Frontotemporal Dementia Archives

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.

Enhanced by Zemanta

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.

Enhanced by Zemanta

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.

Enhanced by Zemanta

Coconut Oil and Alzheimer’s Disease

Back in July 2008, Dr. Mary Newport wrote a case study, “What if there was a Cure for Alzheimer’s Disease and no one Knew?” However, last month it was brought to our attention again when cbn.com did an interview with Dr. Newport (see video below). In her case study, she writes about ketone bodies which serve as fuel for your brain that your body makes when you ingest coconut oil. This may prove to be highly beneficial in fighting Alzheimer’s disease (AD).

Several people sent me e-mail about this interview and since then I’ve been researching various Web sites as well as checking out local retail outlets for coconut oil. Health food stores and specialty supermarkets carry coconut oil in capsule form, although you may be able to find some health food stores carrying the actual oil (I was pleased to find it in a health food store in my area). However, with experts recommending between two and three tablespoons of coconut oil daily for prevention of AD and up to five tablespoons for AD and with each capsule having only about 500 to 1000 mg of oil (each tablespoon is equal to about 15 grams), you would need at least 15 capsules to get one tablespoon. Taking 45 to 75 capsules a day would be quite costly and ill advised.

One of the top producers of coconut oil is the Philippines so I visited a local Filipino market in southern California that was recommended by a Filipino acquaintance who uses coconut oil. It is recommended that you start slowly, and thus far I’ve used about a teaspoon in my morning oatmeal. (I’m trying to get used to greasy oatmeal). I’ve also tried substituting the olive oil in my salad with the coconut oil (the taste did not agree with me). Finally, I substituted one tablespoon of coconut oil for butter and syrup on my pancakes and that was by far the tastiest option. But since I don’t eat pancakes every day, I continued to experiment and now I find that adding coconut oil to a small amount of coffee or tea works well.

Bruce Fife, ND, author of Stop Alzheimer’s Now!: How to Prevent & Reverse Dementia, Parkinson’s, ALS, Multiple Sclerosis & Other Neurodegenerative Disorders cautions that proper diet is also a necessary component. Simply adding coconut oil to the diet will produce disappointing results. He says that the fundamental problem associated with Alzheimer’s disease is the inability of the brain to effectively utilize glucose, or blood sugar, to produce energy. The brain then needs another source of energy and this comes in the form of ketone bodies produced in the liver. Medium chain triglycerides (MCTs) like coconut oil are converted into ketones in the body.

There are different methods of producing coconut oil. According to Tropical Traditions, a producer of coconut oil, “Virgin Coconut Oil can only be achieved by using fresh coconut meat or what is called non-copra. Chemicals and high heating are not used in further refining, since the natural, pure coconut oil is very stable with a shelf life of several years. There are currently two main processes of manufacturing Virgin Coconut Oil:

1. Quick drying of fresh coconut meat which is then used to press out the oil. Using this method, the coconut meat is quick dried, and the oil is then pressed out via mechanical means. This is the most common type of “Virgin” or “Extra Virgin” (see below) coconut oil sold in the market today that you will find in stores. It is mass-produced.

2. Wet-milling. With this method the oil is extracted from fresh coconut meat without drying first. “Coconut milk” is expressed first by pressing. The oil is then further separated from the water. Methods which can be used to separate the oil from the water include boiling, fermentation, refrigeration, enzymes and mechanical centrifuge.

Currently there is no known medication to prevent or stop Alzheimer’s disease. Coconut oil offers hope for this disease affecting 5.4 million Americans. Should you decide to try it, let me know how you’re ingesting it.

Memory and Focus

Many people have problems with memory and focus as they age.  Whether the problems are the beginning stages of dementia or just a lack of focus, the following exercise can help to ensure that aging has less power to rob you of precious memories.  In addition, this exercise provides a possible solution for insomnia.

1.  Focus on the events of the day in order from arising in the morning until you go to sleep. The good news is that you will fall asleep long before you reach the end of the day.

2.  During the process, visualize each step of the day.  The process should include all activities, conversations, thoughts and individuals met during the day.  It might be seen as a video recording of the day played back only in your brain.  Focus on details.

3.  Initially, the mind video will be playing in fast forward.  It will be difficult to pick out the small details such as thinking over your today list or looking in the mirror while brushing one’s teeth.  In addition, scenes may jump out of sequence from morning to afternoon and then back to getting out of bed.  However, your goal is to play the video in sequence.

