Category Archives: pharmaceuticals

Are you a good candidate for the new Alzheimer’s drug?

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Patient getting an IV infusion

On January 6, 2023, the FDA approved Leqembi, the first drug shown to slow Alzheimer’s. Leqembi (Lecanemab) is manufactured by the Japanese drugmaker Eisai and co-developed by Eisai and Biogen. The drug is for patients with mild or early-stage Alzheimer’s dementia.

How does it work?

Lecanemab is an antibody that removes sticky deposits of the protein amyloid beta from the brain. Leqembi (the brand name in the US) neutralizes the protein and marks it for clearance by the immune system before clumping occurs. The result is fewer beta-amyloid aggregates, or plaques, in the brain, potentially slowing the progress of the disease. Results from a late-stage study showed that the drug reduces the rate of cognitive decline in patients with early Alzheimer’s by 27%.

How is it given?

Leqembi is administered intravenously once every two weeks to patients who have a diagnosis of early or mild Alzheimer’s. During the first 14 weeks of taking the drug, patients must be closely monitored and get brain scans to make sure there is no brain swelling.

What are the risks?

Cerebral edema, also called ARIA-E, is the main risk. It involves the breakdown of the tight endothelial junctions of the blood-brain barrier and results in the accumulation of fluid in the brain. In general, common side effects of ARIA-E include easy bruising/bleeding, numbness/tingling of the hands/feet, unsteadiness, unexplained muscle weakness, vision changes, muscle joint pain, butterfly-shaped rash on the nose and cheeks, symptoms of heart failure (including shortness of breath, swelling ankles/feet, and unusual tiredness. Patients who have chest pain or seizures should get medical help immediately.

Biogen has issued these warnings and precautions: Leqembi can cause amyloid-related imaging abnormalities-edema (ARIA-E) and -hemosiderin deposition (ARIA-H). ARIA-E can be observed with MRI imaging as brain edema or sulcal effusions, and ARIA-H as microhemorrhage and superficial siderosis. ARIA is usually asymptomatic, although serious and life-threatening events, can occur including seizures. They are rare, however.

Reported symptoms associated with ARIA may include headache, confusion, visual changes, dizziness, nausea, and gait difficulty. Focal neurologic deficits may also occur. Symptoms associated with ARIA usually resolve over time.

In one study listed on Biogen’s news release (although it doesn’t say how many patients were treated) 3% of the patients who took the drug had symptomatic ARIA. It resolved itself in 80% of those patients. One patient had a brain hemorrhage after one treatment with the drug. https://investors.biogen.com/news-releases/news-release-details/fda-approves-leqembitm-lecanemab-irmb-under-accelerated-approval

The majority of ARIA-E radiographic events occurred early in treatment (within the first 7 doses), although ARIA can occur at any time and patients can have more than one episode. Other studies have reported that patients taking Leqembi who had brain hemorrhages died. This information is on the Biogen news release, also. https://investors.biogen.com/news-releases/news-release-details/fda-approves-leqembitm-lecanemab-irmb-under-accelerated-approval

Patients who have had a cerebral hemorrhage, aneurysm, brain lesions, stroke, brain contusion, or other brain and vascular pathologies are advised to not take the drug because there is a risk of a brain hemorrhage. Most doctors would not administer the drug in any of these cases.

How much does Leqembi cost?

A year’s treatment will cost about $26,500. Currently, there are few options outside of self-pay. Most of the patients who are potential candidates for the drug are on Medicare, and the Federal program’s coverage is very limited, so far. Patients who can pay out of pocket will be able to start the treatment if they are a good candidate for Leqembi and are able to find a doctor and health care system to work with.

So far, Soleo Health is the sole specialty pharmacy distributor for Leqembi. Soleo Health will distribute Leqembi to provider offices and infusion centers, and administer it across the company’s ambulatory infusion centers nationwide, including those operated by its provider division, Virtis Health. This division offers therapeutic and diagnostic services to people with complex diseases requiring special management.

The company reported that it operates more than 40 infusion centers across the U.S.

