Archive for March, 2010

Alzheimer’s Disease and Sundowning

“Sundowning” or “sundowners syndrome” is a term that some say is unique to Alzheimer’s disease although there has not been a definitive conclusion. It is a behavior where sundowners become more demanding, upset, suspicious, and disoriented late in the day and especially after dark.

I was reading an issue of the Golden Gazette, a wonderful publication for seniors in Fairfax County, VA. In it, someone asked a question about her father who has Alzheimer’s disease and gets confused at night and doesn’t sleep well. As a result, she (as a caregiver) is finding it more and more difficult to get a good night’s rest.

The expert answering the question said that there is a tendency for individuals suffering from acute or chronic confusion to become more confused, restless and insecure late in the day, especially after dark. They may wander all night and it’s possible that they’ll see, hear, and believe things that aren’t real.

After staying up all night, of course, they doze off during the day. It appears that their biological clock is reversed. One theory according to wisegeek.com is that the constant daily mental processes for normal living can become overwhelming for the elderly during evening hours. They simply have too much incoming information and their restricted cognitive abilities become overloaded. The result is a period of irritability and negative thoughts.

Mayoclinic.com suggests that fatigue, low lighting, and increased shadows might be contributing factors as well. Suggestions include:

  • Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
  • Limit caffeine and sugar to morning hours.
  • Serve dinner early and offer a light snack before bedtime.
  • Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.
  • In a strange or unfamiliar setting such as a hospital, bring familiar items such as photographs or a radio from home.

“Sundowning” or “sundowners syndrome” will definitely take a toll on the caregiver.  It is imperative that the caregiver seek help. The caregiver needs to take good care of him/herself first in order to be able to take care of others.

Alzheimer’s Disease and the Best Pancakes

Like many people, we sometimes have pancakes for breakfast. I grew up with Bisquick and when I started my own household, pancakes made with Bisquick was a tradition I followed. Now I know there’s sodium aluminum phosphate in a box of Bisquick and now I also know that there’s a possible link between aluminum and Alzheimer’s disease. What an Alzheimer’s brain looks like, ways to prevent Alzheimer’s disease, Alzheimer’s disease research and many more subjects will be topics for future discussion. But in this post I decided to to see if I could find a substitute for Bisquick.

I looked for recipes where I could make a large amount of pancake mix and store it for future use. I have two to share. Enjoy!

Homemade Pancake Mix from Women’s World
9 cups all-purpose flour
1 cup sugar
1/4 cup baking powder
1 teaspoon salt
Combine flour, sugar, baking powder and salt. Store in airtight container at room temperature until ready to use. Before using, stir mixture and lightly spoon into measuring cups, then level off by sweeping top with straight-edged spatula. Makes about 10 2/3 cups, enough to prepare 4 batches of pancakes

Fluffiest-Ever Pancakes from Women’s World
2 2/3 cups Homemade Pancake Mix
2 eggs
1/4 cup butter, melted
1 teaspoon vanilla extract
1 3/4 cups seltzer or club soda
Preheat oven to lowest setting. Lightly grease large nonstick skillet or griddle; heat over medium heat. Place Pancake Mix in large bbowl, making well in center. In small bowl, whist together eggs, butter, and vanilla; pour into well. Whist egg mixture in Pancake Mix until slightly moistened. Add seltzer; whisk until blended and smooth. Drop batter by 1/4 cupfuls into pan; cook until bubbles start to rise through top of pancakes and bottoms are browned, 1-2 minutes. Flip pancakes over; cook until lightly browned on bottoms, 1 minute. Transfer to baking sheet; keep warm in oven while cooking remaining pancakes. Makes 12 pancakes.

To make Maple-Blueberry Pancakes, stir 1 tablespoon maple extract and 2 1/2 cups fresh blueberries into batter. If desired, serve with butter, syrup, and additional blueberries. Makes 16 pancakes. (You can save money by using frozen blueberries, but don’t mix them into the batter — they’ll turn gray. Just drop them on top of each pancake after spoon the batter into the pan.

Homemade Pancake Mix from cooks.com
10 cups all-purpose flour (3 lbs.)
2 1/2 cups instant nonfat dry milk
1/2 cup sugar
1/4 cup baking power
2 tablespoons salt
Combine all ingredients in a large bowl. Stir together to blend well. Put in a large airtight container. Label. Store in a cool, dry place. Use within 6 to 8 months. Makes about 13 cups of pancake mix. This mix works for both waffles and pancakes.

Pancakes or Waffles from cooks.com
2 cups homemade pancake mix
1 cup water
1 egg
2 tablespoons oil (waffles – 3 tbsp.)
Beat smooth with a wire whisk or fork. This makes eight (4-inch) pancakes or four large waffles.

Syrup (better than “store bought”)
1 1/2 cups water
1 teaspoon vanilla
1/4 cup pure maple syrup
Combine ingredients in a saucepan and bring to a boil. Boil gently until sugar is completely dissolved. Store in tightly covered container in the cupboard. Keeps indefinitely.

To make pecan waffles, sprinkle chopped pecans on the batter just before closing the waffle iron. For strawberry waffles, top hot waffle with fresh or thawed frozen strawberries and whipped cream.

In previous posts, I’ve talked about the different stages of Alzheimer’s and some of the signs of Alzheimer’s at each of the Alzheimer stages. I’ve also mentioned dementia vs. Alzheimer’s and frontotemporal dementia. Once our brain memory is lost and we begin exhibiting symptoms of Alzheimer’s, currently there is no known guaranteed way of getting it back. For that reason, even one small step of eliminating aluminum from the diet may be helpful. Watch for future posts on aluminum and Alzheimer’s disease.

