Category Archives: caregiver

Alzheimer’s and the Thyroid

I wish I could shout this from the mountain top: “when Alzheimer’s or dementia present themselves get the thyroid checked”.

About a year ago, I read an article on hypothyroidism and posted it to this blog. The article described the symptoms of hypothyroidism and how it is associated with an increased risk of Alzheimer’s disease in women only. The symptoms of hypothyroidism include: forgetfulness, weight gain, depression, dry skin, and fatigue. All of these were present in my mother. As a result, I asked our personal physician to check my mother’s thyroid. Sure enough she was suffering from a sluggish thyroid. He prescribed levothyroxine.

The results of the medication for us were remarkable. Within a couple of months my mother started to smile more often. Next thing I knew, my mother started to experience an occasional hearty laugh. Something she had not done in years. If you are a caregiver, like me, you will understand how frustrating it can be when your loved one stops laughing and smiling. I believe you will understand how wonderful I felt when I heard my mother laugh for the first time in years. My mother continues to smile with greater frequency and I can tell you she went for years without a smile before the introduction of the drug. An additional benefit included a slow but gradual loss of weight(about 8 pounds so far). We were fortunate that we read the article on hypothyroidism. If you, a friend, or a loved one is suffering from dementia or Alzheimer’s please get the thyroid checked closely.

In the book The Alzheimer’s Action Plan: The Experts’ Guide to the Best Diagnosis and Treatment for Memory Problems the authors discuss in detail physical problems that can and do effect memory. The book is worth obtaining. It is full of beneficial information and resources.

I am not trying to mislead you here. The prescribed drug did not cure my mother’s Alzheimer’s. But, there is quite a bit of research which indicates that hypothyroidism can present as Alzheimer’s or dementia.

Original content the Alzheimer’s Reading Room

Previously on the Alzheimer’s Reading Room.

Abnormal Thyroid Levels Can Increase Risk For Alzheimer’s Disease in Women

Overuse Of Antipsychotics Among Nursing Home Residents With Dementia

Is it Alzheimer’s or something else?

Alzheimer’s Question, Where can I get the best medical evaluation for my wife?


Playbook for Alzheimer’s Caregivers

Follow the link to get your free copy.

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Tackle the challenges of caregiving with this free football style “playbook” by Frank Broyles, former Athletic Director of the University of Arkansas Razorbacks. The Playbook is an engaging, how-to guide written for those who care for someone with Alzheimer’s. Coach Broyles cared for his late wife Barbara, who had Alzheimer’s disease.

“My wife Betty is in the early stages of Alzheimer’s. The minute I received the ‘Playbook,’ I sat down and read it word for word. What a huge blessing for me to find a straight forward, ‘been there’ account of what lies ahead.
Thank you!”
John Cater
Richmond, Texas

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Big belly in middle age triples risk of dementia

I am an Alzheimer’s Caregiver: Big belly in middle age triples risk of dementia


Book Review: The 36-Hour Day

The 36-Hour Day: A Family Guide to Caring for People with Alzheimer Disease and Memory Loss in Later Life

This best-selling book is the “bible” for families caring for people with Alzheimer disease…offering comfort and support to millions worldwide. In addition to the practical and compassionate guidance that have made The 36-Hour Day invaluable to caregivers, the fourth edition is the only edition currently available that includes new information on medical research and the delivery of care.

The new edition includes:

new information on diagnostic evaluation-resources for families and adult children who care for people with dementia-updated legal and financial information-the latest information on nursing homes and other communal living arrangements-new information on research, medications, and the biological causes and effects of dementia.

Tami Greene said…

This book has been the single most helpful tool my family has been given to help us help my mother as she progresses with Alzheimer’s Disease. While other books have touched on many of the topics in this book, no where else have we found as much practical information on how to avoid confrontations with her; ways to improve her daily living; ideas to keep her involved with us and to provide meaning to her life; questions to ask her doctors; types of resources that are available (depending on your area); what to expect as the disease progresses; and how to help each other as we take on the many different roles needed to provide care for her.

