Alzheimer's update

Caregivers and healthcare professionals, here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle

Time to Step Up

Over the years we've accomplished so many things together: Passage of the National Alzheimer's Project Act (NAPA) (P.L. 111-375), the unveiling of the first-ever National Alzheimer’s Plan, enhancements to government benefits programs for individuals with Alzheimer's, introduction of critical legislation, and increased federal funding for Alzheimer’s research in the midst of challenging budgetary times. In the past year alone we've seen a host of new bipartisan co-sponsors for the HOPE for Alzheimer's Act, new members of the Congressional Task Force on Alzheimer’s Disease, dozens of town hall events, thousands of in-person meetings with elected officials, and a growing recognition of the Alzheimer's crisis among federal officials. 
By reaching out to your elected officials, via the phone and through our action alerts & petitions you've created change and made a difference in the lives of those affected by this devastating disease. You’ve repeatedly demonstrated your commitment to conquering Alzheimer's. Isn’t it time members of Congress did the same?
Tell Congress To Support Alzheimer’s Caregivers. Urge your members of Congress to support the HOPE for Alzheimer’s Act.
The Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act (S.709/H.R. 1507) will improve diagnosis of Alzheimer's disease and increase access to information on care and support for newly diagnosed individuals and their families. An early and documented diagnosis when coupled with access to care planning services leads to better outcomes for individuals with Alzheimer’s as well as their caregivers. Tell your member of Congress that families living with this devastating disease need HOPE!
Save the Date!
Mark your calendars now for the 2014 Alzheimer’s Association Advocacy Forum, taking place April 7-9 in Washington D.C. The Association’s 26th annual Forum includes the National Alzheimer's Dinner, an excellent opportunity for advocates to celebrate another exemplary year of advocacy, growing awareness and leadership in advancing Alzheimer's research and support.  Visit alz.org/forum/ to learn more about the Advocacy Forum.Have you downloaded our ALZ Advocacy mobile app yet? Visit alz.org/advocateapp on your iPhone or Android device

More Evidence Links Atrial Fibrillation and Dementia Risk

Caregivers and healthcare professionals, here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition

Medscape Today

Atrial fibrillation (AF) is significantly associated with cognitive impairment and dementia, independent of history of clinical stroke, a new meta-analysis has found.
Previous research had highlighted the association between AF and cognitive decline, but it was assumed that this association was mediated through clinical stroke because patients with AF are 4 to 5 times more likely to develop clinical stroke, said lead author Shadi Kalantarian, MD, MPH, research fellow, Massachusetts General Hospital Cardiac Arrhythmia Service, Boston.
"We wanted to know if this association was independent of that stroke history, and we observed that it was," he told Medscape Medical News.
The study, the first to collect and present separate data for dementia and cognitive impairment, provides the most comprehensive evidence to date of the potential effects that AF has on cognition, but also highlights "critical gaps" in understanding the mechanism underlying the association, said Dr. Kalantarian.
The study is published in the March 5 issue of the Annals of Internal Medicine.
21 Studies
Researchers searched 5 large databases — MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE — as well as reference lists, with no language restrictions, for studies that reported the association between AF and cognitive impairment or total dementia.

