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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.

The Brain Support awards: The Best, Worst, and Weirdest

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It’s Brain Awareness Week and a good time to assess what we are doing to enhance our memory, focus, cognition and other mental processes.

I recently read “In Pursuit of Memory: The Fight Against Alzheimer’s” by Dr. Joseph Jebelli, a British neuroscientist. It is a wonderfully written comprehensive analysis of the disease, including a history of research, theories, clinical trials, and possible ways to stave off the disease. Although the research and scientific language might dissuade some readers, I found the book very readable and accessible, especially since Jebelli includes his personal account of his grandfather’s Alzheimer’s disease. Here are some of his recommendations for supporting brain health.

The Best Brain Support Awards

  • Staying socially and physically active has a positive effect on mood and well-being.
  • Eating a healthy diet, especially the Mediterranean diet (lots of fresh fruits and veggies, cold-water fish such as wild salmon and sardines, whole grains, and healthy oils (olive, walnut, avocado) and nuts). For more ideas on how to eat well, read 20 Ways to give your body the best nutrition it deserves.
  • Using turmeric to season your food or taking a turmeric supplement. Dr. Jebelli writes about an in vitro (in a petri dish) study in which curcumin, the bioactive ingredient in turmeric, actually dissolves the beta-amyloid plaque found in the Alzheimer’s brain. Beta-amyloid is responsible for creating the plaques that inhibit the communication between neurotransmitters, leading to loss of memory and other functions. For more information about turmeric read Turmeric does a body good.
  • Maintaining a positive attitude

Additionally, here are a couple of my favorite brain support aids.

1. Coconut oil–I was skeptical when I first heard that Alzheimer’s patients were having a reversal of the disease process after consuming coconut oil. But after hearing anecdotal stories, I am very curious about how coconut oil improves cognitive performance in individuals with Alzheimer’s. A Spanish study published in March 2017 concluded that after consuming 40 ml of coconut oil each day for 21 days, (divided into two servings) 44 patients with Alzheimer’s exhibited a significant improvement in language skills. Read more about it: How does coconut oil affect cognitive performance in alzheimer patients?

Coconut oil contains medium-chain triglycerides, which go directly to your liver. The liver naturally converts the oil into ketones. Ketones are chemicals made in your liver. You produce them when you don’t have enough insulin in your body to turn sugar (or glucose) into energy. Ketones are released into the bloodstream where they are transported to the brain as an alternative fuel. Other fats are not readily released into the blood stream and are typically mixed with bile released from the gallbladder before they can be broken down in the digestive system.

Dr. Mary Newport, author of the 2011 book “Alzheimer’s Disease: What if there was a cure?: The story of ketones,” discovered that when her husband ingested coconut oil his Alzheimer’s-impaired cognition improved. In fact, it improved so much that “by the fifth day I felt as though I had gotten my husband back,” says Newport. “His personality and sense of humor returned, he was less depressed, and was able to walk normally again. And he started running and resumed the activities of vacuuming and mowing the lawn.” Additionally, two months after he started taking coconut oil his Mini Mental State Examination (MMSE) score went from 12 to 20 out of 30 points, and he was able to draw the face of the clock, says Newport.

Therapeutic levels of medium chain triglycerides (MCTs) have been studied at 20 grams a day, or about 7 level teaspoons. That comes to about 240 calories per day, since one tablespoon of coconut oil is about 120 calories. But there are no significant long-term human clinical studies completed at this point in time.

A groundbreaking research study of a ketone ester in an Alzheimer’s mouse model was released for publication January 4, 2012 in Neurobiology of Aging. This study showed that compared to animals fed a normal control diet, the Alzheimer’s model mice that were fed ketones had significantly less amyloid plaques and tangles in their brain. The animals also showed reduced anxiety, and improved learning and memory compared to the mice fed the control diet.

Mild to moderate Alzheimer’s patients are having good results from a medical food called Axona® which contains a proprietary formulation of medium-chain triglycerides. Axona, which provides an alternative fuel for the brain, as does coconut oil, is a medical food product and not a drug or a dietary supplement. Medical food products are regulated by the FDA, but are in a unique category separate from drugs and dietary supplements. Axona is available by prescription, and is used in conjunction with other Alzheimer’s medications. For more information visit: http://about-axona.com/

Since we have yet to see long-term human clinical trials, I would not call coconut a miracle remedy for Alzheimer’s disease as indicated by Dr. Mary Drew. But if my husband were still alive I would definitely try giving him coconut oil or Axona. Besides some possible minor gastrointestinal side effects and a slight weight gain, adding medium-chain triglycerides to the health regimen of someone with Alzheimer’s disease might just make a difference.

