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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In this, the third of our series of breakthrough tests for Alzheimer’s disease, scientists at the University of California San Diego (UCSD), have developed a fast and accurate method for quantifying subtle, sub-regional brain volume loss using magnetic resonance imaging (MRI). This study promises to improve diagnosis and monitoring of Alzheimer’s disease (AD).

The techniques were applied to the dataset of the multi-institution Alzhiemer’s Disease Neuroimaging Initiative (ADNI). What the scientists at UCSD were able to demonstrate was that the sub-regional brain volume measurements outperform available measures for tracking the severity of AD, including widely used cognitive testing and measures of global brain-volume loss.

According to insciences.org, the new research shows that changes in the brain’s memory regions, in particular a region of the entorhinal cortex, offer sensitive measures of the early stages of the disease. According to Anders M. Dale, PhD, professor of neurosciences and radiology at the UC San Diego School of Medicine, who led the study, “Loss of volume in the hippocampus is a consistent finding when using MRI, and is a reliable predictor of cognitive decline. However, we have now developed and validated imaging biomarkers to not only track brain atrophy, but distinguish the early stages of Alzheimer’s disease from changes related to normal aging.”

The study’s co-author, James Brewer, MD, PhD, a neurologist and assistant professor in the Departments of Radiology and Neurosciences at UCSD adds that, “The technique is extremely powerful, because it allows a researcher to examine exactly how much brain-volume loss has occurred in each region of the brain, including cortical regions, where we know the bad proteins of Alzheimer’s disease build up.”

If a picture is worth a thousand words, here are serial MRI brain scans, taken six months apart, that show progression from mild cognitive impairment to Alzheimer’s disease with significant atrophy (blue) and ventricle enlargement (orange/red).

For more information, see “Analyzing Structural Brain Changes in Alzheimer’s Disease” at insciences.org.

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Alzheimer’s Research Part 2

Taken from Reuters.com

from Reuters.com

In July of this year, Reuters reported that new tests assessing brain changes and body chemistry are showing promise at diagnosing Alzheimer’s disease in its earliest stages. Studies presented at an Alzheimer’s Association meeting in Vienna, Austria included:

  1. Irish researchers found scans measuring brain volume and a combination of memory tests accurately identified nearly 95 percent of people who had progressed from mild cognitive impairment to early Alzheimer’s disease.  Michael Ewers of Trinity College Dublin and colleagues studied 345 participants in the ADNI study with mild cognitive impairment, a precursor to Alzheimer’s. They looked at an array of tests and found three memory tests plus MRI measurements of brain volume in the left hippo campus — a region closely linked to memory — were most predictive of disease progression.
  2. U.S. researchers found that a type of brain scan that measures glucose combined with low scores on memory tests was a strong predictor of disease progression. Susan Landau of the University of California, Berkeley used data on 85 patients and found positron emission tomography scans that measure glucose in the brain and poor memory recall were strong predictors. People who did poorly on these measures were 15 times more likely to progress to Alzheimer’s within two years.
  3. A team at Duke University in North Carolina led by Dr. Allen Roses found that a gene called TOMM40 raises Alzheimer’s risk. The gene predicted the age of Alzheimer’s development within a five- to seven-year window in people over 60. It is closely linked to another Alzheimer’s gene called APOE4. Both APOE4 and TOMM40  account for an estimated 85-90 percent of the genetic effect according to Roses.

As was mentioned in Part 1, there’s progress, but we still have a long ways to go to find an effective test. But even if we were to have a conclusive test, doctors still have very few effective treatments for Alzheimer’s disease. And still, as it has been for a long time, only an autopsy will reveal definitively whether or not a person truly has Alzheimer’s disease.

Alzheimer’s Research Part 1

Although there is still no conclusive test for the determination of Alzheimer’s disease (AD), there is hope and occasionally, new information. Last month, Science Daily reported that:

Elderly people exhibiting memory disturbances that do not affect their normal, daily life suffer from a condition called “mild cognitive impairment” (MCI). Some MCI patients go on to develop Alzheimer’s disease within a few years, whereas other cases remain stable, exhibiting only benign senile forgetfulness. It is crucial to develop simple, blood-based tests enabling early identification of these patients that will progress in order to begin therapy as soon as possible, potentially delaying the onset of dementia.

A group of investigators, led by Professor Massimo Tabaton of the University of Genoa, Italy, have data that sheds light on this issue. The results of their research are published in the October issue of the Journal of Alzheimer’s Disease.

The investigators report that the concentration in blood of amyloid beta “42,” the toxic molecule that is believed to be the main cause of Alzheimer’s disease, is, on average, higher in MCI cases that went on to develop Alzheimer’s disease approximately three years later. The values of amyloid beta in blood vary considerably among the patient groups examined (MCI that develop Alzheimer’s disease; MCI stable; normal subjects). “This variability is likely very important,” Dr. Tabaton noted and went on to add, “but means that this needs further work before we can use this test for a definitive diagnosis.” For example, the scientists are going to set up a test that picks up a variant of amyloid beta potentially more specific of the disease.

There’s progress, but we still have a long ways to go to find an effective test. A conclusive blood test would certainly be ideal. But even if we were to have a conclusive test, doctors still have very few effective treatments for Alzheimer’s disease. And still, as it has been for a long time, only an autopsy will reveal definitively whether or not a person truly had Alzheimer’s.

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