MIDNIGHT MUNCHIES ALL YEAR LONG

Midnight snacks can go a lot further than New Year's Eve celebrations. Read how late-night munchies solved night wandering and behavioral challenges for people with dementia.

Like many nursing homes, the Parker Jewish Institute in New Hyde Park, N.Y., was having problems with some of its dementia patients wandering at night. The staff worried about falls, but they didn't want to hand out more psychotropic medicines to make the patients sleepy. The medications often had harsh side-effects and actually increased the risk of falling.

At the same time, of the 42 residents, 8 to 10 were constantly moving.

But one night, a certified nursing assistant accidentally stumbled on a solution.

Her boss, Aura Gordon, an RN manager, told the story this week at the Aging in America conference in Chicago. A patient, "a lovely man," got out of bed around 2 a.m., as was his custom, picked up his newspaper and headed down the hall. He was preparing to "go to the market," which had been his pattern when he was working. The nurse saw him and figured if he thought he was going to work, he should eat a little something. She gave him a slice of cake and a cup of coffee. He ate the cake, drank the coffee, and then went back to bed.

Thus began the midnight snack program at 8 South, a unit at Parker. Within weeks, Gordon has persuaded the home to provide snacks for the nighttime wanderers: cake, sandwiches, cookies, pudding, Jell-O, juices, coffee. They added bananas when they discovered that one very agitated woman -- who didn't want to eat the nursing home food because she thought it was poisoned -- immediately calmed down when she had a banana. They don't know why, but now they always have bananas on hand. And they make sure some of the snacks are sugar-free, for their diabetic patients.

Gordon says patients with dementia often don't know what time it is, which causes some to get up at all hours, ready to go. They get confused, and sometimes even violent, when they are urged back into their rooms and to bed. She reported that, since the snack program began, they saw falls and related injuries decrease by 50 percent. And, they also saw a decrease in pressure sores (also known as bed sores, or nosocomial ulcers). Now, she says, there are no sores in all of 8 South.

It's not rigorous scientific research, but 8 South is much calmer now, 24 hours a day.

(Source:  Alzheimer’s & Dementia Weekly, 29 December 2013)

CONCUSSIONS MAY LEAD TO ALZHEIMER'S PLAQUE BUILDUP FOR SOME

Concussions have already been linked to the Alzheimer’s-like degenerative brain disease chronic traumatic encephalopathy (CTE) in athletes and military members who have experienced repeated head blows and traumatic brain injuries.

Now, a new study links concussions to Alzheimer’s disease itself.

Mayo Clinic researchers gave brain scans to 141 Minnesotans who had been experiencing memory problems, and found those who had suffered a brain injury that caused them to black-out had more amyloid plaques in their brain than those who hadn’t.

Amyloid plaque is the telltale sign of Alzheimer’s disease, formed by pieces of a sticky protein that break off in the brain and clump together. Some clumps may form in brain regions involved in learning, memory and thinking, the Alzheimer’s Association explains. More plaques form as the disease progresses.

Researchers gave brain scans to 448 people without any memory or cognitive problems, and 141 people who had mild cognitive impairment (MCI), a condition characterized by declines in memory and thinking skills that aren’t caused by aging. They were also asked whether they had ever experienced a brain injury that caused them to lose consciousness. People with MCI are at a heightened risk of developing Alzheimer’s or another type of dementia, but not everyone with the condition will get worse.

The researchers found 18 percent of those with MCI had reported a prior brain injury, and on scans, they saw the patients had an average of  18 percent more amyloid plaques than those with no history of head trauma. They found no plaque differences in any of the brain scans of people without memory problems, regardless of whether they'd had a brain injury.

"Interestingly, in people with a history of concussion, a difference in the amount of brain plaques was found only in those with memory and thinking problems, not in those who were cognitively normal," study author Dr. Michelle Mielke, a researcher who studies the epidemiology of neurodegenerative diseases at the Mayo Clinic in Rochester, Minn, said in a statement. “The fact that we did not find a relationship in those without memory and thinking problems suggests that any association between head trauma and amyloid is complex."

The study was published on 26 December 2013 in Neurology.

One expert not involved in the study thinks the research may lead to earlier interventions to protect injured brains.

"Drugs that block the development of amyloid or increase its removal from the brain may help protect persons with traumatic brain injury from Alzheimer's disease, though that has not been demonstrated," Dr. Richard Lipton, Director of the Division of Cognitive Aging and Dementia and the Montefiore Headache Center at Albert Einstein College Of Medicine in New York City, told USA Today.

In October, a study found seniors who reported poor quality sleep were more likely to accumulate amyloid plaques in the brain than those who got more than five hours of shut-eye each night.

