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Friday, May 28, 2010



I just came across a small study by Tomislav Majic and colleagues from Charite Hospital in Berlin, and I feel I just have to comment on this. They noted that as a person's dementia worsens, disruptive behaviors, depression, and apathy tend to increase. In this study they analyzed data on 304 dementia patients from 18 facilities in Berlin. They found that while the anti-dementia drugs (the cholinesterase inhibitors Aricept, Exelon and Razadyne, and an NMDA receptor antagonist--Namenda) were rarely prescribed, patients instead were usually being treated with neuroleptic drugs. One definition of a neuroleptic drug is a "tranquilizer used to treat psychotic conditions when a calming effect is desired." These drugs can have serious and life threatening side effects and should only be given when less harmful drugs have failed. That's why the FDA has given them all "Black Box Warnings." It's now the "gold standard" for the best dementia treatment options that one of the cholinesterase inhibitors PLUS Namenda be given together. That combination has been shown to reduce agitation and aggression and slow the progression of cognitive and functional decline over either drug alone, and over no treatment. Of course, non pharmacologic options should always be ongoing--things such as tailored activities, exercise, established routines and a well trained staff to be able to appropriately redirect a person with dementia. I have seen what these drugs can and cannot do, and if this person with dementia is my loved one, I want them on the anti-dementia meds. That's the best we can hope for now since there is still no cure. We can only hope to slow the progression a bit and at the same time, increase their quality of life. The argument for anti-dementia drug combination therapy was made by a study sponsored by NIH (National Institute for Health). This was not a drug company sponsored study. It was carried out in the Memory Disorders Unit at Massachusetts General Hospital and conducted by Dr. Atri, et al. The results were published in the September 2008 issue of Alzheimer Disease and Associated Disorders and included data from 382 AD patients collected over the course of 15 years. They were trying to see if there really was any measurable benefits to giving these two anti-dementia meds together versus only a cholinesterase inhibitor, or versus no treatment. They measured cognitive performance over time as well as functional dependence over time. For cognitive results, the data showed that untreated patients had 3 to 4 errors per year on testing. The combination of Namenda plus a cholinesterase inhibitor decreased that deterioration by 2 errors per year. When 1 error per year could mean the difference between a person remembering the name of their relative, this is very significant. For functional outcomes, the combination therapy again showed increased abilities over the period of decline over just the cholinesterase inhibitor alone, or no treatment. That could mean the different between a person being able to stand up when asked to at the end of 4 years. This has huge implications for facility caregivers as well as family members.
I must disclose to you that I am on the Speaker's Bureau of Forest Labs for their dementia drug Namenda, however, even if I were not, my experience has shown me without a doubt that these drugs do help and do not have the severe side effects of the antipsychotics. I have no qualms whatsoever about recommending these anti-dementia drugs, and I urge you to ask your physician to try them before resorting to the more dangerous drugs. It's always, always, always a guessing game when it comes to which drugs will work with dementia, but if meds are required, you should always opt for the least harmful drugs first.
Dr. Majic's article was seen in the current issue of Deutsches Arzteblatt International (Dtsch Arztebl Int 2010; 107[18]: 320-7).
We have to do better at treating these elders in facilities, and combination therapy of the anti-dementia meds is a huge first step, so I urge you to push for it.

Saturday, May 22, 2010



Can you imagine life without 1 or 2 of your favorite flavors? Researchers Katherine Piwnica-Worms, R. Omar, J. Hailstone, and J. Warren used jelly beans to test subject's ability to discriminate and identify flavors, as well as to assess combinations of flavors as to whether they were appropriate and pleasant. An example they used was the combination of vanilla and pickle. Their research finds evidence that there is a loss of meaning for flavors in patients with "semantic dementia." This is a degenerative disease that affects the temporal lobes of the brain, and the meanings of the words become lost. So, if my temporal lobes were being affected by this type of dementia, and you asked me if I wanted my favorite chocolate ice cream, I would have no idea what you were asking me. And even if you gave me that favorite flavor, I would not necessarily be able to identify it as something I love. This research helps provide clues to some of the abnormal eating patterns some people with dementia develop, such as faddism, or possibly a pathological sweet tooth.
I asked an elderly woman one day when we were driving back from a family reunion, if she wanted to stop for a milkshake. She readily agreed, but when I asked her what
flavor she wanted, she was unable to understand my question. She couldn't remember that she loved chocolate. I ordered chocolate for her and she enjoyed it immensely, so I took comfort in that. It hurt to think she couldn't remember chocolate, but I rejoiced to see that she did still enjoy it that particular day.
We never know what area of the brain will be affected next by dementia. We must continue to alter our perception of what this person wants or likes because they may have just decided they want pickles and vanilla ice cream--and they would actually probably enjoy it.
This article is titled "Flavour processing in semantic dementia" and can be read in Cortex, Vol. 46, Issue 6 (June 2010) published by Elsevier.

