Bobby Speaking

Learning How to Communicate with Someone Suffering From Alzheimer's Disease

2011-03-04T12:29:00.000-05:00

As I thought about this I came to a simple conclusion. Instead of trying to change Alzheimer's World, instead of trying to fight Alzheimer's World, not only would I accept Alzheimer's World as a reality, I would go into Alzheimer's World and learn how to communicate effectively...

By Bob DeMarco
Alzheimer's Reading Room

Earlier today, Carole Larkin published an interesting article -- How the Loss of Memory Works in Alzheimer’s Disease, and How Understanding This Could Help You.

The article described in layman's terms how problems with short term memory are directly related to the region of the brain known as the hippocampus; and, how when this brain region stops functioning properly a person losses their ability to store information.

A person suffering from Alzheimer's disease can hear you and even respond to you. What they can't do is remember what the hell you just said. Well, in layman's terms anyway.

I grappled with this problem several years ago as I was constructing my own understanding of how Dotty was thinking (or not thinking) and feeling. I named the parallel universe that Dotty lives in -- Alzheimer's World.

Continue Reading Learning How to Communicate with Someone Suffering From Alzheimer's Disease

The Plan to End Alzheimer's Disease by 2020 (Podcast)

2010-11-19T13:03:00.000-05:00

At the most recent TEDMED conference Rudy Tanzi spoke about the plan to end Alzheimer's disease by 2020.

Rudy Tanzi is one the world's leading Alzheimer's disease research scientist.

Click above to Listen. Please share this podcast with family, friends, support groups, and the Alzheimer's community.

If you don't see the podcast go here.

Original content Rudy Tanzi the Plan to End Alzheimer's Disease by 2020 (Podcast)

Advice and Insight into Alzheimer's Disease

2010-03-13T19:36:00.000-05:00

“You will never do anything in this world without courage. It is the greatest quality of the mind next to honor.” --Aristotle.....

By Bob DeMarco

The Metamorphosis of This Alzheimer's Caregiver (Part One)
The more I learned the more I wanted to know. I learned a great deal about Alzheimer's disease--including the science. It helped me understand a very mystifying disease. It helped me to put a frame around something that is difficult if not impossible to describe.

Alzheimer's World -- Two Circles Trying to Intersect
When Alzheimer's strikes communication and behavior change abruptly -- overnight. It is up to the caregiver to adjust since the person suffering from Alzheimer's is incapable of the adjustment. Understanding this need is the first big step.

Communication in Alzheimer's World
Let's face it, dealing with Alzheimer's is not easy. Understanding Alzheimer's disease is not easy...

The Metamorphosis of This Alzheimer's Caregiver (Part Two)
It is difficult to describe the range of emotions a caregiver might feel or experience in a single day. Imagine being happy and then sad, caring then angry, focused then frustrated -- an almost endless stream of feelings and emotions that conflict.....

The Metamorphosis of This Alzheimer's Caregiver -- I Wish
Once I entered Alzheimer's world I did learn something fascinating -- my mother is full of feelings and emotion. I learned that I could connect with her....

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Alzheimer's Caregiver Lament -- I can't take her out because she eats with her hands
The positive effects of socialization, initiative, and motivation on the part of Alzheimer's sufferers and their caregiver should not be overlooked. I believe these are as important as the medication......

How We Beat Alzheimer's Incontinence -- A Solution
We are on a three day roll. No pee pee. No pee pee pajamas. No pee pee underwear. No pee pee pants...

Alzheimer's Caregiver Lament -- This is Not the Person I Knew
In order to communicate effectively with a person suffering from Alzheimer's disease you need to come to an understanding that they are now living in a new world -- I often refer to this as Alzheimer's world...

Which Drugs Increase the Risk of Falling for the Elderly
Falls are the leading cause of both fatal and nonfatal injuries for adults sixty-five and older...

I promised not to put my parents in a nursing home
The decision to keep a parent home or place them in a facility is never an easy choice, and is usually contemplated for a long time. The horror stories we’ve all heard about nursing homes can make anyone cringe.

Twinkle Twinkle Little Star
Sometimes while looking at all those stars I begin to look at the space between the stars -- I call this the Blue Nowhere...When I look at the Blue Nowhere, I begin to imagine all the persons suffering from Alzheimer's disease. The Blue Nowhere is very vast.

Alzheimer's Caregiver Love
"The ordinary arts we practice every day at home are of more importance to the soul than their simplicity might suggest." -- Thomas Moore.....

Random Thought at the End of 2009
Alzheimer's will try to rob the Alzheimer's caregiver of their spirit. It will try and send them into the black hole of depression. Every day Alzheimer's whispers in the ear of the caregiver -- give up.

