Alzheimer's and Dementia Counseling and Education:
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Thursday, December 01, 2011



When you have a loved one with a type of dementia such as Alzheimer's in the family, you may be dreading the upcoming holiday season. That feeling is certainly understandable given that these elders often act unpredictably, and unintentionally say hurtful things to family members. I would like to offer some tips to help you survive the holiday emotionally intact:
- Give up the idea that you can have all of the traditional foods and activities this year. You may have to pick and choose a few of the least upsetting for the elder. Large crowds of people (family) cannot be tolerated for very long, and they certainly will not remember names or relationships and will become agitated when asked to do so. Always give them clues such as "Dad, here's the boy wonder of the family, my little brother Davy and his family."
- If the elder believes a daughter is his wife, and calls her by his wife's name, you may be able to simply laugh and say something like "Dad, I'm not Mom! I know I look at lot like she did when she was younger, but I'm Alice, your oldest daughter." If that doesn't work and the the elder still insists, you must agree, and slowly change the subject. Possibly changing your appearance in some way will help him let go of his belief.
- Tone down the noise on all activities. Rousing family sing-a-longs may only upset the elder, not only because of the noise level, but because they may not be able to participate as they used to. Small children running about making noise can also upset the elder who may think they are being injured if they are squealing or screaming in delight.
- If your parent has dementia and the tradition is for you and your family to always visit for a week or two and stay at the family home, you will all be more comfortable if this year you choose to stay elsewhere and just visit the family home daily. Routines are very important to elders with dementia, and when "new" people are introduced into that daily routine, they become more confused and upset.
- Remember that your goal, and the goal of everyone in the family, is to keep the elder with dementia safe, happy, calm and treated with dignity at all times. They cannot change the way they are responding to their environment. You and the rest of the family, whose brains are not damaged, are the ones who must do the changing and work to achieve the goal at all times. That means if the elder insists it's not December, but February instead, then you must apologize and say something like "Oh, I'm sorry. I am really confused here. Of course, you're right. I think you would enjoy coming with me now and ..." It will serve no purpose whatsoever to try to continually reorient that elder to your reality and they will only become agitated and possibly combative if you continue to try.
- Never say "Do you remember..." You are just setting them up for failure and frustration when they cannot remember. Instead, give them clues such as "I remember when this picture was taken, that's me, and that's you...." Keep photo albums out where they can be easily accessed. The long-term memories are still there, and they will enjoy looking through the photos and remembering. If they do not remember, or tell you you're wrong, don't argue, simply apologize, and move on to the next picture.
- Preserve rest periods for the elder if that is their routine. They can become more confused and unsteady on their feet when they become over tired.
- If the elder is starting to become agitated, first check for all the likely reasons such as needing to use the bathroom, hungry, thirsty, too much noise, etc., and then remove them to a quiet place and bring up some wonderful memories that you know will help them become calm again. Possibly remembering a favorite pet, or the story of a treasured vacation. Don't correct errors in the their stories. This is their new reality and trying to change it for them will only upset them.
- Music is stored in a different area of the brain, and so many elders with dementia who can no longer speak or know what words mean, can sing an entire well-remembered song. Be sure to tap into those songs.
- If you have small children who will attend a holiday mealtime with you and the elder with dementia, it's a good idea to prepare them in advance for some behavior that they will notice and comment about. For example, if the elder can no longer use utensils to eat with and will use their fingers, you may have to tell the child in advance that "Grandpa is having some trouble with his brain, and sometimes he can't remember how to use his fork and spoon. We know you're a big boy now and no longer eat with your hands, but that is the only way Grandpa can eat right now. We must all just remind Grandpa that we love him and help him in any way we can."
- Traveling with an elder with dementia will challenge your patience and the abilities of the elder. If you must travel, it will be much easier and safer if you have a third person present to help you.
- Allow the elder to participate in any way they can. If Mom used to always make the holiday bread, can she still participate by gathering ingredients and helping knead the dough?
You and your loved ones can still create many new and happy memories of the holiday with the elder with dementia when you keep the above tips in mind so the elder does not become overstimulated, more confused or angry. It becomes a matter of letting go of past expectations, and embracing this elder exactly where they are today.

