UTIs (URINARY TRACT INFECTION) Cause Behavioral, Not Physical Symptoms in Elders

Denise Altman's 81-year-old mother suffers from chronic depression which often makes her sad and agitated. When her mom acted confused on the phone or had a glassy-eyed look in person, Altman and her sister, who shared in their mother's care taking duties, figured the symptoms were just a result of their mom's depression. The confusion would last a few days and was often followed by a fever, and then their mother complained of painful urination a few days later. Finally, a doctor diagnosed Altman's mother with a urinary tract infection, or UTI (Urinary Tract Infection).  But the infection would reoccur, causing the sisters concern.

Altman's sister began charting their mother's symptoms. Each time she suffered the confusion and fever, a UTI diagnosis came just days later.

"It took us a while, several months actually, to determine that when our Mom got into these states, it wasn't just the depression," recalls Altman. "It never occurred to my sister and me that the symptoms could be a UTI."

That's because older adults often present different symptoms of a urinary tract infection, explains Amanda Smith, M.D., Medical Director at the Byrd Alzheimer's Institute at the University of South Florida. In fact, UTI symptoms in older people are often behavioral.  

A UTI is an infection of the urinary tract, most commonly the bladder. For most people, the need to urinate frequently and/or urgently are two key symptoms of a UTI. So is a burning sensation when you go, and urine that is an off color or has an odor.  Sometimes, a small amount of blood in the urine is visible.  But in older adults, those symptoms are often missing. Instead, older adults may suffer from unexplained incontinence, vague fatigue or significant changes their behavior and mental status.

"Older people can get markedly confused, agitated, or sleepy," says Dr. Smith. "Sometimes they can see things that aren't there, like bugs crawling on the ceiling. They can have false beliefs and become paranoid."

According to Dr. Smith, a UTI is the most common cause of a sudden increase in confusion in an older person with dementia.  The medical community isn't sure why older people have these heightened behavioral symptoms, although with dementia patients, the inability to communicate may be part of the reason.

So why do people get UTIs in the first place?  In younger people, urinary tract infections are sometimes related to frequent sexual activity.  But in older folks, hygiene changes may come into play, either because of confusion or physical limitations – such as arthritis or suffering a stroke – which can make it difficult for a person to keep themselves clean.

Caregivers play an important role in recognizing a UTI.  Dr. Smith suggests that caregivers be on the lookout for these six symptoms:

• The need to go to the bathroom frequently or urgently
• Complaints of discomfort while urinating
• Frequently touching themselves
• Cloudy, dark, or foul-smelling urine
• A new onset of incontinence
• Any sudden change in the mental status such as, lethargy,   hallucinations, restlessness or yelling, when it was not present before                            

Dr. Smith also warns caregivers to seek medical attention as soon as possible if their loved one becomes difficult to wake up, since this can be a sign of delirium, which is considered a medical emergency.

Urinary tract infections sometimes resolve on their own, but they are easily treated with antibiotics. When left untreated, UTIs can lead to chronic incontinence. But UTIs can spread to the kidneys and cause damage. When that happens, patients often experience a fever and severe pain.  More importantly, the infection could spread to the bloodstream and cause sepsis or even death in some cases.

Once Altman recognized the behavioral symptoms that often accompany her mother's UTI's she and her sister could be more vigilant about having their mother tested and prescribed medication.  "It's nice to have that early warning," she notes.  "It's well worth sending in a specimen when the symptoms become apparent, as early treatment saves our mom days of feeling bad and being more confused than usual.  "Once Altman recognized the behavioral symptoms that often accompany her mother's UTI's she and her sister could be more vigilant about having their mother tested and prescribed medication.  "It's nice to have that early warning," she notes.  "It's well worth sending in a specimen when the symptoms become apparent, as early treatment saves our mom days of feeling bad and being more confused than usual."

Article recommended to read, click at: Urinary Tract Infections (UTIs) In The Elderly

(Source:  AgingCare.com)

  

Alzheimer's Diagnosis: More Tests Improve Chance Of Early Detection

Two or three tests are better than one, when it comes to predicting the onset of Alzheimer's disease, a new study suggests. 

The research, published in the Journal Radiology, shows that using more than one diagnostic test could better predict which people with mild cognitive impairment will go on to develop Alzheimer's disease. 

"Misdiagnosis in very early stages of Alzheimer's is a significant problem, as there are more than 100 conditions that can mimic the disease. In people with mild memory complaints, our accuracy is barely better than chance," study researcher P. Murali Doraiswamy, MBBS, professor of psychiatry and medicine at Duke Medicine, said in a statement. "Given that the definitive gold standard for diagnosing Alzheimer's is autopsy, we need a better way to look into the brain." 

