Thursday, 16 October 2008

Brain Cells Start To Grow

Brain cells start to grow


A new study suggests that seniors who line dance, play bridge or a musical instrument may be doing more than just having fun: They may be warding off the risk of developing dementia, including Alzheimer's, a progressive brain disease which afflicts four million Americans.


People who played the hardest gained the most. For example, seniors who did crossword puzzles four days a week had a 47% lower risk of dementia than those who did puzzles once a week.


Line dancing also offered a hedge against dementia because it forces the brain to work and the body parts to coordinate. Any mentally challenging activity like learning a new dance step might spur the brain to establish new connections or perhaps to grow new brain cells. The extra brain power may compensate for any loss of brain cells that could result from Alzheimer's.


According to the Keiser Institute on Aging, by the year 2010, those in the 55-74 age group will outnumber 25-34-year-olds by 18 million. Statistics show 800,000 individuals are turning 65 every month with China, the US and UK leading the pack.


More ageing-related health problems are expected to surface around the world. So, do something to keep your brain active and protect yourself against future memory loss.


(Source:  New England Journal of Medicine)

Caregiver's Story - "Lost World" - The Effects of Alzheimer's Disease in the Later Stages are Devastating as the Afflicted Person Slips into Oblivion

Hi, Dear Members,


I just came across this Article "LOST WORLD", written by our Member & Caregiver, Catherine Siow, published in the Star Newspaper on 17 September in conjunction with the World Alzheimer's Day.  Would like to share with you all as some of you may have missed this article earlier with another write-up of her entitled "FADING MEMORIES".


We look forward to your feedbacks and sharing of your personal care-giving experiences.


Warm regards,




Lost world

(By Catherine Siow, NACON Member & Caregiver)


The effects of Alzheimer's disease in the later stages are devastating as the afflicted person slips into oblivion.


INEVITABLE is the progressive deterioration in the health of an Alzheimer's disease (AD) patient as the years pass by. The emotional and physical toll on both the afflicted person and their family caregivers are tremendous, especially when the patients do not recognise their nearest and dearest anymore – a condition referred to as agnosia. Distressing though it may be, the caregivers can still help to maintain the dignity and quality of life of their loved ones by managing the symptoms.


Dr Yau Weng Keong, Consultant Physician and Geriatrician at Hospital Kuala Lumpur, visiting Consultant Physician and Geriatrician at Hospital Tuanku Jaafar, Seremban, and member of Alzheimer's Disease Foundation Malaysia (ADFM) Advisory Panel of Medical Specialists, gives the low-down on agnosia and related symptoms of sundowning and wandering in AD patients.


What is agnosia?


Agnosia is the inability to recognise close ones or objects. The affected person is unable to make meaning out of one or more of their senses despite intact sensory abilities. For example, the person may have good vision but is unable to identify a lamp.


Agnosia can lead to the inability to recognise family members and even one's own reflection in the mirror. There are multiple other causes besides AD.


What about Sundowning? Why does it occur?


Sundowning is a phenomenon unique to AD whereby the person becomes more confused, agitated, restless and insecure in the late afternoon and early evening. The patient may become more demanding, suspicious or disoriented.


No one is sure what causes sundowning, but most likely it is from progressive deterioration of the brain. As the AD progresses and the person understands less about what is happening around them, they become more frantic in trying to restore their sense of familiarity or security.


Sundowning may relate to lack of sensory stimulation after dark. At night, there are fewer cues in the environment, with the dim lights and absence of noises from routine daytime activity. It can be worse after a move or change in the person's routines. Also, AD patients tire more easily, even with very few demands on their thinking ability. This makes them more restless and difficult to manage when they are tired.


How can one deal with such a problem?


Strategies for handling sundowning include the following:


·            Keep the person active in the morning and encourage him/her to have a rest after lunch. If    tiredness worsens sundowning, an early afternoon rest may help.

·             Don't physically restrain the person. Let them pace where they are safe. A walk outdoors can help reduce restlessness.

·            Some people are comforted by soft toy animals, pets, hearing familiar tunes or an opportunity to carry out a favourite pastime.

·            Try not to arrange baths or showers for the late afternoon if these are upsetting.

