dementia views you can use: June 2018

Saturday, June 30, 2018

How to help those with dementia with their medications

Aston University: www.aston.ac.uk

Study reveals patients often struggle to manage their drug regime
Community pharmacists could be used more to support patients and carers
Some carers find the responsibility of their role stressful

New research funded by Pharmacy Research UK, reveals people with dementia may struggle with managing their medication – exposing them to side-effects, medication errors and an increased risk of non-adherence to drug treatment.

Researchers at Aston University, Hull University and the UEA interviewed family carers, people with dementia, nurses, GPs and community pharmacists for the project.

Their year-long research found that as dementia develops the person struggles to manage their own medication and increasingly relies on support from family carers. This is often their partner, who may also be taking many medicines and finding the carer role stressful, thus increasing the risk of medication error.

The study showed that for some carers this was a real burden of responsibility and that they hid their anxieties.

Lead researcher Dr. Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston said: “Our study found incorrect dosing, forgetting to give the medication and taking medicines which should have been stopped.”

Professor Chris Fox, Consultant Old Age Psychiatrist from UEA’s Norwich Medical School said: “There can be severe health impact for both the patient and carer - too often in my clinical practice I come across patients and families overburdened and unclear about their medication regimes. This can result in more visits to their GP and hospital and is a cause of avoidable NHS admissions.”

Dr. Andrea Hilton from Hull University added: “There is a substantial role for community pharmacists and their teams to assist carers; many pharmacists have day-to-day contact both with carers and people with dementia. Community pharmacy is in a unique position to support and embrace patient-centred care and this is currently under-utilised. This research highlights that community pharmacists should be working more with GP practices and have full access to patients’ medical records. Furthermore, home visits should be conducted for medication reviews.” Barbara Woodward-Carlton a former carer and a member of the Alzheimer’s Society Research Network highlighted: “During the years I looked after my mother who had Alzheimer's disease I wish I had known what help I could have had from community pharmacists.

“My mother was an extremely pleasant person who always wanted to co-operate but found it incomprehensible that she should be taking any medication at all. At one point when she was very ill, I continued the medication she had been given including 'water tablets' without realising that she was dehydrated..."
"I live with the shame of not knowing that as she was barely drinking and eating I should have stopped that medication. I welcome that community pharmacists are increasingly seen as those who can advise, educate and help those of us who care for others."

Dr. Clare Walton, Research Manager at Alzheimer’s Society said: “Seven in 10 people with dementia are also living with other health conditions and managing multiple medications which can be a tremendous challenge. Finding new and innovative ways to support people with dementia and their carers to safely and correctly age their medication is a focus for future research.”

Dr. Maidment added: “People with dementia are amongst the most vulnerable members of society and need more support with medication management. We need to develop new ways of supporting people with dementia manage their management and then test how well these new ways work.”

Reference Article: A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist, Ian D. Maidment PhD, Lydia Aston MA, Tiago Moutela MA, Chris G. Fox MBBS Bsc Mmmedsci MRCPsych MD, Andrea Hilton PhD, Health Expectations>, doi: 10.1111/hex.12534, published 19 January 2017.

About the study

A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist is published in the journal Health Expectations.
The research was funded by Pharmacy Research UK (PRUK), the principal funder of pharmacy research in the UK. Founded as a result of a merger in 2012 of two previous research funding charities, PRUK has a broad programme of research in place. PRUK funds both research projects and individual bursaries to improve skills across the pharmacy sector. More information is on their website www.pharmacyresearchuk.org
The National Institute for Health Research (NIHR) Dementias Writing Group support was critical to develop this research. The NIHR Dementias Writing Groups are a central component of the framework for co-ordinating and supporting dementia research in the UK. The groups provide a route through which new ideas for clinical studies are developed.
Anyone interested in registering their interest in participating in other dementia research studies can sign up to Join Dementia Research online at www.joindementiaresearch.nihr.ac.uk