Dr. Shadi Kalantarian

The analysis included 21 studies representing geographically diverse regions, such as Asia, North and South America, Europe, and Australia. Fourteen studies reported the association between AF and cognitive impairment or dementia in patients with or without a history of stroke, and 7 studies examined the association of AF with cognitive impairment or dementia after stroke.
In a combined analysis of the 14 studies that investigated the association between AF and dementia or cognitive impairment, 9 of which were prospective, AF was significantly associated with the risk for cognitive impairment (relative risk [RR], 1.40; 95% confidence interval [CI], 1.19 - 1.64).
There was significant heterogeneity, however, possibly due to variance in participant characteristics. With use of a random-effects model, pooled estimates were almost the same for prospective and cross-sectional studies.
Heterogeneity was still seen in prospective studies, possibly because of different outcome measures. When the analysis was restricted to dementia outcomes, which are more accurately diagnosed than cognitive impairment, the heterogeneity was eliminated but the association didn't change substantially (RR, 1.38; 95% CI, 1.22 - 1.56).
Limiting the analysis to studies using the Mini-Mental State Examination, the most widely used screening tool for cognitive decline, also did not appreciably change the results.
In the 7 studies reporting cognitive impairment or dementia after a stroke, AF was associated with a more than 2-fold increased risk (RR, 2.70; 95% CI, 1.82 - 4.00).
To evaluate the association independent of stroke history, the investigators did a meta-analysis of studies that either excluded patients with a history of stroke or adjusted for stroke in the multivariate adjusted model. For this analysis, the RR was 1.34 (95% CI, 1.13 - 1.58).
Dr. Kalantarian emphasized that the association was independent of "clinically overt stroke," that is, strokes with which patients had been diagnosed, and that they had reported.
Possible Mechanisms
Shared risk factors, such as hypertension, congestive heart failure, and diabetes, which tend to accumulate as the population ages, might explain the association between AF and cognitive decline. Another explanation could be the hypercoagulable state in patients with AF or stasis of blood in the left atrium that may lead to formation of thrombi in the left atrial appendage and then to stroke.
Other unproven mechanisms, said Dr. Kalantarian, could involve cerebral hypoperfusion — that is, less blood going to the brain might affect cognition — or the proinflammatory state in both AF and dementia.
Perhaps the most plausible explanation is that AF increases the risk for silent infarcts, which would mediate the association between AF and cognitive impairment, said Dr. Kalantarian. However, 1 study in the analysis that excluded patents with a history of stroke with detailed imaging also showed an association between AF and cognitive impairment.
"That's only 1 study in the literature, and it says that there's a gap in our knowledge," said Dr. Kalantarian. "We think that silent infarct is a major contributor, but we can't say that it's 100% the underlying mechanism and that other things are not contributing. It's probably multifactorial; that other factors are contributing as well."
Priority should be given to studies that will elucidate the underlying mechanism, she added.
The authors used several objective criteria to assess the quality of individual studies. Of the 9 prospective studies in the broader population, 6 had "reasonably good quality" in that they matched 5 or 6 of the 7 quality criteria, said Dr. Kalantarian.
However, 6 of the 21 studies met 3 or fewer quality criteria, mainly because of a higher potential for misclassification of AF or outcome, inadequate adjustments for potential confounders, and the presence of attrition bias. Sensitivity analyses that excluded these studies did report similar results, though.
Another possible limitation was that stroke was mostly self-reported or derived from medical records and rarely confirmed by imaging.
The study results warrant further well-designed longitudinal studies with better adjustment for potential confounders and with detailed information on subtype of dementia, according to the authors. As well, clinical trials to evaluate interventions that may lower the risk for cognitive impairment in patients with AF are also needed, they said.
In future trials, "investigators should consider cognitive function as a new outcome to be assessed in interventional studies for the treatment of AF," the authors write.
Critical Question
Asked to comment on these findings for Medscape Medical News, Stefan Knecht, MD, professor, neurology, St. Mauritius Therapieklinik, Meerbusch, Germany, said he's not convinced that the meta-analysis adequately answers the critical question of whether cognitive impairment is linked to something other than stroke in patients with AF.
For one thing, he said, asking patients for their history of stroke is a weak tool because if they have had "silent" strokes, they wouldn't be aware of it, and so would not report it.
. Given the propensity of AF to cause strokes, it's not clear by what means other than some sort of stroke AF would affect brain function, he pointed out.
"There are actually several questions still to be answered," he said. "What kinds of strokes occur in AF to cause cognitive impairment? How much of a problem is this? How much of this is related to the type of treatment patients receive? And what can we do about it?"
The paper simply confirms that a relationship does exist between AF and cognitive impairment, but the authors do little to disentangle possible mechanisms, added Dr. Knecht.
"Could they have done so? I think so. For example, they could have tried to sort out differences in cognitive impairments in patient with versus patients without a history of stroke."
Dr. Kalantarian noted that she and her colleagues didn't have enough data to separate out different domains of cognition.
"The methodology of cognitive assessment is so variable and not many studies look at specific domains of cognitive function," she said. "That's why we were not able to say, for example, that patients with AF are more prone to have executive dysfunction."
Dr. Kalantarian and Dr. Knecht have disclosed no relevant financial relationships.
Ann Intern Med. 2013;158:338-346. Abstract

