Category Archives: mental-health

The loneliness of caregiving: How to stay socially connected

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Closeup of old woman hands holding mobile phone

Woman with mobile phone

My husband had younger-onset Alzheimer’s disease. The hardest thing for me during the duration of his illness was that I lost my companion. He was the person I made important decisions with. The person I went to movies with, ate dinner with, had interesting conversations with, traveled with, and shared delight with over the accomplishments of our children. He was the one I could complain to if I had a headache, stomach ache, or sore throat, without worrying about being called a hypochondriac or a baby. He was also the person who always cheered me on when I succeeded in achieving my goals.

When it came time to make the decision to move him to a memory care home, I especially missed having him help me decide on which room he’d live in, what type of furniture to buy, and the mattress he would sleep on. When it came time to bury him, it was agonizing for me to choose the plot of land where he would be laid to rest, and where I will be eventually interred.

During my many years of caregiving, I would often hide behind a mask of cheerfulness. It helped. I didn’t feel like a prisoner because I hired people to take my husband out to see a movie. Several of his friends kindly took him to lunch on a regular basis. It takes an effort to maintain friends and to stay socially involved, especially if you no longer work outside the home.

I promised myself that I wouldn’t let my husband’s disease ruin my life. I kept an active calendar filled with dance classes, lunches with friends, and even pursued a certificate in nutrition–all the while he was ill.

But it took planning and some might think I was a bit selfish. But when you look at the grand picture of caregiving, taking care of your personal needs is anything but being selfish. Studies show that 40 to 70 percent of family caregivers experience symptoms of clinical depression. One of the reasons, besides the daily stress, is isolation and loneliness.

Now for the lecture part: If you are a caregiver it is vital that you maintain a social network. Here are some ideas:

  • Stay connected with friends and family either through Facebook or another social media outlet, or by telephone or email, etc.
  • Make a lunch date with a friend at least once a week.
  • Many places of worship offer support for caregivers and families, including social events.
  • Go to a class—any kind of class: knitting, dance, weight training.
  • Join a support group—The Alzheimer’s Association offers classes and workshops for caregivers and for the person with memory loss.
  • Ask your friends and family for respite care. Have someone come over for a couple of hours a week so you can at least get out for a walk or go grocery shopping.
  • Go to the movies with a friend. It’s a great way to escape into another world for a few hours.
  • Call a best friend who is happy to talk; call someone who makes you laugh–laughter is truly the best medicine.
  • Bring your loved one to a Memory Cafe/Alzheimer’s Cafe. The challenges of living with memory loss can sever social connection at a time when it is needed most. Throughout the US and Europe, this casual social meeting is for caregivers and their care partner (the person they are caring for). Memory Cafes offer a way to socialize, explore art, music, poetry and listen to discussions and presentations. A Dutch psychologist opened the firs Memory Cafe in Holland. today there are about 200 Memory Cafes in the U.S.
  • Chat online with other caregivers. The Alzheimer’s Association offers chat rooms and so does the American Cancer Society. Check Elder Care Online for chat room and caregiver forum links. ElderCare Online’s Caregiver Support Network brings together online resources, groups and experts to create a virtual community dedicated to improving quality of life for you and your loved ones.

Is it a good idea for Alzheimer’s and dementia patients to use marijuana?

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Doctor hand holding dry medical cannabis on table close up

Doctor writing a prescription for  medical marijuana

I live in Colorado, one of the few states where medical marijuana is legal, as well as recreational marijuana for adults 21 years or older. Before it was legal, my husband, who suffered from anxiety, stress and depression from Alzheimer’s disease, smoked it in a pipe and ate marijuana cookies and brownies. It calmed him down and, most importantly, put a grin back on his face. He would get happy, and although I did not partake it helped me to relax, too–just because he was happier and more relaxed.

How does marijuana help Alzheimer’s?

Numerous studies show that cannabis helps:

THC, the psychoactive chemical in marijuana, helps reduce agitation and increase weight in people suffering from Alzheimer’s disease. Anxiety is defined as the inability to settle down and includes behaviors such as verbal outbursts, pacing and restlessness, all of which may lead to patient combativeness. Additionally, Alzheimer’s patients often experience weight loss because they stop recognizing when they are hungry.

Clinical studies

Researchers at the Meridian Institute for Aging in New Jersey gave a daily dose of 10 to 20 milligrams of dronabinol (an artificial version of THC marketed under the name Marinol) to 48 patients who had been diagnosed with Alzheimer’s disease and anorexia. After one month, two-thirds of the patients were significantly less agitated, and all of them had gained weight. There were no adverse side effects reported, such as falls, seizures or depression.Study results suggest dronabinol, a synthetic version of THC, the active ingredient in Cannabis sativa L (marijuana), may reduce agitation and lead to weight gain in patients with Alzheimer’s disease,

A 2014 preclinical study published in the Journal of Alzheimer’s Disease found that very small doses of tetrahydrocannabinol (THC), a chemical found in marijuana, can slow the production of beta-amyloid proteins, thought to be a hallmark characteristic and key contributor to the progression of Alzheimer’s. http://www.ncbi.nlm.nih.gov/pubmed/25024327. THC could be a potential therapeutic treatment option for Alzheimer’s disease through multiple functions and pathways. The study is among others to support the effectiveness of THC in prohibiting the growth of toxic amyloid plagues.

