Archive for January, 2013

Placement in a memory care or skilled nursing unit is a very difficult and gut wrenching decision, one of the most stressful decisions I have ever seen anyone make.  Most people suffering from a dementing condition are cared for at home by either their spouse or one of their children.  However, there may come a time when a caregiver can no longer safely manage alone at home. The most typical reasons for placement are behavioral problems (e.g., wandering, aggression, delusions, hallucinations), incontinence, refusal of personal care, and/or caregiver illness or stress.  Unfortunately, placement is usually secondary to a crisis rather than a planned extension of care.  Placement is better executed as part of a palliative and safe memory care plan rather than a reaction to a crisis.  The objective is to continue to engage in a comfortable and stimulating life […]


One of the most difficult lessons for those who are caregivers for persons with Alzheimer’s disease or other dementias to learn is to not fight futile battles.  The mind over matter strategy does not work.  We are used to being persistent to teach or learn new things and used to the benefits of practice in learning new behaviors, skills, or information.  These practices offer diminishing returns as the memory loss progresses.  Caregiving – whether in a facility or at home – needs to be built around what still works and needs to increasingly involve external prompts to initiate even retained skills. Let’s consider some examples of strategies that were helpful to several of my clients.  The intention was to reduce frustration, errors, and conflict as well as to improve stimulation for persons in early to middle stage dementia. Those in […]


What have we learned about memory disorders and Alzheimer’s disease over the past year? 1.  Despite the increasing pressure to use PET scans to diagnose Alzheimer’s disease the results may be misleading.  About two thirds of community dwelling participants were misdiagnosed with Alzheimer’s disease based on positron emission tomography scan readings using amyloid-specific tracers. We need to be cautious about using brain scans to make a diagnosis of Alzheimer’s disease. Studies used to make the case for the accuracy of scans have so far only used highly selected participants – a sampling bias that may distort results. 2.  Janssen released results from trials on a compound named bapibrzumab, which is a monoclonal antibody that is meant to decrease amyloid production thereby modifying the progression of Alzheimer’s disease.  The 18-month trial in patients with mild to moderate disease was stopped because […]

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