The study, conducted by Duke Medicine researchers, included 97 people with mild cognitive impairment who were part of the Alzheimer's Disease Neuroimaging Initiative. Researchers had the study participants undergo the typical diagnostic procedures for Alzhiemer's - which includes cognitive testing -- as well as three other diagnostic tests. They included magnetic resonance imagine (MRI), cerebrospinal fluid analysis and fluorine 18 fluorodeoxyglucose positron emission tomography (also known as FDG-PET). 

The study participants were followed for up to four years. Researchers found that the rate of misdiagnosis was highest when the study participants only received the typical cognitive testing - 41.3 percent. However, that percentage went down with each additional test the person was given, with the lowest percentage of misdiagnosis occurring when all three tests were administered - 28.4 percent. 

And of all the tests, the FDG-PET seemed to add the most diagnostic value, the researchers noted. 

According to the Alzheimer's Association, the earlier memory loss conditions are discovered, the better. That's because doctors are then able to know which medications to prescribe - and not to prescribe - early on, and patients can be aware of potential safety issues that may crop up.

(Source:  Huffpost Healthy Living, 21 January 2013)

BERRIES ARE GOOD FOR THE BRAIN

Older women who regularly ate blueberries and strawberries had slower rates of cognitive decline than those who ate berries infrequently, a new study found. The findings, part of the large and on- going Nurses’ Health Study, were published in the Annals of Neurology.

The study analysed results from some 16,000 women who had completed extensive questionnaires about the foods they ate, beginning in middle age and then every four years thereafter. They also underwent tests of memory and thinking skills every two years, starting at age 70.

Over the next four years, the researchers found, those women who ate the most strawberries and blueberries had the lowest rates of memory decline. The greatest benefit occurred in women who ate at least one serving of blueberries or at least two servings of strawberries per week. Including berries in your regular diet, the researchers estimated, was associated with a delay in cognitive aging of up to two-and-a-half years.

"Among women who consumed two or more servings of strawberries and blueberries each week, we saw a modest reduction in memory decline,” said study author Dr Elizabeth Devore, a researcher at Harvard Medical School. “This effect appears to be attainable with relatively simple dietary modifications."

Berries are rich in health-promoting flavonoids, the pigments that give them their colour. Flavonoids are also found in other fruits and vegetables, as well as herbs, grains, legumes and nuts at well. In the study, total flavonoid intake was also associated with less declining in brain function.

The authors noted that there is "substantial biologic evidence" to support a diet rich in berries and other foods rich in flavonoids in protecting the brain. Several flavonoids have been to reduce levels of inflammation, which scientists increasingly link to Alzheimer’s and other forms of dementia. Flavonoids are also potent antioxidants, which prevent cell damage from the reactive forms of oxygen known as free radicals, and have been shown to have other protective effects on brain cells as well.

Dietary studies can be unreliable, experts caution that, since people may not fill our food surveys accurately, and it can be difficult to tease out the cause-and-effect relationship between what we eat and the many factors that contribute to sound health. But "what makes our study unique is the amount of data we analysed over such a long period of time,” said Dr. Devore. “No other berry study has been conducted on such a large scale."

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Source: Elizabeth E. Devore ScD, Jae Hee Kang ScD, Monique M. B. Breteler MD, PhD, Francine Grodstein ScD: “Dietary intakes of berries and flavonoids in relation to cognitive decline.” Annals of Neurology Online, 25 April 2012.

If Dementia Causes Sleep Problems

Sleep problems are common in people with dementia, but there are things caregivers can do to help their charges get a peaceful night's rest.

The American Academy of Family Physicians mentions these tips to help people with dementia sleep better:

•  Create a consistent bedtime routine and morning wake time.
•  Create obvious ways to tell the time of day, such as placing clocks in visible areas and     opening blinds.
•  Limit the amount of caffeine, sugar and junk food in the person's diet.
•  Encourage daily exercise early in the day.
•  Cut down on napping.
•  Create a peaceful bedroom environment.
•  Make sure to control any pain.

(Source:  MedicineNet.com, January 2013)

Dementia, Late-Life Depression May Be Linked

Older people with depression may be more likely to experience mild mental impairment or dementia than their peers, Dutch researchers report.

In a study of nearly 2,200 Medicare recipients aged 65 and older, researchers led by Dr. Edo Richard of the University of Amsterdam examined the association between late-life depression and dementia and thinking/memory difficulties known as mild cognitive impairment (MCI).

