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Monthly Archives: April 2016
Why you should see a doctor if you’re worried about your memory
I’ve done it. You’ve probably done it, too. Forgetting where you parked your car is not uncommon. Once I parked in a four level garage at a mall and walked up and down the stairwell with my then-teenaged daughter, who couldn’t find the car either. I ended up calling security and had the guard drive me through the parking garage until I found the car. That was a bit embarrassing. But forgetting where you parked or the name of a familiar face are common age-related memory lapses. I’ve always been lousy at remembering names of people I know, characters from novels, and the names of movies and actors. That doesn’t mean I’m losing it. My explanation, although it might not be scientific, is that I have so many facts and information stored in my brain that my memory is discretionary.
But if you have difficulty recognizing a relative, find your missing keys in the refrigerator, or get lost driving in the town you’ve lived in for years, you should make an appointment with your health care provider. Because if you do have cognitive impairment, the sooner you get help the better.
One of the first signs that my husband (who died from early-onset Alzheimer’s disease) was having memory lapses was that he started getting lost while driving the car in our home town. That scared him, and it scared me. I finally got him to agree to see a doctor, two years after I suspected that something was wrong.
There are lots of reasons to see a doctor if you or your loved one suspects that you are having cognitive difficulties.
- Individuals who start to forget things or get confused can become depressed, anxious, angry, and/or frustrated because they don’t understand why their thoughts aren’t clear or why they are having difficulty performing certain tasks that were always easy. My philosophy is that knowledge is power. It’s better to know what is happening than to be left in the dark. A consultation with a health professional can help explain what is going on.
- According to researchers at the University of Michigan, more than half of older adults with signs of memory loss never see a doctor about it. Although there is still no certain way to prevent or forestall most cognitive diseases, knowing that someone has serious memory problems can alert family members and friends to a need for changes in the person’s living arrangements that can be health-or even life-saving. Early evaluation and identification of people with dementia may help them receive care earlier,” says study author Vikas Kotagal, M.D., M.S. “It can help families make plans for care, help with day-to-day tasks including observed medication administration, and watch for future problems that can occur. In some instances, these interventions could substantially improve the person’s quality of life.”
- If driving becomes difficult it’s important to get an evaluation from your local Driver Motor Vehicle department because of liability and safety issues. This is a very touchy subject and was one of the most difficult thresholds for my husband and me to cross through. He continually blamed me for being the ogre who took away his car keys. But it’s important to know that if a caregiver, spouse or other significant family member knows that a loved one has a diagnosis of Alzheimer’s or other dementia, that family member could be held responsible in case of an accident. If, god-forbid, someone is killed, the repercussions could be emotionally, physically and financially disastrous.
What Should You Do?
- Make an appointment with your general physician and express your concerns. Your doctor will ask you some questions such as: how are you sleeping at night? How often do you drink alcohol? Are you sedentary? Do you exercise? Are you depressed? What is your typical diet? Your doctor might do a blood panel to determine if you have any organic markers such as low thyroid or anemia that could affect your energy and memory.
2. Your doctor might give you a brief memory assessment or refer you to a memory clinic for further evaluation. The MMSE (Mini-Mental State Exam,http://www.mountsinai.on.ca/care/psych/on-call-resources/on-call-resourc…) is an eight-minute test that has been used since 1975. According to neurologists, the 10-12 minute MoCA (Montreal Cognitive Assessment,http://www.mocatest.org/about/), used since 1996, is more discerning.
Don’t delay. Make an appointment if you or your loved one has memory concerns.
10 Signs of Alzheimer’s Disease
1. Memory loss that disrupts daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality
Kotagal V, Langa KM, Plassman BL, Fisher GG, Giordani BJ, Wallace RB, Burke JR, Steffens DC, Kabeto M, Albin RL, Foster NL. Factors associated with cognitive evaluations in the United States. Neurology. 2015 Jan 6;84(1):64-71.
Can vitamin E slow functional decline in patient’s with Alzheimer’s?
First we heard that vitamin E helps, and then we heard that it does not help prevent Alzheimer’s disease.1 The newest research suggests that a daily dose of 2000 IU per day of vitamin E might help to slow functional decline for patients with mild to moderate Alzheimer’s, and that it could help reduce the amount of care these patients require by two hours a day.
