Reminiscence activity and therapies

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

About.com

Reminiscence refers to recollections of memories from the past. It is familiar to us all and can be utilised for the benefit of others. For people with Alzheimer’s disease encouraging the act of reminiscence can be highly beneficial to their inner self and their interpersonal skills. Reminiscence involves exchanging memories with the old and young, friends and relatives, with caregivers and professionals, passing on information, wisdom and skills. It is about giving the person with Alzheimer’s a sense of value, importance, belonging, power and peace.

Reminiscence activity and therapies are used frequently in our own lives and well as in therapeutic settings and residential care. We all use it to cope in times of stress, such as mourning, it can also help reduce injury to our self image and it can create a feeling of intimacy and give special meaning to contact time with others.

Different Mediums used for Reminiscence Therapy and Activities
A variety of mediums can assist the act of remembering that use different senses. It means that people who have difficulty communicating verbally can have the opportunity to do so in other ways. Establishing identity with or without words is a good example of how we have to adapt, giving a valuable opportunity to acquire and use new skills of communication.

Visually: photographs, slides. Painting pictures, looking at objects of autobiographical meaning.

Music: using familiar tunes from the radio, C.Ds, or making music using various instruments.

Smell or taste: using smell kits, different foods

Tactile: touching objects, feeling textures, painting and pottery.

Types of Reminiscence Activities and Therapies
Reminiscence can be used as individual, group or family sessions and is generally categorised in three main types:

Simple reminiscence. Here the idea is to reflect on the past in an informative and enjoyable way.

Evaluative reminiscence is more of a therapy and may, for example, be used as a life reviewing or sometimes conflict resolving approach.

Occasionally, unpleasant and stressful information is recalled and this has been called offensive-defensive reminiscence. It can be the either the cause or the result of behavioral and emotional issues. Dealing with them can provide resolution - a coming to terms with life events and possible closure.

Inclusion of Caregivers, Friends and Relatives in Reminiscence Activity 
In a care facility, or in a professional setting, the co-operation and inclusion of relatives and friends can enhance the reminiscence time for all parties. They may be able to provide photos or remember incidents in the person’s life that can increase the pleasure and engage a person with Alzheimer’s attention more fully. Friends and relatives can also provide valuable information on any subject that a person may find distressing or upsetting that require increased support.

The Right to Refuse Activity Involvement and Alzheimer's
Remember to respect the individual’s involvement and contributions. By all means try to encourage participation but if a person does not want to be involved in the activity respect their right to refuse. Their refusal is as valid as yours, for self protection, privacy, as an act of autonomy and power over their situation.

'Clever' new test gives more clues about Alzheimer's disease

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

E Max Health

Scientists know mild cognitive impairment or MCI can interfere with daily functioning. In an effort to discover how even mild cognitive impairment that leads to Alzheimer’s disease affects daily living, researchers have developed a ‘clever’ new test that could lead to ways to retrain the brain.

The finding could mean increased independence for anyone on the path to Alzheimer’s and provides new insights into what processes interfere with carrying out daily activities in the presence of even mild memory deficits.

Terry Goldberg, PhD, a professor of psychiatry and behavioral science at the Hofstra North Shore-LIJ School of Medicine and director of neurocognition at the Litwin Zucker Center for Research in Alzheimer's Disease and Memory Disorders at The Feinstein Institute for Medical Research in Manhasset, NY and colleagues designed the test

The goal is to help people who will develop Alzheimer’s disease function better in their daily lives.

Goldberg explains the test involves tapping into the semantic processing system in the brain that has broader implications for how a person functions in their daily life.

Clinicians are trained to focus on short-term memory problems when screening for cognitive impairment and Alzheimer’s disease. The researchers wanted to find out if there are other memory impairments that haven’t been picked up on before.

To perform the test, the researchers needed a test that did not rely on verbal skills. “If you ask someone what is bigger, a key or an ant, they would be slower in their response than if you asked them what is bigger, a key or a house,” explained Dr. Goldberg in a news release.

The Dartmouth College of Education explains semantic processing as understanding the meaning of words: “…you might depend in part on semantic processing to know that when you read “cat” it means or refers to that warm, furry, purring thing that jumps on your lap and meows.”

For the study, researchers tested 25 patients with MCI, 27 patients with Alzheimer's and 70 people with no memory deficits.

The finding showed major differences between cognitively fit people and those with MCI and Alzheimer’s

“This finding suggested that semantic processing was corrupted,” said Dr. Goldberg. “MCI and AD (Alzheimer's disease) patients are really affected when they are asked to respond to a task with small size differences."

