Thursday, 26 June 2008

Dementia Can Hit After A Stroke In Prime Life



In November 2005, Davida Godett seemingly had it all. She had a great job and was on the fast track to earning her MBA.


Then, on an otherwise uneventful Monday morning, Godett crashed: She had a mini-stroke that temporarily stopped the blood flow to her brain.


Godett went to a nearby emergency room and recovered. She didn't really dwell on the fact that she was at high risk for another attack. After all, she reasoned, strokes strike older people, and she was only 29.


Then, right around Valentine's Day 2007, Godett started to slur her words. One side of her body felt numb. She had had a severe stroke.


This time, when Godett, an accountant in Philadelphia, tried to resume her life, she ran into major problems. At work, she had trouble adding up numbers, planning ahead or even thinking clearly.


BETTER LIFE: Rounding up the latest studies on Alzheimer's and dementia


The damage from the stroke had left her with vascular dementia, the second-leading cause of dementia in the USA behind Alzheimer's. Godett was only 31 at the time. Most people who have dementia are 65 or older, but according to the Alzheimer's Association, an estimated 500,000 people ages 55 to 64 struggle with some form of dementia.


Work becomes impossible


"No one knows how many people such as Godett face the demon of dementia before age 55 — a time when the demands of work and family life are intense," says Katie Maslow, Associate Director for Quality Care Advocacy at the Alzheimer's Association.


"Anyone who has been working and has dementia is going to lose their job," Maslow says. "Patients often have trouble qualifying for disability insurance and struggle to pay for housing, food and medical care," she says.


"Vascular dementia occurs when a stroke or a series of strokes temporarily blocks blood flow to the brain," says Claudette Brooks, a Neurologist and Stroke Expert at the West Virginia University School of Medicine in Morgantown.


Godett's stroke damaged parts of her brain that let her store and retrieve information.


"Before the stroke, I could add numbers in my head. I was gifted in that area," Godett says. Back on the job, she started to have trouble closing out the books each month. She'd pick up the phone and forget what she was about to say.


"I didn't realize it at first," she says. But a colleague noticed the lapses. "I was getting worse."


In April 2007, two months after the stroke, she had to leave her job.


According to a 2006 report by the Alzheimer's Association on early dementia, only 22% of people with disabling memory or cognitive problems stay on the job. The report notes that 62% of such people had an annual income of less than $11,000.


"We often hear from families who are quite desperate," Maslow says. Some people, including Godett, get disability insurance through an employer or from the federal government. But Godett says her disability check doesn't cover her living expenses.


"I have outstanding medical bills," she says. "It's been difficult to maintain everything."


The effect on families goes beyond finances. Maslow says dementia patients may not be able to fully care for children at home. In some cases, roles are reversed, and children are put in the position of caring for a parent, she says.


Daily tasks aren't easy, either


The damage to Godett's brain has left her with permanent disabilities. She still takes her son to school each morning and does her own household chores, but she has to expend a lot of effort on the simplest things.


Take grocery shopping


Godett can't easily put the steps together in her mind to go to the grocery store. She can't plan well enough on her own to gather her list, drive to the store, go through and pick out the items she needs and pay for them.


Never mind counting the change


Things she used to take for granted now tax her mind and leave her exhausted by day's end. "This has been so difficult," she says.


Brooks says people who have early-onset dementia often fall through the net of social services. They don't qualify for Medicare, the health insurance program for the elderly. They often have trouble going through the steps they need to collect disability, and the bills they face are enormous.


"African-Americans such as Godett are at twice the risk of having a stroke. They are also at higher risk of developing vascular dementia," says Emil Matarese, the Neurologist who treats Godett.


"The high risk can be traced mostly to other health conditions such as obesity, diabetes and hypertension," says Matarese, who is also a spokesman for the American Stroke Association.


But other than her race, Godett has none of the known risk factors for stroke. "She's a beautiful, thin, healthy lady," Matarese says. "She did everything right."


But Godett represents a fact of life: There's nothing modern medicine can do to alter her risk profile.

So she does the best she can to provide for her 5-year-old son. She relies on family members to help drive her to the grocery store. She struggles to pay the bills.