Patients treated with Leqembi also can receive support through Soleo Health’s Alzheimer’s disease Therapeutic Care Management Center, or TCMC, whose interdisciplinary staff includes physician specialists, nurse practitioners, registered nurses, therapy-care pharmacists, reimbursement specialists, and patient care ambassadors. The center is supported by the company’s nationwide specialty pharmacies, Soleo Health stated.

More information on Soleo Health’s services for Leqembi and Alzheimer’s disease is available by contacting its Alzheimer’s TCMC at 844-960-9090 or via email at alzheimers@soleohealth.com.

Is it worth the risk?

This is a tough question. If I were in the position of deciding whether to put my loved one on Leqembi I’d have to think long and hard if the risk of their having a brain bleed and possible hemorrhage is worth the possibility of living six months, nine months, or a year or two longer without dementia. On the other hand, it’s too early to know just how beneficial the drug will be. I’d probably not be first in line and would wait a bit to see how much Leqembi is helping and whether Medicare is going to cover at least part of the cost.

Maybe Leqembi will turn out to be the silver bullet we’ve been waiting for, and will totally clear out the amyloid plaques. Now wouldn’t that be fantastic?!

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

Can you prevent COVID-19 with supplements or medications?

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Man fighting viruses and bacteria

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

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

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

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

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

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

Vitamins and minerals that support your immunity

Vitamin A

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

Vitamin B complex

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

Vitamin C

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

Vitamin D

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

Researchers at Northwestern University analyzed publicly available patient data from 10 countries and discovered a strong correlation between vitamin D levels and cytokine storm—a hyper-inflammatory condition caused by an overactive immune system — as well as a correlation between vitamin D deficiency and mortality. http://www.sciencedaily.com/releases/2020/05/200507121353.htm

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

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

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

Selenium

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

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

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

Most convincingly, the researchers found that the COVID-19 cure rate was significantly associated with selenium status, as measured by the amount of selenium in hair, in 17 cities outside of Hubei. http://www.sciencedaily.com/releases/2020/04/200429105907.htm

Zinc

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

Herbs and mushrooms

Echinacea

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

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

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

Stay healthy by maintaining a healthy lifestyle

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

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

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

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

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

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

Why it’s important to get diagnosed early

For a full explanation, click here to read a blog I posted August, 20202. https://barbracohn.com/blog/page/2/

Here are the bullet points:

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

What new tests are available to detect Alzheimer’s?

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

How it works

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

How much does it cost?

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

Other causes for memory issues

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

New drug for delaying symptoms

The FDA recently approved a new drug for Alzheimer’s. Aducanumab isn’t a cure, but it’s the first drug to get this far in an approval process that actually modifies the underlying pathology of the disease, and helps delay cognitive decline in early stage Alzheimer’s. Read about it in my last post. https://wordpress.com/post/barbracohn.com/6470

Clinical research studies for people with early symptomatic Alzheimer’s

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

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

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

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

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



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

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

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

How does Aducanumab work?

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

Aducanumab is a monoclonal antibody that targets amyloid-beta.

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

Aducanumab in clinical trials

In 2007, Neurimmune licensed the exclusive rights to Biogen, which sponsored several clinical trials investigating Aducanumab in humans. Together, Neurimmune’s and Biogen’s scientists published a study in Nature 2016 that described how one year of monthly intravenous infusions of Aducanumab reduces brain beta amyloid in a dose- and time-dependent manner in patients with pre-dementia or mild Alzheimer’s disease. 1https://www.nature.com/articles/nature19323

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are there any negative side effects from taking Aducanumab?

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

How is the drug administered?

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

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

How much will it cost?

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

Where can I buy it?

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

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

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

References

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

Is your loved one in denial about their Alzheimer’s diagnosis?

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After my husband had a heart attack in 1994, a friend told him that he appeared to have one foot in heaven. Morris was more focused on the celestial world and less engaged in his life on earth. He hibernated in his home office, and spent just a handful of hours at his business office each week. He watched too much television, and filled much of his day meditating. His greatest joy was participating in spiritual singing groups.

But I knew something was very wrong. I had an aunt who passed away from Alzheimer’s disease so I was familiar with the symptoms. When Morris started getting lost driving around town, when he departed for a road trip with our son and left behind his suitcase, and when he couldn’t give a friend’s son directions to the high school that Morris had graduated from, I suspected Alzheimer’s.