 

Cost of Alzheimer's disease

Caregivers and healthcare professionals, here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition

Examiner

While cancer and heart disease are the leading killers of Americans, Alzheimer’s disease and other dementia disorders lead in treatment costs. The total annual treatment cost for Alzheimer’s disease in the U.S. is as much as $215 billion, the Associated Press reported April 3.
And what makes Alzheimer’s disease so expensive to treat is not medical care or medications but helping those with the disease simply live their daily lives, according to a new study from the RAND Corp.
“The economic burden of caring for people in the United States with dementia is large and growing larger,” said Michael Hurd, the study’s lead author and a senior economist at RAND, a nonprofit research organization. “Our findings underscore the urgency of recent federal efforts to develop a coordinated plan to address the growing impact of dementia on American society.”
The RAND report also gave a new estimate for how many Americans are living with Alzheimer’s disease: 4.1 million. Previous estimates from the Alzheimer’s Association put the number at about 5.2 million Americans.
Dementia is a chronic disease of aging characterized by progressive cognitive decline that interferes with independent functioning. Alzheimer’s disease is the most common form of dementia and the sixth leading cause of death in the United States.
The direct cost of treating dementias and Alzheimer’s diseases, which includes medications and nursing homes, is about $109 billion annually, the report said.
The cost of caring for heart disease is about $102 billion and cancer about $77 billion.
The informal care for dementia and Alzheimer’s patients by family members and others pushes the total cost of dementia care even higher, reaching as much as $215 billion.
The Rand Alzheimer’s disease study was sponsored by the National Institute on Aging and was published in the New England Journal of Medicine on April 4.
One of the reasons that Alzheimer’s disease is so expensive to treat is because people with dementia disorders live four to eight years on average after diagnosis, while some live for decades — needing specialized care throughout that time.

 

How music helps those with dementia

Activities directors and other healthcare professionals here is a great dementia resource for caregivers and healthcare professinals.

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Huffington Post
Leann Reynolds

Celia shares a picture of herself as a 7-year-old girl. Her young mother is leading her in a dance. Then she pulls out a second photograph, taken one week before her mother passed away from Alzheimer's at the age of 78. In this image, they are dancing again. This time, Celia is leading.

"As soon as I felt her lose herself to Alzheimer's, I would bring in my iTunes and play Spanish music for her," said Mrs. Pomerantz. "Then I could convince her to do anything -- we would dance over to the shower or out to get a meal."

Mrs. Pomerantz intuitively found what experts say is useful tool in helping people with Alzheimer's disease and other forms of dementia.

"Music speaks to a person's feelings, so it is a sensory and not intellectual experience," said Martha Tierney of the Alzheimer's Association. "That is partly why it works -- there is no pressure to understand it and they can just experience it."

Tapping into her mother's lifelong love of salsa music by world-renowned musicians such as Tito Puente, Celia Cruz and Pancho Sanchez, from her native Puerto Rico, Mrs. Pomerantz found a way to interact with her mother even after her mother lost her ability to talk.

"When my mother would hear music, she would give life to the music," she said, adding that her mother became known as the "dancing queen" at her final nursing home. "It brought her back to happy moments of maybe dancing with her own mother, or even her grandmother. It gave her a confidence, peace and serenity." Mrs. Pomerantz chronicled her mother's Alzheimer's in a Kindle book, "Alzheimer's: A Mother Daughter Journey."
While not everyone can rely on a history of family dancing and cultural music, it is important to find out what type of music your loved likes and keep playing it for them.

