4 MEMORY SYSTEMS OF THE BRAIN AND DEMENTIA

Normal aging leads to changes in the brain, especially in areas involved in learning and memory.

Over time, changes in the brain can make it more difficult for an older person to learn new tasks or to retrieve information from memory, such as someone's name.

With Alzheimer's disease or a related dementia, the damage is more severe and ultimately affects larger regions of the brain.

The human brain contains an estimated 100 billion nerve cells (neurons). Chemical and electrical activity allows these neurons to perform their tasks and to communicate with one another. This elaborate communication system controls vital body functions and enables us to think, see, move, talk, remember, and experience emotions.

There are four different memory systems of the brain -- episodic, semantic, procedural, and working.

Memory Systems

Episodic Memory

The temporal lobe, which contains the hippocampus, and the prefrontal cortex are important to episodic memory, which enables us to learn new information and remember recent events. The hippocampus is one of the first brain structures damaged in Alzheimer's disease and accounts for one hallmark of early Alzheimer's: difficulty remembering recent events, without any trouble remembering events from long ago.

Semantic Memory

Semantic memory governs general knowledge and facts, including the ability to recognize, name, and categorize objects. This system also involves the temporal lobes and, researchers suspect, multiple areas within the cortex. People with Alzheimer's disease may be unable to name a common object or to list objects in a category, such as farm animals or types of birds.

Procedural Memory

The cerebellum is one of the structures involved in procedural memory. Procedural memory is what enables people to learn skills that will then become automatic (unconscious), such as typing or skiing. This memory system typically is not damaged in Alzheimer's disease or is one of the last cognitive domains to deteriorate.

Working Memory

Working memory involves primarily the prefrontal cortex. This memory system governs attention, concentration, and the short-term retention of needed information, such as a street address or phone number. Problems with working memory can impair a person's ability to pay attention or to accomplish multi-step tasks. Numerous cognitive disorders, such as Alzheimer's, Parkinson's, and Huntington's disease as well as dementia with Lewy bodies, can affect working memory.

In a nutshell, persons living with Alzheimer's or dementia cannot remember to remember. As a result, they can no longer either recall or use new memories in the future.

Nevertheless, persons living with dementia continue to surprise us with their stories and memories of the past.

This should be the focus of our compassionate caregiver efforts.

(Sources of information: John Hopkins +Alzheimer's Reading Room)

Dear Caregivers, 

A very good article and full of wisdom which we all should take a read, 5 Qualities of Caregiving Excellence, from Angil Tarach-Ritchey (RN GCM) who has over 30 years of experience and is a nationally known expert in senior care and advocacy (Source:  Alzheimer’s Reading Room).

Relationships can be tested to the limit when there is a caregiver and care recipient within a family relationship.

In a paid caregiving position there are those who have something special within them and those who are just making an income. I think about and meet all types of caregivers on a daily basis.

Not everyone is suited to provide care in a family situation or as a paid position. So what are the characteristics that an excellent caregiver has? I believe there are 5 core qualities an excellent caregiver possesses.

1. EMPATHY

My belief is empathy is the #1 core characteristic of an excellent caregiver. I often question if this is inherent within us or this is something which can be learned?

I tend to believe it’s a lot of inherent and a big mix of environment. I also believe there are degrees of empathy. Some can empathize more than others. If you can totally put yourself in the place of who you are caring for, you will do nothing but provide excellent care.

The question is always how would I want to be treated and taken care of under these circumstances? If that is the core basis for how you provide care you will provide caring, compassionate, and dignified care with a great attitude.

2. DEPENDABILITY

Someone who is in need of care has lost some degree of independence. They have to be able to depend on the person or people providing assistance to them.

Imagine being unable to obtain your own meal, bathe yourself, get dressed, or go to the bathroom independently. Imagine the feelings involved when you lose that independence and have to ask for help. Imagine having no one to count on when you need them.

It is difficult enough for a person to lose independence without having the added burden of finding someone reliable to help them. When you provide care, it is crucial that you are dependable. So many vulnerable seniors’ lives depend on the assistance and care of another to live a safe and happy life.

3. PATIENCE

Besides children, most care recipients are elderly. As we age our bodies no longer move the way they used to. Add an injury, or physical illness and movement is more difficult, slower and may be painful.

Parts of our bodies may not work at all, such as after a stroke, or with a disease such as advanced Parkinsons, or arthritis. With an illness of the brain, such as Alzheimer’s there is memory loss, and loss of the ability to process information.