(Source:  CBS News, 27 December 2013)

WHERE ALZHEIMER'S STARTS, WHY IT STARTS THERE, AND HOW IT SPREADS THROUGHOUT THE BRAIN

Alzheimer’s disease starts in the entorhinal cortex (yellow).

Using fMRI in mouse (left) and human (right) brains, the researchers provide evidence that the disease spreads from the entohrinal cortex (yellow) to other cortical regions (red) — the perirhinal cortex and posterior parietal cortex.

Study Shows Where Alzheimer’s Starts and How It Spreads

Using high-resolution functional MRI (fMRI) imaging in patients with Alzheimer’s disease and in mouse models of the disease, Columbia University Medical Center (CUMC) Researchers have clarified three fundamental issues about Alzheimer’s:

·                     where it starts,

·                     why it starts there,

·                     and how it spreads.

In addition to advancing understanding of Alzheimer’s, the findings could improve early detection of the disease, when drugs may be most effective. The study was published today in the online edition of the journal Nature Neuroscience.

“It has been known for years that Alzheimer’s starts in a brain region known as the entorhinal cortex,” said Co-Senior Author Scott A. Small, MD, Boris and Rose Katz Professor of Neurology, Professor of radiology, and Director of the Alzheimer’s Disease Research Center. “But this study is the first to show in living patients that it begins specifically in the lateral entorhinal cortex, or LEC. The LEC is considered to be a gateway to the hippocampus, which plays a key role in the consolidation of long term memory, among other functions. If the LEC is affected, other aspects of the hippocampus will also be affected.”

The study also shows that, over time, Alzheimer’s spreads from the LEC directly to other areas of the cerebral cortex, in particular, the parietal cortex, a brain region involved in various functions, including spatial orientation and navigation. The researchers suspect that Alzheimer’s spreads “functionally,” that is, by compromising the function of neurons in the LEC, which then compromises the integrity of neurons in adjoining areas.

A third major finding of the study is that LEC dysfunction occurs when changes in tau and amyloid precursor protein (APP) co-exist.

“The LEC is especially vulnerable to Alzheimer’s because it normally accumulates tau, which sensitizes the LEC to the accumulation of APP. Together, these two proteins damage neurons in the LEC, setting the stage for Alzheimer’s,” said Co-Senior Author, Karen E. Duff, PhD, Professor of Pathology and Cell Biology (in psychiatry and in the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain) at CUMC and at the New York State Psychiatric Institute.

In the study, the researchers used a high-resolution variant of fMRI to map metabolic defects in the brains of 96 adults enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP).  All of the adults were free of dementia at the time of enrollment.

“Dr. Richard Mayeux’s WHICAP study enables us to follow a large group of healthy elderly individuals, some of whom have gone on to develop Alzheimer’s disease,” said Dr. Small. “This study has given us a unique opportunity to image and characterize patients with Alzheimer’s in its earliest, preclinical stage.”

The 96 adults were followed for an average of 3.5 years, at which time 12 individuals were found to have progressed to mild Alzheimer’s disease.  An analysis of the baseline fMRI images of those 12 individuals found significant decreases in cerebral blood volume (CBV) — a measure of metabolic activity — in the LEC compared with that of the 84 adults who were free of dementia.

A second part of the study addressed the role of tau and APP in LEC dysfunction. While previous studies have suggested that entorhinal cortex dysfunction is associated with both tau and APP abnormalities, it was not known how these proteins interact to drive this dysfunction, particularly in preclinical Alzheimer’s.

To answer this question, explained first author Usman Khan, an MD-PhD student based in Dr. Small’s lab, the team created three mouse models, one with elevated levels of tau in the LEC, one with elevated levels of APP, and one with elevated levels of both proteins. The researchers found that the LEC dysfunction occurred only in the mice with both tau and APP.

The study has implications for both research and treatment.

“Now that we’ve pinpointed where Alzheimer’s starts, and shown that those changes are observable using fMRI, we may be able to detect Alzheimer’s at its earliest preclinical stage, when the disease might be more treatable and before it spreads to other brain regions,” said Dr. Small.

In addition, say the researchers, the new imaging method could be used to assess the efficacy of promising Alzheimer’s drugs during the disease’s early stages.

(Source:  Alzheimer’s Reading Room, 28 December 2013)

Thanksgiving Prayer Reflecting on the Humorous Side of Aging

WATCH this Video:

One "little old lady" shines a light on the foibles of aging, to the delight of an audience filled with senior-care experts. 

With the timing of a professional comedian, this diminutive "little old lady" shines a very funny light on the foibles of aging, to the delight of an audience filled with senior-care experts. 

