dementia views you can use: June 2019

Saturday, June 29, 2019

How pharmacists can help with dementia medication

Caregivers, and healthcare professionals,here is some great information

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

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

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 tw

Aston University: www.aston.ac

HELP FROM THE PHARMACY:

Study reveals patients
need help managing drugs
Community pharmacists could be used more to support patients and carers
Assisting carers reduces error and anxiety

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 projeHelp with Medication Struggles
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.”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.”

Patient-Centered Care in Dementia

patient-Centered Care in Dementia

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

Thursday, June 27, 2019

How to bath those with dementia without a struggle

Senior man in bath washing himself smiling : Stock Photo

Teepa Snow, a nationally acclaimed Alzheimer's and dementia care specialist, teaches her students how a person with dementia perceives his/her world and how to properly adapt one's own behavior to increase communication and mutual understanding.

Learn Teepa Snow's effective hands-on techniques to ease your daily caregiving tasks and increase the quality of life for your loved one or patient. In this training DVD, Teepa demonstrates effective approaches to bathing, eating, dressing, transfers, and how to respond to certain types of behaviors in patients with dementia.

"The Art of Caregiving" is presented by The Pines Education Institute of SW Florida and facilitated by Teepa Snow, MS, OTR/L, FAOTA.

SOURCE:

Pines Education Institute of S.W. Florida and Teepa Snow

Monday, June 24, 2019

How B vitamins decrease brain loss

Nature Made Vitamin B-12 Timed Release Tablets 1000 mcg

The American Academy of Neurology

The American Academy of Neurology

ST. PAUL, Minn. – A key study shows that vitamin B12 may protect against Alzheimer’s, adding more evidence to the scientific debate about whether the vitamin is effective in reducing risk of memory loss. The research is published in Neurology®, the medical journal of the American Academy of Neurology

“Our findings show the need for further research on the role of vitamin B12 as a marker for identifying people who are at increased risk of Alzheimer’s disease,” said study author Babak Hooshmand, MD, MSc, with Karolinska Institutet in Stockholm, Sweden. “Low levels of vitamin B12 are surprisingly common in the elderly. However, the few studies that have investigated the usefulness of vitamin B12 supplements to reduce the risk of memory loss have had mixed results.”

For the seven-year study, researchers took blood samples from 271 Finnish people age 65 to 79 who did not have dementia at the start of the study. During that time, 17 people developed Alzheimer’s disease. Blood samples were tested for levels for homocysteine, an amino acid associated with vitamin B12, and for levels of the active portion of the vitamin, called holotranscobalamin. Too much homocysteine in the blood has been linked to negative effects on the brain, such as stroke. However, higher levels of vitamin B12 can lower homocysteine.

The study found that for each micromolar increase in the concentration of homocysteine, the risk of Alzheimer’s disease increased by 16 percent, whereas each picomolar increase in concentration of the active form of vitamin B12 reduced risk by two percent. The results stayed the same after taking into account other factors, such as age, gender, education, smoking status, blood pressure and body mass index. The addition of folate did not appear to raise or lower the risk of Alzheimer’s disease.

“More research is needed to confirm these findings before vitamin B12 should be used solely as a supplement to help protect memory,” said Hooshmand.

Vitamin B12 can be found in fish, poultry and other meat products.

MORE INFORMATION:

The study was supported by the Karolinska Institutet, the Swedish Research Council for Medical Research, the European Commission Seventh Framework Programme, the Academy of Finland, the Ragnhild and Einar Lundströms Minne Lindhés Foundation, the Stohnes Foundation, the Gamla Tjanarinnor Foundation and the Dementia Foundation of Sweden.

SOURCE:

The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as epilepsy, dystonia, migraine, Huntington’s disease, and dementia. For more information about the American Academy of Neurology, visit http://www.aan.com.

Thursday, June 20, 2019

Easy ways to fight dementia

Monday, June 17, 2019

How to unlock your brain' s potential

How are you caring for your brain?
According to the Alzheimer's Association, every 65 seconds
someone in the United States develops Alzheimer's disease.
What can you do if you want to help protect your cognitive health (the ability to think clearly, learn and remember)? More
research is needed, but evidence is strong that healthy
lifestyle habits, strong social connections and regular intellectual activity may help keep your brain active.

June is Alzheimer's & Brain Awareness Month

Here's what to do

1 Eat right

2 Exercise your brain

3 Exercise your body

4 Socialize

Wednesday, June 12, 2019

Best way to communicate with those who have dementia

Understand how people with dementia see the world. Learn the right thing to say & how to say it. See how to adapt to the world of dementia, better communicate with a person with Alzheimer's & improve their quality of life.

This video is an excerpt of "It's All In Your Approach", a 2 1/2 hour training DVD for caregivers.