Inside Alzheimer's How to Hear and Honor Connections with a Person who has Dementia

Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 1,200 articles with more than 9,000 links on the Internet. Bob resides in Delray Beach, FL.

Original content Bob DeMarco, the Alzheimer's Reading Room

Communication in Alzheimer's World

2010-01-19T19:53:00.003-05:00

This isn't simple to do, but it is necessary -- you need to start accepting that when a person suffering from Alzheimer's says something they believe to be true it is in fact a reality. It is their reality.

By Bob DeMarco

It takes a lot of energy, learning, and patience to deal with the Alzheimer's disease.

In order to begin the process of dealing with communication in a world fill with Alzheimer's you first need to make a simple important decision -- you want to decrease both your stress as caregiver, and the stress of the person suffering from Alzheimer's.

Read that carefully, you want to reduce stress. You want to change the dynamic. You want to change for the better -- you want and need to change the way things are.

You might be wondering why I just repeated myself. Why? Because I believe it is necessary to get focused on what you want to accomplish, if you ever expect to accomplish it. It must become a deep and strong desire within you.

A goal.

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For example, that they just ate and can't possibly be hungry. You remind them over and over that they can't be hungry because they just ate.

Ever done that or something similar raise your hand? I'm raising both hands.

After the thousandth or so time of correcting my mother, telling her firmly she just ate, and watching her get frustrated or angry, I finally realized something had to change -- this something was me. I had to change.

I want to interject here that my mother even after six years still tells me she is hungry right after eating. She frequently tells me after breakfast and lunch that she hasn't had a thing to eat all day. She tells people on the telephone at night -- I haven't had a thing to eat all day. She -- honestly -- believes that what she is saying is true.

---------------
My guess is that you experiences the frustration of hearing your loved one repeating the same words that you believe to be untrue over and over. You see and experience the same crazy behaviors over and over.

What you believe to be true, and what the person that is suffering from Alzheimer's believes to be true are often diametrically opposed. The exact opposite.

Here is the one thing you need to understand. Your view of reality and your loved one's view of reality might be very different.
---------------
Ask yourself, what are you doing and how are you reacting when someone suffering from Alzheimer's says something you know to be incorrect or untrue?

What are you feeling when this happens?

Are you constantly correcting them?

If you are constantly correcting a person suffering from Alzheimer's you are "cruising for a bruising".

You are heading for the big stomach ache in the sky.

Say hello to your new found friends -- anger, stress and angst.

Do you really want to befriend anger, stress and angst?
---------------
Sooner or later you must make a decision.

Do I want to do this for the next ten years? Do I want to feel like this for the next ten years? Or, is there an alternative?
---------------
This isn't simple to do, but it is necessary -- you need to start accepting that when a person suffering from Alzheimer's says something they believe to be true it is in fact a reality. It is their reality.

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 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.

I feel confident when I say this -- you are not going to be able to convince a person suffering from Alzheimer's that they are wrong, and you won't be able to convince them that your reality is the true reality.

When you do this you are asking the person suffering from Alzheimer's to come back into your world.
---------------
Think about what I am saying here. I am asking you to develop a frame of reference, a new and different behavior that is one hundred percent diametrically opposed to the way you think and act -- the way you thought and acted for your entire life. Whew.

This isn't easy. It could be one of the hardest things you have ever tried to accomplish.

Here is the bad news. Even though I was well aware of what I needed to accomplish, trying as hard as I could, it still took years to get there -- to get into and comfortable with Alzheimer's world.

Once I made it into Alzheimer's world I reaped rewards that are almost impossible to imagine or describe.

When you make it to Alzheimer's world you begin the process of redefining reality. Instead of trying to brow beat your loved one back into your reality, you start to interact with them based on their view of reality.

For example. When my mother says, I am hungry, I'm starving -- I say ok, we are going to eat in a little while. Instead of telling her -- you just ate, you can't be hungry.

If she asks how long before we eat, I don't say in two hours -- I say, in half hour or soooo. The so in this sentence means when it is time to eat. Either half hour, or when it is time to eat.

Instead of an argument, my mother now reacts positively to this response.

Over time she also started saying something she never said before, instead of saying I'm hungry, I am starving, she sometimes says -- Bobby, what did I eat today?

When I answer by recounting our meals, she still makes a funny face, the face of disbelief, but she doesn't get angry or upset, and neither do I.

When I recount to her what she has eaten I have to be very careful. Careful to tell her with a smile on my face, and in a low calm voice. Not like a lecture. If she gets that bewildered look on her face -- confusion -- that is ok because I can then change the topic.

On the other hand, if I allow my mother to get angry and disconcerted then she will start going into the black hole of Alzheimer's world. When my mother goes into the black hole, I can feel the Alzheimer's trying to drag me into the black hole. At the minimum, stomach ache.

