Important in dementia diagnosis

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University of Kentucky

DIAGNOSING DEMENTIA: Find out how people diagnosed with Alzheimer's may lack Alzheimer's plaques and actually have P.A.R.T. Dementia. (That is, Primary Age-Related Tauopathy, or PART for short). Learn why this matters in treatment & research.

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LEXINGTON, Ky — A multi-institutional study has defined and established criteria for a new neurological disease closely resembling Alzheimer’s disease called primary age-related tauopathy (PART). Patients with PART develop cognitive impairment that can be indistinguishable from Alzheimer’s disease, but they lack amyloid plaques. Awareness of this neurological disease will help doctors diagnose and develop more effective treatments for patients with different types of memory impairment. 

The study, co-led by Peter T. Nelson, MD, PhD, of the University of Kentucky's Sanders-Brown Center on Aging, and John F. Crary, MD, PhD, of Mount Sinai Hospital, was published in the journal Acta Neuoropathologica.

Yes Tangles, No Plaques

“To make an Alzheimer's diagnosis you need to see two things together in a patient’s brain: amyloid plaques and structures called neurofibrillary tangles composed of a protein called tau,” said Dr. Nelson, a professor of neuropathology at the University of Kentucky's Sanders-Brown Center on Aging. “However, autopsy studies have demonstrated that some patients have tangles but no plaques and we’ve long wondered what condition these patients had.” 

Plaques in the brain, formed from the accumulation of amyloid protein, are a hallmark of Alzheimer’s disease. Until now, researchers have considered cases with only tangles to be either very early-stage Alzheimer’s or a variant of the disease in which the plaques are harder to detect. However, previous in-depth biochemical and genetic studies have failed to reveal the presence of any abnormal amyloid in these patients. Although tangle-only patients can have memory complaints, the presence of plaques is a key requirement for an Alzheimer’s diagnosis.

No Plaque? You're PART

In the current study, investigators from the United States (including five from Sanders-Brown), Canada, Europe, and Japan came together to formalize criteria for diagnosing this new neurological disorder. The study establishes that PART is a primary tauopathy, a disease directly caused by the tau protein in tangles. Many of the neurofibrillary tangles in Alzheimer’s brain, in contrast, are thought to arise secondarily to amyloid or some other stimuli. The researchers propose that individuals who have tangles resembling those found in Alzheimer's but have no detectable amyloid plaques should now be classified as PART.

PART is most severe in patients of advanced age, but is generally mild in younger elderly individuals. The reason for this is currently unknown, but unlike Alzheimer’s disease, in which the tangles spread throughout the brain, in PART cases the tangles are restricted mainly to structures important for memory.

It is too early to tell how common PART is, but given that tangles are nearly universal in the brains of older individuals, it might be more widespread than generally recognized. While further studies are required, new diagnostic tests using brain scans and cerebrospinal fluid biomarkers for amyloid and tau are finding surprisingly high proportions of patients (as many as 25% in some studies) with mild cognitive impairment that are positive for tau but negative for amyloid.

DIAGNOSING PART: More Targeted Therapy, Improved Accuracy

“Until now, PART has been difficult to treat or even study because of lack of well-defined criteria,” said Dr. Nelson. “Now that the scientific community has come to a consensus on what the key features of PART are, this will help doctors diagnose different forms of memory impairment early. These advancements will have a big impact on our ability to recognize and develop effective treatments for brain diseases seen in older persons.”

Identifying the type of neurological disorder in the early stages of disease is critical if treatment is to begin before irreparable brain damage has occurred. However, in the absence of clear criteria, different forms of neurological disorders have been hard to distinguish. As a result, PART patients may have confounded clinical trials of amyloid-targeting drugs for Alzheimer’s disease as these treatments are unlikely to be effective against tangles. Along with the development of better biomarkers and genetic risk factors for dementia, the new diagnosis criteria will help PART patients to receive more targeted therapy and improve the accuracy of clinical trials for Alzheimer’s drugs. 