Most studies of vitamin E, including this new one, have focused on alpha-tocopherol, a synthetic form of vitamin E. This is extremely significant because in its natural form vitamin E consists of many compounds—including d-alpha tocopherol, high gamma tocopherol, mixed tocopherols and tocotrienols—that have been proven safe and beneficial. If the natural form of vitamin E had been used in this study, the outcome might have been even better. And if it had been used in the countless studies done over the years, many of which were negative, the results might have been different.
In the current study, researchers followed 613 patients with mild to moderate Alzheimer’s disease, all of whom were taking an acetylcholinesterase inhibitor (Aricept, Exelon, Razadyne). Of these patients, 155 received 20 mg a day of memantine – a class of drugs used to treat Alzheimer’s – while 152 patients received 2,000 international units a day (IU/day) of vitamin E, 154 received a combination of both and 152 took a placebo. The patients who took the vitamin E had a 19% reduction in their functional decline, compared with the patients who received the placebo. The researchers said that this was equivalent to approximately 6.2 months in time over the 2.3 year follow-up period.
They also noted that memantine and a combination of both memantine and vitamin E demonstrated no clinical benefit for the patients.
The researchers pointed out that functional decline as a result of Alzheimer’s disease is increasingly recognized as having a significant impact on a patient quality of life, as well as putting a strain on social and economic costs. But they said their findings suggest that vitamin E could combat these factors.
What you should know
Vitamin E is naturally found in a variety of foods including eggs, fortified cereals, meat, nuts, poultry, some fruits and vegetables (green, leafy vegetables, avocados, asparagus, kiwi, broccoli, pumpkin, sweet potato, mangos, tomatoes, papayas), wheat germ, sunflower and safflower oils.
Taking a high dosage of alpha-tocopherol alone has been shown to deplete the body of other forms of vitamin E, which are much more powerful antioxidants and have been proven to have unique health properties. And taking a single form of vitamin E, such as synthetic alpha-tocopherol, denies the very fact that nature offers seven different forms of tocopherols and tocotrienols for a reason.
In order to get the full protective benefits of vitamin E, it’s important to make sure you’re taking a supplement that contains a full spectrum of vitamin E compounds—including d-alpha tocopherol, high gamma tocopherol, mixed tocopherols and tocotrienols.
The bottom line is this: Based on the large body of scientific evidence that’s been published over the past several decades, we should all be taking a wholesome full spectrum vitamin E … because full spectrum vitamin E is safe and good for your heart, your brain, your overall health, and as a protectant against cancer and degenerative diseases.
1. Isaac MG, Quinn R, Tabet N. “Vitamin E for Alzheimer’s disease and mild cognitive impairment.” Cochrane Database Syst Rev. 2008 Jul 16;(3):CD002854. doi: 10.1002/14651858.CD002854.pub2.
2. Dysken Mw, et al. “Effect of vitamin E and memantine on functional decline in Alzheimer disease: the TEAM-AD VA cooperative randomized trial.” JAMA. 2014 Jan 1;311(1):33-44. doi: 10.1001/jama.2013.282834.
Seniors get a free cognitive exam as part of Medicare’s yearly wellness exam
Take advantage of this free cognitive exam. If you are a senior, it could make a huge difference in your overall well-being.
Despite clear signs that their memory and thinking abilities have gone downhill, more than half of seniors with these symptoms haven’t seen a doctor about them, a new study finds. 1
University of Michigan researchers and their colleagues say their findings suggest that as many as 1.8 million Americans over the age of 70 with dementia are not evaluated for cognitive symptoms by a medical provider, which in some patients can lead to a failure to uncover modifiable causes of thinking or memory impairment. 1
The study, published online in Neurology, the medical journal of the American Academy of Neurology, documents a clear lack of clinical testing for seniors with signs of cognitive problems.
“Early evaluation and identification of people with dementia may help them receive care earlier,” says study author Vikas Kotagal, M.D., M.S., who sees patients at the University of Michigan Health System and is an assistant professor in the U-M Medical School’s Department of Neurology. “It can help families make plans for care, help with day-to-day tasks including observed medication administration, and watch for future problems that can occur. In some instances, these interventions could substantially improve the person’s quality of life.”