Co-author of the study, Neel Nabar, cautions against drawing quick conclusions from the study and says that numerous previous studies have shown that marijuana helps Alzheimer’s patients by reducing anxiety and inflammation, and improving appetite.

In this study, the researchers gave Alzheimer’s-afflicted mice various doses of pharmaceutical cannabinoids, which are 100 to 800 times more potent than marijuana compounds. The treated mice did not perform any better than untreated mice on memory tests, and they had just as much brain plaque formation as the untreated mice.

Can it reduce brain inflammation?

In 2005 researchers from Madrid’s Complutense University and the Cajal Institute published an article in the Journal of Neuroscience showing that  a synthetic cannabinoid appeared to reduce brain inflammation in Alzheimer’s.  Some researchers believe that reduction of this inflammation helps to prevent the mental decline associated with this disease.

Three years later, in March 2008, the Royal Pharmaceutical Society of Great Britain unveiled research showing that cannabis-based treatments could improve memory loss in Alzheimer’s sufferers.   Spanish researchers, this time working with a research team from Israel, found that one of the 400 compounds in the marijuana plant could significantly slow memory problems caused by the disease.  A by-product of their research was the finding that the same drug can also help Type 1 diabetes (formerly known as insulin dependent diabetes).

In observing my husband’s reaction to smoking pot and eating edibles, I can say that neither helped to improve or slow down his memory decline. 

In December 2008, results of a study showing that it’s the anti-inflammatory effect of cannabis that appears to help in Alzheimer’s disease were published.  Scientists continue to debate about the role inflammation of the brain plays in Alzheimer’s, and many researchers believe that it plays an important role in the dementia process.

The question comes up that if reduction of inflammation is all it takes to halt mental decline associated with Alzheimer’s, why doesn’t taking an anti-inflammatory, such as ibuprofen, help the condition?  Supposedly, anti-inflammatory drugs such as these have been shown in tests to help young brains, but not to help older brains.I have not found any such studies, but I do believe, along with numerous researchers, that inflammation is a major culprit in chronic disease.

Turmeric has been shown to be a traditional anti-inflammatory spice that has been found to have a protective effect against Alzheimer’s and dementia. Look for my future post about how turmeric supports memory and helps prevent dementia.

Therapeutic Cannabis Dosage for Alzheimer’s

According to Gary Wenk, Ph.D., author of the December 2008 study and professor of psychology and neuroscience at Ohio State University, “a puff is enough.”  He goes on to say that although this dose would probably have some sort of psychoactive effect strictly medical use is not ruled out.  The drug could be taken before bedtime, Wenk says, and with long-term use, tolerance to these psychoactive effects can develop, so impairment might be minimal with a steady dose anyway.

Don Abrams, M.D., chief of hematology/oncology at San Francisco General Hospital, has studied medical marijuana use in people with HIV for more than a decade. He says, “Cannabis is anti-inflammatory and it is also an antioxidant, and those are two things that we seek in treating neurodegenerative disorders.  It’s there, it’s in nature, if the research does find that it has these benefits, why not take advantage of it?”

Marijuana increases appetite and reduces anxiety

It’s important to note the difference, however, between these findings and the beneficial findings of other studies. Alzheimer’s patients often lose the ability to know whether they are hungry or not, and medical marijuana does help induce appetite. It also reduces anxiety. So, in the end, if you are considering giving your loved one medical marijuana for Alzheimer’s symptoms, be aware that it will probably not help improve memory. But it very well may help increase appetite and reduce anxiety.

My husband ate well until he was in late-stage Alzheimer’s disease. By then, he would not have been able to ingest marijuana in any shape or form. But earlier in the disease process it helped him feel better when everything in his world was being tossed and turned upside down. If you are looking for an antidote to anxiety and depression, consider it for a loved one with Alzheimer’s or dementia. If you prefer not to deal with the nasty odor (some people like it, I don’t) then ask your doctor about the pharmaceutical THC tincture. Or, you can always bake marijuana cookies and brownies. Just make sure they are in a container that is child-proof and hidden from your pets, visitors and children.

