Cataract surgery reduces dementia risk

It seems that almost all my friends are needing cataract surgery. And that’s probably a good thing. Because studies are indicating that cataracts increase your risk of developing dementia.

What is cataract surgery?

Nine in ten people develop cataracts by the time they’re 65, and an estimated 2 million (mostly older) Americans get cataract surgery every year.

A cataract is an opacification or clouding of the natural lens of the eye. The surgery involves the removal of the lens and replacement with an intraocular lens or artificial replacement for the lens of your eye. It’s considered one of the safest, most effective, and most common procedures performed today.

Research shows a link between vision loss and dementia

A recent study in JAMA Internal Medicine analyzed the relationship between cataract surgery and the risk of developing dementia. The researchers discovered that people who had cataract surgery had a 29 percent lower risk of developing dementia when compared to people who didn’t have the surgery.

The research also found that glaucoma did not affect the risk of dementia.

How does cataract removal protect brain health?

  • Cataracts can reduce vision, which may lead to depression. Depression is a risk factor for dementia.
  • One study found that the integrity of the eye is essential for the structure and function of the brain. “Cataract patients often present with accelerated age-related decreases in brain function, but the underlying mechanisms are still unclear.” Vision impairment can lead to reduced sensory input to the brain, and this leads to less brain stimulation and loss of brain function.
  • People who have vision loss may be less engaged in physical activity and social interaction. This can lead to an increased risk of dementia.

Ways to help prevent cataracts

  • Eat a Mediterranean-based diet including foods that are high in vitamin C, vitamin E, lutein and zeaxanthin. Low levels of lutein and zeaxanthin are associated with cataracts, whereas higher levels help to reduce the risk of developing cataracts.
  • Lutein and zeaxanthin are carotenoids and are found in spinach, Swiss chard, kale, parsley, pistachios, green peas, egg yolks, sweet corn, and red grapes. They are best absorbed when eaten with a healthy fat such as olive oil or avocado.
  • Wear sunglasses to protect your eyes from UV rays.
  • Quit smoking. Smoking increases the free radicals superoxide and hydroxyl radicals that damage the lipids and proteins in the eyes. This causes deposits to form on the lens of the eyes and leads to cataract formation.
  • Maintain healthy blood sugar levels. People with diabetes are more likely to develop cataracts.
  • Restrict consumption of alcohol, which can increase the risk of cataracts by increasing the body’s inflammatory response, free radical production in the eyes, and dehydration. Dehydration affects the proteins in the lens of your eyes.
  • Get regular eye exams.

Get more bang for your buck

If your eye doctor is suggesting that you have surgery to remove cataracts, do it sooner than later. Because cataract surgery will not only sharpen your vision, it may very well sharpen your mind.

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: TheCaregiver’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.

Aging and Memory Loss: What’s normal, what’s not, and how to seek help (this article appeared in the Daily Camera’s Aging at Altitude Special Section, spring 2022)

Most of us have had “senior moments” where we’ve run into a friend and momentarily forget their name. Or we search the house for eyeglasses that are perched on our head. Or we walk in circles trying to locate our car in the mall parking lot. Those forgetful moments are fairly typical of being a member of the 21st century with a headful of thoughts and responsibilities.

Putting the car keys in the refrigerator might be something you do if you’re distracted, but storing a dozen cans of pineapple in the dishwasher, or forgetting how to drive home are not normal memory slips. These types of forgetfulness could be a sign of cognitive impairment or a dementia. But the latest research is showing that if you treat early signs of mental decline, you can slow down and possibly reverse cognitive decline.

Ilene Naomi Rusk, Ph.D. is a neuropsychologist, functional brain health coach, and director of The Healthy Brain Program at the Brain and Behavior Clinic (2523 Broadway #200, Boulder, CO, 303-938-9244). Dr. Rusk acts like a detective to fully understand the root causes of a person’s psychological and brain health issues. Then she works with the patient and a functional medicine team with personalized diagnostics, and treatment or interventions, from brain training to nutrition guidance.