The study, published online Dec. 31 in the Journal Archives of Neurology, found that people with depression were 40 percent more likely to have mild mental impairment and more than twice as likely to have full-blown dementia. Although depression also was linked to greater risk for incident dementia, it was not associated with incident problems with thinking and memory.

The study authors said those with both mild cognitive impairment and depression were at increased risk for developing dementia, particularly vascular dementia. They noted, however, that these patients were not at greater risk for Alzheimer's disease, the most common form of dementia.

"Our finding ... suggests that depression develops with the transition from normal cognition to dementia," the authors wrote in a journal news release.

Depression affects between 3 percent and 63 percent of people with mild cognitive impairment. Previous studies have found that those with a history of depression are at greater risk for dementia. The researchers added that there is no clear explanation for the link between late-life depression and cognitive impairment, and their study does not establish a direct cause-and-effect relationship.

(Source:  MedicineNet.com, 4 January 2013)

Loneliness Increases Dementia Risk Among the Elderly

People who feel lonely are significantly more likely to develop clinical dementia over a period of 3 years compared with those who do not feel lonely, a Dutch study of the elderly suggests.

Tjalling Jan Holwerda, ARKIN Mental Health Care and the Vrije Universiteit Medical Centre, Amsterdam, the Netherlands, and multicenter Dutch colleagues found that after adjustment for other risk factors for dementia, older individuals who expressed feelings of loneliness had a significantly greater risk of developing clinical dementia over a 3-year follow-up period than individuals who did not harbor such feelings.

In contrast, social isolation, not or no longer being married, and not having social support were not associated with a higher risk for dementia in multivariate analysis.

"Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life," investigators observe. "And [loneliness] can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention."

The study was published online December 10 in the Journal of Neurology, Neurosurgery and Psychiatry.

AMSTEL Study

For the study, investigators tested the association between social isolation, defined as living alone, being unmarried or without social support; feelings of loneliness; and incident dementia in 2173 community-living older individuals who were without dementia and who were involved in the Amsterdam Study of the Elderly (AMSTEL).

At baseline and again at follow-up 3 years later, all participants underwent a home assessment that included questions on sociodemographic items.

Participants were also assessed using the Geriatric Mental State Examination along with a structured psychiatric interview and diagnostic algorithm in the form of the Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT).

A diagnosis of clinical dementia was defined as having GMS AGECAT scores of level 3 or higher.

"Of the participants living alone at baseline, 9.3% had developed dementia at 3 years follow-up compared with 5.6% of participants living with others (P = .001)," the authors note.

Among those who were not or who were no longer married, 9.2% had developed dementia at follow-up compared with 5.3% of those who were married (P = .001), they add.

Of those without social support, 5.6% had developed dementia at follow-up compared with 11.4% of those receiving social support (P = .000).

Slightly more than 13% of participants who expressed feelings of loneliness at baseline also met criteria for dementia 3 years later compared with 5.7% of those who expressed no such feelings, a 64% greater risk of developing clinical dementia after multivariate analysis (odds ratio [OR], 1.64; 95% confidence interval, 1.05 - 2.56; P = .000).

Bivariate Analysis showed that those who lived alone as well as those who were not or were no longer married had a higher risk of meeting criteria for dementia 3 years later compared with participants living with others and those who were married.

In contrast, Bivariate Analysis indicated that not having social support was associated with a lower risk of having dementia at follow-up.

Table: Risk for Dementia by Living Situation

Category                            Risk for Dementia (OR)

Living alone                        2.52

Living with others                1.67

Not/no longer married          2.24

Married                              2.31

Not receiving social support  2.03

Receiving social support       2.47

"Further research is needed to investigate whether cognitive deterioration and dementia are a consequence of feelings of loneliness or whether feelings of loneliness are a behavioural reaction to diminished cognition," the authors observe.

They add that to develop a better understanding of how loneliness may affect the development of dementia, "we need to know whether [these feelings] are a signal of a prodromal stage of dementia or a direct result of neurodegenerative pathology affecting social skills."

The study was funded by grants from the Netherlands Health Research Promotion Programme and the Netherlands Foundation for Mental Health. The authors have disclosed no relevant financial relationships.

J Neurol Neurosurg Psychiatry. Published online December 10, 2012. Abstract.

(Source:  Medscape Medical News, 18 December 2013)

Alzheimer’s Diagnosis Presents New Challenge For ‘Bravest Man In The Universe’

"I got a story I want to tell

Gather round me

Gather round me boys and girls"

—Bobby Womack, "The Bravest Man in the Universe," June 2012

He's survived two different types of cancer (colon and prostate), and toured while suffering from two collapsed lungs and pneumonia. Now, Singer/Songwriter, Bobby Womack, faces a newer, deadlier challenge: Alzheimer's disease.