4.  As you continue the exercise several days in a row, you should begin to see some differences.  That which was once a just big chunk of time will begin to develop into fully visualized scenes, which include people, conversations, room decor, signs and thoughts.  Details will become clearer.

5.  It should become a daily challenge to remember more of the day.  You will become more aware of the things you normally would have done without much thought.  Since you know you must recall, your focus changes.  You are using brain cells not previously harnessed.  While the nighttime exercises may be a cure for insomnia, the daytime exercises help you to focus, improve your memory, and lower the chances of developing dementia.

By improving one’s daytime focus and recalling events of the day, it is possible for people to avoid memory loss and dementia.  Additionally, these activities can help with insomnia.

The ideas in this article are adapted from a blog on how to become a better chess player, but certainly seem appropriate for anyone concerned with dementia and having problems with memory and focus.

http://www.mychessblog.com/one-simple-mental-exercise-to-improve-your-mind-power/

 

Facebook Light for Dementia Patients

According to Medical News Today, there is a version of Facebook called Facebook Light being developed by SINTEF, the largest research organization in Scandinavia. This will enable the elderly and those with dementia to maintain important social contact. This will enable them to maintain their level of functioning longer, according to research and experience.

According to Tone Oderud, a research scientist at SINTEF, the elderly are being excluded from social media today. The user interface is too advanced for many of them. Oderud is working in a multidisciplinary research team to develop a web-based communications application which is simple enough to enable even people with dementia to use it. The goal is to create a simpler and more secure everyday life for elderly and senile people, their relatives and personnel in the community care services.

Furthermore, research scientists believe that contact through social media can improve the quality of health and life for the great numbers of elderly and those with dementia in our society. At the same time, this can ease the burden on therapists and caregivers.

Testing of other web-based communications systems have already been started. They include a “digital diary” and “scrapbook” with personal photos, newspaper cuttings, and other online information. Oderud says that both of these improved communication between both relatives and the community care services in an informal but valuable way.

The article states that the tests showed that constant, simple contact between relatives and the support services improved everybody’s security and at the same time it reduced the time the caregivers needed to follow up concerned relatives. This holds great potential in all fields of caregiving.

A prototype is currently being tested in the city of Drammen in southern Norway.

Prolonged stress does ugly things and now, possibly lead to Alzheimer’s disease (AD). Researchers at the Munich-based University of Minho in Braga, Portugal, have shown that stress, and the hormones released during stress, can accelerate the development of Alzheimer disease-like biochemical and behavioral pathology. Protein deposits in nerve cells are a typical feature of Alzheimer’s disease: the excessive alteration of the tau protein through the addition of phosphate groups — a process known as hyperphosphorylation — causes the protein in the cells to aggregate into clumps. Nerve cells die as a result and those in the hippocampus and the prefrontal cortex are important for learning, memory, and higher cognitive functions.

In this study, rats subjected to stress such as overcrowding and placement on a vibrating platform for one hour daily for one month showed increased hyperphosphorylation of tau protein in the hippocampus and prefrontal cortex. The animals that showed these changes in tau had deficient memories showing problems in the hippocampus area and impaired behavioral flexibility showing deficiency in the prefrontal cortex.

Less than 10 percent of Alzheimer cases are genetic. Previous studies have shown that stress leads to the formation of beta-amyloid, another protein implicated in Alzheimer’s disease. According to Osborne Almeida from the Max Planck Institute of Psychiatry, their findings indicate that stress hormones and stress can cause changes in the tau protein like those that arise in Alzheimer’s disease. The next step will be to see if results obtained in animals are applicable to the development of non-familial forms of Alzheimer’s disease.

Related Article: Stress Significantly Hastens Progression of Alzheimer’s Disease

Enhanced by Zemanta

Last week the Alzheimer’s Association released its new 2011 Alzheimer’s Disease Facts and Figures report. The statistics are grim. It is the sixth leading cause of death and of the top 10, it’s the only one where we do not know exactly how it can be prevented, cured, or slowed. Yes, we do have many research studies going on, but there has not been anything definitive. Most of the studies are just the tip of the iceberg and require further research. Some have produced disappointments. Highlights from the report include the following:

  • An estimated 5.4 million American’s have Alzheimer’s disease. Another American develops Alzheimer’s disease every 69 seconds.
  • In 2010, 14.9 million family and friends provided 17 billion hours of unpaid care to those with Alzheimer’s and other dementias.
  • The cost of caring for those with Alzheimer’s to American society will total $183 billion in 2011.
  • Deaths from Alzheimer’s increased 66 percent between 2000 and 2008, and Alzheimer’s is the only cause of death among the top 10 in America without a way to prevent, cure, or even slow its progression.

