you can to be a […]

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Caring for a person with Alzheimer’s disease can be a difficult job. Caregivers will likely have many new responsibilities. The person with dementia will be the focus of attention as decisions must be made about living arrangements, caregiving, and financial and legal matters.

While it’s certainly important to do everything you can to be a helpful advocate and caregiver, it’s equally important not to neglect yourself. Caregiving can be time-consuming and stressful. The stress may be compounded by financial strain, because many services required by people with Alzheimer’s disease are not covered by Medicare or health insurance.

As your caregiving role increases, you may have less free time, experience frequent interruptions at work, and find it hard to deal with your own health and interests. You might have trouble sleeping. At times you may feel angry, lonely, bitter, and resentful. These are normal feelings, and you shouldn’t feel guilty about having them.

It’s helpful to have a support group, such as close friends and family; a church, synagogue or other spiritual community; or an organized support group of caregivers. By expressing your emotions among supportive individuals, you’re less likely to take them out on the person with dementia. Support groups also can be valuable sources of information, and they offer a safe and accepting environment in which to share your experiences.

Counseling for Caregivers

You might also consider seeking individual counseling with a social worker or psychologist. For many people, the stress of caregiving can be exhausting. For some it leads to depression when the demands of caregiving become overwhelming. This is not unusual; nearly half of all caregivers become depressed at some time.

Alzheimer’s disease takes an obvious toll on marriages. It’s upsetting to witness your life partner diminish cognitively, forgetting aspects of shared history and becoming increasingly dependent. Relationships can become strained as communication becomes more difficult. Psychiatrists have discovered that working with spouses and other family members on creative ways of maintaining communication not only eases stress on caregivers but helps the person with dementia.

Many people reach a point at which they simply can’t handle the stress and must move their loved one to a nursing home or other facility. Researchers have found, however, that caregivers who receive support and counseling not only are able to keep the Alzheimer’s patient home longer, but they also are less stressed.

One study found that people with Alzheimer’s whose spouses received counseling and support were able to remain at home for one and a half years longer before being placed in a nursing home than people whose spouses did not receive counseling. The caregivers who had access to counseling and support were better able to tolerate the memory and behavior problems, were more satisfied with support from family and friends, and had fewer symptoms of depression. A follow-up to this study found that spouse caregivers who received counseling and support were better able to preserve their own health.

Caregivers often have a tendency to neglect their own health. In addition to depression, caregiver stress can make people susceptible to other medical problems, such as hypertension, irritable bowel syndrome, migraines, heart problems, and ulcers. One study found that older adults caring for a family member with dementia were at higher risk for cognitive impairment and dementia themselves. That’s why it’s important for you to keep up with regular doctor visits. Continue to eat a healthy diet, get plenty of rest, and exercise regularly. Consider simple exercises, such as brisk walking, swimming, or jogging, on most days of the week (see “Self Care for Caregivers”).

Caregiver Stress

How you deal with the stress of caregiving will depend to some degree on your personality and the way you cope with stress. People with a take-charge attitude may experience less stress, for example. However, the complexities of caregiving can make coping difficult for just about anyone.

A need to learn new skills might magnify your stress. For example, a husband may have to learn to cook and manage his wife’s former household tasks. If the spouse who handled the finances and wrote the checks is the one to develop Alzheimer’s disease, the other partner might have to take a quick course in basic finances.

Above all, don’t try to do everything yourself. Caregiving is too big a job for one person. Get the help you need from family, friends, home attendants, support groups, adult day programs, and respite care. Find out what resources are available in your community from senior centers or your local agency on aging. Ask family and friends to visit and help out. People, even family, often need to be directly requested to get involved. They may assume everything is fine because they haven’t explicitly been asked to help. They may need to know specifically what kind of help you need.

For example ask a friend or family member to research available programs or activities. This kind of help could even be done by someone who doesn’t live nearby. Or a friend or relative could come and have dinner once a week, take the person with Alzheimer’s to lunch, or for a walk. An adult child or other family member could help with some doctor’s visits. These kind of concrete requests help family and friends feel involved, and help lessen the burden on the primary caretaker.

Working together in this way will help ensure that the person with Alzheimer’s gets the best possible care. And getting support will help both you and your loved one feel less socially isolated.

Caregiving doesn’t have to be a negative experience. In fact, many people derive an increased sense of purpose from their new responsibilities, and they grow emotionally. Take care of yourself, take one day at a time, and allow people to help you. Focus on and enjoy what your loved one can still do. Perhaps most importantly, don’t lose your sense of humor. A little humor can get you through some rough situations, and it makes life a lot more fun. Alzheimer’s disease doesn’t remove a person’s sense of humor. So, laugh with your loved one. You’ll both enjoy it.

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8. The Role of the Caregiver https://universityhealthnews.com/topics/memory-topics/8-the-role-of-the-caregiver/ Thu, 26 Dec 2019 16:15:58 +0000 https://universityhealthnews.com/?p=128099 Because there is currently no treatment that will reverse the effects of Alzheimer’s disease, a decline in mental abilities is inevitable. Over time, a person with Alzheimer’s disease will need increasing amounts of assistance with a variety of daily activities, including bathing, dressing, paying bills, and getting around. It often falls to family members or […]

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Because there is currently no treatment that will reverse the effects of Alzheimer’s disease, a decline in mental abilities is inevitable. Over time, a person with Alzheimer’s disease will need increasing amounts of assistance with a variety of daily activities, including bathing, dressing, paying bills, and getting around. It often falls to family members or close friends to provide this care.