And she prays.


"Every morning when I wake up, I give thanks," she says. "I really believe that it helps."


Godett says she has found an unexpected joy in her life, one that comes with not dwelling on the past or fretting about the future.


"I cherish every single second of the day," she says. "Because you just never know."

Thursday, 19 June 2008

Help Children Understand The Effects Of Alzheimer's

When a family member has Alzheimer's, children may feel upset, confused or scared by the puzzling changes they see. Help them understand how the brain works and how it affects the person with the disease.


Learn How Your Brain Controls Everything You Do:


Are you a fan of Harry Potter, Hermione, Ron and the rest of the crew at Hogwarts School of Witchcraft and Wizardry? The fun of reading an exciting book depends on your brain, an organ more powerful than any wizard. Your brain interprets written letters as words and builds words into a story. If the story is part of a series like Harry Potter, your brain weaves your memories of the earlier instalments into the new adventures.


In addition to reading, understanding and remembering, the brain enables you to plan, to make decisions and to recognize people, pets and places. Your brain also controls your movements and activities like breathing and your heartbeat, stuff you don't even have to think about.


The Source of Brain Power:


Your brain gets much of its power from 100 billion nerve cells, or neurons (NUR-awhns), that control reading, remembering, deciding, moving your body and other activities that involve thinking and planning. Nerve cells share information at 100 trillion tiny connections called synapses (SIH-nap-sez). These connections form networks that are more complex than any computer.


At these connections, nerve cells communicate using tiny electrical signals and pulses of special messenger chemicals. Your brain codes everything you know in patterns of nerve cell connections and the strength of the cell-to-cell signals. Learning something creates a new pattern of connections and makes certain signals stronger.


At every moment of the day or night, millions of messages are speeding through your nerve cell communication pathways, enabling your brain to receive, process and store information and to send instructions all over your body.
These images use a special kind of X ray called a positron emission tomography (PET) scan to show areas of the left side of the brain that are active while people perform language tasks. The white line is a rough outline of the left-side view of the brain. Nerve cells involved in each task are working hardest where an image is red. Nerve cell activity decreases as the colours progress through the rainbow from red to violet. Black areas are not involved in these tasks.
Alzheimer's Disease: When Brain Power Fails
Like any other body organ, the brain can break down. One of the most common brain disorders that people can develop as they age is Alzheimer's (AWLS-high-murz) disease. You may have a relative or older friend with Alzheimer's. It strikes about one-tenth of people over 65 years old and almost one-half of those who live past 85.
In Alzheimer's disease, brain cells lose their ability to form new connections with other cells. Supplies of messenger chemicals also decline. These losses make it hard for people to learn new information. If you told someone with Alzheimer's disease when the next Harry Potter book was due out, he or she would have trouble remembering the date.
Existing nerve cell connections also disappear and information stored in them fades. People with Alzheimer's disease have problems recalling the names of friends or titles of beloved books. They forget who is president of the United States, how to pay bills and other important information.

As the disease gets worse, nerve cells begin to die. The death of nerve cells destroys the brain's ability to understand the world. People with Alzheimer's may want to avoid excitement and being around too many people, even at holidays and family gatherings. When they grow confused or frightened they may cry or become angry because their surroundings no longer make sense to them.

Eventually, widespread cell death erases the most basic knowledge stored in the brain. People lose their ability to recognize family and friends and even forget who they are and where they live.

In its latest stages, Alzheimer's disease destroys brain cells that control moving and swallowing. People at these stages need constant care. Eventually they die from Alzheimer's disease.

No one yet knows why or exactly how Alzheimer's disease destroys brain cells, but scientists worldwide are working to solve the mystery. Everyone affected by the disease would like to close the book on Alzheimer's. Perhaps during your lifetime we will be lucky enough to see the end of the sad Alzheimer's story.

(Source: the sad Alzheimer story.)

Tuesday, 17 June 2008


My mom was born in the year of the rooster.  It is said that people born under the year of the rooster are very sociable and outspoken.  Most of all, they love making their friends and family happy and very much loved and respected by all who know them. These personalities were so typical of my mom.  But all this came to an end when my mom had Alzheimer's.


