Category Archives: Alzheimer’s

Summertime Eating Tips to Help Caregivers Keep Their Cool

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Background texture of pink and white rose petals

Rose Petals Make a Delicious Cooling Drink and Jelly

 

It’s summertime and the livin’ is easy—or at least we’d like it to be. If you’re tired and stressed out from caregiving, here are some tips to help you stay cooler in summer.

According to the ancient Indian system of Ayurveda our body consists of three main elements or doshas—Vatta, Pitta and Kapha. Pitta consists of water and fire. It’s hot, so during summer when the temperature rises we want to eat cooling foods. Eating cooling foods not only keeps us from overheating, it reduces the tendency to get irritable, impatient and angry.

  • 1) First and foremost, stay hydrated. It’s especially important to make sure you and your loved ones are getting enough liquids because when we forget to drink we can become dehydrated quickly, which leads to other health problems. It’s also crucial to keep the brain hydrated in order to maintain mental alertness. Drink plenty of water and stay away from carbonated and caffeinated drinks. Herbal teas, and fresh fruit or vegetable juices are great in summer. Just remember that fruit juices are high in sugar and calories.
  • 2) Enjoy the bounty of summer fruits and vegetables. The summer fruits such as peaches, apricots, cherries, watermelon, cantaloupe, and berries are especially good for helping the body reduce the fiery heat of summer. According to Ayurveda, some of the recommended summer vegetables include cucumber, green leafy vegetables, green beans, squash, zucchini, asparagus, beets and eggplant.
  • 3) Sprinkle on the herbs and spices. They’re easy to use and contribute added flavor and antioxidants to your diet. Cooling spices include cardamom, coriander, fennel and tumeric. Cooling herbs include cilantro, mint and dill.
  • 4) Avoid hot, sour and salty foods including fermented food, red meat, and greasy and spicy food. Excess pitta aggravates the tendency towards heartburn and gastric hyperacidity.
  • 5) Here’s some good news—Ayurveda recommends ice cream during the hot summer months! So by all means, enjoy! Dementia patients are especially fond of ice cream. If the person you are caring for refuses to eat or eats very little, try serving ice cream. It contains protein, calcium and calories, and it’s easy to serve and eat. If weight gain or cholesterol is a concern, select a dairy-free version of America’s favorite dessert. Rice Cream, Coconut Bliss and Soy Delicious make delicious non-dairy, frozen desserts.
  • 6) My roses are bursting with fragrance and beauty. Roses are especially cooling and ff you have rose bushes that are free of chemicals, here’s a special treat to make: Rose Petal Jam. It’s fun and easy and the person you are caring for might even like to get into the act. It’s also very cooling and pacifies irritability. Spread it on toast, put a teaspoon on top of a scoop of ice or add it to warm milk for a yummy nightcap. (see recipe below)
  • 7) Make a lassi using a tablespoon of rose petal jam. Or use this delicious recipe to make the classic, cooling Indian-style milkshake.

Rose Petal Jam

Ingredients

  • ◦ 1 cup fresh rose petals (must never have been sprayed with any chemicals)
  • ◦ 3/4 cup water
  • ◦ 1 lemon, juice of (1/4 cup)
  • ◦ 2 1/2 cups sugar or evaporated cane juice crystals
  • ◦ 1 package pectin
  • ◦ 3/4 cup water

Directions

  1. Puree rose petals, 3/4 cup water and lemon juice in blender until smooth.
  2. Slowly add sugar.
  3. Blend till all sugar has dissolved; (leave in blender) Stir 1 package pectin into 3/4 cup water, bring to a boil, and boil hard for 1 minute. Pour mixture into blender with rose petal mixture until well blended.
  4. Do this very quickly – it sets up FAST!! Pour into small, sterilized jelly jars.
  5. Let set for 6 hours, till firm.
  6. Will keep one month in refrigerator.
  7. Freezes well.

 

Rose Water Lassi

  • 2 1⁄2 cups plain yogurt
  • 1/2-teaspoon fine sugar
  • ¼ tsp of ground cardamom
  • 2 teaspoons pure rosewater
  • 3⁄4 cups Ice water
  • 1 cup Ice cube cracked
  • Fragrant rose petals for garnish

Blend the yogurt, sugar, cardamom, rose water and iced water in a blender for 2 minutes. Add the ice and process for another 2 minutes. Pour the lassi into tall, refrigerated glasses and garnish with rose petals. Chill out and enjoy!

Protecting Yourself and Loved Ones from Elder Abuse

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Stop Elder Abuse Sign

Stop Elder Abuse Sign, An American road stop sign with words Elder Abuse with stormy sky background

World Elder Abuse Awareness Day is June 15th and according to the World Health Organization elder abuse is a violation of human rights and a significant cause of illness, injury, loss of productivity, isolation, and despair. It touches people across all socioeconomic groups, cultures, and races. But only about one in five cases is ever reported. People with dementia are particularly vulnerable because they are unable to recognize that they are being abused or to report it.