2. Phosphatidylserine (PS) is one of my favorite daily supplements. I notice a difference in my mental acuity when I take it. And when I forget to take it, I am definitely not as sharp as I like to be. PS protects the integrity of brain cell membranes, facilitates the efficient transport of energy-producing nutrients into cells, and enhances brain cell energy metabolism. PS has been sanctioned by the FDA as a safe “brain booster.”Because there are global concerns about mad cow disease, commercial sources of PS, once derived from cows, are now made from soy-derived PS.How does phosphatidylserine work? Phosphatidylserine keeps fatty substances soluble and cell membranes fluid.  It also helps to increase glucose metabolism in the brain. This is especially significant because Alzheimer’s disease has been called a type of diabetes–diabetes 3- because the Alzheimer’s brain is inefficient in metabolizing glucose. PS has also been found to increase the number of neurotransmitter receptor sites in the brain.

A study published in August 2015 found that PS decreased cholinesterase, the enzyme that interferes with the brain’s uptake of choline. Most importantly, the patients who took supplemental PS showed an improvement in their memory. In conclusion, PS decreased cholinesterase, improved memory.

The Worst Brain Support Awards 

You have probably heard it before, but it’s worth repeating. Refrain or at least cut back on eating these foods. They really do a body harm, and especially your brain.

  • Alcohol
  • Refined carbs
  • Soda, and high fructose corn syrup, which tricks your brain into thinking you’re hungry when you’re not
  • Trans Fatty acids in processed foods, margarines, salad oils, bakery goods, potato and corn ships, candies
  • Saturated fats meat, chicken skin, full fat dairy products and butter

Lack of sleep has been demonstrated to increase risk of dementia and other health concerns. For more information about the importance of sleep, read 16 ways to sleep better . . . so you can be a better caregiver.

Sitting all day and not getting enough exercise is bad for the body and bad for the brain. If you have an office job where you sit most of the day try to get up and move every hour or so. And during your lunch break, go outside for a walk. You will feel so much better!

The Weirdest Brain Support Awards

Stress has a big impact on brain health.  But there are dozens of ways to reduce stress and protect our overall health and brain health. Here are some that were a surprise to me.

  • Applying pressure to the space between your second and third knuckle (the joints at the base of your pointer and middle fingers) supposedly calms you down instantly because it activates a nerve that, according to Sharon Melnick, author of “Success Under Stress,” “loosens the area around the heart, so any fluttery feeling you feel when you’re nervous goes away.”
  • Kissing helps your brain release endorphins, the feel-good neurotransmitters. Laura Berman, Ph.D., a Northwestern University researcher found that in a study of 2,000 couples, those who only kissed when they had sex were eight times more likely to report feeling chronically stressed or depressed. So kiss often and more passionately.
  • I see “the lemon trick” every so often on Facebook. Well, it’s not a trick and it’s not lemon. Rather, this post is about a dietary supplement made from a lemon balm plant called Blueness that is grown only in Bavaria, Germany. The marketing copy claims that if you take this supplement within one hour you will be thinking “I can do anything if I just set my ind to it.” It supposedly improves rapid fire oscillation, which means you’ll be able to remember where you parked your car and the names of people you haven’t seen in years), and you won’t be destined to a life of “What’s this thingamajig called?” It sounds too good to be true, but the hype convinced me to continue reading to the end, where I discovered that the supplement is pretty expensive. No thanks.

I’d love to hear about your favorite brain support tips.

I will send to the first 10 people who respond a chapter from my book “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s and Dementia” called “Living in the Now.” The chapter includes affirmations for staying positive throughout the day and techniques for staying present when you are worried about the futurefrom my book.

“Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia” by Barbra Cohn contains a treasure trove of information on how to stay connected with your loved one, keep calm, improve immunity, reduce stress and feel happier and healthier. Plus, it includes 20 healing modalities that the caregiver can do alone or with their loved one. Available wherever fine books are sold and on Amazon.

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A UTI, fall or a cold can lead to cognitive decline and even death in a person with Alzheimer’s disease

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Dementia disease and a loss of brain function and memories

November is Alzheimer’s Awareness Month 

People with Alzheimer’s who get even a mild respiratory or gastrointestinal infection, or a bump or bruise are at risk for having a significant, permanent memory loss, according to a report that was published in the September 8, 2009 issue of the journal Neurology. These patients can have high levels of tumor necrosis factor—alpha (TNF-a)—a protein that is linked to inflammation and is associated with memory loss and cognitive decline.