Statistics about Alzheimer’s disease usually focus on the numbers of people who have the disease. But the burden of Alzheimer’s disease falls on more people than this. Loved ones are affected as well. According to the Alzheimer’s Association, more than 16 million Americans provide unpaid care for people with Alzheimer’s or other dementias. Two-thirds of them are women and one-third of them are age 65 or older.

More than half of people with Alzheimer’s disease are cared for at home. At some point, outside services will be needed and it may be necessary to move the person with dementia to an assisted living or skilled care facility.

Caring for a person with Alzheimer’s disease can be a challenging and complex task, and caregivers need constant information and support. This chapter reviews some general information about caring for a person with dementia. There are many other resources available as well. Several helpful agencies are listed in the Resources section at the end of this report. One in particular is the Alzheimer’s Association: a nonprofit organization dedicated to providing education and support for people diagnosed with the condition, as well as for their families and caregivers. The Alzheimer’s Association offers support groups, workshops, and written materials for caregivers. The more acquainted you become with strategies for handling the changes that occur, the easier it will be for you to offer loving and supportive care. And you will feel less alone.

The Realities of Caregiving

As a person with Alzheimer’s disease loses the ability to function in certain ways, he or she will increasingly require help. In general, the caregiver must be the person’s advocate, ensuring his or her safety, medical well-being, and financial security. The caregiver must assist with day-to-day activities and provide emotional support. Caregivers must compensate for the person’s cognitive problems and cope with the behavioral problems.

In the mild stage, people with Alzheimer’s disease usually can manage on their own, provided that someone checks on them regularly (at least once a day). However, they most likely will need help with finances, and they may need someone to do the grocery shopping. As the disease progresses, they will need more help with household activities.

In the moderate stage, living alone is no longer an option. Assistance will be required with grooming, dressing, meal preparation, and household chores. The most care is required in the severe stage.

Caregiving can be challenging in a number of ways. For people with Alzheimer’s disease, the growing loss of independence and privacy can be very frustrating, and even depressing. They may express their frustration by resisting help and insisting that they are still capable of doing things, even if they aren’t.

Some people with Alzheimer’s disease become suspicious of the very people who are trying to help them, especially those who are taking over financial responsibilities. This is understandable, given the mental changes that occur in people with Alzheimer’s.

When dealing with troublesome or confusing behaviors, it’s helpful to think about the situation from the perspective of the person with the cognitive impairment. This will help you find appropriate ways to respond that don’t exacerbate the problem. It also will help you come up with creative memory aids and other methods to help the person compensate for cognitive deficits.

Some resources, including books, manuals, and instructional videos, to help caregivers work with people with dementia are available from the Center for Applied Research in Dementia (see the Resources section). They developed memory techniques for people with Alzheimer’s disease based on an education system called Montessori, which was first developed for young children. Using these techniques, caregivers assist people with Alzheimer’s disease to make the most of the skills and habits they have retained, such as singing, playing a musical instrument, playing golf, or any other activity that engages the person. The key is to personalize the program by identifying activities, hobbies, and skills that the person enjoys and finding ways to continue these activities, possibly in a modified fashion. Memory exercises, such as sorting items into categories and matching colored balls to cups, may help to improve memory for some people.

Communication

As Alzheimer’s disease worsens, communication will become more difficult, but not impossible. It’s very important to talk with your spouse, parent, or friend and find out directly from them how you can assist them. This will be easier in the mild stage of the disease, but it’s important to continue communicating throughout the course of the illness. Even in the severe stage, a person with Alzheimer’s disease will still want to communicate.

Sometimes communication is hindered by poor vision or impaired hearing. Make sure the person with Alzheimer’s has his or her vision and hearing regularly tested, and get glasses or a hearing aid, if necessary.

Keep in mind that people with Alzheimer’s disease can generally comprehend more than they can express with language. If your loved one is having difficulty finding the right words to express a thought, it doesn’t mean she can’t understand you if you offer suggestions. Also, remember that spoken language is only one form of communication. Body language, tone of voice, and facial expressions are all aspects of communication that help get a message across.

Language difficulties will vary among people with Alzheimer’s disease. Some common problems include the following: being unable to find the right words, using the same words repeatedly, having difficulty forming sentences correctly, inventing words for familiar objects, and speaking less often.

Given these problems, it often takes patience to understand what a person with Alzheimer’s disease is trying to convey. Listen carefully and try to get as many nonverbal cues as possible. Give the person time to think and describe what he wants. If he’s having trouble finding the right words, offer suggestions. But avoid telling him he’s wrong. Instead, repeat what you think he’s trying to say for clarification. If you still don’t understand, you can ask him to point or gesture. It’s also helpful to try to get a sense of the emotions behind the words. Sometimes the person’s feelings are more essential to what’s being communicated than the actual words.

When speaking to someone with Alzheimer’s disease, there are some ways to accommodate cognitive deficits. Speak in a calm voice, look the person in the eye, and use short and concise sentences. The person may forget what you’ve just said, so repeat yourself patiently when necessary. When giving the person directions, break up the task into one-step instructions. Tell them one step at a time. Frame questions so that they require a yes or no answer or a choice between two options. For example, don’t say, “What would you like for dinner?” Instead, say, “Would you like chicken or fish for dinner?”

