ADFM National Alzheimer's Caregivers Network Malaysia

Memory : Six Key Signs That Memory Loss May Be Serious

2012-05-15T01:18:00.000+08:00

At least three-fourths of people over age 50 report that their memory is not as good as it was. The reality is that more than 90 percent of those who do complain about memory impairment do not have Alzheimer's or dementia. Many memory complaints reflect changes in ability over time but appear to be relatively minor and due to normal age-related changes in the function of the brain.

So how do you know if your loved one is part of the minority whose changes in memory are more serious and warrant an evaluation by a health professional?

Red flags - Momentarily forgetting someone's name or a specific word is actually normal and does not necessarily worsen with age. The following behaviors, in contrast, may be signs that something more serious is taking place:

1.   Difficulty with routine tasks. Trouble completing tasks that a person has done many times before, like figuring out a tip at a restaurant, filling out tax forms or managing a checkbook, is a real reason for concern.

2.   Getting lost. Another red flag is when a person becomes lost while walking or driving in a familiar place, even the person says the navigational difficulties were due to inclement weather or having to make a big detour. This too is a potential warning sign of early Alzheimer's or dementia that needs to be investigated further.

3.   Loss of recent memory. Forgetting what you had for dinner the day before or what movie you watched a few hours earlier is not always a sign of normal brain aging. Other warnings include forgetting important dates or events or repeatedly asking the same question.

4.   Forgetting simple words. People with Alzheimer's or dementia may also have difficulty following or joining in a conversation. They may stop in the middle of a sentence and be unable to pick up where they left off. This is different from the occasional difficulty coming up with a name or word.

5.   Poor judgment in financial matters. It's not uncommon for people with Alzheimer's or dementia to buy things they don't need, to give away significant sums of money to telemarketers or unscrupulous salespeople, or to repeatedly make donations in response to mailed or telephoned requests to legitimate organizations.

6.   Mood change. People with Alzheimer's or dementia may exhibit confusion, suspicion, fear, depression or anxiety, traits that they never had before.

Finally, when a person regularly complains about poor memory and mentions that it is worsening from the year before, it should be looked into.

(Source: John Hopkins Health Alert, 14 May 2012)

Does Namenda Work? Dr. Rabins Addresses a Difficult Question

2012-05-14T02:11:00.000+08:00

In this excerpt from a recent issue of the Memory Disorders Bulletin, Medical Editor Dr. Peter V. Rabins confronts the difficult question: What do you do when a caregiver asks, "Dr. Rabins, do you think that Namenda is really working?"

Namenda (memantine) was widely available for about 20 years in Europe before it received approval in 2003 for Alzheimer’s disease therapy from the Food and Drug Administration (FDA). Namenda is approved for people with moderate and severe Alzheimer’s disease, but some doctors, including memory and dementia experts, offer it to all of their patients with Alzheimer's, regardless of the severity of their symptoms.

Many doctors who are specialists in Parkinson's disease and frontotemporal dementia are using Namenda for their patients with dementia symptoms, even though it is not FDA-approved for that. While it is perfectly within their purview to use a medication "off label" for Alzheimer’s disease if they feel it's warranted, I hope studies will be carried out to tell us whether Namenda does have positive benefits.

There is no cure for Alzheimer’s disease, so the goal of drug therapy for Alzheimer’s disease is to help manage the symptoms. Improvement in cognition is an indicator that Namenda might be working. Therefore, when a caregiver asks me if I think that Namenda is working or not for their loved one, I answer "yes" only when I can see an improvement on a scale that measures cognition or thinking.

Should you choose Namenda? The decision to use Namenda depends more on the preferences of the Alzheimer’s disease patient and his or her family than on the science. Many families and caregivers say, "If Namenda might help, even a little bit, I want my loved one to take it."

On the other hand, some families and patients say, "I don't want to take something that will only make a small difference." For these individuals, I work to get them as much information about Alzheimer’s disease as possible to help manage any behavioral or psychiatric symptoms and to address the financial, legal, ethical and social problems they are facing.

There is no "right" or "wrong" when it comes to this issue. It is the patient and family who should make the final decision, not the doctor. I feel the same way about stopping Namenda. It is up to the patient and family to decide once they are given the information in a balanced and fair manner.

However, colleagues whose opinions I value feel that a drug such as Namenda offers false hope and the benefit is so minimal that it should not be used unless family members feel strongly that they want to try it with their loved one.

(Source: John Hopkins Health Alert, Posted in Memory on 7 November, 2011)

Antipsychotic Medications and Dementia: What Are the Risks?

2012-05-14T01:42:00.000+08:00

Most people with dementia or Alzheimer's disease will, at some point in their illness, show signs of aggression, agitation or psychosis. When these symptoms are so severe that individuals present a serious risk to themselves or to others, a class of drugs known as antipsychotics (or neuroleptics) are often used.

However, several recent studies have found that antipsychotics are associated with an increased risk of death when used in older people with dementia and Alzheimer's disease. In fact, the U.S. Food and Drug Administration (FDA) now mandates that drug makers add what is referred to as a "black box" warning to the labels of all antipsychotics, alerting doctors and patients to this increased mortality risk in people with dementia-related psychosis.

Since those warnings were first implemented in 2005, the use of antipsychotics for older people with dementia has declined significantly. Nonetheless, almost 10 percent of antipsychotic use is still attributed to people with dementia. In addition, about one third of nursing home residents with dementia receive antipsychotics.

Typical and Atypical Antipsychotics. Antipsychotic drugs were first developed in the 1950s to treat schizophrenia.

The first generation of these drugs is sometimes referred to as "typical" or "conventional" antipsychotics; they include chlorpromazine and haloperidol (Haldol). Typical antipsychotics work by blocking the receptors for the neurotransmitter dopamine and can cause a number of side effects that affect physical movement, such as tremors, rigidity, restlessness and muscle spasms.

In the 1990s, a second generation of antipsychotics known as atypical was introduced. These also block dopamine receptors but have fewer of the movement-related side effects that plagued users of the older, typical antipsychotics. Still, atypical antipsychotics have potentially serious side effects, including drowsiness, dizziness, blurred vision, rapid heartbeat, sexual dysfunction and skin rashes. They can also cause significant weight gain, and if left unchecked, people taking them may risk developing diabetes or high cholesterol levels. Examples of atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel).

(Source: John Hopkins Health Alert, 13 February, 2012)

Memory : Advanced Dementia: Why Do Some Skills Remain?

2012-05-14T01:10:00.003+08:00

A subscriber to the Johns Hopkins Memory Disorders Bulletin asked: “I recently read a newspaper interview with a famous neurologist who described the case of a musician who had completely lost his memory to dementia, yet was capable of playing piano concertos -- from memory at a professional level. Having cared for my mother, who died from Alzheimer's, I do not see how this is humanly possible. Can you please explain?”
Dr. Peter Rabins answers: “I have also observed individuals who have advanced Alzheimer's disease but can still play bridge or music. There are several plausible explanations. Most likely, the retained ability is "highly developed," that is, something the person was especially good at. Usually, there is some deterioration from the very high level at which the person could once perform, but the remaining skills are still far above average. Often, what is retained is something learned a long time ago.

In Alzheimer's disease and most dementias, new information is lost first and information that was learned long ago is retained for a much longer period. As a result, the person with dementia can play a piece of music learned many years ago, but not learn a new piece of music. In vascular dementia, the deficits are described as "patchy" because some abilities are intact and others are impaired -- the difference depends on whether a particular area of the brain has been injured or not.”

(Source: John Hopkins Health Alert, 2 April 2012)

Memory : A New Take on What Causes Alzheimer’s

2012-05-14T00:55:00.000+08:00

More than a century after German psychiatrist Alois Alzheimer first lectured about the gooey mass of plaques and tangles he noted in a postmortem brain tissue sample, scientists are still debating what causes Alzheimer's disease.

The majority of scientists have agreed that plaques result from overproduction of beta-amyloid -- a protein found in the cell membrane of neurons. In people with Alzheimer's, this protein accumulates in clumps between brain cells.

But recently, researchers from Washington University in St. Louis arrived at a new theory: that rising brain levels of beta-amyloid do not mean that patients are making more of it but that they can no longer clear it from their brains as effectively.

The study - As reported in the journal Science, the investigators tested 24 people, average age 74, and separated them into a group composed of people with minor Alzheimer's disease and another whose members were cognitively normal. Special testing revealed that both groups produced beta-amyloid at the same average rate within the brain.

The study subjects were then tested to see how the beta-amyloid was cleared from their brains. One of the ways the brain does this is by moving it to the spinal fluid for disposal. The researchers took samples of cerebrospinal fluid by inserting a needle into the subjects' backs and drawing off the fluid that normally surrounds the spinal cord. They found that those with Alzheimer's had decreased clearance of beta-amyloid from the brain to the cerebrospinal fluid -- about 30 percent less than those who were cognitively normal. This suggests that Alzheimer's is associated with disruption of the brain's ability to normally handle the beta-amyloid.

What it means - Early diagnosis of Alzheimer's has been elusive. But because researchers have uncovered a possible mechanism of early disease development, it is possible that this discovery could lead to both a test for early detection and the development of effective therapies to stop or reverse Alzheimer's memory disruption. They calculate that it would take an adult 10 years to build up enough amyloid in his or her brain to reach the amount typically present in someone with Alzheimer's.

This knowledge could offer doctors a window of opportunity to diagnose someone long before dementia symptoms develop. Once they learn they are at risk for dementia, people could make more concerted efforts to reduce their personal risk factors for Alzheimer’s. At the same time, pharmaceutical companies could work on targeted medications to halt brain damage before symptoms become irrevocable.

(Source: John Hopkins Health Alert, 23 April 2012)

Memory : Is Your Loved One Overmedicated?

2012-05-14T00:41:00.000+08:00

Behavioral and neuropsychiatric symptoms of dementia can be extremely challenging and distressing for patients and their caregivers. Antipsychotic medications may be the only option if the patient's behavior is potentially harmful to him- or herself or to others.

Antipsychotic medications are often prescribed "off-label" for dementia patients in nursing homes to alleviate the agitation, aggression or psychotic behavior that is either distressing to the patient or else makes them a danger, but the Food and Drug Administration (FDA) has not approved any drugs for the treatment of behavioral symptoms of dementia. What's more, antipsychotics carry an FDA black box warning that older patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death.

Drugs Versus Alternatives

There are ways to deal with difficult dementia patients that don't involve the use of drugs. Once a medical cause has been ruled out, the nursing and medical staff should look for environmental triggers that can be avoided or minimized.

Changes in the environment might include increasing contact with caregivers, switching roommates, adjusting the temperature in the room or providing stimulating activities.

Simply paying attention to a patient can often ease disruptive symptoms.

In some cases, difficult behavior can be safely managed by reducing boredom, providing intellectual and physical stimulation, exercise, calming music and pet therapy.