I can only assume that by listening to her lament -- I am hungry, I'm starving -- and by responding to her reality rather than correcting her -- our communication has improved. The amount of anger, stress and angst is greatly reduced.
---------------
This new form of communication lead to less stress, anger and angst. It seems to have a cumulative effect. Less stress build up across a series of situtations, leads to less angry and nutty behavior from my mother.

Less conflict, fewer explosions. More happiness.
---------------
The goal in all communications with a person suffering from Alzheimer's should be to connect with the patient in a positive, constructive, effective way.

So instead of telling my mother -- you just ate. I accept her reality that she is hungry and respond in a positive proactive way.

What you want to be doing here is try to establish a positive pattern of communication. This requires you to develop calm, effective responses that are easily accepted by the person suffering from Alzheimer's.

By establishing positive patterns of communication over a series of situations you learn how to deal with the new reality that is at the core of what I call Alzheimer's world.

The more you practice the better you get at it.

Before you know it, Alzheimer's world becomes another dimension in your life. You learn how to operate effectively in this world. Instead of a sinister, confusing world it becomes a parallel universe.

Easier to understand, easier to accept.
---------------
I feel very confident when I say this. While a person suffering from Alzheimer's can't remember, they are full of feelings and emotions.

As a caregiver, when you try to correct a person with Alzheimer's you are likely to bring out a negative emotion in them. How would you like to be told over and over -- you are wrong?

How would you act?

What emotion would you be likely to express?

Would you like the person that is constantly telling you -- you are wrong?

I'll let you decide the answer.
---------------
Effective communication with someone suffering from Alzheimer's requires you to identify the emotion behind the persons words. To learn ways to address what they are feeling and to validate those feelings.

Right now, it is likely that when a person suffering from Alzheimer's says something that is opposed to reality --as you understand it -- that you immediately feel an urge to correct them (or worse).

Is this you?

You aren't listening when you do this. You are making the situation about you and your feelings -- not about them. You are trying to drag the person into your world, and it just won't work.

You want to avoid any and all situations that lead to an argument.

When an argument ensues it is likely that the person suffering from Alzheimer's gets agitated and says those mean and angry words you dread.

Ask yourself, who is at fault? How can this dynamic be changed?
---------------
If you are caring for someone with Alzheimer's you will need to go into their world -- Alzheimer's world -- in order to maintain your own sanity and well being.

The first steps are to start listening to what they say. To accept what they are saying as a "reality". They believe it to be true, why can't you?

Understanding that Alzheimer's world reality is different -- is a big and important step. A necessary step to communicating effectively with someone that suffers from Alzheimer's.

While you are at it try and remember this. They have Alzheimer's. You are the caregiver. It really is up to you to change. It is up to you to adjust.

The person suffering from Alzheimer's would adjust if they could -- they can't.
---------------
I want to close by giving you this construct.

I often think of my mother and myself as two magnets. Every magnet has two fields -- a north pole and a south pole.

If you put the two north poles together (or south poles) the two magnets will repel each other.

If you put the two opposite poles of a magnet together they will attract each other. They will stick together (like glue).

Once you learn to put these two opposite poles together your life as an Alzheimer's caregiver will change. On the other hand, if you keep trying to put the same poles together they will continue to repel each other.

Once you accept Alzheimer's world and learn how to operate in Alzheimer's world you'll learn that opposites can indeed attract. And stick together like glue.

This is a very pleasant and rewarding way to feel.

I'm not the only one that knows this.

My name is Bob DeMarco, I am an Alzheimer's caregiver. My mother Dorothy, now 93 years old, suffers from Alzheimer's disease. We live our life one day at a time.

Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 1,050 articles with more than 8,000 links on the Internet. Bob resides in Delray Beach, FL.

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The Housing and Credit Crisis Explained

2009-06-09T16:30:00.000-04:00

This presentation on the Housing and Credit crisis is the best I have seen. It explains everything from soup to nuts.

Each slide contains a graph that is well explained.

They say a picture is worth a thousand words.

Once you get through this, you will understanding the current credit crisis in housing, and what to expect in the years ahead.

If you take the time to view and read this you will be fully informed.

Hit the full screen button in the upper right hand corner of the panel below.

T2 Partners Presentation on the Mortgage Crisis

Publish at Scribd or explore others: Research Business & Economics Finance Non-fiction world culture

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Bob DeMarco is a citizen journalist and twenty year Wall Street veteran. Bob has written more than 500 articles with more than 11,000 links to his work on the Internet. Content from All American Investor has been syndicated on Reuters, the Wall Street Journal, Fox News, Pluck, Blog Critics, and a growing list of newspaper websites. Bob is actively seeking syndication and writing assignments.