A friend of the couple who founded Home Instead Senior Care, Mary Maxwell was asked to give the invocation at the company's 2009 Convention. Initially it seemed like a normal prayer, but it soon took a very funny turn. Her deadpan delivery and lines like ...This is the first time I've ever been old... and it just sort of crept up on me ... had everyone rolling in the aisles. 

For more of Mary's unique view on aging, check out her video blog on CaregiverStress.com:
http://www.caregiverstress.com/voice/...


(Source:  Alzheimer's & Dementia Weekly, 24 November 2013)

AMLODIPINE IS RACING TO BE THE 1ST VASCULAR DEMENTIA TREATMENT

Amlodipine, an inexpensive drug approved for high blood pressure, could become the first ever treatment for vascular dementia. Vascular dementia is one of the most common forms of dementia. Find out how amlodipine can help.

The widely prescribed drug amlodipine has shown promising effects in people with vascular dementia, the most common type of dementia after Alzheimer's disease. The Alzheimer's Society and the British Heart Foundation (BHF) have announced the beginning of a major new £2.25m clinical trial to test the drug's effectiveness in people with the condition.

Experts based at the School of Medicine, Dentistry and Biomedical Sciences at Queen's University Belfast will recruit nearly 600 people with vascular dementia for a groundbreaking two year trial into the drug's potential as a dementia treatment. The Researchers, led by Professor Peter Passmore, hope to show that 10mg a day of the drug can significantly improve memory and cognitive health. As amlodipine is already licensed and known to be safe, the treatment – which costs the NHS just £1.07 a month – could be in use as a treatment within five to ten years.

Vascular Dementia is caused by problems with the blood supply to the brain and affects about 150,000 people in the UK. Those with heart conditions, high cholesterol and diabetes are especially at risk, and it can be triggered by a stroke. There are currently no available treatments for vascular dementia yet there are fewer ongoing clinical trials for the condition than there are for hay fever.

Amlodipine is used to treat high blood pressure, a major risk factor for vascular dementia. It is known to enter the brain and researchers think it might work by protecting brain cells from damage when blood supply to the brain is poor.

Professor Peter Passmore at the School of Medicine, Dentistry and Biomedical Sciences, and lead investigator, said:

'Vascular dementia is a very common disease and to date no major trial has been successful in developing an effective treatment for this disease. We hope, using evidence from previous research, and by trialling the drug amlodipine we may get a step closer to improving the outcomes of patients with vascular dementia in the next decade.'

Jeremy Hughes, Chief Executive at Alzheimer’s Society said:

'It is scandalous that despite affecting 150,000 people there are no effective treatments for vascular dementia and very few new treatments under investigation. This groundbreaking trial could be the best hope we have to get an effective treatment in use in the next decade.

'Developing new drugs from scratch can costs hundreds of millions and take up to twenty years but our flagship Drug Discovery programme aims to test existing drugs in people with dementia, fast-tracking the process and bringing new treatments to market faster and more cheaply.

Professor Peter Weissberg, Medical Director at the BHF said:

'The 2.3 million people living with coronary heart disease in the UK are at increased risk of developing vascular dementia. Unfortunately, as yet, there are no effective treatments for this devastating condition.

'Amlodipine is a widely prescribed, blood pressure lowering treatment that has shown some promising effects in vascular dementia. The BHF and Alzheimer's Society have joined forces to fund this definitive study. If positive, it would pave the way for an affordable treatment for vascular dementia in the near future.'

(Source:  Alzheimer’s & Dementia Weekly, 8 December 2013)

DIAGNOSING DEMENTIA: ALZHEIMER'S MAY REALLY BE MINI-STROKES

What causes memory problems? Often, it's plaque in the brain, which leads to Alzheimer's. Now, new research shows a more common culprit may be vascular brain injury. Find out about this type of cognitive decline from stroke, mini-stroke and high blood pressure. Learn why diagnosing the right cause effects therapy and treatment.

Alzheimer's is connected to sticky plaques made of beta-amyloid that choke brain cells, thereby causing dementia. People may act like they have Alzheimer's when they really have vascular dementia. Vascular dementia is caused by vascular events (related to blood vessels) such as strokes and mini-strokes, so treatment is different. (Mini-strokes occur in the brain when blood vessels clog up or burst. They can accumulate slowly and can go unnoticed for years.)

For example, the damage caused by plaque is typically treated with acetylcholinesterase inhibitors like Aricept®. These drugs target the nervous system. Vascular problems like mini-strokes are treated with blood-targeting medications and therapies.

Alzheimer's disease and vascular dementia are two types of dementia that are common in the elderly. A person's dementia can even be caused by a combination of the two, called "Mixed Dementia."