However, if someone is in psychological agony and nondrug approaches have failed, medication might help. The risks and benefits of prescribing antipsychotics to people with dementia need to be carefully considered. While dementia patients are difficult to care for, even when drugs are administered, the practice of overmedication to make patients "manageable" is certainly not acceptable.

Advocating for your loved one with dementia

When someone with dementia is cared for in a nursing home, the support of family and friends is still critical, since the person can't adequately advocate on his or her own part. Family members must learn about the medications that are being dispensed, the reasons for their use, proper dosages and possible side effects.

If you notice that your loved one seems to be showing greater confusion after starting a drug, say something. Bring this to the attention of the doctor who prescribed the medication and discuss what steps can be taken to improve his or her quality of life. By maintaining this dialogue, you will be doing everything you can to ensure the best care for your loved one.

(Source: John Hopkins Health Alert, 9 May 2012)

Reminder To Filial Son Moves Others To Care For Their Aged Parents

2012-05-13T17:27:00.000+08:00

(Source, The Sunday Star, By Yvonne Lim, yvonnelim@thestar.com.my, 12 May 2012)
Nobody visits the Leong car air-conditioning service shop here without learning a thing or two about filial piety.

And not many leave without shedding a tear or two after reading a framed “Letter from Mom” with its reminder of a child's duty to his aged parents.

The letter taking pride of place in the shop of 60-year-old Leong Swee Kee reads in part:

“My Child, when I get old, I hope you understand and have patience with me."

Cherished possession: Leong showing a family photo which includes his late mother (middle, in grey)-RONNIE CHIN/The Star
“When my knees get weaker I hope you have the patience to help me get up."

“Like how I used to help while you were little."

“Do you remember learning how to walk?”

Leong said the “letter” was put together by his sister-in-law in memory of his mother, Chung Thye, who died last year at age 103.

“She had a stroke in 1997 which left her barely able to function on her own. My five brothers and I took care of her until she died in May last year,” he said, nodding towards pictures of his mother which adorn the wall.He added: “Those who have cared for a stroke patient understand the challenges. Many times, people came up to me and asked why I did not put my mother in an old folks' home since caring for her at home was so troublesome?

“I told them that my mother had worked hard and sacrificed so much to raise my four brothers and me single-handedly after our father passed away when I was seven. It was an honour for us to take care of her in her old age.”

Leong described his mother as “generous and giving”, and said that many of his customers remembered her as the old lady who would serve them boiled sugarcane juice while they waited for their car to be serviced.

“She cared more about what she could do for others than what they could do for her,” he said.

Watch Video -> Letter from Mom

The father of two grown-up children said he put up the “letter” in his shop to remind customers, especially young people, the importance of caring for their parents.

“Some customers cry after reading it. One man came up to me weeping. He said he was taking care of his own father who suffered a stroke recently and the letter had encouraged him greatly,” he said.

Leong believed that he and his brothers had by example taught their children the meaning of filial piety.

“It is a good feeling to know that I was a good son to my mother. It has been a year since she passed away, and I still miss her a lot,” he said.

“But I am happy to know that she lived a rich, long life with the people she loved and who loved her in return.”

2012-05-12T17:58:00.000+08:00

MALACCA ALZHEIMER’S DISEASE SUPPORT GROUP

MALACCA Alzheimer’s Disease Support Group is organizing a Public Talk on ”DEMENTIA …...   WHO CARES !!!” by Speaker, Mr Willie Kwa, a professionally trained UK Mental Health Practitioner. Join us at the talk for a time of learning, encouragement and bonding with those who care.

DETAILS:

TITLE OF TALK : " DEMENTIA ...........WHO CARES!!! "

SPEAKER : MR WILLIE KWA

DAY/DATE : SUNDAY, 20 MAY 2012

TIME : 2:00pm - 5:00PM

VENUE : ACE Centre, 115 - I, Lorong Mayang 3, Taman Peringgit Jaya, 75400 Melaka

PROGRAMME

2.00pm :   Registration of Attendance
2.20pm :   Welcome Address by Chairman, MADSG Commtittee
2.30pm :   " DEMENTIA .......WHO CARES!!! "
3.30pm :   Q & A Session
4.00pm :   Light Refreshments

SYPNOSIS: 'People with dementia have a past/present/future and continues to be a person of worth and dignity and deserving the same respect as any other human being. Carers deserve to be given the same status.'

SPEAKER’S PROFILE:
Willie Kwa from UK is Malaysian born and bred. Willie is the Advisor on Caregiving from ADFM Panel of Medical Specialists. A Distance Carer for his loving late Mom who had Vascular Dementia. Wiillie who is a qualified Mental Health Practitioner has been professionally delivering care within the National Health Services (NHS) for over 40 years and retired in 2007. Since retirement, he has been working as locum for care agency delivering care at various private Dementia Care Home. 35 years of his professional working life were spent with people who have Dementia.

REGISTER HERE (compulsory first come first served basis) OR

SMS to: 016 - 902 0757 with full name/s & Tel/mobile contacts

For further information, please contact Alice 016 - 902 0757 / 06 - 284 7886

Please click at “ MAP “ for directions to ACE Centre, Malacca

ANNOUNCEMENT:

ADFM 3RD NATIONAL CAREGIVERS WORKSHOP 2012 ON 12 - 13 OCTOBER 2012, FIRST WORLD HOTEL, GENTING (Program details will be announced soon)

JOIN YOUR STATE SUPPORT GROUP AND ADFM NATIONAL CAREGIVERS NETWORK
SIGN UP at: http://admalaysia.ning.com/main/authorization/signUp
Email: caregivers.adfm@gmail.com
TEL: 03-7956 2008 / 016 608 2513 (Jenny)
Website: www.adfm.org.my

Who Is Worse Off: People With Alzheimer’s OR Their Caregivers?

2012-05-01T21:10:00.000+08:00

Though they look through the prism of the future from different angles, people with Alzheimer's disease and their loved ones will likely find their lives dramatically altered after the onset and diagnosis of AD.

Certainly, the person who develops the disease is facing a life-altering and ultimately terminal disease. However, because of the intensive care needed by people with advanced Alzheimer's, and the pain involved in watching a loved one gradually lose their cognitive abilities, some people wonder if the caregivers endure more than the person with the disease.

Every case of Alzheimer's disease is as unique as the individual with the disease, and every caregiver brings unique traits to their caregiving journey. Each configuration, also, has different resources, different support systems and different coping skills. Thus, there is no one answer, and if there were the answer would likely change, depending on the challenges of any particular day.

A Quick Look At The Alzheimer's Journey From Inside

At this time, Alzheimer's disease is considered incurable. People who develop AD tend to die from seven to 10 years after diagnosis, though some can live as long as 20 years. Still, upon diagnosis, the person diagnosed knows instantly that his or her life is going to change dramatically.

Though testimonies from people with AD illustrate that many people with dementia continue to enjoy life for a number of years, there is no denying that their life will change dramatically, over time.

The person with AD must come to terms with the fact that as time moves forward, he or she is likely to lose the ability to live independently. Worse for many people, is the realization that one's memories and ability to reason will likely be stripped away. Their feeling of dignity as a human being is subject to being altered, as well.

Most people like feeling as though they have some control over their lives. The person with Alzheimer's lives in a world that is increasingly confusing, and often frightening, as the stages of the disease move forward. Making sense of one's surroundings becomes nearly impossible.

Paranoia is an understandable development in many people with Alzheimer's. When the brain tells a person one thing and everyone around this person is saying the opposite, it would be natural to wonder if people are playing tricks on them, lying to them or even stealing from them. Paranoid behavior in AD is quite common and causes great pain to both the person with the disease and the caregiver.

People with the disease generally become completely dependent on others, which is hard enough for most people. However, with AD, the person will likely lose the ability to remember who their caregivers are from moment to moment. Spouse, child, grandchild? Eventually, only the feeling of being dependent on a complete stranger may remain.

The Caregiver's Journey

Caring for a person with Alzheimer's is intensive and stressful, and it can be all-encompassing. After a loved one is diagnosed with Alzheimer's disease people generally suffer through an agonizing period of grief. It seems impossible to accept the fact that their spouse or parent has a disease that will rob him or her of personality, memories and the ability for self care. Yet, there is no alternative but to accept the diagnosis and move forward.

One of the first things most people do after the diagnosis is to plan for the inevitable changes Alzheimer's brings. However, with Alzheimer's there are many variables. Some people do quite well for months or even years. Others will decline quickly. Yet, the family must try to look ahead at the changes that will most likely occur, and plan with their loved one how best to manage the disease and future care.

With AD, people can change moods in an instant. The caregiver may be constantly on edge, worrying about mood swings, incontinence issues or the person wandering away and getting lost. Some people with AD have significant personality changes, which is distressing to loved ones.

Watching the slow process of Alzheimer's rob a loved one of memories and abilities can be excruciating. People who love and care for someone with Alzheimer's disease face the daily task of accepting the losses their spouse or parent must endure, all the while knowing that at the end of this journey they will suffer the second loss of their loved one through death.

The paranoia that often accompanies Alzheimer's can turn the diagnosed person against his or her caregiver, leaving the caregiver feeling helpless and ineffective.

Alzheimer's disease is progressive and there is a downward spiral through recognized stages, however that doesn't mean the disease leads down a straight path. This uncertainty can contribute to the caregiver feeling uniquely alone and isolated, even when support services are offered.

Considering the challenges that people with Alzheimer's disease and their caregivers face, is there any joy at all in the journey? For many, yes. Caregivers can and do find joy in caring for someone they love, even if exhaustion and occasional impatience can make them wonder how long they can continue this intensive care. Most people eventually need to include paid outside help.

As for the person with Alzheimer's, many find a new determination after the diagnosis to live each day as fully as possible. They are aware of the changes that loom in their future, which makes the present more precious.

Who has a more difficult time? I believe that question is like most other quality of life questions. The attitude of the people involved, as well as their resilience, their flexibility and ability to accept what life hands them, will make the answer to this question unique for every Alzheimer's family.

(Source: By Author, Columnist and Speaker, Carol Bradley Bursack, Agingcare.com, April 2012)

（SAT）19MAY12 ADFM Free Public Seminar "Caring For the Person With Dementia-The Person Centred Way" By Dr Ng Li-Ling and Ms Lim Hwee Er

2012-04-28T06:37:00.000+08:00

Dear Caregivers/Members,

ADFM National Caregivers Network is organizing a FREE Public Seminar for Caregivers of People with Dementia, sponsored by Esai (Malaysia) Sdn Bhd and hosted by Faculty of Nursing, MAHSA University College.

SPEAKERS : DR NG LI-LING, and MS LIM HWEE ER

Date : SATURDAY, 19 MAY 2012
Time : 8:00am – 1:30pm
Venue : Block A, 1st Floor, MAHSA University College, Jalan University Campus, off Jalan University, 59100 Petaling Jaya

PROGRAMME

OBJECTIVES:
1. To have An Overview of Dementia and Its Management.
2. To understand A Person Centred Care Approach to Dementia.