About Aston University

Founded in 1895 and a University since 1966, Aston University has been always been a force for change. For 50 years the University has been transforming lives through pioneering research, innovative teaching and graduate employability success. Aston is renowned for its opportunity enabler through broad access and inspiring academics, providing education that is applied and has real impact on all areas of society, business and industry. True to Aston’s Coat of Arms which bears the word ‘Forward’, in 2016 Aston held a year-long anniversary celebration to recognise its heritage and achievements, but with a focus to drive forward the next stage in the University’s exciting journey. www.aston.ac.uk/50
Aston's Vice Chancellor and Chief Executive, Professor Alec Cameron, is the principal academic and executive officer of the University. Alec has overall responsibility for Aston's executive management and day-to-day direction.

SOURCE:

Aston University: www.aston.ac.uk

Tuesday, June 26, 2018

Wake up the brain

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]

Studies show this 5-minute workout wakes up your brain cells by exercising the important muscles in your body. Rated as one of the best exercises for the 50+ age group, this series is low-impact and highly effective. Go ahead, it's easy!

Brain fitness is closely correlated with keeping fit with regular exercise. This fitness workout plan will give you the best way to start the day. It will help you to get fit; you will feel more alert and ready for whatever other keep fit plans you have. And the bonus is that you will be brain fit for life, too

Customize your use of this video so that it works best for you. Start and stop it a few times wherever it feels right until you have the routine in your mind. Once you have the routine, it will take only 5 minutes.

This is a great way to get a simple yet complete workout in just 5 minutes a day.

http://brainandmemoryfoundation.org

Why use Workout Exercises for Fitness?

This best fitness workout plan isn't strenuous
You don't need special clothes
The keep-fit exercises are a great wake-up for your brain
And the fitness workout is suitable for all ages -- and fantastic for the over-50's!

This program seems simple -- and it is. But the series of fitness exercises is designed to get each of the major muscle groups engaged and active -- just what you need for a fitness workout that will keep you fit for life. It isn't a weight loss program but it will give you the energy to start on that if that is what you are looking for.

Try it even if you are not as active now as you once were. Life experiences differ and some folk can't do the standing parts anymore. Well, no worries -- just do the arm exercises and most of the leg exercises sitting down. You are still achieving a lot and you will feel much better for the few minutes spent on these exercises for fitness. You can even do the 'lying down' ones in bed!

You don't have to accept memory loss as a way of life! Exercise is a key factor in brain health. Want to see some solid research showing how exercise improves memory? Go to the "Pick a Topic" box in the right column and click on "Exercise".

If you prefer a written copy of the Workout Exercises for Fitness, go to http://brainandmemoryfoundation.org.

The Brain and Memory Foundation was established by Dr. Allison Lamont and Gillian Eadie to help the over-50 age group build more brain connections as a buffer against dementia and Alzheimer's disease.

Sunday, June 24, 2018

How to survive being a caregiver

As “aging in place” becomes part of the new-millennial zeitgeist, seniors, as well as Alzheimer’s and Parkinson’s patients, are choosing to stay at home as long as doing so is feasible and safe.

Even those who are able to remain living independently still rely on a minimum of assistance from neighbors or family members to perform the activities of daily living. As a result of this trend in growing older, the “caregiver” has become a popular substitute for serious medical assistance in the home.

A caregiver is anyone who provides help to another person in need such as an ill spouse or partner, a disabled child, or an aging relative. However, family members who are actively caring for an older adult often don’t self-identify as a “caregiver.” Recognizing this role can help caregivers receive the support they need.

Caregiving can offer many rewards. For most caregivers, being there when a loved one needs them is a core value and something many wish to provide.

But a shift in roles and emotions is almost certain. It is natural to feel angry, frustrated, exhausted, alone or sad. Caregiver stress — the emotional and physical stress of caregiving — is common.

Factors like having fewer years of formal education, living with the person for whom they are caring, social isolation and depression are often the beginnings of a syndrome known as “caregiver stress.”