With today's technology, both vascular brain injury as well as beta-amyloid plaque can be detected in the brain. They both cause memory and thinking problems, called "cognitive impairment". If the cognitive impairment is strong and interferes with a typical person's day, it is called dementia. If it is mild, it is called MCI (Mild Cognitive Impairment).

Until now, doctors generally assumed that when they saw cognitive impairment, it was probably from plaque building up in the brain. Treatment and therapy were given accordingly. New research is showing that vascular brain injury from strokes or the mini-strokes often caused by high blood pressure may deserve the greater part of their attention.

A study at the Alzheimer’s Disease Research Center at UC Davis has found that vascular brain injury from conditions such as high blood pressure and stroke are greater risk factors for cognitive impairment among non-demented older people than is the deposition of the amyloid plaques in the brain that long have been implicated in conditions such as Alzheimer’s disease.

Published online early today in JAMA Neurology (formerly Archives of Neurology), the study found that vascular brain injury had by far the greatest influence across a range of cognitive domains, including higher-level thinking and the forgetfulness of mild cognitive decline.

The researchers also sought to determine whether there was a correlation between vascular brain injury and the deposition of beta amyloid (Αβ) plaques, thought to be an early and important marker of Alzheimer’s disease, said Bruce Reed, associate director of the UC Davis Alzheimer’s Disease Research Center in Martinez, Calif. They also sought to decipher what effect each has on memory and executive functioning.

“We looked at two questions,” said Reed, professor in the Department of Neurology at UC Davis. “The first question was whether those two pathologies correlate to each other, and the simple answer is ‘no.’ Earlier research, conducted in animals, has suggested that having a stroke causes more beta amyloid deposition in the brain. If that were the case, people who had more vascular brain injury should have higher levels of beta amyloid. We found no evidence to support that.”

"The second,” Reed continued, “was whether higher levels of cerebrovascular disease or amyloid plaques have a greater impact on cognitive function in older, non-demented adults. Half of the study participants had abnormal levels of beta amyloid and half vascular brain injury, or infarcts. It was really very clear that the amyloid had very little effect, but the vascular brain injury had distinctly negative effects.”

“The more vascular brain injury the participants had, the worse their memory and the worse their executive function – their ability to organize and problem solve,” Reed said.

The research was conducted in 61 male and female study participants who ranged in age from 65 to 90 years old, with an average age of 78. Thirty of the participants were clinically “normal,” 24 were cognitively impaired and seven were diagnosed with dementia, based on cognitive testing. The participants had been recruited from Northern California between 2007 to 2012.

The study participants underwent magnetic resonance imaging (MRI) ― to measure vascular brain injury ― and positron emission tomography (PET) scans to measure beta amyloid deposition: markers of the two most common pathologies that affect the aging brain. Vascular brain injury appears as brain infarcts and “white matter hyperintensities” in MRI scans, areas of the brain that appear bright white.

The study found that both memory and executive function correlated negatively with brain infarcts, especially infarcts in cortical and sub-cortical gray matter. Although infarcts were common in this group, the infarcts varied greatly in size and location, and many had been clinically silent. The level of amyloid in the brain did not correlate with either changes in memory or executive function, and there was no evidence that amyloid interacted with infarcts to impair thinking.

Reed said the study is important because there’s an enormous amount of interest in detecting Alzheimer’s disease at its earliest point, before an individual exhibits clinical symptoms. It’s possible to conduct a brain scan and detect beta amyloid in the brain, and that is a very new development, he said.

“The use of this diagnostic tool will become reasonably widely available within the next couple of years, so doctors will be able to detect whether an older person has abnormal levels of beta amyloid in the brain. So it’s very important to understand the meaning of a finding of beta amyloid deposition,” Reed said.

“What this study says is that doctors should think about this in a little more complicated way. They should not forget about cerebrovascular disease, which is also very common in this age group and could also cause cognitive problems. Even if a person has amyloid plaques, those plaques may not be the cause of their mild cognitive symptoms.”

(Source:  Alzheimer’s and Dementia Weekly, 11 December 2013)

CAUSES OF CHALLENGING BEHAVIORS

Difficult behaviors can make caring for someone with Alzheimer's and other kinds of dementia a challenge. One way to approach this is to try to determine the cause of those behaviors so that we can respond more appropriately. All behaviors have meaning, so by figuring out what may be causing the behavior, we can hopefully address the unmet need underneath it.

1.   Physical Causes of Challenging Behaviors in Dementia

- Identifying Unmet Needs to Reduce Behavior Difficulties

2.   Psychological/Cognitive Causes of Challenging Behaviors in Dementia - How Feelings and Thoughts Affect Behavior

3.   Environmental / External Causes of Challenging Behaviors in Dementia

1.   10 Physical Causes of Challenging Behaviors:

As we look at various causes, consider physical causes. Physical (or biological) issues, such as discomfort or hunger, can cause people with dementia to act out or resist care.

