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Wednesday, November 28, 2012

Detecting Alzheimer's disease November 28, 2012

This blog is quoted from part of The NYTimes on November 16, 2012  article "For Alzheimer’s, Detection Advances Outpace Treatment Options" which indicates that the new scan which bacame available in June for testing your brain for amyloids and plaques presents patients and their families with more questions than answers and a positive test result may prevent patients from obtaining long term care insurance.

There are already more than 300 hospitals and imaging centers, located in most major metropolitan areas, that are ready to perform the scans, which are not yet covered by Medicare and cost thousands of dollars.

The scans show plaques in the brain — barnaclelike clumps of protein, beta amyloid — that, together with dementia, are the defining feature of Alzheimer’s disease. Those who have dementia but do not have excessive plaques do not have Alzheimer’s. It is no longer necessary to wait until the person dies and has an autopsy to learn if the brain was studded with plaques.

So it is tempting to get the scan if you feel your loved one is forgetting more than is typical; there is anticipation of relief if the scan is negative, but what if it is positive? There is no treatment available, clinical trials may have significant side effects and the vague fears are then reality. There is nothing more to do, than to get one's affairs in order and prepare to watch our loved one deteriorate slowly.

Scientifically, this is good news if we are sure that the hypothesis is correct. How many scans have been done on non-demented people to show how much plaque is normal? How much of our retirement income or savings should we spend to find out something we can do nothing about? Is it better to wait until the treatment science catches up with the detection science before jumping on the scan bandwagon?

Fear of Alzheimer's disease is the number one fear of illness now in America, overshadowing heart disease and cancer. Let's not let this fear tempt us into rash expensive decisions which could make our lives and those of our loved ones worse, not better.

Sunday, November 25, 2012

Holiday Stress- Sunday November 25,2012

I struggled mightily this year about bringing my husband from the care facility to our home for the holiday afternoon as we had such a pleasant visit the day before when we sat with him for an hour in the afternoon and ate at the Village Inn. He did not appear agitated and was so glad to see both me and my son Steve. The decision was reached on the basis of stress, both his and mine. What would Bob do when the guys were watching football? What would he do while I was cooking and serving? How would he relate to guests, to being in the house? Would he want to return home during dinner?

Bob’s comfort level these days depends a lot on constant individual attention to his needs. Could I provide that attention at a dinner party? I would have changed his routine and added stress to Bob’s day and to mine, so he ate turkey dinner with his staff and we visited the day after. He didn’t know but I heard the care facility went out of its way to provide an ample and delicious festive meal.

Hosting Thanksgiving dinner felt satisfying from the menu design to the bright red flowering amaryllis I placed as the centerpiece on the table. Permitting three friends plus my family to bring side dishes help serve and clean made for a stress-free meal. I served coffee in my mother’s fragile china cups, used my husband’s annotated recipes and made his Famous Thanksgiving Jell-O mold which keeps him in our hearts. I am grateful for and thoroughly enjoy the family and friends I am privileged to have with me without feeling devastated by the sadness of the losses each new separation brings.

Thursday, November 22, 2012

Risk Factors We CAN Change 11/22/2012

Happy Thanksgiving to you all. As we gorge ourselves on delicious traditional and experimental foods this year, let's decide to make a few lifestyle changes to help ourselves avoid Alzheimer's disease if possible. Here is the remainer of the article, quoted from The Huffington Post Healthy Living.

