Why it’s important to get an early diagnosis when cognitive problems appear

Doctor talking with patient

There were several indications that something was wrong with my husband two years before he was diagnosed. This tall, good-looking man, a graduate of the Wharton School of Business at the University of Pennsylvania, was having trouble calculating how much tip to leave a waitress. When we went to Spain for our twenty-fifth anniversary, Morris couldn’t figure out how much money the hotel would cost in dollars. This man, who once memorized trains and airplane schedules without even trying, followed me around the city like a puppy dog as we boarded a subway or bus enroute to tourist attractions.

That following fall — our daughter’s last year in high school — Morris couldn’t give directions to a friend who was taking the SAT at the high school my husband had attended. I got out the map to help him, but he couldn’t read the map. That was the moment I knew something was very wrong. When he left for a road trip to California without our son and forgot his suitcase, I sat on the stairs and cried. I couldn’t deny it any longer. I had a strong suspicion that Morris had Alzheimer’s disease, and although I pleaded with him for two years to see a neurologist, he refused.

What if he had gotten an early diagnosis? Would it have helped?

There’s no way to know for sure, but probably it would have. Because as soon as he started taking Aricept he stopped getting lost driving around our small city. And I started giving him nutritional supplements, which also seemed to help. Read “5 Things that Help Dementia that your Doctor Probably Hasn’t Mentioned.” https://barbracohn.com/2019/09/25/5-things-that-help-dementia-that-your-doctor-probably-hasnt-mentioned/

Professionals, both researchers and physicians and the Alzheimer’s Association, recommend that an early, accurate diagnosis is the key to living a less stressful life for both the patient and the family.

Here’s why:

  1. Cognitive problems can be caused by a number of physical conditions other than Alzheimer’s disease, vascular cognitive impairment, Lewy Bodies dementia and Frontotemporal dementia (FTD). These include thyroid problems, hydrocephalus, a brain tumor, and even depression. When my mother was severely dehydrated and hospitalized with a urinary tract infection (UTI), a psychiatrist called to tell me that she had full-blown dementia. “No she doesn’t,” I said. And sure enough, after being put on an IV saline drip Mom regained her full mental capacity. Memory problems can result from dehydration, severe diabetes and some forms of Parkinson’s disease, traumatic brain injury, HIV, and Huntington’s disease.

Certain medications can affect mental clarity and balance. Be sure to ask your pharmacist about drug contraindications, and interactions with natural supplements. Alcohol abuse and binge drinking can destroy brain cells that are critical for memory, thinking, and decision making and mimic or lead to dementia.

2. Cognitive symptoms may be reversible. There are a number of holistic doctors who claim that their protocol can treat the root cause of cognitive decline and Alzheimer’s disease. Please read my blog ” Significant study points to MIND diet for improving brain health and preventing Alzheimer’s disease.” https://barbracohn.com/2018/11/09/significant-study-points-to-mind-diet-for-improving-brain-health-and-preventing-alzheimers-disease/

Dale Bredesen, MD, a physician scientist in the Department of Pharmacology at UCLA who’s published more than 220 papers on Alzheimer’s, has spent 30 years looking at the root causes of the neurodegenerative phenomenon in hopes of eradicating it. In 2018, Bredesen published the case studies of more than 100 patients in cognitive decline in the Journal of Alzheimer’s Disease & Parkinsonism. https://www.omicsonline.org/open-access/reversal-of-cognitive-decline-100-patients-2161-0460-1000450.pdf

In her editorial in the Lancet Neurology, published in May 2020, Joanna Hellmuth, MD, of the UCSF Memory and Aging Center, said the “Bredesen protocol” – named by neurologist Dale Bredesen, MD – has reeled in patients and their families seeking hope outside of the physician’s office for a disease that is currently incurable.

The Bredesen protocol is propounded in his 2017 bestseller The End of Alzheimer’s Program and can be accessed for $1,399, which includes protocol assessments, lab tests and contact with practitioners, who provide the regimen for additional fees. Online support and cognitive games are available for an additional monthly charge. This protocol is timely, costly and requires steadfastness. But if you have the time and means, it’s probably worth a try.

3. An early diagnosis is empowering. Before the disease has progressed to the point where decision making is difficult, the patient can be included in financial and estate planning, creating end-of-life wishes and durable power of attorney decisions, etc.

4. An early diagnosis is easier for the physician to make when the patient is able to answer questions. Later in the progression of the disease, the patient isn’t able to make observations or answer accurately.

5. Family and loved ones who might be confused by particular behaviors such as anger, depression, disinterest, can better understand why their parent or spouse or significant other is behaving the way they are. This helps to preserve the person’s dignity rather than have someone close to them yell at them, treat them poorly, or want to distance them self, etc.