Morris thought I was ridiculous and refused to see a doctor. It took two more years before he finally agreed. After ruling out metabolic diseases, depression, nutritional deficiencies, and a brain tumor, the diagnosis was quick and clear. Yet, Morris continued to disbelieve that the doctor said he wouldn’t be able to drive in a couple of years.

There’s actually a term for denial of diagnosis. Anosonosia is the medical term for a person who lacks the insight of awareness to understand their own condition. A person with Alzheimer’s can refuse to believe that they have the disease because their brain isn’t fully capable of understanding the illness. Or the person might be in denial because of the stigma attached to having dementia or Alzheimer’s.

How can you help your loved one?

  1. Don’t keep reminding the person of their diagnosis. Instead, be supportive and allow him/her to do as much as they are capable of without taking over for them.
  2. They most likely feel depressed or bewildered or scared, or all of the above. Be a friend and let them know you are there for them.
  3. Listen to their rants, their feelings, their fears. And know that their outbursts of anger are not personal, although that’s difficult. Usually the person closest to the patient is the one that is subjected to the most anger and frustration. Your loved one is scared of how their world is falling apart. You are probably just as scared. Join a support group. The Alzheimer’s Association near you offers support groups for both the person with dementia and for family members. It is a god-send. https://www.alz.org/
  4. Encourage your loved one to do things that will reduce symptoms of the disease. Exercise, socialize (which may be difficult during the pandemic), listen to music, plant a garden, do art projects. There are dozens of ideas to reduce stress for both the patient and the caregiver in my book “Calmer Waters: The Caregiver’s Journey Through Dementia.” https://www.amazon.com/Calmer-Waters-Caregivers-Alzheimers-Dementia/dp/1681570149/ref=sr_1_1?s=books&ie=UTF8&qid=1543875890&sr=1-1&keywords=calmer+waters
  5. Pharmaceuticals for Alzheimer’s help to slow down the progression of the disease. Encourage your loved one to take what the doctor has prescribed.
  6. Although there is no magic bullet, natural supplements also help. Read: “5 Things that Help Dementia that your Doctor Probably Hasn’t Mentioned.” https://wordpress.com/block-editor/post/barbracohn.com/5277
  7. Focus on eating a Mediterranean diet that includes fish, lots of fresh vegetables and fruit, nuts, and healthy fats—olive oil. https://wordpress.com/block-editor/post/barbracohn.com/5170
  8. Help your loved one decrease use of cigarettes and alcohol.
  9. Emphasize a structured routine including getting to bed on time.
  10. Beautiful and simplify the environment with uplifting music and fresh flowers.

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

5 Things that Help Dementia that your Doctor Probably Hasn’t Mentioned

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Photo by Anastasia Dulgier

As a researcher and writer for manufacturers of nutrition supplements, I was in a unique position to care for my husband who was diagnosed with younger-onset Alzheimer’s disease right after his 60th birthday. Morris had opened and operated one of the first natural foods stores in Colorado in the late 1960s. After we married in 1974, I helped him run it. Working in a natural foods store was a natural fit for me because I had been a vegetarian for several years and was eager to learn more about natural health.

Later, I obtained a master’s degree in professional writing and my first job out of school was working as chief copy writer for a manufacturer of nutritional supplements. I learned a lot about supplements and ended up forming my own copy writing service. I learned how to interpret scientific studies, which especially came in handy when Morris was diagnosed with Alzheimer’s disease.

After the initial shock, I immediately went to work researching the drug protocol for Alzheimer’s. I discovered Namenda before it was FDA approved in the U.S. and ordered it from a European company. I gave Morris nutritional supplements, in addition to the prescribed pharmaceuticals, and butted heads with the neurologist who didn’t think that vitamins or minerals could possibly help someone with Alzheimer’s disease.

There have been some negative studies indicating that supplements don’t relieve symptoms of Alzheimer’s disease. But from what I can tell, they have been poorly designed and seem to be the fodder for sensational headlines. But there have also been many studies that show some dietary supplements can slow down dementia symptoms, and in some instances even reverse symptoms.