 It all started when mom began to forget very easily and accused the cleaning lady of stealing her money.  Initially, I thought that mom was getting very forgetful as she tend to be quite careless with her things. However, the accusation got worst and almost everything was forgotten instantly like her appointments and the conversations she had.  Soon mom just could not do the daily chores without any incidents like leaving the tap on with water running and pots left burning on the stove.


My family never realized that mom was beginning to have Alzheimer's then. It was only when her behavior got worse each day that we realized something was wrong.  My brother consulted his friends who were doctors and it was in 1999 that we took mom to the hospital where she was diagnosed with Alzheimer's .


It was a difficult time for both mom and the family during the first few years. We did not know how to cope with mom's erratic behavior and since all of us were busy at work , mom was left to care for herself alone.  Thinking back about the early years, mom must have realized the changes in her and that resulted in mom being so depressed all the time and she lost a lot of weight then.


There were some unforgettable scary incidents. One remained a mystery to us to this day.  That was  when  mom  just took off  to her sister's house without informing us and when she was at her sister's house, she would just take off and came back home.  We could never figured out how mom found her way home as she had no money and no keys to get into the house.  We concluded she was blessed with a nice taxi driver and she still had the agility to climb over the gate .


Recalling back, I guessed it must have been a very difficult time for mom. During this time, we also noticed mom began to hallucinate. She thought the people on TV could actually talk to her and she would create her own stories. I remembered getting so angry with mom all the time and was picking fights with her very often. Mom's irrational behavior was taking a toll on everyone in the family and we simply just did not know how to cope. It only began to cool down when my family started to learn more about the disease. When we were no longer in denial, we began to accept mom for what she is.  By accepting, I also decided to have mom slept in the same room with me so I could keep watch over her. Hence, the first lesson I learnt in dealing with mom was ACCEPTANCE.


As time progressed, mom began to lose her sense of dressing. From someone who was extremely stylish, mom began to have the worst sense of dressing and she hated going for showers.  I then took up the duty to help mom with her showers.  In order to make the showers more enjoyable, I would sing to mom and tell her she would be so clean and pretty after that. I would let mom dress herself and on family outings, I made mom put on her lipstick and combed her hair. Whatever mom could still manage on her own, I let her do it as I wanted her to remember as much as she could.  


Thankfully, there were many things that mom still loved very much for example beautiful clothes, flowers and durian.  Hence, I bought books on flowers or artificial flowers for mom.  My dad would place the flowers at strategic places in the house like in the bathroom or places where mom would hang around.  My dad would also bring along the books whenever he took her to the hospital to keep mom occupied while waiting.  During weekends, we would take mom to the mall and looked at all the beautiful dresses.  During durian season, we would ensure we fed her with lots of durian.


My dad would take care of mom during the day making sure she had her meals and kept her company by watching old movies and listening to songs of yesteryears. When I came back from work, I took over the duty to ensure she had her evening walk, talked to her, massaged her and watched TV with her. Very soon, our lifestyle practically adjusted to mom's.  Everything was planned with mom in mind first.  The second lesson I learnt from taking care of mom was PATIENCE and LOVING UNCONDITIONALLY.  


By the 7th year, mom was beginning to lose a lot of her abilities. Mom could not communicate much.  It was more like a one syllable like why, what, yes, no.  Without the ability to communicate, we have to learn to adjust again. Now, we have to observe on mom very closely. And mom being so restless, we have to  keep a close watch as we were afraid she would fall or trip over. At times, mom would just stuff things in her mouth like tissue papers and artificial flowers.  Thus, we  have to constantly watch out for her all the time as we never know what she would do.


Things took a drastic turn in 2006 when mom had to undergo surgery whereby her appendicitis was removed.  It was a lot of guess work for the doctors and the family as well as we could not tell exactly what was wrong. What touched me at that time was watching mom cried when she was admitted to the hospital.  At that point, I realized mom was conscious of what was going on even though she could not express herself.  Thankfully the surgery went well and within 2 months, mom regained back her strength. We were afraid mom would lose some of her senses but her reflexes and coordination was still very good. She could respond to our actions and I was happy that she could still remember her family.