Avoid dictating to the person or overloading her with information. And don’t argue or criticize. This can cause confusion, fear, and anxiety.

If the person with Alzheimer’s disease has an angry outburst, don’t take it personally. This is often caused by feelings of frustration. Try to determine the cause of the frustration, and reassure the person as much as possible. Tell her not to worry about something she’s forgotten to do, or her inability to find a misplaced item. Using kind words, tell her she’s not alone and that you are there to help her.

In the later stages of the disease, communication remains important, even though verbal skills are considerably impaired. Sharing time with nonverbal activities, such as listening to music, dancing, looking at photographs, or holding hands, may substitute for conversation.

Memory and Reminiscence Aids

Memory aids are generally helpful in the mild stage of Alzheimer’s disease. There are no standard aids that work for everyone. A person with Alzheimer’s disease will probably have to try out different memory tricks to see what helps.

Some people carry around a notebook with the names and phone numbers of people they often call. The notebook also may contain written reminders about chores, and instructions for doing tasks. Some people leave written reminders in strategic places around the house—for example, a note on the washing machine with step-by-step instructions for turning it on. Other people find that labeling things is helpful. Written signs may be placed around the house that read “refrigerator,” “sock drawer,” “bathroom,” etc. Also, place a calendar on the wall and mark off the days to make it easier to remember the day and date.

These memory aids will facilitate day-to-day tasks. It’s also important to have cues for remembering key people and events in the person’s life. Keep favorite photographs, newspaper clippings, and other things that are meaningful to the person in prominent locations around the home or on a bulletin board. You might also want to make a book with pictures and other mementos of important people and events from the past.

Bathing, Dressing, Grooming

In the moderate and severe stages of the disease, a person with Alzheimer’s will need more help with basic hygiene and grooming, such as bathing, dressing, and dental care. This may be difficult. People with dementia resist assistance with personal care for a number of reasons. They might not want anyone intruding on their privacy. Also, the process of bathing and dressing can become too complicated and confusing. A person with Alzheimer’s might not remember when she last took a bath and insist that she doesn’t need one.

To smooth the way for a problem-free bath, try to prepare everything in advance. Run the bath water, have towels nearby, make the room temperature comfortable. Then give the person one-step instructions: “It’s time for a bath.” “Unbutton your shirt.” “Now take off your pants.” “Step into the bathtub.” If the person is self-conscious about being naked, respect her dignity. Allow her to hold a towel in front of her body when getting in and out of the tub or shower. Make sure there are non-slip adhesives on the floor of the tub and a grab bar to prevent falls.

Try to maintain the bathing routine the person has already established. If she’s always bathed in the morning right before breakfast, keep to that schedule. If bathing becomes difficult, don’t require her to take a bath every day. Sometimes a sponge bath can substitute if you meet with insurmountable resistance.

When it comes to dressing, keep clothing choices simple. Help the person pick out coordinated clothes and then lay them out in the order they are to be put on. If necessary, give the person short instructions. When purchasing new clothes, think about comfort and simplicity. Shirts that button in the front are sometimes easier than pullover tops. If buttons and zippers are too difficult to manage, try replacing them with ­Velcro. Slip-on shoes are easier than shoes with laces.

People with Alzheimer’s also will eventually need help with oral hygiene. As the disease progresses, brushing and flossing teeth will become difficult. Rather than telling the person to brush her teeth, you may need to break it down into smaller steps: “Take a piece of dental floss and wrap it around your fingers.”  “Floss your teeth.” You may need to demonstrate for her. Regular trips to the dentist continue to be important for a person with Alzheimer’s disease. Inform the dentist of the person’s condition ahead of time. You may need to search around to find a dentist who has experience working with people who have Alzheimer’s.

Wandering

Wandering is very common among people with Alzheimer’s disease, and it can be dangerous if the person wanders out of the house and gets lost. There are a number of strategies to deal with wandering. First, safeguard the house to make it less likely that the person will wander out the front door. For example:

  • Place an alarm on the doorknob.
  • Use childproof doorknob covers.
  • Paint doors the same color as surrounding walls, making it more difficult for the person with dementia to identify the door.
  • Install motion-activated alarms, which trigger an alarm if the person crosses an infrared beam.

Enroll the person in the Alzheimer’s Association’s “Safe Return” program. This program provides an identification bracelet, necklace, clothing tags, and wallet cards with contact information in case the person is found wandering. Make sure you have a recent photo available in case it is needed to help find someone who has wandered.

Sometimes people wander because they’re bored, restless, or confused. One way to reduce wandering is to keep the person with Alzheimer’s engaged in activities. Go for walks or include the person in simple household chores, such as folding laundry.

Sleep Problems

People with Alzheimer’s disease are at increased risk of having disturbed sleep. They can become agitated and disoriented and stay awake all night. Medical experts don’t fully understand why sleep disturbances occur in Alzheimer’s disease, but there are some theories. It might simply be that the person hasn’t had enough activity during the day to be tired at night, or that older adults in general need less sleep than younger people do. Also, nighttime is associated with increased confusion known as sundowning (see Chapter 3), which leads to agitation that interferes with going to sleep. In addition, there may be a disturbance in the internal biological clock, which upsets the normal sleep/wake cycle.