My purpose is not to convince you one way or the other. Rather, I encourage you as a caregiver to learn about dietary supplements and other modalities that have science backing them up.

  1. Souvenaid is a once-daily drink containing a mixture of long-chain omega-3 fatty acids, uridine, choline, B vitamins, vitamin C, vitamin E, and selenium) with some clinical evidence to suggest that it can benefit dearly Alzheimer’s patients. Doctors can prescribe it as a medical food in Australia and Europe, but it is not yet available in the United States. It is, however, available online. Read about the clinical evidence here: https://alzres.biomedcentral.com/articles/10.1186/s13195-019-0528-6

2. What about the use of cannabis for dementia? I live in Colorado where cannabis has been legal since 2014. Medical marijuana has been legal here since 2000. My husband smoked marijuana before it was in legal in Colorado to relieve his anxiety. He also ate “edibles.” It definitely calmed him down and made him happy, which may be the best outcome associated with cannabis. I did not notice any cognitive improvement.

This is the latest study on cannabis for dementia, published July 17, 2019.

 Limited evidence from one systematic review and one uncontrolled before-and-after study suggested that medical cannabis may be effective for treating agitation, disinhibition, irritability, aberrant motor behavior, and nocturnal behavior disorders as well as aberrant vocalization and resting care, which are neuropsychiatric symptoms associated with dementia.

There was also limited evidence of improvement in rigidity and cognitive scores as assessed by Mini-Mental State Examination. The evidence from the systematic review came from four of its primary studies, whereas its remaining eight included studies did not find favorable or unfavorable evidence regarding the effectiveness of cannabinoids in the treatment of dementia. Sources of uncertainty included the low quality of evidence in the primary studies of the systematic review and the fact that the uncontrolled before-and-after study was a nonrandomized pilot study in 10 dementia patients that reported descriptive outcomes without statistical analysis. No relevant evidence-based clinical guidelines regarding the use of medical cannabis for treating dementia were identified.

3. Vitamin D has been associated with memory loss and cognitive decline. Older adults with low vitamin D levels are at higher risk of dementia and may lose their cognitive abilities faster than those who have normal levels. This is one of the several reasons why everyone, except maybe those who work outdoors year-round, should take a vitamin D supplement.

4. Vitamin E includes several compounds: d-alpha tocopherol, high gamma tocopherol, mixed tocopherols and tocotrienols. Headlines have screamed that people who take more than 400 IUs of vitamin E have a 5 percent greater risk of death than those who don’t take the supplement. Unfortunately, the studies analyzed in this report used only alpha-tocopherol, a synthetic form of vitamin E. The studies were flawed in many other ways, but the important thing to understand is that when you take a full spectrum vitamin E, you are protecting your brain, your heart, and your overall health. A recent study looked at the relationship between tocotrienol and Alzheimer’s disease. Based on its ability to act as a free-radical scavenger, the authors concluded that it has the potential to help reduce risk of Alzheimer’s. https://www.ncbi.nlm.nih.gov/pubmed/29987193

5. I gave St. John’s wort to my husband until he was in late-stage Alzheimer’s disease. By then he needed a pharmaceutical anti-depressant. But the St. John’s wort worked well for mild to moderate depression.

Here’s what we know about St. John’s wort:

Pharmaceutical drugs usually come with a long list of possible side effects. Although some natural products can also have side effects, they are not as common and are usually less severe. One thing to note, though, about natural products is that it may take longer for them to be effective.

It’s always important to read and study when caring for a loved one. Become an informed caregiver. It will help you, your extended family and the person you so lovingly devote your time and energy to. Blessings to you.

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

How dehydration can lead to delirium and other health issues

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Different drinks in glass jugs on white background. Ideas for summer cocktailsIt’s hot outside and it’s easy to get dehydrated. Our body is 50-65% water. The brain, which is 70% water, gets dehydrated just like your body. When it is dehydrated, neurotransmission—which is heavily dependent on water—is impaired, resulting in poor memory, concentration and impaired abstract thinking.

