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.

Resources

1. Changes in Relationships (Web page) Single copy free (800) 272-3900 Available online: http://www.alz.org/living_with_alzheimers_changes_in_relationships.asp

2. Sexuality (Topic Sheet) Single copy free (800) 272-3900 Available online: http://www.alz.org/national/documents/topicsheet_sexuality.pdf

3. Intimacy and dementia: is there a time to stop having sex? Kennard, C. http://www.healthcentral.com/alzheimers/c/57548/24937/time-stop-sex

4. Intimacy, marriage and Alzheimer’s. San Francisco, CA: Eldercare Online. http://www.ec-online.net/Knowledge/articles/intimacy.html

People with Alzheimer’s who get even a mild respiratory or gastrointestinal infection, or a bump or bruise are at risk for having a significant, permanent memory loss, according to a report that was published in the September 8, 2009 issue of the journal Neurology. These patients can have high levels of tumor necrosis factor—alpha (TNF-a)—a protein that is linked to inflammation and is associated with memory loss and cognitive decline.

In the study, which was done at the Clinical Neurosciences Research Division at the University of Southampton, United Kingdom, 222 Alzheimer’s patients were followed for six months. Of those, 110 people had an infection or injury that resulted in inflammation. These individuals had twice the memory loss during that period of time as the individuals who did not have an illness or injury. Researchers attribute the memory loss to inflammation. In patients whose TNF-a levels were high to begin with, an infection increased their memory loss to 10 times more than those who had low TNF-a levels.

Clive Holmes, PhD, lead researcher, said that this population should be vaccinated against the flu, and infections and injuries should be treated as soon as possible.

Tips for keeping you and your loved one healthy and safe

• Inoculate against flu, pneumonia and shingles
• Boost immunity with zinc, vitamin D and vitamin C
• Prevent falls and accidents (recommended: Complete Guide to Alzheimer’s Proofing Your Home by Mark Warner http://store.nexternal.com/shared/StoreFront/default.asp?CS=ageless&StoreType=BtoC&Count1=668834865&Count2=585975289&CategoryID=3&Target=products.asp
• Reduce systemic inflammation with a curcumin (turmeric extract) supplement
• Use a humidifier to moisturize nasal passages and mucous membranes to help keep them healthy
• Engage in gentle exercise to reduce inflammation
• Keep hydrated by drinking at least 6-8 glasses of water each day

It’s not surprising that scientists found that brain inflammation plays a big role in the progression of Alzheimer’s disease in a recent study. The study that was published in the journal Brain, http://brain.oxfordjournals.org/, indicates that an overactive immune system can result in inflammation, and that inflammation is not the result but rather the cause of the disease.

Researchers looked at the tissue of both healthy brains and the brains of people with Alzheimer’s disease. The brains of the people who had Alzheimer’s had higher levels of microglia or immune cells, which suggested brain inflammation. The molecules that regulate the number of microglia became more active as the severity of the Alzheimer’s increased, resulting in even higher levels of inflammation.

Carolyn Gregoire, Senior Health & Science Writer for the Huffington Post, wrote that “In another experiment, researchers showed that the chemical known as GW2580 reduced memory loss and behavioral problems in mice with an Alzheimer’s-like condition. “

The mice that were given a drug containing the GW2580 chemical showed fewer memory and behavioral problems that the untreated mice.

What can you do to reduce risk of inflammation?

Dr. Gomez-Nicola, lead author of the study, is hoping to work with the pharmaceutical industry to find a suitable drub that can be tested in clinical trials on people. Until then,

The findings also suggest that a diet and lifestyle focused on fighting inflammation could be important in preventing Alzheimer’s.