In the study, which was done at the Clinical Neurosciences Research Division at the University of Southampton, United Kingdom, 222 Alzheimer’s patients were followed for six months. Of those, 110 people had an infection or injury that resulted in inflammation. These individuals had twice the memory loss during that period of time as the individuals who did not have an illness or injury. Researchers attribute the memory loss to inflammation. In patients whose TNF-a levels were high to begin with, an infection increased their memory loss to 10 times more than those who had low TNF-a levels.

Clive Holmes, PhD, lead researcher, said that this population should be vaccinated against the flu, and infections and injuries should be treated as soon as possible.

It is not uncommon for an elderly person to die from a urinary tract infection, especially someone who has dementia. Even a mild cold can develop into a serious pneumonia and lead to death in an elderly person. My husband developed a kidney stone, and died six weeks later. He progressed from a person in mid- to late-stage Alzheimer’s to someone in the final stage of Alzheimer’s, unable to walk or talk.

Tips for keeping you and your loved one healthy and safe

  • Inoculate against flu, pneumonia and shingles
  • Boost immunity with zinc, vitamin D and vitamin C
  • Prevent falls and accidents (recommended: Complete Guide to Alzheimer’s Proofing Your Home by Mark L. Warner
  • Reduce systemic inflammation with a curcumin (turmeric extract) supplement
  • Use a humidifier to moisturize nasal passages and mucous membranes to help keep them healthy
  • Engage in gentle exercise to reduce inflammation
  • Keep hydrated by drinking at least 6-8 glasses of water each day
  • Reduce risk of urinary tract infections with D-Mannose powder and cranberry extract 
  • Use essential oils (lemon, peppermint, lavender, frankincense, bergamot, thyme, sandalwood, vetiver, myrrh) to boost immunity. 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
  • Eat yogurt. 70% of your immune system lies in your gut. Probiotics are live bacterial microorganisms that populate the human gastrointestinal tract. They combat the daily bombardment of toxins and pathogens (bacteria, fungus, parasites, and viruses) that enter our digestive system every day through contaminated food and other toxins. Recent studies show that the bacteria in your gut can also affect your mental health, mood and stress levels. Fermented foods such as kombucha, Greek yogurt, kefir, sauerkraut, miso, cottage cheese are probiotics. Probiotic bacteria colonize the digestive tract with good bacteria. Prebiotics are the food and nutrients that feed probiotics. Prebiotic fiber is found in fruits and vegetables such as artichokes, jicama, wild yams, onions and garlic, asparagus, beans, oats, chicory root and Jerusalem artichokes. Prebiotics support mineral absorption, vitamin utilization, and healthy blood sugar levels. Your gut needs both pro- and prebiotics in order to stay healthy and keep you healthy.
  • Drink mineral broth. It helps alkalinize the body and warm the system. It also helps counter the negative effects of stress. Have it as a bowl of soup or sip it throughout the day. Use your vegetables scraps or chop 2 cups yams, 1 medium potato, 1 cup zucchini, 1 cup cabbage, 1 cup green beans, 2 cups celery, 1 cup onions. Add herbs, garlic, parsley–anything you like. Place in a large pot, cover with water, bring to a boil, turn down to a simmer, and cover for 3-5 hours. For more information read chapter  31 “Nutrition” in “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia” by Barbra Cohn

BarbraCohn__

Five surprising causes of memory loss

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Mind concept graphic for memory loss or alzheimer's diseaseAfter my husband had a surgical procedure that required anesthesia, not only did he wake up groggy, but his early stage Alzheimer’s disease worsened. He got lost driving in our home town and had more difficulty with everyday activities. Years later, it was a kidney stone that sent him over the edge into a downward spiral. It’s not a surprise that anesthesia can cause memory loss, temporary or permanent. But it came as a surprise when something as common as a kidney stone had a severe impact on my husband’s mental condition and overall health.

There is a link between common infections such as UTIs (urinary tract infections), the flu, colds, and stomach viruses and their effect on memory in the elderly and dementia populations. A significant study found that people with Alzheimer’s, who get even a mild respiratory or gastrointestinal infection, or a bump or bruise are at risk for having a significant, permanent memory loss, according to a report that was published in the September 8, 2009 issue of the journal Neurology. These patients can have high levels of tumor necrosis factor—alpha (TNF-a)—a protein that is linked to inflammation and is associated with memory loss and cognitive decline.

