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Category Archives: dementia

Guidelines For The Diagnosis And Treatment Of Dementia

People with mild to moderate dementia (and Alzheimer’s) are usually cared for by the family personal care physician and the patient’s family. The personal care physician is often very busy and is not a specialist in the area. The family is often ill equipped to take on this task due to lack of formal training, education, and experience. Family caregivers and the primary caregiver usually take a learn as you go approach. A team of physicians, teachers, and researchers have created a set of guidelines for personal care physicians on how to manage dementia once a diagnosis is made. This article should be read by physicians but I found it very helpful as a caregiver. From the caregiver perspective it will help you understand the services you need and help you interact with your family physician to assure that appropriate actions are being taken and treatments rendered.

Guidelines for the diagnosis and treatment of dementia (PDF)

Canadian Medical Association Journal Press Release

People with mild to moderate dementia are cared for largely by family physicians as well as the patient’s own family, and management of care can be complex and challenging. A team of clinicians, teachers and researchers from the University of Calgary, Dalhousie University, McGill University, Sunnybrook Health Sciences and the University of Toronto, University of Ottawa, University of Western Ontario, Universite de Montreal, University of Saskatchewan and affiliated institutions have created comprehensive guidelines for family physicians on how to manage dementia once a diagnosis has been made. This approach focuses on supporting both the patient and the primary caregiver.

From Diagnosis and treatment of dementia: Approach
to management of mild to moderate dementia

Recommended actions to assist patients with a mild to moderate
dementia and their families after a diagnosis has been made

• Inform the patient and his or her family (if present and appropriate) of the
diagnosis (this would include general counselling and responding to specific
questions)

• Identify the presence of a family caregiver, what support this person can
offer, his or her status (i.e., evidence of strain) and his or her needs (this
would include trying to deal with any identified needs) — ongoing activity

• Decide on the need for referrals for further diagnostic and management
assistance (e.g., referral to genetic clinic for suspected familial cases) —
ongoing activity

• Assess for safety risks (e.g., driving, financial management, medication
management, home safety risks that could arise from cooking or smoking,
potentially dangerous behaviours such as wandering) — ongoing activity

• Determine presence of any advance planning documents (e.g., will, enduring
power of attorney, personal directive). If there are no such documents, advise
that they be drafted. Note that this may include assessing the patientís capacity
to either draft these documents or whether they should be put into effect.

• Assess the patient’s decision-making capacity — ongoing activity

• Refer the patient and family to the local office of the Alzheimer Society of
Canada (www.alzheimer.ca/english/offices/intro.htm [English] or
http://www.alzheimer.ca/french/offices/intro.htm [français])

• Provide information and advice about nonpharmacologic and pharmacologic
treatment options and availability of research studies*

• Develop and implement a treatment plan with defined goals; continually
update plan

• Monitor response to any initiated therapy

• Monitor and manage functional problems (e.g., urinary incontinence) as they
arise

• Assess and manage behavioural and psychological symptoms of dementia as
they arise

• Monitor nutritional status and intervene as needed

• Deal with medical conditions and provide ongoing medical care

• Mobilize community-based and facility-based resources as needed (this
includes being knowledgeable about supportive housing and long-term care
options and the appropriate timing, and process, for facility placement)

David B. Hogan MD, Peter Bailey MD, Sandra Black MD, Anne Carswell MSc PhD, Howard Chertkow MD,Barry Clarke MD, Carole Cohen BA MD, John D. Fisk PhD, Dorothy Forbes RN PhD,Malcolm Man-Son-Hing MSc MD, Krista Lanctôt PhD, Debra Morgan RN PhD, Lilian Thorpe MD PhD

Contact: Dr. Hogan, University of Calgary, 403-220-4578, dhogan@ucalgary.ca

Original content the Alzheimer’s Reading Room.

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Ten Million Baby Boomers likely to suffer from Alzheimer’s during their lifetime

I am a baby boomer. My mother suffers from Alzheimer’s disease. Five years ago, I left my job as the CEO of a small software company to take care of my mother. I am living the devastating effects of Alzheimer’s from the front row.

It is rare to meet baby boomers that are concerned about their own uncertain fate when it comes to Alzheimer’s disease. This includes most of my close friends. Fifteen thousand baby boomers are turning 60 each day.

• Every 71 seconds someone develops Alzheimer’s disease.

• Alzheimer’s disease is now the sixth leading cause of death (recently surpassing diabetes).

One in every eight adults over the age of 65 suffers from Alzheimer’s disease.

• One out of every two adults over the age of 85 suffers from Alzheimer’s disease.

Ten million baby boomers will develop Alzheimer’s disease in their lifetime.

Alzheimer’s disease is certain brain death. Imagine living in a world where you can recount experiences from 1936, but can’t remember your birthday party five minutes after it ended. Meet my mother. My mother never suffered a major illness. She never had an operation. Five years after her diagnosis she is in very good health. But, her brain is dying. She doesn’t know it.