10 Ways to Reduce Inflammation

1. Olive oil contains oleocanthal, a compound that can lower inflammation.
2. Onions—sautéed, grilled or raw— are delicious and packed with antioxidants and anti-inflammatory compounds.
3. Fiber lowers C-reactive protein (CRP) a substance in the blood that’s a sign of inflammation. Foods that high in fiber include oatmeal, chia and flax seeds, bran, apples, raspberries, legumes. Foods containing carotenoids, the photochemical that provides color to foods such as carrots and watermelon, are good for lowering CRP.
4. Cold-water fish such as salmon, tuna, sardines and anchovies contain omega-3 fatty acids that reduce CRP and interleukin-6, another inflammatory protein in your blood.
5. Nuts including walnuts, pistachios and almonds contain monounsaturated fat, protein and fiber that help reduce inflammation.
6. Fruits, especially berries, and raw and cooked vegetables, especially leafy greens, provide antioxidants and anti-inflammatory compounds. Try to get at least 4 or 5 each day and include as many colors of the rainbow, as possible.
7. Herbs and spices including turmeric, garlic, ginger, cayenne, black pepper, cinnamon, allspice, cloves, oregano, rosemary, marjoram, and sage add flavor and anti-inflammatory benefits.
8. Shitake mushrooms contain ergothioneine, and other compounds that inhibit inflammation.
9. Teas, including matcha green tea and tulsi contain anti-inflammatory antioxidants.
10. It’s so important to get adequate sleep and to exercise on a regular basis.

Good luck and feel free to email me with comments and questions.

Traveling during the holidays is always a challenge. And going through security, boarding the plane, and sitting for hours is a double challenge for someone who has dementia. Here are a few tips to make it easier:

• If possible, pack everything in a light backpack to carry on board to avoid waiting at baggage claim.
• Check in online to avoid lines at the airport.
• Leave the lace-up shoes at home. Velcro shoes or slip-on shoes are a must.
•  Most airports have a seating area a few feet from where you pick up your belongings where you can put yourself back together.
• Just beyond that is a handicapped seating area where you can hitch a ride on an electric cart that brings you to your gate.
•  Use the family restrooms, rather than the public restrooms.  Your loved one will appreciate the help.
• Take advantage of early boarding.
•  Bring your own food, snacks and water.
•  Let a flight attendants know about special needs. They are more than willing to help.
•  Don’t worry about your loved one getting locked inside the cabin restroom. It is possible to open the door from the outside.
• Bring a CD player or get headphones for entertainment and relaxation.
• Sit back and try to relax!

Instead of worrying about what to give a friend or loved one who suffers from Alzheimer’s disease or dementia consider this. What that person really wants more than anything is to just be with you.

So here’s a list of things you can do together.

• People with dementia love ice cream. Share a pint of his or her favorite. Bring the toppings and arrange them on a table in little bowls—sprinkles, chocolate chips, chopped fruit, whipped cream, butterscotch or chocolate sauce, etc.
• Watch a comedy together. It doesn’t matter if your loved one can follow the plot or not. If you laugh, he or she will probably join in the merriment. Laughter triggers the production of endorphins; the brain chemicals that reduce the sensation of pain and make you feel good.
• Bring a dog to visit your loved one. If you don’t have one, borrow one. There’s nothing like a friendly pup to cheer someone up and add some excitement.
• Listen to music together. Big Band Music is usually a hit with most 70, 80 and 90 year olds. If your loved one is younger, you can try classic rock.
• Get out the paint brush, paper and water colors. You don’t have to be an artist or art teacher to have fun with your loved one. Painting and drawing is a great way to share time together, and to even express feelings of frustration, irritation and fear—on paper.
• Dance to the music. If your loved one is still mobile help him or her get up and move. The exercise will enhance memories, even if temporarily. A short surge of condensed exercise boosts the compression of memories in both elders in good mental shape as well as those with slight cognitive impairment, according to new research by a team of scientists from UC Irvine’s Center for the Neurobiology of Learning & Memory.http://www.cnlm.uci.edu/
• Go for a drive and get some fresh air. Just getting out of the house or memory care home does a body good. Put on a CD and sing together.
• Hold hands, give a foot massage, tell stories without saying, “remember when . . .”
• Just breathe together and be still in the silence. It’s the greatestgift of all.

I recently went to the funeral of the last person in my Alzheimer’s support group to die. When we and our spouses stumbled through the dark early days of trying to figure out where to turn for support and information, we formed a club that no one ever chooses to join: the Alzheimer’s early-onset support group. We’d meet together in one room with a group facilitator and celebrate birthdays and anniversaries, and tell travel stories before breaking into two groups: 1) the memory loss group and 2) the caregiver group.