SOURCE: 
University of Kentucky

MORE INFORMATION:
The University of Kentucky’s Sanders-Brown Center on Aging http://www.centeronaging.uky.eduwas established in 1979 and is one of the original ten National Institutes of Health (NIH)-funded Alzheimer’s disease Research Centers. The SBCoA is internationally acclaimed for its progress in the fight against illnesses facing the aging population. 

The article is titled, “Primary age-related tauopathy (PART): a common pathology associated with human aging.” The other contributors are: John Q. Trojanowski, Steven E. Arnold, Jonathan B. Toledo, Juan C. Troncoso (University of Pennsylvania); Julie A. Schneider (Rush University Medical Center); Jose F. Abisambra, Erin L. Abner, Gregory A. Jicha, Janna H. Neltner, Masahito Yamada (University of Kentucky); Irina Alafuzoff (Uppsala University); Johannes Attems (Newcastle University); Thomas G. Beach (Banner Sun Health Research Institute); Eileen H. Bigio (Northwestern University); Nigel J.Cairns, Walter A. Kukull, Thomas J. Montine (University of Washington); Dennis W. Dickson, David S. Knopman, MelissaE. Murray (Mayo Clinic); Marla Gearing (Emory University); Lea T. Grinberg (UC San Francisco and University of Sao Paulo); Patrick R. Hof (Mount Sinai); Bradley T.Hyman (Harvard Medical School); Kurt Jellinger (Institute of Clinical Neurobiology, Vienna); Gabor G. Kovacs (Medical University Vienna); Julia Kofler (University of Pittsburgh); Ian R. Mackenzie (University of British Columbia); Eliezer Masliah (University of California, San Diego); Ann McKee (Boston University); Ismael Santa-Maria, Michael L. Shelanski, Jean Paul Vonsattel (CUMC); William W. Seeley (UC San Francisco); Alberto Serrano-Pozo (University of Iowa); Thor Stein (VA Medical Center & Boston University); Masaki Takao (Tokyo Metropolitan Geriatric Hospital); Dietmar R. Thal (University of Ulm; Charles L. White 3rd (University of Texas); Thomas Wisniewski (New York University); and Randall L. Woltjer (Oregon Health Sciences University).

The study was supported by grants from: the Society for Supporting Research in Experimental Neurology, Vienna, Austria; the National Institutes of Health; Medical Research Council ; National Institute for Health Research ; the Dunhill Medical Trust; Alzheimer's Research UK (ARUK), and the Alzheimer's Society, Louis V. Gerstner, Jr., Foundation; Alzheimer’s Association, FP7 EU Project Develage, Comprehensive Brain Research Network, Grant-in-Aid for Scientific Research, and Daiwa Health Science Foundation, BrightFocus Foundation, Alzheimer’s Association NIRGD-12- 242642, Alzheimer Forschung Initiative; German Ministry for Research and Education (BMBF) FTLD-Net, Robert H. and Clarice Smith and Abigail Van Buren Alzheimer’s Disease Research Program of the Mayo Foundation.

Dementia communication tips

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SunriseSeniorLiving.com 

Good communication is critical when families and friends get together. Communicating may be difficult between people with memory-loss and their loved ones. Check out these 5 helpful communication tips and books. 

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The following tips can help make communications with those experiencing memory loss meaningful:

1. Center yourself. As soon as you start to get upset or frustrated, stop and concentrate on taking deep, slow breaths while focusing on something that makes you feel calm and collected.
   
2. Use empathy. Using empathy to connect includes focusing on the experience of your loved one with memory loss. It is important to connect with their feelings, rather than the context of their words.
   
3. Enter their world. Unless your loved one is in the very early stage of memory loss and wants to be reminded of a date, time or other reality based topic, join their journey rather than force reality on them.
   
4. Ask open questions. Use open-ended questions to redirect the conversation and to show that you’re interested in exploring what is important to them. For example, if your loved one is insisting on visiting their deceased mother, rather than reminding them that she passed away, ask her to tell you about her mother and listen with empathy as she expresses her feelings.
   
