Category Archives: education

Exercise slows decline in Alzheimer’s patients

I can attest, exercise makes a difference. My mother now has the tendency to sit around all day. On those days when I can get her to go to Gold’s Gym with me she is a completely different person. The look on her face, from dull to smiling, is more than enough to tell me that exercise works to her benefit.

The article on the next page talks about the effects of exercising on Alzheimer’s patients.

“Nursing home residents with Alzheimer’s disease who participate in a moderate exercise program have a significantly slower deterioration than those who receive routine medical care, researchers have shown.”

Exercise slows decline in Alzheimer’s patients

NEW YORK (Reuters Health) – Nursing home residents with Alzheimer’s disease who participate in a moderate exercise program have a significantly slower deterioration than those who receive routine medical care, researchers have shown.

Dr. Yves Rolland, of Hospital La Grave-Casselardit in Toulouse, France, and colleagues examined the effects of a program of exercise for one hour twice weekly on activities of daily living, physical performance, nutritional status, behavioral disturbance and depression among 134 Alzheimer’s disease patients in nursing homes.

The patients were 83 years old on average. They were assigned to the exercise program, which focused on walking, strength, balance and flexibility training, or to routine medical care for 12 months.

As reported in the Journal of the American Geriatrics Society, 110 participants completed the study. Among the 56 subjects in the exercise group who completed the study, the rate of adherence to the program was about 33 percent on average.

At the end of the 12 months, the average activities-of-daily-living score was significantly more improved in the exercise group than in the routine medical care group, Rolland’s team reports.

In addition, average walking speed improved significantly more in the exercise group than in the routine medical care group at 6 months and 12 months.

However, the exercise program had no apparent effect on behavioral disturbance, depression or nutritional assessment scores.

ORIGINAL SOURCE: Journal of the American Geriatrics Society, February 2007.


Alzheimer’s and Loneliness Linked

People who are lonely are twice as likely to develop Alzheimer’s disease, a large US study has suggested.

Source Archives of General Psychiatry

A total of 823 older persons free of dementia at enrollment were recruited from senior citizen facilities in and around Chicago, Ill. Loneliness was assessed with a 5-item scale at baseline (mean ± SD, 2.3 ± 0.6) and annually thereafter. At death, a uniform postmortem examination of the brain was conducted to quantify AD pathology in multiple brain regions and the presence of cerebral infarctions.

The study found that the risk of Alzheimer’s disease was more than doubled in lonely persons compared with persons who were not lonely. The study also concluded that Loneliness is associated with an increased risk of late-life dementia but not with its leading causes.


The Seven Stages of Alzheimer’s

Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and developed several methods of “staging” based on these patterns.

Source Alzheimer’s Association

The Seven Stages of Alzheimer’s

Staging systems provide useful frames of reference for understanding how the disease may unfold and for making future plans. But it is important to note that not everyone will experience the same symptoms or progress at the same rate. People with Alzheimer’s live an average of 8 years after diagnosis, but may survive anywhere from 3 to 20 years.

The framework for this section is a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline. This framework is based on a system developed by Barry Reisberg, M.D., Clinical Director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.

Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe and severe Alzheimer’s disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage and late-stage categories.

Stage 1:
No impairment (normal function)

Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.

Stage 2:
Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer’s disease.

Individuals may feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers.

Stage 3:
Mild cognitive decline

Early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms:

Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:

Word- or name-finding problems noticeable to family or close associates.

Decreased ability to remember names when introduced to new people.

Performance issues in social or work settings noticeable to family, friends or co-workers.

Reading a passage and retaining little material.

Losing or misplacing a valuable object.

Decline in ability to plan or organize.

Stage 4:
Moderate cognitive decline
(Mild or early-stage Alzheimer’s disease)

At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:

Decreased knowledge of recent occasions or current events.

Impaired ability to perform challenging mental arithmetic-for example, to count backward from 75 by 7s.

Decreased capacity to perform complex tasks, such as planning dinner for guests, paying bills and managing finances.

Reduced memory of personal history.

The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations.

Stage 5:
Moderately severe cognitive decline
(Moderate or mid-stage Alzheimer’s disease)

Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:

Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated.

Become confused about where they are or about the date, day of the week or season.

Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s.

Need help choosing proper clothing for the season or the occasion.

Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children.

Usually require no assistance with eating or using the toilet.

Stage 6:
Severe cognitive decline
(Moderately severe or mid-stage Alzheimer’s disease)

Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may:

Lose most awareness of recent experiences and events as well as of their surroundings.

Recollect their personal history imperfectly, although they generally recall their own name.

Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces.

Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet.

Experience disruption of their normal sleep/waking cycle.

Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly).

Have increasing episodes of urinary or fecal incontinence.

Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding.

Tend to wander and become lost.

Stage 7:
Very severe cognitive decline
(Severe or late-stage Alzheimer’s disease)

This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement.

Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered.

Individuals need help with eating and toileting and there is general incontinence of urine.

Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.


Alzheimer’s: Understand and control wandering

One of the questions I am most frequently asked is if I am worried that my mother might wander away from me and get lost. Wandering is one of the more widely known behaviors of people suffering from Alzheimer’s disease. This article from the Mayo Clinic explains this behavior and some of the likely causes and remedies.

Source Mayo Clinic

Alzheimer’s: Understand and control wandering
Find out why people with Alzheimer’s wander and what you can do to keep them safe.

Alzheimer’s disease can erase a person’s memory of once-familiar surroundings and make adaptation to new surroundings extremely difficult. As a result, people with Alzheimer’s sometimes wander away from their homes or care centers and turn up — frightened and disoriented — far from where they started, long after they disappeared.

Wandering is among the most unsettling and even terrifying behaviors people with Alzheimer’s display. Often poorly clad, they leave safety at random hours and strike out into unknown territory, for no apparent reason. But this seemingly aimless activity usually does have a reason. It’s often an attempt to communicate after language skills have been lost.

Wandering may communicate something as simple as “I’m feeling lost,” or “I feel as though I’ve lost something.” It can also signal such basic needs as hunger and thirst, the need to void, or the need for exercise or rest.

Other causes of wandering:

Too much stimulation, such as multiple conversations in the background or even the noise of pots and pans in the kitchen, can trigger wandering. Because brain processes slow down as a result of Alzheimer’s disease, the person may become overwhelmed by all the sounds and start pacing or trying to get away.

Wandering also may be related to:

Medication side effects
Memory loss and disorientation
Attempts to express emotions, such as fear, isolation, loneliness or loss
Restlessness or boredom
Stimuli that trigger memories or routines, such as the sight of coats and boots next to a door, a signal that it’s time to go outdoors
Being in a new situation or environment

Tips to prevent wandering
Although it may be impossible to completely prevent wandering, changes in the environment can be helpful. For example, a woman who was a busy homemaker throughout her life may be less likely to become bored and wander if a basket of towels is available for her to fold.

People with Alzheimer’s often forget where they are. They may have difficulty finding the bathroom, bedroom or kitchen. Some people need to explore their immediate environment periodically to reorient themselves.

Posting descriptive photographs on the doors to various rooms, including a photo of the individual on the door to his or her own room, can help with navigation inside the home. Offering a snack, a glass of water or use of the bathroom may help identify a need being expressed by wandering. Sometimes the wandering person is looking for family members or something familiar. In such cases, providing a family photo album and sharing reminiscences may help.

Watch for patterns
If wandering occurs at the same time every day, it may be linked to a lifelong routine. For instance, a woman who tries to leave the nursing home every day at 5 p.m. may believe she’s going home from work.

This belief could be reinforced if she sees nursing home personnel leaving at that time. A planned activity at that hour, or arranging for staff to exit through a different door at the end of their shift, could provide a distraction and prevent the wandering behavior.

Make a safer environment
If wandering isn’t associated with distress or a physical need, you may want to focus simply on providing a safe place for walking or exploration.

Living spaces will be safer after you remove throw rugs, electrical cords, and other potential trip-and-fall hazards. Rearranging furniture to clear space can help. Childproof doorknobs or latches mounted high on doors help prevent wandering outside. Sometimes a stop sign on an exit door is enough.

Rooms that are off-limits pose a different problem. Camouflaging a door with paint or wallpaper to match the surrounding wall may short-circuit a compulsion to wander into such rooms. Night lights and gates at stairwells can be used to protect night wanderers.

Help ensure a safe return

The Alzheimer’s Association’s Safe Return program is designed to help identify people who wander and return them to their caregiver. Caregivers who pay a $40 registration fee receive:

An identification bracelet
Name labels for clothing
Identification cards for wallet or purse

Registration in a national database with emergency contact information
A 24-hour toll-free number to report someone who is lost
You can register someone by filling out a form online at the Alzheimer’s Association’s Web page or by calling (888) 572-8566.

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