From here I learnt lesson No 3 that is, CHERISH every day with your loved one because nothing stays constant.  I realized mom was getting worse each day so I tried to treasure whatever moment I have with her.  I made it a point to tell her how much I loved her every day.   I would hug mom every night before I put her to sleep, before I left for work and the moment I returned from work. Very often, my brother and me would make silly faces at mom just to make her laugh.  


Things began to change in early 2007.  Mom got tired easily and slept quite a bit. That worried us as mom was very active before.  By mid 2007, I noticed that mom was getting quite weak and frail.  She was smiling less which was such an uncommon sight.  Her abilities were getting worse like only brushed one side of her teeth and  swallowed her mouth wash.  Mom also lost her appetite.


Feeding mom began to be a very difficult process. Mom was taking at least an hour or more to eat and we have to try all sorts of ways just to get mom to eat.  By then, mom would just eat one spoon or two by herself and we ended up feeding her instead. We changed her diet to very soft food and got her to eat smaller amount but more frequent daily.   


Towards the end of 2007, mom had problems swallowing her food.  We also started to notice mom was breathing harder and her legs sometimes swell.  For years, we have been taking mom for her evening walks but mom was getting weaker so the walks was shorter and much less frequent.  Concerned for mom's well being, my dad would play the role of the doctor and monitor mom's pressure daily to ensure mom was doing fine. 


I was spending more time with my mom and everything was just centered around mom.  I had no social activity for a long time but it was all worth it when you find your mom struggling out of her chair reaching out to you with a smile when you returned home.  Seeing her smile especially when she was doing much less these days was truly the most treasured feeling I ever had.  


The family welcomed 2008 with much sadness as mom was diagnosed with lung cancer.  Even at such critical stage, mom was conscious where she was and once again shed tears whilst she was in the hospital and this time much more . It was truly very stressful for the family and thankfully by god's grace, we managed to celebrate Chinese New Year with mom at home.


Today, I count my blessings even though mom was robbed of most of her abilities.  One thing God never took away from mom was her ability to recognize her family even till the very last moment.  Mom went off peacefully in her sleep on 19 February 2008.

Monday, 16 June 2008


Alzheimer's affects the mind and has no cure, so it makes sense to consider that a person in the beginning stages of the illness might prefer not to know, or could crash into a hopeless depression if they find out.


Family members frequently struggle with the dilemma of whether or not to share a diagnosis of Alzheimer's disease with a loved one, particularly when it is a parent. Doctors are regularly faced with this problem, especially when the patient is the only one to tell, such as elderly people who have outlived their spouses and other family members. 


So how much does one tell the patient? 


It's a harder question than one even imagines. Researchers at the University Hospital in Nottingham, England found in a 1999 study that only 40 percent of the geriatricians and psychiatrists who responded to their survey regularly told their patients they had been diagnosed with Alzheimer's disease.


Questions about the certainty of the diagnosis, doubts about the patient's ability to understand, the level of insight and the possibility of detrimental effects were all factors that influenced the responses.


General practitioners surveyed in a study conducted by the Department of Geriatrics of Broca Hospital in Paris, overwhelmingly (72 percent) chose not to share the diagnosis with the patient for "psychological reasons" despite most (88 percent) believing it was their role to announce the diagnosis to the patient.  The doctors were less reluctant to discuss the diagnosis with family members, but still were inclined to refer to symptoms such as stress, depression and behaviour problems rather than put the name of "Dementia" to the problem.


On the other end of the spectrum, Dr. Simone Gordon, an adjunct professor at Yeshiva University's Wurzweiler School of Social Work and a long-time psychotherapist with a busy practice, was brief and to the point on the issue. "I think ethically the doctor should tell," she said.


In a study conducted by researchers at the Department of Neurology in the Taipei Veterans General Hospital, family members had similar views.


The vast majority of those who were surveyed, 93 percent, said they would want to be told if they themselves were diagnosed with Alzheimer's disease. When it came to being the bearers of bad news, not as many family members were willing to reveal such news to someone else in the family who had received that diagnosis, but still a clear majority (76 percent) thought that to be the best course of action.