"I had a client who attacked his wife while they were driving," said Nataly Rubenstein of Alzheimer's Care Consultants in Miami Beach, Florida, explaining that the patient's dementia led him to feel agitated in a car. "It turns out his favorite music was the Bee Gees, and now he sits in the car holding the CD case while listening that music."
After her own mother was diagnosed with Tick's Disease (a form of dementia), Ms. Rubenstein was her primary caregiver for 16 years. She recalled that one day when her mother was in a particularly "nasty" mood, the sound of Tom Jones' "What's Up Pussycat?" on the radio calmed her down.

Despite being an expert in dementia care, Ms. Rubenstein stumbled into this soothing tool to help her mother's combative and belligerent nature, which she said is very pronounced with Tick's disease. However, she cautions caregivers to be extremely sensitive to finding music that their loved one will feel a connection to and not just randomly turn on the radio.

"If it wasn't familiar music to them, then it could aggravate them," she said. (She added half-jokingly: "If I ever get dementia, please dear God, I hope my caregivers don't play rap!")

Alzheimer's robs people of their short-term memory, explained Ms. Tierney, but their long-term memory can remain largely intact. "They maintain vivid memories of the past," she said. "A woman may look at her elderly husband and not recognize him as her husband because he does not look 35 years old anymore. So if you were to play music from that time period it would speak to her current reality."

In addition to finding the right music to soothe a loved one with Alzheimer's, a caregiver needs to also be aware of minimizing other sensory stimulation. "A radio can be too distracting with ads," Ms. Tierney said. "And headphones may work for some, but not others. There should not be a TV on in the same room, or other distracting noise."

That said, many people have found that live music can be particularly welcome for many Alzheimer's patients. This can be in the form of someone singing old camp songs, Christmas carols, church hymns, small symphonies and more.

Find out more about how therapeutic music can be for loved ones with Alzheimer's and other illnesses at the American Music Therapy Association's website, www.musictherapy.org.
"A person with Alzheimer's feels like everything is unfamiliar all of the time," Ms. Tierney said. "Allowing them to spend time with music that they recognize and retain memories of gives them the sense of familiarity in a world that is otherwise extremely confusing."To learn more about treatment options visit Homewatch CareGivers' Pathways to Memory page. Pathways to Memory is a program offered exclusively by Homewatch CareGivers and is comprised of two distinct service options: Specialized Dementia Care and Focused Memory Training.

What Causes Sundowning? Frustration or Chemistry?

Caregivers and healthcare professionals, here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition

Ohio State University

COLUMBUS, Ohio – New research provides the best evidence to date that the late-day anxiety and agitation sometimes seen in older institutionalized adults, especially those with dementia, has a biological basis in the brain.

The findings could help explain “sundowning,” a syndrome in which older adults show high levels of anxiety, agitation, general activity and delirium in late afternoon and evening, before they would normally go to bed.

“It’s a big problem for caregivers.  Patients can get aggressive and very disruptive,” saidTracy Bedrosian, lead author of the study and a doctoral student in neuroscience at Ohio State University.

“There have been a few clinical studies documenting sundowning, but until now there hasn’t been research in animals to see what’s going on in the brain to explain this.”

The new study found that aged mice showed significantly more activity and more anxiety-like behaviors in the hours before they would normally sleep when compared to middle-aged mice – just like sundowning in humans.

In these aged mice, the researchers found changes in parts of their brain associated with attention, emotions, and arousal, all of which could be associated with the behavior seen in sundowning.

In addition, mice that were genetically engineered to have an Alzheimer’s-like disease also showed more anxiety before sleep than did other mice.

“Some people have argued that sundowning could be explained just by a buildup of frustration of older people who couldn’t communicate their needs over the course of the day, or by other factors,” said Randy Nelson, co-author of the study and professor of neuroscience and psychology at Ohio State.

“But our findings suggest there is a real phenomenon going on here that has a biological basis.”

The study will appear in the online Early Edition of the Proceedings of the National Academy of Sciences.