Discomfort or Pain

Sometimes behaviors are caused by physical discomfort or pain. For example, if your mother has pain that is unnoticed, she may become restless, anxious or resist being moved or cared for.

Hunger or Thirst

Some people with Alzheimer’s wander around, searching for a snack or a drink. If your loved one needs more snacks or drinks, keep food out on the counter that's safe and easy to eat. You can also fill a covered cup with ice water and a straw and set it out on the counter. This may prevent wandering or restlessness.

Poor Nutrition

As opposed to actively seeking food or drinks, some people don't take in enough food. Perhaps your father lives on his own and is trying to be as independent as possible. He may report that all is well, but unexplained weight loss or a tour of his kitchen may reveal this isn’t the case. Poor nutrition can increase confusion and cause such behaviors as apathy or resistance to care. Older adults with early dementia often struggle with planning and making meals, and may not be getting adequate nutrition. If your father is still able to manage the other areas of living independently, try looking into such services as senior meals or meals-on-wheels to assist with meeting his nutritional needs.

Dehydration

Dehydration is closely linked with poor nutrition. Some people intentionally avoid drinking lots of water because they struggle with incontinence. Others simply forget to drink water throughout the day. Dehydration can cause decreased awareness, disorientation and increased confusion, increasing the risk of wandering and other behaviors. Depending on what medications your loved one is taking, proper hydration can be especially important because some medications can build up in the body and become toxic.

Fatigue

Being overly tired can also result in challenging behaviors. We all have less patience and tolerance when we’re tired, and it’s the same for the person with dementia. Poor sleep can certainly trigger behavior challenges in dementia, especially because people may lack the inhibition to temper their feelings of irritation or crankiness.

A Need for Exercise

Did your mother get some exercise today? If not, she may need to go for a walk or stretch her legs. Building in a time for exercise, even if it’s just walking through the house or the halls, can decrease restlessness.

A Need to Use the Bathroom/Incontinence

Perhaps your loved one is attempting to get up again out of her chair, after you’ve reminded her many times to stay seated so she won’t fall. Rather than getting frustrated with her and viewing her as stubborn, consider that she might not be able to find the words to express her need for the bathroom or to convey that she is uncomfortable, wet and in need of a new incontinence pad and change of clothes.

Urinary Tract Infection

A urinary tract infection (UTI), sometimes called a bladder infection, can dramatically affect behavior. If someone shows a sudden change in behaviors, be sure to investigate this as a possible cause. Other symptoms of a UTI include cloudy urine, pain while urinating (so watch for grimacing while your loved one is using the bathroom), foul smell and fever.

Sensory Impairments

Does the person you’re caring for have a deficit in hearing or vision? This can increase his anxiety since he might be startled by your nearness or touch. Be aware of this deficit and compensate for it by approaching the person from the front, speaking into the ear that has better hearing or gently touching him on the arm to indicate your presence.

Decreased Ability to Communicate Needs or Preferences

Deficits in communication can range from mild difficulties with finding the right words to a complete inability to make needs known. This can cause feelings of helplessness and frustration, which in turn can trigger a behavior problem. Being intentional in adhering, as much as possible, to preferences and routines can help minimize this frustration.

2.   Psychological/Cognitive Causes of Challenging Behaviors in Dementia - How Feelings and Thoughts Affect Behavior

Challenging behaviors are often among the more difficult aspects of coping with Alzheimer's and other dementias. As we consider how to reduce these behaviors, which can be distressing to both the person with dementia and the caregiver, it can be helpful to evaluate the possible psychological and cognitive causes. These include the person's emotions and thoughts.

Psychological and Cognitive Causes:

Boredom

Is your loved one bored? Maybe he needs some more routine in the day or more mental stimulation and interaction with others. Boredom can cause people with dementia to act out negatively or withdraw and become apathetic. If you're the caregiver for someone with dementia, try structuring his day by providing a regular time for games, conversation and physical activity.

Loneliness

Loneliness can also trigger certain behaviors in dementia, such as wandering, sexually inappropriate acts, aggression or agitation.

Sundowning

Sometimes, people with dementia may experience an increase in agitation or restlessness as evening approaches. Research hasn’t conclusively shown why this is, but it’s called sundowning since behaviors often get worse in the evening as the sun sets. Keeping a quiet routine and several lights on in the house may help.