At age 68, the man who inspired Jimi Hendrix and has worked with a pantheon of musical legends—from the Rolling Stones and Elvis Presley, to Aretha Franklin and the Gorillaz—has been diagnosed with early stage Alzheimer's, reports the British Broadcasting Corporation (BBC).

A Disease of Loss

"I once was lost,

But now I'm found

When I bear up so high,

I always know how to come down…"

—Bobby Womack, "The Bravest Man in the Universe," June 2012

Womack visited a doctor after he started having trouble remembering the names of his colleagues and the words to his songs.

"How can I not remember songs that I wrote? That's frustrating," Womack told BBC reporter Giles Peterson.

Alzheimer's memory loss typically follows a particular pattern—referred to as "first-in, last out…last in, first out."

The disease first robs a person of their short-term recall (what they did a few hours ago, the names of new acquaintances). Eventually childhood and young adult memories are also affected. The timetable varies from person to person; some individuals experience rapid deterioration of their recollections, while others may decline over a number of years.

Dealing with pain by pursuing passions

"The bravest man in the Universe

Is the one who has forgiven first

Yeah, shame on me, shame on you,

It's up to us,

What we say and what we do."

—Bobby Womack, "The Bravest Man in the Universe," June 2012

Following in the footsteps of other luminaries recently diagnosed with dementia (Glen Campbell, Pat Summit), Womack refuses to surrender his passion for music to Alzheimer's.

Along with seeking support from a network of reliable family and friends, experts agree that continuing to pursue the activities that they have a passion for is a key to helping a person cope with an Alzheimer's diagnosis and can help keep their minds sharp for as long as possible.

"With the support of many good doctors, my family, and all of my wonderful fans, I will continue to write, and perform and bring good music to the people for as long as I can," the recent Rock and Roll Hall of Fame inductee told CNN reporters.

Really, one should expect nothing less from the man whose latest album, entitled, "The Bravest Man in the Universe," gained critical acclaim in 2012 as a soul-moving work of lyrical art.

(Source:  AgingCare.com, 7 January 2013)

Early Parkinson's Patients May Suffer Some Symptoms in Silence

People with early stage Parkinson's Disease often experience anxiety, constipation, drooling and other symptoms not related to movement problems, new research finds. Yet help is possible if doctors know about the problem, study suggests.

Because movement problems are the main symptom of the disease, these non-motor symptoms often go undiagnosed and untreated, according to the study, which was published in the January 15 issue of the Journal Neurology.

"Oftentimes people with early Parkinson's don't even mention these symptoms to their doctors, and doctors don't ask about them," study author Tien Khoo, of Newcastle University in England, said in a Journal News Release. "Yet many times [the symptoms] can be treated effectively."

The researchers asked 159 newly diagnosed Parkinson's disease patients and 99 people without the disease whether they experienced any of 30 non-motor symptoms, including gastrointestinal problems, sleep problems and sexual problems.

The Parkinson's patients had an average of eight of the non-motor symptoms, while those without Parkinson's had an average of three. The most common symptoms for Parkinson's patients were drooling, urinary urgency, constipation, anxiety and a reduced sense of smell.

Excess saliva or drooling was a problem for 56 percent of Parkinson's patients and only 6 percent of those without the disease. Constipation affected 42 percent of Parkinson's patients and 7 percent of those without the disease. Anxiety was reported by 43 percent of Parkinson's patients and 10 percent of those without the disease.

"These results show that Parkinson's affects many systems in the body, even in its earliest stages," Khoo said. "Often these symptoms affect people's quality of life just as much if not more than the movement problems that come with the disease. Both doctors and patients need to bring these symptoms up and consider available treatments."

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about Parkinson's disease.

(Source: HealthDay News, 14 January 2013)

Beta-Blockers Linked to Fewer Alzheimer's Lesions

The use of beta-blockers for the treatment of hypertension was associated with fewer Alzheimer's-type brain lesions on autopsy than other antihypertensive medications, a new study shows.

The study, which is to be presented at the upcoming American Academy of Neurology meeting in March, was conducted by a team led by Lon White, MD, University of Hawaii, Honolulu.

"These results suggest that beta-blockers may have some special benefits in reducing Alzheimer-type brain lesions," Dr. White told Medscape Medical News.