Teepa Snow, a nationally acclaimed Alzheimer's and dementia care specialist, teaches her students how a person with dementia perceives his/her world and how to properly adapt one's own behavior to increase communication and the patient's quality of life.

"It's All In Your Approach" is presented by The Pines Education Institute of SW Florida and facilitated by Teepa Snow, MS, OTR/L, FAOTA.
© 2012, Pines Education Institute of S.W. Florida and Teepa Snow

Monday, June 10, 2019

Alzheimer,s agitation-How to reduce it

MEDICATION & MOOD:

Aggression and agitation are hard challenges in dementia. An important study may offer some simple answers.

In a preliminary 10-week randomized trial, patients with probable Alzheimer disease who received the combination medication dextromethorphan-quinidine demonstrated less occurrences and severity of agitation, compared to patients who received placebo, according to a study in JAMA (The Journal of the American Medical Association)¹.

Dr. Jeffrey Cummings, director of the Cleveland Clinic Lou Ruvo Center for Brain Health, said, "Agitation in Alzheimer's disease is one of the most disabling aspects of the disease. It interferes with the patient's life. It interferes with the ability of the caregiver to take care of the patient. It degrades the quality of life of both the patient and the caregiver."

Agitation & Aggression

Agitation and aggression are highly prevalent in patients with dementia and are associated with distress for patients and caregivers, greater risk of institutionalization, and accelerated progression to severe dementia and death. Nonpharmacological interventions are recommended as first-line therapy, but many patients fail to respond. Although many classes of psychotropic drugs are prescribed for agitation, safety concerns and modest or unproven efficacy limit their use, according to background information in the article.

Drug Combo

Dextromethorphan is commonly used in cough medicine. Quinidine is normally used to regulate an abnormal heart beat. Cummings said the combination pill had a substantial effect, greatly reducing agitation compared to the patients who got the placebo. Furthermore, he said, the caregivers also benefited. "There was a reduction in the stress experienced for caregivers of the patients who were treated with the dextromethorphan-quinidine combination.

The combination of the drugs is also approved for the treatment of pseudobulbar affect (a neurologic disorder characterized by episodes of emotional displays such as crying), and there is evidence suggesting the potential benefit of these drugs for agitation. The researchers randomly assigned 220 patients to receive dextromethorphan-quinidine or placebo in stage 1. In stage 2, patients receiving dextromethorphan-quinidine continued; those receiving placebo were stratified by response and re-randomized to dextromethorphan-quinidine or placebo. The 10 week trial was conducted at 42 study sites.

Trial Results

A total of 194 patients (88 percent) completed the study. Analysis combining stages 1 (all patients) and 2 (re-randomized placebo nonresponders) showed significantly reduced measures of agitation (occurrence and severity of symptoms). Patients treated with only dextromethorphan-quinidine had an average 51 percent reduction in the measure of agitation from baseline to week 10, compared with 26 percent for those treated with only placebo.

Adverse events included falls (8.6 percent for dextromethorphan-quinidine vs 3.9 percent for placebo), diarrhea (5.9 percent vs 3.1 percent, respectively), and urinary tract infection (5.3 percent vs 3.9 percent, respectively). Serious adverse events occurred in 7.9 percent with dextromethorphan-quinidine vs 4.7 percent with placebo. Dextromethorphan-quinidine was not associated with cognitive impairment or sedation.

Conclusions

"These preliminary findings require confirmation in additional clinical trials with longer treatment duration," the authors write.

Pending further evidence, there is a reasonably strong case to prioritize dextromethorphan-quinidine as an off-label treatment for agitation, possibly as a safer alternative to atypical antipsychotics, writes Anne Corbett, Ph.D., of King's College London, and colleagues in an accompanying editorial.

"However, while further studies are conducted to verify the efficacy and safety of this approach, it will be important to achieve a robust international expert consensus regarding the prioritization of potential treatments for agitation in patients with dementia to improve the consistency of clinical practice. This approach also must understand and incorporate patient and caregiver views regarding the evaluation of risk and benefits in relation to these treatments."

Source:

¹The JAMA Network Journals, Sep 22/29,2015

References:

Clive Ballard, Samantha Sharp, Anne Corbett. Dextromethorphan and Quinidine for Treating Agitation in Patients With Alzheimer Disease Dementia. JAMA, 2015; 314 (12): 1233 DOI: 10.1001/jama.2015.10215
Jeffrey L. Cummings, Constantine G. Lyketsos, Elaine R. Peskind, Anton P. Porsteinsson, Jacobo E. Mintzer, Douglas W. Scharre, Jose E. De La Gandara, Marc Agronin, Charles S. Davis, Uyen Nguyen, Paul Shin, Pierre N. Tariot, João Siffert. Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia. JAMA, 2015; 314 (12): 1242 DOI: 10.1001/jama.2015.10214

Thursday, June 6, 2019

Why is Parkinson"s disease on the rise?