In the first experiment, researchers compared middle-aged adult mice (7 months old) with aged mice (29 months old) that would resemble humans in their 80s.

Results showed that the aged mice were significantly more active than middle-aged mice in the two to three hours before they would normally go to sleep.

“The middle-aged mice had a distinct pattern of activity, with three peaks of activity during their waking hours,” Bedrosian said.

“But the aged mice had a flattened rhythm in which they showed the same level of activity throughout their active period.”

That means that in the evening, when the middle aged mice would slow down compared to their peak activity levels, the aged mice kept going.

The mice were also tested for anxiety-like behaviors at two different times during their waking hours.  The mice were placed in a maze where they were allowed to explore open areas – which are more anxiety-producing – or hide in enclosed areas.

The middle-aged mice showed consistent levels of anxiety at both times of the day.  However, the aged mice showed more anxiety when tested soon before they would have gone to sleep, which is consistent with sundowning, Bedrosian said.

There were also differences in the brains of the aged mice when compared to the middle aged mice.  The researchers looked specifically at the cholinergic system, because loss of function in that system is associated with dementia and many of the circadian changes associated with ageing.

Findings in aged mice showed greater expression of a certain enzyme – acetylcholinesterase – before sleep than earlier in the day.  High levels of this enzyme are associated with anxiety and agitation.

However, in the middle-aged mice, there were no time-of-day differences in the expression of this enzyme.

Nelson noted that drugs used to control levels of acetylcholinesterase are sometimes used on dementia patients, although there has been no research evidence that it actually had an effect on sundowning.

“These drugs were prescribed for other purposes, but it also seemed to calm patients down.  Now we have some evidence on why it works,” Nelson said.

The researchers also found differences in expression of two other proteins in the brains of the aged mice that are also associated with behavioral disturbances.

“All of these results converge to suggest there are changes in the cholinergic systems of aged mice that may be contributing to the anxiety and agitation symptoms that we documented,” Bedrosian said.

In another experiment, the researchers used mice that were genetically engineered to develop Alzheimer’s-like disease in their brain.  They were compared, at nine months of age, to similar wild-type mice of the same age.

The Alzheimer’s-like mice showed more anxiety-type behaviors when tested before they would normally sleep than they did when tested earlier in their waking period.  That is consistent with sundowning in humans, the researchers said.

However, the wild-type mice showed no differences in anxiety levels based on the time of day they were tested.

Nelson said one of the theories about sundowning is that it is tied to disruptions that often occur in the biological clocks of older people, where their sleep-wake cycles are fragmented.

To test this theory, the researchers also treated the aged mice with melatonin for four weeks in order to help consolidate their circadian rhythms.  However, this treatment did not work to reduce anxiety issues in the mice.

Nelson said melatonin alone may not work because it doesn’t deal with the disruptions in the cholinergic system that was identified in this study.

“We need to study whether treating cholinergic dysfunction alone or in combination with melatonin treatment will help deal with sundowning symptoms,” he said.

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SOURCE:
The Ohio State University

Best pain relieving devices for those with dementia

Dementia healthcare professionals, other healthcare professionals and caregivers, here is some information you will find useful for clients and loved ones with dementia as well as others you might care for.

 

There are times that a person with dementia may be in pain and they have trouble or are resistive to taking medication. One way to relieve their pain is to use an LGMedSupply Muscle Stimulators , Ultrasound Units and/or Tens Unit for relief of pain for you or for someone you care for who needs pain relief and/or rehabilitation. 

 

These devices are relatively easy to use, cost effective and do not require the patient or loved one swallow any pills which as you know can be difficult for a patient to take especially if they have dysphagia (swallowing difficulties).

 

LGMedical Supply Company is easy to deal with because they have a wide variety of the latest and greatest pain relieving supplies. They are always adding products because they have an excellent research and development team. They do not charge unreasonable rates and they are always having specials on their products. Besides this, they stand by their products, and they have an excellent customer service department. Employees of LGMedical are always willing to share product information so you can choose the right products for you, your clients or your loved one.