·             Nightlights or a radio playing softly may help the person sleep.

·             Some people find warm milk, a back rub or music calming.

·             Some may need medication. Discuss with the doctor.

·             Avoid arguing or asking for explanations.

·             As caregiver, remember to have adequate rest yourself.


Why do they wander?


AD patients wander for multiple reasons. Some of them may be searching for something, such as the bathroom, or trying to get away from a noisy or confusing environment. A few may even be trying to fulfil tasks from their former occupations or reliving the past.

If they've recently moved to a new environment, wanderers may be searching for something or someone familiar. They may also be trying to satisfy a basic need, such as hunger or thirst, but can't remember what to do or where the kitchen is located.

AD sufferers often lose the ability to vocalise pain. Instead, they may become restless or try to escape their pain by wandering.

If wandering occurs at the same time every day, it may be linked to a lifelong routine. For instance, a woman who tries to leave the nursing home every day at 5pm may believe she's going home from work. This belief could be reinforced if she sees the nursing home staff leaving at that time. Having an activity at that hour could distract her urge to wander. Another option might be to have staff exit through a different door.


How best can the family caregiver deal with such episodes of non-recognition, sundowning and wandering?


The most important element is the person caring for the patient. There is a need for the caregiver to have inner strength and a cheerful spirit to give their loved one tender loving care. Caregivers must try and get more information (through reading and talking to others), and ventilate their problems and feelings. Otherwise, their emotions may have a negative impact on their loved ones. This is especially so with agnosia.

Seeking help from doctors, nurses and others is also important.




Fading memories

(By Catherine Siow, NACON Member & Caregiver)

In conjunction with World Alzheimer's Day on Sunday, a caregiver shares her roller-coaster ride as her mother enters a more severe stage of the illness often referred to as The Long Goodbye.

DEALING with losses is an everyday affair in my life as sole caregiver to my mother who was diagnosed with Alzheimer's disease in 1998 at age 66. In the early days when mum lost her cooking skills, I removed her wok and gas stove from the kitchen. When she started misplacing money and other possessions, I took over her finances and removed clutter from our home environment.

My fellow caregivers from the support group and I used to brainstorm on how best to care for our loved ones, making things as safe and secure as possible for them. But none of what we had discussed since our group started in 1998 was of any help to me on the day when mum lost recognition of me.



 It was the usual weekend at home and mum and I had just finished dinner. She had bathed earlier and was in her pyjamas. I was at the dining table preparing the weekly marketing list. Mum came up, looked at me and asked (in Hakka): "Why has Li Moi (my Chinese name) not come to take me home yet?" After my second or two of shock, I stared at her and demanded: "Then who am I, who am I?" Mum looked at me for a while, then walked away – she had no answer. I ran upstairs, hot tears streaming down my cheeks, and cried for a couple of minutes. Then I went downstairs, put on her favourite Karaoke VCD and distracted her back into sorting her box of coloured beans (her occupational therapy).

The following weekend, the non-recognition episode repeated. After this second incident, I started mum on day-care seven days a week.

It has been one-and-a-half years since that fateful day which signalled the start of a more severe stage in mum's illness and the start of another roller-coaster ride for me in dealing with the emotional stress of care-giving for her.

For several months, I was overwhelmed with guilt for my confrontational reaction. I slipped into depression as I could not accept that mum could forget me. There's just the two of us at home and I have been her sole caregiver for the past 10 years, giving her the best care even as I struggled with the role reversal in our mother-daughter relationship.

In three months, I lost 10kg. My support group friends did their best to help me but to no avail. Ironically, I snapped out of depression when I was assailed with various health problems. I had to make myself well so that I could take care of mum.

And so, mum and I adjusted again to another new routine. I am extra vigilant of the way I talk and behave with her. Every day, I make peace with the fact that mum is gradually withdrawing into a world of her own, one which is increasingly out of my reach.

But since mum went for day-care seven days a week, she has not failed to recognise me. Every evening, when I pick her up (it is a nursing home 10 minutes' drive from our house), she would happily announce: "My daughter is here. Thank you. Bye-bye." In the car, she would go into her usual tirade: "Why so late from work? I am very hungry. The people here don't give me food," even if she had just eaten.

