How in the World Will I Pay for Long-term Caregiving?

Financial planning is an important factor in long-term caregiving.

Having a long-term caregiving plan is a must for family caregivers, especially if their loved one has Alzheimer’s disease or other chronic health conditions. In 2018, the Alzheimer’s Association estimated that the total lifetime cost of care for someone with dementia was  $341,840.

When we placed my husband in a memory care home in 2008, it cost roughly $6,000 a month, which covered a private room and extras like a weekly massage. Everything is more expensive today. The Alzheimer’s Association lists the following median costs for long-term care services in 2021. From what I’ve seen, the costs are typically higher on the East and West Coasts and lower in rural towns, and in the Midwest, the South, and western states.

  • Home care: A paid non-medical home health aide is $24 per hour and $960 per week (40 hours of care).
  • Adult day services: $74 per day.
  • Assisted living facilities: $4,300 per month or $51,600.
  • Private room in a nursing home: $290 per day or $105,850 per year.
  • Semi-private room in a nursing home: $225 per day or $93,075 per year.

What’s the difference between assisted living and a nursing home?

By the time a person with dementia is ready for a care facility, they need lots of assistance so it’s best to consider a home that offers memory care in a locked-down environment. Locked-down isn’t as bad as it sounds. It just means that the residents can’t leave the facility and wander off and get lost. The exterior doors are locked, but residents are usually free to roam the halls and go in and out of their rooms and living areas.

An assisted living home offers some care such as transportation to doctor appointments and help taking medications. And some offer designated living areas for people with dementia. But generally, residents in assisted living facilities are in fairly good health and are able to take care of their personal needs.

A nursing home provides medical care 24 hours a day. Meals are prepared by the staff, residents usually eat in a dining room, or in their own room, and care is provided ranging from help getting dressed and bathing, to rehabilitation from a fall or bone breakage.

People with dementia and Alzheimer’s disease are usually placed in memory care homes that cater to their particular needs. Memory care homes aren’t exactly nursing homes because not everyone with dementia has another physical illness. But the cost is comparable to that of a nursing home because of the amount of hands-on care that is needed, which includes bathing, brushing teeth and getting dressed, toileting, etc.

Consider respite care

Respite care provides short-term relief for primary caregivers. It can be a life savior when you’re at your wit’s end and “just can’t take it anymore.” There’s no need to feel guilty. All caregivers need a break in order to recharge, destress, and take care of their own needs—which is crucial to staying healthy.

Respite care can be provided at home, in a healthcare facility, or at an adult day center. It can be arranged for a few hours or for several days or weeks. For more information about respite care:,

Financial help

As soon as you or a loved one is diagnosed with Alzheimer’s, or other dementia or chronic disease, make an appointment to see an elder attorney. They will inform you of your options and help with long-term planning.

For instance, in Colorado, in 2020, one month in a nursing home costs nearly $9,000. That’s more than $100,000 over the course of a year. Many elderly individuals spend down their life savings on nursing home costs so they can eventually qualify for financial assistance

If both spouses are living, and one of them is healthy, the healthy spouse can be left with little money on which to survive. An elder law attorney can help families avoid this unfortunate, but common, scenario.

The Community Spouse Resource Allowance is useful when there is concern the couple has too many assets to receive financial assistance from Medicaid to pay for long-term care. This particular allowance lets the healthy spouse keep a portion of the joint assets, up to $128,640 in 2020.

Another allowance, the Minimum Monthly Maintenance Needs Allowance, or MMMNA, lets a healthy spouse retain part of their ill spouse’s monthly income. ps://

If you plan to hire an elder attorney, please check reviews and ask for referrals for a competent elder attorney. Unfortunately, the elder attorney I hired made a mess of things for me and my family, and I had to hire an additional attorney to straighten things out.

Other options

• Call 800.827. 1000 or visit In addition to Medicare, the person with dementia may qualify for a number of public programs. These programs provide income support or long-term care services to people who are eligible.

• Contact your local family and senior services office. They can provide you with information about help in the home, long-term care options, legal support, Medicare and Medicaid, public assistance benefits, services, and programs, guidance, and tips on accessing services, caregiver support training, and more.

• Contact your local Alzheimer’s Association for information about services and support groups. They offer classes for caregiving on everything ranging from financial planning to how to get your loved one to take a shower.

Taking time for yourself

Caregivers get burned out if they don’t take some time off to recharge. And in the worst-case scenarios, caregivers end up being sick and having to be taken care of. If you don’t take care of yourself, who will take care of the person you were lovingly taking care of?

Here are links to a couple of articles I posted on this blog about ways that caregivers can achieve more peace and less stress.,

Have a safe, satisfying, and stress-free (as much as possible) Thanksgiving. And please take a little respite time for yourself, even if that entails just walking around the block for 30 minutes.

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie, and many other fine independent bookstores, as well as public libraries.

Healthy and delicious winter squash recipes

Butternut squash soup with apples and sweet paprika

The color orange is everywhere right now, and the view from my office window is exquisite. Although I dislike seeing the trees lose their leaves to winter, the period building up to the ‘big shed’ is resplendent with color. Pumpkins adorn doorsteps and soups and stews burst with color and the wonderful antioxidant, beta carotene, that provides us with a natural immune booster.

Here are a few of my favorite winter squash recipes to help make your autumn a cozy and healthy season.