In the study done at the Clinical Neurosciences Research Division at the University of Southampton, United Kingdom, 222 Alzheimer’s patients were followed for six months. Of those, 110 people had an infection or injury that resulted in inflammation. These individuals had twice the memory loss during that period of time as the individuals who did not have an illness or injury. Researchers attribute the memory loss to inflammation. In patients whose TNF-a levels were high to begin with, an infection increased their memory loss to 10 times more than those who had low TNF-a levels. Clive Holmes, PhD, lead researcher, said that this population should be vaccinated against the flu, and infections and injuries should be treated as soon as possible.

Other surprising causes of memory loss

  1. 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 recently died from a UTI that quickly became septic.
  2. Vitamin B12 is essential for normal nerve function. A deficiency can lead to confusion and dementia. It is vital to get 2.4 micrograms of B12 in your diet every day from sources such as dairy products, meat and fish, or from foods fortified with vitamin B12. Vegans must take a B12 supplement since the vitamin is found in animal foods.
  3. Sleep apnea causes one to stop breathing during the night. It can be very brief and very frequent, but it is treatable. Unfortunately, sleep apnea islinked to memory loss and dementia, according to Constantine Lyketsos, MD, director of the Memory and Alzheimer’s Treatment Center at Johns Hopkins Medicine and professor and chair of psychiatry at Johns Hopkins Bayview. You might have sleep apnea if you wake up with a headache and have daytime fatigue — or if your partner complains of loud snoring. A study published in The Journal of Neuroscience found that untreated sleep apnea affects spatial navigational memory. This type of memory includes being able to remember directions or where you put things like your keys. The research suggests that deep sleep, also known as rapid eye movement (REM) sleep, plays an important role in memory. Dr. Lyketsos explains that for people with sleep apnea, oxygen delivery to the brain is interrupted several hundred times during the night . He says, The brain is stressed, so people wake up, and the injury sleep apnea causes can show up as a variety of memory loss symptoms. If you or someone you know has sleep apnea, please make an appointment with your health practitioner.
  4. Some medications such as statins (cholesterol-lowering drugs), sleeping pills, antidepressants, anti-anxiety medications and some painkillers have been found to increase the risk for reversible cognitive side effects, including memory loss and confusion. A commonly prescribed type 2 diabetes drug, metformin, has also been associated with memory problems. A study published in Diabetes Care found that people with diabetes who took the drug had worse cognitive performance than those who did not take it.
  5. Thyroid disease can cause poor memory, especially in seniors. Hypothyroidism is very common in people over 60 and it steadily increases with age. It is believed that up to one in four individuals in nursing homes may have undiagnosed hypothyroidism. Memory loss or declining cognitive functioning which is frequently attributed to old age, might be the only symptom of hypothyroidism in an elderly person. If there is a family history of thyroid disease, past treatment for hyperthyroidism or a history of surgery and/or radiotherapy to the neck, a physician might be able to better establish a link leading to a diagnosis. Thyroid disease is a lifelong disorder that can be treated with medication, but the patient must be closely monitored to make sure the correct dosage is prescribed.

Tips for protecting your memory and keeping you and your loved one healthy and safe

  • Inoculate against flu, pneumonia and shingles
    Boost immunity with zinc, vitamin D and vitamin C
  • Take a complete B-vitamin supplement to make sure you are getting a balanced amount of B vitamins.
  • Prevent falls and accidents (recommended: Complete Guide to Alzheimer’s Proofing Your Home by Mark Warner http://store.nexternal.com/shared/StoreFront/default.asp?CS=ageless&StoreType=BtoC&Count1=668834865&Count2=585975289&CategoryID=3&Target=products.asp
  • Reduce systemic inflammation with a curcumin (turmeric extract) supplement
  • Use a humidifier to moisturize nasal passages and mucous membranes to help keep them healthy
  • Engage in gentle exercise to reduce inflammation
  • Keep hydrated by drinking at least 6-8 glasses of water each day
  • Encourage seniors to use the bathroom several times a day, approximately every two to three hours.
  • Make sure the senior is maintaining good hygiene, with showers at least several times a week.
  • If the person is incontinent, make sure he or she changes undergarments frequently.

There are other articles on my blog that discuss how to support your memory and cognition. Please subscribe today, and feel free to send me your questions.

To your health.

Sincerely,

Barbra Cohn