"When I am asked in my clinical practice about Alzheimer's prevention, I recommend attending to reversible risk factors for other conditions that impact negatively on the brain, particularly stroke and heart disease," adds Dr. Relkin. "After addressing things such as high blood pressure, cholesterol and diabetes, the most actionable advice I can give is to make lifestyle changes, such as regular physical exercise, weight control and eating a heart-healthy diet."
Reduce your risk of stroke: The first and most important thing you can do is reduce your risk of stroke. Stroke and Alzheimer's share many risk factors and the likelihood of dementia is doubled after a stroke. While it's not clear exactly why, considerable evidence (some of it gathered by the unique Nun Study) shows that two brains with an identical burden of AD pathology (plaques and tangles) can function quite differently. The non-stroke affected brain is more likely to function well, and the stroke-affected brain is more likely to develop dementia, including those affected by so-called "silent strokes."
In lifestyle terms, this means being a fanatic about controlling your blood pressure and atherosclerosis (hardening of the arteries), as well as high cholesterol and diabetes. Quit smoking. Read more from me about stroke prevention here.
Avoid concussion and head trauma: From research on professional football players to World War II vets and boxers, the evidence is mounting that traumatic brain injury has lifelong consequences, one of which is a marked increase in Alzheimer's, as well as Parkinson's disease, depression and suicide risk. The worse the injury, the higher the risk. Professional football players' risk of death from Alzheimer's or ALS appears to be increased almost four times.
Treat depression: Suffering from depression in midlife, and especially later in life is associated with increased Alzheimer's risk. Highly effective treatment is available for depression and should be pursued. (See my advice in depression here.)
Increase your activity and exercise: You don't have to do a triathlon, but the more you move, the better your vascular health, which is directly related to many types of dementia. A recent study even suggested that jogging five times a week normalized the otherwise much elevated risk of people with two copies of the gene variant ApoE-4.

Control your diabetes: High glucose levels, including after meals, can double your lifetime risk for developing Alzheimer's.
Keep your mind alive: It's too much to say that doing crosswords and playing cards alone can stave off Alzheimer's, but there is a correlation between active brain engagement and reduced risk. A recent study suggested that lots of mental activity delays the onset of cognitive decline (although decline was also faster once it began). But if you only have time or energy for physical or cognitive exercise, it has recently been shown that, although both are good, physical exercise is better at keeping the brain healthiest.
Sleep better: Sleep apnea has long been recognized as a cause of decreased daytime alertness, but recent studies suggest it may also increase the risk of dementia. For the obese, weight loss alone can sometimes help to eliminate sleep apnea, but in many cases other medical interventions are required.
Lots of things in life are beyond our control, but we should all take heart from what we can do. I urge you to take a walk and eat a healthy snack to celebrate... before it's too late.

Tuesday, November 20, 2012

Alzheimer's Risk Factors November 20, 2012

Richard Blesdine, MD, a geriatic physician has written a clear article on the risk factors for developing Alzheimer's disease. He has divided them by type-those we can change will appear in this column on Thursday

AD risk factors that you cannot change
There are two kinds of risk factors: those you can't control and those you can. Here are some risks factors that you should be aware of, even if you can't change them.
Family History: Having one parent with AD doubles your risk; two parents with AD puts you at five times greater risk.
Age: About 5 percent of Alzheimer's patients have early onset disease, but the vast majority of cases are late-onset. Seventy-four is the most common age for detection. Dementia is never an inevitable part of aging, but getting older is a risk factor. The number of Alzheimer's cases doubles every five years after age 65 and AD risk hits about 50 percent after age 85.
Genetics: People with two copies of the apolipoprotein (ApoE4) gene appear to be at about 10 to 15 times greater risk, and one copy triples the risk. That said, having one or even two copies of the gene does not mean you will definitely develop Alzheimer's. For this reason, most physicians do not recommend taking the blood test for ApoE4, except in research settings. (A different variant of the same gene, ApoE2, provides some protection against the disease.) New genes that increase risk continue to be identified, holding out promise for greater understanding of basic mechanisms, and, therefore, hope for prevention.
Multiple mutations of a number of genes are the most common cause of early-onset AD (before age 60). Members of these unfortunate families with such mutations definitely will develop AD.
On the bright side, earlier this year researchers reported an exciting discovery: a rare gene mutation that appears to offer strong protection against Alzheimer's, even for people at high genetic risk.
Being a woman: More women than men develop Alzheimer's Disease. Although women outlive men, and age is a powerful risk factor, the weight of evidence suggests that women are still at slightly higher risk than men. And there is no doubt that women bear the major burden of caregiving for persons of both sexes with AD.
Down's Syndrome: About half of all people with Down's Syndrome will develop symptoms of Alzheimer's by their 50s, but almost all at autopsy show the typical pathologic features of AD.
Risk factors that you can change
The lifestyle changes listed below are not revolutionary, except in this respect: You may never have realized they can cut your risk of dementia. And authorities say that every little bit helps.
"Alzheimer's disease whittles away cognitive reserve, which is the brain's ability to tolerate damage without loss of thinking abilities. Anything that can be done to avoid brain damage and/or increase cognitive reserve can potentially delay dementia symptoms," says Norman Relkin, M.D., Ph.D., founding director of the Weill Cornell Memory Disorders Program and a member of the Board of Directors of the American Federation for Aging Research.
I will quote the rest of this article on Thursday.