For the test, the scientists used factual, competitive questions. “If you ask someone what is bigger, a key or an ant, they would be slower in their response than if you asked them what is bigger, a key or a house,” explained Dr. Goldberg.

Then they threw in images designed to require more processing by showing incongruent pictures - a small ant and a big house or a big ant and a small house.

Participants with cognitive impairment or AD became confused and took longer to answer.

Mildly impaired participants functioned somewhere in between the group with no memory deficits and those with Alzheimer’s disease.

After they identified problems with semantic processing, the researchers turned to the UCSD Skills Performance Assessment scale to find out if the subtle declines seen in memory interfere with a person’s daily functioning.

The test reveals a person’s ability to write a complex check or organize a trip to the zoo on a cold day, the researchers explain.

“The semantic system is organized in networks that reflect different types of relatedness or association,” the investigators wrote in their study. “Semantic items and knowledge have been acquired remotely, often over many repetitions, and do not reflect recent learning.”

The finding is important because it gives clues that something besides memory – in this case processing existing knowledge – is slowing down.

In an accompanying editorial David P. Salmon, PhD, of the Department of Neurosciences at the University of California in San Diego points out the test shows people who will later develop Alzheimer’s disease gradually lose their ability to process knowledge and that it happens early. He agrees the finding also shows even mild memory deficits can interfere with ‘usual activities of daily living’.

Goldberg and his team plan to continue their studies to see if semantic problems get worse as the disease progresses. The finding is published in the American Journal of Psychiatry.

Finding more clues to Alzheimer’s disease with the new test suggests retraining the brain might strengthen semantic processing. It’s not episodic memory loss that interferes with daily functioning, but instead semantic memory.

North Shore-Long Island Jewish Health System

Depression in Elderly May Predict Dementia

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

WebMD

 Depression is common among older people who go on to develop Alzheimer’s disease, leading to widespread speculation that it may be one possible cause for age-related dementias.

Now, a new study suggests that rather than being a cause of memory decline, depression in older people may be an early symptom ofdementia.

When researchers evaluated 2,000 elderly New Yorkers for depression and then followed them, they found that depression accompanied memory declines but did not necessarily come first.

Depression Predicted Dementia

Having memory problems that are not severe enough to be diagnosed as dementia, but that are more pronounced than the changes associated with normal aging, is known as mild cognitive impairment. Many people with MCI develop dementia, but some do not.

The new research shows that having mild cognitive impairment along with depression doubled the risk of developing full-blown dementia.

But researcher Jose A. Luchsinger, MD, MPH, of Columbia University Medical Center, says depression appears to be a symptom that accompanies age-relatedmemory loss, such as mild cognitive impairment, rather than a separate risk factor for it.

It also means that depression among the elderly should be recognized as a possible early warning sign of age-related memory decline.

The study was published online today in the journal Archives of Neurology.

“When depression and memory complaints occur together in the elderly it is often assumed that the memory problems are caused by the depression,” Luchsinger says. “The thinking is often that by treating the depression the memory problems will go away, but this may not be the case.”

Memory Loss May Lead to Depression

He says older people who are depressed and have memory complaints should be evaluated for mild cognitive impairment or other early signs of dementia.

Neurologist Gayatri Devi, MD, of New York City’s Lenox Hill Hospital, says it makes sense that older people with early memory loss would be more vulnerable to depression.

“Especially in the early stages when people realize that something is not quite right but they don’t really understand what is happening, it is natural to become depressed,” she says.

Devi agrees that depression and memory loss in older patients are too often lumped together instead of being evaluated separately.

“Depression may be related to (memory) decline or it may be totally unrelated,” she says. “From a clinical perspective it is important to understand this. If a patient comes to me in her 70s or 80s with no history of depression and no clear reason for depression, such as the loss of a spouse or a child, I will certainly consider cognitive loss as a possible reason and do the appropriate tests.”

By Salynn Boyles

Alzheimer's Disease Early Cognitive Problems Identified

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

Medical News Today

Early indicators of Alzheimer's disease have been discovered and published in the latest issue of American Journal of Psychiatry. The findings reveal that people who are beginning to develop the disease often show problems with processing semantic and knowledge based information before severe symptoms of the disease begin showing. 

The study is the first of its kind to review mild cognitive impairment (MCI) associated with Alzheimer's disease in a systematic way and reveal the early indicators, signs and symptoms. Terry Goldberg, PhD, director of neurocognition at the Litwin Zucker Center for Research in Alzheimer's Disease, and his colleagues developed a test to identify any problems with a person's ability to process semantic or knowledge based information. 