Mum still has quite a bit of her social skills intact. She is ever the cheerful and gracious "hostess" and my pride and joy. Some of the elderly at the home are wheelchair-bound and mum would sit beside them and "entertain" them. Seeing mum chatting away happily is rather gratifying for me and helps mitigate my guilt for putting her there. They close the gate at 8pm, which allows me time to get through the evening traffic on work days. On weekends, I pick mum up at six. I usually send her at 10am after we've had breakfast together and she has had her bath. Mum can still bathe herself but I run a strict "quality control" check.

Though I wrestle with constant adjustments in care-giving for mum as the illness strips away more and more of her memory, it is not always downtime as we do have fun escapades together, especially when we holiday abroad.

We toured Sydney-Melbourne in 1998, London-Paris in 2000, the French Alps-Lake Geneva in 2004 and Perth, Australia, in 2006. I always opt for the two-seater row near the washroom and let mum have the window seat. On take-off, I'd hold her hand and tell her to "swallow saliva". When the plane is still in mid-flight, mum would ask: "Why is the bus not moving?" and I'd answer: "It's picking up passengers." When there's turbulence, mum would remark: "Why doesn't the bus driver know how to drive?" and I'd say: "Oh, the road has many potholes." The best part of the flight is when the plane is about to land on a clear day. Mum would be in awe of the sight below: "Wah, so many cars and houses, all so tiny!"

The Perth trip was the first time I used the wheelchair service for mum. At Perth airport, I had to queue up at the immigration checkpoint while mum was wheeled away by an airport attendant. When I rejoined mum, she waved to the pretty blonde attendant and said: "Terima kasih banyak banyak."

Last December, when my elder brother (my only sibling) and his three teenage children took mum for a weekend stay at Awana, Genting Highlands, mum had a similar non-recognition episode after dinner. She went up to him and asked: "Who are you?" After his initial shock, my brother answered gently: "I am Fah Chai" (his childhood name). Mum looked at him and retorted: "Fah Chai where got so fat?" (My brother has doubled in size since his schooldays.)

That night and the following night, my brother and his kids played mahjong with mum till bedtime. Mum can still play mahjong well and that's what we did this Chinese New Year when I spent two whole days with her at home.

I am blessed that mum still listens to me when I tell her to do things. Every night, after she has had her snack and bath, I'd prepare her for bed at 9.30. Then it's lights off except for the little lamp in her room. I'd go upstairs and listen to her for about five minutes. Then I'd have my quiet time till 11 before calling it a day. I'd be up by 5.30am and would be all freshened up before I go downstairs to see to mum who gets up around seven.

Lately, mum has started wandering at night so I removed even more "clutter" from the area downstairs, where she is queen of the territory. Mum has never climbed upstairs, where I reign over my sanctuary.

I am grateful that mum is still independent enough to allow me this private space but I constantly make sure that she feels safe and loved in her current space so that she does not retreat too quickly into her distant world where I would be forgotten.



Saturday, 4 October 2008

How To Avoid Losing Muscle As You Age


We've all heard plenty about osteoporosis (dangerously low bone mass), and its less severe sibling, osteopenia. Not as familiar is sarcopenia, the age-related decline in muscle mass and function.  Its exact causes are still unknown, though it clearly contributes to frailty and a loss of independence in people's later years. There are things you can do to prevent its ill effects, and also to improve your condition if you're already feeling its consequences.


As a rule, muscle mass declines with age, starting in the 40s and picking up speed after about age 50. Then the typical rate of muscle loss really begins to outpace the rate of muscle gain, so that there's an increasing net deficit, says Robert Wolfe, a Professor of Geriatrics and Director of the Centre for Translational Research in Aging and Longevity at the University of Arkansas for Medical Sciences. How dangerous that is depends how much muscle you start out with. The kind of decline that makes a lifelong runner go from a very fast 10k time to a slightly slower one in his 60s is not a big concern (except for the frustrated runner). The kind of decline in muscle mass that weakens an already frail elderly person so much that he or she is more prone to falls and can't lift a small bag of groceries onto the counter is something to worry about.