In this study, family members struggled with the same important reasons to tell the patient as did the doctors. A patient's or family member's right to know, the possibility and responsibility of helping cope, and obtaining early treatments to slow down the progression of the illness were some of the reasons that convinced respondents it was best to share the diagnosis with the patient.


Those who did not agree were concerned about the risks of worsening the disease, causing the patient emotional distress or even to consider suicide, as well as other factors.


These figures were substantiated by a study carried out by a team led by P.M. Conor, who reported that 83 percent of family members who came along with the Alzheimer's patient to the memory clinic did not want their relative to be informed of the diagnosis.

However, as in the Taiwan study, the majority of relatives – 71 percent -- said they WOULD want to be told themselves in the same situation.


More than 80 percent of geriatric psychiatrists said they usually did not inform their Alzheimer's patients who already reached a stage of severe dementia. However, they nearly always told those who were in the early stages.


The same doctors also reported an inverse relation with regard to informing caregivers about the diagnosis: they tended to share the information with caregivers of severely demented patients more than with caregivers of people only mildly affected.


Dr. Barnett S. Meyers, a Professor of Psychiatry at The New York Hospital Cornell Medical Centre, makes a strong, well-documented and thoroughly-footnoted case that patients can generally bear the devastating news, and there is little justification for doctor or caregiver to interfere with a patient's right to know:


"Arguments that awareness of the diagnosis of Alzheimer's disease does damage by causing stigmatisation and depression are not based on empirical evidence. Thus, the greater than 20% prevalence of depression identified in early cases may result from a variety of causes, including awareness of memory loss symptoms and the pathophysiology of the disorder.  Despite the association between confrontation of cognitive deficits and transient emotional reactions, there is no evidence of long term sequelae. Furthermore, the ability of patients with Alzheimer's disease to deny their illness through psychological defences or neuropsychological deficits mitigates against arguments that awareness of diagnosis leads to lasting psychological damage."


Dr. Barnett Meyers is clearly in favour of informing the patient of the diagnosis. Beyond the patient's right to know, he goes on to emphasize the advantages of early treatment aimed at slowing the progression of the disease, which can best take place when a person is fully informed of their condition. A diagnosis of Alzheimer's does not mean it is over, and a well-prepared person has many good days ahead. To drive home that point, the doctor headlines his editorial with a subtitle that sums up one clear reason for telling patients they have Alzheimer's disease: "Important for planning their future."





Wednesday, 11 June 2008

Bright Light Improves Dementia Symptoms

Study Shows Brighter Daytime Lighting Brings Improvement in Mood, Behaviour

(Source:  By Kelli Miller Stacy, WebMD Health News, 10 June 2008)


Turning up the lights during the daytime may boost mood and improve behaviour in elderly adults with dementia, according to a new study.


Mood swings, sleep problems, and behavioural issues frequently affect those with dementia-related cognitive decline. Such disturbances can increase the person's risk of being admitted to an assisted living facility, according to background information in the journal article.


Environmental light affects the body's 24-hour biological clock, also known as the circadian rhythm. Too little light exposure can throw off the sensitive balance of the circadian timing system. Disturbances in circadian rhythm can lead to sleep woes. A hormone called melatonin also plays an important role in the maintaining the system's circadian rhythm.


Rixt F. Riemersma-van der Lek, MD, of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, and colleagues wanted to see how bright light with or without melatonin supplements would affect symptoms of dementia and sleep disturbances.


Their study is published in the June 11 issue of The Journal of the American Medical Association.

The study included 189 adults about 86 years old on average, mostly female, at 12 elder care facilities in the Netherlands. Most participants had dementia. Researchers randomly assigned the participants to a daily dose of melatonin or placebo (fake pill). The patients took the study medicine every night for an average of 15 months.


The facilities kept their lights on each day from about 9 a.m. to 6 p.m.; half of the facilities increased the intensity of their ceiling-mounted lights.


The researchers learned that bright light resulted in a modest improvement in dementia symptoms. Specifically, the use of bright daytime lighting:


·         Reduced cognitive scores on a mental status exam by a relative 5%.