Curried butternut squash soup with apples from The Silver Palate Cookbook4 Tbs sweet butter (serves 4-6)

  • 4 Tbsp sweet butter
  • 2 cups finely chopped yellow onions
  • 4-5 tsp curry powder
  • 2 medium-size butternut squash –(about 3 pounds altogether)
  • 2 apples, cored, peeled and chopped
  • 3 cups chicken soup
  • 1 cup apple juice
  • Salt and freshly ground black pepper, to taste
  • 1 shredded unpeeled Granny Smith apple garnish


  1. Melt the butter in a pot. Add chopped onions and curry powder and cook, covered, over low heat until onions are tender, about 25 minutes.
  2. Peel the squash , scrape out the seeds, and chop the flesh.
  3. When onions are tender, pour in the stock, add squash and apples, and bring to a boil. Reduce heat and simmer, partially covered, until squash and apples are very tender, about 25 minutes.
  4. Pour the soup through a strainer, reserving liquid, and transfer the solids to the bowl of a food processor or mixing bowl. Add 1 cup of the cooking stock and process until smooth. You can also use a hand blender or plunger, also called “smart sticks.”
  5. Return pureed soup to the pot and add apple juice and additional cooking liquid, about 2 cups, until soup is of desired consistency.
  6. Season to taste with salt and pepper, simmer briefly to heat through, and serve immediately, garnished with shredded apple.

Stuffed acorn squash (serves 4)

  • 2 acorn squash
  • 2 tsp olive old
  • 1/4 tsp kosher salt
  • 1 cup chopped leeks (1 small leek)
  • 1 cup chopped apple or pear (1-2 fruit)
  • freshly ground pepper
  • 2 cups sliced tender greens into ribbons (Swiss chard, spinach, kale)
  • 4 fresh sage leaves, coarsely chopped
  • 2 cups cooked quinoa, millet or rice
  • 1/2 cup grated cheddar cheese
  • 1/2 cup roasted pecan pieces


  1. Preheat oven to 375 degrees.
  2. Cut 2 acorn squash in half through the stem, and remove seeds and strings
  3. Place squash flesh-side down in the dish and bake until very tender when pricked with a fork, 30-40 minutes. Remove from the oven and raise oven temperature to 425 degrees.
  4. Place olive oil in a skillet and cook the leeks until soft, about 3 minutes. Add apple, 1.4 tsp salt, pepper and cook for an additional minute.
  5. Add cooked greens, the grain, and pecans.
  6. Cook for another minute, stirring to combine. Remove from heat.
  7. Flip over the squash and fill with the prepared mixture. Sprinkle with cheese and bake about 10 minutes until the cheese melts.

Okay, so cake isn’t the healthiest, but once in a while it’s a delectable treat. My college roommate’s mom made this for us when we went to her home for a weekend. Although I don’t make it often, it always comes out perfectly and it’s a sure hit.

Pumpkin cake

  • 2 cups cooked pumpkin or 1 can of pumpkin
  • 2 cups flour
  • 1 cup coconut sugar (I always cut the amount of sugar by half. The recipe calls for 2 cups.)
  • 2 tsp cinnamon
  • 1 cup coconut oil
  • 4 eggs, beaten
  • 2 tsp. baking soda
  • 1/2 tsp salt

Mix eggs and sugar. Beat well. Add oil and beat. Add flour, spices, and salt. Blend in pumpkin and beat well. Pour into greased tube pan. Bake 40-50 minutes at 350 degrees.


  • 8 oz pkg cream cheese
  • 1 stick butter
  • 1 tsp vanilla extract
  • 4 cups powdered sugar
  • Combine butter and cream cheese in the bowl of a stand mixer (or you may use an electric mixer) and beat until creamy, well-combined, and lump-free.
  • Add vanilla extract and salt and stir well to combine.
  • With mixer on low, gradually add powdered sugar until completely combined.
  • Use to frost completely cooled cake or cupcakes.

Enjoy! Have a happy and safe Halloween!

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie, and many other fine independent bookstores, as well as public libraries.

Can you prevent COVID-19 with supplements or medications?

Man fighting viruses and bacteria

The short answer is not really. But there’s a lot you can do to boost your immune system.

You’ve probably heard about the use of ivermectin, the anti-parasite drug that people are using to prevent COVID. Clinical trials have repeatedly failed to demonstrate the drug is effective against the virus. Yet, many continue to ignore the warning that taking ivermectin can cause harmful side effects and even death.

The confusion arose initially because the use of ivermectin in India was showing some promising results. Shortly after, however, the group that was recommending it updated their guidance. Their original message was that ivermectin shortened and lessened symptoms based on the information from a European panel. Their new guidance recommends “against using ivermectin for treatment of patients with any severity of COVID-19. Ivermectin should only be used in the context of a randomized controlled trial.”

Epidemiological data from other countries that recommended ivermectin suggests that ivermectin didn’t slow down the rate of new infection. As of May 2021, there isn’t reliable clinical evidence indicating that ivermectin is beneficial in preventing or curing COVID-19. The WHO and the U.S. FDA have adopted a similar position stating that “ivermectin should not be used for the treatment of outpatients with COVID-19, unless in the context of a clinical trial.”

Remdesivir is the only drug that is approved by the FDA to treat COVID-19. It is NOT used to prevent it.

No supplements have been clinically proven to reduce the risk of contracting COVID-19. However, it doesn’t hurt, and it may very well help, to boost your immune system in the same way you would in order to stave off colds and flu.

Vitamins and minerals that support your immunity

Vitamin A

Beta Carotene is the antioxidant of choice for people who are unsure about which vitamin A to take. It is the precursor of vitamin A and can be converted into vitamin A if the body needs it. It gives added protection to the immune system, skin, eyes, and lungs.

Vitamin B complex

B vitamins are important for a healthy immune response, and numerous healthy body processes.

Vitamin C

Vitamin C (as ascorbic acid, calcium ascorbate) is the body’s primary water-soluble antioxidant, which makes it an important weapon in your immune system’s arsenal against bacteria and viruses. It also helps protect unsaturated fatty acids, and the fat-soluble vitamins A and E from being oxidized, therefore protecting their potency.  Since your body can’t manufacture it, vitamin C must be obtained through diet and supplementation. A protective vitamin essential to over-all body health, vitamin C also helps:  in the production of collagen and maintenance of healthy skin; promote the healing of wounds, scar tissue, fractures;  give strength to blood vessels; prevent and treat the common cold; the body utilize iron and folic acid; support the thymus gland; enhance T-cell production, increasing resistance to viral and bacterial infections, and some allergies.