The emotional and physical demands involved with caregiving can strain even the most resilient person. That’s why it’s important to take advantage of the many resources and tools available to help provide care for loved ones. When performing such life-giving tasks, it is difficult to remember that without taking care of oneself, taking care of anyone else is unhealthy and even impossible.

The National Institute on Aging shared ways to alleviate the stress incurred when taking care of a loved one. Some of those suggestions follow.

Accept help. Be prepared with a list of ways that others can help you, and let the helper choose what he or she would like to do. For instance, a friend may offer to take the person you care for on a walk a couple of times a week. Or a friend or family member may be able to run an errand, pick up your groceries or cook for you.

Focus on what you are able to provide. It’s normal to feel guilty sometimes, but understand that no one is a perfect caregiver. Believe that you are doing the best you can and making the best decisions you can at any given time.

Set realistic goals. Break large tasks into smaller steps that you can do one at a time. Prioritize. Make lists and establish a daily routine. Begin to say no to requests that are draining, such as hosting holiday meals.

Get connected. Find out about caregiving resources in your community. Many communities have classes specifically about the disease your loved one is facing. Caregiving services such as transportation, meal delivery or housekeeping may be available.

Join a support group. A support group can provide validation and encouragement as well as problem-solving strategies for difficult situations. People in support groups understand what you may be going through. A support group can also be a good place to create meaningful friendships.

Seek social support. Make an effort to stay well-connected with family and friends who can offer nonjudgmental emotional support. Set aside time each week for connecting, even if it’s just a walk with a friend.

Set personal health goals. For example, set goals to establish a good sleep routine, find time to be physically active on most days of the week, eat a healthy diet and drink plenty of water.

Many caregivers have issues with sleeping. Not getting quality sleep over a long period of time can cause health issues. If you have trouble getting a good night’s sleep, talk to your doctor.

See your doctor. Get recommended vaccinations and screenings. Make sure to tell your doctor that you’re a caregiver. Don’t hesitate to mention any concerns or symptoms you have.

Respite Care

It may be difficult to leave a loved one in someone else’s care, but it’s often necessary. In-home respite care might be able to send a caregiver on a regular basis to allow the primary caregiver time away from the home, or to rest or take care of personal business.

There are also adult centers that provide daily schedules of care and activity oriented events designed for adults with constant care requirements. Some of these facilities also care for children, and combining the two groups can be beneficial for both.

Short-term nursing homes might also be an option. Some memory care facilities and nursing homes accept short-term patients while the primary caregiver is away.

Sue Lamborn, Outreach and Community Relations Manager for Thrive Alliance, offered a simple plan to alleviate caregiver stress.

“Remember that you are not alone. There are resources out there designed to take care of the caregivers, and sometimes caregiving is the hardest job. People just don’t realize how taxing it can be,” she said.

Friday, June 22, 2018

Rights of those with dementia

Bupa

The Global Dementia Charter outlines the self-evident rights of people living with dementia. Watch this video on these 10 most basic rights. Then download the charter entitled, 'I Can Live Well with Dementia'.

As the largest international provider of specialist dementia care, and the only international federation of Alzheimer associations and global voice on dementia, Bupa and the Alzheimer's Disease International intend to revolutionize care and to campaign to ensure people living with dementia live well, and that their family and friends are properly supported.

That is why we have joined forces to outline, for the first time, what we believe are the rights of people living with dementia, wherever they are in the world. Our joint Global Dementia Charter has been written for, and endorsed by, people living with the condition.

We are committed to shaping global dementia care and having people living with dementia lead happier lives, for as long as they can. That is our vision. This is our purpose.

Downloads:

The charter

Enablers

Booklet

SOURCE:

Bupa

Wednesday, June 20, 2018

Facetime for dementia

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]

American Academy of Neurology (AAN)

WHEN DIAGNOSING DEMENTIA, NEUROLOGISTS KNOW that nothing is as important as spending time face-to-face. Understanding symptoms and clinical clues in exams are the critical aspects of neurology. Learn how America's healthcare system holds up to this standard.