More from All American Investor

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Kindle: Amazon's 6" Wireless Reading Device

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Original content All American Investor

Around my Blogosphere

2009-01-25T17:33:00.000-05:00

Are the Democrats peddling voodoo economics?

A Simple Three Minute Test Can Detect the Earliest Stage of Alzheimer's Disease

Goog 411

If it is not Alzheimer's, What is it?

The $4350 Medicare Donut Hole

Yes We Can Include Energy

According to Bob Pisani's blog, "Goldman Sachs: A Sigh Of Relief On Street" what company did Credit Suisse criticize?

2008-12-17T09:11:00.002-05:00

CNBC Bonus Bucks Trivia
CNBC Million Dollar Portfolio Challenge

Squawk on the Street

Question: According to Bob Pisani's blog, 'Goldman Sachs: A Sigh Of Relief On Street' what company did Credit Suisse criticize?"

Get the Answer

TauRx Therapeutics-- New treatment halts progress of Alzheimer's disease

2008-08-09T13:12:00.001-04:00

clipped from alzheimersreadingroom.blogspot.com

The results of the Phase 2 study of TauRx's new treatment strongly suggest that it is possible to halt progression in mild and moderate Alzheimer's. TauRx is continuing to refine its treatment and hopes that restoration may be possible at least at the earlier stages with improved versions of its drug. Tangles are already destroying nerve cells in parts of the brain critical for memory in people in their fifties and upwards. The ultimate goal is to develop a product that is convenient for patients that could be widely used at the very earliest stages of the disease, long before patients experience the first symptoms of Alzheimer's.

Amazon.com Widgets

The Evolution of Home Ownership

2007-09-26T11:20:00.000-04:00

Forty-three percent of housholds aged 20-34 already own a home. Nationally about 70 percent of households now own a home. With a return to more normal lending practices and higher interest rates it is likely that the back log of homes already being built and homes from foreclosures will cause a long term hangover in the housing market.

These numbers indicate that housing is a big long term problem for the economy. This problem is not likely to resolve in a couple or few years. It seems that houses are over owned at this point in time. Demogrpahics already in place favor downsizing (retirement) and shrinkage in the pool of available new buyers. This indicates a long term, possibly a decade, hangover in the housing market. That is much longer then anything now being anticipated in the market place.

It is likely that we will see significant mark downs in prices in the years ahead in the formerly hot areas like New York, California, and Florida.

More details on next page.

Get the detailed paper from the Atlanta Fed

Source Atlanta Fed: Mortgage Innovation Boosted Home Ownership

After holding steady for three decades, the share of U.S. households owning their own home jumped from 64% in 1994 to 69% in 2005. The primary cause, argues a new staff study from the Federal Reserve Bank of Atlanta, was the introduction of new mortgage products that reduced the initial down payment needed by a home buyer.

The paper, by Matthew Chambers, Carlos Garriga, and Don E. Schlagenhauf, examines changes in home ownership by age cohort. The U.S. population aged in the last decade, boosting the share of the population in age cohorts that are more likely to own a home. But the authors conclude this explains just 16% to 31% of the rise in total home ownership. The introduction of new mortgage products, in particular those that allowed little or no down payment, accounts for 56% to 70% of the increase. Such “loans tend to be the contract of choice for younger cohorts which explains an important part of the increase in the aggregate homeownership rate observed since 1994,” they say. Indeed, while the homeownership rate rose for all age groups in that period, it rose most for households under age 35: it jumped to 43% from 37.3%

Magnetoencephalography (MEG)

2007-08-31T15:59:00.000-04:00

This development has wonderful implications for diagnosing Alzheimer's; it has far reaching implications for those predisposed by genetics to Alzheimer's disease.

Read this article at the Alzheimer's Reading Room

The latest in Financial Infotainment--Minyanville

2007-07-19T12:57:00.000-04:00

A friend of mine sent me a link to this website, Minyanville. The site is will worth visiting. Informative and entertaining. The stuff on China, subprime loans and trading is thought provoking. Chances are good you will be sending this link along to your freinds.

Some examples of the headline stories.

Fire in the Hole!
Todd Harrison
...as yesterday’s false alarm once again proved, structural smoke won’t matter until someone actually sees a fire.

Testing the Waters of Intel
Jeff Macke
Plucking at the strings of lunacy, trying to find something valid enough to trade off, thus becomes a somewhat futile exercise...

Stocks To Watch: Dell, eBay, Ford, IBM, Sysco
Minyanville Staff
Today's top stories and some stocks with potential to move...

Bear Stearns' Hedge Fund Mess
Bennet Sedacca
Brokerage paper has been widening relative to Treasuries of late, but so has everything else, as perhaps it should.