The results of the test showed that there are a number of semantic impairments that are associated with MCI. In order to prevent adding further confusion to the study, the researchers implemented an element of the test that did not require any verbal response. This part of the test measured a person's ability to make a judgment of two sets of facts by their ability to differentiate size. For example, they would be shown a picture of an ant and a house and asked which was bigger. The time it took for them to answer the question would reveal the extent of their inability to process semantic information. 

A total of 122 people were tested, of whom 25 had MCI, 27 had Alzheimer's and the other 70 were cognitively "normal". There was a big difference in the ability to process the information among the MCI and Alzheimer's patients compared to the healthy controls. According to Dr. Goldberg: "This finding suggested that semantic processing was corrupted. MCI and AD (Alzheimer's disease) patients are really affected when they are asked to respond to a task with small size differences." 

The researchers then added an element to the task by showing the participants pictures of a big house and small ant and also a big ant and small house. The MCI and AD patients were able to successfully complete the first part of this task but had a lot difficulty (unable to answer or delayed response) when shown the picture where the big ant looked just as big as the small house. The patients with MCI were functioning better than the Alzheimer's patients but not nearly as well as the healthy controls. 

They used the UCSD Skills Performance Assessment scale to determine how much of an effect impaired semantic processing has on carrying out everyday functions. It assesses stuff like a person's ability to organize day trips out and write complex checks. The authors of the study said: "The semantic system is organized in networks that reflect different types of relatedness or association. Semantic items and knowledge have been acquired remotely, often over many repetitions, and do not reflect recent learning." 

This indicates that it could well be possible to repair semantic processing connections through training. According to Dr. Goldberg: "It tells us that something is slowing down the patient and it is not episodic memory but semantic memory." 

David P. Salmon, PhD, of the Department of Neurosciences at the University of California in San Diego, said in an accompanying editorial: 

"semantic memory deficit demonstrated by this study adds confidence to the growing perception that subtle decline in this cognitive domain occurs in patients with amnestic mild cognitive impairment. Because the task places minimal demands on the effortful retrieval process, overt word retrieval, or language production, it also suggests that this deficit reflects an early and gradual loss of integrity of semantic knowledge."



He concluded: "second important aspect of this study is the demonstration that semantic memory decrements in patients with mild cognitive impairment may contribute to a decline in the ability to perform usual activities of daily living." 

A previous study carried out by researchers from The Australian National University developed a test that was able to predict Alzheimer's disease among middle aged people. The finding, along with this one opens possibilities of early detection and intervention in healthcare settings.

Written by Joseph Nordqvist 
Copyright: Medical News Today 

Alzheimer's Disease: Amyloid 'Proponents' Soldier On

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

MedPage Today

Year in Review

By John Gever, Senior Editor, MedPage Today

Click the bottom right corner of the video player for full screen.

As part of the Year in Review series,MedPage Today reporters are revisiting major news stories and following up with an analysis of the impact of the original report, as well as subsequent news on the topic. Here's what's happened with drug development for Alzheimer's disease since we published the first 2012 piece on what appeared to be the demise of beta-amyloid as a drug target for symptomatic disease.

When drug giant Eli Lilly announced in August that both EXPEDITION trials of its anti-amyloid drug solanezumab had failed to show a significant benefit, many in the field thought that would be the end of the line for such agents, at least for patients showing clear signs of cognitive impairment.

The failure followed a string of other disappointing results with a variety of agents targeting the rogue protein.

Another monoclonal antibody drug, bapineuzumab, had also shown no clinical benefit in a large trial. Likewise, compounds aimed at inhibiting secretase enzymes responsible for producing beta-amyloid in vivo were disappointing.

And before that, an immunotherapy intended to mobilize the body's own immune system against beta-amyloid plaques had also failed.

Even staunch advocates of the so-called amyloid hypothesis in Alzheimer's disease -- which holds that beta-amyloid protein plaques are a key causative factor in the neurodegeneration that underlies the condition -- had changed their thinking.

People like John Morris, MD, of Washington University in St. Louis, were saying that, by the time symptoms appear, beta-amyloid has already done its damage. Instead, anti-amyloid drugs would be effective only if introduced much earlier in the disease process, before plaques have become extensive and before neurodegeneration has really taken hold.

But a funny thing happened -- Lilly didn't get the message that the drug was a dud. The company still believes that solanezumab has a future in treating symptomatic Alzheimer's disease.

And the company is not alone. Merck recently announced that it was taking a secretase inhibitor into a large trial in patients with symptomatic disease.