Vitamin D

Vitamin D supports immunity in two ways: 1) It is necessary for the production of antiviral peptides in the respiratory tract, making the respiratory tract less likely to be infected with a virus. 2) It helps promote a balanced inflammatory immune response.

Researchers at Northwestern University analyzed publicly available patient data from 10 countries and discovered a strong correlation between vitamin D levels and cytokine storm—a hyper-inflammatory condition caused by an overactive immune system — as well as a correlation between vitamin D deficiency and mortality.

According to Ali Daneshkhah, the study’s first author, “Cytokine storm can severely damage lungs and lead to acute respiratory distress syndrome and death in patients. This is what seems to kill a majority of COVID-19 patients, not the destruction of the lungs by the virus itself. It is the complications from the misdirected fire from the immune system.”

The research team believes that this is where vitamin D plays a major role. Vitamin D enhances our innate immune systems, and prevents our immune systems from becoming dangerously overactive. This means that having healthy levels of vitamin D could protect patients against severe complications, including death from COVID-19.

Lead researcher Vadim Backman said, “ Our analysis shows that it might be as high as cutting the mortality rate in half. It will not prevent a patient from contracting the virus, but it may reduce complications and prevent death in those who are infected.


Selenium is an essential trace element obtained from the diet (i.e. fish, meat and cereals) which has been found to affect the severity of a number of viral diseases in animals and humans.

Margaret Rayman, Professor of Nutritional Medicine at the University of Surrey, said: “Given the history of viral infections associated with selenium deficiency, we wondered whether the appearance of COVID-19 in China could possibly be linked to the belt of selenium deficiency that runs from the north-east to the south-west of the country.”

Examining data from provinces and municipalities with more than 200 cases and cities with more than 40 cases, researchers found that areas with high levels of selenium were more likely to recover from the virus. For example, in the city of Enshi in Hubei Province, which has the highest selenium intake in China, the cure rate (percentage of COVID-19 patients declared ‘cured’) was almost three-times higher than the average for all the other cities in Hubei Province. By contrast, in Heilongjiang Province, where selenium intake is among the lowest in the world, the death rate from COVID-19 was almost five-times as high as the average of all the other provinces outside of Hubei.

Most convincingly, the researchers found that the COVID-19 cure rate was significantly associated with selenium status, as measured by the amount of selenium in hair, in 17 cities outside of Hubei.


You may have used zinc lozenges to shorten the length of a cold. It does seem to work. Zinc has been shown to inhibit various coronaviruses in a couple of studies. SARS coronavirus, and ZN (2+) inhibits coronavirus.  However, it hasn’t been tested on COVID-19. Still, it is always a good idea to make sure you are taking a zinc supplement, and that doesn’t mean the zinc lozenge. Most people are deficient in zinc. A researcher at the University of Pittsburgh recommends taking 25 mg of zinc morning and evening.

Herbs and mushrooms


Echinacea is one of America’s best-selling herbs for fighting colds and upper respiratory illnesses and stimulating the immune system to help fight infections for good reason. It supports the immune system by activating white blood cells, promotes nonspecific T-cell activation, a type of white blood cell that’s important in providing resistance to bacteria and viruses, and it activates a non-specific immune response via a part of the immune system known as the alternate complement pathway.

Astragalus membranaceus (root extract) – also known as huang qi, was used in China for at least 2,000 years before European botanists discovered its medicinal qualities in the 1700s.  In China this popular herb is believed to strengthen chi, the body’s defensive energy that protects against invading pathogens such as bacteria and viruses. Western herbalists classify astragalus as an adaptogenic herb, meaning that it is a substance that normalizes and balances all of the body’s systems, increasing your ability to handle physical and mental stress.

Ganoderma lucidum (fruit extract) – also known as Ling zhi and Rieshi, this mushroom has been highly esteemed in Chinese medicine for more than 4,000  years for its ability to promote longevity and maintain vitality. There have been numerous studies in the past two decades done on the mushroom, and scientists have discovered that it contains anti-inflammatory agents and other compounds including polysaccharides, amino acids, triterpines, ascorbic acid, sterols, lipids, alkaloids, and trace minerals, that are being studied for their effect on the immune system.

Stay healthy by maintaining a healthy lifestyle

These are just some of the immune-boosting and stimulating natural ingredients that can help you stay strong and resistant to the flu and colds. Even more important is getting enough sleep, eating plenty of fruits, vegetables, and low-fat protein, and exercising regularly.

All the best to you and your family for a healthy, beautiful fall.

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie, and many other fine independent bookstores, as well as public libraries.

Is your care partner driving you nuts?

Stressed caregiver

It’s hard to maintain equanimity and patience when your care recipient is constantly repeating him/herself. Of is following you around the house like a puppy dog. Or is accusing you of “stealing” their wallet, or is getting up several times during the night so you’re unable to get the sleep you need for your own health and in order to take care of them without losing your cool.

When I couldn’t handle my husband’s early stage Alzheimer’s behavior, I’d simply leave the house and walk around the block. But as the disease progresses and it isn’t safe to leave your care partner alone in the house, that’s not always possible.

Here are 16 things that might help you keep your sanity, and your care partner’s too. 