Most neurologists provide face-to-face care of neurology patients, many of whom have complex condition such as Alzheimer's disease, epilepsy and Parksinson's disease -- diseases that require extensive evaluation and management. However, a new study published in Neurology, the medical journal of the American Academy of Neurology, finds face-to-face care by neurologists is severely undervalued by Medicare and reimbursed at a substantially lower rate than what Medicare pays doctors for performing tests and procedures.

"Spending time understanding patient's symptoms and performing a detailed examination are the critical aspect of neurology -- nothing else is more important," states study author Kevin A. Kerber, MD, of the University of Michigan Health System and a member of the American Academy of Neurology. "There are new policies that incentivize this work for physicians, but these policies specifically exclude neurologists -- which could be a big missed opportunity to improve neurologic care in the United States."

The study reviewed all Medicare payments to neurologists in 2012 based on physician payment data that was released publicly for the first time in April 2014. The study found that 60 percent of Medicare payments to neurologists was for evaluation and management (E/M) services. Evaluation and management services are used in diagnosing complex conditions, selecting appropriate tests and treatments, and following up with patients with chronic conditions. E/M services are generally not reimbursed as highly as procedural services, which include performing or interpreting tests or conducting procedures, such as taking a biopsy.

"We wanted to use this Medicare data to assess whether neurologists should be considered E/M-based doctors or procedure-based doctors. These data were very clear that neurologists are E/M-based providers -- which fits well with the neurology community's longstanding emphasis on the history, talking to patients, and examination. Exactly why neurologists were not included but some other specialties were is not clear."

Neurologists receive a higher proportion of their payments from E/M services than surgical specialties, which had a range of 9 percent to 51 percent of payments from E/M services, but a lower proportion than primary care providers, which had about 85 percent of payments for E/M services.

"These data highlight the problem neurologists had with the Affordable Care Act's Primary Care bonus, which gave a 10 percent bonus payment to physicians with E/M codes for at least 60 percent of their charges -- yet neurologists were not included in this program," said Neil A. Busis, MD, of the University of Pittsburgh School of Medicine, who wrote a corresponding editorial and who is a Fellow of the American Academy of Neurology. "Two-thirds of neurologists met this threshold in 2012, and would have been included if the policy incentivized physicians by what services they provide rather than by their specialty."

"The new policies mean that a provider who refers their patient to a neurologist for their expertise could receive a higher payment for the service than the neurologist -- even if the neurologist takes more time on the history and examination, and improves the patient's symptoms," said Kerber. "I'm not sure we want these imbalances in payments per service."

Kerber noted that a previous study showed that the demand for neurologists is growing as an aging population increases the rate of diseases such as dementia and stroke. "Estimates suggest that the US could use 11 percent more neurologists right now, and that shortfall is projected to grow to 19 percent by 2025," Kerber said.

The current study found that the median neurologist received nearly 75 percent of Medicare payments from E/M services. More than 20 percent of neurologists received all of their Medicare payments from E/M services. Neurologists made up 1.5 percent of all providers, and received 1.8 percent of all payments.

MORE INFORMATION:

An AAN employee was a co-author on the study, but the study was not sponsored by the AAN. Neil A. Busis, the editorial author, is a member of the AAN Board of Directors.

SOURCE:

American Academy of Neurology (AAN)

Reference:

L. E. Skolarus, J. F. Burke, B. C. Callaghan, A. Becker, K. A. Kerber. Medicare payments to the neurology workforce in 2012. Neurology, 2015; DOI:10.1212/WNL.0000000000001515

Monday, June 18, 2018

More good news about chocolate that is dark

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]

Loma Linda University Health
New studies show dark chocolate improves memory & mood, boosts immunity and reduces stress as well as inflammation.