Hope for Reversing Alzheimer’s Disease

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Group of mature people doing yoga

Seniors practicing yoga for relaxation and flexibility

For dozens of techniques and tools for supporting cognitive health and reducing mental decline check out my book “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s and Dementia” — Available wherever books are sold, including amazon.com and barnesandnoble.com

On the summer solstice, the longest day of the year, there are approximately 17 hours of light. This year it happened to coincide with the Strawberry Moon, the June full moon. It’s a special time for healing and wrapping yourself and your loved ones in a luxurious robe of compassion and kindness. The longest day of the year is also a special day that thousands of Alzheimer’s Association volunteers join together to raise millions of dollars to honor those facing Alzheimer’s disease for educational programs and research.

It’s a particularly appropriate time to learn about a new study that suggests that a drug and lifestyle regimen can reverse mental decline in Alzheimer’s patients and those with mild cognitive impairment. First, it’s important to know that the study only included 10 patients, some with mild cognitive impairment, subjective cognitive impairment or Alzheimer’s disease. The researchers created personalized multi-faceted treatment programs for each patient, including diet changes, exercise, improved sleep, brain stimulation, drugs and vitamins.

The patients were treated for between five and 24 months. All 10 patients showed improvements in thinking and memory, and some were even able to return to work and complete tasks that had become impossible for them as their mental abilities declined, according to United Press International.

“The magnitude of improvement in these 10 patients is unprecedented, providing additional objective evidence that this programmatic approach to cognitive decline is highly effective,” Dr. Dale Bredesen, a professor at the Buck Institute and the University of California Los Angeles, said in a news release.

I have not seen the study, so I can’t comment on the specifics, but the overall treatment plan sounds as though it includes a healthy lifestyle regimen, which could be applied to anyone who wants to maintain mental acuity, stamina, a stronger immune system and overall physical health. The one caveat with the personalized multi-faceted treatment program in the study is that it is vital that the patient continues and maintains the program. Because as soon as an individual ceased to be regular, the old symptoms returned and the decline was steady.

 

Here is my list of 10 recommendations for maintaining cognitive function and boosting brain power

  1. Drink at least 8-10 glasses of water to keep your body hydrated and to flush out toxins. The brain is 70% water when fully hydrated. When it is dehydrated, neurotransmission—which is heavily dependent on water—is impaired, resulting in poor memory, concentration and impaired abstract thinking.
  2. Ginkgo biloba has been proven in hundreds of studies to help blood circulation to the brain, sharpening mental performance, increasing concentration and short-term memory. A well-known study in The Journal of the American Medical Association showed that supplementation with 40 mg of ginkgo three times a day for one year had a positive effect on patients with Alzheimer’s disease. A placebo-controlled, double-blind, randomized trail of an extract of Ginkgo biloba for dementia. 
  1. Vitamin B complex optimizes cognitive activity and brain function, has a positive effect on memory, learning capacity and attention span, and supports a healthy nervous system and a stable mood. Vitamins B6 and B12, in particular, play a role in the synthesis of serotonin, the neurotransmitter linked to improving memory, lifting mood and regulating sleep.
  2. Omega-3 fatty acids are rich in DHA, the major unsaturated fat in the brain. This long-chain fatty acid provides the necessary fluid quality to the membranes of the nerve cells so that electrical nerve impulses can flow easily along the circuits of the brain. One study found that Alzheimer’s patients given an omega-3-rich supplement experienced a significant improvement in their quality of life.
  3. Eat more blueberries! Their active antioxidants have been shown to protect and restore brain function. One recent study revealed that feeding blueberry extracts to mature mice partially reversed some signs of brain aging.
  4. Avoid alcohol. People who drink too much alcohol often show shrinkage or atrophy of the cerebral cortex, the seat of memory, learning, reasoning, intelligence, and emotions. Reduced cortical thickness in abstinent alcoholics and association with alcoholic behavior
  5. Avoid smoking. Smoking constricts blood vessels, making less blood, oxygen, and nutrients available to the brain. It also replaces oxygen with carbon monoxide, a chemical that damages brain cells.
  6. Incorporate a regular exercise program into your daily routine. An easy way to start is by walking 30 minutes a day at least five times a week. Yoga is wonderful for staving off arthritis pain, maintaining flexibility and for relaxation.
  7. Maintain your social connections. Loneliness can actually lead to health problems and mental decline. Join a group—any kind of group: worship,  hiking, scrabble, table tennis, knitting, discussion group, or book club. Volunteer at a food bank, soup kitchen or animal shelter. It’s important to stay connected and to feel as though you are a contributing member of society.
  8. Sleep well by getting to bed before 11:00 pm, eating your last meal before 8pm, turning off your electronic devices, and eliminating light in your bedroom. Studies have indicated that sleep deprivation can increase risk of dementia and Alzheimer’s disease. If you have trouble sleeping consider using a lavender essential oil spray on your pillow or a sachet of lavender inserted into the pillowcase. There are lots of natural sleep aids available at your local health food store, such as melatonin, calcium/magnesium, valerian, hops, etc. Consult with a nutritional consultant about what might work best for you.

Best of luck with your lifestyle changes and best of health to you and your family.

 

 

 

 

 

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.

 

 

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