Archive for December, 2013


brain

Do computerized brain-training programs really work? Will doing Sudoku or crossword puzzles help to ward off cognitive decline?

As we age, our brain (like the rest of our body) loses some of the agility it once had. Normal aging is associated with a slower processing speed and less efficient working memory in the brain. These age-related changes, however, are modest; they are very different than neurological disorders such as Alzheimer’s disease. Furthermore, scientists now know that our brains are able to adapt, change, and re-organize throughout our entire lives — a phenomenon known as “neuroplasticity”. This means our neurons (nerve cells) have the capacity to learn and re-wire, even into old age. An old brain can learn new tricks!

So maybe you’re still asking — will ‘brain training’ help to promote brain health? Buyer beware. The research on such programs is preliminary and should be considered with caution. The games and exercises designed to improve brain performance aim to use neuroplasticity to improve core cognitive abilities; however, it is unclear whether these effects translate to real-life performance or whether these interventions have any appreciable effect on preventing neurological diseases.

In reality, there are many far more compelling interventions that may help to stave off cognitive decline than brain games or mind teasers. For example, brain-derived neurotrophic factor (BDNF) is a key component of neuroplasticity. Physical exercise and low-fat diets have been linked to increased production of BDNF and aid in neuroplasticity (Gomez-Pinilla, 2011). Want the most bang for your buck when it comes to brain health? Consider adopting a lifetsyle that incorporates regular physical exercise and a healthy, balanced diet.

Caution: There is still no proven method for preventing or delaying cognitive decline.

References

Gomez-Pinilla, F. G. (2011). Exercise impacts brain-derived neurotrophic factor plasticity by engaging mechanisms of epigenetic regulation.European Journal Of Neuroscience33(3), 383-390.

lumosity.com

Smith, G. M. (2009). A Cognitive Training Program Based on Principles of Brain Plasticity: Results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) Study. Journal Of The American Geriatrics Society57(4), 594-603.

Zelinski, E. M., Spina, L. M., Yaffe, K., Ruff, R., Kennison, R. F., Mahncke, H. W., & Smith, G. E. (2011). Improvement in memory with plasticity-based adaptive cognitive training: results of the 3-month follow-up. Journal Of The American Geriatrics Society59(2), 258-265. doi:10.1111/j.1532-5415.2010.03277.x

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i love sleeping

Unfortunately for the 15 million caregivers and 5.2 million living with Alzheimer’s disease (AD), sleep disturbances are a common occurrence among those with dementia. These disturbances can diminish the caregiver’s and care recipient’s quality of life. Research indicates that nearly half of those diagnosed with Alzheimer’s will exhibit disrupted sleep (Salami, Lyketsos, & Rao, 2011) at some point during their illness.  In AD, sleep disturbances are typically characterized by waking up throughout the night, daytime napping, and daytime drowsiness (Salami, Lyketsos, & Rao, 2011). Lack of sleep or poor sleep quality can also cause disorientation, confusion, and disordered thinking during the day, compounding the cognitive symptoms the person may already be experiencing. Furthermore, sleep disturbances, “increase the risk of physical and psychological morbidity in the persons with dementia and their caregivers” (McCurry et. al., 2011, p.1393) and increase the likelihood of institutionalization.

Sleep is clearly a prevalent issue in AD, but how do we overcome these challenges? More research is needed to effectively answer this question, but below are some evidence-based recommendations that might assist in promoting regular, good quality sleep.

Non-Drug Interventions

  • Maintain regular times for getting to bed and arising.
  • Establish a comfortable, secure sleeping environment — reduce noise or other stimuli, make sure bedding and room temperature are comfortable, provide nightlights and/or security objects.
  • Discourage staying in bed while awake or watching television while in bed; use the bedroom only for sleep.
  • Increase sunlight exposure during the day.
  • Have the person avoid excessive evening fluid intake and empty the bladder before going to bed.
  • Avoid daytime naps if the person is having trouble sleeping at night.
  • Treat any pain symptoms.
  • Engage in regular daily exercise, but no later than 4 hours before bedtime.
  • If the person is taking cholinesterase inhibitors (e.g. Exelon, Aricept) avoid giving the medicine right before bed

sleep

Final Thought

If you notice disturbed sleep in the person with dementia, it may be helpful to have a physician, such as a neurologist, give his opinion. Medication side effects, chronic illnesses, mood disorders, etc., could be contributing to the problem, and a medical doctor is best to address these issues.