5. Try asking the extreme. Asking the extreme means that you ask the person to tell you the best or worst thing about what they are expressing.

Make cognitive ability better

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• National Institutes of Health, by Tianna Hicklin, Ph.D

NEW RESEARCH:

Improving brain vessel-drainage in the lab enhanced cognitive abilities. Disrupting it increased buildup of Alzheimer’s proteins. Learn why researchers see this as a potentially good way to combat the cognitive decline seen in aging and Alzheimer's.

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At a Glance

• Researchers found that the waste clearing vessels in the brain don’t work as well as mice age, leading to waste buildup.
• Improving vessel drainage in older mice enhanced their cognitive abilities, while disrupting these vessels increased buildup of Alzheimer’s disease-related proteins.
• These results suggests a possible way to combat the cognitive decline seen in aging and age-related diseases.

The body clears waste and fluid from tissues through a system called the lymphatic system. Lymph is the colorless fluid in specialized vessels that carries immune cells and waste like toxic compounds and cellular debris. Waste is filtered out of lymph as it passes through lymph nodes. The lymph then goes back into the bloodstream. 

It was long thought that the brain didn't have a lymphatic system and instead relied solely on waste slowly diffusing from brain tissue into the cerebral spinal fluid. This system, managed by brain support cells called glial cells, is called the glymphatic system.

Recently, researchers found conventional lymphatic vessels in the meninges, the tissue that covers the brain. These vessels surround blood vessels in the meninges, allowing waste products from the cerebral spinal fluid to drain out. 

Previous studies have shown that aging can lead to protein buildup in the brain. Buildup of a protein called amyloid-beta is a hallmark of Alzheimer’s disease. A team lead by Drs. Sandro Da Mesquita and Jonathan Kipnis at the University of Virginia in Charlottesville set out to investigate the role of the brain’s lymphatic system in the buildup of proteins in the brain. Their research was supported by NIH’s National Institute of Aging (NIA). Results were published in Nature on August 9, 2018.

Disrupting Garbage Disposal Impairs Learning & Memory

Obstructing lymphatic vessels (green) in a mouse model of Alzheimer’s disease significantly increased buildup of harmful amyloid-beta (red) in the brain. Left panels, control mouse; right, after disruption of lymphatic vessels. Top panels, meninges; bottom, hippocampus region.Kipnis lab

The team studied disrupted lymph vessels in the meninges of young mice using three different methods. Each led to decreased drainage of large molecules from the cerebral spinal fluid into lymph nodes. Mice with impaired lymphatic vessels also had reduced movement of large molecules from the cerebral spinal fluid into certain areas of the brain involved in learning and memory. Notably, mice whose meningeal lymph vessels were disrupted showed reduced spatial learning and memory abilities compared with healthy mice. 

The researchers then compared the brain waste systems of older mice with younger mice. They found that the lymphatic vessels were narrower in the older mice and that molecules did not drain out of the cerebral spinal fluid into the lymph nodes as well.

Giving Lymphatic Vessels a Boost

The researchers boosted lymphatic function in both the younger and older mice with methods that increased the diameter of the lymphatic vessels and increased cerebral spinal fluid drainage. However, only the older mice showed improved cognitive function. 

Impairing brain lymphatic vessels in two different young mouse models of Alzheimer’s disease led to higher levels of amyloid-beta deposits in the meninges. This suggested that impaired lymphatic vessels might be a previously unappreciated factor in development of Alzheimer’s disease. Therefore, the researchers performed a postmortem analysis on the brains of nine people who’d had Alzheimer’s disease and eight without the disease. They found amyloid-beta deposits in the meninges of the Alzheimer’s patients, similar to what was seen in the mice with impaired lymphatic vessels.

Maintain High Brain Functionality

“It may be very difficult to reverse Alzheimer’s, but maybe we would be able to maintain a very high functionality of this lymphatic vasculature to delay its onset to a very old age,” Kipnis says. 