The Market's Remarkable Symmetry
The market may have an agenda higher in terms of time and price, but... there are many clusters of time, price and pattern projecting a turning point in this neighborhood.

Subscribe to Robert T DeMarco Weblog by Email

hedge funds, infotainment, investing, minyanville, subprime loans, trading

Robert T DeMarco Weblog: CNBC Portfolio Challenge Bonus Bucks Answers

2007-04-18T11:42:00.000-04:00

CNBC Portfolio Challenge Bonus Bucks Answers for Wednesday, April 18, 2007 and CNBC Million Dollar Portfolio Challenge

According to the Mortgage Bankers Association, borrowing costs on 30-year fixed-rate mortgages averaged how much last week?

The European Patent Forum kicks off today in which major European city?

Get the Answers

CNBC Million Dollar Portfolio Challenge

2007-03-30T12:47:00.000-04:00

CNBC Portfolio Challenge Bonus Bucks Answers for Friday, March 30, 2007 and CNBC Million Dollar Portfolio Challenge

How many new stores did Home Depot open in the U.S. in 2006?
The FDA-approved drug Provenge is used to fight what disease?

Get the Answers

Alzheimer's Disease Rate Rises to More Than Five Million in the United States

2007-03-20T17:24:00.000-04:00

Someone Develops Alzheimer's Every 72 Seconds, According To New Alzheimer's Association Report.

The Alzheimer’s Association today reports that in 2007 there are now more than 5 million people in the United States living with Alzheimer’s disease. This number includes 4.9 million people over the age of 65 and between 200,000 and 500,000 people under age 65 with early onset Alzheimer’s disease and other dementias.

Read more about this topic at The Alzheimer's Reading Room

Long Live Sanjaya, the American Idol Underdog

2007-03-09T16:25:00.000-05:00

Hey, I don't mind admitting it, I watch American Idol. Frankly, I find the show uplifting. What could be better than watching young people reach for their dream--the American Dream. If nothing else you need to admire them for have the courage to go for it. It beats sitting on your butt dreaming about what you want.

And I'll tell ya what. I am a big fan of Sanjaya. That's right. The kid has a voice like Stevie Wonder.

The thing that interests me the most is the fact that every single person I know hates the kid and does not believe he deserves to be in the top twelve. Well guess what? Most of them have been paying off their weekly bets to me as the kid moves on.

They continually ask me what I see in Sanjaya? I honestly believe he has a "fantastic" voice. No he isn't a showman, nor does he have a big act. He looks like a deer in the headlights. But let's face it I am not the only one that sees something in the kid, America, or a slice of America believes in him.

Do I think he will make it much further? No, I don't. On the other hand, it won't surprise me if he goes another couple of weeks. One thing for sure, he is going to need to knock the cover off the ball if he intends to move on this week. Can he deliver the big big performance when he needs it? I for one am rooting for him.

I was sorry to see Sundance go. He is really terrific. But, sometimes they just don't seem to learn you gotta sing something popular. A tremendous rendition of a song none of us every heard of insures one thing--back you go to your day job. Right Constantino?

Exercise slows decline in Alzheimer's patients

2007-03-08T12:17:00.000-05:00

I can attest, exercise makes a difference. My mother now has the tendency to sit around all day. On those days when I can get her to go to Gold's Gym with me she is a completely different person. The look on her face, from dull to smiling, is more than enough to tell me that exercise works to her benefit.

"Nursing home residents with Alzheimer's disease who participate in a moderate exercise program have a significantly slower deterioration than those who receive routine medical care, researchers have shown."

Read the article in its entirety at the CareGiver: The Book Weblog

Free Over the Air High Definition Television

2007-02-19T14:40:00.000-05:00

"Did you know you can receive high definition TV programing free via a simple antenna? Imagine inviting your friends over and showing them a picture that is often clearer than cable and without the monthly cable bill."

To read the article in its entirety go to Robert T DeMarco Weblog: Free Over the Air High Definition Television.

Clinton/Obama: Hillary Clinton: I'll End This War

2007-02-03T00:07:00.000-05:00

Hillary Clinton: I'll End This War

The CareGiver: Dementia

2006-11-28T23:15:00.000-05:00

I ran across this factsheet on Dementia from the Milton S Hershey Medical Center. The section entitled, What are the Symptoms, is particularly interesting.

Source Milton S Hershey Medical Center

Dementia

What is it?

Dementia is the gradual deterioration of mental functioning, such as concentration, memory, and judgment, which affects a person’s ability to perform normal daily activities.

Who gets it?

Dementia occurs primarily in people who are over the age of 65, or in those with an injury or disease that affects brain function. While dementia is most commonly seen in the elderly, it is not a normal consequence of the aging process.