WHO SHOULD ATTEND:
Caregivers and Family members, health care workers who work in nursing homes/hospitals, social workers, home assistants & all members who directly or indirectly are involved in the care of dementia patients.

SPEAKER’S PROFILE:

1. DR Ng LI-LING, MBBS, MMed (Psych), FAMS, is a Senior Consultant Psychiatrist currently practicing at Department of Psychological Medicine, Changi General Hospital, Singapore. She received specialist training in the field of Psychogeriatrics in the United Kingdom in 1991. Since 1993, she has been the Vice-President of the Singapore Alzheimer’s Disease Association and has had significant experience in the management of people with dementia and their families. In addition, Dr Ng is actively involved in the planning of services for the elderly with mental illnesses and is a strong advocate for the greater awareness of the special needs of this sub-group.

2. MS LIM HWEE ER holds a Masters of Health Service Management (University of Sydney) and a Bachelor of Health Sciences (Hons) (OT) (University of Teesside, UK). An Occupational Therapist, her years of clinical experience working with the elderly people of various geriatric/psychogeriatric conditions spans from hospitals to community services including nursing homes, day centers and home-based services. She also has vast experience providing consultancy services in planning and implementing specialized services and programs such as early dementia programs and hostel. An ACTA Certified Trainer, she is involved in development and implementation of WSQ certified and regular training and workshops for professionals, family caregivers and the public in collaboration with various organizations such as Tsao Foundation, HPB, SSTI and CSC on issues related to eldercare and well elderly programs, sitting on various committees including Alzheimer’s Disease Association Steering Committee for Person Centered Care, The Adult Protection Team (MCYS) and Dementia Taskforce and National Dementia Network Dementia Homecare Subgroup. Hwee Er is currently in private practice with Goshen Rehabilitation & Consultancy Services.

REGISTRATION:

1. Email Registration Form to : jenny@adfm.org.my OR Fax to: 03-7960 8482.
2. SMS to 016-608 2513 with full name/s & Tel/mobile contacts if you do not have Email access.

For further information, please call 603–7956 2008 / 7958 3008 (Jenny).

SPONSORED BY: ESAI (MALAYSIA) SDN BHD        HOSTED BY: MAHSA UNIVERSITY COLLEGE

ORGANIZED BY: ADFM NATIONAL CAREGIVERS NETWORK

JOIN ADFM NATIONAL CAREGIVERS NETWORK
SIGN UP at: http://admalaysia.ning.com/main/authorization/signUp

Email: caregivers.adfm@gmail.com
Website: www.adfm.org.my

(SAT) 7APRIL12 - ADFM Free Public Talk "Planning Ahead for Care of People with Dementia in Community" By Dr Gemma Law, Chartered Psychologist (UK)

2012-03-31T17:05:00.000+08:00

ADFM National Caregivers Network is organizing a Free Public Talk for Caregivers of Dementia, sponsored by Eisai (Malaysia) Sdn Bhd.

Date : SATURDAY, 7 APRIL 2012

Time : 2:30pm – 5:10pm

Venue : ADFM PJ Daycare Centre, 6 Lorong 11/8E , Seksyen 11, 46200 PJ

PROGRAMME

02:00pm : Registration of Attendance
02:30pm : Welcome Address by ADFM Chairman, Datuk Dr Yim Khai Kee
02:40pm : “Planning Ahead for Care of People with Dementia in Community” by Dr Gemma Law
04:40pm : Q&A Session
05:10pm : Light refreshments.

OBJECTIVES:

To get the message across to the caregivers that the planning ahead is to prepare themselves how to cope when different situation does come up such as:

1. having another stroke
2. increasing dependency at home due to frailty and aging process
3. prevention of falls
4. feeding problems
5. Having psychotic features
6. Failing to respond to external stimuli
7. Financial arrangement and application for guardian, etc
8. Coping with death and dying process

There are many more and the mentioned situations or incidents are commonly occurred at moderate/late stage of dementia. Preparation for strengthening their resilience and coping strategies should plan ahead - knowing what is going to happen and how to reduce the stress level …… .

Who Should Attend:

Caregivers and Family members, health care workers who work in nursing homes/hospitals, social workers, home assistants & all members who directly or indirectly involve in the care of dementia patients.

SPEAKER’S PROFILE:

Dr Gemma Law, Assistant Professor College of Life Science & Technology School of Professional & Continuing Education at HKU. Dr Gemma Law, a Chartered Psychologist (UK) is a well known Speaker at regional and world conferences on related Alzheimer's/Dementia areas. She has over 10 years' clinical experiences in nursing and mental health care. Her research area includes family caregiving burden, psychosocial intervention, behavioral management, and case management approach in dementia care. She has been involved with several pioneering projects as a Consultant such as, developing community dementia day care, carers forum, training programs for volunteers and family caregivers and centre for behavioral management. Her publications include developing dementia day care, use of assessment pack and individual care plan, self help kit, home care management, care of persons with moderate and late stage of dementia.

Registration:

1. Email Registration Form to jenny @adfm .org .my or Fax to 03-7960 8482.

2. SMS to 016-608 2513 with full name/s & Tel/mobile contacts if you do not have Email access.

For further information, please call 016–608 2513 or 03 – 7956 2008.

SPONSORED BY: EISAI (MALAYSIA) SDN BHD

JOIN ADFM NATIONAL CAREGIVERS NETWORK

SIGN UP at: http://admalaysia.ning .com /main/authorization/signup

Website: www.adfm .org .my

Email: caregivers.adfm@gmail.com

Greetings from Alzheimer’s Disease Foundation Malaysia !

2012-03-13T20:33:00.005+08:00

Dear Caregivers/Members,

Welcome to Our ADFM National Caregivers Network!

In life, change happens.

A life changing event may be anticipated, planned or more often than not - an uninvited guest. When a loved one is diagnosed with Alzheimer’s, you find yourself thrust into the role of a caregiver, and life as you know it, can cease to exist.

Alzheimer's disease never affects just one person in a family. Your life has changed, too, from your social life and relationships to your goals and priorities. "Changed" isn't even the word - you've gone through a total upheaval, the kind that splits a life in two. In the years before Alzheimer's, you may have worried about the lawn or local politics or today's kids. As an Alzheimer’s Caregiver, your primary worry is about getting through the day.

Once Alzheimer's disease strikes, Alzheimer's caregivers get to witness the craziness that comes with Alzheimer's day in and day out. However, the most frightening fear is knowing that the day will come when your loved one - won't know you—this is the most horrific feeling of them all for an Alzheimer's caregiver!

In the early days of caring, the caregiver deals with a disease that is difficult, sometimes impossible to understand. Welcome to Alzheimer’s World - Don't be afraid or reluctant to step into this new and very different world.

In Alzheimer's World, reality takes on a different shape. Reality in Alzheimer's World is a reflection of what the person suffering from Alzheimer's thinks and believes. It is this reality that you must focus on, not the way YOU think things are, or should be.

Choosing to deny or fight unexpected change means you will struggle all your life. Difficult though it may be, you need to acknowledge your fears, anger, grief, guilt and feelings of being alone and navigate from victim to acceptance.

Consciously embracing the role of caregiver permits you to take charge of your life. It doesn’t make it any easier because there is no more demanding, heart wrenching or patience-trying job than caregiving.

Choosing to take control of your life means making proactive decisions that recognize your needs as well as those of your loved one.

Taking charge is not a selfish act because if you do not take care of yourself, you may not be there when you are needed. You can’t be an effective caregiver for the care recipient if you are exhausted, depressed, resentful or in poor health.

Recognizing that you have options and choices is in the best interest of your immediate and extended family. It is wise to remain flexible and stay open minded when making decisions, but the key to retaining your sanity is to set limits on what you are willing to do without compromising your safety or putting your loved ones at risk.

The first step is to identify your strengths and recognize your limitations. You’re setting yourself up for failure if you attempt to prepare meals for the care recipient and you don’t know how to turn on the oven or set the microwave. A happier option is to ask for support from your friends, family or community resources.

In addition, because your loved one needs to maintain a sense of independence, self-respect and self-control, it is critical to permit Alzheimer’s patients to do as much as possible on their own. Be sure you let the care recipient know that you trust them and appreciate their efforts.

The challenge as a caregiver is to stay the course when your loved one becomes unlovable. Keeping a positive attitude when this happens is essential because your attitude drives your actions. It is also true that your perception of a situation directly influences your attitude.

When a family member ignores you, is argumentative, aggressive, hostile or even violent it is not easy to remain supportive and provide loving care. If this happens to you, try to view the outburst from the loved ones perception. Keep your cool and attempt to understand why he/she is reacting in this way. Listen carefully to pick up on a word, phrase, facial expression or other hint that will help pinpoint the underlying cause of the unwanted behaviour. Avoid taking the outburst as a personal threat or attack.

It is non-productive to respond to anger with anger. However, be quick to seek help if violent or abusive behaviour escalates or reoccurs. Never forget that you have rights as a caregiver and don’t hesitate to stand up for yourself.

When the situation is under control and everyone involved has had a chance to catch their breath and calm down, replay the scene with the intention of identifying what may have triggered the individual’s actions.

Based on your observations, past relationship with your loved one and your intuition, set some guidelines for future interactions such as avoiding sensitive subjects, events or troubling memories and replacing hot button words with more benign or neutral statements. Your objective is to prevent a potentially threatening confrontational or highly emotional environment

Whether you made a deliberate decision to become a caregiver or found yourself in the role because your spouse, parent or adult child was diagnosed with Alzheimer’s disease, be proud of your role as a caregiver - but don’t expect to be super human. Take care of yourself and take a respite as often as you need it.

Someone is depending on you and someone wants you to stay well because they care about you.

FINALLY, the most effective and important of all, is for you to show and to give complete compassion – the tender loving care approach will never fail! The first principle of love for persons with cognitive disability is to reveal to them their value by providing attention, concern and tenderness. Any experienced carer knows that the person with dementia, however advance, will usually respond better to someone whose affection is affirming in tone.

Try it – you will be surprised with the positive results.

Good Luck and Happy Caregiving!
Ong Eng Joo

JOIN ADFM NATIONAL CAREGIVERS NETWORK

National Platform for The Caregivers Community

SIGN UP : REGISTER HERE

2012-02-19T06:05:00.000+08:00

Dear Caregivers/Members,

ADFM National Caregivers Network is holding a Presentation on:

Date : Saturday, 24 March 2012

Time : 2:00pm - 5:00pm

Venue : ADFM PJ Daycare Centre, 6, Lorong 11/8E , Section 11, 46200 PJ

PROGRAMME

1:30pm : Registration of Attendance

2:00pm : Welcome Address by Chairman, Datuk Dr Yim Khai Kee

2:10pm : “DEMENTIA – CARE GIVING OR GIVER, AND COMMUNICATION”
4:10pm : Q & A Session

4:40pm : Light refreshments

SYNOPSIS

1. “Care Giving OR Giver” are honourable phrase. Do we understand what it means ??????