  1.  Simplify communication by asking one question at a time. Break down complex ideas, and give only one choice, i.e. when helping your care partner get dressed simply ask “Do you want to wear the blue or green shirt?” Don’t ask open-ended questions. Ask questions with yes or no answers, if possible.
  2. Before speaking, make sure the television, radio, and music are turned off. Look directly in the eyes of your care partner. Use their name and maintain eye contact.
  3.  Provide a gentle physical touch. Just stroking someone’s arm, shoulders or head can reduce agitation.
  4. Put on soothing music. Or, if your care partner loves dance music (Big Band or Rock n/Roll, Latin), turn up the volume and dance!.
  5. Reduce or avoid use of caffeine, sugar, tobacco and alcohol.
  6. Reduce clutter, noise, and the number of visitors.
  7. Bring out the family photo albums to help the person reminisce about happier times. They may not remember what they ate 30 minutes ago, but chances are they will remember special events from the past.
  8. Go for a walk together, or drive to a park where you can sit together and watch children play, or the ducks swim in a pond.
  9. Schedule a relaxing massage for both of you. It will do you good!
  10. Ice cream works like magic. Go for a drive to your favorite ice cream shop.
  11. If your care partner accuses you of stealing their money, let them keep a small
    amount of money in a wallet. When they make an accusation, simply pull out the
    wallet to show them the money is still in there. In case they hide the wallet
    and you’re unable to find it, have a spare one on hand that looks identical to
    the original one.
  12.  If you need to bring your care partner to an appointment, leave plenty of
    extra time for getting dressed, eating, moving from the house to the car, etc.
    If you feel rushed and stressed, they will pick up on your feelings and start
    mirroring them.
  13. Use essential oils to immediately diffuse feelings of sadness, depression, anxiety, etc. Lavender oil is the most frequently used fragrance. You can also try bergamot, grapefruit,
    lemon, orange, clary sage, geranium, rose, and ylang ylang, frankincense, and myrrh. Put the oil in a diffuser or spray bottle to mist your collar or pillow. Find a fragrance that is pleasing to your care partner. It’ll help him/her also.
  14. It’s important to get at least 6 hours (preferably 7 or 8) of sleep every night. Of course, this isn’t always possible if you are caring for someone and need to get up at night, or are worried about paying the bills, taking care of the car, getting a new stove, etc. If you can’t get in the hours at night, put your feet up for 10 minutes during the day when your care partner naps. Or take a power nap. It really helps.
  15. Get help! Hire someone to come in a couple of times a week so you can get out of the house. If your budget doesn’t allow it, contact your county’s area agency on aging or senior care services agency for information about respite care.
  16.  When all else fails, maintain your sense of humor. Towards the end of my husband’s
    10-year Alzheimer’s journey, for some reason, we both shared a lot of
    meaningless laughs, probably because the whole damn journey was so exhausting
    for both us and what else was there to do? I had already shed more tears than I
    had in all the years leading up to the diagnosis.

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie, and many other fine independent bookstores, as well as public libraries.

I’m a little worried about my memory

Woman forgot to pick her granddaughter up from preschool.

Yesterday I had my annual wellness exam. It was the first time that my doctor asked me if I had any memory concerns. It made me sit up straight and realize that I am definitely in the age group of people who start showing signs of mild cognitive impairment. I nodded or shook my head in response to her questions and then said, “When I walked into my bedroom the other door I completely forgot why I had gone in there. My little granddaughters were playing hide and seek and when I said, ‘I don’t know why I came in here,’ they looked up at me confused and wondered why I was acting a little strangely.'”

Was I concerned? Yes, a little. I’ve done that before, but this time I was frozen for a few seconds. And actually, lately I’ve noticed that my spelling isn’t as sharp as it used to be. Neither is my long-term memory.

I’m even more concerned because I took the MindCrowd test, a short memory test in which you need to read and memorize 12 pairs of words. You’re given one word and asked to complete the pair, before the screen moves rather quickly to the next pair. To be honest, I didn’t do very well, and I was a little nervous while I was taking the test. It was more difficult for me than the Mini Mental Exam, which is given to people who are evaluated for Alzheimer’s disease.

As I said to my doctor, I know I don’t have Alzheimer’s disease. I’m kind of an expert on the disease and symptoms because I cared for my husband who had younger-onset Alzheimer’s disease for 10 years. And I wrote a book about our journey.

But I, and lots of my girlfriends, are somewhat concerned that we’re developing mild cognitive impairment. Should we be worried?

Here’s what I know

Approximately 12-18% of people age 60 or older are living with Mild Cognitive Impairment (MCI).

Researchers have found that more people with MCI than those without it go on to develop Alzheimer’s disease or a related dementia. An estimated 10 to 20% of people age 65 or older with MCI develop dementia over a one-year period.

MCI is more common in men (19 percent) than in women (14 percent), according to a 2010 study in the Neurology.

  • MCI prevalence was higher among people with the APOE e4 gene, a known risk factor for late-onset Alzheimer’s, a form of the disease that usually occurs at age 65 or older.
  • A greater number of years spent in school was significantly associated with decreased MCI prevalence, from 30 percent among participants with less than nine years of education to just 11 percent in those with more than 16 years of education.
  • MCI prevalence was higher in participants who never married, as opposed to those currently or previously married.

Signs of cognitive decline

  • Forgetting appointments and dates.
  • Forgetting recent conversations and events.
  • Feeling increasingly overwhelmed by making decisions and plans.
  • Having a hard time understanding directions or instructions.
  • Losing your sense of direction.
  • Losing the ability to organize tasks.
  • Becoming more impulsive.

I don’t forget appointments, but I do forget events that occurred in the past decade or so. But then again, I’m good at remembering details about many events that others don’t remember. I typically don’t get overwhelmed about making decisions and plans. But then again, I had tons of work this summer and did get a little overwhelmed. I don’t have a hard time understanding directions, unless it’s something like installing a toilet or putting together a new machine, which I will gladly leave for my handyman. I rarely lose my sense of direction, but then again, it’s not as acute as it once was and I do get turned around while hiking sometimes. I never have trouble organizing tasks. In fact, I often multi-task. I am not typically impulsive.

