Category Archives: Alzheimer’s Disease

My Aunt, who was a prominent dress designer in New York City, suffered and died from Alzheimer’s disease.  She was such a delight in her younger years.  However, because her schedule was so challenging, she often ate the wrong types of foods… lots of high cholesterol and fatty foods, which caused atherosclerosis. Atherosclerosis is a disease in which plaque builds up inside your arteries and restricts the amount of oxygen and nutrients from your heart to the rest of your body. We generally think of atherosclerosis as a condition of the heart, but there is a lot of evidence that strongly associates it with Alzheimer’s disease. Instead of cholesterol-filled plaques in your arteries, plaques made of a substance called amyloid develop in the brain tissue itself, associated with the loss of memory and eventually, loss of life.

Unlike a problem with your foot or your back or even another vital organ, brain disease can attack your feeling of self-worth. Alzheimer’s disease kills nearly 85,000 American each year.  It is one of the most physically and emotionally burdensome diseases, for both suffers and caregivers.  Unlike a stoke, which can kill instantly and without any warning, Alzheimer’s involves a slower, more subtle decline over years.

A senior scientist at the Center for Alzheimer’s Research in a review article stated, “Alzheimer’s Disease is Incurable but Preventable.”  Diet and lifestyle changes could potentially prevent millions of cases a year. There is an emerging consensus that “what is good for our hearts is also good for our heads,” because clogging of the arteries inside of the brain with atherosclerotic plaques is thought to play an important role in the development of Alzheimer’s disease.

In 2014 an article was written and published in the journal Neurobiology of Aging.  It stated that “vegetables, legumes (beans, peas and lentils), fruits, and whole grains should replace meats and dairy products as the primary staples in the diet.”

Autopsies have shown repeatedly that Alzheimer’s patients tend to have a higher build up of plaque and narrowing of the arteries within the brain.  This can drastically reduce the amount of blood, and therefore the amount of oxygen your brain receives.  Eating more vegetables and leading a healthier life style which includes exercise, meditation, and a positive attitude toward life may therefore be very useful in preventing Alzheimer’s disease.

Does the treatment of vascular risk factors like high blood pressure and high cholesterol make a difference?  Researchers at the Center for Alzheimer’s Research followed 400 people with cognitive impairment for four years using a CT scan that evaluates the amount of brain artery blockage.  Those with the least amount of plaque in their heads remained relatively stable over the years.  Those, however with more cholesterol buildup got worse and those with the most blockage rapidly declined.  Their ability to carry on the activities of daily living was affected.  An inefficient blood supply to the brain has very grave consequences on brain function.

A recent study of 300 patients with Alzheimer’s were studied.  Those with all their vascular risk factor treated showed significantly less decline.  Their progression of their disease was slowed down, compared with those who went untreated.

Dr. Michael Greger, after reviewing these facts stated that the “goal of medicine is to provide patients with hope and when there is no hope, to offer understanding.”  Today, we can offer patients with Alzheimer’s hope. We can offer you a plan to prevent the onset of Alzheimer’s. We can offer your loved ones with Alzheimer’s a means to slow down the progression of the disease.

Dementia is an umbrella for several types of diseases.  Alzheimer’s disease is one type of dementia.  Let me explain.

Dementia is a broad description which includes many different symptoms of general decline in mental ability.  It must be severe enough to interfere with daily life.  It is caused by injury or loss of brain cells (neurons).  Once brain cells are injured, they lose their ability to communicate with other cells, leading to dysfunction.

According to the Alzheimer Association, there are a number of conditions that affect the brain and can be attributed to the category of dementia:  Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. Other causes for dementia include Lewy body dementia, frontotemporal dementia, heavy alcohol use, Huntington’s disease, Parkinson’s disease, and Creutzfeldt-Jakob disease.

Gerontologists have found that some conditions can cause dementia-like symptoms.  These include reactions to medications, metabolic problems and endocrine abnormalities, nutritional deficiencies, infections, poisoning, brain tumors, anoxia or hypoxia (conditions in which the brain’s oxygen supply is either reduced or cut off entirely), and heart and lung problems.    These conditions can be reversed with the correct diagnosis, treatment and care.

Signs and symptoms of dementia may vary greatly.   They typically include at least two of the following mental functions:  memory loss; problems with speaking, language or other communication skills; problems focusing and pay attention; impairments in reasoning and judgment; and even difficulty comprehending what is seen.  Many dementias are progressive, meaning symptoms start out slowly and gradually get worse.  Although dementia (especially Alzheimer’s disease), is common in very elderly individuals, it is not a normal part of the aging process.