The complete 2011 Alzheimer’s Disease Facts and Figures report allows you to get information specific to your state. Let’s hope we will have a major breakthrough this year and the 2012 report will be a lot more promising.

The Alzheimer’s Association produced a video capturing these statistics.

Meditation is often associated with words such as relaxation, peacefulness, and calm. Researchers and scientists have for some time now endorsed the value of meditation. Not only do people who practice meditation feel calm and happy, they also report enhanced cognition and memory abilities. Although researchers at the Massachusetts General Hospital did not include those with Alzheimer’s Disease (AD), they sought to study the benefits of mindfulness meditation training and in my opinion, this can certainly apply to the AD population.

A recent study that was supported by the Institutes of Health, The Mind and Life Institute and the British Broadcasting Company studied the changes in the brain after an 8-week mindfulness meditation program. The findings from the study have been published in the Psychiatry Research: Neuroimaging, January 30 issue. It reports that this is the first time that changes in the brain and related improvements have been documented due to meditation over a period of time.

Magnetic Resonance Images (MRI) were taken two weeks before and after the Mindfulness-Based Stress Reduction Program Program was conducted, for both the control group and the group that practiced mindfulness meditation. This form of mediation focuses on the feelings, emotions and state of mind in a non judgmental manner. The study group conducted meditation exercises for about 27 minutes daily. Their responses to a mindfulness questionnaire showed a marked improvement when compared with those made before the study began.

MRI after the mindfulness meditation program focused on parts of the brain that have shown improvement in earlier studies. The images showed an increase in the grey matter density of the hippocampus, a part of the brain that affects memory and learning. Similarly, brain parts that are related with compassion, self understanding and introspection also increased in size.

The participants reported reduced stress and this was correlated with the reduction in density at the amygdala, the part of the brain that affects the stress and anxiety that an individual experiences. However the insula, which is believed to be associated with self awareness, did not show any changes. More research in this direction may be required.  The MRI of the control group showed no changes in the same period of time.

There is no known cure for Alzheimer’s disease, but mindfulness meditation may aid Alzheimer’s disease patients in dealing with AD more effectively. Britta Hölzel, PhD, is first author of the paper and a research fellow at Massachusetts General Hospital and Giessen University in Germany. James Carmody, PhD, of the Center for Mindfulness at University of Massachusetts Medical School is the co-author.

Enhanced by Zemanta

Carmellia sinesis foliage

Green tea is my favorite drink and is in the news again. Now it’s exciting to hear that green tea may help prevent Alzheimer’s disease. The latest news comes out of Newcastle University where Dr. Edward Okello, executive director of the university’s Medicinal Plant Research Group, reports that when green tea is digested by the body, the polyphenol compounds that are in green tea will produce new chemicals that can protect the cells from toxic damage and hence, reduce the risk of Alzheimer’s disease. The digested chemicals also slowed down the rate of cancer growth.

Digestion is the critical component. Because we put foods into our body that we consider “healthy,” it does not mean that out body absorbs the nutrients. At noranagatani.com, I have a post about enzymes. There is also a fascinating book on enzymes written by DiQue Fuller, Ph. D. Click this link or the link to the right — The Healing Power of Enzymes.

In the United States, black tea has been the predominant tea, but green tea is becoming more popular. What is green tea? It is tea whose leaves have been steamed and dried without fermenting and therefore, there’s minimal oxidation during processing. It originates from the leaves of Camellia sinensis. The green tea that I like is the Japanese version. Over the years, they have improved on the quality and taste from the original import from China over 500 years ago. Alibaba.com has a discussion of the difference between Chinese green tea and Japanese green tea in case you are considering green tea in your diet.

The study, “In vitro protective effects of colon-available extract of Camellia sinensis (tea) against hydrogen peroxide and beta-amyloid (A(1-42)) induced cytotoxicity in differentiated PC12 cells,” was published in Phytomedicine. The next step is for the team to test whether the beneficial compounds are produced during digestion after healthy human volunteers consume tea polyphenols. Perhaps, one day, green tea might be the simple answer we’re looking for to help prevent Alzheimer’s disease.