These are some of the examples that would cause someone to move slowly, respond slowly or repeat conversations. It takes a patient person to provide care when we can move and process quickly, but the person we are assisting cannot.

I often see caregivers contribute to loss of independence because of impatience. We are in a hurried society and typically spend our lives in a fast pace. It can be difficult to slow down to the pace of the person we are caring for, but it is crucial in excellent caregiving.

A good rule is to allow a person to do as much as they can for themselves, and to avoid doing things for a person they can do for themselves. Doing too much contributes to the loss of physical abilities and increased dependence. It can also damage the dignity of a person and this is an important part of their mental health and quality of life.

Give the care recipient ample time to comfortably be assisted with their activities of daily living (ADL’s), and to complete as many tasks as possible on their own. If you aren’t patient, you will end up providing more care, not less. Use the time to slow down your hurried life and enjoy the process of caregiving.

Persons with memory loss will repeat questions, and comments. This can be enough to test anyone’s patience when you’ve heard the same question 30 times that day.

Here again, empathy is needed. EVERY single time a person with dementia asks a question, they truly believe it is the very first time they have asked it. You MUST respond as if it’s the first time you heard the question asked.

I cringe when I hear a caregiver tell a care recipient with dementia, “I just told you”, or “don’t you remember?” This vulnerable person affected by this horrible disease truly doesn’t remember you just told them, and they honestly cannot remember. 

These responses typically come with a frustrated tone of voice, and sometimes anger. Again, empathy counts! Imagine asking someone a question for the very first time, and they respond in an angry voice and scowl, and you know you never asked them before. Rather than getting to this point of frustration become a pro at redirection!

Sometimes redirection can take a while to start working because dementia can cause someone to get fixated on something, but the better you get at it, the less your patience will be tested. Direct the care recipient towards something they enjoy, or change the conversation to a joyful time earlier in their life. Photo albums are always helpful in redirection.

If the care recipient is angry, and uncooperative, give them space, and a bit of time. If they are not in danger of hurting themselves or others remove yourself from the situation. Give everyone time to breathe and calm down. Wait 15 or 20 minutes and reproach in a calm and loving manner. If the source of the frustration is a task that can be put off -- put it off. If it’s something that needs to take place as soon as possible, like changing an incontinence brief, try a different approach.

4. STRENGTH

As I mentioned above, caregiving can be very difficult. Whether you are paid or unpaid there will be days and times when you feel like you are at your limit.

You may be having a bad day yourself, the care recipient may be having a bad day, or you are just burned out. Times like these call for strength.

You must be strong enough to recognize when you are in need of time off, when you need to adjust care, when you need to dig deep within yourself for patience.

Caregiver’s seem to be in a frequent battle with the outside world regarding advocacy and fighting for services, or through red tape of insurance, or healthcare bureaucracy. It takes a lot of patience and strength to advocate for your care recipient.

Recognize what your weaknesses are and when to get additional assistance. If you get frustrated and exhausted it will not only affect you, but it contributes to the person you’re caring for feeling like a burden, and everyone loses.

Take time off, get additional assistance, and again put yourself in a place of empathy. Caregiving is not for sissy’s!

5. Flexiblity

Caregivers have to be some of the most flexible people I know. Things can change in an instant when you are caring for someone. 

Family members can be called home from work, need to get their loved one to the doctor, or hospital. The health situation can fluctuate, and personality and behaviour can change on the drop of a dime.

Paid caregivers can lose a client to a hospital admission, have to stay on their shift longer because of a health crisis, or get a new patient at the last minute. There are constant schedule changes, and client changes. You must be open to change because whether you like change or not, it will happen.

People who value strict schedules and sticking to a routine have a lot of difficulty in the caregiving role. I have spent my career knowing that as soon as I have my day planned out something is sure to change and I will have to tend to whatever has become the priority. Caregiving is best for people who can adapt quickly, and accept change easily.

There are other qualities and characteristics I could talk about, but I believe those stem from the core 5. Being kind, and gentle stems from empathy and patience. Obtaining the best healthcare possible is a result of empathy and strength. Keeping the care recipient safe comes from empathy, dependability and strength. Every situation and every caregiving moment spent will require empathy.

Whether you are providing care now or will be in the future, you have to ask yourself if you are able to put yourself in the shoes of the person, or people you care for.

This requires you to be judgment free of their situation, and have the ability to understand what it must feel like in their place.

If the person has advanced Alzheimer’s, take yourself to the place it would be like when they were healthy, and then started to realize they couldn’t remember things, or lost their way. Understand how it felt to receive the diagnosis of Alzheimer’s, knowing there is no cure and your abilities will most likely diminish. Think about what it would be like to have a stranger bathe or dress you.