Dehydration can also result in delirium. Delirium is a mental disturbance that is exhibited by a new or worsening confusion, changes in one’s consciousness or by hallucinations. It has a sudden onset from hours to days. It can be reversed but it’s easier to prevent delirium than to reverse it.

When my mom was admitted to the hospital for a UTI (urinary tract infection), she developed delirium. A psychiatrist called me to report that my mom was exhibiting full-blown dementia. I had just spoken to Mom a day before and she sounded fine. I refused the offer of an antipsychotic drug for her, knowing well the high risk of putting an older adult on those drugs. (see Why you should throw away that antipsychotic drug prescribed for your loved one). As it turned out, my mom was severely dehydrated. After a couple days on a hydrating intravenous solution she returned to her normal self.

It’s important to learn the signs of dehydration in everyone, but especially in seniors and young children. The physical symptoms are usually clear: dry lips and mouth, no tears when crying, decreased urine output, sunken eyes, headache, lethargy, dark urine and extreme thirst. The mental symptoms are not as obvious, but can result in mental confusion, irritability and delirium.

Many older adults often limit their fluid intake because they may be incontinent or fear accidents. Those who have limited mobility may try to avoid another trip to the toilet. Individuals who have aphasia (inability to speak due to dementia or brain damage from  stroke, etc.) may not be able to express their thirst.

If you are a caregiver, and that includes caring for yourself!) here are some helpful guidelines:

  • Encourage and remind your care partner to drink.
  • Drinking healthy fluids is important as eating healthy foods. Water is the top choice, followed by milk, vegetable and fruit juices. Remember that juices contain a lot of sugar, both natural and added, so don’t overdo them. Soups are nourishing and hydrating but be aware of the sodium content. Avoid carbonated and caffeinated drinks which have a diuretic effect.
  • Serve liquids at a temperature that your care partner likes. Not everyone enjoys ice water.
  • Flavor water with lime or lemon.
  • Remind your care partner not to wait until s/he is thirsty. By then s/he is already dehydrated.
  • Serve juicy fruits such as watermelon, which contain lots of water.
  • Offer healthy popsicles as an addition to drinks and to those who refuse water.

The rule of thumb is to have 48 to 64 ounces of non-sweetened, non-artificially sweetened drinks. Hydration keeps the body in proper pH (how acidic or alkaline your body is) and protects it from getting dehydrated, which is a cause of inflammation and other kinds of imbalances. Dehydration can also contribute to urinary tract infections (UTIs).

The dangers of UTIs

Urinary tract infections are notorious for causing delirium and delusional behavior in the elderly. When younger people get a urinary tract infection, they typically experience painful urination, an urgent need to urinate, lower abdominal pain, back pain on one side, and fever and chills. However, an older adult might not experience those symptoms. As we get older our immune system changes and it responds differently to infection. Instead of pain symptoms, seniors with a UTI may show increased signs of confusion, agitation or withdrawal. In older adults with dementia, these behavioral changes may come across as part of that condition or signs of advanced aging. If the underlying UTI goes unrecognized and untreated for too long, it can spread to the bloodstream and become life-threatening. In fact, I have a dear friend who died from a UTI that quickly became septic.

Always: Keep the patient hydrated since urination can flush out unwanted bacteria from the urinary tract.

The next time your mind is muddled, drink a tall glass of water and notice the difference. Drink plenty of water, fresh juices, and herbal teas to stay hydrated, flush out toxins and enjoy mental clarity—in summer and all year round.

 

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

What does marijuana do for Alzheimer’s and dementia patients?

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Medical marijuana from the DoctorMy husband passed away eight years ago from younger-onset Alzheimer’s.  Recreational marijuana is now legal in Colorado, but before medical marijuana was legal I’d find a way to obtain it for him to smoke or eat in cookies and brownies. It calmed him down and made him happy. It reduced his anxiety, but it definitely did not help his memory. And that’s not what I was looking for. I just wanted him to feel calmer, and in so doing, it helped me feel more at ease. (Please read Is it a good idea for Alzheimer’s and dementia patients to use marijuana?)