In his presentation, Willie Kwa hopes to explore the understanding of care giving and issues surrounding how care is action that is, direct care intervention, non medical therapies, etc, etc.

2. “Communication” is a key action associated in any given life interaction, more so with someone who has DEMENTIA.

The goal in all communications with a person who has Alzheimer’s disease should be to connect with the person in a positive, constructive, effective way.

SPEAKER

Mr Willie Kwa from UK is Malaysian born and bred. A distance Carer for a loving Mom who had Vascular Dementia. Willie, a qualified Mental Health Practitioner, has been professionally delivering care within the National Health Services (NHS) for over 40 years and retired in 2007. Since retirement, Willie has been working as locum for care agency delivering care at various private Dementia Care Home. 35 years of his professional working life were spent with people who have Dementia.

Registration:

1. Compulsory registration (first come first serve basis) due limited places.

2. Email attached Registration Form to : jenny@adfm.org .my / Fax: 03-7960 8482 OR SMS Jenny at 016-608 2513 with full name/s and Tel/mobile contact if you do not have internet access.

For further information, please call Tel: 03-7956 2008/016–608 2513.

JOIN ADFM NATIONAL CAREGIVERS NETWORK

National Platform for The Caregivers Community

SIGN UP at: http://admalaysia.ning .com /main/authorization/signUp

From: ADFM National Caregivers Network

February 2012

The Agony of Isolation and Family Caregiving : An Alzheimer’s Tragedy

2012-02-17T12:39:00.002+08:00

The pain of isolation for the family caregiver increases exponentially as Alzheimer’s advances. On a scale of one to ten, ten being the highest, isolation must be at the top of the list. As a woman once wrote and providing care for her aging father, “With Easter tomorrow I’m feeling forgotten by people around me and it’s making me feel blue”. It is estimated that millions of baby boomers will be diagnosed with Alzheimer’s within the next decade. For every one diagnosed with Alzheimer’s, a primary family caregiver is becoming responsible for an average of four to six years, and perhaps as long as 20 years, after the diagnosis of Alzheimer’s according to the Alzheimer’s Association (http://www.alz.org/news_and_events_generation_alz.asp).

When I became a family caregiver for my husband 10 years ago, I was focusing on creating systems to provide the best care possible, safety was top of my to-do list and living two lives at once (taking care of all his needs, thoughts and feelings along with mine) required a shift in perspective. By the time I felt established as a family caregiver, I noticed everyone around me had disappeared, my social activities were non-existent because there was no time after devoting 24/7 to my husband, and I was feeling extremely isolated in this world - not even able to share thoughts and feelings with my husband for fear of confusing him even more.

Words that come to mind when pondering on this feeling of isolation are: sadness, mourning, loss, fear, and despair. Although I have a background as a mental health counselor and know the importance of combatting isolation, it became obvious to me that devoting 24/7 on family caregiving duties and responsibilities became overwhelming for me. Such a schedule did not leave any room for reaching out and getting in touch with others. There was no energy or desire for engaging in activities outside my home. I was simply physically and emotionally exhausted, and the expression “can’t see the forest for the trees” seems fitting.

What I found most helpful was an occasional visit from my sister and her husband who were able to see physical and emotional changes in me because they know me well. My sister did not hesitate to “drag” me to a restaurant when I was having a professional caregiver for a few hours for respite. She also did not hesitate to let me know when it was time to place my husband in long-term care because he no longer was able to walk unassisted and all the lifting on him meant my own body was starting to fail me. Did you know there is research showing that an individual living at home does not live any longer than living in long-term care?

It has been almost two years since my husband moved into long-term care but I am still recovering from being a family caregiver. I must have slept at least four months, sleeping in bed or a recliner (any time of day or night) in those months. Now that I have more time and can get out and socialize, I have trouble finding avenues where I might make new friends. Creating an exercise program that benefits me has not been as easy as I thought, but I’m getting there. Results of this isolation includes, but is not limited to, premature aging, depression, exhaustion, high blood pressure and even despair in many family caregivers. They often feel they have been abandoned by family, friends and even their close neighbors. In reality it is often the profound emotional and physical changes in them that create such feelings, whether these feelings are real or imagined.

POSSIBLE SOLUTIONS:

Treat caregiving as though you were a profession and take regular breaks. Keeping a 24/7 schedule is a recipe for disaster. My advice is to find in-home help or support early after becoming a family caregiver. Start from the first day to look for that professional help and get out of the house while that individual is there with your loved one. Let family members know that you need them in your life now more than ever and visit with them more often. In order to visit relatives avail yourself of respite care in long-term care where you know there is a team of professional caregivers to cover your time away from home. Take time to pause in order to be able to ask for what you want from others.

Know the four stages a family caregiver will experience (http://www.practicalcaregiverguides.com/four-stages-of-caregiving) and actively take steps to manage each stage better:

1. Early Stage: Basic care

2. Middle Stage: Intermediate care

3. Late Stage: Advanced care

4. Bereavement Stage: End-of-life care

If you care for a parent or relative outside your home, consider moving them into your home to minimize travel time on your part. Get financial advice early in order to make proper budgetary adjustments so the financial stress is reduced and it is possible to make ends meet. On holidays and special occasions treat yourself so that you feel special. Finally, you may want to consider the services of a professional Alzheimer’s coach to provide the guidance and support you need through this challenging period in your life.

About the Author:

Ethelle G. Lord has her Doctorate of Management in Organizational Leadership from the University of Phoenix (2010). Dr. Lord is An Adjunct Professor of Business, Author and Professional Alzheimer’s Coach. She has her own coaching business at Remembering for You (dot) Com and Teamwork Coaching (dot) Com. From 1992-1996 she had a private practice in mental health counseling; in the late 80s she was a paralegal for Legal Services for the Elderly and from 1992-1996 she was a two-term President of the Maine Gerontological Society of Maine. Ethelle is married to Maj. Larry S. Potter, USAF Retired. They live in Maine.

Visit : http://remembering4you.com and contact the author at Info@remembering4you.com.

AN ALZHEIMER'S VALENTINE

2012-02-14T16:10:00.001+08:00

(Source: By Tom and Karen Brenner, Alzheimer's Reading Room)

We were impossibly young and so beautiful,
When we met and fell in love.

You were the cool guy from the big city
I was the shy small town girl.

I bring you photographs of those days long ago,
You look and smile and ask me who those people are.

I take your hand. It is warm and strong in mine,
You don’t remember me but you know that we belong together.

I tell you the stories of those two young people
You listen intently and study their faces.

And look into my face,
With wonder in your eyes.

I have come to understand that it doesn't matter,
That you no longer remember who we were then.

It only matters that we can sit and hold hands,
While I tell you stories of our past.

Like an old photograph, memory can fade away,
But love endures.

In the touch of hands, in a smile,
In the wonder I see in your eyes.

Memory Gate Opened by Deep Brain Stimulation

2012-02-14T00:30:00.005+08:00

Could a small jolt to the brain be the answer to memory loss?
A new study at UCLA may raise hopes for those suffering from the effects of Alzheimer's and other brain-diminishing diseases. In a small sampling, seven patients with epilepsy—including some with memory impairment—had wires inserted into their brains, delivering electrical current to clusters of neurons that no longer function properly and cause seizures. In the process, researchers noted that all seven patients also exhibited improved memory, allowing them to navigate a virtual taxi cab through a computer-generated town created for the study.
Although very preliminary, the experiment saw improvement even in those patients not suffering from memory impairment, indicating that this stimulating technique might also benefit those with perfect cognitive functioning.
Now, if it could only help us find our car keys.
_________________________________________________________________________________

Have you ever gone to the movies and forgotten where you parked the car? New UCLA research may one day help you improve your memory.

UCLA neuroscientists have demonstrated that they can strengthen memory in human patients, by stimulating a critical junction in the brain. Published in the Feb. 9 2012 Edition of the New England Journal of Medicine, the finding could lead to a new method for boosting memory in patients with early Alzheimer's disease.

The UCLA team focused on a brain site called the entorhinal cortex. Considered the doorway to the hippocampus, which helps form and store memories, the entorhinal cortex plays a crucial role in transforming daily experience into lasting memories.

"The entorhinal cortex is the golden gate to the brain's memory mainframe," said senior author Dr. Itzhak Fried, a professor of neurosurgery at the David Geffen School of Medicine at UCLA. "Every visual and sensory experience that we eventually commit to memory funnels through that doorway to the hippocampus. Our brain cells must send signals through this hub in order to form memories that we can later consciously recall."

Fried and his colleagues followed seven epilepsy patients who already had electrodes implanted in their brains to pinpoint the origin of their seizures. The researchers monitored the electrodes to record neuron activity as memories were being formed.

Using a video game featuring a taxi cab, virtual passengers and a cyber-city, the researchers tested whether deep-brain stimulation of the entorhinal cortex or the hippocampus altered recall. Patients played the role of cab drivers who picked up passengers and traveled across town to deliver them to one of six requested shops.

"When we stimulated the nerve fibers in the patients' entorhinal cortex during learning, they later recognized landmarks and navigated the routes more quickly," Fried said. "They even learned to take shortcuts, reflecting improved spatial memory.

"Critically, it was the stimulation at the gateway into the hippocampus — and not the hippocampus itself — that proved effective," he added.

The use of stimulation only during the learning phase suggests that patients need not undergo continuous stimulation to boost their memory, but only when they are trying to learn important information, Fried noted. This may lead the way to neuro-prosthetic devices that can switch on during specific stages of information processing or daily tasks.

Six million Americans and 30 million people worldwide are diagnosed with Alzheimer's disease each year. The progressive disorder is the sixth leading cause of death in the United States and the fifth leading cause of death for those aged 65 and older.

"Losing our ability to remember recent events and form new memories is one of the most dreaded afflictions of the human condition," Fried said. "Our preliminary results provide evidence supporting a possible mechanism for enhancing memory, particularly as people age or suffer from early dementia. At the same time, we studied a small sample of patients, so our results should be interpreted with caution."

Future studies will determine whether deep-brain stimulation can enhance other types of recall, such as verbal and autobiographical memories. No adverse effects of the stimulation were reported by the seven patients.

WATCH VIDEO: New Study-Electric Shocks To Brain Improve Memory

(Source: Alzheimers Weekly & Dementia Weekly, 12 February 2012)

Hope For Early Alzheimer's Test In Spinal Fluid

2012-02-13T23:23:00.000+08:00

New research led by Nottingham University in the UK suggests abnormal levels of seven proteins in spinal fluid could be markers for the early stages of Alzheimer's disease, raising hopes of a test for a disease that is difficult to diagnose at the beginning. The researchers write about their findings in the Journal of Alzheimer's Disease.