I highly recommend this book to others; in fact, I have purchased multiple copies to share with family members and donate to my local library – that’s how helpful and important this book is!

Arthur Jones said…

This is a excellent book and reference for those learning to deal with Alzheimer. Plenty of resources and ideas of what to look for when caring for someone with this disease. You can get a good idea of what to expect and how to help those suffering with this devastating disease. Easy to understand and read. Can’t recommend this book enough.


Finding a ‘Medical Home’ for $2 a Month

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Good primary care is cheap, country doctor Benjamin Brewer declares in his latest column.


It’s almost become cliché to speak of “soaring health-care costs,” so it’s rather jarring to see the words “cheap” and “care” in the same sentence. But Brewer says good quality primary care is “cheaper than your cellphone bill. Cheaper than a tank of gas. Cheaper than dinner and a movie.”

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Finding a Medical Home May Be Just What the Doctor Ordered


I’ve always considered my practice a one-stop shop for nearly anything medical. We can provide the initial evaluation for almost any problem and treatment of most things. My wife considers my practice my second home, considering all the time I spend there.

Recently, the Illinois Medicaid program decided that nearly every recipient of public aid needed something called a “medical home.” The idea is to provide an accessible, lower-cost point of entry into the health-care system than a hospital emergency room. A practice that agrees to provide the home makes a commitment to take an active, integrated approach to coordinating a patient’s medical care.

Does the “medical home” system sound like a good one to you? Do you think some patients would take advantage of it? Is there a lesson here that might lead to solving our current health care crisis? Join a discussion.2

My practice signed up for the medical home program. It was either that or opt out of Medicaid entirely. Because we’re in a rural area with a lot of patients on public assistance, we decided to give it a try. Last May, we became the official home for 177 Medicaid recipients. The next month we were shocked to find ourselves responsible for coordinating the care of more than 2,200 people on Medicaid. By July, those who had signed up or were placed on our roster by the state leveled off at about 1,700. Patients can change doctors if they want to. The advantage to us is that for the first time ever an insurer, in this case Illinois Medicaid, is compensating us for being a medical home, something we were already doing in large measure. If Medicare and private insurers acted the same way, I’d be more hopeful about the future of primary care. (See this article3 on the efforts of a business coalition to shore up primary care through medical homes.) We’re receiving an average of $2 per person per month in addition to our office visit fees for services that we had traditionally been obligated to provide free.

At our practice this means patients’ records are maintained electronically. Patients and their doctors have 24-hour access to the information or advice from us by phone or email. We provide prenatal care, delivery services, child and adult care in the office and the hospital. We measure our quality quarterly by looking at some key indicators. We don’t avoid patients of any age or gender or those with chronic, pre-existing conditions. We maintain a list of available specialists and coordinate referrals and follow-up.

Two bucks a month may not sound like much for all that work and responsibility, but it should just about cover the costs for our electronic medical records, computers, quality tracking and annual IT support. For the insurer and for patients, there should be savings and better health. Patients who don’t have a medical home incur higher health costs and report more illness.

A case in point comes from the 875 readers of my last column4 who anonymously completed the online health survey called “How’s Your Health” that I mentioned. Some had primary care doctors in addition to saying they are seeing a specialist. Of those people, 25% said they’d lost track of “who is in charge” of their care. These people reported a 100% increase in being hospitalized or using the emergency department in the last year compared to those with a single doctor coordinating their care. In addition, the group that said it “doesn’t know who is in charge” had a dramatic decline in all indicators of health. (Thanks to Dr. John Wasson at Dartmouth and Dr. Gordon Moore at the Ideal MicroPractice Project for crunching those numbers and passing them along.) If the gaps in care for these astute readers resulted in such problems, I can only imagine what folks with lesser skills and means would report. Back in the ’90s, managed care failed at cost control by trying to make primary care physicians gate-keeping clerks and pushing the liability risks for such management on doctors. I’m not advocating a return to that failed approach.