I started the Alzheimer’s Reading Room to keep track of the thousands of articles and many books I was reading. I soon realized I could help the ten million Alzheimer’s Caregivers worldwide by personalizing this information on my blog. Later on, I decided to start writing about our successes in fighting the disease, our decisions on treatments, our new life style, where to look for help, and news about the search for a cure. I stick to information I believe is useful and helpful. There is an enormous amount of new information each day; it’s difficult to identify the best and most useful information. This is my job.

I now know there are many things baby boomers can do to lower the odds of contracting Alzheimer’s disease. I do all of these things for myself each day. There are things you can do to stave off the disease. You need to start doing them now. You cannot wait. With this in mind, I am broadening my mission on the blog to include information to help baby boomers understand and take action against Alzheimer’s

Here are few things baby boomers should be doing right now:

High blood pressure (hypertension) is a cause of cognitive decline. Hypertension causes build-up of beta-amyloid in the brain. This is a complication frequently associated with Alzheimer’s disease. Take action to get your blood pressure down now.

High cholesterol levels in your 40s may raise the chance of developing Alzheimer’s disease decades later. Failure to deal with this condition effectively could raise the odds of contracting Alzheimer’s disease by fifty percent. Get your cholesterol checked often and get it down.

B12. A recent study found that people with higher levels of vitamin B12 were six times less likely to experience brain volume loss. A simple blood test is all that is needed to check the level of B12 in your system. You should start eating foods rich in B12 and consider getting B12 shots to raise the amount of B12 in your system.

Big Belly. Having a large belly in middle age nearly triples the risk of developing dementia.

Cocoa flavanols. A recent study at Harvard found that those who regularly drank a cocoa flavanol-rich beverage had an eight percent increase in brain blood flow after one week, and 10 percent increase after two weeks. I highly recommend incorporating this into your diet.

Exercise. A new study just released shows that regular exercise is one of the best ways to reduce your risk of dementia and can help slow progression of Alzheimer’s disease.

In the days ahead, I will be writing more about ways to combat Alzheimer’s disease. If you know someone currently caring for a loved one with Alzheimer’s disease please tell them about the blog. You can subscribe to the blog via email or reader by taking the appropriate action on the blog.

They are predicting that ten million baby boomers will suffer from Alzheimer’s disease. By spreading the word and taking action we can lower the number. Let’s get together on this.

Original content the Alzheimer’s Reading Room

 

Vitamin B12 May Protect Against Brain Shrinkage in Baby Boomers

These findings should be of special interest to baby boomers now entering their 60s. It could be a good idea to consult with a physician about B-12 shots.

A study conducted by researchers at the Oxford Project to Investigate Memory and Ageing (OPTIMA) found that people with higher levels of vitamin B12 were six times less likely to experience brain volume loss.

Vitamin B12, a nutrient found in meat, fish and milk, may protect against brain volume loss in older people. The researchers studied 107 volunteers age 61 to 87 who did not have cognitive impairment when they volunteered. The volunteers underwent yearly MRI brain scans, cognitive and memory tests and physical exams for five years.

This study suggests that simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory, says Anna Vogiatzoglou of the Department of Physiology, Anatomy and Genetics at Oxford University. Research shows that vitamin B12 deficiency is a public health problem, especially among the elderly, so more vitamin B12 intake could help reverse this problem. Without carrying out a clinical trial, we acknowledge that it is still not known whether B12 supplementation would actually make a difference in elderly persons at risk for brain shrinkage.


Vitamin B12 may protect the brain in old age

Vitamin B12, a nutrient found in meat, fish and milk, may protect against brain volume loss in older people, according to a University of Oxford study.

For the study, 107 people between the ages of 61 and 87 underwent brain scans, memory testing and physical exams. The researchers from the Oxford Project to Investigate Memory and Ageing (OPTIMA) also collected blood samples to check vitamin B12 levels. Brain scans and memory tests were also performed again five years later.

The study, published in the journal Neurology, found that people who had higher vitamin B12 levels were six times less likely to experience brain shrinkage compared with those who had lower levels of the vitamin in their blood. None of the people in the study had vitamin B12 deficiency.

Many factors that affect brain health are thought to be out of our control, but this study suggests that simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory,” says Anna Vogiatzoglou of the Department of Physiology, Anatomy and Genetics at Oxford University. “Research shows that vitamin B12 deficiency is a public health problem, especially among the elderly, so more vitamin B12 intake could help reverse this problem. Without carrying out a clinical trial, we acknowledge that it is still not known whether B12 supplementation would actually make a difference in elderly persons at risk for brain shrinkage.”

Previous research on the vitamin has had mixed results and few studies have been done specifically with brain scans in elderly populations. We tested for vitamin B12 levels in a unique, more accurate way by looking at two certain markers for it in the blood,” adds Ms Vogiatzoglou.

Ms Vogiatzoglou says the study did not look at whether taking vitamin B12 supplements would have the same effect on memory.

The study was supported by the UK Alzheimer’s Research Trust, the Medical Research Council, the Charles Wolfson Charitable Trust, the Norwegian Foundation for Health and Rehabilitation through the Norwegian Health Association, Axis-Shield plc and the Johan Throne Holst Foundation for Nutrition Research.