Parkinson's is the world's fastest growing neurological disorder. On average, Parkinson's-dementia sets in 8 years after diagnosis. Learn of strategies & challenges against an impending pandemic.

Amsterdam, NL - For most of human history Parkinson's disease (PD) has been a rare disorder. However, demography and the by-products of industrialization are now contributing to an impending Parkinson's pandemic, according to experts writing in a supplement to the Journal of Parkinson's Disease. They say that this pandemic can be addressed by the Parkinson's community forming a "PACT" to prevent the disease, advocate for policies and resources aimed at slowing its spread, care for all those affected, and treat with effective and novel therapies.

Article continued below...

Fastest Growing Neurological Disorder

Neurological disorders are now the leading cause of disability globally, and the fastest growing neurological disorder in the world is PD, a slowly progressive disorder that affects movement, muscle control, and balance.

In 1855, forty years after Dr. James Parkinson first described the condition, approximately 22 people of 15 million in England and Wales died of PD.
In 2014, roughly 5,000 to 10,000 individuals of 65 million in the UK died of PD.
From 1990 to 2015, the number of people with PD doubled worldwide to over six million.
Driven principally by aging, this number is projected to double again to over 12 million by 2040.
Additional factors, including increasing longevity, declining smoking rates, and increasing industrialization, could raise the burden to over 17 million.

We Can Truly Talk About a Pandemic

**IMAGE:** Projected global burden of Parkinson's disease accounting for changes in aging, longevity, smoking rates, and industrialization, 1990-2040.
*IMAGE CREDIT: Department of Neurology and Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, USA*

"By 2040, we can truly talk about a pandemic that will result in increased human suffering, as well as rocketing societal and medical costs. How can the community be made aware of this scenario and implement changes in research priorities and care programs to lessen the burden of the upcoming pandemic?" cautioned Patrik Brundin, MD, PhD, Van Andel Research Institute, Grand Rapids, MI, USA, Editor-in-Chief of the Journal of Parkinson's Disease.

According to lead author Ray Dorsey, MD, from the Department of Neurology and Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, USA, "The tide of PD is rising and spreading. PD exacts an enormous human toll on those with the disease and those around them. The strain of caregiving has adverse health consequences of its own. The economic costs of PD are also substantial, poised to grow, and at least in the US, overwhelmingly directed at institutional care, which few desire."

Unprecedented Rise

The incidence of PD increases with age and the world's population is aging, as the number and proportion of individuals over 65 is rapidly growing. The combined result of these two factors is an unprecedented rise in the number of people with PD.

Independent of PD, global life expectancy has increased by six years in the last two decades. This will likely increase the number of individuals with advanced PD who are more difficult to treat and can have limited access to care. Numerous studies have found that the risk of PD decreases among smokers by approximately 40%. If the association is causal, which remains to be determined, decreasing smoking rates could lead to higher rates of PD.

Unbridled Activism, Effective Therapies, New Models

Finally, the by-products of industrialization may be contributing to the rising rates of PD. Specific pesticides, solvents, and heavy metals, have been linked to PD - exposure to these agents is preventable.

"In the past century, society has successfully confronted pandemics of polio, breast cancer, and HIV to varying degrees. Central to the success of these efforts was unbridled activism," stated Dr. Dorsey. Following these examples, the authors propose that the Parkinson's community form a "PACT" to prevent, advocate for, care, and treat the disease through understanding the root causes (environmental, genetic, and biological), expanding new care models that seek to bring expert care to all, and developing new highly effective therapies. The most effective therapy (levodopa) is now fifty years old.

Preventable & Not Inevitable

"We hope that this article will raise awareness of the challenge and form the basis for a community-led response to address one of the great health challenges of our time," added co-author and Associate Editor of the Journal of Parkinson's Disease Bastiaan R. Bloem, MD, PhD, from the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands.

"The PD pandemic is preventable, not inevitable," conclude the authors.