More research is needed to determine whether altering lymphatic vessels in people would have any benefit. 

SOURCE:

• National Institutes of Health, by Tianna Hicklin, Ph.D

Mind and body diet

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• Frontiers news release, via EurekAlert.

18 diet studies showed the Mediterranean Diet improved cognition and fought Alzheimer's in countries around the world. No matter what your age, see why the Mediterranean Diet can help keep your brain healthy. 

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Eating a Mediterranean diet can slow down cognitive decline.

The diet can improve your mind (as well your heart), shows a study published in the open-access journal Frontiers in Nutrition. 

Following a Mediterranean diet was shown to be associated with slower rates of cognitive decline, reduced conversion to Alzheimer's, and improvements in cognitive function.

The main foods in the Mediterranean diet (MedDiet) include plant foods, such as leafy greens, fresh fruit and vegetables, cereals, beans, seeds, nuts, and legumes. The MedDiet is also low in dairy, has minimal red meat, and uses olive oil as its major source of fat.

Leading author Roy Hardman from the Centre for Human Psychopharmacology Swinburne University of Technology Melbourne Australia and his colleagues evaluated all the available papers between 2000-2015 that investigated if and how a MedDiet may impact cognitive processes over time. In total, 18 out of the 135 articles met their strict inclusion criteria.

Most Surprising Result

"The most surprising result was that the positive effects were found in countries around the whole world. So regardless of being located outside of what is considered the Mediterranean region, the positive cognitive effects of a higher adherence to a MedDiet were similar in all evaluated papers;" he said.

Attention, memory, and language improved. Memory, in particular, was positively affected by the MedDiet including improvements in: delayed recognition, long-term, and working memory, executive function, and visual constructs.

Slowing Cognitive Decline

"Why is a higher adherence to the MedDiet related to slowing down the rate of cognitive decline? The MedDiet offers the opportunity to change some of the modifiable risk factors," he explained.

"These include reducing inflammatory responses, increasing micronutrients, improving vitamin and mineral imbalances, changing lipid profiles by using olive oils as the main source of dietary fats, maintaining weight and potentially reducing obesity, improving polyphenols in the blood, improving cellular energy metabolism and maybe changing the gut micro-biota, although this has not been examined to a larger extent yet."

Cognitive Benefits to All Ages

Moreover, the benefits to cognition afforded by the MedDiet were not exclusive to older individuals. Two of the included studies focused on younger adults and they both found improvements in cognition using computerized assessments.

The researchers stress that research in this area is important due to the expected extensive population aging over the next 20-30 years. They envision that the utilization of a dietary pattern, such as the MedDiet, will be an essential tool to maintain quality of life and reduce the potential social and economic burdens of manifested cognitive declines like dementia.

"I would therefore recommend people to try to adhere or switch to a MedDiet, even at an older age," Hardman added.

Like many researchers, Hardman takes his research home: "I follow the diet patterns and do not eat any red meats, chicken or pork. I have fish two-three times per week and adhere to a Mediterranean style of eating."

REFERENCE:

Adherence to a mediterranean-style diet and effects on cognition in adults: a qualitative evaluation and systematic review of longitudinal and prospective trials, Roy Hardman et al., Frontiers in Nutrition, doi: http://dx.doi.org/10.3389/fnut.2016.00022, published online 22 July 2016.

SOURCE:

• Frontiers news release, via EurekAlert.

Is marijuana a dementia risk factor?

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The American College of Cardiology

As marijuana legalization spreads, new research is improving our understanding of side effects. Heart cells have cannabis receptors relevant to vascular squeezing ability. Learn about marijuana's link to vascular dementia. 

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WASHINGTON - Using marijuana raises the vascular risks of stroke and heart failure, major risk factors leading to vascular dementia. Even after accounting for demographic factors, other health conditions and lifestyle risk factors such as smoking and alcohol use, the data is compelling, according to research being presented at the American College of Cardiology’s 66th Annual Scientific Session.