For instance, knowing that a stroke or vascular issues in the brain caused dementia means patients can work to control risk factors like blood pressure that might otherwise cause it to keep worsening. If your physician suspects Alzheimer’s disease, there are drugs that can help delay the onset of full-blown dementia, and the possibility of placement in a memory care facility, which can help offset the catastrophic cost of the disease.
If you’ve had Part B for longer than 12 months, you can get the free Medicare Annual Wellness Exam to develop or update a personalized plan to prevent disease and disability based on your current health and risk factors. The exam includes:
• A review of your medical and family history
• Developing or updating a list of current providers and prescriptions
• Height, weight, blood pressure, and other routine measurements
• Detection of any cognitive impairment
• Personalized health advice
• A list of risk factors and treatment options for you
• A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.
This visit is covered once every 12 months (11 full months must have passed since the last visit).
Don’t delay. Call and make an appointment today. It’s free for all people with Medicare, and it’s to your and your family’s benefit.
- In addition to Kotagal, the study’s authors include Kenneth Langa, M.D., Ph.D., who holds professorships in both the U-M Medical School and Institute for Social Research; U-M neurologist Roger Albin, M.D., U-M neuropsychologist Bruno Giordani, Ph.D. and U-M researcher Mohamed Kabeto, M.S. Authors from other institutions are Brenda Plassman, Ph.D. of Duke University, who directs the ADAMS study from which the data on dementia patients was obtained; and James Burke, M.D., Ph.D., Gwenith G. Fisher, PhD, Robert B. Wallace, MD, MS, David C. Steffens, MD, MH and Norman L. Foster, MD. Langa is a member of the U-M Institute for Healthcare Policy and Innovation.
The study was supported by the University of Michigan, the National Institute on Aging (AG027010, AG009740, and AG007137), and University of Utah. Reference: Neurology,doi/10.1212/WNL.0000000000001096
Sexual Intimacy Between Care Partners
The topic of sex is often uncomfortable in the best of relationships in the best of times. The topic is especially prickly when one of the partners has Alzheimer’s disease.
There are no rights or wrongs when it comes to sexual intimacy between care partners, and sometimes the topic gets shoved under the rug and totally forgotten. But what if the person with Alzheimer’s has an increase in sexual desire and the care partner wants nothing to do with sex?
A person with dementia might express unusual behaviors, and feelings can get hurt when one care partner rejects the other. Sexual intimacy between a caregiver and person who has dementia eventually wanes because at some point the roles of the two people in the relationship change. The caregiver might feel that he or she is caring for a child, and it’s unnatural for a parent to have sex with his or her child. But human beings are sexual creatures. We need and thrive on physical intimacy and touch.
Here are some suggestions to help you navigate the challenges of fulfilling sexual and/or intimacy needs while coping with Alzheimer’s disease or another form of dementia.
If you are a caregiver who would like to continue a sexual relationship with a loved one who is in a memory care home it’s important that your needs are respected by the care staff. Ask them to respect your need for privacy, and determine the best time for an overnight stay.
- As embarrassing as it might seem, magazines such as Playboy or Maxim can provide the stimulation that a male needs to fulfill his sexual needs.
- A weekly or bi-weekly massage provides intimate physical contact. Combined with aromatherapy it’s a wonderful way to nourish a person’s natural desire for human touch. If you are uncomfortable doing the massage, then hire a professional massage therapist.
- Getting into bed with a loved one and cuddling or spooning promotes physical intimacy.
- Holding hands and sitting side by side while listening to music, watching a movie, or looking at photographs is a sweet way to connect with another person.
- Caregivers whose care partners no longer recognize them might develop new emotional ties that lead to a sexual relationship. Newfound happiness can erase feelings of loneliness and despair, but feelings of guilt can also arise. In cases such as these speaking with a therapist can help clarify and alleviate conflicted feelings.
- Changes in Relationships (Web page) Single copy free (800) 272-3900 Available online: http://www.alz.org/living_with_alzheimers_changes_in_relationships.asp
- Sexuality (Topic Sheet) Single copy free (800) 272-3900 Available online: http://www.alz.org/national/documents/topicsheet_sexuality.pdf
- Intimacy and dementia: is there a time to stop having sex? Kennard, C. http://www.healthcentral.com/alzheimers/c/57548/24937/time-stop-sex
- Intimacy, marriage and Alzheimer’s. San Francisco, CA: Eldercare Online. http://www.ec-online.net/Knowledge/articles/intimacy.html