References

Cole, C., & Richards, K. (2005). Sleep and cognition in people with Alzheimer’s disease. Issues In Mental Health Nursing26(7), 687-698.

McCurry, S. M., Pike, K. C., Vitiello, M. V., Logsdon, R. G., Larson, E. B., & Teri, L. (2011). Increasing Walking and Bright Light Exposure to Improve Sleep in Community-Dwelling Persons with Alzheimer’s Disease: Results of a Randomized, Controlled Trial. Journal Of The American Geriatrics Society59(8), 1393-1402. doi:10.1111/j.1532-5415.2011.03519.x

Salami, O., Lyketsos, C., & Rao, V. (2011). Treatment of sleep disturbance in Alzheimer’s dementia. International Journal Of Geriatric Psychiatry,26(8), 771-782. doi:10.1002/gps.2609

When one person receives a diagnosis of Alzheimer’s disease (AD) or a related dementia, the news reverberates throughout the entire family. All family members are affected in its wake, and each person will process the news differently. Children and teens, for instance, might experience acute grief and emotional losses that are different than an adult’s experience. Furthermore, it is estimated that as many as 250,000 children aged 8 to 18 are family caregivers for those with AD in the US (Rosenthal & Greer, 2011) . With millions of families being affected by the disease — and so many children on the front line of caregiving — it is crucial that we understand and overcome the unique challenges faced by this young group.

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Keep Open Lines of Communication

Although children/teens may not be privy to everything that is happening in the household, that doesn’t mean they are spared any stress or anxiety. The young person might be aware of the tense atmosphere in the family, but not understand why. This could cause them to blame themselves, feel guilty, or retreat from family involvement. Therefore, it could be more damaging to ‘sweep the issue under the rug’ rather than to address it head-on. Even if the truth is unpleasant, it is better to be open and honest about changes as they occur.

When a family member is diagnosed, it could be helpful to schedule a family meeting or one-on-one conversation with the youngsters. This will help to facilitate on-going discussion about the disease, and it will allow family members to freely surface concerns or questions.

Answer Questions Honestly

Respond simply to questions in an age-appropriate, honest way. Children are astute observers and are often aware if someone is being inauthentic. Remember to address and validate the young person’s emotions. Listen attentively to the child/adolescent and offer reassurance.

Teach Your Child about the Disease

Education about the disease can often aid in dispelling fears and anxiety. Use concrete examples or even humor to help educate your child or adolescent. For example, you could say ‘Even if Grandpa sometimes forgets your name, he really enjoys spending time with you’ or ‘If grandma says something mean or upsetting, remember is the Alzheimer’s disease making her act this way”. Picture books have also been shown to be effective in teaching children about dementia and older adults (Holland, 2005). Encourage your child to ask questions. Be patient and use words that are easy to understand. Reassure your child that just because a person in the family has Alzheimer’s, it does not necessarily mean that he or she or other family members will get the disease too.

Create Opportunities for your Child to Express Feelings

Agitation, withdrawal, poor performance at school, lost of interest in activities, etc. are all possible indications that the young person is suffering emotionally. It is important to create an environment that is conducive to open expression of feelings. Teens may need some additional prodding in order to open up. Younger individuals may express themselves better through painting, poetry, or a journal.

Encourage your Child/Teen to get Involved in Caregiving

Allowing the young person to be involved in caregiving, can help him/her to feel included and in control of the situation. Teach your child about appropriate communication techniques, such as speaking slowly and using body language. Below are some ideas on activities children can share with a person with dementia:

  1. Bake cookies
  2. Take a walk around the neighborhood
  3. Put a puzzle together
  4. Weed a garden or plant flowers
  5. Color or draw picturesbcp036-05
  6. Make a scrapbook of family photographs
  7. Read a favorite book or story
  8. Eat a picnic lunch outside
  9. Watch your favorite TV show together
  10. Listen to or sing old songs

However, be careful to not overwhelm the teen/child with responsibility, and he/she should probably not be left alone with the person with dementia. Acknowledge and appreciate the young person’s efforts in caregiving.

Early-onset Alzheimer’s disease (EOAD)

Early-onset Alzheimer’s disease affects individuals in their 50’s, 40’s or even younger. When someone is diagnosed with EOAD, their children may still be school age and living at home. In these cases, the children in affected families often take on more caregiving responsibilities and experience greater emotional upheaval, as their parent loses mental faculties during critical developmental periods. It is important to exhibit even greater patience and understanding with these unique cases.