“It’s good for everyone to have baseline neuropsychological testing in mid-life even if you have no memory issues,” says Rusk. Most people think cognition is memory, but it’s much more than that. It’s memory, learning, attention and focus, visual and spatial skills, and how we absorb information, retain it and then share it. Cognition is also how we process things visually, auditorily, and spatially.”

There are different categories of cognitive health versus cognitive impairment that can clue me into whether or not someone is headed towards dementia, says Rusk.

“Subjective Cognitive Impairment (SCI) is when you notice a change in your cognition and think ‘I’m a little different than I used to be’, but other people can’t tell and it wouldn’t show up on a memory test.

“The next category is Mild Cognitive Impairment (MCI). This is when you notice changes in your thinking and people around you may or may not notice changes. With MCI you might also have some challenges on neuropsychological tests that show empirical changes. This is a staging system,” says Rusk. “With MCI there’s a great opportunity to intervene, and we want to intervene as early as possible because once you have Mild Cognitive Impairment it’s easier to slip into dementia,” she adds.

The best thing is to tell your doctor if you have concerns and then go to see someone to get properly assessed.

“I recommend that people go directly to a neuropsychologist or neurologist after they’ve spoken to their family physician to look for root causes. There are so many prevention strategies and a new functional medicine methodology to approach cognitive decline. Functional Medicine practitioners look at blood sugar control, blood pressure, gut health, latent, mold, infections, inflammatory markers, stress, sleep patterns, chronic loneliness, and trauma. These are all important things when looking at modifiable root causes of cognitive impairment,” says Rusk.

“We no longer think that Alzheimer’s is only a disease of the brain. That’s definitely an endpoint,” she says. “Everything from dental health to herpes is being looked at, and the amyloid theory of Alzheimer’s is even being questioned by some people. I see trauma healing and stress reduction as important interventions. Chronic stress affects so much in our physiology and unhealed trauma leaves physiologic imprints.

 It’s also important to know,” she adds, “that 70% of dementias are of the Alzheimer’s type and 30% of dementias fall into other categories such as Frontal Temporal Dementia, Parkinson’s, Lewy Bodies, etc. getting properly diagnosed is very important.

The brain pathology of Alzheimer’s often starts 20 years before there are clinical signs. “A person goes from no dementia to SCI, MCI, early stages of dementia, mild, moderate, and severe stages,” says Rusk. “My goal is prevention, and my favorite thing to do is talk to young people about brain health. If we can intervene early, the decline can be delayed and even sometimes prevented.”

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: TheCaregiver’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.

Dental hygiene for people with dementia

oral hygiene products

As with any debilitating disease, Alzheimer’s and other dementias pose limitations to what a patient can and can’t do. Good dental hygiene is one of the self-care daily habits that, unfortunately, often fall by the wayside in cognitively impaired individuals.

In the beginning stages of Alzheimer’s, a daily reminder might be all it takes to ensure that a person with dementia continues with their dental hygiene routine. As the disease progresses, the individual might need a more hands-on approach.

Why is dental care for dementia patients important?

It doesn’t matter whether you have dementia or are in tip top shape, dental care is a primary factor in overall health. Maintaining your dental health is much more than having a beautiful smile. Tooth decay and gum disease can affect your heart, your lungs, and your brain.

Periodontal disease has been linked to diabetes, heart disease, and Alzheimer’s disease.

According to the U.S. Centers for Disease Control and Prevention, one out of every two American adults over the age of 30 has some form of gum disease. Oral bacteria can migrate to distant sites in the body. Elderly and immuno-compromised patients, such as those suffering from cancer, diabetes or rheumatoid arthritis, may be especially vulnerable to systemic oral pathogens.