Solanezumab

The drug is a monoclonal antibody that binds to solitary, soluble strands of beta-amyloid protein, causing it to be eliminated by the body's waste-clearance mechanisms before they aggregate into insoluble plaques.

In announcing that the EXPEDITION studies had failed to meet their primary endpoints, Lilly indicated that they nevertheless had suggested a hint of benefit in some patients.

"A pre-specified secondary analysis of pooled data across both trials showed statistically significant slowing of cognitive decline in the overall study population of patients with mild-to-moderate Alzheimer's disease," the company said.

"In addition, pre-specified secondary subgroup analyses of pooled data across both studies showed a statistically significant slowing of cognitive decline in patients with mild Alzheimer's disease, but not in patients with moderate Alzheimer's disease."

And, in October, Lilly reported that another set of analyses conducted by the Alzheimer's Disease Cooperative Study consortium had backed up the firm's own interpretation of the data.

Encouraged by these findings, Lilly announced earlier this month that it would initiate another phase III study of solanezumab in patients with mild Alzheimer's disease. It had not set important details on the design and duration, but indicated that it would start by September of 2013.

MK-8931

This is Merck's oral inhibitor of beta secretase or BACE, one of the enzymes (the other principal one is gamma secretase) that cleaves beta-amyloid protein from a larger precursor molecule.

By blocking this enzyme, beta-amyloid production should be greatly diminished. As with solanezumab, the idea is that formation of insoluble plaques will be diminished as well.

A phase I study showed that MK-8931 reduced beta-amyloid protein levels in cerebrospinal fluid by more than 90% in healthy individuals.

With Merck's announcement that it was commencing a phase II/III trial with MK-8931, it is the most advanced of several BACE inhibitors in development.

The 78-week trial, dubbed EPOCH, will initially test three doses of the drug against placebo, to be followed with a larger efficacy study in up to 1,700 patients.

Notably, EPOCH will enroll patients with symptomatic, mild-to-moderate Alzheimer's disease.

Is Amyloid a Useful Target at All?

John Morris told MedPage Today that the evidence from past anti-amyloid drug trials had shown convincingly that, when symptoms have developed, it's too late to reverse them by shutting down further production of beta-amyloid protein.

The time to intervene, he has come to believe, is when plaque formation is under way -- and this can now be detected in PET scans -- but before they are so extensive as to cause irreversible neuron loss.

Morris stressed that the solanezumab and MK-8931 trials could provide much useful data, but he is most excited about other studies set to get under way soon that will test anti-amyloid agents in this "preclinical" Alzheimer's disease population.

"These trials could be the best test yet of the beta-amyloid hypothesis," he said.

And what if it fails in this setting too?

"It would be extremely disappointing and also, I think, would be a major reason to reconsider" the amyloid hypothesis, Morris said.

Another researcher who has been more skeptical of the hypothesis all along is Sanjay Pimplikar, PhD, of the Cleveland Clinic in Cleveland.

In an interview with MedPage Today, he said that beta-amyloid is undoubtedly a factor in the pathology of Alzheimer's disease. But there are too many other factors that also play a role in the disease to justify singling out beta-amyloid as the point of therapeutic attack.

Morris said that the field would certainly look at tau protein -- hyperphosphorylated versions of which form toxic structures in the brain in Alzheimer's disease -- as an alternative target if the next trials of anti-amyloid drugs fail.

Pimplikar said that, in addition to tau, inflammatory processes within the brain are also clearly a factor in neurodegeneration and may be susceptible to drug therapies. The relative importance of the various contributors to Alzheimer's disease may even vary from one patient to the next.

"Let's not think of Alzheimer's as one disease, but as many diseases, like breast cancer," he toldMedPage Today. "When you have a breast cancer patient, you ask the question, is she HER2-positive? Then you treat her with Herceptin. Is she ER-positive? Then you use tamoxifen. You don't treat all the breast cancer patients the same way."

Alzheimer's disease also is not likely to respond to any given single drug in all patients -- or perhaps even in any patients.

"A monotherapy is most likely not going to work," Pimplikar said.

He added that lifestyle changes -- which recent studies have shown can be effective in reducing Alzheimer's disease risk and perhaps in reversing some symptoms -- will certainly be a component of future treatment strategies.

"Look at the cardiovascular diseases," Pimplikar said. "Of course, you can put [patients] on Lipitor. But you tell them, you must lose weight, you must control your cholesterol [intake] and your sodium."

"Similarly, for Alzheimer's disease, hopefully we'll have a drug in the next 5 years. Maybe immunotherapy will work, maybe anti-tau will work. But that particular pharmaceutical has to be supported by lifestyle changes."