What happens physically to the normal aging brain?

The brain changes more than any other part of the body. Yes, even more than our complexion that withers and wrinkles. Physically, the frontal lobe and hippocampus, the areas involved in higher cognitive function and encoding new memories starts to shrink around age 60 to 70. Fewer synaptic connections are made, which may contribute to slower cognitive processing. White matter, consisting of myelinated nerve fibers that carry nerve signals between brain cells, shrinks, and neurotransmitters that play a role in cognition and memory deceases.

Normal brain aging

  • Difficulty learning something new: Committing new information to memory can take longer.
  • Multitasking: Slowed processing can make planning parallel tasks more difficult.
  • Recalling names and numbers: Strategic memory, which helps with remembering names and numbers, begins to decline at age 20.
  • Remembering appointments: Without cues to recall the information, the brain may put appointments into “storage” and not access them unless something jogs the person’s memory.

So what do I think? Am I developing MCI? I certainly hope not, and I really don’t think so. I spend a lot of time using my cognitive skills. I’m a writer, and am at my best while sitting at the computer writing words. But my memory is definitely not what it used to be, nor is it as good as my mother’s was when she was well into her 80s. But I take ginkgo, phosphatidylserine, B vitamins, and Lion’s mane mushroom, and I know they help because when I don’t take them, my mind is fuzzy. I’m not going to worry, because worrying does no good but add stress. But I will continue to eat a plant-based Mediterranean diet, which is proven to stave off premature aging, and try to get enough sleep and exercise

P.S. I repeated the MindCrowd test and scored really well!

P.P.S. No, I never forgot to pick up my granddaughter from preschool. 🙂

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie, and many other fine independent bookstores, as well as public libraries.

10 ways to get siblings to help with the care of a parent

Family caregiver meeting

Today, June 20, is the longest day and for families in the throes of Alzheimer’s, it probably won’t seem any different than most days. Every day that you spend caring for a loved one whose needs are demanding is the “longest day.” In order to reduce the burden on yourself, it’s imperative that you carve out some “me time” each day. You’ve heard it before, but it is worth repeating: You need to take care of yourself, because if you get sick who will take care of your loved one?

Sharing the care

If you’re caring for a parent, have you had a conversation with your siblings about sharing the responsibility? Family dynamics and unresolved issues can make it harder to get everyone to pitch in. And of course, location makes a huge difference. An adult child who lives nearby the parent needing help, typically bears the brunt of the responsibility. In fact, a study done by the National Health and Aging Trends (2011-2017) found that three quarters of older adults reported receiving help from only one child.

In order to avoid resentment, divvy up the tasks.

Here’s how

  1. Have a family meeting. If there already is conflict and disagreement among siblings, find a professional to facilitate the meeting in a neutral place, such as a library meeting room, a church, mosque, temple, or synagogue, etc. If the parent being cared for wants to be included and is cognitively aware, include them.
  2. Introduce the purpose of the meeting and have an agenda. Begin with facts such a “Mom or Dad needs full-time care.” Or, “it’s time to move Mom or Dad to a memory care because she/he needs more care than I can provide.” Or, “Mom or Dad is still able to stay at home, but needs assistance. How can each of us help?”
  3. To clarify the situation, maybe include a doctor or nurse explain the medical issues and forecast what the future will look like.
  4. Next, discuss the care plan. Who can provide hands-on care at home? What kind of financial contribution can everyone provide? If the parent can remain at home, split up the day-to-day tasks such as grocery shopping, meal preparation, rides to the doctor, picking up medications, providing companionship, housecleaning, yard-care, etc.
  5. Acknowledge everyone’s feelings. Individuals will be at different places in their own lives. One sibling may be a new parent. Another may have lost their job. Or a sibling may live thousands of miles away. Or a sibling may be angry at a parent and not want to be involved at all. In these cases, ask gently if there is anything they can do to lighten the load for the others.
  6. If your parents have planned for retirement and were proactive about estate planning, your task will be easier than if they haven’t. Have them help you find the appropriate papers and resources as soon as possible while they are capable. Get the names and contact information for their legal professionals and make sure someone has been designated as power of attorney and durable medical power of attorney. If your parents have not done due diligence in sorting out their affairs and they are still able to, you need to stress the importance of doing so immediately. This is extremely important in the care of a parent. A sibling who is not involved in the hands-on care should be assigned this task.
  7. We’ve all become zoom experts in the past year and a half. Schedule monthly caregiver meetings so everyone stays informed about your parent’s needs. If a new care plan is needed, discuss the details.
  8. Make sure there is a point person for emergencies. Connect the family on “WhatsApp.”
  9. Take advantage of local resource such as Meals on Wheels and adult day programs.
  10. If siblings are unwilling to cooperate or if the situation escalates into an unmanageable situation, seek help. Call your local Area Agency on Aging. For more information, call the Family Caregiver Alliance, 800-445-8106 or visit and click on Family Care Navigator.

Express appreciation for any help your family is able to provide. Accept your siblings for who they are and understand that not everyone will agree with everyone’s opinion. Sharing the care for parents can either drive a wedge between siblings or bring them closer. Hopefully you’ll be able to communicate like adults and understand each other’s needs during the trying and stressful period that requires parenting our parents.

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie, and many other fine independent bookstores, as well as public libraries.

If you suspect that you or a loved one has Alzheimer’s, you need to read this.

June is Alzheimer’s and Brain Awareness Month. If you suspect that you or a loved one might have Alzheimer’s disease, here’s what you need to know.

After decades of not making progress with pharmaceuticals for Alzheimer’s disease, researchers are finally coming up with some promising results. There’s a brand new blood test for the disease that you can take instead of going through a series of expensive and sometimes painful tests. And there’s a brand new drug that delays cognitive decline in early stage Alzheimer’s. We still don’t have a cure, but there are a number of clinical trials that someone diagnosed with Alzheimer’s can enroll in.