6. Individuals diagnosed early can take advantage of support groups, and caregivers can learn ways to better manage medications, and learn strategies for coping with unexpected and unusual behaviors and the ordinary progression of the disease. The Alzheimer’s Association was a godsend for me. I was able to connect with other caregivers who knew exactly what I was going through. I could talk about what was happening all day with my best friend, but there was no way she would be able to fully understand the stress of caregiving and the grief of losing a partner to Alzheimer’s. https://www.alz.org/alzheimers-dementia/research_progress/clinical-trials/about-clinical-trials

7. Getting an early diagnosis provides the opportunity to possibly enroll in a clinical trial. TrialMatch is a clinical trial matching service for Alzheimer’s and other dementias. It is a free, easy-to-use service that connects individuals living with AD, caregivers, and healthy volunteers with current research studies. Their continuously updated database of AD clinical studies includes hundreds of pharmacological and non-pharmacological studies being conducted at sites throughout the U.S. and online.

8. An early diagnosis allows the patient to prioritize what is important to them, whether it’s creating a masterpiece or traveling the world. There is still time at this point in the disease to enjoy a happy, satisfying life.

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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 Bound.org, and many other fine independent bookstores, as well as public libraries.

Does dementia increase a person’s risk of getting Coronavirus?

Elderly woman looking sad out the window.Although dementia in itself doesn’t increase one’s risk, there are other factors that might contribute to a person’s increased risk.

Does the patient have any underlying conditions such as high blood pressure, diabetes, auto-immune disease, lung diseases including asthma and COPD, cancer? All of these increase risk of serious symptoms associated with the COVID-19 virus.

If a person with dementia is living at home, s/he may be at increased risk if they forget to wash their hands or socially distance. And, of course, as we are all well aware of, patients in care  facilities are at higher risk simply for the fact they are communally living together. Caregivers come in and out of the facility, go to their homes, and may be interact with others. See Should you move a family member back home from a care facility?

What can you do?

  • If your loved one is living at home and can still read, place sticky notes around the house  (refrigerator, bathroom, kitchen sink) in appropriate places to remind him/her to wash their hands.
  • Call often to check in. Use Zoom or Skype, Facetime, if the person can manage technology. Amazon’s new Portal, which is like a large iPad that is kept plugged in, is an easy device. Check it out: It’s a smart, hands-free video calling device with Alexa built-in.
  • Make sure your loved one has adequate food. If s/he can still prepare meals, drop off their groceries. If they have trouble in the kitchen, bring home-cooked meals or make arrangements with an organization such as Meals on Wheels that can deliver foods.
  • If you have to go inside the person’s home, make sure you have on a mask and gloves, and maintain physical distance as much as possible.
  • A person with dementia is probably not keeping a clean, tidy home, which is important to health and wellness. Try to clean around the person. Have him or her sit in front of the TV or at the kitchen table, while you vacuum and clean the bathroom. Then move him/her to another room in order to clean the kitchen.
  • The main thing is to stay in daily contact. Have the grandkids write notes and draw pictures to send in the mail. If you live in the same town, visit from the lawn and have your loved one sit on the front or back porch.
  • Set up a daily schedule for your loved one. Keep it posted on the fridge. For example: 8:00–wake up, toilet, brush teeth, shower. 8:30 Take meds, eat breakfast. 9:30 Do fitness routine, etc. Do 10 sit-to-stands while watching TV. Walk through the house for 10 minutes a couple times a day.
  • It’s important to protect our loved ones physically but to engage them socially to prevent loneliness and to keep them mentally stimulated. Here’s a great way for seniors whose dementia is minimal.

Well Connected (formerly called Senior Center Without Walls), is a telephone-based national program that offers free weekly activities, education, friendly conversation, classes, support groups, and presentations to individuals 60 years or older anywhere in the United States for English and Spanish speakers. There are activities occurring throughout the day, every day 10:00 am-8:00 pm, Mountain Time, depending on the day. Sessions run between 30 minutes to one hour.

Play a game, write a poem, go on a virtual tour, meditate, share a gratitude, get support, and most importantly, connect and engage with others every day. Well Connected is a community consisting of participants, staff, facilitators, presenters, and other volunteers who care about each other and who value being connected. All groups are accessible by phone and many are accessible online.

Well Connected offers 75 different programs. People can join a particular group, call in the same time each week, hear the same voices on a regular basis and make friends. This has a positive impact on their emotional and physical life. “The gratitude activity, which is offered twice a day, is especially popular and well attended,” says Wade, Social Call director (see below). “Participants share something they are grateful for. This allows for an increase in social connectedness. We also have fun and intellectual programs that help individuals feel valued, stimulated and engaged, and sometimes we invite presenters from the outside in.”

Wade pointed out that Well Connected, is not just for people with mobility concerns. We get folks who are active, people who are married and individuals in a co-housing situation. Anyone can feel lonely, she says. “We take a survey every year and the results indicate that 85% of our participants feel more intellectually stimulated and  socially connected. And on a daily basis, we get calls of gratitude from participants who say, ‘this program saved my live,’” says Wade.

Well Connected also offers a program called Social Call, in which volunteers call participants for a weekly phone visit. For more information, email coviaconnections@covia.org or call 877-797-7299.

Well Connected is an award-winning program of Covia, formerly called Episcopal Senior Communities. For more information: To register call 1-877-797-7299,  https://covia.org/services/well-connected/


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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 Bound.org, and many other fine independent bookstores, as well as public libraries.

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.


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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 Bound.org, and many other fine independent bookstores, as well as public libraries.