My friend’s mother lived in Florida where she had round-the-clock nursing care in her own home. At the end of her life she suffered from dementia and was frail and bed-ridden. When Cheryl (name has been changed) went for a visit, she discovered that her mother had been cruelly beaten, and even though her two caregivers were women, it was apparent there she had been sexually abused. The poor woman’s genital area was swollen and bruised.

Physical abuse is not the only type of abuse targeted at the elderly. I know of two families who lost their inheritance because of financial fraud and theft. In one family the elderly father was cared for by a young woman who convinced him to marry her in order to be the beneficiary of his estate. The man’s family was unable to get a penny or access to the family home they had grown up in. Another elderly man assigned a trustee to overlook his financial affairs. The trustee stole his money and even though one of his adult children is a lawyer, the family was unable to recover a penny of their inheritance.

We’ve all heard of telephone scams in which a caller claims he is a jailed grandson who pleads with his grandparents to send bail money, or the IRS scam where the caller threatens severe consequences if the senior doesn’t pay tardy taxes.

These types of occurrences are all too common, especially in under staffed, under funded nursing homes.

Report abuse

Abuse can occur anywhere: at home, in nursing homes, and memory care homes. If you suspect abuse don’t hesitate to report it. You do not have to prove anything. It is up to the professional staff to investigate your suspicions, and put the proper safety measures in place.

Types of abuse

  • Physical–causing pain or injury
  • Neglect–failure to provide food, shelter, clothing, medical and other necessities required to provide a safe, nurturing environment
  • Emotional and Psychological—Verbal assaults, harassment, threats, intimidation
  • Confinement –restraining or isolating the person
  • Financial—Scams, misuse or withholding of the person’s financial resources to the disadvantage of the elderly person, and to the advantage of another person.
  • Deprivation—Denying the person medication, medical care, food, shelter or physical assistance
  • Sexual abuse –Any sexual activity, including fondling, when the person is unable to understand, unwilling to consent, or threatened or physically forced

Signs of abuse

  • Bruises, pressure marks, broken bones, abrasions and burns
  • Bruises around the breasts and genital area could indicate sexual abuse
  • Poor hygiene, bed sores, unattended medical needs, unusual weight loss
  • Sudden withdrawal from normal activities, unexpected depression, and a sudden change in alertness can be an indicator of emotional abuse. However, these symptoms can be the result of a progression of dementia or other disease.
  • Sudden changes in financial situation can be a result of exploitation.
  • Aggressive behavior from a caregiver or from the person being cared for can result in verbal or emotional abuse on either end.

Caregivers also are the recipients of abuse from the person they care for. If a caregiver feels physically threatened it’s important to get help in providing safe care for the person being cared for, possibly in a facility.

What can you do to protect yourself and your loved ones?

Report suspected mistreatment to your community’s Human Services Adult Protection agency and/or law enforcement office. Even if a situation has already been investigated, if you believe circumstances are getting worse, continue to speak out.

If you or others experience abuse or neglect in a community setting:

Adult Protective Services (APS) is there to help. The APS mission is to ensure the safety and well-being of elders and dependent adults. Unfortunately, it is estimated that millions of U.S. elders, from all walks of life, face abuse and neglect every year. Anyone can be victimized. However, there are things you can do to help protect yourself from abuse and neglect…

Human Services provides help with:

  • In-home assessment for abuse, neglect, and/or exploitation
  • Crisis intervention
  • Monthly visits by a case worker, if risk continues
  • Assistance with housing and/or placement to alternative housing
  • Assistance with obtaining benefits
  • Money management
  1. To report suspected abuse in a nursing home or long-term care facility, contact your local Long-Term Care Ombudsman. Each licensed long-term care facility is required to display a poster with the facility’s assigned ombudsman’s name and contact information. If you are a resident or family member of a resident in a facility, call the ombudsman listed on the poster. To learn more about the ombudsman program visit: Long-term care ombudsmen are advocates for residents of nursing homes, board and care homes and assisted living facilities. http://www.ltcombudsman.org
  2. Caregivers (both family and professionals) are most often the abusers of the elderly. Stress and feelings of being overwhelmed may provoke unintentional belligerent feelings. If you feel overwhelmed or frustrated as a caregiver, talk to someone for support.
  3. To speak with an Alzheimer’s Association Care Consultant call: 1-800-272-3900
  4. To find a support group in your area visit http://www.alz.org/apps/findus.asp
  5. To receive support from other caregivers visit https://www.alzconnected.org/
  6. To report an incident or concern of abuse or neglect, call the Alzheimer’s Association (1.800.272.3900) or Eldercare Locator (1.800.677.1116). You’ll be connected to your state or local adult protective services division or to a long-term care ombudsman. You do not need to prove that abuse is occurring — it is up to the professionals to investigate suspicions.
  7. Read more: http://www.alz.org/care/alzheimers-dementia-elder-abuse.asp#ixzz2W9DhCbSL
  8. Keep in contact. Talk with your older friends, neighbors, and relatives. Maintaining communication will help decrease isolation, a risk factor for mistreatment. It will also provide a chance to talk about any problems they may be experiencing.
  9. Join Ageless Alliance, a national, non-profit grassroots organization working to to promote aging with dignity and eliminate elder abuse, neglect and exploitation through Awareness, Advocacy and Action. Based at the Center of Excellence on Elder Abuse and Neglect at the University of California, Irvine, Ageless Alliance is a grassroots campaign to give a voice to those who have been affected by elder abuse and abuse of adults with disabilities.
  10. Plan ahead to protect against financial exploitation. Download a handout on ways to protect yourself or a loved one. http://www.ncea.aoa.gov/Resources/Publication/docs/NCEA_ProtectYourself_web508.pdf
  11. Be aware of the possibility of abuse. Look around and take note of what may be happening with your older neighbors and acquaintances. Do they seem lately to be withdrawn, nervous, fearful, sad, or anxious, especially around certain people, when they have not seemed so in the past?
  12. Contact your local Area Agency on Aging (AAA) office to identify local programs and sources of support, such as Meals on Wheels. These programs help elders to maintain health, well-being, and independence—a good defense against abuse. See the Eldercare Locator, www.eldercare.gov Welcome to the Eldercare Locator, a public service of the U.S. Administration on Aging connecting you to services for older adults and their families.You can also reach us at 1-800-677-1116.