I am not a scientist, but having interpreted studies for the nutritional supplement industry for several decades I can say that it’s possible to find a pro and con study for almost any drug, nutraceutical, herb, vitamin or mineral. Every person is unique, every situation is unique and every environmental factor will influence the outcome of a scientific study in some way. This fact is especially interesting: Because of the federal restrictions, researchers’ only legal source of cannabis for study is a Mississippi farm. But the marijuana plants there are not necessarily identical to those that people get at the dispensary or on the street. Just another indication that studies don’t always demonstrate accurate findings.

Marijuana studies vary in quality and the conclusions are frequently conflicting, according to experts on the issue. What we do know is that marijuana contains hundreds of chemical compounds, the most powerful of which are delta-9-tetrahydrocannabinol, or THC, and cannabidiol, or CBD. THC produces the psychoactive effects — the marijuana high. CBD has a role in pain control and also moderates the effect of THC. But many strains of marijuana in use today have high concentrations of THC and little CBD to balance it. The long-term effects of this shift are unknown.

Here are some recent studies showing the effects of marijuana use on cognition, dementia and heart health.

  1. It’s a known fact that high beta-amyloid—the culprit in Alzheimer’s disease—triggers inflammation and nerve cell death. This leads to memory loss and cognitive deficits. A study published in the journal Aging and Mechanisms of Disease (Amyloid proteotoxicity initiates an inflammatory response blocked by cannabinoids) found that the compound THC (tetrahydrocannabinol) reduced beta-amyloid levels and eradicated the inflammatory response to beta-amyloid, preventing nerve cellular death. While clinical trials are needed to confirm the role THC might play in protecting nerve cells against beta-amyloid, the researchers believe their findings shed more light on the role beta-amyloid plays in Alzheimer’s disease, which could pave the way for new treatments.
  2. Another study examined mice with induced symptoms of Alzheimer’s. The laboratory animals were given a combination of THC and CBD.  The animals displayed improved learning and had less evidence of amyloid clumps in their bodies. Other researchers believe that targeting the CB2 receptor could control the activity of microglia, (a type of cell located throughout the brain and spinal cord) preventing the potentially harmful overactivation of the immune system in the brain.
  3. A Harvard study indicates that medical marijuana has a positive impact on executive functioning in adults. The study points out that medical marijuana products themselves may protect against the executive function deficits that affect most recreational marijuana users because of the inherent differences between medical and recreational products. Medical products are usually low in THC, the primary psychoactive constituent of the plant, and high in other cannabinoids, including CBD. CBD is a non-psychoactive component touted for its therapeutic potential, which may also mitigate some of the negative effects of THC. On self-report questionnaires, patients also indicated moderate improvements in quality of sleep and depression. Obviously, individuals with dementia and Alzheimer’s are not  making important decisions, but this study shows how cannabis can help with sleep and mood.
  4. Research presented in March 2017 at the American College of Cardiology’s 66th Annual Scientific Session showed that using marijuana raises the vascular risks of stroke and heart failure, both major risk factors leading to vascular dementia. Research in cell cultures shows that heart muscle cells have cannabis receptors relevant to contractility, or squeezing ability, suggesting that those receptors might be one mechanism through which marijuana use could affect the cardiovascular system. The study drew data from the Nationwide Inpatient Sample, which includes the health records of patients admitted at more than 1,000 hospitals comprising about 20 percent of U.S. medical centers. Researchers extracted records from young and middle-aged patients—age 18-55 years—who were discharged from hospitals in 2009 and 2010, when marijuana use was illegal in most states. Marijuana use was diagnosed in about 1.5 percent (316,000) of more than 20 million health records included in the analysis. Comparing cardiovascular disease rates in these patients to disease rates in patients not reporting marijuana use, researchers found marijuana use was associated with a significantly increased risk for cardiovascular events such as stroke, heart failure, coronary artery disease and sudden cardiac death. Marijuana use was also linked with a variety of factors known to increase cardiovascular risk, such as obesity, high blood pressure, smoking and alcohol use. After researchers adjusted the analysis to account for these factors, marijuana use was independently associated with a 26 percent increase in the risk of stroke and a 10 percent increase in the risk of developing heart failure.