Vascular Health

Coming at a time when marijuana, medically known as cannabis, is on track to become legal for medical or recreational use in more than half of U.S. states, this study sheds new light on how the drug affects vascular health. While previous marijuana research has focused mostly on pulmonary and psychiatric complications, the new study is one of only a handful to investigate cardiovascular outcomes. 

“Like all other drugs, whether they’re prescribed or not prescribed, we want to know the effects and side effects of this drug,” said Aditi Kalla, MD, Cardiology Fellow at the Einstein Medical Center in Philadelphia and the study’s lead author. “It’s important for physicians to know these effects so we can better educate patients, such as those who are inquiring about the safety of cannabis or even asking for a prescription for cannabis.”

Nationwide Inpatient Sample

The study drew data from the Nationwide Inpatient Sample, which includes the health records of patients admitted at more than 1,000 hospitals comprising about 20 percent of U.S. medical centers. Researchers extracted records from young and middle-aged patients—age 18-55 years—who were discharged from hospitals in 2009 and 2010, when marijuana use was illegal in most states. 

Marijuana use was diagnosed in about 1.5 percent (316,000) of more than 20 million health records included in the analysis. Comparing cardiovascular disease rates in these patients to disease rates in patients not reporting marijuana use, researchers found marijuana use was associated with a significantly increased risk for cardiovascular events such as stroke, heart failure, coronary artery disease and sudden cardiac death.

Marijuana - Independent Association

Marijuana use was also linked with a variety of factors known to increase cardiovascular risk, such as obesity, high blood pressure, smoking and alcohol use. After researchers adjusted the analysis to account for these factors, marijuana use was independently associated with a 26 percent increase in the risk of stroke and a 10 percent increase in the risk of developing heart failure. 

“Even when we corrected for known risk factors, we still found a higher rate of both stroke and heart failure in these patients, so that leads us to believe that there is something else going on besides just obesity or diet-related cardiovascular side effects,” Kalla said. “More research will be needed to understand the pathophysiology behind this effect.”

Heart Cells Have Canabis Receptors

Research in cell cultures shows that heart muscle cells have cannabis receptors relevant to contractility, or squeezing ability, suggesting that those receptors might be one mechanism through which marijuana use could affect the cardiovascular system. It is possible that other compounds could be developed to counteract that mechanism and reduce cardiovascular risk, Kalla said. 

Because the study was based on hospital discharge records, the findings may not be reflective of the general population. The study was also limited by the researchers’ inability to account for quantity or frequency of marijuana use, purpose of use (recreational or medical), or delivery mechanism (smoking or ingestion).

Further Insights

Kalla suggested that the growing trend toward legalization of marijuana could mean that patients and doctors will become more comfortable speaking openly about marijuana use, which could allow for better data collection and further insights into the drug’s effects and side effects. 

SOURCE:

• The American College of Cardiology
  The American College of Cardiology is a 52,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, offers cardiovascular accreditation to hospitals and institutions, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications.

Prevent dementia apathy

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• Based on the article by Victoria M. Indivero for Penn State.

Apathy strikes 90% of people with dementia, sooner or later. Faster decline and care problems result. Proper stimulation makes all the difference. Learn why. 

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People with dementia are less likely to be apathetic if they live in an appropriately stimulating environment, according to nursing researchers.

According to a report by The Centers for Disease Control, about half the people in nursing homes have dementia. 90% of them experience apathy at some point, one of the most common neurobehavioral symptoms in dementia. Those with mild dementia will decline more quickly into severe dementia if they also suffer from apathy. 

A stimulating environment made all the difference in this revealing study of 5 factors. Specifically, moderate stimulation did the most to lift people out of their apathy, while none or too much made it worse.