To combat nighttime sleeplessness, keep the person with Alzheimer’s busy during the day. Don’t offer caffeinated beverages in the evening. There also are medications that can help with nighttime agitation and sleep disturbances.

Researchers have looked into ways to readjust the sleep/wake cycle. Exposing the person to bright light early in the morning (thus cueing the body that it is morning and time to be awake), restricting the amount of time spent in bed, and using the over-the-counter remedy melatonin (a substance naturally produced by the body to regulate sleep/wake cycles) have been shown in studies to be helpful.

For safety, put nightlights in the bedroom and bathroom to avoid falls in the middle of the night. Restrict access to rooms by locking doors or installing safety gates. Install door sensors to alert people in the house that the person is awake.

If you want to coax the person back to sleep, speak calmly and remind him of the time. Ask if he’s up because he needs to use the bathroom or if he wants something. If he won’t go back to bed, but will fall asleep on a couch or in a lounge chair, allow him to do that.

Exercise

Exercise, such as brisk walking, has demonstrated benefits for both physical and mental health in people with dementia. It can reduce physical decline, frailty, and falls.

An analysis of 30 studies on the effects of exercise on people with cognitive impairment confirms this. Exercise was found to increase overall fitness and mental function, and to have a positive impact on behavior in people with dementia. Another study found that regular aerobic exercise, specifically brisk walks for at least 150 minutes a week, improved memory for people in the mild stage of Alzheimer’s disease, and there was less shrinkage of the hippocampus. Therefore, regular walks of 20 to 60 minutes with a companion should be part of a routine for as long as possible.

Maximize Existing Function

In part, a caregiver’s job is to help people with Alzheimer’s disease carry out tasks they can no longer manage. But it’s equally important to encourage them to continue doing things they are still able to do, and to find creative ways to help them compensate for cognitive deficits. For example, a person who has lost the ability to communicate effectively with speech may be better able to communicate in other ways, such as through music or art. Music and art therapists can help bring out a person’s musical or artistic side.

Care Options

Most people with Alzheimer’s disease live at home, with care provided by family and friends. But there are other care options. The living situation for each individual will depend to a large extent on the current family situation.

A person with Alzheimer’s disease who lives alone with no family close by may be able to manage for a while in the mild stage of the disease. But the person will need to be taken in by a family member, have in-home care, or move to an assisted-living facility or nursing home before the disease makes living alone dangerous. People with Alzheimer’s disease can put themselves in danger in several ways, such as forgetting to turn off the stove, opening the door to a stranger who may rob them, forgetting to eat, or scalding themselves with hot water.

If the person with Alzheimer’s disease is living with a spouse, child, or another adult who has good mental function, and is in reasonably good health, it’s possible to remain in the home. At some point, a home health aide may be needed (part-time or full-time) to help with care. If the person with Alzheimer’s disease is being cared for at home, respite care services may be helpful for providing relief for the caregiver and to give the patient a social outlet.

Adult Day Services

Adult day services, which serve adults who are physically or cognitively impaired, are one type of respite care. This is a place where people with Alzheimer’s disease can come for part of the day to interact socially and engage in recreational activities in a safe and supportive environment.

Adult day services offer caregivers a chance to go to their job or have free time without worrying about the safety of their loved one. Adult day programs offer people with Alzheimer’s disease a place where they can interact with other people, receive services such as physical or speech therapy, and get some exercise.

Most adult day services will pick up and drop off participants and provide nursing care, personal care, counseling, therapeutic activities, and rehabilitation therapies. These may include reminiscence groups, exercise classes, arts and crafts, and music therapy. A meal is usually provided, as well as assistance with daily activities.

An innovative approach to adult day care recreates a 1950s small town environment. A company called Town Square (www.shtownsquare.com) is building adult day care facilities that provide activities for older adults in a nostalgic environment of diners, theaters, and various businesses designed to replicate the types of places people in their 70s and 80s would have gone to when they were teenagers and young adults. Spending time in imitation towns such as this, reminiscing about past events and life experiences, has been shown to have positive effects on mood and cognition. Only a few of these reminiscence towns have been built in the United States, but more are planned.

The number of adult day services has been growing over recent years to meet the increasing demand. Online resources to find one in your area include the National Association of Area Agencies on Aging (www.n4a.org) where you can search for agencies in your local area. A local senior center and your doctor also can suggest some resources.

Adult day programs are offered by hospitals, nursing homes, senior centers, and religious, fraternal, and neighborhood organizations. Depending on the type of organization providing the service, the cost can vary widely. Some programs may use a sliding scale or even be free. Adult day services are not covered by Medicare, but they may be covered by Medicaid or private long-term care insurance.

Once you’ve identified one or more adult day services, you should do some investigating (some questions to ask are listed in the “Questions to Ask an Adult Day Service Provider” checklist.) It’s also a good idea to pay a visit and see for yourself whether it meets the needs of your loved one. Look for a clean and pleasant atmosphere with sturdy, comfortable furniture. Watch the staff interact with participants. You may want to try out the service for three or four days before making a longer-term commitment.

Because an adult day service is an unfamiliar setting, it will probably take several visits before a person with Alzheimer’s disease feels comfortable there. The caregiver may want to accompany him the first few times until he adjusts.