Periodontal disease is also associated with weight loss and wasting, which might contribute to cognitive decline. Gum disease often results in tooth loss, which often leads to problems with chewing, swallowing and food selection. And individuals don’t absorb nutrients from food efficiently if it is not chewed well. Evidence from several studies indicates deterioration in nutritional status in individuals missing teeth.

Certain medications can cause dry mouth

Decongestants, antihistamines, painkillers, diuretics and antidepressants are known to reduce saliva flow. Saliva neutralizes acids produced by bacteria in the mouth and helps protect you from microbes that can multiply and lead to infection and disease. The problem is, salivary glands are less productive as we age. Individuals with dementia also forget to drink when they’re thirsty. It’s important to be alert to cracked lips and dry mouth in your care partner in order to know when an individual is dehydrated.

8 Tips for preventing dry mouth

  • Sip water throughout the day—carry a water bottle.
  • Suck on hard, sour candies.
  • Chew sugarless gum.
  • Avoid or reducing the medications listed above.
  • Use Biotene, Plax, or ACT mouthwash which contain no alcohol.
  • Eat fibrous foods like apples, carrots and celery. They’re mildly abrasive and sweep bacteria and plaque off the teeth.
  • Use a humidifier to keep the membranes moist.
  • Get regular dental check-ups and alert the dentist about dry mouth. The teeth can sometimes be coated with protective substances that protect the teeth from bacteria and plaque.

12 Ways to assist dementia patients with oral hygiene

  • Talk your patient through the steps of brushing, if necessary. Put your hand over their hand that is holding the brush to guide them.
  • We typically brush our teeth in the bathroom. However, if it’s more comfortable for someone to brush while sitting down on a chair or in bed, by all means provide a plastic tub and glass of water for the patient.
  • As dementia progresses, it becomes more difficult for patients to visit their dentist for regular cleanings. It also becomes more difficult for caregivers to help with daily brushing, which is why caregivers must be more diligent in trying other techniques.
  • If a regular toothbrush is hard to hold and manipulate, try an electric toothbrush. Or, provide a toothbrush with a large handle. Some caregivers get creative and put the handle through a tennis ball to give the patient something heftier to hold onto.
  • Don’t use fluoride toothpaste if the patient is inclined to swallow it. If the patient doesn’t like toothpaste, try using baking soda and water, or just plain water.
  • Flossing is very important. See “Does gum disease really cause Alzheimer’s disease?” Flexi-Floss, Stim-u-dent-or a tiny brush makes the job a bit easier.
  • If you can trust the patient not to swallow mouthwash, try an anti-plaque mouthwash when brushing is not feasible.
  • Ask your dentist about using a super soft toothbrush or one with a sponge head instead of a bristle head. Foam oral swabs are available at medical supply companies.
  • If your patient wears dentures, make sure to take them out and clean them daily. Use a soft brush to clean the patient’s gums and roof of their mouth when the dentures are removed.
  • Be alert to dental pain which may be exhibited by rubbing of the jaw or cheek, flinching while being shaved or having their face washed, refusing to put dentures back in, moaning, flinching, etc.
  • As mentioned in the above section, eating fibrous foods like apples and celery, and drinking plenty of water can help prevent plaque build-up.
  • It’s important to find a dentist who is patient and knowledgeable about dementia in order to make your patient’s dental visits as pleasant as possible. Let the staff know ahead of time about any concerns. If your patient gets agitated, ask his/her physician for an anti-anxiety medication beforehand. Or, use a homeopathic remedy such as calcarea carbonica or aconite, or an essential oil such as lavender oil to reduce anxiety. For a list of herbal remedies that reduce anxiety see “20 Natural Remedies for Depressed Caregivers (and everyone else).”


  1. Hee Lee, K, Wu, B, and Plassman, B. Cognitive function and oral health—related quality of life in older adults. JAGS. 2013: 61: 1602-1607.