If you can do those things, you will always provide care that is of the best quality possible. If you cannot, I recommend alternative care for a family member or another choice of career.

Care recipients deserve no less than the best we have to offer.

ADVICE TO HELP YOU IMPROVE OVERALL MEMORY

Although memory impairment is common as we age and usually is not a sign of a serious neurological disorder, it can be frustrating and socially embarrassing. The minor memory lapses that occur with age-associated memory impairment can't be eliminated completely; however, a number of strategies can improve overall memory at any age.

Place commonly lost items in a designated spot. If you're prone to losing certain items, such as keys or eyeglasses, pick a spot and always put the items there when you are not using them.

Write things down.  If you have trouble remembering phone numbers or appointments, write them down and place the list in a conspicuous spot. Making a daily "to do" list will remind you of important tasks and obligations.

Say words out loud.  Saying "I've turned off the stove" after doing so will give you an extra verbal reminder when you later try to recall whether the stove is still on.

Use memory aids.  Use a pocket notepad, cell phone, wristwatch alarm, voice recorder or other aids to help remember what you need to do or to keep track of information.

Use visual images.  When learning new information, such as a person's name, create a visual image in your mind to make the information more vivid and, therefore, more memorable.

Group items using mnemonics.  A mnemonic is any technique used to help you remember. For example, when memorizing lists, names, addresses and so on, try alphabetizing them or grouping them as an acronym -- a word made from the first letters of a series of words (for example, NATO stands for North Atlantic Treaty Organization).

Concentrate and relax. To remember something, concentrate on the items to be remembered. Pay close attention to new information and try to avoid or block out distractions. It is also beneficial to relax.

Get plenty of sleep. During sleep the brain consolidates and firms up newly acquired information. Studies indicate that people are better at remembering recently learned information the next day if they have had a good night's sleep.

Rule out other causes of memory loss. If you suspect that you are having memory difficulties, consult your doctor. Some medical conditions and certain other factors can cause memory problems that can be corrected. These include depression, hearing or vision loss, thyroid dysfunction, certain medications, vitamin deficiencies and stress.

(Source:  Scientific American Health After 50 Alerts, 16 February 2015)

DEMENTIA AFFECTS "TASTE" MEMORY: DID YOU KNOW?

Getting enough to eat is a fairly common challenge for people with dementia. A study from Japan suggests that trouble recognizing familiar foods or remembering what a dish tastes like could play a role.

The investigators recruited 65 older adults: 30 had Alzheimer's disease, 20 had vascular dementia and 15 healthy participants served as controls. The participants were presented with replicas (so there would be no odors) of three popular dishes in Japan. They were asked to name the dishes and then to identify replicas of food materials included in them. Participants were also asked to name and describe expected tastes -- such as "sweet," "salty" or "bitter" -- of 12 replica foods.

What they found. Compared with healthy controls, those with Alzheimer's disease and vascular dementia had significantly lower scores on the food and taste cognition tests. Eight of 12 dementia patients, described as poor eaters, had especially low taste cognition scores. Imaging studies showed that taste cognition disorders in those with dementia were highly related to damage of the insular cortex -- a region of the brain associated with taste.

If your loved one is not eating enough, talk to the doctor. Any number of problems could be responsible; for example, difficulty swallowing. If a medical cause is ruled out, support groups or Alzheimer's disease organizations can be good sources for practical ways to deal with mealtime challenges.

This study was published in International Psychogeriatrics (Volume 26, page 1127).

(Source:  Scientific American Health After 50 Alerts, 26 February 2015)

TO KEEP YOUR MIND SHARP: DON’T SKIMP ON SLEEP

The health benefits of a proper night's rest have been shown to help numerous conditions, from hypertension to diabetes and depression. Now, increasing evidence points to the importance of good-quality sleep in keeping your memory and cognitive abilities sharp, too.

Experts recommend that older adults get seven to eight hours of sleep each night for overall good health and optimal functioning. Unfortunately, that may be easier said than done because sleep patterns change with age, and older individuals report more problems in getting to -- and staying -- asleep.

According to the National Institute of Health that nearly half of people aged 60 or older report insomnia. In addition, their sleep is not as deep as it was at a younger age, and they tend to wake more often during the night. Chronic pain, increased sensitivity to noise, and medical problems like obstructive sleep apnea and restless legs syndrome also rob older individuals of restorative sleep.