But it makes sense to me that there be fair payment for primary care services that require a lot of what is now largely uncompensated work beyond an office visit. The cost would be peanuts, and the benefits of improved care could be enormous. What’s missing in the debate over our nation’s health-care crisis is that primary care is cheap. Cheaper than your cellphone bill. Cheaper than a tank of gas. Cheaper than dinner and a movie. It’s so cheap the average person doesn’t value it properly. I could have covered my salary for 2007 and the costs of all my staff and overhead for less than $20 per patient per month, including maternity and hospital care. My practice covers 80% to 90% of what the average person would ever need a doctor for. Compare that to what you or your employer is paying for health coverage, and you’ll find that the high costs are due largely to catastrophic illnesses, hospital charges and money going to middlemen.

Even though I’d like to, I can’t offer comprehensive primary care on a subscription basis for $20 per month. The Illinois Department of Insurance would send me to the slammer for running an unlicensed insurance company.

But most Americans could afford a package that combined $20-per-month primary care, $4 generic pharmacy prescriptions and some catastrophic coverage. If the combination was tax-deductible for the individual, then I think it would be a slam dunk. Netflix can rent you 4 movies a month for $23.99, but I’m not allowed to rent you a medical home for less than you’d spend to watch a movie each week. Before we’re saddled with an unaffordable national health plan, we should consider renting an affordable medical home.
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Alzheimer’s and Brain Fitness

I mentioned before that daily exercise has a dramatic effect on the quality of my mother’s daily life. I first started taking her to Gold’s Gym about three years ago. I did this after reading about the potential benefits of exercise for Alzheimer’s patients. I feel confident in saying that exercise has had a dramatic positive effect on her daily life, and that exercise is a critical component in staving-off the horrid effects of Alzheimer’s disease.

A growing body of research indicates that regular aerobic exercise can boost your brain’s memory and cognitive processing speed by stimulating a process called neurogenesis (the creation of new neurons in the brain). I am including two articles that I believe you will find of interest.

That is 91 year old mom in the picture. She is pictured here riding a bicycle at Gold’s Gym in Delray Beach, Florida.

Lobes of Steel
The New York Times

The Morris water maze is the rodent equivalent of an I.Q. test: mice are placed in a tank filled with water dyed an opaque color. Beneath a small area of the surface is a platform, which the mice can’t see. Despite what you’ve heard about rodents and sinking ships, mice hate water; those that blunder upon the platform climb onto it immediately. Scientists have long agreed that a mouse’s spatial memory can be inferred by how quickly the animal finds its way in subsequent dunkings. A “smart” mouse remembers the platform and swims right to it.

In the late 1990s, one group of mice at the Salk Institute for Biological Studies, near San Diego, blew away the others in the Morris maze. The difference between the smart mice and those that floundered? Exercise. The brainy mice had running wheels in their cages, and the others didn’t.

Scientists have suspected for decades that exercise, particularly regular aerobic exercise, can affect the brain. But they could only speculate as to how. Now an expanding body of research shows that exercise can improve the performance of the brain by boosting memory and cognitive processing speed. Exercise can, in fact, create a stronger, faster brain.

This theory emerged from those mouse studies at the Salk Institute. After conducting maze tests, the neuroscientist Fred H. Gage and his colleagues examined brain samples from the mice. Conventional wisdom had long held that animal (and human) brains weren’t malleable: after a brief window early in life, the brain could no longer grow or renew itself. The supply of neurons — the brain cells that enable us to think — was believed to be fixed almost from birth. As the cells died through aging, mental function declined. The damage couldn’t be staved off or repaired.

Gage’s mice proved otherwise. Before being euthanized, the animals had been injected with a chemical compound that incorporates itself into actively dividing cells. During autopsy, those cells could be identified by using a dye. Gage and his team presumed they wouldn’t find such cells in the mice’s brain tissue, but to their astonishment, they did. Up until the point of death, the mice were creating fresh neurons. Their brains were regenerating themselves.