Phosphatidylserine Memory Booster

Last month a friend gave me an issue of  Woman’s World magazine. In it was a tiny article, Ward off Alzheimer’s with the new “Memory” Pill! As the author of this Alzheimer’s disease blog, that certainly caught my attention. It’s called phosphatidyl serine (PS) or more commonly spelled as one word in the scientific community, phosphatidylserine. It says, “it’s a supplement proven to prevent age-related memory loss and help your brain function as if it were 12 years younger!” Now, wouldn’t that catch your attention, too? Could we all use a memory booster?

Since it’s such a short article, let me share the rest of it.

PS helps restore the brain’s supply of acetycholine, a neurotransmitter that’s crucial for memory, reports Thom Lobe, M.D., of Beneveda Medical Group in Beverly Hills, California. In one study, folks who took 100 mg., three times a day, scored 30% higher on memory tests after just 12 weeks! Your Rx: 200 mg. to 300 mg. daily in supplement form (find it in health-food stores). Important: Ask your doctor before taking this or any supplement, especially if you also take an anticoagulant drug.

If phosphatidylserine is such an impressive supplement, shouldn’t all Alzheimer’s patients be on it? According to the Mayo Clinic, “Several studies involving phosphatidylserine indicate a benefit — improved cognitive abilities and behaviors. However, improvements in memory lasted only a few months and were seen in people with the least severe symptoms.” They go on to say that earlier studies were based on brain cells of cows. However, because of concerns about mad cow disease, most manufacturers now produce phosphatidylserine supplements from soy or cabbage derivatives. So it’s not really known if the plant-based supplements are equally effective.

WebMD adds that phosphatidylserine is a chemical that the body can make, but it gets most of what it needs from foods. Side effects include insomnia and upset stomach for doses over 300 mg. They warn that there could be drug interactions. Click here for more information and click on Interactions.

So the old adage, if it’s too good to be true, it probably is, appears to be in effect here. Have you ever taken phosphatidylserine? What is your opinion?

We have reached the final stage of Alzheimer’s disease (AD) as defined by the Alzheimer’s Association: Stage 7 Very Severe Cognitive Decline — Severe or late-stage Alzheimer’s disease. There are many places on the Internet where you can get information about Alzheimer’s disease and when one is diagnosed with Alzheimer’s or has a family member diagnosed with the dreaded disease, one cannot get enough information.

One outstanding source of information is the Fischer Center for Alzheimer’s Research Foundation. They have an excellent Web site discussing the seven clinical stages of Alzheimer’s disease, but they break it down further into sub-stages. Below is the Alzheimer’s Association summary of “Stage 7 Very Severe Cognitive Decline.” It will be followed by a description of the Fischer Center’s sub-stages of stage 7.

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.

According to the Fischer Center for Alzheimer’s Research Foundation, there are 6 consecutive functional sub-stages for stage 7. In brief, they are:

  1. Speech is limited to approximately a half dozen intelligible words or fewer in the course of an intensive contact and attempt at an interview with numerous queries. (approximately 1 year)
  2. Speech becomes even more limited — a single intelligible word. (approx. 1.5 years)
  3. Patients lose the ability to ambulate independently. (approx. 1 year)
  4. Patients lose the ability to sit up independently. Patients will fall over when seated unless there are arm rests to hold the patient up in the chair. (approx. 1 year)
  5. Patients will lose the ability to smile. Only grimacing facial movements are observed in place of smiles. (approx. 1.5 years)
  6. AD patients lose the ability to hold up their head independently. (approx. 1.5 years)

Keep in mind that these are not independent sub-stages. They can overlap. I never saw my father to this last stage, although I recall having to sit him up because he was always tilting to one side. It is really important even in earlier stages to have a chair with a side because they fall asleep easily.

Of the 35 million people in the world living with AD or a related dementia, those that receive the best care have the best chance of living the longest. Many pass away due to other illnesses. In the case of my dad, the official cause was pneumonia contracted after surgery for a broken hip from a fall in a nursing home. Although sometimes I wonder — did he have osteoporosis and did the broken hip cause the fall and not vice versa? Men don’t often get screened for osteoporosis and if that’s the case, the hip breaks first followed by the fall.

In just 20 years, the number of Alzheimer’s cases is expected to double. The longer you live, chances are you’ll find yourself in this unfortunate situation. Are you doing anything to prevent or slow down dementia?

Research shows that we forget 30% of what we’ve heard after 20 minutes, and 50% within a half-hour.

Continuing to use the stages as defined by the Alzheimer’s Association, Stage 6 is severe cognitive decline or also defined as moderately severe/mid-stage Alzheimer’s disease. As 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

One of the common problems is that the Alzheimer’s patient sleeps during the day and is awake at night. What a challenge for the caregiver. Can you imagine having your sleep interrupted every night? I do remember dad getting up at night and wandering around the house and needing help getting back to bed. I was always afraid that he would not know who I was and hit me. (He was a boxer in his youth). I could feel myself tensing up.

The big fear is your loved one wandering and becoming lost. In dad’s case, doors were always locked and someone was always watching him. However, many times when we’d take him out and upon returning, he would say he wanted to go home. No amount of convincing him that we were indeed at his home, was believable to him, but a short drive around the block and back home was generally enough to convince him. Of course, he could never tell us what “home” meant. His childhood home? His previous home? If only it was possible to read his mind to determine what he was trying to communicate.