2. Elsig, F, Schimmel, M, Duvernay, E, Giannelli, SV, Graf, CE, Carlier, S, Herrmann, FR, Michel, JP, Gold, G, Zekry, D and Muller, F. Tooth loss, chewing efficiency and cognitive impairment in geriatric patients. Gerodontology. 2013: 1-8.

3. Chalmers, JM, Carter, KD, and Spencer, AJ. Oral diseases and conditions in community-living older adults with and without dementia. Spec Care Dentist. 2003: 23: 7-17.

4. Fabiano, JA. Oral health management in the patient with dementia. Medscape. May 24, 2011.

Does Alzheimer’s Cause Vision Problems?

Depressed old woman in eyeglasses on ophthalmologist appointment, vision problemMy husband wore glasses. And he had Alzheimer’s. And he had a retinal tear that required a laser procedure, which was no fun.

My kids and I thought Morris’s vision was deteriorating because he couldn’t see objects, such as a drinking glass right in front of him. This went on for years. Sometimes he was afraid to walk, thinking he’d fall or run into something. But it wasn’t his vision. The problem was in his brain.

It can be difficult to tell the difference between sight loss and visual problems due to dementia. Often times, one condition can mask the other.

Here’s what I learned.

People with Alzheimer’s and other dementias have visual difficulties caused by what is happening in the brain. They can still have healthy eyes, or have vision that hasn’t changed significantly. Their perception problems are not due to how clearly they see, but to changes in the brain.

Some of these difficulties may indicate dementia. My husband had to deal with almost every one of these issues.

  • reading
  • recognizing people
  • coping with low light, bright light or both
  • finding objects
  • avoiding obstacles
  • recognizing food on the plate
  • seeing well even with glasses on

In Alzheimer’s dementia, there are five main areas of visual deficit that can affect perception.

(See the last section, below, for some ways to help with these issues.)

  • reduced ability to detect motion
  • reduced peripheral vision
  • loss of depth perception
  • difficulty recognizing colors, especially in the blue-violet range
  • reduced contrast sensitivity to gradients of color–trouble picking out objects that are surrounded by similar colors, i.e. finding the toilet in a bathroom where the floor, walls and toilet are all white

Alzheimer’s disease can be detected through an eye test

According to researchers, changes in your sight and smell may be the key to early detection of Alzheimer’s disease. A decreased sense of smell is an early clue. In the case of vision, people with Alzheimer’s have fewer blood vessels and less blood flow in the retina (back of the eye). The retinal nerve that comes out of the brain gets narrower and this can be detected by an eye test that uses a non-invasive scanning technique called OCTA (optical coherence tomography angiography).

Having a thinner retina can also cause blurry vision at first that may interfere with normal activity, making things to appear hazy or out of focus.

Results from two studies show that OCTA can see signs of Alzheimer’s disease in a matter of seconds. Researchers at Duke University in North Carolina compared the retinas of 39 people with Alzheimer’s, 37 people with Mild Cognitive Impairment (MCI), and 133 healthy people. The average age was 71.

The researchers excluded various people from the study, including people with non-Alzheimer’s dementia, diabetes, high blood pressure, neurological conditions like multiple sclerosis, glaucoma, age-related macular degeneration or poor vision.

They took scans looking at the tiny blood vessels in different parts of the retina, and then compared blood vessel density between the groups. They found that people with Alzheimer’s had fewer blood vessels and less blood flow in the retina than healthy controls and those with MCI, and that a specific layer of the retina was thinner. They also found that the small blood vessels in the retina are altered even in patients who have a family history of Alzheimer’s but have no symptoms.

Because the retina is connected to the brain by way of the optic nerve, researchers believe that the deterioration in the retina and its blood vessels may mirror the changes going on in the blood vessels and structures in the brain, thereby offering a window into the disease process.

Because genes play a significant role in how Alzheimer’s disease begins and progresses, another team of researchers from Sheba Medical Center in Israel examined 400 people who had a family history of the disease but showed no symptoms themselves. They compared their retina and brain scans with those who have no family history of Alzheimer’s.