References

http://www.afateens.org/

http://www.alz.org/living_with_alzheimers_just_for_kids_and_teens.asp

Holland, M. (2005). Using picture books to help children cope with a family member’s alzheimer’s disease. YC Young Children, 60(3), 105-109. Retrieved from http://search.proquest.com/docview/197697278?accountid=27927

Rosenthal Gelman, C., & Greer, C. (2011). Young children in early-onset alzheimer’s disease families: research gaps and emerging service needs. American Journal Of Alzheimer’s Disease & Other Dementias26(1), 29-35. doi:10.1177/1533317510391241

Alzheimer’s is a highly individualized disease and symptoms may vary widely from person to person. Every human being is unique, and we respond to challenges and disease uniquely. Similarly, caregivers and family members of those with dementia represent distinctive family systems and dynamics. The roles we encompass as family members may change with the progression of the disease, particularly as the person requires more care and he/she loses decision-making powers. It is not uncommon for family tensions to grow and conflict may ensue. Moreover, families that were dysfunctional before the onset of the disease, may have an increased level of difficulty in overcoming obstacles and various changes (Podgorski & King, 2009). However, greater family harmony and cohesion has been associated with reduced caregiver burden and reduced levels of behavioral issues and agitation in the care recipient. Understanding the impact of dementia on the entire family unit is of critical importance, if we hope to combat these adverse effects and maintain family solidarity and synchrony.

family conflict

Accept and Ask for Help

Although it can be challenging, if the primary caregiver is receptive to asking for and accepting offers of help, their burden and stress levels may be lessened and greater family harmony may result.  Being specific in asking for help and delegating tasks that match the helper’s strengths are two method of facilitating this process. Click here for a sample check list that caregivers or caregiver-helpers may wish to use.

Ability to be Flexible

Families that are successful in caregiving often possess a greater willingness to adapt to change and be flexible. If the family is too rigid, they may be unable to make changes and everyone potentially suffers. Family members may maintain outdated roles which are no longer beneficial to the group. For instance, a parent that will not accept help from her adult daughter because she believes it is not the daughter’s responsibility, hinders an opportunity to bring needed help into the home. Taking on additional responsibilities and new roles are a difficult transition to undergo, but having clear communication and support within the family unit may help to make the transition less stressful.

Old Family Dynamics Die Hard

Issues related to divorce, family secrets, financial disputes, etc., could be resurfaced as the family convenes over the person’s diagnosis. Families that exhibit dysfunctional patterns of relating to one another before the onset of the dementia, typically continue these patterns throughout the journey with the disease. However, families with higher levels of cohesion, lower levels of family conflict, and clear communication channels, often fare better under the stresses of caregiving.

Although dysfunctional family patterns may be difficult to change, coming together regarding a family member’s dementia may be an opportunity to reconnect and rebuild fragmented relationships within the family. In certain cases, it may be helpful to seek the advice of a professional, such as a family therapist, to help facilitate this change.

References

Mitrani, V. B., Feaster, D. J., & McCabe, B. E. (2005). Adapting the Structural Family Systems Rating to Assess the Patterns of Interaction in Families of Dementia Caregivers. Gerontologist45(4), 445-455.

Peisah, C. (2006). Family conflict in dementia: prodigal sons and black sheep. International Journal Of Geriatric Psychiatry21(5), 485-492.

Podgorski, C., & King, D. (2009).Losing function, staying connected: family dynamics in provision of care for people with dementia. Generations33(1), 24-29.

Sherman, C. W., & Bauer, J. W. (2008). Financial conflicts facing late-life remarried alzheimer’s disease caregivers*. Family Relations, 57(4), 492-503. Retrieved from http://search.proquest.com/docview/213938206?accountid=27927

Tremont, G., Jennifer, D. D., & Bishop, D. S. (2006). Unique contribution of family functioning in caregivers of patients with mild to moderate dementia. Dementia and Geriatric Cognitive Disorders, 21(3), 170-4. Retrieved from http://search.proquest.com/docview/232494894?accountid=27927

Vernooij-Dassen, M., Joling, K., van Hout, H., & Mittelman, M. S. (2010). The process of family-centered counseling for caregivers of persons with dementia: Barriers, facilitators and benefits. International Psychogeriatrics, 22(5), 769-77. doi:http://dx.doi.org/10.1017/S1041610210000050