For more information please contact Professor David Smith on david.smith@pharm.ox.ac.uk

Or the Press Office, University of Oxford, 01865 280528, press.office@admin.ox.ac.uk.

* OPTIMA, the Oxford Project to Investigate Memory and Ageing, is tackling one of the great medical and social challenges of our time: the diseases of the ageing brain. It aims to deepen our understanding of the changes that occur in the brain as we age, in a longitudinal study of normal volunteers and patients with memory problems. In revealing the differences between normal brain ageing and diseases like Alzheimer’s disease, OPTIMA will lay the foundations for the development of new forms of prevention and treatment. http://www.medsci.ox.ac.uk/optima

* Oxford University’s Medical Sciences Division is one of the largest biomedical research centres in Europe. It represents almost one-third of Oxford University’s income and expenditure, and two-thirds of its external research income. Oxford’s world-renowned global health programme is a leader in the fight against infectious diseases (such as malaria, HIV/AIDS, tuberculosis and avian flu) and other prevalent diseases (such as cancer, stroke, heart disease and diabetes). Key to its success is a long-standing network of dedicated Wellcome Trust-funded research units in Asia (Thailand, Laos and Vietnam) and Kenya, and work at the MRC Unit in The Gambia. Long-term studies of patients around the world are supported by basic science at Oxford and have led to many exciting developments, including potential vaccines for tuberculosis, malaria and HIV, which are in clinical trials.

Original content the Alzheimer’s Reading Room

 

The 36-Hour Day

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This best-selling book is the “bible” for families caring for people with Alzheimer disease. The book is ranked the number one best seller in three categories on Amazon: Alzheimer’s disease, Caregiving, and Eldercare. It carries a five star review from customers.


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

In addition to the practical and compassionate guidance that have made The 36-Hour Day invaluable to caregivers, the fourth edition includes new information on medical research and the delivery of care.


This 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.

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Helping those who help others: the Modified Caregiver Strain Index

I found this video to be wonderfully enlightening. I suggest that all Caregivers and family/friends of caregivers take the time to view this video. Often overlooked, caregivers can suffer from depression. The job tends to wear you down over time.

The Modified Caregiver Strain Index helps to determine the level of strain a caregiver is experiencing. The combination of stress and burden does effect a caregivers’ overall health. The index assesses 13 aspects of physical health, family finances, social interactions, time demands, and employment. By identifying the sources and degree of strain, the index can help in the selection of interventions that can be used to alleviate caregivers’ strain and improve the lives of caregivers and care recipients.

To watch this free video Helping those who help others follow the link. Please be patient at the start up. While this video was designed for nurses I believe it is useful for anyone trying to understand the issues faced by caregivers. If you suspect a caregiver you know is suffering from depression you will want to see this video. It should serve as a wake-up call for children who have an elderly parent serving as a Caregiver.

Original content The Caregiver

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UCSF Memory and Aging Center

I just visited the UCSF Memory and Aging Center for the first time. This new YouTube channel set up by UCSF is designed to educate patients, caregivers and health professionals about the various forms of neurodegenerative diseases. This is a great new vehicle and you can subscribe for free.

You can go to the website for a video that explains their mission.

Go here to learn more about Alzheimer’s and Frontotemporal Dementia.

This video caught my attention: Loss of moral reasoning and sense of self. While I have not experienced this problem with my mother, I am often asked about moral reasoning and how to deal with this.

 

The measurement of everyday cognition (Everyday Cognition Questionnaire)

This looks like a very useful tool.

“Results suggest the Everyday Cognition [questionnaire] shows promise as a useful tool for the measurement of general and domain-specific everyday functions in the elderly”


Questionnaire Evaluates Everyday Cognition in Elderly

A caregiver-rated questionnaire to evaluate everyday cognitive function in the elderly is effective and can differentiate between cognitively normal and impaired individuals, according to a report in the July issue of Neuropsychology.

Sarah Tomaszewski Farias, Ph.D., from the University of California Davis in Sacramento, Calif., and colleagues developed a caregiver-rated questionnaire, Everyday Cognition, comprised of multiple subscales to assess cognitively mediated functional abilities in older adults. The instrument was validated in caregivers (spouses, adult children, other family members, friends and others) of 576 elderly adults, of whom 174 were cognitively normal, 126 had been diagnosed with mild cognitive impairment, and 276 had been diagnosed with dementia.

The researchers found that the instrument’s factor structure consisted of one global factor and six domain-specific factors (everyday memory, language, visuospatial abilities, planning, organization, and divided attention). The questionnaire correlated with established measures of functional status and global cognition, but less well with age and education, and was able to distinguish the clinical groups. The global factor and everyday memory domain could differentiate normal from mild cognitive impairment, the global factor and the everyday language domain could differentiate dementia from mild cognitive impairment, and other patterns could distinguish between mild cognitive impairment subtypes.

“Results suggest the Everyday Cognition [questionnaire] shows promise as a useful tool for the measurement of general and domain-specific everyday functions in the elderly,” Farias and colleagues conclude.

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