“Even when we corrected for known risk factors, we still found a higher rate of both stroke and heart failure in these patients, so that leads us to believe that there is something else going on besides just obesity or diet-related cardiovascular side effects,” the lead researcher said. “More research will be needed to understand the pathophysiology behind this effect.”

Conclusion

A lot of clinical research needs to be done in order for the medical community and Alzheimer’s Association to recommend the use of cannabis for Alzheimer’s and dementia.

As with any pharmaceutical, it’s important to understand that no drugs are, as a general rule, 100% safe. But if they can fix something, we take a calculated risk by using them. If cannabis calms down an agitated person, helps with sleep, puts a smile on one’s frozen face, it might be worth trying. If you do decide to give it to an individual with Alzheimer’s, please be cautious. Start with a very small dose in a cookie or brownie and see what the reaction is. Watch for signs of distress and nausea. And hope for some sense of calm and joy.

It helped my husband relax and appear as his old, happy self. But it certainly didn’t help his cognition.

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

 

 

 

 

 

 

Are you putting yourself at risk for dementia with OTC medications and prescription drugs?

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Reading Instructions from PharmacyA new study links the increased risk of dementia with certain medications. (Anticholinergic drugs and risk of dementia: case-control study) The focus of the study was on drugs that have anticholinergic effects. Acetylcholine is vital to memory and learning. There are lower levels of this neurotransmitter in the brains of people with Alzheimer’s disease. Additionally, animal studies have shown that anticholinergic drugs may contribute to brain inflammation, another risk factor for dementia.

It’s estimated that approximately 50% of adults in the U.S. take one or more medications with an anticholinergic effect. Some of the most common are:

  • amitriptyline (Endep, Elavil), paroxetine (Paxil, Pexeva), and bupropion (Aplenzin, Wellbutin). These drugs are commonly taken for depression)
  • oxybutynin and tolterodine, taken for an overactive bladder, found in Ditropan, Oxytrol.
  • diphenhydramine, a common antihistamine found in: Advil PM, Aleve PM, Bayer PM, Benadryl, Excedrin PM, Nytol, Simply Sleep, Sominex, Tylenol PM, Unisom, etc.
  • Chlorpheniramine, found in Actifed, Allergy & Congestion RElief, Chlor-Trimeton, Codeprex, Efidac-24 Chlorpheniramine, etc.

According to Shelly Gray, professor pharmacy at the University of Washington, and author of  Cumulative Use of Strong Anticholinergics and Incident Dementia” (March 2015, JAMA Internal Med.), the longer people took the drugs and the higher the dose, the higher the risk of dementia, although it’s important to note that short-term use was not linked to higher risks.

Gray suggested that people, especially seniors, who have trouble sleeping find a non-drug therapy for insomnia Celexa and Prozac for depression and Claritin for allergies.  She emphasized that it is important to speak with one’s doctor before stopping a medication that you have been taking.

Natural alternatives

Help for depression

  1. Get some physical exercise every day; even just a 20 minute walk helps tremendously.
  2. Use aromatherapy oils. For more information about the use of aromatherapy to reduce stress, improve immunity, reduce agitation, and to promote relaxation read chapter 18 “Aromatherapy” in “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia” by Barbra Cohn
  3.  I gave my husband Ginkgo biloba for depression (and also took it myself). It helped right up until he was in late stage Alzheimer’s. One word of advice, not all brands are efficacious, so pick one carefully. Also note that it takes about 6 weeks to notice an effect. This is a typical difference of taking a pharmaceutical versus a natural remedy.
  4. 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.
  5. 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.
  6. 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.

Natural sleep aids

  1. Try valerian, passion-flower or skullcap herbal tea at least a couple of hours before bedtime.
  2. A cup of warm milk with a small pinch of cardamom, coriander, cinnamon, turmeric and cumin, and an 1/8 of a tsp of ghee is a tasty and relaxing bedtime drink. The calcium in the milk is a muscle relaxant and the Indian spices help induce relaxation. Experiment to see which spices you like.
  3. Eat a banana. Bananas contain potassium and magnesium that help reduce risk of muscle cramps. These two minerals also support heart health and cognitive function.
  4. A drop in blood sugar during the night can cause us to wake up. Although it’s better to not go to sleep on a full stomach, a small protein snack such as a slice of cheese or smear of peanut butter on a cracker can help maintain balanced blood sugar.
  5. Melatonin supplements help some people, but you might have to experiment with the dosage. I like Natural Vitality’s Natural Calm, a powdered calcium supplement that you put in water or juice. I also like the homeopathic remedy Hyland’s Calms Forte.
  6. Spritz lavender oil on your pillow or put a sachet of lavender flowers under your pillow.