·         Cut depression symptoms by a relative 19%.

·         Calmed slow increases in functional limitations by slightly more than half (53%).


Adding melatonin helped patients fall asleep about eight minutes faster and sleep longer by 27 minutes. The researchers recommend melatonin supplements only in combination with light. Melatonin combined with brighter lighting cut agitated behaviour by 9%.


"The simple measure of increasing the illumination level in group care facilities [improved] symptoms of disturbed cognition, mood, behaviour, functional abilities, and sleep," the researchers write. "The long-term application of whole-day bright light did not have adverse effects ... and could be considered for use in care facilities for elderly individuals with dementia."



Friday, 6 June 2008





Aging safely in our home is a goal many of us would like to achieve.  A person with Alzheimer's disease or another dementia can live in the comfort of their own home or caregiver's home provided that safety measures are in place.


The tips in this section will help you and the person prepare to live safely each day.

Introduction    c               

When caring for a person with Alzheimer's disease, having a safe and supportive home is important. There are steps you can take to adapt the home to the person's changing needs.

Limit access to dangerous places
The person with dementia may be at risk if he or she can reach certain areas of the home or outdoors.
  • Lock or disguise hazardous areas. Cover doors and locks with a painted mural or cloth. Use swinging or folding doors to hide entrances to the kitchen, stairwell or garage.
  • Install locks out of sight. Place deadbolts either high or low on exterior doors to make it difficult for the person to wander out of the house.
  • Remove locks in bathrooms or bedrooms so the person cannot get locked inside.
  • Use child-proof locks and door knob covers to limit access to places where knives, appliances and poisonous cleaning fluids are stored.
  • Use appliances that have an auto shut-off feature. Some brands of irons, toaster ovens and coffee makers have this feature.
ADapt to vision limitations


The person may not be able to distinguish colours and understand what is being seen because of changes in his or her vision.


  • Diffuse glare and bright light by removing mirrors and glass tops. Block bright sunlight by covering windows with blinds, shades or sheer draperies.
  • Create an even level of lighting by adding extra lighting in entries, outside landings, areas between rooms, stairways and bathrooms. Changes in levels of light can be disorienting to a person with dementia.
  • Use contrasting coloured rugs in front of doors or steps to help the individual anticipate staircases and room entrances. Avoid using a dark-coloured rug because it may appear to be a "hole."
  • Use night lights in hallways, bedrooms and bathrooms to prevent accidents and reduce disorientation


Beware of dangerous objects and substances


Even the most basic appliance or household object can become dangerous for the person with dementia.


·         Remove electrical appliances from the bathroom, such as electric razors or hair dryers, to reduce the risk of electrical shock.

·         Put away dangerous appliances and utensils like mixers and knives.

·         Remove the knobs from stove burners. Install a hidden gas valve or circuit breaker so the person cannot turn on the stove.

·         Put away grills, lawn mowers, power tools and guns. The person may not recall how to safely use these items.

·         Supervise smoking and the use of alcohol.

·         Clean out the refrigerator regularly, throwing out any old food. The person with dementia may be unable to tell the difference between fresh and rotten food.

·         Keep walking areas clear by removing magazine racks, coffee tables and floor lamps.


Creating a supportive home


Make sure your home supports the person's changing needs, which is just as important as safety.


  • Enroll the person in MedicAlert® + Alzheimer's Association Safe Return®, our 24-hour nationwide emergency response service for individuals with Alzheimer's or related dementia that wander or who have a medical emergency.  
  • Encourage independent movement by moving furniture or other obstructions to create more space for wheelchairs or walkers.
  • Help the person reminisce. In key locations, place scrapbooks, photo albums or old magazines and encourage conversation about them.
  • Play music to prompt dancing, clapping or other kinds of exercise. Keep noise level low – loud, distracting sounds could overwhelm the person.
  • Enjoy supervised outdoor activities like gardening or walking.
  • Keep a list of emergency phone numbers and addresses for Safe Return, local police and fire departments, hospitals and poison control help lines.
  • Check fire extinguishers and smoke alarms.