Study co-author Dr Kevin Morgan, Professor of Human Genomics and Molecular Genetics at Nottingham, told the press on Tuesday that the findings are "a new lead for improving early diagnosis of Alzheimer's disease".

An early diagnosis of Alzheimer's disease would help people prepare for the future and also enable them to be involved in clinical trials at a much earlier stage of the disease, when treatments are more likely to show positive results, he added.

About 820,000 people in the UK have dementia, of which Alzheimer's disease is the most common form. Dementia often develops slowly and is not always obvious in the early stages. It can be difficult to distinguish from the mild forgetfulness often seen in normal ageing.

Morgan and colleagues compared samples of cerebrospinal fluid (CSF) from 33 people with Alzheimer's disease, 10 people with mild cognitive impairment, and 20 healthy older people. Mild cognitive impairment is a condition where people have problems with thinking and memory but not to an extent that it interferes with everyday life.

They compiled profiles of the proteins in each sample and then compared them with each other to see if they could find something distinctive in the samples from people with Alzheimer's disease.

The results showed that the samples from people with Alzheimer's diseases tended to have higher levels of four proteins, and lower levels of three other proteins.

A protein called SPARCL1 proved to be the strongest predictor for Alzheimer's. When the researchers tested the samples using only this protein, they could tell whether a person had Alzheimer's disease to an accuracy of 65%.

This accuracy went up to 95% when they tested for abnormal levels of all seven proteins.

The researchers repeated the tests with a new set of CSF samples from 32 healthy people and 30 people with Alzheimer's disease. This time, when they tested for all seven proteins, the accuracy was 85%.

The team now plans to use their findings to develop a blood test for an early diagnosis of Alzheimer's disease.

Morgan said:

"It will also be important to investigate what causes these specific proteins to change as Alzheimer's develops."

By understanding the underlying changes in the biochemistry of Alzheimer's, we have a better chance of developing new treatments, he said, adding that:

"Dementia can only be defeated through research, and I hope these findings could take us a step closer to that goal."

Dr Marie Janson, Director of Development at Alzheimer's Research UK, who part-funded the study, said the findings have "opened up a new avenue for research".

She emphasized how difficult it is to diagnose Alzheimer's, as memory problems can be symptomatic of various conditions.

"This study has the potential to help create a vital tool for doctors to identify patients that need further investigation - but these results must now be followed up in order to achieve that goal," she added.

(Source: Medical News Today, 12 February 2012)

Treat Sleep Apnea – Prevent Vascular Dementia

2012-02-13T06:49:00.002+08:00

A new study links Sleep Apnea to strokes and vascular dementia. Early treatment of Sleep Apnea can protect you from these vascular events.

Study Highlights:
- Sleep apnea is common in people with silent strokes and small lesions in the brain. This vascular damage often evolves into vascular dementia.
- Having more than five sleep apnea episodes per night was associated with silent strokes.
- Early treatment of sleep apnea may help reduce risk of silent strokes in these patients.

People with severe sleep apnea may have an increased risk of silent strokes and small lesions in the brain, which are common foundations of vascular dementia.

The research came out of a small study presented at the American Stroke Association’s International Stroke Conference 2012.

The researchers found:
- Ninety-one percent (51 of 56) of the patients who had a stroke had sleep apnea and were more likely to have silent strokes and white matter lesions that increased risk of disability at hospital discharge.
- Having more than five sleep apnea episodes per night was associated with silent strokes.
- More than one-third of patients with white matter lesions had severe sleep apnea and more than 50 percent of silent stroke patients had sleep apnea.
- Even though men were more likely to have silent infarcts, correlations between sleep apnea and silent infarcts remained the same after adjustment for such gender differences.

As the strokes, infarcts and lesions accumulate, the vascular damage to the brain increases. If left unchecked, too much damage cascades into vascular dementia.
Jessica Kepplinger, M.D., is the study’s lead researcher and stroke fellow in the Dresden University Stroke Center’s Department of Neurology at the University of Technology in Dresden, Germany. Dr. Kepplinger said,

"We found a surprisingly high frequency of sleep apnea in patients with stroke that underlines its clinical relevance as a stroke risk factor."
"Sleep apnea is widely unrecognized and still neglected. Patients who had severe sleep apnea were more likely to have silent strokes and the severity of sleep apnea increased the risk of being disabled at hospital discharge."

The patients — average 67 years old, white and 54% women — underwent overnight in-hospital testing for sleep apnea.

MRI and CT scans were used to check for silent strokes and white matter lesions. Neuroradiologists were blinded to the sleep study findings and outcome.

Researchers suggested sleep apnea should be treated the same as other vascular risk factors such as high blood pressure.

Kepplinger said, "Demographic characteristics in our study are comparable to western European populations, but our findings may not be entirely generalizable to other populations with diverse ethnicities such as in the U.S."

The researchers plan more studies on sleep apnea, particularly in high-risk patients with silent strokes and white matter lesions, to determine the impact of non-invasive ventilation and on short-term clinical outcome, researchers said.

WATCH VIDEO -> Preventative Tips-Treat Sleep Apnea To Prevent Vascular Dementia

More information on:

1. Sleep Apnea Ages Your Brain

2. Is Sleep Apnea Connected to Dementia?

3. Sleep Related Breathing Disorders

(Source: Alzheimer's Weekly and Dementia Weekly News, 12 February 2012)

Research Update : In Mice, Cancer Drug Reduces Beta-Amyloid and Helps Memory

2012-02-13T04:14:00.000+08:00

(Source: Alzheimer's Association Research Update, 10 February 2012)

A report published online by Science Express on Feb. 9, 2012, describes a research study in mouse models of Alzheimer's disease of an FDA-approved cancer therapy called bexarotene. The researchers believe that drug will enhance clearance of an abnormal protein associated with Alzheimer's (beta amyloid protein) from the brain by increasing levels of another protein, known as ApoE. The scientists found that the orally-administered drug rapidly lowered levels of soluble beta amyloid and amyloid plaques in both young and older test animals, and also improved some cognitive and behavioral deficits. This study is exciting because it investigates a possible new approach to treating Alzheimer's disease.

Bexarotene is used to treat cutaneous T-cell lymphoma (CTCL, a type of skin cancer) in people whose disease could not be treated successfully with at least one other medication.

This study, while very interesting, is also very preliminary. Mouse models of Alzheimer's are limited in how closely they represent human Alzheimer's. We are still far away from knowing if this has potential as a therapy for people with Alzheimer's. However, it is intriguing preliminary research that deserves further study.

People with Alzheimer's and their caregivers should not ask their doctor for this drug to treat Alzheimer's disease. That said, investigating an already FDA-reviewed and -approved therapy may mean that the drug development process takes a somewhat shorter time because the drug has already been tested in people. There is still a great deal to learn. For example, without trials in people with Alzheimer's, we know nothing yet about dose levels or how this compound may interact with approved Alzheimer's drugs.

To learn more, following is a report from the Washington Post on 10 February 2012

Cancer Drug Shows Promise In Mouse Alzheimer’s Study

Mice in the early stage of Alzheimer’s disease had some of their brain abnormalities reversed and their declining mental function restored when they were given low doses of a rarely used cancer drug.

The drug, bexarotene, stimulated the removal of beta-amyloid, a substance whose accumulation in the brain appears to be the main cause of Alzheimer’s dementia. After treatment, the animals fared better in tests of memory and social behavior, according to a study published online Thursday by the journal Science.

The findings were dramatic, but their relevance to people with Alzheimer’s disease is unknown. But because the drug is already approved for human use, finding out may be easier than if the drug were an entirely new chemical compound.

“It has to work in humans like it works in mice or we can pick up and go home,” said Gary E. Landreth, a neuroscientist at Case Western Reserve University School of Medicine, who headed the experiment.

A study of bexarotene’s effects in normal brains will start in a few months. Clinical trials in people with early Alzheimer’s — or at high risk for the disease for genetic reasons — will take years. If the drug’s effect in human brains turns out to be different, it may never move on to be tested in Alzheimer’s patients.

Nevertheless, the researchers think speed is important, as they fear that people might start using the drug before it is fully evaluated. A few days ago, Landreth got a call from a physician in another city. A person who had heard of the drug through the grapevine had asked for a prescription for bexarotene.

“We’ve got to work fast, and we have got to be right. We can’t screw this up,” Landreth said.

About 5.4 million Americans have Alzheimer’s disease, which is the leading cause of dementia. About 5 percent of people in their late 60s suffer from it, and possibly half of people in their late 80s. By 2050, 1 in 85 people worldwide will have the disease, according to one estimate.

Bexarotene is in the retinoid family of compounds, which are all chemically related to Vitamin A. Retinoids affect cell division and growth, immunity and other essential biological functions.

Sold under the trade name Targretin, bexarotene is approved by the Food and Drug Administration as a treatment for cutaneous T-cell lymphoma, a disease diagnosed in about 3,000 Americans a year. It is an “orphan drug,” a designation that gives drug companies an incentive to develop medicines for rare diseases. Orphan drugs stay under patent protection longer than regular drugs. It has been tried against other forms of cancer, without impressive results.

Numerous “candidate” Alzheimer’s drugs, which looked promising in lab studies, have washed out in recent years.

Last month, Pfizer and a smaller partner announced that they were abandoning a drug called Dimebon as a possible Alzheimer’s drug after it failed to show benefit in a clinical trial. In 2010, Lilly halted development of a different compound, semagacestat. At the Alzheimer’s Association, an advocacy organization, the new study’s results were greeted with that history noted.

“This is an early study and it was in mice,” said Maria C. Carrillo, the organization’s director of scientific relations. “We need to be cautiously optimistic and pursue this lead as we would any other.” She added that what makes “this an exciting study is that it involves a repurposed drug.”

The Case Western experiments were conducted by Paige E. Cramer, a graduate student in Landreth’s lab. The mice used had genetic defects that allowed beta-amyloid to accumulate in their brains, which in turn changed their behavior. The animals, however, are an imperfect model for the human disease. They don’t lose brain cells after beta-amyloid accumulates as people with Alzheimer’s do. (In people, dementia can begin even before cells die, as beta-amyloid disrupts the normal firing of nerve cells.)

Bexarotene spurred the production of “apoE,” a protein that breaks down beta-amyloid molecules floating in the watery fluid between brain cells. Beta-amyloid levels fell by 25 percent within a few days of a single dose. The drug also stimulated housekeeping cells called microglia to consume plaques of solidified beta-amyloid.

While the density of plaques fell by 75 percent over a few weeks, eventually they reaccumulated. Curiously, however, the animals’ behavior didn’t regress to its former state.

“It appears that the measurable activity of the brain is not affected by the presence of the plaques. I think that is a really interesting finding that will stimulate a lot of new science,” Landreth said.