Why it’s important to get diagnosed early

For a full explanation, click here to read a blog I posted August, 20202.

Here are the bullet points:

  • Cognitive problems can be caused by a number of physical conditions.
  • Cognitive symptoms may be reversible.
  • An early diagnosis is empowering as far as estate planning, and end-of-life planning, etc.
  • An early diagnosis is easier for the physician to make when the patient is able to answer questions.
  • Family and loved ones might be confused by particular behaviors which will be explained.
  • An early diagnosis allows individuals to take advantage of support groups, and caregivers to learn ways to better manage medications, the environment, etc.
  • Getting an early diagnosis provides the opportunity to enroll in a clinical trial.
  • The patient can prioritize what is important to them while they are still able to make decisions.

What new tests are available to detect Alzheimer’s?

PrecivityAD is the first blood test for Alzheimer’s to be cleared for widespread use and one of a new generation of such assays that could enable early detection of the leading neurodegenerative disease—perhaps decades before the onset of the first symptoms. The test uses mass spectrometry to detect specific types of beta-amyloid, the protein fragment that is the culprit in Alzheimer’s disease. As plaques in the brain build up, levels of beta-amyloid decline in the surrounding fluid. The levels can be measured in spinal fluid samples. The new blood test can determine where beta-amyloid concentrations are significantly lower. PrecivityAd is designed to be used for people 60 to 91 years old with early signs of cognitive impairment.

How it works

  • Your doctor orders the PrecivityAd blood test and schedules a blood draw appointment.
  • Your blood sample is sent to the lab for analysis by mass spectrometry.
  • Your doctor receives the report and discusses the results with you.

How much does it cost?

The test costs $1,250. Since it is new and is not currently covered by private insurance, Medicare or Medicaid, patients must pay out-of-pocket for the test. A six-month interest-free payment plan is available, and a financial assistance program is available for patients who medically and financially qualify. The assistance program can bring the costs down to between $25 and $400 for eligible patients.

Other causes for memory issues

One benefit of the PrecivityADTM blood test is that if Alzheimer’s markers
are not detected, additional costly tests may be avoidable and your physician can explore other causes for memory and cognitive issues. Other causes for memory issues include: hypothyroidism, head trauma or injury, certain medications or a combination of medications, emotional disorders, depression, strokes, amnesia, alcoholism, vitamin B012 deficiency, hydrocephalus, brain tumors, and other brain diseases.

New drug for delaying symptoms

The FDA recently approved a new drug for Alzheimer’s. Aducanumab isn’t a cure, but it’s the first drug to get this far in an approval process that actually modifies the underlying pathology of the disease, and helps delay cognitive decline in early stage Alzheimer’s. Read about it in my last post.

Clinical research studies for people with early symptomatic Alzheimer’s

The objective of a clinical research study is to answer questions about the safety and effectiveness of potential new medications. These studies have to be completed before a new treatment is offered to the public. There are currently more than 3000,000 clinical studies taking place throughout the world.

For those who are qualified, taking part in research studies offers several benefits:

  • Getting actively involved in their own health care
  • Having access to potentially new research treatments 
  • Having access to expert medical care for the condition being studied, since investigators are often specialists in the disease area being studied
  • Helping others by contributing to medical research

One way to find information about clinical trials is by searching this website: is an interactive online database, managed by the National Library of Medicine. It provides information about both federally and privately supported clinical research. is updated regularly and offers information on each trial’s purpose, who is qualified to participate, locations, and phone numbers to call for more information.

The Alzheimer’s Association also has a service called TrialMatch that provides customized lists of clinical studies based on user-provider information. The free, easy-to-use platform allows you to see which studies are a good fit for you or a family member.
Visit TrialMatch
. You can also call 800.272.3900 or email to get started. You’re under no obligation to participate. You can reach out to researchers directly to sign up, or let researchers know that you are open to being contacted with more information about their study. You can also browse available clinical studies by location and type, or sign up to be notified when new studies are posted that are relevant to you.

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie, and many other fine independent bookstores, as well as public libraries.

New drug cites a 22% reduction in cognitive decline in early stage Alzheimer’s.

The FDA hasn’t approved a new drug for Alzheimer’s disease in more than 17 years. It looks like that is about to change. Aducanumab isn’t a cure by any means, but it’s the first drug to get this far in an approval process that actually modifies the underlying pathology of Alzheimer’s, and helps delay cognitive decline in early stage Alzheimer’s.

How does Aducanumab work?

Amyloid-beta is a protein that is normally present in the brain. In the Alzheimer’s brain the abnormal levels of the protein clump together to form amyloid plaques. Researchers think that these clumps lead to brain cell death.

Aducanumab is a monoclonal antibody that targets amyloid-beta.

Researchers developed it using Neurimmune’s proprietary Reverse Translational Medicine Platform. Neurimmune scientists discovered Aducanumab with a team of researchers at the University of Zurich. The human antibody targets the aggregated amyloid-beta. Through this interaction, Aducanumab could reduce the number of amyloid plaques present in the brain. This ultimately may slow neurodegeneration and disease progression.

Aducanumab in clinical trials

In 2007, Neurimmune licensed the exclusive rights to Biogen, which sponsored several clinical trials investigating Aducanumab in humans. Together, Neurimmune’s and Biogen’s scientists published a study in Nature 2016 that described how one year of monthly intravenous infusions of Aducanumab reduces brain beta amyloid in a dose- and time-dependent manner in patients with pre-dementia or mild Alzheimer’s disease. 1

The history of the clinical trials of Aducanumab is confusing. If you want to read the details about the trials continue reading. If you want the bottom line , scroll down and read from *But Biogen reversed course and decided to continue the trials.