LOMA LINDA, CA — Findings from two studies show that consuming dark chocolate that has a high concentration of cacao (minimally 70% cacao, 30% organic cane sugar) has positive effects on:

Stress levels
Inflammation
Mood
Memory
Immunity.

Effects of a Regular-Sized Chocolate Bar

“For years, we have looked at the influence of dark chocolate on neurological functions from the standpoint of sugar content - the more sugar, the happier we are," said Dr. Lee Berk.

While it is well known that cacao is a major source of flavonoids, this is the first time the effect has been studied in human subjects to determine how it can support cognitive, endocrine and cardiovascular health.

Lee S. Berk, DrPH, , served as principal investigator on both studies. Dr. Berk is associate dean of research affairs, School of Allied Health Professions and a researcher in psychoneuroimmunology and food science from Loma Linda University.

"Positive Impact"

Berk added, "This is the first time that we have looked at the impact of large amounts of cacao in doses as small as a regular-sized chocolate bar in humans over short or long periods of time, and are encouraged by the findings. These studies show us that the higher the concentration of cacao, the more positive the impact on cognition, memory, mood, immunity and other beneficial effects.”

The flavonoids found in cacao are extremely potent antioxidants and anti-inflammatory agents, with known mechanisms beneficial for brain and cardiovascular health. The following resultswere presented in live poster sessions during the Experimental Biology 2018 meeting.

Two Studies on Dark Chocolate with 70% Cacao

These results were based on two important studies:

Dark Chocolate (70% Cacao) Effects Human Gene Expression: Cacao Regulates Cellular Immune Response, Neural Signaling, and Sensory Perception

· This pilot feasibility experimental trial examined the impact of 70 percent cacao chocolate consumption on human immune and dendritic cell gene expression, with focus on pro- and anti-inflammatory cytokines. Study findings show cacao consumption up-regulates multiple intracellular signaling pathways involved in T-cell activation, cellular immune response and genes involved in neural signaling and sensory perception - the latter potentially associated with the phenomena of brain hyperplasticity.

Dark Chocolate (70% Organic Cacao) Increases Acute and Chronic EEG Power Spectral Density (μv2) Response of Gamma Frequency (25-40Hz) for Brain Health: Enhancement of Neuroplasticity, Neural Synchrony, Cognitive Processing, Learning, Memory, Recall, and Mindfulness Meditation

· This study assessed the electroencephalography (EEG) response to consuming 48 g of dark chocolate (70% cacao) after an acute period of time (30 mins) and after a chronic period of time (120 mins), on modulating brain frequencies 0-40Hz, specifically beneficial gamma frequency (25-40Hz). Findings show that this superfood of 70 percent cacao enhances neuroplasticity for behavioral and brain health benefits.

Berk said the studies require further investigation, specifically to determine the significance of these effects for immune cells and the brain in larger study populations. Further research is in progress to elaborate on the mechanisms that may be involved in the cause-and-effect brain-behavior relationship with cacao at this high concentration.

SOURCE:

Loma Linda University Health
Loma Linda University Health includes Loma Linda University's eight professional schools, Loma Linda University Medical Center's six hospitals and more than 900 faculty physicians located in the Inland Empire of Southern California. Established in 1905, Loma Linda University Health is a global leader in education, research and clinical care. It offers over 100 academic programs and provides quality health care to over 40,000 inpatients and 1.5 million outpatients each year.

Saturday, June 16, 2018

Saunas for dementia prevention

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]

Sauna bathing is inversely associated with dementia and Alzheimer's disease in middle-aged Finnish men. Tanjaniina Laukkanen, Setor Kunutsor, Jussi Kauhanen, Jari Antero Laukkanen. Age and Ageing 2016; 0: 1-5. doi: 10.1093/ageing/afw212

Frequent sauna bathing can reduce the risk of dementia, according to a recent study carried out at the University of Eastern Finland. In a 20-year follow-up, men taking a sauna 4-7 times a week were 66% less likely to be diagnosed with dementia than those taking a sauna once a week. The association between sauna bathing and dementia risk has not been previously investigated.