The behavioral tests involved an animal’s ability to remember a cage in which it had gotten a shock, to find a submerged platform in a pool of water, to identify a smell and to build a nest. After treatment with the drug, all those activities returned to normal.

Several physicians with patients taking bexarotene say they’ve never noticed mental improvement from the drug, although they have few, if any, demented patients under their care.

“I have treated over 500 patients with cutaneous T-cell lymphoma in studies and in practice with bexarotene and have not heard any beneficial effect on the brain or cognitive function,” Madeleine Duvic of M.D. Anderson Cancer Center in Houston wrote in an e-mail.

“We really didn’t see anything like this,” said Heather Wakelee, a cancer researcher at Stanford University. She noted, however, that demented people were excluded from studies of bexarotene in advanced cancer.

ALZHEIMER'S ASSOCIATION INVOLVEMENT

Six months before this research was published, the Alzheimer's Association awarded the senior scientist on this article, Gary Landreth of Case Western Reserve University, Cleveland, our prestigious Zenith Award in 2011 for research that will follow on from this study to investigate this drug and how and why it works in this way, perhaps setting the stage for trials in people.

We need to create more treatment targets for Alzheimer's disease and the only way to do that is with more research, especially basic research into the causes and progression of the disease. The Alzheimer's Association commendsthe Obama Administration for dedicating new resources in the fight against Alzheimer's in a uniquely challenging fiscal year in advance of the first ever National Alzheimer's Plan. The Alzheimer's Association will continue to support the process underway to develop the first National Alzheimer's Plan led by Health and Human Services Secretary Kathleen Sebelius. This will help ensure the nation is equipped to overcome Alzheimer's the public health crisis of this century and meet the goal set forth by the Administration to prevent and effectively treat Alzheimer's disease by 2025.

Metals Could Be A Potential Target In Fighting Alazheimer's

2012-02-02T15:06:00.001+08:00

One of the many theories explaining Alzheimer's disease is that some of the harm is caused by toxic metals accumulating in brain. Now a new study lends more credibility to the toxic metal theory.

Research into how iron, copper, zinc and other metals work in the brain may help unlock some of the secrets of degenerative diseases like Alzheimer's and Parkinson's.

Iron and copper appear to accumulate beyond normal levels in the brains of people with these diseases, and a new, Australian study published Sunday shows reducing excess iron in the brain can alleviate Alzheimer's-like symptoms - at least in mice.

A genetic mutation related to regulating iron is linked to ALS, or Lou Gehrig's disease. Zinc, on the other hand, appears to impair memory if its levels get too low or if it gets into a brain region where it doesn't belong, as it can with traumatic brain injury.

Research into the complicated, invisible roles these metals play in brain diseases has lagged behind study of the more-visible proteins that are damaged or clump together in the brains of Alzheimer's and Parkinson's sufferers. But better understanding metals' role in the brain could help shed light on a range of medical conditions and might offer a new route for developing treatments, scientists say.

"The field is coming around to the idea of the cause of Alzheimer's being multifactorial," and disturbed metal regulation could be one of those factors, says Ralph Nixon, Chairman of the Alzheimer Association's Medical and Scientific Advisory Council and Director of the Silberstein Alzheimer's Institute at New York University.

Tiny metal ions - charged particles of the elements - serve several essential functions in the body, including facilitating chemical reactions to generate energy and preserving the structure of proteins. Strict checks and balances in a healthy body keep metal levels within a tight range.

But the biological changes that come with disease and aging - as opposed to poisoning from outside sources like food, supplements or metal pans - can knock levels of these metals out of whack in the brain.

Iron, for instance, is a "double-edged sword" because it interacts with oxygen to help the body generate energy, but also can produce free radicals, highly reactive molecules that can cause cell damage, says James Connor, professor and vice chairman of neurosurgery at Penn State University in Hershey.

If the body has too little iron, such as with anemia, the body doesn't generate enough energy to sustain important functions. But an overabundance of iron accumulated in the brain is toxic. Significantly higher accumulations of metal have been observed in the brains of people with Parkinson's and Alzheimer's disease than in healthy people of the same age, says Ashley Bush, a Professor of Pathology at the University of Melbourne.

The new study, conducted by Dr. Bush and colleagues and published in the Journal Nature Medicine, examined the amount of iron in the brains of mice that were bred unable to produce the tau protein, which helps stabilize the structure of neurons. Tau damage is associated with Alzheimer's and Parkinson's.

As the mice aged, they suffered symptoms similar to people with both diseases, including impaired short-term memory, and also exhibited an accumulation of iron in their brains. When the researchers gave them a drug removing excess iron, the symptoms reversed. This means normally functioning tau is necessary for removing iron in the brain, Dr. Bush says. The finding bolsters previous research showing that bringing down iron may be a path to new treatments.

"An accumulation of iron in neurons seems to be a final end-stage event in neurodegeneration, whether it be Alzheimer's or Parkinson's, [or] any [condition] related to tau abnormalities," says Dr. Bush, who is also a fellow at the university's Mental Health Research Institute.

Other proteins affected in Alzheimer's also play a role in metal regulation. The amyloid precursor protein is important in helping export iron from the brain, according to work published in the Journal Cell in 2010. Presenilin, another protein that aids in metal uptake, is also disturbed in diseased brains, according to a study published in Journal of Biological Chemistry last year.

Similar findings link copper accumulation and brain disease, though not as much research has been conducted as with iron, scientists say.

In addition to iron accrual, lower-than-normal levels of zinc have been found in patients with Alzheimer's and Parkinson's disease, according to work by George Brewer, an emeritus professor at the University of Michigan, and Edward Fitzgerald at the University at Albany-SUNY, published last year in the American Journal of Alzheimer's Disease and Other Dementias. Dr. Brewer now is a consultant to Adeona Pharmaceuticals Inc., based in Ann Arbor, Mich., which is developing a zinc-based treatment for Alzheimer's, he says.

Besides Adeona, a handful of other biotechnology companies have also been testing experimental metal-lowering drugs for treatment of Alzheimer's or Parkinson's. But developing such drugs is tricky because it is hard to target metals in specific parts of the brain. Simply lowering or increasing the amount overall in the body may not be beneficial, researchers say.

Metals may play a vital role in other brain conditions.

Stephen Lippard, a Chemistry Professor at the Massachusetts Institute of Technology, and colleagues from Duke University and the University of Toronto, found zinc helps neurons communicate in the hippocampus, a brain region involved in learning and memory. Disturbing this interaction, or ushering zinc into a brain region where it doesn't belong, could affect memory formation and the occurrence of epileptic seizures, says Dr. Lippard, who studies the role of metal ions in biology, neuroscience, and medicine. Their work was published in September in Neuron.

"It's important that the medical community continue to be alerted to the connection between metal ions and neurological disease," says Dr. Lippard.

Dr. Connor and his Penn State team have shown that patients with ALS have a higher rate of mutation in a gene, HFE, that regulates iron absorption. Carriers of the mutation have higher levels of iron in the brain and a fourfold increase in risk of ALS, according to a 2004 study published in the Journal of Neurological Sciences.

They have also been trying to figure out why the patients with multiple sclerosis lose the protective coating, called myelin, surrounding their axons, the part of the nerve cell that conducts electrical impulses. The cells responsible for making the myelin have elevated iron, making them more vulnerable to damage and death, says Dr. Connor.

Metals, Positive and Negative

Several metals play vital roles in the human body, but diseases can disturb their balance, causing harm.

Iron

Normal function: Involved in oxygen transport; needed to make energy for cells.

In the brain: Excess levels of iron are linked to Alzheimer's and Parkinson's diseases. Proteins and mutations related to iron delivery or absorption appear to be connected to Lou Gehrig's disease and multiple sclerosis.

Copper

Normal function: Helps transport oxygen, often works in tandem with iron.

In the brain: Wilson disease stops the body from getting rid of copper, which can cause speech problems, tremors and muscle stiffness. Disruption in copper regulation causes Menkes disease, which leads to abnormally low copper levels.

Zinc

Normal function: Helps make DNA and RNA, regulates cell death, and plays a role in short-term memory and learning.

In the brain: Low levels or the presence of the metal in areas of the brain where it isn't normally found are thought to impair memory.

Watch Video -> Do Toxic Metals In The Brain Cause Alzheimer's

(Source: WSJ (The Wall Street Journal), 31 January 2012, By SHIRLEY S. WANG)

(SAT) 11FEB12 Talk "Caring with Love" Organized By ADFM KL-PJ Caregivers Support Group

2012-01-11T15:57:00.003+08:00

Dear Caregivers/Members,

ADFM KL-PJ ALZHEIMER'S CAREGIVERS SUPPORT GROUP

MONTHLY GATHERING & TALK

“CARING WITH LOVE”

SATURDAY, 11 FEBRUARY 2012 AT 2:00PM

ADFM PJ DAYCARE CEMTRE

(No. 6, Lorong 11/8E,Section 11, 46000 PJ)

BY SPEAKER, MADAM LEONG SIK WAI

Program:
2:00pm : Registration of Attendance
2:30pm : Welcome address by the Chairperson
2:40pm : “Caring with Love” by Guest Speaker, Mdm Leong Sik Wai,
3:40pm : Sharing and Q & A Session
4:20pm : Refreshments

The Objective:

· To reinforce on the patient’s feeling and caregiver’s coping skill.

· How caregivers can better understand the physical, emotional, and mental changes of their patients.

· Caregiver’s feeling - understand own feeling, be able to cope with patient’s condition/changes.

· Learn the techniques - “LOVE” (how to love ), Emotion Freedom Technique.

The Speaker:

Mdm Leong Sik Wai is currently a Nutrionist with Merck, a Pharmaceutical Company, a Caregiver for her late Dad, Speaker for the Malaysian Healthy Aging Society’s Caregivers Workshop on “Caring with Love” and Volunteer with the Tzu Chi Charity Foundation. She obtained her BSc.(Hons) Nutrition from UKM.

To Register, submit "Registration Form" and Email: jenny@adfm.org.my OR Fax: 03 - 7960 8482.

Further enquiries, call Jenny at ADFM 03-7956 2008/7958 3008 / SMS 016-608 2513 or Email: jenny@adfm.org.my

JOIN ADFM NATIONAL ALZHEIMER'S CAREGIVERS NETWORK

The National Platform for The Caregivers Community

From: ADFM KL-PJ Caregivers Support Group

January 2012

Advice to Keep Dementia at Bay

2012-01-11T03:36:00.001+08:00

Recently, researchers looking into cognitive decline and dementia have made encouraging findings. Although it was believed that the adult brain could not develop new neurons (or brain cells), scientists have learned in the past decade or so that the human brain is pliable and adaptive. The brain can actually add new neurons even late in life and continually form new connections among existing neurons -- a phenomenon known as neuroplasticity.

This means that while an aging brain may have signs of damage, it can often compensate for them, at least initially. And engaging in mentally stimulating activities like reading, taking a class or playing board games is one way to bolster this process.

