In my last post, I reviewed Alzheimer’s Care with Dignity by Frank Fuerst. It’s a book that I believe should be at your fingertips. In this post and others to follow, I want to highlight some of the chapters that were especially interesting and helpful. One of the most important members of your team is your doctor and in this post, I highlight how to choose a doctor for Alzheimer’s disease patients. However, Fuerst quotes the Alzheimer’s Association in the June 2006 report to Congress:

When a person under age 65 goes to a doctor with symptoms of dementia, the doctor may not even think of dementia as a possibility or may not know how to diagnose it. As a result, getting an accurate diagnosis can be a long, difficult, and frustrating process.

For Fuerst, it took almost three years and he states:

If one suspects early onset dementia, one should choose a doctor who can distinguish between depression, menopause, and dementia. A neuro-psychiatrist may be more likely to recommend tests that will give a more accurate diagnosis. The best choice for most people is a doctor whom other doctors highly recommend.

What makes an ideal doctor? A Mayo Clinic study suggests the following:

1. Confident
2. Empathetic
3. Humane
4. Personal
5. Forthright
6. Respectful
7. Thorough

Are there any other traits you could recommend?

“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.

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?

Sylvia Mackey

In last week’s post, I talked about attending the 23rd Annual Caregiver Conference — Shedding Light on Dementia Care. The program closed with inspirational speaker, Sylvia Mackey, wife of John Mackey, former football player for the Baltimore Colts, who has frontotemporal dementia (FTD) something common to many football players. She shared her thoughts on how to care for a dementia patient.

According to the Mayo Clinic, frontotemporal dementia (frontotemporal lobar degeneration) is an umbrella term for a diverse group of uncommon disorders that primarily affect the frontal and temporal lobes of the brain — the areas generally associated with personality, behavior and language.

Frontotemporal dementia is often misdiagnosed as a psychiatric problem or as Alzheimer’s disease. But frontotemporal dementia tends to occur at a younger age than does Alzheimer’s disease, typically between the ages of 40 and 70. John Mackey was diagnosed at 60.

Before putting her husband in an assisted living facility, Sylvia was his primary caretaker. They were living in California, but they moved back to the Baltimore area because he was most familiar with that area. She had several examples of using the NFL to convince her husband to do certain things like take a shower. “The NFL commissioner is coming so you need to take a shower” and he would comply.

She had several suggestions to help the caretakers in the audience.

1. Learn to laugh; it has no side effects. She recommended Finding Meaning with Charles.
2. Use creativity to solve new challenges.
3. Focus on one positive thing when in a challenge.
4. Reflect on special moments.

Sylvia showed us an unconditional love for her husband and through laughter and tears was an inspiration to all of us. To read more about the couple, click here.

This being the week of Thanksgiving in the United States, I am grateful to all of you for pausing to read my blog. I wish all of you a very safe and Happy Thanksgiving!

Brain Tour from Alzheimer's Association (click image)

Just what is Alzheimer’s disease (AD)? Everyone seems to agree that it is the most common form of dementia accounting for at least half of all dementia cases. (See previous post on discussion of dementia). There is also agreement that in advanced Alzheimer’s disease, a person cannot function intellectually and socially. According to the Mayo Clinic, “Alzheimer’s disease is not a part of normal aging, but the risk of the disorder increases with age. About 5 percent of people between the ages of 65 and 74 have Alzheimer’s disease, while nearly half the people over the age of 85 have Alzheimer’s.”

What is happening in the brain that is causing a person not to be able to function intellectually and socially? Take the “Brain Tour” on the left and notice the shrinkage of the brain as well as the tangles. Just looking at those pictures explains the confusion, doesn’t it?

According to the Mayo Clinic, there are currently three major areas that doctors depend on to make a diagnosis:

1. Lab tests
2. Neuropsychological testing (extensive assessment of thinking and memory skills)
3. Brain scans
   • Magnetic resonance imaging (MRI)
   • Computerized tomography (CT)
   • Positron emission tomography (PET)

Although memory assessments should always be conducted by a medical practitioner, here are two quick paper and pencil tests. The first was published by Times Online (UK) called the “Five Minute Alzheimer’s Test.” The second one is on the Web site of a well-known Alzheimer’s drug, but it states, “This screening tool cannot be used to tell if your loved one has a medical problem, only whether he or she should be tested.” It was adapted from Galvin JE, et al. The AD8, a brief informant interview to detect dementia. Neurology 2005:65:559-564.

Once again, do not draw any conclusions from these memory tests. As discussed by Carrie Hill, Ph.D. in “What you Need to Know about Screenings for Memory Problems,” she states:

1. A memory screening should not be used to make a diagnosis
2. A memory screening does not replace a diagnostic workup
3. Memory screenings should only be performed by qualified professionals
4. Memory screenings should be confidential and provide follow-up resources
5. Memory screenings can be used to establish a baseline
6. Opinions differ on the value of memory screenings. Here she talks about the different views of the two leading non-profit Alzheimer’s organizations — Alzheimer’s Foundation of America and Alzheimer’s Association.

In our next blog post next week, we will look at the most recent diagnosis tools. In the meantime, have you done your Sudoku for today?