They found that the inner layer of the retina is thinner in people with a family history. The brain scan showed that their hippocampus, an area of the brain that’s first affected by the disease, had already begun to shrink. Both factors, a thinner inner retina layer and smaller hippocampus, were associated with scoring worse on a cognitive function test.

The goal of this latest research is to find a quick, inexpensive way to detect Alzheimer’s at the earliest signs. Diagnosing Alzheimer’s is a currently a challenge. Some techniques can detect signs of the disease but are impractical for screening of millions people: Brain scans are expensive and spinal taps can be harmful. Instead, the disease is often diagnosed through memory tests or observing behavior changes. By the time these changes are noticed, the disease is advanced. Even though there is no cure, early diagnosis is critical as future treatments are likely to be most effective when given early. Early diagnosis would also give patients and their families time to plan for the future.

Regular eye exams are important

I wondered how the doctor could ascertain what Morris’s eye glass prescription was since Morris was unable to read the eye chart. The ophthalmologist assured me that they have their way of checking someone’s eyes without verbal feedback. The doctor adapts the test for the patient, and allows for more time. It is important, however, that someone who knows the patient well accompanies him/her.

People with dementia can have the typical causes of sight loss that many aging people have, including cataracts, macular degeneration, normal aging of the eye, and stroke.

Ways to help your patient with sight loss and dementia

  • Make sure their eyeglass prescription is current.
  • Clean the glasses often, and try to prevent loss or misplacement by attaching them to a strap, lanyard or chain.
  • Improve the lighting where the patient lives, and install automatic lights that come on at dusk.
  • Use contrasting colors to help the patient discern places and things, i.e. Serve colorful veggies (which are higher in antioxidants and vitamins) on a white plate. Put DO NOT ENTER signs on outside doors, if there is a risk your patient might wander, etc.
  • Play books on tape, or read to your patient if he/she is unable to read.
  • Focus on what your patient can do and is familiar with, and help him/her to have positive experiences.


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.

A popular prostate cancer treatment puts men at risk for Alzheimer’s & dementia

Man thinking.

I know several men with prostate cancer. In fact, one of them is on his death-bed. But don’t worry. It’s a slow-growing cancer, and it’s possible to live with it for a long time. It’s also possible to avoid. (see below) But first, here are some things you should know

The American Cancer Society predicts that 220,800 new cases of prostate cancer would be diagnosed in 2015. An estimated 27,640 men will die of it. African-American men are more likely to get prostate cancer and have the highest death rate. Other than skin cancer, prostate cancer is the most common cancer in American men. In other parts of the world — notably Asia, Africa, and Latin America — prostate cancer is rare.

If you are a man over 50 years old and don’t already suffer from prostate problems, the odds are 2 to 1 that you will before you turn 59.

Almost all men experience the symptoms of prostate enlargement and some form of prostate-induced discomfort during their lifetime, and especially after the age 50. These include frequent and urgent urination, urination through the night, a weak stream or one that is difficult to start or stop, and reduced sexual libido. The symptoms typically appear with the beginnings of hair loss and eventual baldness. The cause is an imbalance of sex hormones.

The connection between dementia and ADT therapy

A new study at the Perelman School of Medicine at the University of Pennsylvania found there is a connection between androgen deprivation therapy (ADT) — a testosterone-lowering therapy for prostate cancer– and dementia.

Their previous studies have shown men who undergo ADT may be at an increased risk of dementia, including Alzheimer’s disease, compared to men who were not treated with the therapy. This new analysis — the largest of its kind ever performed on this topic — shows that all existing studies taken together support the link to dementia and show a possible link to Alzheimer’s.

This is not good news. The common side effects of ADT are hot flashes and enlarged breasts, which are definitely annoying but symptoms you can live with. Dementia and Alzheimer’s are another story.

