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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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.

Dancing and Mental Acuity

This is an old study completed in 2001 and reported in the New England Journal of Medicine, but one that covered 21 years, a significant period of time. The study, done at the Albert Einstein College of Medicine, measured the mental acuity in aging by observing rates of dementia, including Alzheimer’s disease, of 469 seniors 75 and older. The focus of the study was to see if any physical or cognitive recreational activities influenced mental acuity. Dancing was the most beneficial.

The cognitive activities included:

  • Reading books
  • Writing for pleasure
  • Doing crossword puzzles
  • Playing board games or cards
  • Playing musical instruments
  • Participating in organized group discussions

Physical activities included:

  • Playing tennis or golf
  • Swimming
  • Bicycling
  • Dancing
  • Walking for exercise
  • Doing housework
  • Participating in group exercises

Today, almost everything you read suggests that physical activity plays an important role in maintaining your brain as well as your heart. In this study, however, almost none of the physical activities appeared to offer any protection against dementia. This study specifically looked at whether or not there were ways to reduce the risk of dementia and the only physical activity to offer protection against dementia was frequent dancing!

Here are some of the results:

Dancing frequently – 76% – the greatest risk reduction of any activity studied, cognitive or physical.
Doing crossword puzzles at least four days per week – 47%
Reading – 35%
Bicycling and swimming – 0% reduced risk
Playing golf – 0%

The researchers believe that the dancers are more resistant to the effects of dementia as a result of having greater cognitive reserve and increased complexity of neuronal synapses. Like education, participation in some leisure activities lowers the risk of dementia by improving cognitive reserve. They also said we need to keep as many of those paths active as we can while also generating new paths to maintain the complexity of our neuronal synapses.

More recently, Science Daily reported in 2010 that two recent studies conducted by University of Missouri researchers found that participation in dance-based therapy can improve balance and gait in older adults. Improved functionality among seniors can decrease their risk of falling and reduce costly injuries.

I love line dancing and I attend classes when my schedule permits. This video is a link to one of the sessions and as you can see, not everyone learns at the same pace, but everyone has a lot of fun. Eventually,we all get it. The short Asian woman in green in the back row is 80 years old. What an inspiration. Now that I know the huge benefit of dancing, I will definitely want to continue.

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Alzheimer’s Action Day

Today is Alzheimer’s Action Day and September is World Alzheimer’s Month. Let’s all wear purple and show our support.

You’ve seen the staggering figures. There are already more than 5 million Americans diagnosed with Alzheimer’s disease and by 2050 as many as 16 million Americans will have the disease. Will you be counted in that figure? Let’s do all we can to take care of ourselves and to support the Alzheimer’s Association to eliminate this awful disease.


 

ICAD 2011

Last month the Alzheimer’s Association International Conference (AAIC) — there has been a name change from the International Conference on Alzheimer’s Disease (ICAD) — had their annual meeting in Paris, France with more than 5,000 scientists in attendance. Each year we look forward to hearing about the latest advances in detection and cure for Alzheimer’s disease. The good news is that there’s progress toward earlier detection, but as one of the leading causes of death, the bad news is that there is still no cure.

In my next two posts, I will present a study that caught my interest because it has to do with lifestyle changes that we can make to potentially lower our risk for Alzheimer’s disease. In the United States, the researchers found that there are seven potentially modifiable risk factors:

  1. Physical inactivity
  2. Depression
  3. Smoking
  4. Mid-life hypertension
  5. Mid-life obesity
  6. Low education
  7. Diabetes

To view a summary of the Alzheimer’s disease research presented, click here.

Next year the conference will be held in Vancouver, British Columbia, Canada, July 14 -19, 2012.

 

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Caregivers of Alzheimer’s disease patients have one of the toughest jobs in the world and yet sometimes one of the most rewarding. Stephanie Jewett, RN, MBA, in an article in ezinearticles.com, offers the following tips for caregivers in a home setting.

  • Find something they love to do and keep that favorite thing going everyday, i.e. take a walk in the park, watch their favorite television show or read articles in a magazine. Go to the Internet and learn more about their favorite subject.
  • Keep life simple; follow a schedule everyday. Eat at particular times, keep hair appointments to one specific day a week, and enjoy a meal out once a week, on the same day.
  • Get lots of rest – take a nap if one feels tired, but don’t sleep the day away. Get up at the same time each day, bathe and then have a nutritious breakfast each and every day!
  • Go through scrapbooks and old pictures, reminding them of family members — their names, ages, etc.
  • Get a dog or a cat so that the patient has some responsibility and company in the home. Pet therapy is one of the best methods known to keep a person happy and healthy.

As a caregiver, your top priority is to take care of yourself so that you will have the strength and stamina to take care of your loved one. So the tips for your Alzheimer’s disease patient apply to you as well. Take good care!

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Scientists are looking at a biomaker that may possibly aid in the identification of individuals with mild memory problems who will eventually develop Alzheimer’s disease. The finding, which was published in the online version of Neurology, the journal of the American Academy of Neurology. It is believed that the new biomarker may prove to be more accurate compared to already established biomarkers.

According to the study author Robert Perneczky, MD, of the Technical University Munich in Germany, identifying individuals who will have Alzheimer’s disease earlier will be an important development. Once treatments that can be used for the prevention of the disease are available, it will become easier to treat and even prevent memory loss.

Fifty eight people with mild cognitive impairment (MCI) participated in the study. It is estimated that as many as 15% of the people who have MCI will develop Alzheimer’s every year.

Cerebrospinal fluid was taken from each participant and tested for certain proteins. Participants were then studied for about three years. Of the participants, 21 developed Alzheimer’s, 27 remained with MCI while 8 people regained normal cognitive skills. Researchers discovered that participants who later developed Alzheimer’s had significantly high levels of sAPPβ or soluble amyloid precursor protein beta in their cerebrospinal fluid.

Based on their findings, the researchers discovered that the person’s age, a protein called tau, and sAPPβ were excellent predictors of future cases of Alzheimer’s. Using these factors as a basis, it was easier to predict if an individual ran the risk of developing the disease. The accuracy for this prediction is pegged at about 80%.

A protein amyloid known as Aβ1-42 or amyloid beta1-42 was once considered one of the biomarkers significant to Alzheimer’s disease. However, it was not used as one of the predictive factors in the study.

The results, Perneczky said, suggest that sAPPβ could be useful as a biomarker and that it may even be better than Aβ1-42 for use in diagnosing Alzheimer’s earlier. The reason for this may be that Aβ1-42 can only indicate events at a later stage – events that already point to the accumulation of amyloid plaques in the brain. Since sAPPβ can be used as a critical initial step in determining if the disease will develop, it is likely to provide a more accurate indication on important pathological events.

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