While the precise causes of sarcopenia aren't fully understood, lack of exercise, poor nutrition, hormonal changes, and body-wide inflammation are all potential culprits. Some of those causes can be addressed, but there may simply be some inherent consequences of aging that can't be fully remedied - that is, our frustrated aging runner is going to see his 10k time get slower, to some degree, no matter what he does. But when it comes to the activities of daily living, "you can absolutely do something about that for your entire life," Wolfe says.


The tool that everyone agrees works to shore up muscles: exercise, at every age. Ideally, that would include both a basic, progressive strength-training program as well as an aerobic fitness routine (like a brisk 30-minute walk every day). "Healthy muscle is not only about being stronger and bigger," says Miriam Nelson, Director of the John Hancock Centre for Physical Activity and Nutrition at Tufts University. Strength training that builds muscle helps keep older folks stable and surefooted, and strong enough to do basic things like get out of a chair. Indeed, some data suggests that men who lift weights a few times a week in their 50s and 60s can maintain their muscle mass, not simply slow the rate of decline, in those years, she says. But to be healthy, muscle tissue needs to effectively store glycogen and have capillaries that infuse it with blood, both of which are aided by the aerobic component.


Researchers are also investigating the role of nutrition. Insufficient protein, especially if it's accompanied by insufficient calories in general, can contribute to sarcopenia, says Douglas Paddon-Jones, Director of Exercise Studies for the General Clinical Research Centre at the University of Texas Medical Branch in Galveston. There's a debate among protein proponents over how much to eat, expressed in grams per kilogram of body weight, but the simpler rule of thumb is to eat small amounts of protein distributed throughout the day, he says. Aim for 4 ounces of quality protein, like fish, chicken, beef, or dairy products, three times a day, to maximize muscle growth. (Vegetarians can eat soy, a complete protein, or combine proteins like rice and beans to get the essential amino acids found in animal protein.) Four ounces isn't much--about the size of a deck of cards--so there's no need to go overboard. (Paddon-Jones has been an investigator in studies funded by the Cattlemen's Beef Association.)


Not every person needs to worry about sarcopenia, says Nelson. Many obese folks have muscle in addition to excess body fat, which may protect them but because obesity carries its own health risks, it's better to be leaner and build up muscle through exercise. See where this is going? A balanced exercise program, at whatever age or fitness level, is a good place to start to help protect against sarcopenia, as well as osteoporosis, and to promote other health benefits.


My colleague Deborah Kotz wrote last fall about why senior citizens should exercise. And I wrote recently about how a 65-year-old personal trainer works with people his own age.

(Source:  By Katherine Hobson, September 19, 2008 � US News)

Thursday, 2 October 2008

Inconsistent Memory Tests May Predict Alzheimer's

Monday, September 22, 2008

Older people who perform inconsistently on memory tests may be at increased risk for Alzheimer's disease, a preliminary new study suggest.


Most memory testings rank individuals on a scale that compares them against healthy individuals. This approach, however, does not take into account variations in testing that occur with a single individual. Some people may show a lot of individual variation in memory and thinking tests over many months.


The current study, published in The Journal of the American Medical Association, aimed to look at whether individual variation in memory tests in a single individual predicted the later onset of Alzheimer's.


Researchers at the Albert Einstein College of Medicine in New York evaluated 897 individuals, age 70 or older. All were part of The Einstein Aging Study, an ongoing study of aging and dementia of people living in a New York Bronx neighbourhood.


Every 12 to 18 months, the study participants underwent detailed neurological and neuropsychological evaluations. The researchers included tests for verbal IQ, attention, memory, and executive function, a measure of how well people can think and sort information. The tests were designed to measure the function of various parts of the brain involved in recall, memory and thinking.


Of the 897 participants, 61 people, or 6.8 percent, developed dementia during an average follow-up period of 3.3 years. Of those, 47 participants had Alzheimer's, and 18 had dementia related to blood-vessel problems in the brain. During the study, 128 individuals died, which would be expected for people this age. Of those, 18 had developed dementia.


The researchers found that people who performed inconsistently on the memory tests were at increased risk of developing Alzheimer's and other forms of dementia. They note that further testing in greater numbers of people of varying ages and physical conditions is required to confirm these findings. However, the findings do open up the possibility that charting an individual's performance on a variety of memory and thinking tests over time may offer new windows into diagnosing dementia earlier.