On March 21, 2019, the manufacturer (Biogen) announced it had ended two Phase 3 clinical trials of Aducanumab for Alzheimer’s. The drug had failed a “futility analysis,” which means a clinical trial is stopped when the interim results suggest that it is unlikely to achieve statistical significance.1

But then just five months later, Biogen announced that they were applying for FDA marketing approval. They explained that data gathered in the three months between the start of the futility analysis and the decision to end the trial hadn’t been used in the original analysis. After adding the additional three months of data, they realized that a subset of patients who had been given higher doses saw significant benefits on measures of cognition and function, including memory, orientation and language. Those patients also saw benefits in daily living activities.2

The OptumRx Pipeline Surveillance team observed that despite the positive reported outcomes, Aducanumab has only demonstrated a statistically significant improvement in one of the two pivotal trials. Further, in the one positive trial, the reported improvements were small, and the true clinical relevance of the findings remain uncertain.

Researchers have completed three Phase 1 trials. These were assessing Aducanumab in healthy volunteers (NCT02782975) and in Alzheimer’s disease patients in the U.S. (NCT01397539) and Japan (NCT02434718).

A fourth, randomized, double-blind, and placebo-controlled Phase 1 trial (NCT01677572), PRIME, enrolled 192 pre-dementia and mild Alzheimer’s patients at 32 sites in the U.S. The goal was to assess the safety and effect of different aducanumab doses versus a placebo on amyloid plaques. Researchers measured this with positron emission tomography imaging.

Interim results from the first 165 patients showed that all doses of Aducanumab (given as monthly infusions into the bloodstream) significantly reduced amyloid plaques in the brain in a time- and dose-dependent manner. During the first year, 40 patients from both groups discontinued treatment. Little to no change was apparent in the placebo group after one year. The greatest reduction was present at higher doses. Aducanumab also appeared to slow the rate of cognitive decline. Researchers measured this as a change in the clinical dementia rating sum of boxes (CDR-SB) and the mini-mental state examination (MMSE).

They presented results from a long-term extension of the PRIME trial at the 2017 Clinical Trials on Alzheimer’s Disease meeting. In total, 143 patients from the initial trial opted to continue in the long-term extension study, where all patients received Aducanumab. This included data from patients who had been on Aducanumab for up to three years. During this time, patients who received Aducanumab continued to experience a time- and dose-dependent reduction in amyloid plaque levels.

Biogen also began two large-scale randomized, double-blind, and placebo-controlled Phase 3 clinical trials in people with early-stage Alzheimer’s disease. The first trial, called ENGAGE (NCT02477800), aimed to enroll 1,350 patients at 187 sites in North America, Australia, Europe, and Asia. The second trial, called EMERGE (NCT02484547), also sought to enroll the same number of patients at 194 sites in North America, Europe, and Asia.

The goal of both trials was to assess the efficacy of Aducanumab, given once a month at low and high doses by infusion into the bloodstream. Researchers measured the effectiveness of the treatment by changes from the start of the study in the CDR-SB, MMSE, Alzheimer’s disease assessment scale-cognitive subscale 13 items (ADAS-Cog 13), and Alzheimer’s disease cooperative study-activities of daily living inventory mild cognitive impairment version (ADCS-ADL-MCI) scores over a 78-week period. They had expected to complete the trials in 2022.

The company halted the trials because an independent data monitoring committee found that they were unlikely to meet their primary objective. This was based on initial data from the trials and not on safety concerns. Follow-up visits and closing-out activities for both trials are now complete.

The Phase 2 EVOLVE trial (NCT03639987) began in late 2018 to evaluate the safety of continued dosing of Aducanumab in participants with mild cognitive impairment due to Alzheimer’s disease or with mild Alzheimer’s disease dementia. This trial also was halted in March 2019 as a result of the committee’s findings.

*But Biogen reversed course and decided to continue the trials.

later analysis based on additional follow-up data, showed that EMERGE met its primary goal. Patients receiving the highest dose of Aducanumab experienced a significant reduction in the progression of cognitive and functional impairments. Although ENGAGE failed to meet its primary goal, Biogen stated that data from the sub-group of patients who had sufficient exposure to the medication also showed significant benefits. These and other supportive findings formed the basis of the company’s BLA (Biologics License Application) submitted to the FDA requesting the approval of Aducanumab for the treatment of Alzheimer’s disease.

In August 2020, Aducanumab was granted priority review by the FDA, meaning that the agency plans to expedite the review process to determine whether they will approve the medication. 

Are there any negative side effects from taking Aducanumab?

Researchers said a majority of the test subjects taking Aducanumab showed no negative side effects. In some cases, however, patients experienced swelling in the brain called “amyloid-related imaging abnormalities” (ARIA) and headache.

How is the drug administered?

Intravenous doses of Aducanumab are given about 4 weeks apart over approximately 52 weeks for a total of 14 doses. Qualifying patients can continue into the long-term extension at a dose approximately 4 weeks apart for up to an additional 112 doses.

When will Aducanumab become available?
The FDA process for reviewing applications for approval, called New Drug Applications or NDAs, usually takes around 10 months. Biogen has said the Aducanumab application has about 4,500 files with more than 2.5 million pages of data and information. Biogen believes a decision will be made by June 7, 2021. Though the FDA would continue to monitor the effects of the drug, to ensure no unexpected side effects from prolonged usage, after approval the drug can be made available widely. People with Alzheimer’s disease may have a new medication to take soon.

How much will it cost?

Aducanumab is expensive, with the annual cost projected to be around $50,000 for the recommended dosage, based on one infusion per month. Even if the drug is approved by the FDA, the Centers for Medicaid and Medicare Services can determine for themselves how much Medicaid and Medicare will cover Aducanumab if the cost is high. PET brain scans to detect amyloid beta plaques would probably be necessary to determine aducanumab coverage, and those are expensive as well.