Frustration with a Loss of Control

Some people become frustrated, angry or aggressive because they're aware of the need to depend on others for many things. They may have lost the ability to administer their own medications, make decisions or care for themselves. Often, they're not able to express this clearly by saying, "I'm so frustrated because I feel like everyone is telling me what to do and where I have to go." But those feelings may be present inside. If you sense someone is frustrated, it can be helpful for you to acknowledge this occasionally by saying with a smile, "I'm sorry to be the bossy daughter, mom" or simply, "Are you feeling frustrated?"

Hallucinations/Paranoia/Delusions

Unfortunately, people with Alzheimer’s often experience hallucinations (seeing or hearing something that is not present), paranoia, or delusions. If someone is not in touch with reality, it’s best not to argue or try to persuade him that he’s incorrect. Arguing can increase his frustration and anxiety since he may feel that his fears are not being taken seriously.

Confusion About Reality

While it seems obvious that confusion can be the cause of behavioral concerns, we need to remember that dementia affects that brain. Someone may act or react inappropriately because they don't understand the situation. For example, if a nursing aide is bathing a resident at a long-term care facility, the resident may not understand that he needs that assistance with physical care and may misinterpret it. If you have the television on at home, pay attention to what is on. Even if you think of it as just background noise, your loved one might not know that the TV show isn’t real and could react to it in an anxious or aggressive manner.

Depression

Depression is a significant cause of challenging behaviors. Feelings of sadness and hopelessness can cause apathy (a lack of motivation and feelings of listlessness), and can also cause an increase in confusion. In fact, pseudodementia, a condition where depression blunts emotions and thoughts to the point where it appears the person has progressive dementia, can develop.

Anxiety

Often, anxiety and depression go hand in hand with a dementia diagnosis. These feelings may be difficult to identify at times because the person may have trouble expressing them. Observe for signs of anxiety, such as pacing, worried facial expressions, repetitive questions or statements, hand-wringing, etc., and report them to his physician.

Catastrophic Reaction

A catastrophic reaction is when someone significantly overreacts to something or someone. Perhaps you have ruled out many other causes and yet the behavior, such as physical aggression, continues. It’s possible that it’s a catastrophic reaction to events or stimulation that the person just can’t comprehend; perhaps it's triggering a past negative experience. Your best approach, after ensuring her safety, is to remain calm and reassuring, give her some time and physical space and then return to provide her care after she is calm. You can also try to determine if there's a pattern to her reactions that you could change by approaching her differently.

3.   Environmental / External Causes of Challenging Behaviors in Dementia

Many of the behavioral concerns that arise in Alzheimer's and other dementia have specific causes. In order to effectively address and reduce some of those challenging behaviors, we need to first consider what might be causing the person to behave that way.

One way to approach this is to look at what's happening around, and outside of, the person with dementia. Evaluating the setting can help us determine if there are situations that may be triggering a behavioral reaction by someone whose memory, comprehension or orientation is limited.

Environmental Causes of Challenging Behaviors:

Overwhelmed by Stimulating Surroundings

Are there too many choices, is it too noisy or is more than one person speaking at the same time to your mother with Alzheimer’s? These are examples of situations that can be overwhelming for someone with dementia. She can’t process everything as well as she used to, so if the environment is too busy, this can trigger anxiety, frustration, anger or withdrawal.

Change in Routine

If your usual routine with your loved one is to rise mid-morning and eat a hot breakfast, getting up at 8 a.m. to rush off to an early doctor’s appointment might be difficult. Take this into consideration; when possible, keep consistency in the routine.

Unfamiliar Environment

Changing someone's usual environment can trigger such behaviors as restlessness, aggression and agitation. For example, when your loved one is admitted into the hospital, provide extra reassurances through your presence and through verbal reminders like, "It's going to be okay; I'm here with you." You can also offer comforting touch such as holding his hand (if this is something that usually calms the person).

Lack of Personal Space

Everyone has a personal bubble of space they’re used to keeping as their own. Individuals with Alzheimer’s or another dementia may have an increased sensitivity to a person coming into their space or a decreased awareness of others’ space.

Confrontation with Others

Sometimes, other people unknowingly trigger uncooperative or aggressive behavior in others with dementia. For example, in a facility, one person who is confused may not realize that another person is also confused, and this may unknowingly trigger a reaction of anger or frustration.

Caregiver Approach

This is a critical factor in the behavior of those with Alzheimer’s or other dementias. If the person receiving care feels rushed, patronized or unimportant, this can easily trigger frustration that shows up as resistance, hitting or verbal aggression. Focusing on how caregivers approach someone and interact with them is one of the most effective ways to manage and reduce challenging behaviors in dementia.

(Source:  About.com by Esther Heerema, MSW)

NEW ALZHEIMER'S DRUG ON THE MARKET BY 2017?