All of the mice showed this vivid proof of what’s known as “neurogenesis,” or the creation of new neurons. But the brains of the athletic mice in particular showed many more. These mice, the ones that scampered on running wheels, were producing two to three times as many new neurons as the mice that didn’t exercise.

But did neurogenesis also happen in the human brain? To find out, Gage and his colleagues had obtained brain tissue from deceased cancer patients who had donated their bodies to research. While still living, these people were injected with the same type of compound used on Gage’s mice. (Pathologists were hoping to learn more about how quickly the patients’ tumor cells were growing.) When Gage dyed their brain samples, he again saw new neurons. Like the mice, the humans showed evidence of neurogenesis.

Gage’s discovery hit the world of neurological research like a thunderclap. Since then, scientists have been finding more evidence that the human brain is not only capable of renewing itself but that exercise speeds the process.

“We’ve always known that our brains control our behavior,” Gage says, “but not that our behavior could control and change the structure of our brains.”

The human brain is extremely difficult to study, especially when a person is still alive. Without euthanizing their subjects, the closest that researchers can get to seeing what goes on in there is through a functional M.R.I. machine, which measures the size and shape of the brain and, unlike a standard M.R.I. machine, tracks blood flow and electrical activity.

This spring, neuroscientists at Columbia University in New York City published a study in which a group of men and women, ranging in age from 21 to 45, began working out for one hour four times a week. After 12 weeks, the test subjects, predictably, became more fit. Their VO2 max, the standard measure of how much oxygen a person takes in while exercising, rose significantly.

But something else happened as a result of all those workouts: blood flowed at a much higher volume to a part of the brain responsible for neurogenesis. Functional M.R.I.’s showed that a portion of each person’s hippocampus received almost twice the blood volume as it did before. Scientists suspect that the blood pumping into that part of the brain was helping to produce fresh neurons.

The hippocampus plays a large role in how mammals create and process memories; it also plays a role in cognition. If your hippocampus is damaged, you most likely have trouble learning facts and forming new memories. Age plays a factor, too. As you get older, your brain gets smaller, and one of the areas most prone to this shrinkage is the hippocampus. (This can start depressingly early, in your 30’s.) Many neurologists believe that the loss of neurons in the hippocampus may be a primary cause of the cognitive decay associated with aging. A number of studies have shown that people with Alzheimer’s and other forms of dementia tend to have smaller-than-normal hippocampi.

The Columbia study suggests that shrinkage to parts of the hippocampus can be slowed via exercise. The subjects showed significant improvements in memory, as measured by a word-recall test. Those with the biggest increases in VO2 max had the best scores of all.

“It’s reasonable to infer, though we’re not yet certain, that neurogenesis was happening in the people’s hippocampi,” says Scott A. Small, an associate professor of neurology at Columbia and the senior author of the study, “and that working out was driving the neurogenesis.”

Other recent studies support this theory. At the University of Illinois at Urbana- Champaign, a group of elderly sedentary people were assigned to either an aerobic exercise program or a regimen of stretching. (The aerobic group walked for at least one hour three times a week.) After six months, their brains were scanned using an M.R.I. Those who had been doing aerobic exercise showed significant growth in several areas of the brain. These results raise the hope that the human brain has the capacity not only to produce new cells but also to add new blood vessels and strengthen neural connections, allowing young neurons to integrate themselves into the wider neural network. “The current findings are the first, to our knowledge, to confirm the benefits of exercise training on brain volume in aging humans,” the authors concluded.

And the benefits aren’t limited to adults. Other University of Illinois scientists have studied school-age children and found that those who have a higher level of aerobic fitness processed information more efficiently; they were quicker on a battery of computerized flashcard tests. The researchers also found that higher levels of aerobic fitness corresponded to better standardized test scores among a set of Illinois public school students. The scientists next plan to study how students’ scores change as their fitness improves.