What causes it?

Dementia is caused by the death of brain cells. Brain cells can be destroyed by brain diseases, such as Alzheimer’s disease, or strokes (called vascular or multi-infarct dementia), which decrease blood flow to the brain. Lewy body dementia is another common cause attributed to changes in brain tissue. Other causes can include AIDS, high fever, dehydration, hydrocephalus, systemic lupus erythematosus, Lyme disease, long-term drug or alcohol abuse, vitamin deficiencies/poor nutrition, hypothyroidism or hypercalcemia, multiple sclerosis, brain tumor, or diseases such as Pick’s, Parkinson's, Creutzfeldt-Jakob, or Huntington's. Dementia can also result from a head injury that causes hemorrhaging in the brain or a reaction to a medication.

What are the symptoms?

In most cases, the symptoms of dementia occur gradually, over a period of years. Symptoms of dementia caused by injury or stroke occur more abruptly. Difficulties often begin with memory, progressing from simple forgetfulness to the inability to remember directions, recent events, and familiar faces and names. Other symptoms include difficulty with spoken communication, personality changes, problems with abstract thinking, poor personal hygiene, trouble sleeping, and poor judgment and decision making. Dementia is extremely frustrating for the patient, especially in the early stages when he or she is aware of the deficiencies it causes. People with dementia are likely to lash out at those around them, either out of frustration or because their difficulty with understanding makes them misinterpret the actions of others. They become extremely confused and anxious when in unfamiliar surroundings or with any change in routine. They may begin a task, such as cooking, then wander away aimlessly and completely forget what they had been doing. Dementia is often accompanied by depression and delirium, which is characterized by an inability to pay attention, fluctuating consciousness, hallucinations, paranoia, and delusions. People in advanced stages of dementia lose all control of bodily functions and are completely dependent upon others.

How is it diagnosed?

Dementia is diagnosed through a study of the patient’s medical history and a complete physical and neurological exam. The doctor will speak with those close to the patient to document a pattern of behavior. He or she will also evaluate the patient’s mental functioning with tests of mental status, such as those that require the patient to recall words, lists of objects, names of objects, and recent events. Diagnostic tests, such as blood tests, x-rays, or magnetic resonance imaging (MRI), positron emission tomography (PET), or computed tomography (CT) scans, can help determine the cause of the dementia.

What is the treatment?

In some instances, treating the cause of dementia may successfully reverse some or all of the symptoms. This is the case when the cause is related to a vitamin/nutritional deficiency, tumor, alcohol or drug abuse, reaction to a medication, or hormonal disorder. When dementia is related to an irreversible destruction of brain tissue, such as with Alzheimer’s disease, Lewy body dementia, or multiple strokes, treatment involves improving the patient’s quality of life as much as possible. This includes maintaining a stable, safe, supportive environment and providing constant supervision. While this may be done in the home, people in the advanced stages of dementia may require round-the-clock care in a long-term healthcare facility. It is important to provide the patient with structured activities and avoid disruptions to his or her daily routine. Many patients enjoy therapeutic activities, such as crafts or games, designed specifically for people with dementia. Some medications, such as donepezil and tacrine, have been effective in improving the mental functions of those in the beginning stages of dementia. Patients with hallucinations and delusions may also be treated with antipsychotic drugs, while antidepressant medications are used to treat depression.

Self-care tips

There is currently no known way to prevent dementia associated with Alzheimer's disease. You can decrease your risk of dementia associated with stroke by maintaining a healthy lifestyle, following a heart-healthy diet, and controlling high blood pressure and high cholesterol. Healthy lifestyles, including not smoking and not abusing drugs and alcohol, go a long way in keeping most people in good health. Caring for a person with dementia is stressful. It is important to learn all you can about the disease, seek the help of support groups, and find a responsible caregiver who can give you a break when needed. There are daycare programs specifically designed for patients with dementia that are good for the patient and the family.

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This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

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The CareGiver: Americans Fear Alzheimer’s More Than Heart Disease, Diabetes or Stroke

2006-11-26T20:36:00.000-05:00

A recent study by the MetLife Foundation found that Americans fear getting Alzheimer's disease more than heart disease, stroke, or diabetes. Alzheimer's ranks second in the minds of American's only to cancer.

MetLife Survey Highlights

The Complete MetLife Survey on Alzheimer's: What America Thinks (36 pages)

The Major Findings of the Study included the following:

Finding 1: Americans fear Alzheimer’s disease.

Finding 2: Americans Know Little or Nothing about Alzheimer’s.

Finding 3: One-third of Americans say they have direct experience with Alzheimer’s disease.

Finding 4: Most Americans are concerned that they will be responsible at some point for someone with Alzheimer’s disease.