Where can I buy it?

I ordered Memantine for my husband from Europe before it was available in the U.S. India manufacturers provide many of the drugs sold in the U.S. I found this website for an Indian Pharmaceutical company which sells Aducanumab throughout the world.

The problem, of course, with buying Aducanumab from an Indian pharmacy is that you’d have to find a doctor who is willing to administer it intravenously. Since it is expected to be approved this summer, it’s probably more prudent to wait until you can get it prescribed by your doctor. But keep in mind that you might be able to save money by ordering it from India even after it is approved by the FDA.

Although Aducanumab isn’t a cure for Alzheimer’s, it is the first drug that is showing some promise for providing more time to individuals with this insidious disease.


  1. The Lancet. A resurrection of aducanumab for Alzheimer’s disease. Published December 4, 2019. Accessed January 7, 2020.
  2. Bio Space. Biogen Alzheimer’s Plans Met with Hope, Some Skepticism. Published: December 6, 2019. Accessed January 7, 2020.

20 Ways to prevent falls in Alzheimer’s patients

Woman falls on slippery bathroom floor.

People with Alzheimer’s and other types of dementia are four to five times more likely to fall than older people who don’t have cognitive impairment. They are also three times more likely to fracture their hip when they fall, which leads to surgery and immobility. The rate of death following a hip fracture for those with Alzheimer’s is also increased.

A person with dementia may have trouble recognizing sight, sound or touch. Their vision may be distorted, not because of an actual eye problem but because of how the brain interprets what it is seeing. They may have problems with depth perception, get confused by patterns or light intensity, and they may lose coordination of movement and physical strength.

Some of these changes are inevitable and irreversible. However, movement and physical activity can go a long way toward fall prevention.

Scott Salus, occupational therapist and co-owner with physical therapist Daniel Basta, of Kind Rehabilitation says, “One of the main things that helps prevent falls is understanding that a fear of falling is one of the best predictors that someone will eventually fall.

“It’s really important to address falls before they happen. Caregivers need to come from an honest and firm place, because the moment someone has their first fall that can be the moment they lose their independence,” he says.

When Salus’ then-65-year-old, physically-fit mother and her boyfriend were moving, he insisted they look into the future to think about mobility issues. Would it be more prudent to live in a ranch than a multi-level home? “You can start the conversation early and plan for an eventuality that may never take place,” he says.

Salus, who specializes in working with patients with dementia and Parkinson’s, says, “The process of fall reduction is a delicate one that includes practicing every-day activities. We

reassure patients that it’s safe to practice pulling up their pants, or going into a shower fully clothed.”

He evaluates if the patient has vertigo when bending to tie their shoes or getting up from a seated position. Have they had a recent surgery or new diagnosis? How do they manage pain? Do they need a commode, or learn to reposition their arms, feet, and legs when toileting or getting out of a chair?

A physical therapy program might include exercises for strength, flexibility, good posture, and gait training. Learning to maintain balance while you’re walking and distracted or multi-tasking is also important, Salus adds.

The Feldenkrais Method® (Awareness Through Movement® and Functional Integration® developed by Moshe Feldenkrais) is another modality that helps prevent falls by teaching individuals to pay closer attention to the way they move.

Al Wadleigh, a Feldenkrais practitioner who teaches privately and at the Longmont Senior Center, starts a chair class by asking the participants to begin with a scan by turning the awareness inward. “Get a sense of how you’re making contact with the chair and with your feet on the floor. How is your weight distributed on the pelvis? Now roll back and forward to sense how your lower back is in relationship to the chair,” he says.

“We go through the lessons—and there are 2,000 of them—to fill out the idea of exploring and sensing what feels good. It’s to figure out, when given a better opportunity and choice, what the nervous system prefers. It’s development learning in order to change habits from old injuries, surgeries, emotions, work, and thoughts that don’t serve us.”

The aim of Feldenkrais is to invigorate your brain and nervous system with new ways of organizing and sensing your movement in the world. “Around age 50 the brain says ‘we’re not using all our neuro-pathways.’ We have fewer to rely on, so we have to neutralize the old habits in order to live life with more vitality,” Wadleigh adds.

He ends the class by asking participants to do a self-inquiry. One person says, “I’ve done the pelvis rock many times but sitting on a chair made it clearer.”

Wadleigh responds that the smaller the movement the more precise it can be. Once you’re aware of what you’re not aware of, you can fill in those parts.”

Another person with Multiple Sclerosis says that one of his feet was dragging that morning. “Now I can lift it up.” He adds, “I feel a centered-ness since doing Feldenkrais, and have better structure. Now when I stand and I’m reaching for something I’m able to move easier. That’s big for me.”

20 Tips for preventing falls

  1. Have adequate lighting throughout the house; place night lights in the bedroom and bathroom.
  2. Limit liquids after dinner to reduce night-time toileting.
  3. Get adequate sleep.
  4. Remove loose area rugs.
  5. Wear gripping socks, sturdy slippers, or shoes in the house.
  6. Avoid unsafe shoes, i.e. flip flops and high-heels.
  7. Place guardrails where needed.
  8. Stand up slowly.
  9. Use a walker or cane for steadiness.
  10. Declutter and remove excess furniture.
  11. Implement an exercise program to support muscle strength, stability, and balance.
  12. Use a “reach stick” to grab out-of-reach items.
  13. Do not use a step ladder.
  14. Eliminate or reduce alcohol and smoking.
  15. Be wary of medications that cause dizziness, sleepiness, and unsteadiness.
  16. Be attentive to pain management.
  17. Be aware of where your pet is to avoid tripping.
  18. Get adequate calcium and vitamin D to maintain bone health.
  19. Maintain a healthy weight.
  20. Get regular vision and hearing check-ups.
Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie, and many other fine independent bookstores, as well as public libraries.