What is it about exercise that prompts the brain to remake itself? Different scientists have pet theories. One popular hypothesis credits insulin-like growth factor 1, a protein that circulates in the blood and is produced in greater amounts in response to exercise. IGF-1 has trouble entering the brain — it stops at what’s called the “blood-brain barrier” — but exercise is thought to help it to do so, possibly sparking neurogenesis.

Other researchers are looking at the role of serotonin, a hormone that influences mood. Exercise speeds the brain’s production of serotonin, which could, in turn, prompt new neurons to grow. Abnormally low levels of serotonin have been associated with clinical depression, as has a strikingly shrunken hippocampus. Many antidepressant medications, like Prozac, increase the effectiveness of serotonin. Interestingly, these drugs take three to four weeks to begin working — about the same time required for new neurons to form and mature. Part of the reason these drugs are effective, then, could be that they’re increasing neurogenesis. “Just as exercise does,”Gage says.

Gage, by the way, exercises just about every day, as do most colleagues in his field. Scott Small at Columbia, for instance , likes nothing better than a strenuous game of tennis. “As a neurologist,” he explains, “I constantly get asked at cocktail parties what someone can do to protect their mental functioning. I tell them, ‘Put down that glass and go for a run.’ ” .

This Is Your Brain on Something Other Than Exercise

The human brain undergoes neurogenesis — the creation of new cells — throughout a person’s life, although the amount depends on a variety of factors, not just exercise.

Researchers ID Brain Network That May Help Prevent or Slow Alzheimer’s Disease

These highlighted spots of activity represent a brain network. People with more cognitive reserve may use such networks more efficiently or use alternative networks to deal with Alzheimer’s pathology. These highlighted spots of activity represent a brain network.

Columbia University researchers have uncovered some clues about why “mental exercise” appears to provide protection against Alzheimer’s disease and dementia.

A team from Columbia University Medical Center (CUMC) identified a brain network within the frontal lobe associated with cognitive reserve, the process that allows individuals to maintain function despite mental decline due to aging or Alzheimer’s disease.

The finding may illuminate how higher levels of cognitive reserve – thought to replenish by regular engagement in mentally stimulating activities such as taking classes, gardening and volunteering – provide such protection. Researchers hope the results of the study lead to advancements to prevent or delay the onset of Alzheimer’s disease or other age-related memory conditions. The study, published in the current issue of Cerebral Cortex, was led by Yaakov Stern, a professor at the Taub Institute for the Research on Alzheimer’s Disease and the Aging Brain and director of the Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center at CUMC.

To obtain the data, researchers gave participants, categorized as young (between 18 and 30 years old) and elderly (between 65 and 80 years old), one of two different memory tasks, one involving a series of letters and a second involving a series of nonsensical shapes. Individuals completed the tasks while undergoing functional magnetic resonance imaging (fMRI).

Researchers designed the activities with increasing difficulty to allow observation of the participants’ brain activation, as the tasks got progressively harder. Findings demonstrated that individuals with higher levels of cognitive reserve were able to activate this network in the brain while working on more difficult tasks, while participants with lower levels of reserve were not able to tap into this particular network.

Related links

Interview With Dr. Stern: Complex Brain Circuits May Protect Against Alzheimer’s, In Vivo, Dec. 14, 2005

Related research by Professor Stern:

The Concept of Cognitive Reserve: A Catalyst for Research

“With the identification of this brain network – located within the frontal lobe – that is active during the performance both of these verbal and spatial tasks and probably other types of tasks as well, we believe we have accomplished an important first step towards improving our understanding of how cognitive reserve is expressed within the brain,” said Stern, a professor of clinical neuropsychology in the Departments of Neurology, Psychiatry and Psychology at the Columbia University College of Physicians and Surgeons.

“The network was found more often in younger participants, signifying that the network may degrade during the natural aging process,” said Stern. “If this degradation process can be slowed or halted, it may benefit the millions of people living with devastating memory decline.”