Help Them Stay Engaged

Ying-Ling Jao, assistant professor of nursing, Penn State, identified 4 negative consequences of apathy in dementia:

1. Persons with dementia who are also apathetic won't be curious about the world around them;
2. They are not motivated to carry out activity nor engage with those around them, in either a positive or a negative way.
3. The individuals' cognitive function will likely decline faster.
4. Caregivers will have more difficulty with their caregiving and are more likely to become depressed.

Jao observed 40 nursing home residents with dementia. She watched videos of each taken throughout a typical day. Three videos were chosen for each resident from recordings made during a previous study:

• One taken at a mealtime,
• One during a direct interaction between the resident and staff
• One that was randomly selected.

Jao reports her results in The Gerontologist. She said,

'The purpose of this study was to examine the relationship between environmental characteristics and apathy in long-term care residents with dementia. My interest in apathy was mainly driven by my clinical observations in nursing homes when I was a nurse practitioner student. I remember that no matter which nursing home I visited, I often saw a crowd of residents sitting in the living room or hallway with no interest in the surroundings and no emotional expression.'

5 Influences on Apathy in Dementia

Jao zoomed in on five key characteristics that affect the quality of life in nursing homes:

1. Environmental stimulation
2. Ambiance
3. Crowding
4. Staff familiarity
5. Light and sounds.

Of the five, clear and strong environmental stimulation associated most strongly with lower apathy in residents. This means an environment without competing background noise, and with a single straightforward stimulus. A good example is music therapy in a quiet room. A strong stimulus is intense, persistent, interesting and out of the ordinary. Even routine activities, such as a regular conversation or meal, count as moderate stimulation. A birthday party is considered strong simulation. 

Strong Stimulation, No Stimulation, Overwhelming Stimulation

Assistant Professor Jao said, 

'Interestingly, our results showed that clear and , dementia viewsstrong environmental stimulation is related to lower apathy, while no stimulation or an overwhelming environment with no single clear stimulation is related to higher apathy.'

'One of the innovative features of this study is that we used the Person-Environment Apathy Rating scale to measure environmental stimulation at an individual level. I believe that the same stimulation may be perceived differently or bring about different responses for different individuals in the same environment based on the individual's characteristics, interests and relevance to the stimulation. In fact, a stimulus may be clear to one person but unclear to another because of differences in hearing or visual abilities, especially in older adults.'

'One of the most important implications of these findings is that they will guide us in designing appropriate physical and social environments for dementia care that helps prevent or decrease apathy. We need more people to care about apathy for older adults with dementia.'

Jao plans to continue this research by replicating the study with a larger sample size and by looking more closely at the quality of interaction and communication between nursing home residents and their caregivers. 

Source:

• Based on the article by Victoria M. Indivero for Penn State.

Reference:

1. Y.-L. Jao, D. L. Algase, J. K. Specht, K. Williams. The Association Between Characteristics of Care Environments and Apathy in Residents With Dementia in Long-term Care Facilities. The Gerontologist, 2015; 

Dementia and hyperthermia risk

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National Institute on Aging
National Institutes of Health
U.S. Department of Health and Human Services

Overheating and dementia are a tricky combination. In dementia, be careful with the danger of hyperthermia (a kind of overheating) almost any summer day. Learn how to avoid the heat and get quick relief. 

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Now that Li Ming is retired, she likes to work in her garden—even in hot weather. Then last summer, an unusual heat wave hit her area. The temperature was over 100°F, and the humidity was at least 90%. By the third day, her daughter Kim came over because Li Ming sounded confused on the phone. Kim found her mom passed out on the kitchen floor. Li Ming's large fan wasn't enough to fight the effect of heat and humidity. She had heat stroke, the most serious form of hyperthermia.

How to Respond

Almost every summer, there is a deadly heat wave in some part of the country. Too much heat is not safe for anyone. It is even riskier for older people and especially for those with a dementia such as Alzheimer's. It is important to get relief from the heat quickly. If not, one may begin feeling confused or faint. The heart could become stressed and maybe stop beating.