Other treatments for prostate cancer include surgery, radiation, and brachytherapy, a type of internal radiation that plants radioactive “seeds” in the prostate. But these treatments also carry risk of side effects including urine leakage, poor sexual function, and bowel problems. It’s important to speak with your doctor to determine which treatment is best for you and what side effects you are willing to live with.

Prevention is the key

  • b-Sitosterol is one of a group of phytosterols that promote prostrate and male uro-genital health. b-sitosterol and other phytosterols support male urinary and prostate health by inhibiting the uptake of cholesterol into the blood. This redirects the conversion of cholesterol into the steroids from which the sex hormones are made. As hundreds of scientific studies have demonstrated, the cells of the prostate respond to these rejuvenated hormones and de-proliferate, reducing the size of the prostate and the symptoms
  • Boron is found in red wine, raisins, peanuts, apples, pears, peaches, oranges, grapes, lima beans, and peanut butter. Studies have shown that men with the highest boron intake were 65 percent less likely to develop prostate cancer than men with the lower boron intake. Researcher found that boron’s cancer-fighting effects seem to be specific for prostate cancer, so make sure you eat your daily dose of apples and oranges.
  • If you like tomato sauce, you’re in luck. Lycopene is a powerful antioxidant found in red fruits and vegetables, especially tomatoes, watermelon, red grapefruit, and guava. Researchers have linked the frequent use of lycopene from tomatoes to a lower risk of prostate and other cancers. Interestingly, Lycopene is best assimilated and absorbed after eating tomatoes cooked in olive oil.
  • Selenium intake has been directly associated with lower risk of prostate cancer. In a Harvard School of Public Health study, men who received at least 200 micrograms of selenium in a daily nutritional supplement were one-third less likely to get prostate cancer than the men who received a placebo. Selenium is found in tuna, brazil nuts, and sunflower seeds.
  • Zinc is important for a healthy prostate gland. Since the prostate gland requires 10 times more zinc than any other gland or organ in the body, researchers believe that a zinc deficiency might contribute to BPH. Foods that are high in zinc: pumpkin seeds, oysters, beef, lamb, toasted wheat germ, spinach, squash seeds, nuts, dark chocolate, pork, chicken, beans, and mushrooms. Play it safe and take a zinc nutritional supplement. Make sure it contains some copper, which optimizes absorption.

What does the prostate gland do?

The prostate is the size and shape of a walnut and is located under the bladder and directly in front of the rectum. It secretes a thick, whitish fluid that provides about half the fluid in semen, and helps transport sperm.

What causes prostate problems?

After about age 40, the prostate begins to grow in just about every male because DHT (dihydrotestosterone), a potent form of the male hormone testosterone, isn’t excreted efficiently. DHT then accumulates in the prostate, causing prostate cells to rapidly reproduce. Sometimes the enlargement is a sign of cancer. But usually the result is a condition called benign prostatic hyperplasia. Most doctors refer to enlarged prostate simply as BPH.

As BPH develops, the prostate may press against the neck of the bladder or urethra, squeezing the pipe shut, like stepping on a garden hose. This pressure can make it difficult to urinate and may result in a variety of symptoms:

  • Urgency—the need to go immediately
  • During urination, there is a thin stream of urine that stops and starts instead of a full, steady stream
  • Hesitancy or difficulty starting urine flow
  • Dribbling after urinating
  • Nocturia — having to get up frequently at night to urinate
  • Increased frequency of urination
  • Increased risk of infection if the bladder does not empty entirely and urine is retained

Unlike BPH, prostate cancer may not give symptoms in its early, curable stage. This is why every year start in your 40s it’s important to get a PSA (Prostate Specific Antigen) test, in which the blood is analyzed for evidence of cancer.

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” 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 Amazon, Barnes & Noble, Boulder Book Store, Tattered Cover Book Store, Indie, and many other fine independent bookstores, as well as public libraries.