Caregiver Resources

The list on the follow page is a comprehensive list of caregiver resources. It is well worth copying for future reference.

AARP: This organization supplies information about caregiving, long-term care and aging, including publications and audiovisual aids for caregivers. The free online seminar Planning for the Care of Aging Parents is just one example of the educational resources provided.
(800) 424-2277

Alzheimer’s Association 24/7 Helpline: Referral and support.
(800) 272-3900

Benefits CheckUp: This Web site, operated by the National Council on the Aging, identifies federal and state assistance programs for older Americans in each community.

Caregivers Marketplace: A free service for family caregivers that offers savings and education on a wide range of goods and services for anyone who “gives, gets or needs care.”
(866) 327-8340

Caregiving Online: The site pulls together other sites that offer information on maintaining caregiver health

Caregiver Survival Resources: The site aims to help others cope with the demands of caregiving.

Centers for Medicare & Medicaid Services: The official U.S. government site for people on Medicare.

Children of Aging Parents: A nonprofit, charitable organization whose mission is to assist the nation’s nearly 54 million caregivers of the elderly or chronically ill with reliable information, referrals and support, and to heighten public awareness that the health of family caregivers is essential to ensure quality care of the nation’s growing elderly population.
(215) 945-6900 or (800) 227-7294

ElderCare Online: An online community designed to provide comprehensive information and support for those caring for aging loved ones, especially those coping with Alzheimer’s.

Eldercare Locator: A national directory of community services.
(800) 677-1116

Family Caregiver Alliance: Tracks action on key legislative issues of concern to family caregivers and offers advice on how to get involved in advocacy efforts.
(415) 434-3388

Family Caregiving Guides and Directories: A Department of Health and Human Services directory of Web sites for caregivers.

First Gov for Seniors: A Web site maintained by the Social Security Administration to provide an up-to-date overview of health, wellness and financial issues of interest to older persons and their families.

Healthy Caregiver: A magazine and online community dedicated to the issues and interests of contemporary adults caring for aging parents.

HomeCare Online: The National Association for Home Care’s virtual headquarters. NAHC is committed to representing the interests of the home care and hospice community.

Hospice Net
: Organization provides information and support to patients and families facing life-threatening illnesses. Hospice Net is an independent, nonprofit 501(c)(3) organization working exclusively through the Internet.

National Alliance for Caregiving: The NAC is dedicated to providing support to family caregivers of older persons and the professionals who help them and to increase public awareness of issues facing family caregiving.

National Association of Professional Geriatric Care Managers: Care managers are professionals who coordinate caregiving services. They can be helpful when family members are not able to play an active role.
(520) 881-8008

National Family Caregivers Association: NFCA is dedicated to making life better for all of America’s family caregivers. Family caregivers focus on their loved ones’ needs; NFCA focuses on family caregivers.

National Hospice and Palliative Care Organization: The largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. The organization is committed to improving end-of-life care and expanding access to hospice care with the goal of profoundly enhancing quality of life for the dying and their loved ones.
(800) 658-8898

Today’s Caregiver magazine: A print and Web magazine dedicated to those caring for loved ones, written for caregivers by caregivers and dealing with topics like stress and depression management, financial, legal and medical advice, housing and incontinence.

U.S. Administration on Aging: The federal agency that develops programs and information resources for the elderly and their families.

Family Caregivers Online Newsletter: Online educational resource with practical information for family caregivers.

Leah Dobkin is a freelance writer based in Shorewood, Wisconsin. She has more than 30 years’ experience working in the field of aging. She has prepared educational materials and articles for family caregivers, businesses and nonprofit organizations on this subject, has spoken at conferences and has conducted training for employees, employers and community service providers throughout the U.S. E-mail to comment.

“caregiver resources”, “robert t demarco”, alzheimer’s, blog, caregiver, caregiver resources, dementia, elder-care, family caregiving

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