Gerontologists agree, there is no cure for dementia.  Prescription drugs to treat dementia include donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne), and memantine (Namenda).  A new combination of donepezil and memantine (Namzaric) was recently approved by the FDA.  These drugs are often used and may be beneficial in early stages, while dementia is a mild to moderate disorder. Overall benefit, however, may be negligible.

For people with dementia and those who care for them many measures can improve their lives.  Mental, physical and spiritual exercise programs are beneficial with respect to activities of daily living.  Relaxation techniques are very advantageous for reducing stress.

If you or a loved one is experiencing memory difficulties or other changes in thinking skills, don’t ignore them. See a doctor soon to determine the cause.  Professional evaluation may detect a treatable condition. Even if symptoms suggest dementia, early diagnosis allows a person to get the maximum benefit from available treatments.

I love music.  Although I have no talent for producing musical sounds, it seems to permeate my whole being when the right pieces are played.  Did you ever notice that there is music for every mood?    There is special music for each of us that brings forth feelings and memories.  Some music energizes us; other music might make us feel quiet, spiritual or even sad.  Why is this?

Studies show that an unborn baby with 6 months of development has the potential for thought.  He feels the rhythm of his heart beat.  He feels rhythm and sound of his mother’s voice and her body movement.  Children at very young ages can keep time to music.  For humans, this is innate.  It is also the last thing that is lost as they age and or become affected by dementia.

It is no wonder that music has a definite impact on people who have dementia.  As dementia develops into intermediate and advanced stages, patients become isolated in their own world. They can stare into space in a trans and lose their feeling or knowledge of Self.  They become victims of taking a lot of medications and become used to responding or following directions of their caregivers at home or in a facility.  They lose the power to direct their own life.  They struggle with remembering who they are.  How sad.

A man named Dan Cohen is a social worker.  As a volunteer, he brought music on an experimental basis, into a nursing home using an IPod.  He found that dementia patients who had fallen into great depression and/or who had lost their own identity came back to life with music.  They began to sing, dance or move parts of their body to the rhythm.  Their whole demeanor changed.  They went from an existing lump to a happy, engaged human being again. The trick is to find the right music for each patient—the music that has meaning.  Dan Cohen in his studies found that meaningful music or personalized music is inseparable from emotions and can make connections in the brain that have been lost through the advancement of dementia.  Meaningful music wakes up the patient.  The more often the patient experiences this form of music therapy the longer the engagement with life lasts.  It allows them to reacquire their identity.  Do they still have dementia?  Yes.  Music therapy is not a cure for dementia.  It is a means to keep patients engaged in life.

I know that if I keep on repeating it, eventually she will remember that this is where she lives.  I’ve tried so many times to correct her, and it does no good, she still wants to pack her bags and “go home”.  Sometimes she becomes very insistent and seems to feel that I am negating her.  Insistence turns into agitation.  What am I doing wrong?

This demonstrates the frustration of so many family caregivers.  Despite the challenges, you can communicate effectively with your loved one so she or he feels understood, safe, and secure.

The first and most important step is to get into your loved one’s world.  Find out why she/he wants to go home.  The second step is to divert his/her attention.  You might say, “Okay.  First you need a snack.  Are you feeling hungry?  I have some of your favorite cookies here for you.”

Notice, we did not correct her desire to “go home”.  That will cause agitation.  Instead we valued and respected his/her request.  Then we offered another activity that would help him/her forget about the desire to “go home”.  Other tips to communicate effectively with your loved one include the following:

Stay present and speak clearly.  Maintain eye contact, and stay near your loved one so that he or she will know that you’re listening and trying to understand.  Speak in a clear straightforward manner.

Show respect.  Avoid secondary baby talk and diminutive phrases such as “good girl” or “my little honey”.  Don’t assume that your loved one can’t understand you, and don’t talk about your loved one as if he or she weren’t there.

Avoid distractions.  Communication may be difficult (if not impossible) against a background of competing sights and sounds.

Keep it simple.  Use short sentences and plain words.  As the disease progresses, yes/no questions may work best.  Ask only one question at a time.  Break down requests into simple steps.

Don’t interrupt.  It may take longer than you expect for your loved one to process and respond.  Avoid criticizing, hurrying and correcting.