Finding 5: Most Americans recognize the need to create a plan to address the possibility of Alzheimer’s disease, but very few have taken steps to do so.

Conclusion

Americans fear Alzheimer’s and the impact that it could have on their lives in the coming years. And although they may recognize the need to look toward the future, the majority hasn’t started making plans.

The downside of living longer has a high price: Nearly 50 percent of those who are 85 or older are affected, and the rate of Alzheimer’s increases exponentially every five years past the age of 65. And with the aging of America’s population these numbers are sure to become even more dramatic in the future, making it imperative that individuals and institutions plan for the future.

The growing number of people with Alzheimer’s will have an impact on every part of society. The vast majority of people know that this disease may someday affect them, either directly or as a caregiver. In addition, many already know a family member or friend who has Alzheimer’s. They strongly support the concept of planning now to cope with the life-changing impact of the
disease – at least in theory.

Despite widespread agreement, few have taken steps to prepare for the possibility of developing Alzheimer’s. Only a few have a solid understanding of the disease. The overwhelming majorityhas done nothing to plan.

The survey reveals a mismatch between fear of Alzheimer’s and acting on that fear to prepare for the future. The findings from this survey suggest that there is an opportunity to build awareness and help bridge the gaps that were identified in knowledge and behavior. Americans should learn all they can about the disease that will touch so many of us and plan for the future.

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Robert T DeMarco
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The CareGiver: Huperzine A Factsheet (Alzheimer's)

2006-11-18T14:35:00.000-05:00

I recently read about Huperzine A. The following page contains a fact sheet about the herb. Huperzine A may have cognition-enhancing activity in some.

Source Huperzine A

TRADE NAMES

Huperzine A is available from numerous manufacturers generically. Branded products include Memorall (PharmAssure), Huperzine Rx-Brain (Nature's Plus).

DESCRIPTION

Huperzine A is a plant alkaloid derived from the Chinese club moss plant, Huperzia serrata, which is a member of the Lycopodium species. Huperzia serrata has been used in Chinese folk medicine for the treatment of fevers and inflammation.

Huperzine A has been found to have acetylcholinesterase activity. Huperzine B, also derived from Huperzia serrata, is a much less potent acetylcholinesterase inhibitor. Natural huperzine A is a chiral molecule also called L-huperzine A or (-)-huperzine A. Synthetic huperzine A is a racemic mixture called (±)-huperzine A. Huperzine A is also known as HUP, hup A and selagine. In Chinese medicine, the extract of Huperzia serrata is known as Chien Tseng Ta and shuangyiping. Huperzine A derivatives are being developed for pharmaceutical application.

ACTIONS AND PHARMACOLOGY ACTIONS

Huperzine A may have cognition-enhancing activity in some.

MECHANISM OF ACTION

Alzheimer's disease is a neurodegenerative disorder associated with neuritic plaques that affect the cerebral cortex, amygdala and hippocampus. There is also neurotransmission damage in the brain. One of the major functional deficits in Alzheimer's disease is a hypofunction of cholinergic neurons. This leads to the cholinergic hypothesis of Alzheimer's disease and the rationale for strategies to increase acetylcholine in the brains of Alzheimer's disease patients. Two FDA-approved drugs for the treatment of Alzheimer's disease, tacrine and donepezil, are acetylcholinesterase inhibitors.

Huperzine A is also an acetylcholinesterase inhibitor and has been found to increase acetylcholine levels in the rat brain following its administration. It also increases norepinephrine and dopamine, but not serotonin levels. The natural L or (-)-huperzine A is approximately three times more potent than the racemic or (±)-huperzine A in vitro.

PHARMACOKINETICS

There are limited pharmacokinetic studies with huperzine A. It appears that huperzine A is rapidly absorbed from the gastrointestinal tract and transported to the liver via the portal circulation. Some first-pass metabolism takes place in the liver, and huperzine A and its metabolites are distributed widely in the body, including to the brain. Following ingestion, the time to reach peak blood level is approximately 80 minutes.

INDICATIONS AND USAGE

Huperzine A has potent pharmacological effects and, particularly since long-term safety has not been determined, it should only be used with medical supervision. It may have some effectiveness in Alzheimer's disease and age-related memory impairment. It has been used to treat fever and some inflammatory disorders, but there is no credible scientific evidence to support these uses.

RESEARCH SUMMARY

Numerous studies, most of them from China, suggest that huperzine A may be as effective as the drugs tacrine and donepezil in Alzheimer's disease. This is not so surprising since in vitro and animal model tests have demonstrated that huperzine A effectively inhibits acetylcholinesterase, an enzyme that catalyzes acetylcholine breakdown. Tacrine and donepezil work in the same way to conserve acetylcholine in the brain--the mode by which they presumptively improve memory and cognition in those with Alzheimer's and age-related cognitive impairment. Huperzine A may prove superior to tacrine (dose-limited due to its hepatotoxicity) if long-range studies, yet to be conducted, demonstrate its safety.