Longer-Term Respite Care

There can be times when you are unable to carry out caregiving tasks for several days. For example, an emergency may arise or you may go on vacation. For these times, many nursing homes or assisted-living facilities offer respite care programs, usually for up to three weeks. You can find a respite care program in your area by contacting your local chapter of the Alzheimer’s Association or search for the Area Agency on Aging online for local resources.

In-Home Care

Home-care services can fulfill duties ranging from helping with housework to providing skilled nursing care. In the mild stage of the disease, a homemaker or chore worker may be hired to do housekeeping, meal preparation, and shopping. The caregiver also can accompany the person to appointments, the movies, or other activities. These workers don’t provide hands-on care, but they do make it possible for people with Alzheimer’s disease to continue functioning independently for a longer period of time.

Home health aides are the next level of care. They assist people with daily activities, such as bathing, dressing, eating, and using the toilet. Home health aides are not nurses, but they are usually required to receive training and to work under the supervision of a nurse. Depending on the individual needs of a person with Alzheimer’s, home health aides may be necessary from a few hours a day to 24 hours a day, seven days a week.

In-home caregivers can be hired privately or through a home health agency. You can get a referral from your physician or social worker or contact your local Area Agency on Aging. Also, the National Association for Home Care & Hospice has a Home Care Locator on its website (www.nahc.org), which lists home care agencies across the U.S. The national median daily rate for home health aides is $138, according to the Genworth Cost of Care Survey. For homemaker or companion services, the median daily rate is $132. These costs will vary depending on where you live.

Some states require home care agencies to be licensed and to meet minimum standards. If your state has these requirements, check to see if the home care agency you’re considering is licensed.

In most cases, the cost of home care is borne by the person with dementia and the family. Medicare, Medicaid, and most health insurance plans have strict guidelines for covering home health care, and many people with Alzheimer’s do not qualify. Long-term care insurance will cover home care if certain criteria are met.

Housing Options

At some point between the mild and severe stage of the disease, it may make sense for the person with Alzheimer’s to move to an assisted-living facility or nursing home. The decision to move someone to one of these facilities is rarely easy. The timing will depend on individual circumstances. A person living alone will need to move to the safety of an assisted-living facility or nursing home sooner than someone who has a caregiver at home. For the caregiver, the decision is more complex.

Caregiving can be very stressful. Some people move a loved one when caregiving becomes overly burdensome. This may be when the person with Alzheimer’s becomes incontinent or behaviors become unmanageable.

One study found that counseling can help caregivers better cope with memory and behavior problems, which relieves some of the stress of caregiving. Receiving this type of counseling often delays the need to place the person in a nursing home. This is significant, in part because of the high cost of nursing home care. Rates for assisted-living facilities are less, but the cost is still high.

Which facility is most appropriate will depend on the person’s health. A person with few medical problems aside from Alzheimer’s disease can live in an assisted-living facility that is set up to accommodate residents with dementia. If the person has other medical problems, placement in a nursing home may be the better option.

Selecting an assisted-living facility or nursing home can be difficult. Just as with choosing an adult day service, you need to thoroughly check out the facilities you are considering. Get recommendations from your physician, social worker, clergy, family, or friends. Visit each facility and ask questions (see “Questions to Ask When Evaluating Assisted-Living Facilities and Nursing Homes”). The Medicare website has detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country (https://bit.ly/1CHwbuM).

Assisted-Living Facilities

Assisted-living facilities were first conceived to provide healthy older adults with an essentially independent, but communal living environment. Residents rent a room or apartment and are provided with meals, along with housekeeping and laundry services, but they are not offered nursing services. Depending on the facility, assistance with daily activities, such as bathing and dressing, may be available. An assisted-living facility may be acceptable for a healthy person in the mild stage of Alzheimer’s disease.

Some assisted-living facilities also have sections specifically designed for people with Alzheimer’s disease. They offer a safe environment, special assistance for people with the disease, and appropriate activities. An assisted-living facility with a designated Alzheimer’s unit usually can accept people at any stage of the disease if they are otherwise reasonably healthy.

A word of caution: Assisted-living facilities are not as closely monitored as nursing homes. They are not necessarily state licensed, and regulations vary from state to state. The quality of the facilities and of the care varies widely. Take the time to thoroughly investigate a facility before choosing it, and make sure it’s licensed. Also, make sure the facility is in compliance with all state regulations. Contact your state office on aging to find out what laws and regulations apply.

In addition to taking an official tour of the facility, show up unannounced and observe the conditions on your own. When choosing an assisted-living facility, you’ll be given a contract to sign. Show the contract to a lawyer who has expertise in elder law before signing.

The national median cost for a private, one-bedroom unit in an assisted living residence is $4,000 per month, according to the Genworth Cost of Care Survey. Costs vary by state. The pricing can be complex and dependent on the services the resident needs. Assisted-living residences that provide specialized dementia care often charge additional monthly fees.

Long-term health insurance does not cover assisted living, and you can’t count on Medicaid to pay the bill. Although in certain states, Medicaid will pay for some services provided in an assisted-living facility, the overall cost is borne by the individual.

Nursing Homes

Skilled nursing facilities (nursing homes) offer the highest level of care and may be appropriate for people in the moderate or severe stages of Alzheimer’s disease. They provide 24-hour nursing care and supervision, including help with bathing and grooming, medical and nursing care, and activities.