Sunday, November 18, 2012

Violence 100 Words for Sunday, 11/18/12

I saw the movie Lincoln last  evening; two venues, four showings today, 2400 people, in the Mesa theater alone. Our local loyal viewers clapped at the ending, proud that we abolished slavery. I hope my neighbors also saw how difficult it was to secure the majority needed to amend the Constitution, how fairness and equality are the mainstays of our democracy and how compromise, even coercion, among people of differing views can accomplish small pieces of a large goal; it took another hundred years for blacks to obtain their civil rights in our country. Now we struggle for LGBT equality!
It is all too human to resist change; even more human to collect in groups with like-minded others to the exclusion of others which we often feel protects "us" even while it demeans "them." We try to substitute sports team allegiance for clan behavior, hopefully stopping short of the violence that has been known to erupt in soccer match playoffs. We identify with the sports team, rooting for them when they win and often demeaning them when they lose. But often sport team alliance is not sufficient; we resort to the tension between groups that flares into violence and threatens to involve more and more groups who identify and align with one side or the other.
We pick sides, deciding who we feel is the aggressor and who the underdog, but much like sibling squables in which the parent does not recognize that it is often the sweet girl or the younger sibling who instiogates the quarrel, many parents blame the older or the stronger or the one whom the parent perceives  as smarter, ignoring the facts of the quarrel. Most times, home based arguments end with both children being quarantined for a time in separate spaces until the tension subsides and either the children work out a solution or the parents exert their authority to resolve the dispute.
Bullying is to be fought against, self-defense is to be encouraged, resorting to violence is the worst of all methods but if fighting is needed to stop aggression, at least let the participants work out a cease-fire and talk out their issues without senseless escalation which can happen when parents choose sides between their children, when schools and ever larger forces of authority involve themselves in the quarrel which grows to a battle and to a war.

Tuesday, November 13, 2012

Generations November 13, 2012

11/12/12 celebrated a private event for my family as well as the national event of Veteran's Day. We attended a local parade where we watched my nine year-old Webelo scout march with his troop. We saw the banner which read "Never will one group of veterans forget another" as we did with the Vietnam War. The number of World War II veterans is becoming very small with each being driven in a car along the route.
In the afternoon we took our own Korean War veteran out to dinner. Grant helped Grandpa Bob into the car and fastened his seat belt. He sat across from Grandpa and made conversation, was kind and considerate and later he said solemnly, "I'm a scout. That's what scouts do."
The family event was the one hundred year anniversary of my mother's birth. As we shared anecdotes remembered from our relationships with her, I realized again how important it is to build family memories. My children were lucky to grow up living nearby to their grandparents; they have many warm memories to share with the next generation who knew her less as my older grandson was just a baby when his "Grandma Cookie" died. I am now fortunate to live near my two grandsons. What will they remember of me?

Sunday, November 11, 2012

Veteran's Day November 11, 2012

I saw a new interpretation of Shakespeare's play, in opera form, at the movie theater yesterday.The Tempest  portrays the hero Prospero as a rational magician, who conjures up a storm to get revenge against the plotters who removed him from the powerful Dukedom of Milan. This Prospero comes to understand that love supersedes the power of his magic. While Prospero currently battles with the loss of his daughter to maturity and marriage, he also forgives and redeems those who fought against him years ago. There is a parallel to my life, because I struggle to forgive my husband, to whom, by forgetting, I become less important.

It is up to me to learn how to let go, to reduce my expectations of my husband who has Alzheimer’s disease, even lower. Friday, Arbor Rose held a lovely tribute to the 44 veterans who attend their day club and residences , with a program that listed each person’s name and presented a flag, a handshake and a picture taken with the fully uniformed senior care director who is a Major in the Air Force. We sang patriotic songs and ate cake that was baked red, white and blue. Bob did not enjoy sitting in the hot sun among so many people, but he sat between my son Steve and me, holding his program, placing his flag in his shirt pocket and saying again and again that he did not recognize me.