Danish pharmaceutical group Lundbeck said on Monday that it hopes to launch a new Alzheimer's medicine in 2017 in what would be the first new drug for the condition in more than a decade.

Dementia - of which Alzheimer's disease is the most common form - already affects 44 million people worldwide and is set to reach 135 million by 2050, according to non-profit campaign group Alzheimer's Disease International.

There is currently no treatment that can cure the disease or slow its progression, but Lundbeck's new drug - known as Lu AE58054 - is designed to alleviate some of the symptoms and improve cognitive function.

As such, it would build on treatments currently on the market rather than competing with more ambitious projects under way at large drug companies, which aim to modify the biology of the disease.

"If the studies that we are currently running end well, then we will probably be the first company to launch a new Alzheimer's drug in 10 to 15 years," Lundbeck Chief Scientific Officer Anders Gersel Pedersen told Reuters.

The Danish company, together with its Japanese partner Otsuka, is currently testing its experimental Alzheimer's drug in 3,000 patients in four final-stage Phase III clinical studies.

Pedersen said he expected the drug to have annual worldwide sales of considerably more than $1 billion, if it is approved.

"There is a huge market for this kind of medicine, until the day you cure the disease," Pedersen said.

It is more than a decade since the last drug, Ebixa (memantine), also from Lundbeck, was approved to treat Alzheimer's.

Although there is still no treatment that can effectively modify the disease or slow its progression, a number of companies - including Eli Lilly, Merck & Co, Roche and Johnson & Johnson - are pursuing a variety of approaches to get to the root of the memory-robbing disorder.

Health ministers from the Group of Eight countries last week set a goal of finding a cure or a disease-modifying therapy by 2025 - a target that is seen as ambitious given that scientists are still struggling to understand the fundamental biology of Alzheimer's.

(Source:  Reuters, 18 December 2013) 

AN APPLE (OR STATIN) A DAY WILL KEEP THE DOCTOR AWAY: POPULATION HEALTH ANALYSIS

So, that old chestnut your mother told you turns out to be rooted in valid, scientific evidence: eating an apple a day really would keep the doctor away. In fact, according to the new analysis by British researchers, if individuals ate just one extra apple a day, approximately 8500 deaths from vascular disease could be prevented in the UK.

The reduction in vascular deaths by adding an apple to the diet is on par with the reduction that would be observed if all UK individuals over 50 years of age were prescribed statin therapy. In that scenario, 9400 deaths from vascular disease could be prevented if these adults were started on simvastatin 40 mg.

"Statins and apples are both iconic," lead researcher Dr Adam Briggs (University of Oxford, UK) told heartwire . "An apple a day is known throughout the English-speaking world as a saying for health, and statins are now some of the most widely prescribed drugs in the world. So, when you now have a debate in the medical world about increasing the amount of statins prescribed for primary prevention, we wanted to look at what that would mean for population health and if there were other ways of doing it."

In the US, as reported by heartwire , the new American College of Cardiology/ American Heart Association (ACC/AHA) guidelines for the management of cholesterol suggest treating primary-prevention patients if they have an LDL-cholesterol level between 70 and 189 mg/dL and a 10-year risk of atherosclerotic cardiovascular disease >7.5%. In the UK, the guidelines are less aggressive and recommend statin therapy for primary prevention of cardiovascular disease if the 10-year risk score is >20%.

However, Briggs said there is debate in UK about expanding the use of statins to all patients 50 years of age or older.

"What we're trying to say from this analysis is that dietary changes initiated at the population level can have a really meaningful effect on population health," he said. "And second, so can increasing drug prescriptions. Now, we're not trying to say that people should be swapping their statins for apples; that's not where we're going. However, if they want to add an apple to that as part of disease prevention, then by all means do so, because you'll be further along in reducing your risk of fatal heart attacks and strokes."

The new report is published December 17, 2013 in the Christmas issue of BMJ. In addition to this "Comparative Proverb Assessment Modelling Study". 

Apples Are Both Nutritious and Delicious

To assess the potential benefits of putting more patients on statins, the researchers used data from the Cholesterol Treatment Trialists' meta-analysis that showed vascular mortality is reduced 12% for every 1.0-mmol/L reduction in LDL cholesterol. This was applied to the annual reduction in vascular mortality rates in UK individuals 50 years of age or older who were not currently taking a statin for primary disease prevention.

For the apple-a-day assessment, they used a widely published risk-assessment model (PRIME). This model includes a multitude of dietary variables, in which investigators can substitute different food choices to assess the effects on population health. The apple was assumed to weigh 100 g, and calorie intake was assumed to remain constant. This allowed investigators to assess the effect of substituting in one apple daily on vascular mortality in the UK population.