REFERENCES:

"The Emerging Evidence of the Parkinson Pandemic," by E. Ray Dorsey, MD; Todd Sherer, PhD; Michael S. Okun, MD; and Bastiaan R. Bloem, MD, PhD (DOI: 10.3233/JPD-181474) published in the Journal of Parkinson's Disease, Volume 8, Supplement 1 by IOS Press.
SUPPLEMENT TO THE JOURNAL OF PARKINSON'S DISEASE:
The Journal of Parkinson's Disease published a special issue in 2017 to commemorate the 200th anniversary of James Parkinson's "Essay on the Shaking Palsy," and we highlighted eight of the most important advances in Parkinson's research over the past 60 years. As we were working on that special issue, we commented on how the pace of Parkinson's research has accelerated remarkably. We speculated that there would be more advances in the treatment and care of Parkinson's disease during the coming 20 years than were evident during the preceding 200 years. Thus, the idea of a collection of short, forward-looking, and visionary articles was born. Eventually, we identified 19 topics for articles, and we are very excited about the outcome. In 1964 Bob Dylan sang "the times they are a changin';" this special supplement clearly shows that the field of Parkinson's is no exception.

SOURCES:

Sunday, June 2, 2019

How light improves Alzheimer's life

sleep education patient resource information

Light therapy for Alzheimer's increases sleep quality, efficiency and duration, according to an important study. 4 weeks of light therapy also significantly reduced depression and agitation. Learn how.

A key study offers an easy-to-do care tip. Research suggests that light treatment, tailored to increase circadian stimulation during the day, may improve sleep, depression and agitation in people with Alzheimer's and related dementia.

Light is Simple, Inexpensive, Non-pharmacological

Results show that exposure to the tailored light treatment during daytime hours for four weeks significantly increased sleep quality, efficiency and total sleep duration. It also significantly reduced scores for depression and agitation.

Article continued below...

Boosting Daytime Light Levels

"It is a simple, inexpensive, non-pharmacological treatment to improve sleep and behavior in Alzheimer's disease and dementia patients," said principal investigator Mariana Figueiro, PhD, associate professor and Light and Health program director of the Lighting Research Center at Rensselaer Polytechnic Institute in Troy, New York. "The improvements we saw in agitation and depression were very impressive."

Therapy lights are easy to find at places such as:

Your local lighting store
Home Depot
Amazon.com offers a variety of bright therapy lights

There are many ways to boost light levels during waking hours in order to correct changes in the circadian rhythm of people with Alzheimer's. The following video illustrates state-of-the-art LED lighting for the home. A discussion of the Alzheimer's / Sleep / Lighting study continues below the video.

Article continued below...

Dr. Figueiro's research abstract was published in an online supplement of the journal Sleep and was presented in Minneapolis, Minnesota, at the 28th annual meeting of the Associated Professional Sleep Societies LLC.

Light Exposure During the Day

The pilot study involved 14 nursing home patients with Alzheimer's disease and related dementia. A light source producing low levels of 300 to 400 lux of a bluish-white light with a color temperature of more than 9000 K was installed in the residents' rooms. Light exposure occurred during daytime hours for a period of four weeks. Light-dark and activity-rest patterns were collected using a calibrated instrument prior to and after the lighting intervention. Measures of sleep quality, depression and agitation also were collected using standardized questionnaires.

Figueiro added that the improvement in sleep quality also was associated with other noticeable behavioral changes.

"Subjective reports by the nursing staff were that the patients were calmer, eating better and their overall behavior was more manageable," she said.

Second Sleep & Lighting Study

A second "Tailored Lighting Intervention for Alzheimer's and Sleep" study confirmed these results. While all measures improved, the most significant improvement was seen in sleep quality.

"Here we show that if the stimulus (light dose) is carefully delivered and measured, it can have a strong impact on sleep, depression and agitation," said Dr. Figueiro. "Depression was a secondary measure, and I was pleasantly surprised by the positive impact of the light treatment on depression scores."

The study involved 43 subjects diagnosed with Alzheimer's disease and related dementias who were exposed to an active and inactive tailored lighting intervention for successive 4-week periods, spaced by a 4-week washout period. The lighting intervention was added to spaces in which patients spent most of their waking hours and was energized from wake time until 6 p.m. Calibrated personal light meters monitored exposures. Measures of sleep disturbances (Pittsburgh Sleep Quality Index), mood (Cornell Scale for Depression in Dementia) and agitation (Cohen-Mansfield Agitation Index) were collected at baseline and during the last week of the intervention.

REFERENCE:

Tailored Lighting Intervention For Alzheimer’s Patients And Its Effects On Sleep, Mood And Agitation M G Figueiro, M Kalsher, B Plitnick, C Rohan, M S Rea. Sleep, Volume 41, Issue suppl_1, 27 April 2018, Pages A113–A114, https://doi.org/10.1093/sleep/zsy061.294

SOURCE:

American Academy of Sleep Medicine:
Established in 1975, the American Academy of Sleep Medicine (AASM) improves sleep health and promotes high quality patient centered care through advocacy, education, strategic research, and practice standards. With about 9,000 members, the AASM is the largest professional membership society for physicians, scientists and other health care providers dedicated to sleep medicine. For more information, visit http://www.aasmnet.org.

SUPPORT: