Mild Cognitive Impairment Archives

AboutAlz.com Ends Regular Run

It’s been three years since I began this blog. I started it as a way to seek answers for myself. The number of people with Alzheimer’s disease (AD) and other forms of dementia is staggering and the projected numbers are mind-boggling. Each year we are hopeful for the one miracle drug that will cure AD, but we have not reached our goal.

The untold number of hours that caregivers spend caring for their loved ones cannot be measured. It indeed takes a huge toll on their physical and mental health as well as their financial burden.

When I look at the visitor statistics for this blog, I know that other people are looking for answers as well. Although I am encouraged by the numbers to continue this blog, my situation has changed and I have accepted another challenge which requires that I devote some time to achieve success. I may return to writing this blog in the future, but I hope that it will not be necessary as we will have solved the problem and eliminated Alzheimer’s disease.

If I can summarize what we can all do at this point, it’s everything you would do to keep your immune system healthy such as:

  • Get adequate sleep every night.
  • Take enough Omega 3 and other necessary supplements. (Check with your health care provider).
  • Exercise as vigorously as you can.
  • Find enjoyment in life. Do things that you really love to do. Just because it’s been said that crossword puzzles are good for the brain, if you don’t enjoy it, why are you engaging in it?
  • Be grateful no matter what situation you are in. There’s a lesson to be learned in everything.

The Alzheimer’s organization is one source that has been very helpful in keeping us posted with the latest news and there are other sources that I’ve mention in this blog as well. Do check its Web site periodically. As I say good-bye for now, I thank you for your support.

Exercise and Alzheimer’s Disease

As revealed in the Journal of Biological Chemistry “Paper of the Week,” Ayae Kinoshita, a researcher at the Kyoto University Graduate School of Medicine in Japan, exercise is of great significance in fighting against Alzheimer’s disease. Alzheimer’s disease mostly occurs in individuals who are above 65 years of age and is one of the common causes of dementia. This disease is attributed to a number of factors that include the lack of regular exercise as well as an unhealthy diet that includes excess fats.

The research done by Kinoshita included a comparative analysis of voluntary exercise, diet control, and a combination of exercise and diet control in a mouse model with Alzheimer’s disease. Results indicated that regular exercise was of more benefit in reducing formation of β-amyloid—typical characteristic of Alzheimer’s disease — compared to diet control. In addition, exercise triumphed over diet control in restoration of memory loss induced by a fat-rich diet in the mice models. On the basis of this research, the Kyoto University expert recommends that the first priority should be given to exercise in the prevention of Alzheimer’s disease.

 

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The last two months I’ve talked about a lecture that I attended, “Understanding the Person with Dementia: How to Communicate Effectively.” It was presented by Susan Stone who is with the Alzheimer’s Family Day Center (AFDC) in Fairfax, Virginia and does outreach and education. Communicating with a person with Alzheimer’s disease (AD) is a challenge which takes patience and understanding. This is a continuation of her lecture and the final in the series of three articles.

To communicate with a person with Alzheimer’s disease (AD), we need to understand their world. There is no point in arguing or correcting. The patient’s reality is not your reality so join the individual where he is. Simply acknowledge the statement and emotion behind it even though you know that it’s incorrect. Avoid asking questions that they cannot answer. Allow them to reminisce.

Make positive statements. Try going through the day without saying “no.” Difficult? Avoid pronouns like it, he, she. And use very simple explanations. Details often overwhelm them and can cause increased anxiety.

Here are some strategies to consider.

  • Offer guided choices. They are losing their right to make choices so say something like “chocolate or vanilla” and they will likely remember the last word.  The speaker humorously added that if there are only two choices and you want the chocolate one, offer the chocolate one first followed by vanilla since they will probably choose vanilla.
  • Write it down and use labels. During the late stages, labels won’t help, but during earlier stages of AD, they will help.
  • Validate emotions rather than facts.
  • Avoid overstimulation.
  • Model appropriate behavior.
  • Fill in lost words, although this depends on the person.
  • Turn your questions into answers.
  • Use events to measure time.

Listening is extremely important. Learn to read body language to figure out what the person is trying to communicate. Is it pain, frustration, fear, pleasure, boredom? Survey the environment as well to see what’s going on. Focus on the person and listen. One AD patient said,

I have taken time to put words together and I may be unable to repeat it.

Another AD patient said, I’m doing the best I can. They may overhear you talking about them so be careful. The ability to understand what is being said outlasts the ability to speak effectively.

The understanding the person has might come from body language and tone of voice more than from the words that you use. Use humor gently and never at the expense of the individual. But humor is everywhere; just keep looking for it.

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Last month I talked about a lecture that I attended, “Understanding the Person with Dementia: How to Communicate Effectively.” It was presented by Susan Stone who is with the Alzheimer’s Family Day Center (AFDC) in Fairfax, Virginia and does outreach and education. Communicating with a person with Alzheimer’s disease (AD) is a challenge which takes patience and understanding. This is a continuation of her lecture.

As we age, we all experience age-related brain changes, but for Alzheimer’s disease (AD) patients, the changes may be a lot more pronounced. They include:

  • Impaired hearing – especially higher frequencies
  • Lessened ability to determine the location of sound
  • Decreased vision
  • Slower thought processing
  • Slower in adjusting to light changes. (She suggested going into their bedroom earlier and opening the blinds).

Along with age-related brain changes, there are definite communication changes in dementia. They include the following:

  • Word finding problems (initially nouns and pronouns)
  • Frontal lobe damage
  • Word salads (stringing a lot of words together that don’t make sense)
  • Perseveration (repeating words over and over)
  • Mis-naming (but getting close) (An example she gave was someone trying to say Dairy Queen and used the word “king”).
  • Returning to original language (first to learn and last to lose)
  • Loss of ability to recognize and understand words

When approaching a person with dementia, use the person’s name and casually introduce yourself. Approach the person from the front and make sure you have eye contact. Touching the person also helps them to maintain attention. There’s less human touch as a person gets older so touching is important.

Finally, here are tips for initiating conversation.

  1. Speak slowly and clearly. Use e-x-p-a-n-d-e-d speech, but by all means treat them with dignity and not as though they are a child.
  2. Pause at the end of thoughts to give them time to process.
  3. State one request at a time.
  4. Always explain what you are going to do.
  5. Use lots of hand gestures.
  6. Watch the person closely for their reaction. Anxiety leads to anxiousness to regression.

Next month I will continue with more tips.

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A couple of years ago, I wrote about a wonderful Alzheimer’s disease (AD) resource in Fairfax County, Virginia located about 15 miles south of Washington, DC, the Alzheimer’s Family Day Center (AFDC). Not only are they a day care center for AD patients, but they have excellent programs for caregivers. I recently attended one such program on communicating with Alzheimer’s patients.

Titled “Understanding the Person with Dementia: How to Communicate Effectively,” it was presented by Susan Stone who is with AFDC and does outreach and education. Susan is an excellent communicator herself and interacts with the audience extremely well. I want to share some of her thoughts in this article and I will continue next month.

Because communication is only 7% verbal and the rest nonverbal, it is important to not limit your communication to just words. People with Alzheimer’s prefer not to talk on the phone and initiating phone calls is difficult. They have difficulty keeping up with conversation and may not understand your words. Their attention span is limited and they may have trouble finding the correct word. Furthermore, they may pick up only every three to four words.

For example, the conversation may sound like this:

___ WANT ___  ___  ___ GET ___  ___  ___ TAKE ___  ___  ___ . WE ___  ___  ___ APPOINTMENT ___  ___  ___  ___ WE ___  ___  ___ BEFORE ___  ___  ___ HOME.

NOW ___  ___ HURRY.

Here is the entire message:

I WANT you to GET up now and TAKE a good shower. WE have a doctor’s APPOINTMENT at 11:00 and WE can have LUNCH before we go HOME.

NOW please just HURRY!

Getting angry and adding a sharp tone of voice is not going to make this message any easier for the AD person to decipher. Here are some suggestions Susan offered:

  • Restating key words will help.
  • Give one direction at a time.
  • No rushing – time does not mean anything to an AD person.

Here are further suggestions repeating just the key words.

  • Get up. (Offer your hand).
  • Shower.

This is all the person needs to know at this point. They don’t really need to know about the appointment and having lunch is too far in the future to mention it now. You want them to take a shower and all they might remember is having lunch.

More suggestions will be coming next month. I hope this gives some understanding as to why communication is so challenging for those with dementia.

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Overeating and Memory Loss

A recent study shows that overeating more than 2,100 calories a day nearly doubled the risk of memory loss or mild cognitive impairment (MCI). The study concerned those over 70 years old and will be presented at the American Academy of Neurology’s 64th Annual Meeting in New Orleans April 21 to April 28, 2012. According to study author Yonas E. Geda, MD, MSc, with the Mayo Clinic in Scottsdale, Arizona and a member of the American Academy of Neurology, “We observed a dose-response pattern which simply means the higher the amount of calories consumed each day, the higher the risk of MCI.”

According to Wikipedia, MCI is a brain-function syndrome involving the onset and evolution of cognitive impairments beyond those expected based on the age and education of the individual, but which are not significant enough to interfere with their daily activities. It is often found to be a transitional stage between normal aging and dementia.

For this investigation, they turned to the Mayo Clinic Study on Aging, an ongoing, population-based cohort study in Olmsted County, Minnesota. The analysis involved 1233 nondemented participants aged from 70 to 89 years; 1070 patients were cognitively normal, and 163 had MCI.

The subjects noted the amount of calories they ate or drank in a food questionnaire. They were divided into three equal groups based on their daily caloric consumption.

  • One-third consumed between 600 and 1,526 calories per day.
  • One-third consumed between 1,526 and 2,143 calories per day.
  • One-third consumed between 2,143 and 6,000 calories per day.

The analyses were adjusted for history of stroke, diabetes, amount of education, and other factors that can affect risk of memory loss. The risk for the highest calorie group was nearly double that of the lower calorie group. There was no noticeable difference in risk for the middle group.

According to Geda, the findings should be considered preliminary. However, consuming in moderation is a good idea for other medical reasons as well.

The co-authors of the study include Ronald C. Petersen, MD, Fellow of the American Academy of Neurology, and other investigators of the Mayo Clinic Study of Aging in Rochester, Minn.

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