Thursday, November 10, 2011



I recently had an article printed in the Alzheimer's Reading Room (great source for information at www.alzheimersreadingroom.com) where I discuss how many commonly used medications will interact with and work against the anti-dementia meds in the cholinesterase inhibitor class (Aricept, Exelon, and Razadyne). There is a classification of drugs called "anticholinergics" that will essentially cancel out the intended therapeutic effects of both drugs when given together. These anticholinergics are found in many types of medications. Here are a few:
  • Antispasmodics, such as Levsin, Donnatal, Bentyl
  • Bronchodilators such as Atrovent and Spiriva
  • Antiemetics such as Dramamine, Bonine and Antivert
  • Antiparkinson drugs such as Kemadrin, Artane, Cogentin
  • Sleep aides such as Sominex, Nytol, Unisom
  • Cough and cold preparations that contain diphendydramine
  • Atropine which is found in some heart medications and eye drops
  • Urinary incontinence meds such as Ditropan, Toviaz, Vesicare and Detrol
I have only listed a few of the brand medications from each category, and there are many, many more. If your loved one is taking a drug that might be in a category, be sure to ask the physician, or the pharmacist about this interaction with their anti-dementia med. With the thousands and thousands of medications out there to choose from, your loved one's healthcare provider may forget about this interaction that will render both drugs useless, so please be sure to check on this when any new medication is introduced even if it's for a simple cough, or a sleep problem.
The other drug classification used for dementia is the NMDA receptor antagonist and that is Namenda. It works in a totally different way than the cholinesterase inhibitors, so it is not affected by these other drugs.

Tuesday, November 08, 2011



I have seen several research articles lately that discuss new evidence that bilingualism is thought to delay the onset of Alzheimer's symptoms. In Medical News Today (http://www.edicalnewstoday.com/releases/235998.php) in mid-October, researchers at St. Michael's Hospital in Toronto found huge differences in the brains of bilingual people as opposed to unilingual people. They found twice as much damage in the bilingual brains and despite the fact that both groups were similar in levels of education and cognitive skills, the bilingual people's brains seemed to be able to handle twice the level of atrophy without displaying twice the level of decline. Dr. Tom Schweizer, who headed the research, feels that the constant switching over in the brain from one language to another enhances the creation of more neuronal networks. In this study, they examined CT scans of patients with AD, and he hopes to repeat the study with a larger patient sample and by using MRIs to observe brain changes. He mentions in the article that previous studies through observation found that bilingualism seemed to delay onset of the AD symptoms by about five years, but that this is the first study to actually find the physical proof in the CT scans of the damage and delay.
I keep thinking how nice it would be to be able to speak Spanish, and now I'm thinking I ought to move forward on this and get started!

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Friday, October 14, 2011



It's always encouraging to me to see news about how the world is progressing in it's battle against Alzheimer's and other dementias. I recently read an article in Medical News Today (http://www.medicalnewstoday.com/articles/232361.php) that discusses how Dr. Robert Nagele, at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine developed a blood test to determine if a person does or does not have Alzheimer's disease.
This test involves examining blood samples that measure the antibodies the body makes when cells die, so it's a relatively simple test. Their studies showed the test correctly identified 96% of those tested with Alzheimer's, and correctly identified 92.5% of the people in the study who did not have Alzheimer's. They are speculating that the test could be available within a year and may cost around $200.
Early detection of Alzheimer's would facilitate early treatment, and hopefully delay of the progression of the disease. It would also allow families more time to plan for their future and their finances.
There are other laboratories in various stages of testing looking at this type of test, so it sounds pretty hopeful that we will soon have some options for diagnosis that are not so invasive and don't require brain biopsy.