Use visual cues.  Sometimes gestures or other visual cues promote better understanding than words alone.  Rather than simply asking if your loved one needs to use the toilet, for example, take him or her to the toilet and point to it.

Stay calm.  Even when you’re frustrated, keep your voice gentle.  The tone of your voice can send a clearer message than what you actually say.

Communicating with your loved one may be challenging, especially as the disease progresses.  Remember, however, you loved one isn’t acting this way on purpose.  He or she has lost the ability to think clearly, to learn anything new, or to re-learn anything forgotten.  Don’t take it personally.  Use patience and understanding to help your loved one feel safe and secure.

A year after my sister-in-law died from advanced stages of Alzheimer’s disease, her daughter Debbie, age 55 came to me asking, “Will I also have this disease?  I seem to easily forget things I should remember, such as a person’s name, or where I left my keys.”

This is a common fear.  Alzheimer’s disease researcher Robyn Honea of the University of Kansas stated, “It is estimated that people who have relatives, especially mothers, with Alzheimer’s disease are 4 to 10 times more likely to develop the disease themselves compared to people with no family history.”  However, this is not a verdict.

There are two forms of Alzheimer’s, early onset and late onset.  Early onset is rare. Symptoms start before the age of 65.  This type of Alzheimer’s tends to cluster within families.  Often several generations are affected.  In many cases this form of Alzheimer’s is caused by mutation in one of three genes.  People with these extremely rare mutations tend to develop Alzheimer’s disease in their 30s or 40s.  On average, half of the children of a person with one of these rare genetic mutations will inherit the disease.  Those who do not inherit the mutation cannot pass it on and are not susceptible of getting Alzheimer’s.  It is also important to know that these mutations are extremely rare and account for fewer than one in 1,000 cases of Alzheimer’s.

The second form, late onset Alzheimer’s disease is much more common than early onset Alzheimer’s.  It effects people older than 65.  Research is constantly being done for this group.  It has been found that in the regular aging process all of us lose brain vitality (gray matter) and there is brain shrinkage.  Those with parents (especially mothers) with Alzheimer’s experience this at a faster rate than those without parents who have this disease.

What can you do, if you have this concern?  First, share your apprehension with your doctor.  A complete assessment can be made.  It would include family history, a physical exam, a neurological exam, mental clarity tests, and brain imaging.  Second, research reveals that aside from DNA, environment, lifestyle and eating habits also play a large role.  Those who exercise regularly, stimulate mental acuity, and eat a healthy diet can possibly delay, if not circumvent Alzheimer’s disease.

A majority of us know and love someone who has Alzheimer’s disease.    It is so prevalent that every 67 seconds, someone in the US develops this disease.   So far, it cannot be prevented, slowed down, or even cured.  There are no survivors.  It is heartbreaking and frustrating to view.  We do realize that ultimately it is a lonely condition and we can never truly know what it feels like to your loved one.  However, we can get some idea from the people themselves who in the early stage of the disease have written or told about their experience.

My sister-in-law Charlotte was a college professor.  In her early years of her disease she described her experience.  “Imagine yourself in a classroom.  The teacher calls on you to answer a question.  You know you used to be able to answer such a question, but now you can’t.  You feel embarrassed, scared, and alone.  That frustration becomes magnified and repeated constantly throughout the day.”  Charlotte continued, “I was once a person others went to for ideas and direction.  Now I’ve lost that and am forced to be directed and there’s nothing I can do about it as I watch my condition worsen.”

When you think about it, everything we do is premised on memory.  Your memories are a foundation.  They give you context for what you’re supposed to do in a given situation.  Cooking a dinner, driving a car, going to work are all good examples. The person who has Alzheimer’s disease loses memory.  Their brain is damaged.  As the damage increases, the brain just doesn’t have enough information to interpret situations correctly.  Every day they lose a little more.   In the beginning individual memories pop in and out.  However as the disease progresses, the symptoms worsen.  Communication becomes difficult and normal conversations are lost.  Wandering becomes common.  Sometimes it is a product of boredom.  Other times, the person feels he or she wants to go home.  Their current home becomes unfamiliar.  They want to go to their childhood home and re-live with their parents where it is safe and secure.

As their world becomes more confusing, even their closest family members seem like strangers.  A person with Alzheimer’s can feel defenseless and afraid, trapped and angry.  At other times they become irrationally suspicious of the people around them.  As the disease worsens, they no longer realize their deficiencies.  They are in a world of their own, living in the moment and forgetting that moment right after.  As horrifying as it is for us, perhaps it is their salvation.