Air Pollution May Raise Dementia Risk

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

Fisher Center for Dementia Research

Can dirty air be bad for the brain? A new study suggests that smog and other air pollutants may contribute to memory loss and dementia.

The findings, part of a large and ongoing study of nurses in their 70s, found that long-term exposure to air pollution may speed up cognitive decline in older adults. Women who lived in areas with the worst quality air scored lower on tests of memory and thinking than those who lived in cleaner areas.

Exposure to polluted air contributed to the equivalent of about a two-year decline in brain function, which might lead to an earlier onset of Alzheimer’s and other forms of dementia. That translates to about two million cases of Alzheimer’s over a 40-year period, the researchers estimate.

The report, from the Archives of Internal Medicine, is one of the few to study the effects of air pollution on brain health.

It is difficult to establish a direct link between environmental toxins and a disease like Alzheimer’s, because so many factors are involved, and correlation does not equal causation. But this study examined thinking skills over a four-year period and involved a large sample size of more than 19,000 women living in different parts of the United States.

The levels of pollution in the study linked to memory and thinking problems were typical of exposure levels found in many areas of the United States.

Other studies have linked air pollution to an increased risk of heart attacks and strokes. Cardiovascular problems have likewise been linked to dementia and poor brain health.

“Unlike other factors that may be involved in dementia, such as diet and physical activity, air pollution is something we can intervene on as a society at large through policy, regulation and technology,” said Jennifer Weuve, assistant professor at the Rush Medical College in Chicago and the principal investigator of the study. “If our findings are confirmed in other research, air pollution reduction is a potential means for reducing the future population burden of age-related cognitive decline, and eventually, dementia.”

Air pollutants contain chemicals and metals that become suspended in the air. Fine particles may be particularly damaging, reaching deep into the lungs and possibly even penetrating into the brain. Sources of such emissions include cars, diesel-powered equipment and various industrial processes.

In earlier studies, levels of beta-amyloid, a toxic protein that builds up in the brains of those with Alzheimer’s disease, were higher among residents of polluted cities. Another report, from Germany, found that older women who lived near busy roads did worse on memory and thinking tests than similar women who lived in rural areas. Exposure to so-called black carbon, a product of traffic, over the previous one to 11 years has been linked to worse cognitive function in a study from China.

Animal studies have recorded higher levels of brain inflammation in animals exposed to polluted air. Increasingly, scientists believe that inflammation may play a role in Alzheimer’s and heart disease.

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Source: Jennifer Weuve, Robin C. Puett, Joel Schwartz, et al: “Exposure to Particulate Air Pollution and Cognitive Decline in Older Women.” Archives of Internal Medicine, Vol. 172 (No. 3), pages 219-227, 2012.

Alzheimer's Diagnosis: More Tests Improve Chance Of Early Detection

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

Huffington Post

Two or three tests are better than one, when it comes to predicting the onset of Alzheimer's disease, a new study suggests.

The research, published in the journal Radiology, shows that using more than one diagnostic test could better predict which people with mild cognitive impairment will go on to develop Alzheimer's disease.

"Misdiagnosis in very early stages of Alzheimer's is a significant problem, as there are more than 100 conditions that can mimic the disease. In people with mild memory complaints, our accuracy is barely better than chance," study researcher P. Murali Doraiswamy, MBBS, professor of psychiatry and medicine at Duke Medicine, said in a statement. "Given that the definitive gold standard for diagnosing Alzheimer's is autopsy, we need a better way to look into the brain."

The study, conducted by Duke Medicine researchers, included 97 people with mild cognitive impairment who were part of the Alzheimer's Disease Neuroimaging Initiative. Researchers had the study participants undergo the typical diagnostic procedures for Alzhiemer's -- which includes cognitive testing -- as well as three otherdiagnostic tests. They included magnetic resonance imagine (MRI), cerebrospinal fluid analysis and fluorine 18 fluorodeoxyglucose positron emission tomography (also known as FDG-PET).

The study participants were followed for up to four years. Researchers found that the rate of misdiagnosis was highest when the study participants only received the typical cognitive testing -- 41.3 percent. However, that percentage went down with each additional test the person was given, with the lowest percentage of misdiagnosis occurring when all three tests were administered -- 28.4 percent.

And of all the tests, the FDG-PET seemed to add the most diagnostic value, the researchers noted.

According to the Alzheimer's Association, the earlier memory loss conditions are discovered, the better. That's because doctors are then able to know which medications to prescribe -- and not to prescribe -- early on, and patients can be aware of potential safety issues that may crop up.