Honolulu-Asia Aging Study

The findings come from the Honolulu-Asia Aging Study, funded by the US National Institute on Aging, which has followed a large cohort of Japanese-American men who were aged 71 to 93 years at baseline in 1991. They have been examined every 3 years, and now autopsies have started to be performed after the death of the participants.

"One of the key issues to be addressed in the study is how to prevent the development of late-life dementia, which affects about 30-40% of people, the most common form being Alzheimer's," Dr. White explained. "It is now pretty well established that the risk of Alzheimer's is related to mid-life hypertension, more so than late-life hypertension."

In this particular study, they looked at the hypertension-Alzheimer's link in more detail and extended observations to autopsy data.

"With 774 brain autopsies and information on drug use and cognition, this is the largest brain autopsy study ever done in a prospective manner," he said. "And no other study that I am aware of has looked at different treatments for hypertension in relation to Alzheimer's."

Of the 774 patients, both with and without clinical signs of dementia, for whom brain autopsies were available, 610 had been hypertensive or treated with antihypertensive drugs. Drugs used as monotherapy for the treatment of hypertension included beta-blockers (40 patients), angiotensin-converting enzyme inhibitors (n = 35), diuretics (n = 60), calcium blockers (n = 103), and vasodilators (n = 13). In addition, 43 patients were taking beta-blockers in combination with other antihypertensives and 46 were taking other combinations of antihypertensives.

The average age at death was 86 to 87 years in all groups. Education status was similar in all groups, and the incidence of diabetes varied from 17% to 30%. The LPA4 gene was not related to drug treatment. Logistic and linear regression analyses were performed to control for potential biases.

Results showed that patients who had had hypertension and had been taking beta-blockers had fewer Alzheimer-type lesions (both neurofibrillary tangles and amyloid plaques) than those taking no drug therapy or those taking other medications. There was also a significant but less dramatic reduction in infarcts in the small arteries of the brain (a vascular marker of dementia) in patients who had been taking beta-blockers.

The lowest-level Alzheimer's lesions were seen in the patients who did not have hypertension. The group who had been taking beta-blockers had low levels of lesions similar to those of the nonhypertensive group, Dr. White reported. Those who had received beta-blockers plus other medications had intermediate or marginally fewer brain abnormalities.

'First Hint' of Effect

"This is the first hint that different kinds of antihypertensive therapy might have differential effects on Alzheimer's lesions and other brain lesions," Dr. White said. But he cautioned that the numbers are small and nothing definite can be concluded. "This is just a clue that perhaps beta-blockers may be potentially a good choice of antihypertensive for preventing Alzheimer's. But we are obviously a long way from making clinical recommendations."

Speculating on the mechanism, Dr. White noted that beta-blockers reduce pulse rate, which might have an effect on small vessel micro-infarcts in the brain.

"Lifelong exposure of the pulse pressure in the brain might cause some damage," he said. "While we thought beta-blockers may reduce brain micro-infarcts, which they did, we actually saw a larger reduction in the Alzheimer-type lesions which we had not expected. This is somewhat of a mystery at present and may be a chance finding. But if it is a real effect I would think it was something to do with autonomic function."

Dr. White suggested that a reasonable next step could be to test this hypothesis in mice genetically engineered to produce these Alzheimer's lesions. "If we treat these mice with beta-blockers and they develop fewer lesions, then we will know that it is an effect of the drugs," he commented.

The study was supported by grants from the National Institutes of Health. The authors have disclosed no relevant financial relationships.

American Academy of Neurology's 65th Annual Meeting. Abstract 2171. Released January 7, 2013.

(Source:  Medscape Medical News, 7 January 2013)

Is Coconut Oil Good for Alzheimer's? Byrd Institute Launches Research Study

Coconut oil is Alzheimer's most popular and most controversial non-drug treatment. See how it works. Learn about a new study on its effectiveness by Florida's Byrd Alzheimer's Institute. 

Dr. David Morgan is chief executive officer for the Byrd Alzheimer's Institute in Florida. He said about their new study on coconut oil for dementias such as Alzheimer's.
 "When a patient or a family member comes in with a patient, and they're interviewing with the physicians, they always have a question, 'I've heard about coconut oil. What's going on with that."

Alzheimer's Doctors Taking Note of Coconut Oil

"And at least up until this time all we can say is there's anecdotal information, that it may be beneficial, but there hasn't been any kind of research study that's ever been done." 

Dr. Morgan knows that doctors "feel uncomfortable making a recommendation for something that they don't feel justified by the science behind it. And that's part of the reason we're going to do the study, is to determine, can we then provide that justification." 


(Source:  Dementia weekly / Alzheimer's Weekly, 10 January 2013)