Tuesday, August 30, 2011



For some reason, I keep thinking about Coach Pat Summitt and her recent diagnosis of early onset dementia. Last week, I wrote a small blurb about how I feel her courage in pursuing the diagnosis, as well as going public with it, will inspire many families to do the same and thus move forward with their lives rather than huddle in fear of the unknown. But, I keep thinking about it and feel compelled to put my thoughts down in this blog.
Once the media frenzy dies down, the Summitt family will face each day just like any other family dealing with dementia. It appears that Pat will be surrounded and helped by multiple people around her so she can continue to coach for as long as possible, and that is certainly a blessing for them. This too, can be a lesson for others who may not have access to all those helpful assistants. If you want your loved one to be as independent for as long as possible, then seek out ways to help them do that. Is it friends who schedule daily/weekly outings? Is it neighbors or relatives who truly want to help? Is it members of your church who want to help? If you can afford companion care, that's wonderful, but if you can't afford it, then for the sake of your loved one (and your own mental health), take advantage of those friends, neighbors, relatives or church members who wish to step in and help on a regular basis. Please do not think you're taking unfair advantage of them because they too, are getting something out of the relationship with you and your loved one. They feel satisfied and fulfilled that they are helping a fellow human being. They want to give back, and remember that you will have the opportunity to also give back to them once your life is not so consumed with caring for your loved one.
Coach Summitt's son, Tyler is a young man who will walk on this dementia journey with his mother even though I'm positive he would wish for nothing more than a normal life of his own and good mental health for his mother. He will need an awful lot of support in order to not lose his own identity and his future on this journey. As his mother's dementia progresses, his caregiver burdens will increase, as well as his stresses. He must make plans for time away from his responsibilities as a caregiver in order to be a better caregiver. This too, is a lesson for all caregivers. It will be the most difficult "job" you will ever do, but you compromise yourself and your loved one's safety and happiness when you cannot step away and recharge. I think it's okay to think that nobody can take care of your loved one as well as you can, but I don't think it's okay to turn away those people who want to help. Everyone will benefit from more people coming in to help and keep your loved one socialized.
I wish the Summitt family many, many happy and productive days ahead, as I wish every family struggling with dementia the same. It is possible, and I pray you are all able to achieve that goal.

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Wednesday, August 10, 2011



Wouldn't it be nice if it was discovered that by drinking 4-5 cups of coffee per day we could reduce our risk for, or delay the onset of Alzheimer's? The latest news is to keep on drinking your coffee! In a June 22, 2011 edition of Medical News Today (www.medicalnewstoday.com/releases/229287.php), an article entitled "Protection Against Alzheimer's Disease Boosted By Mystery Ingredient in Coffee," was published. It seems Drs. Chuanhai Cao, and Gary Arendash from the University of South Florida have found that some ingredient in caffeinated coffee decreases production of those abnormal beya-amyloid proteins in the brains of Alzheimer's mice. They've narrowed it down to a growth factor in the coffee called "GCSF" and discovered that increased levels of this growth factor in the blood of these mice improved their memory. The mystery component responsible for the improved memory does not appear to be present in other products with caffeine, so they believe it is linked to the coffee plus the caffeine (instant caffeinated coffee was not tested).
Most experts believe that Alzheimer's actually starts in the brain several decades before any symptoms are seen, so Drs. Cao and Arendash feel moderate consumption of caffeinated coffee (4-5 cups daily) could offer a protective effect, which could be increased even more by adding other lifestyle changes such as increased physical and mental activity. Again, they're still dealing with mice, but coffee has been around a long, long time and many people are able to drink it without any problems, so if it's found to offer a protective effect in the brain against Alzheimer's in human, what a great preventative "treatment!"

Friday, July 29, 2011



I was so happy to see that the Alzheimer's Association International Conference in Paris this year presented a symposium which highlighted the increasing evidence of functional and cognitive benefits seen when patients with Alzheimer's are taking a combination of one of the cholinesterase inhibitors (Aricept, Exelon or Razadyne), plus Namenda. The experts concluded that this combination is the best option we have today to help preserve cognitive and functional abilities, and studies are on-going to see at just what stage this combination intervention is most beneficial and for how long. So, if your loved one is on one of these medications, ask the physician to add the other for an increased benefit. These two types of drugs work in completely different ways in the brain, and they are both more effective together than either one is when used alone.
Also, something I recently learned is that a person can build up somewhat of a tolerance to the cholinesterase inhibitors over a period of years, so it may be beneficial to bump up the dose if they're not already at the maximum dose.


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Cindy Keith, RN, BS,
Certified Dementia Practitioner

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