High blood pressure is a risk for (MCI) mild cognitive impairment

Close up of digital monitor device with cuff showing high diastolic and systolic blood pressureDid you know that high blood pressure puts you at risk for developing Mild Cognitive Impairment (MCI)? The problem is, MCI can eventually develop into dementia and Alzheimer’s disease.

A recent study involving 9,400 adults that was published in JAMA (January 28, 19) indicates that you can reduce your risk of MCI by lowering your blood pressure.  Adults in their 50s or older with high blood pressure participated in a clinical trial led by scientists at the Wake Forest School of Medicine in Winston-Salem, NC. The purpose of the trial was to evaluate the effect of blood pressure control on risk of dementia. The participants received either intensive blood pressure control or standard treatment.

Intensive control was used to bring systolic blood pressure below 120 millimeters of mercury (mm Hg), while the purpose of standard treatment was to lower it to under 140 mm Hg. Systolic blood pressure is the pressure in the arteries when the heart contracts. It is the top number in a blood pressure measurement, as in 120 mm Hg over 70 mm Hg.

The results revealed that significantly fewer of those who received intensive blood pressure control went on to develop Mild Cognitive Impairment, compared with those on the standard treatment. The lead investigator Dr. Jeff D. Williamson said that “three years of lowering blood pressure not only dramatically helped the heart, but also helped the brain.”

However, the study did not show that intensive blood pressure control reduced the incidence of dementia. The authors suggested that low numbers and the study finishing earlier than planned could be reasons for this.

What is Mild Cognitive Impairment? 

MCI is a condition in which the individual has some loss of mental acuity, such as forgetting appointments, losing the flow of a conversation, and difficulties making decisions and keeping track of finances, as well as trouble with reasoning. The individual is still able to care for him or herself and live a fairly normal life.

Approximately 15 to 20 percent of people 65 and older have MCI. People living with MCI are more likely to develop Alzheimer’s disease or other dementias. But MCI doesn’t always lead to dementia. In some cases, MCI remains stable or resolves on its own. Some medications may result in symptoms of MCI, including forgetfulness or other memory issues.

There are no pharmaceutical drugs approved in the U.S. for the treatment of MCI. However, the study discussed above, is a good indication that high blood pressure that is controlled through changes in lifestyle can help prevent MCI.

Why is high blood pressure dangerous?

It’s called the “silent killer” because it is insidious. It often has no warning signs or symptoms.

If your blood pressure is high it causes strain on the vessels carrying blood throughout your body. This can injure the vessels and lead to plaque buildup as a response to injury. Eventually, this can lead to narrow blood vessels and then clotting of passageways, which can cause damage to the heart and/or brain. High blood pressure ultimately increases your risk for getting heart disease, kidney disease, dementia, and for having a stroke.

Taking Your Blood Pressure

When your doctor takes your blood pressure, he/she is measuring the pressure in your arteries as your heart pumps. The heart contracts and relaxes during each heartbeat. When it contracts, the blood is being pumped out of the two ventricles (chambers) and your blood pressure goes up. Systolic pressure (the top number in the blood pressure reading) is the peak reading of the pressure produced by this contraction.

When the heart relaxes, blood fills the ventricles and your blood pressure goes down. The diastolic pressure (the bottom number in the blood pressure reading) measures the pressure between the beats as the heart relaxes.

What’s normal blood pressure?

High blood pressure used to be considered 140/90 or higher.

According to the National Heart, Lung and Blood Institute (a division of the Institutes of Health), normal blood pressure is now considered to be lower than 120/80 according to the guidelines released in November 2017.

The guidelines state that for BP above 115/75, every rise of 20/10 mm Hg doubles the risk of cardiovascular disease. Since 2017, the American Heart Association has advised that people with high BP should receive treatment at 130/80 rather than 140/90.

In the new guidelines, the AHA also recommends that doctors only prescribe medication in cases of a previous heart attack or stroke, or in the presence of risk factors such as: age, diabetes, or chronic kidney disease. Rather, at the earlier stages of hypertension, another word for high blood pressure, patients should make lifestyle changes. Here are a number of ways to do that:

10 Ways to support healthy blood pressure and prevent MCI

  1. Eat a nutritious, high-fiber, low-fat heart healthy diet. Learn about the MIND diet.
  2. Beware of your intake of sodium.
  3. Include foods high in phytonutrients—fruits and veggies.
  4. Take nutritional supplements proven to support a healthy heart: magnesium, potassium, B vitamin complex, vitamin D3, CoQ10, Grape seed extract, Resveratrol, Quercetin.
  5. Avoid decongestants if possible. These drugs can raise blood pressure.
  6. Practice a stress reduction technique such as yoga or meditation.
  7. At the minimum, take a walk 3-4 times a week.
  8. Stop smoking and reduce consumption of alcohol.
  9. Drink 6 to 8 glasses of water every day.
  10. If you snore, have sleeping problems, or are sleepy during the day, discuss sleep apnea with your physician.

Give yourself the gift of peace and get plenty of rest and sleep.

Happy Holidays!


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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 Bound.org, and many other fine independent bookstores, as well as public libraries.