This compensation process depends on your "cognitive reserve," the extra, perhaps unused, amount of cognitive ability that can make up for the loss of brain functioning when your brain shows signs of dementia due to the death of cells and their replacement by beta-amyloid plaques. Genetics, early childhood stimulation and education level can influence cognitive reserve but are essentially immutable once you're an adult.

Fortunately, studies have found that you can also increase your cognitive reserve and delay the onset of dementia through a variety of intellectually stimulating leisure activities in middle and later life.

A study in the journal Neurology, for example, found that among 101 people who eventually developed dementia, those who frequently participated in one or more activities, such as reading, writing, doing crossword puzzles, playing card or board games, having group discussions or playing music experienced memory decline more than one year later than those who participated in these activities less often. These pursuits built cognitive reserve and delayed dementia as much as a higher education level did.

It's worth noting that researchers have discovered that watching television is a passive activity that doesn't really stimulate the mind at all; on the contrary, watching television is associated with an increased risk of cognitive decline. One study found that TV watchers were 10 percent more likely than nonwatchers to experience cognitive impairments over a five-year period. A possible explanation: Time spent in front of the TV means less time for the mental, social and physical activities that can help delay dementia.

(Source: John Hopkins Health Alert, 9 January 2012)

Medical News / Treatment Articles: Drugs In Dementia - Everything You Wanted to Know

2012-01-06T20:05:00.000+08:00

VIDEO - Watch Dr Frank Molnar's brilliant presentation on "Drugs in Dementia - The Good, The Bad, The Ugly" at the October 2011 Alzheimer Society of Ottawa and Renfrew County education seminar. Learn the best use of Namenda, Antipsychotics and Cholinsterase Inhibitors like Aricept. See what distinguishes Alzheimer's, Frontotemporal Lobar, Lewy body, Parkinson's, PPA, Semantic and Vascular Dementias. Understand the side-effects and interactions of antibiotic, antidepressant, heart, narcotic and other medications in dementia. Whether patient, caregiver or neurologist, you'll get many answers.

Recommend to read:

1. Charts Comparing Medications to Treat Alzheimer's Disease and Related Dementias

This brief summary does not include all information important for patient use and should not be used as a substitute for professional medical advice. Consult the prescribing doctor and read the package insert before using these or any other medications or supplements. Drugs are listed in alphabetical order.

TECHNICAL FACTS

BRAND NAME	GENERIC (Int'l) NAME	STAGE OF ILLNESS	DRUG TYPE	HOW IT WORKS	LOGO
ARICEPT®	donepezil	Mild to moderate & Moderate to severe	Cholinesterase inhibitor	Prevents the breakdown of acetylcholine in the brain.
EXELON®	rivastigmine	Mild to moderate	Cholinesterase inhibitor	Prevents the breakdown of acetylcholine and butyrylcholine (a brain chemical similar to acetylcholine) in the brain.
NAMENDA®	memantine	Moderate to severe	N-methyl D-aspartate (NMDA) antagonist	Blocks the toxic effects associated with excess glutamate and regulates glutamate activation.
RAZADYNE®	galantamine	Mild to moderate	Cholinesterase inhibitor	Prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain.

PRESCRIPTION FACTS

BRAND NAME	MANUFACTURER’S RECOMMENDED DOSAGE	GENERIC VERSION?	FORMAT	COMMON SIDE EFFECTS	MORE INFORMATION
ARICEPT®	. Initial dose: 5-mg tablet once a day . May increase dose to 10 mg/day after 4-6 weeks if well tolerated.	No	Tablet	Nausea, vomiting, diarrhea	Visit www.fda.gov/cder. Click on “Drugs@FDA,” search for ARICEPT®, and click on drug-name links to see “Label Information.
EXELON®	. Capsule: Initial dose of 3 mg/day (1.5 mg twice a day). . May increase dose to 6 mg/day (3 mg twice a day), 9 mg (4.5 mg twice a day), and 12 mg/day (6 mg twice a day) at minimum 2-week intervals if well tolerated. . Patch: Initial dose of 4.6 mg once a day; may increase to 9.5 mg once a day after minimum of 4 weeks if well tolerated. . Also available as oral solution; same dosage as capsule.	No	Capsule Patch Oral Solution	Nausea, vomiting, diarrhea, weight loss, loss of appetite, muscle weakness	Visit www.fda.gov/cder. Click on “Drugs@FDA,” search for EXELON®, and click on drug-name links to see “Label Information.”
NAMENDA®	. Initial dose: 5-mg tablet once a day. . May increase dose to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day) at minimum 1-week intervals if well tolerated. . Also available as oral solution; same dosage as above.	No	Tablet Oral Solution	Dizziness, headache, constipation, confusion	Visit www.namenda.com. Click on “Prescribing Information” to see the drug label.
RAZADYNE®	. Tablet: Initial dose of 8 mg/day (4 mg twice a day). . May increase dose to 16 mg/day (8 mg twice a day) and 24 mg/day (12 mg twice a day) at minimum 4-week intervals if well tolerated. . Extended-release capsule: Same dosage as above but taken once a day. . Also available as oral solution; same dosage as above.	Yes	Tablet Once-A-Day Extended Release Capsule Oral Solution	Nausea, vomiting, diarrhea, weight loss, loss of appetite	Visit www.razadyneer.com. Click on “Important Safety Information” to see links to prescribing information.

2. Introduction To Medications

Learn about the 4 prescription drugs currently approved by the U.S. Food and Drug Administration (FDA) to treat people who have been diagnosed with Alzheimer’s disease (AD). Treating the symptoms of AD can provide patients with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well.

It is important to understand that none of these medications stops the disease itself.

Treatment for Mild to Moderate AD

Medications called cholinesterase inhibitors are prescribed for mild to moderate AD. These drugs may help delay or prevent symptoms from becoming worse for a limited time and may help control some behavioral symptoms. The medications include: Razadyne® (galantamine, formerly known as Reminyl® and now available as a generic drug), Exelon® (rivastigmine), and Aricept® (donepezil). Another drug, Cognex® (tacrine), was the first approved cholinesterase inhibitor but is rarely prescribed today due to safety concerns.

Scientists do not yet fully understand how cholinesterase inhibitors work to treat AD, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As AD progresses, the brain produces less and less acetylcholine; therefore, cholinesterase inhibitors may eventually lose their effect.

No published study directly compares these drugs. Because they work in a similar way, switching from one of these drugs to another probably will not produce significantly different results. However, an AD patient may respond better to one drug than another.

Treatment for Moderate to Severe AD

A medication known as Namenda® (memantine), an N-methyl D-aspartate (NMDA) antagonist, is prescribed to treat moderate to severe AD. This drug’s main effect is to delay progression of some of the symptoms of moderate to severe AD. It may allow patients to maintain certain daily functions a little longer than they would without the medication. For example, Namenda® may help a patient in the later stages of AD maintain his or her ability to use the bathroom independently for several more months, a benefit for both patients and caregivers.

Namenda® is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work very differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.

The FDA has also approved Aricept® for the treatment of moderate to severe AD.

Dosage and Side Effects

Doctors usually start patients at low drug doses and gradually increase the dosage based on how well a patient tolerates the drug. There is some evidence that certain patients may benefit from higher doses of the cholinesterase inhibitors. However, the higher the dose, the more likely are side effects. The recommended effective dosages of drugs prescribed to treat the symptoms of AD and the drugs’ possible side effects are summarized in the table (see below).

Patients should be monitored when a drug is started. Report any unusual symptoms to the prescribing doctor right away. It is important to follow the doctor’s instructions when taking any medication, including vitamins and herbal supplements. Also, let the doctor know before adding or changing any medications.

3. How Do Alzheimer's Medications Differ?

Which Alzheimer's medications are best? To help answer this question, the ACP/AAFP Committee issued guidelines on the five available medications for Alzheimer's.

An American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) committee issued a clarifying guideline on drug treatment of dementia. Their advice? When trying to decide which medicine is best for a person, the most important considerations are:

Side effects

Ease of Use

Cost

There's no proof that any one of the five drugs available in the United States to treat dementia in general, and Alzheimer's in particular, is more effective than the others.

The committee reviewed published studies for outcomes such as cognition, global function, behavior/mood, and quality of life/activities of daily living. They found only limited high-quality scientific evidence of the effectiveness of the drugs and therefore developed the following cautious recommendations:

· The decision to use approved drugs for dementia should be based on an individualized patient assessment.

· The choice of drugs should be based on tolerability, adverse effect profile,ease of use, and cost.

· There's an urgent need for more clinical research to improve knowledge about the clinical effectiveness of drugs used to treat dementia.

The committee recommended the following kinds of research:

· Evaluate the effectiveness of drug therapy for dementia and assess whether treatments affect key outcomes, such as institutionalization.

· Evaluate the appropriate duration of therapy.

· Head-to-head testing of drugs.

· Test drugs in combination therapy.

The guideline was published in the Annals of Internal Medicine.

Currently, there are five FDA-approved drugs for treatment of dementia. These include four acetylcholinesterase inhibitors - donepezil (Aricept®), galantamine (Razadyne®, Reminyl), rivastigmine (Exelon®), and tacrine - and one neuropeptide-modifying agent - memantine (Namenda®).

While these drugs may improve symptoms or slow disease progression, they don't cure dementia or repair brain damage.

"Doctors, patients and family caregivers desperately want information on how to treat this disease," Dr. Amir Qaseem, senior medical associate in the ACP's Clinical Programs and Quality of Care Department, said in a prepared statement.

"More research is warranted, because the available evidence concerning these pharmaceuticals' effects on quality of life is mixed, and the clinical significance of many of the findings is questionable," Dr. Kenneth G. Schellhase, an AAFP representative on the committee, said in a prepared statement. "In addition, the duration of existing trials was usually less than one year, providing insufficient information to determine the optimal length of treatment, and few trials compare one drug directly with another."

Most existing studies of the five approved dementia drugs focused on statistical significance of changes, but clinically important improvement is what matters to patients, caregivers and doctors, the committee noted. Many studies measuring clinical improvements are currently in progress throughout the world.

4. Behavioral Benefits of Alzheimer's Medications

People with Alzheimer's and other dementias often take medications called cholinesterase inhibitors.

Medical research has demonstrated they are also a safe alternative to antipsychotics for the behavioral and psychological symptoms of dementia.

This is according to a study that appears in the December 2008 edition of Clinical Interventions in Aging.

Currently, the main cholinesterase inhibitors that are offered for Alzheimer's and other dementias are:

Brand Name	Generic Name
Aricept	donepezil HCL
Exelon	rivastigmine
Razadyne®	galantamine HBr

Investigators from the Indiana University School of Medicine, the Regenstrief Institute and Wishard Health Services reviewed nine randomized, double-blind, placebo-controlled clinical trials evaluating the effectiveness of three popular cholinesterase inhibitors in managing behavioral and psychological symptoms displayed by patients with Alzheimer's disease.