For statin therapy, offering the treatment to an extra 17 million individuals and assuming 70% compliance would prevent 9400 vascular deaths each year. Assuming 70% compliance with the apple, even though "apples are of course both delicious and nutritious," say the researchers, the estimated reduction in vascular deaths would be 8500. They add that prescribing statins to all those eligible would lead to 1200 cases of myopathy, 200 cases of rhabdomyolysis, and 12 300 new diagnoses of diabetes mellitus.

Interestingly, the cost of statin therapy from the drug alone would be £180 million compared with £260 million for the apples. However, the authors point out that the National Health Services (NHS) might be able to negotiate apple price freezes ("although defrosted apples may not be so palatable," they add).

To heartwire , Briggs said he was surprised at how well the apples compared with statin therapy. However, he stressed the point is not to encourage patients to stop taking their medication. He points out that the UK has a "five-a-day" campaign to increase fruit and vegetable consumption, but 69% of the population do not meet the recommendations.

Having now studied the science underlying an apple a day for keeping the doctor away, the group jokingly states they will next "model the effect of inquisitiveness on feline mortality rates."

Briggs, along with coauthors Drs Anja Mizdrak and Peter Scarborough (University of Oxford) report no conflicts of interest. Briggs consumes at least five fruits and vegetables per day, Mizdrak tries to, and Scarborough is a vegetarian. All their diets include apples. None of the researchers take statins, and all "purport to be under 50 years old."

(Source:  Medscape Medical News, 8 December 2013)

G8 DEMENTIA SUMMIT AGREES ON STEPS AGAINST A 'GREAT KILLER'

An international effort to approach the problem of dementia was agreed upon by government ministers from some of the world's largest national economies, along with researchers, pharmaceutical companies, and Alzheimer's charities this week at the Group of 8 (G8) Dementia Summit.

Speaking at the Summit, held in London December 11, United Kingdom (UK) Prime Minister David Cameron said he wanted the meeting to go down in history as "the day that the global fight-back began."

"It doesn't matter whether you're in London or Los Angeles, in rural India or urban Japan - dementia steals lives, it wrecks families, it breaks hearts and that is why all of us here are so utterly determined to beat it," Cameron said. "In past generations, the world came together to take on the great killers. We stood against malaria, cancer, HIV and AIDS and we are just as resolute today."

The summit concluded with the publication of a declaration setting out the agreements reached. These included the following:

·         Set an ambition to identify a cure or a disease-modifying therapy for dementia by 2025;

·         Significantly increase the amount spent on dementia research;

·         Increase the number of people involved in clinical trials and studies on dementia;

·         Establish a new global envoy for dementia innovation, following in the footsteps of global envoys on HIV and AIDS and on climate change;

·         Develop an international action plan for research;

·      Share information and data from dementia research studies across the G8 countries to  work together and get the best return on investment in research; and

·     Encourage open access to all publicly funded dementia research to make data and  results available for further research as quickly as possible.

A recent policy brief released by Alzheimer's Disease International estimated that 44 million people worldwide currently have dementia. With the aging of the population, dementia prevalence will continue to rise to an estimated 135 million by 2050, the meeting heard.

Jeremy Hunt, the UK's Secretary of State for Health, warned that dementia could bankrupt the world's healthcare systems, with a current global cost approaching $600 billion. But he added that the human cost was worse.

Hunt highlighted 3 areas of action:  (1) to redouble efforts to find a drug that can halt or reverse the brain decay caused by dementia, (2) to improve diagnosis rates, and (3) to reduce the stigma around dementia in society.

He noted that less than half of patients with dementia in the UK are diagnosed. "Too many people - even some doctors - think there is no point. But with a diagnosis we can give out medicines that help some people; we can put in place support for families; we can encourage lifestyle change - all of which can mean people live at home happily and healthily for many years longer."

On fighting the stigma, Hunt said the first step to improving treatment was to be able to talk about it normally.

Harry Johns, President and CEO of the Alzheimer's Association, also addressed the summit and points out in a release that the target of a cure or treatment by 2025 is similar to that of the US National Plan to Address Alzheimer's Disease.

"The G8 Dementia Summit was an unprecedented opportunity to advance progress internationally - to make Alzheimer's and dementia research a global priority and to promote increased global collaboration," Johns said. "Now we must capitalize on the new connections and increased attention fostered at this landmark event to rid the world of the devastating scourge of Alzheimer's and other dementias."

Additional international meetings to examine the progress of research will be held in the coming years, said Francis Collins, MD, in a release from the Alzheimer's Association, with the next major gathering to be held February 10, 2015, in the United States.

(Source: Medscape Medical News, 13 December 2013)