Many nursing homes have added separate special-care units to meet the needs of people with dementia. The living spaces in these units will have features such as secured exits, single-occupancy rooms, small dining rooms, and designated indoor and outdoor areas for wandering. Activities accommodate the cognitive deficits of people with Alzheimer’s.

The national median cost of a private room in a nursing home is $8,365 a month and $7,441 a month for a semi-private room, according to the Genworth Cost of Care Survey. Costs vary by state. For those who are eligible, Medicaid will help pay the cost, but it can be difficult to qualify for Medicaid if you have financial assets. Speak to an eldercare lawyer to learn about your rights and benefits.

Once you’ve made a choice and moved your loved one into an assisted-living facility or nursing home, you need to maintain an active presence. Even though nursing homes are required to meet certain standards, it’s a good idea to continue to oversee the patient’s care.

Geriatric Care Managers

Understanding the various care options and making decisions about what is best for a loved one can overwhelm family members of a person with Alzheimer’s disease. Professional assistance is available. Geriatric care managers are professionals (usually social workers) who can be hired to assist in a number of ways. Care managers—who usually charge $50 to $200 per hour—can perform an assessment of a person in their home, and devise strategies to keep them safe and help compensate for some of the memory problems. They also can assist with hiring caregivers, and can act as liaison to family members living far away.

A geriatric care manager also can help to determine if assisted living or nursing care is necessary. To find a geriatric care manager in your area, contact the Aging Life Care Association (www.aginglifecare.org).

If you can’t afford a geriatric care manager, contact your local Area Agency on Aging for help. They may be able to send a case manager to do an assessment at no charge. To find the agency near you, enter your zip code at the website
www.eldercare.gov.

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7. Current Treatment Options https://universityhealthnews.com/topics/memory-topics/7-current-treatment-options/ Thu, 26 Dec 2019 16:15:41 +0000 https://universityhealthnews.com/?p=128094 There are no drugs available today that will cure Alzheimer’s disease. And no drug can significantly slow down the damaging effects on the brain. Many drugs have been tested, and a robust research effort continues in the hope of uncovering the therapy or mix of therapies that will stop this devastating disease (see Chapter 11, […]

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There are no drugs available today that will cure Alzheimer’s disease. And no drug can significantly slow down the damaging effects on the brain. Many drugs have been tested, and a robust research effort continues in the hope of uncovering the therapy or mix of therapies that will stop this devastating disease (see Chapter 11, “State of the Research on Alzheimer’s Disease”). The drugs for Alzheimer’s disease that are currently available may temporarily slow the rate of mental decline for some people with Alzheimer’s disease.

Mood and behavior symptoms—such as depression, agitation, anxiety, and delusions—can be managed with different drugs and other therapies.

Some therapies for Alzheimer’s disease don’t involve medication. For example, cognitive rehabilitation programs, originally developed for people who had a stroke or brain injury, have been shown to help people with dementia prolong their ability to do simple daily tasks. Other practical strategies to help people with Alzheimer’s disease are described in Chapter 8.

Alzheimer’s Disease Drugs

There are four U.S. Food and Drug Administration-(FDA) approved drugs to treat Alzheimer’s disease (see “Alzheimer’s Drugs: Essential Facts”). Three of them—donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne)—are types of drugs called cholinesterase inhibitors. The fourth drug, memantine (Namenda), works through a different mechanism.

Cholinesterase Inhibitors

The plaques and tangles of Alzheimer’s disease cause neurons in the brain to die, resulting in deteriorating brain function. Cholinesterase inhibitors don’t stop neurons from dying. Instead, they help to boost the function of the cells that remain. Brain cells communicate via chemicals called neurotransmitters. Acetylcholine is a neurotransmitter that is depleted in the brains of people with Alzheimer’s disease. Cholinesterase inhibitor drugs stop the enzyme cholinesterase from deactivating acetylcholine. In this way, more acetylcholine remains in the brain for mental functioning.

Studies have shown that cholinesterase inhibitor drugs help about half of people who take them to maintain mental function without significant decline for approximately six months to two years. The drugs are generally considered to be most effective when given in the mild-to-moderate stages of Alzheimer’s disease, but donepezil also has been FDA-approved for use in the later stages of the disease.

Cholinesterase inhibitor drugs can help to maintain brain function for a period of time, but once the function is lost it generally cannot be recovered. Because the drugs can’t prevent neurons from dying, they don’t stop the disease from worsening. And some people are not helped by these drugs at all.

People who do respond to cholinesterase inhibitors generally can retain their current level of memory, language ability, orientation, and attention for a longer period of time than if they were not taking the drugs. The drugs also may have beneficial effects on some behavioral symptoms, such as irritability, anxiety, apathy, and delusions. Studies also have shown that people with Alzheimer’s who take the drugs are better able to handle daily self-care activities, thereby decreasing the amount of time caregivers must spend supervising them. People with Alzheimer’s who take a cholinesterase inhibitor often can remain living at home longer before requiring nursing home care.

People who take these medications should have a positive response within three months. The only way to know if a cholinesterase inhibitor will help is to try it. The potential benefits, risks, costs, and side effects should be discussed beforehand with a doctor.