Current memory and thinking tests may detect problems up to seven years prior to the onset of Alzheimer's. Some people are found to have mild cognitive impairment, a form of memory loss that often precedes Alzheimer's. Alzheimer's may be a disease that takes many years, and even decades, to unfold, researchers speculate.


Developing better ways to test for Alzheimer's disease more accurately and at an even earlier stage is important. Experimental treatments for Alzheimer's now under development may be most effective in the very earliest stages of the disease process.


(Source:  <a href=''>Inconsistent Memory Tests May Predict Alzheimer's</a>)

Combining Alzheimer’s Drugs May Offer Sustained Benefits


Physicians often prescribe an Alzheimer's drug for patients newly diagnosed with the disease. A new study shows that combining two kinds of Alzheimer's drugs may provide the greatest benefits in helping to delay the progression of symptoms.


Alzheimer's drugs like Aricept, Exelon and Razadyne were approved by the Food and Drug Administration in the 1990s to treat early to mid-stage Alzheimer's disease. These medications are known as cholinesterase inhibitors, because they slow the breakdown of a brain chemical called acetylcholine that aids memory.


More recently, in 2003, the drug memantine, sold under the brand name Namenda, was approved for the more advanced stages of Alzheimer's. It is sometimes prescribed in combination with one of the older drugs. Namenda works in a different way than those drugs, shielding brain cells from the effects of overexposure to a chemical called glutamate. Excess levels of glutamate are thought contribute to the death of brain cells in people with Alzheimer's.


"There has been the impression that these drugs only work for some patients and for a limited amount of time," said Dr. Alireza Atri of the Massachusetts General Hospital Department of Neurology, lead author of the current study. "One of the problems in judging these drugs has been that patients naturally continue to decline, which can make them think the drugs have stopped working. But our study, which has some unique strengths, indicates that treatment does have long-term benefit."


In the study, researchers at the Massachusetts General Hospital Memory Disorders Unit in Boston analyzed the records of 382 patients who were treated at the clinic from 1990 to 2005. One group of 144 patients did not receive any medication. A second group got a cholinesterase inhibitor, while a third group took that drug plus Namenda. Patients were then given tests of memory and thinking and the ability to carry out everyday tasks every six months.


"Clinical trials that drug companies conduct for FDA approval may only last six months and enrolled patients according to very specific criteria," Dr. Atri explained. "Only large-population studies can really tell us how these drugs work for the full range of patients in real-life situations." The current study lasted for two and a half years.


The results showed significant differences in the rate of symptom progression among all three groups � with the smallest level of decline in those receiving combination therapy.


The researchers also found that the longer patients took these drugs, the greater the differences observed between those not taking drugs and those taking the drugs ― especially in those taking the combination of cholinesterase inhibitor and Namenda. 


"Finding something that could actually modify the course of the disease is the Holy Grail of Alzheimer's treatment, but we really don't know if that is happening or what the mechanism behind these effects might be," Dr. Atri explained. "What we can say now is that providers should help patients understand that the benefits of these drugs are long term and may not be apparent in the first months of treatment. Even if a patient's symptoms get worse, that doesn't mean the drug isn't working, since the decline probably would have been much greater without therapy."


Dr. John Growdon, Professor of Neurology at Harvard Medical School and Senior Author of the paper, added that the study results, if confirmed, could change the way that doctors prescribe Alzheimer's drugs. "Cholinesterase inhibitors are approved for use in mild to moderate dementia, while memantine has been approved for advanced dementia," he said  "But it looks like there is an advantage in prescribing both drugs as initial treatment."


The study, which appeared in the Journal Alzheimer Disease & Associated Disorders, was supported by grants from the National Institute on Aging and the Massachusetts Alzheimer's Disease Research Centre.





Yoga classes stretch mind, as well as body, of Alzheimer's patients


"We are going to play a fun little game, and it requires concentration," Patrice Flesch told her yoga students. Holding up her hands, she quickly extended and retracted her fingers. Her students repeated the motion.