Sleeping Pill Precautions

Be aware that sleeping pills can affect your memory and cognitive abilities. This is particularly true with benzodiazepine-type sedatives, such as diazepam (Valium), temazepam (Restoril), lorazepam (Ativan), oxazepam (Serax) and alprazolam (Xanax and others). Medications in this class have been shown to increase the risk of cognitive impairment and delirium in older adults. Consequently, the American Geriatrics Society (AGS) recommends that drugs in this class not be used for the treatment of insomnia in seniors.

In addition, short-term memory loss has been linked to the over-the-counter antihistamine diphenhydramine (Benadryl), which is also an ingredient in sleep aids such as Tylenol PM and Unisom.

Newer sleep medications, including zolpidem (Ambien and others), eszopiclone (Lunesta) and ramelteon (Rozerem), have come under scrutiny because of reports that some people have experienced incidents like walking, eating or even driving while sleeping during the first few hours after taking the medication, yet having no memory of it the next day. As a further precaution, the FDA warns people who take zolpidem extended-release (Ambien CR) -- either 6.25 mg or 12.5 mg -- not to drive or engage in other activities that require complete mental alertness the following day because levels of the drug can remain high enough to impair these activities.

(Source:  Scientific American Health After 50 Alerts, 2 March 2015)

SAT / 21MARCH15 2.30PM - TALK ON PROBLEMS WITH BALANCING, WALKING AND FALLING - AN EARLY SIGN OF DEMENTIA

To all Caregivers,

We have invited Associate Professor Dr Tan Maw Pin from the Geriatric Medicine, University of Malaya to give a talk at our monthly caregivers sharing session on 21 March 2015.

TOPIC:  Problems with Balancing, Walking and Falling – An Early Sign of Dementia

Day / Date:  Saturday, 21 March 2015

Venue:   ADFM PJ Day-Care Centre, No. 6 Lorong 11/8E, Seksyen 11, 46200 Petaling Jaya    

Program: 

2.00pm    Registration

2.30pm    Talk on “Problems with Balancing, Walking and Falling - An Early Sign of Dementia”

3.30pm     Q&As & Sharing Session

4.30pm     Refreshments

5.00pm     End

Both falls and dementia are very common problems among older people. We know that one in three older persons aged 65 years or older fall every year, and one in five older persons aged 80 years and over suffer from dementia. Recently Professor Joe Verghese in the US published a paper suggesting that certain older individuals who present with falls develop dementia not long afterwards. Don’t worry, it does not mean that once you have fallen once, you will get dementia. What Professor Verghese was referring to is a minority of older people who present with falls as the first sign of their dementia. All doctors who have had some experience in managing older people with falls will tell you that this group of patients definitely exist. Majority of patients we see after a fall will fall because of visual problems, muscle weakness, medications, poor balance, bad choice of footwear or low blood pressure, or any combination of the above factors. In the group of individuals with dementia who first present with a fall, they would have been experiencing brain changes linked to dementia long before the fall, but it’s only after they fall that the family and doctors start seeing the deterioration in memory and other brain function. This has not been fully explained, but it’s likely that the individual and their family were able to adequately compensate for any mild memory problems until the fall then tips the balance, and problems start cascading. In this talk we will be talking in more detail about what causes falls, and how we recognise early dementia, and how we reassure ourselves that the fall is not the first sign of dementia.

The Speaker, Dr Tan Maw Pin graduated from Nottingham University in UK in 1998 and obtained her Membership to the Royal College of Physicians 3 years later while working as a senior house officer in Nottingham. She then obtained a National Training Number in Geriatric Medicine in the North-East of England. In Newcastle upon Tyne she submitted a postgraduate MD thesis on "Autonomic Profile and Cerebral Autoregulation in Neurally-mediated Syncope". After working as a Consultant at the falls and syncope service in Newcastle upon Tyne for 18 months, Dr Tan returned to Malaysia and is now an Associate Professor in geriatric medicine at the University of Malaya. She is committed to research in health issues affecting older Malaysians and is currently the principal investigator to the Malaysian Falls Assessment and Intervention Trial (MyFAIT), and Promoting Independence in our Seniors with Arthritis (PISA) study.

Registration:

·      Forward completed Registration Form to jenny@adfm.org.my or Fax to 03 – 7960 8482  

·      If email or SMS, provide complete details with name/s, mobile contact, indicate you are a caregiver or healthcare worker.

More details, please contact Jenny/Michael at 03-7931 5850. Kindly register early for our refreshment and logistic arrangement.