In one double-blind, randomized study, huperzine A, in injectable form, was tested against a saline control in 56 patients with multi-infarct dementia or senile dementia and in 104 patients with senile and pre-senile simple memory disorders. Huperzine A produced significant positive effects as measured by the Wechsler Memory Scale. Dizziness was experienced by a few of the huperzine A-treated patients.

In another study, this one multicenter, double-blind, placebo-controlled and randomized, 50 subjects with Alzheimer's disease were given huperzine A or placebo for eight weeks. Significant improvement was noted in 58 percent of the patients in terms of memory, cognitive and behavioral functions. Research is ongoing.

CONTRAINDICATIONS, PRECAUTIONS, ADVERSE REACTIONS CONTRAINDICATIONS

None known.

PRECAUTIONS

Huperzine A should be avoided by children, pregnant women and nursing mothers.

Because of possible adverse effects in those with seizure disorders, cardiac arrhythmias and asthma, those with these disorders should avoid huperzine A. Those with irritable bowel disease, inflammatory bowel disease and malabsorption syndromes should avoid huperzine A.

ADVERSE REACTIONS

Adverse effects reported with huperzine A include gastrointestinal effects, such as nausea and diarrhea, sweating, blurred vision, fasciculations and dizziness. Possible adverse effects include vomiting, cramping, bronchospasm, bradycardia, arrhythmias, seizures, urinary incontinence, increased urination and hypersalivation.

INTERACTIONS DRUGS

Acetylcholinesterase Inhibitors: Use of huperzine A along with the acetylcholinesterase inhibitors donepezil or tacrine may produce additive effects, including additive adverse effects. Other acetylcholinesterase inhibitors include neostigmine, physostigmine and pyridostigmine, and use of these agents along with huperzine A may produce additive effects, including additive adverse effects.

Cholinergic Drugs: Use of huperzine A along with cholinergic drugs, such as bethanechol, may produce additive effects, including additive adverse effects.

NUTRITIONAL SUPPLEMENTS

Use of huperzine A with choline, phosphatidylcholine, CDP-choline and L-alpha-glycerylphosphorylcholine hypothetically might produce additive effects, including additive adverse effects.

OVERDOSAGE

There are no reports of overdosage with huperzine A.

DOSAGE AND ADMINISTRATION

There are various forms of huperzine A available, including extracts of Huperzia serrata, natural (-)-huperzine A and synthetic racemic (±)-huperzine A. Natural (-)-huperzine A is approximately three times more potent than the synthetic racemic mixture. The doses of natural (-)-huperzine A used in clinical studies ranged from 60 micrograms to 200 micrograms daily. Huperzine A should only be used with a physician's recommendation and monitoring.

HOW SUPPLIED

Capsules — 50 mcg

Tablets — 50 mcg

LITERATURE

Cheng DH, Tang XC. Comparative studies of huperzine A, E-2020 and tacrine on behavior and cholinesterase activities. Pharmacol Biochem Behav. 1998; 60:377-386.

Cheng DH, Ren H, Tang XC. Huperzine A, a novel promising acetylcholinesterase inhibitor. Neuroreport. 1996; 8:97-101.

Quian BC, Wang M, Zhou ZF, et al. Pharmacokinetics of tablet huperzine A in six volunteers. Chung Kuo Yao Li Hsueh Pao. 1995; 16:396-398.

Tang XC, Kindel GH, Kozikowski AP, Hanin I. Comparison of the effects of natural and synthetic huperzine A on rat brain cholinergic function in vitro and in vivo. J Ethnopharmacol. 1994; 44:147-155.

Xiong ZQ, Tang XC. Effect of huperzine A, a novel acetylcholinesterase inhibitor, on radial maze performance in rats. Pharmacol Biochem Behav. 1995; 51:415-419.

Xu SS, Gao ZX, Weng Z, et al. Efficacy of tablet huperzine-A on memory, cognition and behavior in Alzheimer's disease. Chung Kuo Yao Li Hsueh Pao. 1995; 16:391-395.

Ye JW, Cai JX, Wang LM, Tang XC. Improving effects of huperzine A on spatial working memory in aged monkeys and young adult monkeys with experimental cognitive impairment. J Pharmacol Exp Ther. 1999; 288:814-819.

Zhang RW, Tang XC, Han YY, et al. Drug evaluation of huperzine A in the treatment of senile memory disorders. [Article in Chinese] Chung Kuo Yao Li Hsueh Pao. 1991; 12:250-252.

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Robert T DeMarco

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