When Flesch pressed her palms together and sat cross-legged, she asked, "Does anyone remember this pose?"


One student blurted out the answer: "The goddess pose!"


Words like "concentration," "focus," and "recall" figure highly into Flesch's class: yoga for the memory-challenged. Twice a month, Flesch tailors breathing and exercises for people with Alzheimer's, dementia, and other conditions involving memory loss.


Her thinking: By stretching the body, you relax the mind, which in turn makes it easier to concentrate and remember tasks at hand. The class also serves as a social gathering, providing a place to meet other patients, even if they may not remember one another.


Although variations of yoga have been used to relax the sick and frail, Flesch's holistic approach is unique. She treats her students in a way that lends them grace, dignity, and a sense of control over a disease that can often make them feel powerless.


"It's very grounding. It makes you pay attention, which relates to memory," said Flesch, a commercial photographer and yoga instructor for 35 years. "The yoga trains your mind to focus. Removing stress helps you be able to concentrate more."


Yoga has played a role in relaxation and gentle exercise for some people with Alzheimer's, according to the Alzheimer's Association Massachusetts/New Hampshire Chapter. In some cases, a Caregiver participates with the person. In others, people with early stage Alzheimer's continue their own practice of yoga.


In Pensacola, Fla., a class called "Super Brain Yoga" combines movement with breath to energize brain activity for adults with memory loss. In Australia, an Alzheimer's and Memory Community Centre began a free yoga class for caregivers and people with memory issues.


A study released last year during the Alzheimer's Association's International Conference on the Prevention of Dementia in Washington, D.C., found that regular meditation can bolster cognitive function for people with memory loss.


Whether they meditate alone or in a yoga class, patients will reap benefits, said Dr. Paula Raia, Director of Patient Care and Family Support at the Alzheimer's Association's Local Chapter.  As Alzheimer's and Dementia ravage the brain, sufferers can become agitated and prone to anxiety. Gradually they experience a loss of memory, intellect, and social skills. Their grip on reality progressively slips away.


"The yoga could help the person remain mobile for periods of time," Raia said. "That relaxation reaction, as a result of the mindfulness that the yoga promotes, will cause the person to sleep better, be less agitated and more calm. It's also a social opportunity. They are getting opportunities to meet other people with Alzheimer's so they feel they are not alone. So it's killing several birds with one stone."


'You have the power'


Flesch began teaching these specialized classes 11 years ago.  She believed that yoga might keep them active, both physically and mentally.


"I thought, 'Wouldn't it be interesting to try and work with Alzheimer's,' " she recalled. "I went online to research it, and there was absolutely nothing. That made me wanted to do it even more."


Flesch alters poses and movements from her traditional yoga to make them more cognitive. She emphasizes hand movements, repetition, and chanting. At a recent class, eight people - two in wheelchairs - sat in a circle as soothing music played. Flesch led the class in a series of poses.


Like a patient schoolteacher, she cheerily nudged the students to stretch their fingers wide and make a fist. "This pumps blood into the wrists and gets your circulation going," she explained. "We are all following a sequence."


The class performed a gamut of exercises. They rotated their wrists and looped their arms like backstrokes. They also stretched their legs while rotating their ankles. All smiles, the students eagerly followed along.


Near the end of the class, the group executed the yoga warrior pose. They lunged forward, hands pointed skyward.


"Get in touch with all that strength and power inside you!" Flesch roared. "You have the power! You have the courage! You are in control!"


Her students repeated her mantras. Sister Brigid Courtney, 64, was one of them.


"It's very good to relax and be totally focused on what you are doing," said Courtney.


Like some of her yoga classmates, her memory loss began with everyday things. She misplaced keys in her bedroom. She tried to brew coffee in the laundry room instead of the kitchen. She forgot why she visited certain rooms in her convent.


"It's kind of nerve-wracking and frustrating. It takes so long to put yourself together," said Courtney, her house keys attached to a wristband key chain so she won't lose them.


"I may put something down and not remember where I put it. Sometimes I can't get the right word out of my mouth. I will mix up letters."


Yoga has given her some solace. "It keeps you in touch with your body," she said during stretches. "It's a refreshing thing."

(Source: � 30 September 2008)