The memory loss group usually did an activity like an art project, led by someone trained in Memories in the Making™, or had a discussion on a topic such as why they were angry about the car keys being taken away. The caregiver group vented until the inevitable tears would fall, and we’d support each other with tips about how to go out to eat with your loved one, whether to sleep in the same bed and continue to have sex, or how to get through airport security without your loved one freaking out.

The group no longer meets because our care partners are all gone. They’ve all died from the disease that claims the lives of about 84,000 Americans each year. So, the next question is “what happens when you are no longer a caregiver and you can begin to carve out time for yourself again?”

Life after caregiving seems broad and vast. There is so much time to fill. Figuring out how to fill it can be a challenge or a breath of fresh air. It all depends on the disposition of the person, and the number of years spent caregiving. Someone who has been a full-time caregiver for 10 or 15 or 20 years will have a more difficult time than someone who has been a caregiver for one or two years. Or, maybe not. Maybe after being a caregiver for so many years that person has already decided what to do with the rest of his or her life. Or, maybe that caregiver has lost her identity and feels lost and lonely, and that life is meaningless. Or, maybe another caregiving situation suddenly appears.

My friend, whose husband died last week, knows she wants to go back to school. “Since Paul was so involved in education, I feel driven to get another degree,” she told me.

After the caregiving ends, people experience a wide range of emotions including relief, sadness, grief, emptiness, and loneliness. Some people feel like exploding and letting out all the anger and grief that was bottled up during the time they spent caregiving. Some people feel at peace, knowing that they did everything they could for their loved one. Others look forward with excitement and eagerness to turn the page and write a new chapter of their life.

Whatever you feel, it’s okay. You might need professional support or to lean on the shoulder of a best friend. It’s a new day, and the world is yours to shape in any way that you want to.

For more information on the topic of post-caregiving visit www.aftergiving.com andwww.caregiving.com

Scientists at Georgetown University have found a way to determine if a person has a good chance of developing Alzheimer’s disease within three years. The test was identified in a preliminary study involving 525 people aged over 70. The work identified a set of ten lipid metabolites in blood plasma that distinguished with 90% accuracy between people who would remain cognitively healthy from those who would go on to show signs of cognitive impairment.

The latest study, which is published in Nature Medicine, was led by neurologist Howard Federoff of Georgetown University Medical Center in Washington DC. He and his colleagues tested the participants’ cognitive and memory skills, and took blood samples from them, around once a year for five years. They used mass spectrometry to analyse the blood plasma of 53 participants with mild cognitive impairment or Alzheimer’s disease, including 18 who developed symptoms during the study, and 53 who remained cognitively healthy. They found ten phospholipids that were present at consistently lower levels in the blood of most people who had, or went on to develop, cognitive impairment. The team validated the results in a set of 41 further participants.1

“We don’t really know the source of the ten molecules, though we know they are generally present in cell membranes,” says Federoff. But he proposes that concentrations of the phospholipids might somehow reflect the breakdown of neural-cell membranes. Federoff emphasizes that his results will have to be validated in independent labs, and in much larger studies: “We also have to look at different age groups and a more diverse racial mix, and we need longer study periods.” 1

What are the pros and cons of learning that you will probably succumb to Alzheimer’s disease?
Pros:
1. It gives you time to get things in order, including financial and interpersonal affairs.
2. You might make an extra effort to check things off your bucket list.
3. When the blood test becomes available, there might be drugs available that do a better job of staving off symptoms of the disease, that you could take advantage of.
4. A positive test result would allow you to participate in a clinical trial that might help you personally, and might also change the future for other Alzheimer’s disease patients.
5. Learning that you might develop Alzheimer’s disease could provide the impetus to live as well as possible by exercising, eating a nutritious diet, and reducing bad habits such as smoking and drinking too much.
Cons:
1. Learning that you will probably start losing your mind could have a negative impact on your emotional and mental well being.

Reference

1. Mapstone, M. et al. Nature Med.http://dx.doi.org/10.1038/nm.3466(2014)