However, as I stood next to the photographer who took his picture, he said, “That’s my wife,” and when we finally returned to his quiet room, he said, “You’ve come back to yourself.” We are all trying so hard to maintain that connection but slowly, he is slipping away. And many of these other 43 heroes who fought to preserve our freedoms in the Second World War, the Korean Conflict, Vietnam, the Gulf Wars and the War on Terror are struggling to maintain their own identity. We honor them, we tell their war stories for them,  we celebrate whenever we can with love and respect for them, their families and for the smiling  and sensitive people who care for them now.

Thursday, November 8, 2012

Normal Cognitive functioning November 8,2012

There are already test results filtering from the study in the US of the extensive Colombian family who have the Alzheimer's gene. The most recent study indicates the teams are finding Alzheimer's in people in their 20's, who have normal cognitive skills and no idea they are ill. Their brains show less grey matter than others' and their spinal fluid contains more beta amyloid plaques.
What does this mean? First, medications which prevent the increased production of beta amyloid plaques need to be found and second, these potential medications need to be administered before the brain damage takes place.
The telephone message when I phoned the Alzheimer Institute this week says thay they are looking to find a cure for Alzheimer's disease "without losing a generation." Ouch, that generation includes me and my children.
When we are diagnosed today, we have already lost 20% of our brain function. The medications now available delay the symptoms; the new medications being tested only work on very early diagnosed patients and still only delay the progress of the disease. There is nothing yet to halt the disease or to prevent it.
So what do all adults need to do? Plan financially for the future, plan legally for the future. It will not be sufficient to protect our families from Type A personality heart attack early death (although this advice could hasten that outcome!) Pay attention to your savings and to your investments making decisions that include the possibility of diminished cognitive skill in the future. I know of several families who are in dire financial straits because  one member of the family made disastrous investment choices when his decision-making skills and judgment were diminished by disease.
One family lost $300,000. when a non-diagnosed early stage Alzheimer spouse was embezzeled by a computer scam. Another spouse started gambling and lost the family's life savings before he was diagnosed with Alzheimer's disease.

Alzheimer's is not only a memory-loss disease. Financial decisions need to be made by more than one family member, preferably in consultation with a reputable financial advisor.
"If you see something, say something," a sign in the NY subway, warns us to guard against terrorism; it is also applicable here. Have yourself or your family member tested if you notice signs of disruptive memory loss, increased dependence or irritation, sleep disturbance or non-intentional significant weight loss. We need to change the culture to one of prevention and protection; we need to erase the stigma of reduced cognitive ability.

Sunday, November 4, 2012

Tension November 4, 2012

The drama, tension and conflict are interspersed with humorous one-liners that invite the audience to let out its collective breath by giggling at something absurd, but only momentarily. I sit silently attentive for more than two hours as the story I already know plays itself out. Is it the music, the fast pace of the action, the simultaneous superimposition of two scenes on two continents or is it our collective desire to be held in the suspense, to escape from the problems of our lives and dive into the more exciting, life-risking adventure of patriotic countrymen caught in harm’s way?
This is really a description of how I felt as I watched ARGO, but it also describes how I felt glued to CNN before, during and in the aftermath of Superstorm Sandy. Instead of feeling glad I am safe in Arizona, I wanted to be in New York, experiencing the storm, which sounds to rational me to be an absurd desire. But if I were there, I would know how my friends are faring, I could offer assistance if needed. Here I am safe, but I feel separate from the action. Gladly everyone with whom I've spoken is managing, with or without power, sleeping in the lobby of a building instead of walking up 14 floors, having a small generator blow up because too much use was attempted, enjoying the free bus rides and generally feeling upbeat about the city. Even folks in New Jersey feel that the repairs will provide jobs for many people they know, although we are all saddened by the loss of so many memories at the Jersey shore.
I wish you all the best as you recover from this huge trauma, my thoughts and prayers are with you.