When the Patient has Trouble Eating

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99f56ed5-402e-4a79-87fc-038e8b868a49

Three delicious and nutritous protein shakes

Find more food and nutrition tips in my new book “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s and Dementia”–available wherever books are sold.

Elderly people, people who are ill, and especially people with dementia, sometimes have eating difficulties, which can arise for a number of reasons.

  • Some medications affect taste and decrease appetite.
  • Eating might be one of the few things that a person with Alzheimer’s or dementia still has control over. The memory loss individual might refuse food simply because it’s a way of exerting personal power.
  • A new diet that is introduced due to a health concern such as diabetes, or the introduction of pureed food might cause an individual to refuse food.
  • Depression can result in a lack of interest in food.
  • The sense of taste is the last one to go, but it might be diminished along with the sense of smell.
  • Inactivity can cause loss of appetite, so try to engage the memory loss person in some sort of physical activity. Even a stroll around the block helps.

End-stage Alzheimer’s patients almost always have trouble eating, and ultimately most have trouble swallowing. But if the person you are caring for is losing weight for no particular reason and is still mobile, it is a concern that needs to be addressed. Please consult with your physician when there is any question about weight loss and refusal to eat.

12 Tips for Getting Someone to Eat

  1. Finger foods might be easier to manage than a fork and knife.
  2. Eliminate foods that present a choking risk (hotdogs, chicken or fish that contain bones, etc.)
  3. Provide several small meals throughout the day instead of three large meals.
  4. Make the food tasty by including salt, herbs and spices.
  5. Dementia patients love ice cream. If cholesterol is an issue, substitute a dairy ice cream with a non-dairy frozen dessert such as Rice Dream®, Coconut Bliss or Soy Dream.
  6. Offer healthy snacks throughout the day, such as cheese and apple slices, nut butter on apple slices, smoothies, and diced fresh fruit.
  7. Create a soothing ambience by placing flowers and candles on the table, and playing soft classical music.
  8. Make sure to keep the patient hydrated, especially during the hot summer months.
  9. Provide a comfortable place to eat. If the patient has a bad back, it might be necessary to put a cushion on the chair.
  10. Do a happy, engaging activity before mealtime. Have the memory loss person help set the table or peel vegetables, if possible. Painting, listening to music, playing an instrument, or going for a walk might be all it takes to work up an appetite.
  11. It might be hard for the person to differentiate foods on a plate, especially if they are the same color. Use contrasting colors. For example, serve beets and carrots on white instead of white mashed potatoes on a white plate.
  12. Aromatherapy
  • Bergamot is the flavoring used in Earl Grey Tea. If your patient likes to drink tea, this might be an easy solution. Or, have the person smell bergamot oil, which is used for depression.
  • Citrus oils such as orange, lemon and lime along with ylang-ylang can help alleviate depression.
  • Peppermint and Spearmint are energizing and might stimulate appetite.

 

Protein shake recipes

Protein shakes are nutritious, filling, and nourishing. Use ingredients of your choice without relying on the sugary nutrition drinks that are generously handed out in institutions.

My favorite delicious and easy-to-make shakes

Banana Berry Shake

  • 1 frozen banana
  • ¼ cup sliced strawberries
  • 8 ounces of milk or non-dairy drink such as soy, almond, or coconut milk
  • 1 scoop of whey protein powder
  • Blend together until smooth.

Berry Sunrise Shake

  • 1/3 cup frozen blueberries
  • 3 medium strawberries
  • 8 ounces of orange juice
  • 1 scoop of whey protein powder
  • Blend together until smooth.

Chocolate, Banana, Peanut Butter Protein Shake

  • 1 banana
  • 2 Tablespoons peanut butter
  • 1-cup almond, soy or coconut milk
  • 1 scoop chocolate protein powder
  • 3-5 ice cubes
  • Blend together until smooth

Enjoy!

Why you should see a doctor if you’re worried about your memory

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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?

  1. 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

Reference
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?

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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.

References
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

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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.

Reference

  1. 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