The researchers report that the trial results indicate cholinesterase inhibitors led to a statistically significant reduction in behavioral and psychological symptoms such as aggression, wandering or paranoia when using the same dosage as administered for improving cognitive impairment.

Nine out of 10 Alzheimer's disease patients display behavioral and psychological symptoms of their disease. The review of the clinical trials revealed that cholinesterase inhibitors are safe, producing no major side effects.

"There is a need for safe alternatives to the anti-psychotic drugs currently used to manage the behavioral and psychological symptoms of Alzheimer's disease. The results of the studies we analyzed are encouraging and suggestive that cholinesterase inhibitors are safe and effective alternatives. However, they are underutilized and typically prescribed for less than three months and for less than 10 percent of patients with Alzheimer's disease. Our findings might provide clinicians with useful data to justify the appropriate use of these medications," said Malaz Boustani, M.D., corresponding author of the Clinical Interventions in Aging paper. Dr. Boustani is assistant professor of medicine at the IU School of Medicine, a Regenstrief Institute research scientist, a research investigator with the IU Center for Aging Research, and chief research officer of the Indianapolis Discovery Network for Dementia.

In Alzheimer's disease there is a decrease in acetylcholine, a chemical in the brain that assists memory, thought and judgment. Cholinesterase inhibitors raise acetylcholine levels. Increased concentrations of acetylcholine in the brain leads to increased communication between nerve cells and may improve or stabilize the symptoms of Alzheimer's disease in the early and moderate stages of progression.

Noll Campbell, PharmD, a clinical pharmacy specialist in geriatric psychiatry with Wishard Health Services and corresponding author of the paper, said that, "This class of medications has already been approved by the Food and Drug Administration to manage symptoms of Alzheimer's-type dementia, although their potential benefits on behavioral symptoms are not frequently identified by many prescribers. Clinical trials of cholinesterase inhibitors have shown benefits in several domains of cognitive function as well as behavioral symptoms associated with dementia, and may improve the management of behavioral problems while reducing the use of more harmful medications that are needed to control behaviors."

Dr. Boustani noted that the vast majority of busy primary care physicians, the doctors who see the majority of patients with Alzheimer's disease, are unaware of the details of the studies analyzed in the Clinical Interventions in Aging paper and he hopes that this new paper, which reviewed the studies, will encourage them to prescribe cholinesterase inhibitors, with its benefits for both cognition and behavior symptoms to their Alzheimer's disease patients.

5. Moderate Your Medications

Almost 190,000 Australians have dementia and as Australia's population ages, dementia becomes a bigger challenge for doctors, their patients and carers.

According to the National Prescribing Service Limited (NPS), there are limited benefits to using cholinesterase inhibitors and memantine in the treatment of patients with dementia drug therapy.

Research indicates that the benefits of cholinesterase inhibitors and memantine are small, some people will not respond and adverse effects are common, says NPS clinical expert, Education and Quality Assurance Program Manager, Ms Judith Mackson.

Because the response rate is low and the effects of cholinesterase inhibitors and memantine are small, if these medicines are to be used, it is imperative that they are monitored in order to objectively assess their effectiveness for the patient.

Antipsychotics have a very limited role in some of the challenging behaviours of dementia and the risk of cerebrovascular events and all-cause mortality increases. Consequentially if there are no clear beneficial effects, a trial withdrawal should be attempted because for many patients symptoms will NOT worsen on withdrawal.

A planned, regular and also opportunistic approach to reviewing medications is recommended not only for people with Alzheimer's disease, but all older people using medicines, Ms. Mackson said.

She says health professionals need to encourage the use of non-pharmacological strategies at all stages of dementia. We know that non-pharmacological strategies can help promote and maintain independence, cognitive function and manage the behavioural and psychological symptoms of dementia.

Carers may see medication as the only option, so they will need support and information to help manage their expectations on the effectiveness of medication, she said. "Appropriate counseling for carers from health professionals on the limited benefits of drug therapy is key to best practice. In addition, carers may need information about the process of withdrawal if there are no clear beneficial effects of the medication."

To learn more about how to make informed decisions when working with patients with dementia, the new NPS education program, Treating the symptoms of dementia may be of interest. To obtain a copy,or to find out about the education program, visit the NPS website www.nps.org.au.

(Source: Alzheimer's & Dementia Weekly, 2 January 2012)

Prevention Tip - Exercise Against Alzheimer's ...

2012-01-03T12:28:00.004+08:00

What can we do to fight dementia? There is ever-growing evidence that exercise is both highly therapeutic and powerfully protective.

1. Watch this Video "Staying Active may deter Alzheimer's" for insights to help get your new year in motion.

2. BRAIN CONNECTIVITY BOOSTED BY DIFFERENT "ALZHEIMER'S WALK"

A group of “professional couch potatoes,” as one researcher described them, has proven that even moderate exercise - in this case walking at one’s own pace for 40 minutes three times a week - can enhance the connectivity of important brain circuits, combat declines in brain function associated with aging and increase performance on cognitive tasks.

The study, in Frontiers in Aging Neuroscience, followed 65 adults, aged 59 to 80, who joined a walking group or stretching and toning group for a year. All of the participants were sedentary before the study, reporting less than two episodes of physical activity lasting 30 minutes or more in the previous six months. The researchers also measured brain activity in 32 younger (18- to 35-year-old) adults.

Rather than focusing on specific brain structures, the study looked at activity in brain regions that function together as networks.

“Almost nothing in the brain gets done by one area - it’s more of a circuit,” said University of Illinois psychology professor and Beckman Institute Director Art Kramer, who led the study with kinesiology and community health professor Edward McAuley and doctoral student Michelle Voss. “These networks can become more or less connected. In general, as we get older, they become less connected, so we were interested in the effects of fitness on connectivity of brain networks that show the most dysfunction with age.”

Neuroscientists have identified several distinct brain circuits. Perhaps the most intriguing is the default mode network (DMN), which dominates brain activity when a person is least engaged with the outside world - either passively observing something or simply daydreaming.

Previous studies found that a loss of coordination in the DMN is a common symptom of aging and in extreme cases can be a marker of disease, Voss said.

“For example, people with Alzheimer’s disease tend to have less activity in the default mode network and they tend to have less connectivity,” she said. Low connectivity means that the different parts of the circuit are not operating in sync. Like poorly trained athletes on a rowing team, the brain regions that make up the circuit lack coordination and so do not function at optimal efficiency or speed, Voss said.

In a healthy young brain, activity in the DMN quickly diminishes when a person engages in an activity that requires focus on the external environment. Older people, people with Alzheimer’s disease and those who are schizophrenic have more difficulty “down-regulating” the DMN so that other brain networks can come to the fore, Kramer said.

A recent study by Kramer, Voss and their colleagues found that older adults who are more fit tend to have better connectivity in specific regions of the DMN than their sedentary peers. Those with more connectivity in the DMN also tend to be better at planning, prioritizing, strategizing and multi-tasking.

The new study used functional magnetic resonance imaging (fMRI) to determine whether aerobic activity increased connectivity in the DMN or other brain networks. The researchers measured participants’ brain connectivity and performance on cognitive tasks at the beginning of the study, at six months and after a year of either walking or toning and stretching.

At the end of the year, DMN connectivity was significantly improved in the brains of the older walkers, but not in the stretching and toning group, the researchers report.

The walkers also had increased connectivity in parts of another brain circuit (the fronto-executive network, which aids in the performance of complex tasks) and they did significantly better on cognitive tests than their toning and stretching peers.

Previous studies have found that aerobic exercise can enhance the function of specific brain structures, Kramer said. This study shows that even moderate aerobic exercise also improves the coordination of important brain networks.

“The higher the connectivity, the better the performance on some of these cognitive tasks, especially the ones we call executive control tasks - things like planning, scheduling, dealing with ambiguity, working memory and multitasking,” Kramer said. These are the very skills that tend to decline with aging, he said.

3. Video and Article "10 Ways Exercise Fights Dementia"

Exercise is good, but it's hard to do. Get motivated by learning 10 ways it helps your brain prevent & fight dementias such as Alzheimer's.

4. Video and Article "Walking is Best Brain Protector. The Easiest and The Cheapest"

A recent study that shows walking not only protects the brain, but can help improve memory in older adults. Watch Dr. Morgan Sauer from the St. Vincent Longevity Center.

(Source: The Alzheimer's Weekly and Dementia Weekly, 2 January 2012)

iPods Can Help People With Alzheimer's Remember

2011-12-29T14:39:00.004+08:00

It's a diagnosis that we dread, both for our loved ones and ourselves: Alzheimer's disease. Although at first glance, it may seem that the disease has robbed a person of their sense of self, this is not always the case. Not all people with Alzheimer's and other forms of dementia entirely lose their sense of self. The feelings, emotions and memories of experiences that make them who they are may still reside inside of them. It's their ability to access this sense of self that now becomes the challenge.

Scientists at research organizations, such as the Institute for Music and Neurologic Function (IMNF), have been studying the effects of music on the human condition for more than 30 years. And results have been promising. Now, technology is playing a key role in helping people with Alzheimer's disease and other forms of dementia reconnect to their memories and their loved ones, if only for immediate and short periods of time.

As MP3 players such as the iPod have become more mainstream, they are being used as part of music therapy. A new program, called "Well-Tuned: Music Players for Health," is helping people who suffer from Alzheimer's disease ... and it is music to caregivers' ears.

Professionals from IMNF will work with caregivers to develop a play list of music that is emotionally significant to the person with dementia. The play list is customized based on the elder's life experiences, cultural backgrounds and frame of reference. As with lovers who grow sentimental when "their song" is played on the radio, the right music stimulates the personal associations that it is connected with, sparking memory and renewed "presence." It is best to select music that is familiar, enjoyable and meaningful to the elder with dementia.

How iPod music helps Alzheimer's patients with memory

Caregivers can also enhance the impact of the music with meaningful photos of family, friends or by telling family stories and talking about past events. Often, the music can spark memories that were thought to be long gone, or stimulate recognition of a loved one that moments earlier was no more than a blank face. Music may also help a person with dementia transition more easily throughout the day. Playing lively, upbeat music can be used as a stimulus to help motivate an elder to take a walk or participate in an activity. Alternatively, slower, more calming music will help relax an elder when they are agitated or help them wind down as bedtime approaches. The science behind music therapy has to do with the emotional connections we make to music throughout our life and where in the brain those connections live. Music stimulates the areas of the brain that are involved in emotion, association and long-term memory processes for people with Alzheimer's disease and other forms of dementia. As a result, musical selections that are linked to emotions and personal experiences can unlock memories and associations. Senior residential facilities, adult day care centers, and assisted living centers are now using music therapy as part of the residents' routine. For caregivers, seeing the light of recognition in a loved one's eyes is priceless.

(Source: By Dr. Concetta M. Tomaino, Agingcare.com)