Natural antihistamines

  1. Quercetin is a bioflavonoid that is naturally found in plant foods such as apples, cruciferous vegetables (like broccoli or cauliflower), onions/shallots, green tea and citrus fruits. It stabilizes the release of histamines and helps to naturally control allergy symptoms.
  2. Apple cider vinegar is my new “go to” remedy for almost everything. I take 1 Tablespoon everyday by pinching my nose and drinking water to flush it down. It helps alkalize the body and supports immune function.
  3. Butterbur is a natural herb that is sold as an extract. A study published in August 2005 in Phytotherapy Research found that when compared to an antihistamine, the butterbur extract worked just as well, without the side effect of drowsiness.
  4. Remember that Claritin does not contain diphenhydramine, so use it by all means if these other remedies do not do the trick.

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

Can depression be a sign of dementia?

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Depressed Senior Woman Sitting OutsideDepression can affect our memory, and it can result from not being able to do the things that were once easy for us, as in the case of Alzheimer’s or dementia. Depression can result from a number of factors and it often appears differently in different people

Some people are able to hide the fact that they are terribly depressed. I did. I tried to put on a happy face during my husband’s illness, but inside I often felt as though I was dying. Following the recent suicides of Kate Spade and Anthony Bourdain, we have to remind ourselves that we usually don’t know what is happening inside someone else’s head.

Before my husband was diagnosed with younger-onset Alzheimer’s disease he was withdrawn and depressed. I didn’t know what exactly what was going on, and he was unable to articulate how he felt. I eventually realized that he was depressed because the things that were once effortless for him to do, such as driving around town or figuring out how much tip to leave in a restaurant, had become difficult.

Alzheimer’s and depression often occur simultaneously, which often makes it difficult for physicians to make a diagnosis without further testing. According to James M. Ellison, MD of the Swank Memory Care Center, Christiana Care Health System, approximately half of individuals affected by Alzheimer’s disease will experience clinically significant depressive symptoms at some point.  Depression can occur during any phase of the illness.

Symptoms common to Alzheimer’s and depression

  • Loss of interest in things that were once enjoyable
  • Memory issues
  • Sleeping too much or too little
  • Social withdrawal or isolation
  • Impaired concentration
  • Eating too much or too little
  • Crying, feelings of hopelessness, despair
  • Unmotivated
  • Lack of energy, lethargy, apathy
  • Irritability
  • Thoughts of death or suicide

A case of the chicken or the egg: which came first, Alzheimer’s or depression?

Some health professionals think that depression can put one at greater risk for Alzheimer’s. There is also a belief that depression is a symptom of Alzheimer’s. In any case, physicians feel that a person with dementia who is depressed can experience a quicker cognitive decline and need to rely more on caregivers.

What to do?

8 natural ways to combat depression.

Antidepressants may not work as well with people who have Alzheimer’s and are depressed. Before resorting to antidepressants and other drugs,  try these options:

  1. Provide a safe and calm environment. Light candles at dinner, play classical music, have a vase of fresh flowers on the table.
  2. Get some physical exercise every day; even just a 20 minute walk helps tremendously.
  3. Use aromatherapy oils. For more information about the use of aromatherapy to reduce stress, improve immunity, reduce agitation, and to promote relaxation read chapter 18 “Aromatherapy” in “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia” by Barbra Cohn
  4.  I gave my husband Ginkgo biloba for depression (and also took it myself). It helped right up until he was in late stage Alzheimer’s. One word of advice, not all brands are efficacious, so pick one carefully. Also note that it takes about 6 weeks to notice an effect. This is a typical difference of taking a pharmaceutical versus a natural remedy.
  5. 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.
  6. 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.
  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.

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