Donepezil and the extended-release form of galantamine are taken once a day, while rivastigmine and the short-acting form of galantamine are taken twice a day. Rivastigmine is also available in a skin patch, changed daily, which releases the drug slowly over time, eliminating the need for twice a day dosing. It also may cause fewer side effects than the pill form.

Side Effects. Potential side effects of cholinesterase inhibitor drugs include nausea, diarrhea, vomiting, fatigue, and weight loss. These tend to be more of a problem at the highest doses of the medications, or if the dosages are raised too quickly. If any of these side effects occur, consult your physician, who may reduce the dose or switch you to a different drug.

Memantine

Memantine works on a different neurotransmitter than the cholinesterase inhibitors, and appears to be helpful for people in the moderate-to-severe stages of Alzheimer’s disease. This distinguishes it from cholinesterase inhibitors, which are useful mainly in the mild-to-moderate stages. Rather than increasing levels of acetylcholine, memantine affects the neurotransmitter glutamate.

Glutamate plays an important role in the parts of the brain responsible for learning and memory. Too little of the neurotransmitter can impair learning and memory, but too much can have damaging effects on brain cells. Alzheimer’s disease may be affected by both too much and too little glutamate at different times.

Memantine protects against excess glutamate and boosts levels of glutamate when they are too low. Possible side effects with memantine include headache, dizziness, confusion, and constipation, although the drug is usually well tolerated.

Because memantine works on a different neurotransmitter than the cholinesterase inhibitors, it can be taken together with one of these drugs. Adding memantine to the drug regimens of people who were already taking donepezil further improved cognition, ability to perform daily activities, and overall function, according to an analysis of four large studies. The combination of donepezil and memantine is available in a single pill (Namzaric).

Researchers have not tested all of the possible drug combinations. In addition, combination therapy for people in the mild stages of Alzheimer’s has not been adequately tested, however memantine alone was not shown to be beneficial in mild stage disease.

Cognitive Rehabilitation

It’s often thought that damage to memory and learning systems in the brains of people with Alzheimer’s disease makes it almost impossible to form new memories and learn new information. However, people in the early stage of Alzheimer’s can still learn, and this ability can be enhanced with cognitive rehabilitation techniques. These techniques can help teach people how to recall important information and to perform better at daily tasks.

Rehabilitation programs may involve learning face-name recognition techniques, getting memory notebooks in which to record appointments and schedules, and learning ways to improve financial skills.

One study showed that people in the early stages of Alzheimer’s disease who participated in a cognitive rehabilitation program were able to retain implicit memories as well as younger adults and older adults without dementia. Implicit memory is the unconscious memory for common skills and activities, such as speaking a language or riding a bicycle.

Cognitive rehabilitation has traditionally been used to help people who’ve had strokes or suffered traumatic brain injuries recover cognitive functions and improve memory. Its use for Alzheimer’s disease is relatively new, but the positive results from studies show that people in the early stages of Alzheimer’s disease can still learn.

Behavioral Treatments

In addition to cognitive symptoms, people with Alzheimer’s disease may exhibit behavioral symptoms, including anxiety, agitation, aggression, apathy, depression, delusions, and hallucinations. Drugs may help with some of these symptoms, but they are not always effective and can have undesirable side effects. Before medication is used, caregivers should try non-drug strategies.

Evidence shows that physical exercise may help calm agitated behaviors in people with mild-to-moderate Alzheimer’s disease. In a study of 200 people with Alzheimer’s disease, those who participated in an aerobic exercise program for one hour three times a week for 16 weeks had a reduction in psychiatric symptoms, such as anxiety, irritability, and depression.

Non-Drug Strategies

Changes in behavior often have specific causes, such as physical discomfort or pain that cannot be expressed, fear of unfamiliar surroundings and loud noises, frustration from trying to communicate with others, and annoyance at the inability to take care of household tasks and personal grooming. Moving to an assisted living facility or nursing home can cause agitation and other behavioral problems, as can changes in caregiver arrangements.

Address Physical Complaints. A person with Alzheimer’s disease may be unable to describe specific physical complaints. Therefore, physical discomfort may be expressed as agitation. Look for evidence of common physical discomforts, such as pain, hunger, constipation, urinary tract infection, pneumonia, skin infection, or bone fracture. If present, these conditions should be appropriately treated.

New medical conditions or medications also may be sources of behavioral symptoms. For example, new or worsening vision or hearing problems can cause confusion or frustration. Many older adults, including those with Alzheimer’s disease, take one or more prescription drugs for other health problems. Side effects from these drugs may affect behavior. When a new behavioral symptom occurs, look for a medical cause. A visit to the primary care doctor is recommended.

Reduce Confusion. Once medical conditions have been addressed, there are other effective non-drug strategies that may help with some behavioral problems. For example, consistency in the home environment is important. The home should be arranged to reduce confusion, disorientation, and agitation. Lighting and noise levels should be adjusted to provide a calm environment (the lights shouldn’t be so dim that they cause problems for people with low vision, however). Loud and erratic noises should be avoided. To make the home feel safe and to reduce anxiety, don’t rearrange furniture or make any other drastic changes. Keep personal possessions, including favorite photographs, in visible locations, and don’t move them around.