Friday, May 14, 2010



I want to let people know that I will be interviewed tomorrow - May 15th, 2010, by Jacqueline Marcell on the popular ‘Coping With Caregiving’ Internet radio program. We will be discussing my recently published book "Love, Laughter, & Mayhem - Caregiver Survival Manual For Living With A Person With Dementia," as well as the HUGE one day book launch set for June 10th where purchasers on that one day will receive a TON of bonus gifts worth hundreds of dollars.

The show features interviews with four healthcare professionals and can be heard live worldwide from 3-4:00 pm Pacific Time, with my interview at 3:30 pm PT (6:30 pm ET), segment 3. To listen in, simply click on one of the ‘On Air Listen Live’ buttons at the top of www.wsRadio.com/CopingWithCaregiving.

If you miss the live broadcast, by Tuesday May 18th you can listen-on-demand to the online archive anytime. If you need assistance with listening to Internet radio, please see www.wsRadio.com/how-to-listen.cfm.

The host of the 7-year old program, Jacqueline Marcell, took care of her parents who had Alzheimer that went undiagnosed for over a year, compelling her to dedicate her life to eldercare awareness and reform. She is an international speaker and author of the best-selling book ‘Elder Rage’ www.ElderRage.com.

If your area of expertise is relevant to caregiving, health or aging issues and you would like to be considered for the program, email Jacqueline at J.Marcell@cox.net for the details--tell her I sent you!

Please forward this announcement to those who may have an interest--and I hope you will listen in and send me your comments!



While scrolling through Medical News Today, I found an interesting 5/8/10 article on a paper about to be published in the Journal of the American Geriatrics Society this month. Dr. Maria Norton of Utah State University and her colleagues found that spouse caregivers of people with dementia were six times more likely to go on to develop dementia than caregivers of spouses without dementia. We already know that caregivers sometimes are not very good at taking care of themselves and suffer much higher rates of physical and mental disabilities, but this is the first study to look at their risk for dementia.
This was a relatively small study, with 1,221 married couples who were followed over a period of 12 years. They were age 65 and older, all living in Northern Utah. None of them had dementia at the start of the study, and adjustments were made in the study for socioeconomic status, age, gender, genetic factors, etc. In follow-up, "30 cases (60 individuals) of dementia were diagnosed in both spouses, plus 125 where only the husband developed it, and 70 where only the wife developed the condition."
They found that for male caregivers of a spouse with dementia, their risk for developing a dementia was 11.9 times higher, and for women, it was 3.7 times higher. What we don't know is just how much of this risk is due to caregiver stress, and how much the shared environment played a part in it.
Something we need to keep in mind while looking at these numbers, is that MOST of the participants with spouses who developed dementia, did NOT go on to develop dementia themselves.

Sunday, May 02, 2010



Isn't it great there are dedicated people out there in the world who are working very hard to find answers to awful diseases like Alzheimer's and other dementias? Mayo Clinic has recently published a case-controlled study of whether a combination of physical exercise (of any type) plus computer use would help reduce the risk of acquiring mild cognitive impairment (MCI). Both of those activities have been shown in previous independent studies to reduce the risk of acquiring MCI, but it now appears the combination of the two produce an even greater protection: "The joint effect is more than the expected arithmetic sum," said Yonas Endale Geda, M.D. who was the study's lead investigator. MCI often progresses to Alzheimer's, so this is exciting news! Get out there and take brisk walks, then come home and turn on the computer for awhile! You'll be doing your brain a favor! Happy surfing!


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Cindy Keith, RN, BS,
Certified Dementia Practitioner

Nationally Known Speaker
On Dementia and Alzheimer's Care

Phone 814-235-0691

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