If you suspect someone is suffering from a heat-related illness:

1. Get the person out of the heat and into a shady, air-conditioned or other cool place. Urge the person to lie down.
2. If you suspect heat stroke, call 911.
3. Apply a cold, wet cloth to the wrists, neck, armpits and/or groin. These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
4. Help the individual to bathe or sponge off with cool water.
5. If the person can swallow safely, offer fluids such as water or fruit and vegetable juices, but avoid alcohol and caffeine.

Warning Signs

• Fainting
• Change in behavior—confusion, being grouchy, acting strangely, or staggering
• Dry flushed skin and a strong rapid pulse or a slow weak pulse
• Body temperature over 104°F
• Not sweating even if it is hot, acting agitated

How Can I Lower My Risk?

Things you can do to lower your risk of heat-related illness:

• Drink plenty of liquids—water, fruit, or vegetable juices. Aim for eight glasses every day. Heat tends to make you lose fluids, so it is very important to remember to keep drinking liquids when it's hot. Try to stay away from drinks containing alcohol or caffeine. If your doctor has told you to limit your liquids, ask what you should do when it is very hot.
• If you live in a home or apartment without fans or air conditioning, try to keep your house as cool as possible.
• Limit your use of the oven. Cover windows with shades, blinds, or curtains during the hottest part of the day. Open your windows at night.
• If your house is hot, try to spend at least 2 hours during mid-day some place that has air conditioning—for example, go to the shopping mall, movies, library, senior center, or a friend's house.
• If you need help getting to a cool place, ask a friend or relative. Some Area Agencies on Aging, religious groups, or senior centers provide this service. If necessary, take a taxi or call for senior transportation. Don't stand outside in the heat waiting for a bus.
• If you have an air conditioner but can't afford the electric bills, there may be some local resources that can help. The Low Income Home Energy Assistance Program is one possible resource.

• Dress for the weather. Some people find natural fabrics such as cotton to be cooler than synthetic fibers. Light-colored clothes feel cooler. Don't try to exercise or do a lot of activities when it's hot.
• Avoid crowded places when it's hot outside. Plan trips during non-rush hour times.

Listen To Weather Reports If the temperature or humidity is going up or an air pollution alert is in effect, you are at an increased risk for a heat-related illness. Play it safe by checking the weather report before going outside.

What Should I Remember?

Headache, confusion, dizziness, or nausea could be a sign of a heat-related illness. Go to the doctor or an emergency room to find out if you need treatment.

Older people can have a tough time dealing with heat and humidity. The temperature inside or outside does not have to reach 100°F to put them at risk for a heat-related illness.

To keep heat-related illnesses from becoming a dangerous heat stroke, remember to:

1. Get out of the sun and into a cool place—air-conditioning is best.
2. Drink fluids, but avoid alcohol and caffeine. Water, fruit, or vegetable juices are good choices.
3. Shower, bathe, or at least sponge off with cool water.
4. Lie down and rest in a cool place.
5. Visit your doctor or an emergency room if you don't cool down quickly.

A Senior Watch During hot weather, think about making daily visits to older relatives and neighbors. Remind them to drink lots of water or juice. If there is a heat wave, offer to help them go some place cool, such as air-conditioned malls, libraries, or senior centers.

Additional Resources:

The Low Income Home Energy Assistance Program (LIHEAP) within the Administration for Children and Families in the U.S. Department of Health and Human Services helps eligible households pay for home cooling and heating costs. People interested in applying for assistance should contact their local or state LIHEAP agency or go to http://www.acf.hhs.gov/programs/ocs/liheap.

For a free copy of the NIA’s AgePage on hyperthermia in English or in Spanish, contact the NIA Information Center at 1-800-222-2225 or go to:

• http://www.nia.nih.gov/health/publication/hyperthermia-too-hot-your-health
• SPANISH: http://www.nia.nih.gov/espanol/publicaciones/hipertermia

SOURCE:
National Institute on Aging
National Institutes of Health
U.S. Department of Health and Human Services