The effects of sauna bathing on the risk of Alzheimer's disease and other forms of dementia were studied in the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD), involving more than 2,000 middle-aged men living in the eastern part of Finland. Based on their sauna-bathing habits, the study participants were divided into three groups: those taking a sauna once a week, those taking a sauna 2-3 times a week, and those taking a sauna 4-7 times a week.

The more frequently saunas were taken, the lower was the risk of dementia. Among those taking a sauna 4-7 times a week, the risk of any form of dementia was 66% lower and the risk of Alzheimer's disease 65% lower than among those taking a sauna just once a week. The findings were published recently in the Age and Ageing journal.

Previous results from the KIHD study have shown that frequent sauna bathing also significantly reduces the risk of sudden cardiac death, the risk of death due to coronary artery disease and other cardiac events, as well as overall mortality. According to Professor Jari Laukkanen, the study leader, sauna bathing may protect both the heart and memory to some extent via similar, still poorly known mechanisms. "However, it is known that cardiovascular health affects the brain as well. The sense of well-being and relaxation experienced during sauna bathing may also play a role."

Thursday, June 14, 2018

Caregivers- Ask the doctor about these medications

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]

National Institute on Aging
National Institutes of Health NIH...Turning Discovery into Health

There are 2 things that can be said about all FDA-approved medications:

They help many people.
They have side-effects.

The key is to get the right balance. Here is where to start:

Learn the Basics

Know each medicine (prescription and over-the-counter) the person with Alzheimer's disease takes. Ask the doctor or pharmacist:

Why is this medicine being used?
What positive effects should I look for, and when?
How long will the person need to take it?
How much should he or she take each day?
When does the person need to take the medicine?
What if the person misses a dose?
What are the side effects, and what can I do about them?
Can this medicine cause problems if taken with other medicines?

Managing medications is easier if you have a complete list of them. The list should show the name of the medicine, the doctor who prescribed it, how much the person with Alzheimer's takes, and how often. Keep the list in a safe place at home, and make a copy to keep in your purse or wallet. Bring it with you when you visit the person's doctor or pharmacist.

People with Alzheimer's should be monitored when a new drug is started. Follow the doctor's instructions and report any unusual symptoms right away. Also, let the doctor know before adding or changing any medications.

Use Medicines Safely

People with Alzheimer's disease often need help taking their medicine. If the person lives alone, you may need to call and remind him or her or leave notes around the home. A pillbox allows you to put pills for each day in one place. Some pillboxes come with alarms that remind a person to take medicine.

Often, you will need to keep track of the person's medicines. You also will need to make sure the person takes the medicines or give the medicines to him or her.

Some people with Alzheimer's take medicines to treat behavior problems such as restlessness, anxiety, depression, trouble sleeping, and aggression. Experts agree that medicines to treat behavior problems should be used only after other strategies that don't use medicine have been tried. Talk with the person's doctor about which medicines are safest and most effective. With these types of medicines, it is important to:

Use the lowest dose possible
Watch for side effects such as confusion and falls
Allow the medicine a few weeks to take effect

People with Alzheimer's should NOT take anticholinergic drugs. These drugs are used to treat many medical problems, such as sleeping problems, stomach cramps, incontinence, asthma, motion sickness, and muscle spasms. Side effects can be serious for a person with Alzheimer's. Talk with the person's doctor about other, safer drugs.

Other Safety Tips

Some people, especially those with late-stage Alzheimer's, may have trouble swallowing pills. In this case, ask the pharmacist if the medicine can be crushed or taken in liquid form. Other ways to make sure medicines are taken safely:

Keep all medications locked up.
Check that the label on each prescription bottle has the drug name and dose, patient's name, dosage frequency, and expiration date.
Call the doctor or pharmacist if you have questions about any medicine.

For information about medicines to treat Alzheimer's disease, see the "Alzheimer's Disease Medications Fact Sheet."