Agitation, Irritability, and Aggression. Caregivers can often lessen agitation, irritability, and aggression in a person with Alzheimer’s disease by learning what to expect and how to communicate effectively. Sometimes breaking down a task into its component parts can decrease frustration and help the person to be more self-sufficient. For example, if a person with Alzheimer’s disease gets agitated when asked to brush his teeth, break down the task into smaller directions. Say: “Take the toothbrush.” “Put it under the water.” “Here’s the toothpaste.” “Put the brush in your mouth.” “OK, now you can brush.”

Sometimes, the best remedy for agitation is gentle reassurance from a compassionate caregiver. People with Alzheimer’s disease often mirror the emotions of those around them. If the caregiver becomes angry, agitated, or impatient, the person with dementia may pick up on these emotions and express them. If the caregiver is calm and reassuring, the person with dementia will pick up on that, and this may help.

Caregivers should help people with Alzheimer’s disease plan activities, keep a schedule, and organize their time. Keeping the person involved in household and personal care activities for as long as possible may lessen feelings of helplessness and dependence. It’s also important not to neglect leisure activities, such as music, painting, walking, or reading. Planning activities—both household and recreational—around a set schedule may help to relieve agitation.

Get Support. Counseling and support groups are valuable resources for caregivers to discuss specific behaviors and get advice on how to handle them. The Alzheimer’s Association has chapters across the United States that offer assistance and support groups.

Drug Treatment

If non-drug strategies are not effective and symptoms of depression, anxiety, agitation, sleeplessness, and aggression are severe, a doctor may prescribe medications. Although there are no FDA-approved medications specifically for managing behavioral disturbances due to dementia, doctors have found that a variety of medications can be helpful to patients with these problems.

Antidepressants are designed to treat depression. The antidepressants most commonly used for older persons with dementia are from a group known as selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) or citalopram (Celexa). These drugs have relatively few side effects and are taken once a day. If they don’t work, there are many other antidepressant drugs for the physician to choose from. There is some evidence that antidepressants can help manage agitation in dementia.

Anti-anxiety drugs may be used to relieve anxiety and help the person sleep. These include lorazepam (Ativan) and oxazepam (Serax), which are mentioned here because they do not stay for long times in the body, and therefore have somewhat less potential for adverse side effects. Drugs may be given over the short term to calm a person down during a crisis, or they may be given as needed for longer periods to deal with more persistent problems. The antidepressants mentioned above also have anti-anxiety properties, and can be helpful in the longer-term management of anxiety. All of the drugs used for behavioral symptoms have benefits and potential side effects, including an increased risk for falling. People who are taking them need to be carefully monitored.

Antipsychotic drugs are sometimes used to treat severe agitation, hallucinations, and delusions in people with Alzheimer’s disease. These drugs may be helpful for some people in certain circumstances, but they must be used with extreme caution. Some of the antipsychotic drugs can cause side effects, such as sedation, confusion, and weight gain. In addition, all antipsychotics may increase the risk for death among people with dementia. The FDA has issued a warning about this possibility.

Antipsychotic drugs should most likely be used only as a last resort, and for the shortest possible time at the lowest possible dose. They should not be used to sedate or restrain a person.

It may take several attempts to find the right drug, or combination of drugs, that are most helpful. Even if drugs are used for behavioral symptoms, it is important to continue using non-drug approaches to calm agitated and irritable behavior.

Alternative Treatments

A natural cholinesterase inhibitor, huperzine A, has similar properties to the cholinesterase inhibitor drugs donepezil, rivastigmine, and galantamine. Huperzine A, derived from the Chinese herb Huperzia serrata, is available without a prescription and is promoted as a memory enhancer. This herbal supplement has been used in Chinese traditional medicine for centuries, usually as a treatment for swelling, fever, and blood disorders. Chinese researchers also have found it may be useful for Alzheimer’s disease.

A review of six small trials of huperzine A found that it appears to have some beneficial effects on improving mental function and reducing behavioral problems in people with Alzheimer’s disease, with no obvious side effects. However, a larger trial of huperzine A in individuals with mild-to-moderate Alzheimer’s disease found it was no better than placebo for improving mental function.

Because huperzine A is a natural herb, it doesn’t need FDA approval to be sold, and thus the content of the pills you buy is not guaranteed. In addition, since it works on the same mechanism as the cholinesterase inhibitors, they should not be used together, as doing so would increase the risk of side effects. Huperzine may be a component in some over the counter memory aids. It is therefore very important to always read the ingredients of any combination medicine to make sure they are not duplicating your medications or increasing the risk of side effects.

Antioxidants

Because damage from oxidation caused by potentially harmful molecules called free radicals has been observed in the brains of people with Alzheimer’s disease, researchers have sought to discover whether taking antioxidant vitamins, such as vitamin E, has therapeutic value.

Two studies showed that vitamin E at a dose of 2,000 international units (IU) a day may modestly help with the ability to perform basic daily activities of living. One study included people in the moderate-to-severe stage of Alzheimer’s disease and the other was in people in the earlier stage. Neither study showed that vitamin E improved scores of cognitive function.

These studies have caused some doctors to recommend that their Alzheimer’s patients take 1,000 IU of vitamin E twice a day. It should be noted, however, that this is an extremely high dose. Taking such a high dose should be done only under the supervision of a doctor because there are potential adverse effects, such as an increased risk of bleeding.

As more research is conducted, it is important to consult your physician before taking large doses of any vitamins or other supplements.

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