Now that 70 is in my rear-view mirror, I am increasingly attracted to articles with tittles like “A Plan For Successful Aging” (health.harvard.edu). I am officially one of those “geriatric” clients with whom I have worked for nearly three decades. I am one of the “young old.” I feel that the quality of the rest of my life requires that I don’t focus on the past – I can’t change it. I am the result of my genetics and cumulative experiences (the easy and the difficult, the mistakes and the successes). What follows is my general outline to protect my future as well as I can. 1) Be proactive. Don’t wait for the first fall to take action. I have been “thinking about” getting a medical alert device for my mother-in-law. She recently fell in the bathroom and was unable […]

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Benzodiazepines such as Klonopin (generic = clonazepam), Xanax (generic = alprazolam), Ativan (generic = lorazepam) have a long and controversial history of use to treat behavioral challenges in those with Alzheimer’s disease. These disturbances range from agitation, anxiety, delusions, and hallucinations to sleep disturbances. The controversy deepened with the recent finding of a correlation between benzodiazepine use and risk of dementia. This risk appears to develop with chronic (i.e., daily) use of these medications for three or more months. At this time there is no agreement on use benzodiazepines as an alternative to antipsychotics, which have potentially serious side effects in the elderly. Current guidelines recommend use of benzodiazepines be limited to a few weeks despite the fact that they are often used for years. Long-term daily use of benzodiazepines is associated with increased risk of falls, dependence, and withdrawal […]

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It is increasingly clear that becoming demented as we age is more than just Alzheimer’s disease. There may be few if any “pure” cases of Alzheimer’s disease. It may be the added wear and tear from added medical burdens in conjunction with the pathology of Alzheimer’s that leads to dementia. We already test for factors such as B12 deficiency, thyroid deficiency, and acute infections as they may impact cognitive function and are treatable conditions. However, we ignore many diseases that may take a toll on brain function and cognition. We are just coming to terms that such events as surgery, treatment of cancer, sleep apnea, and repeated head injuries have short and long term effects on cognition. The cumulative load is too much for biological and psychological compensation with time and aging. One often-ignored disease is lung disease such as […]

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There are two main pathways for cognition as we age: normal aging and cognitive decline (abnormal aging). It is important to understand that aging is not a disease, Alzheimer’s is. It seems clear that there are things we can do to protect and enhance cognition during normal aging. What is not clear is whether there are things that we can do to protect against abnormal aging. Staying sharp cognitively is a goal for many seniors as evidenced by the popularity of “brain fitness” programs such as Lumosity. Lumosity alone has some 70 million members from 180 different counties. It’s marketing ads boast that it is “scientifically” developed. There is no clear evidence that mastering their 40 games makes any real world improvement in everyday cognitive functioning let alone protects against abnormal aging. A recent report from the Institute of Medicine […]

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I have been specialized in memory and memory disorders such as Alzheimer’s disease and related disorders for a quarter of a century. Interestingly, in all that time I have read very little about Dr. Alois Alzheimer (6/14/1864 – 12/19/1915). Engelhardt and de Mota Gomes wrote a recent article (“Alzheimer’s 100 anniversary of death and his contribution to a better understanding of senile dementia,” 2015, Arquivos De Neouro-Psiquiatria, 73, 159-162 PMID 25742587) in honor of the upcoming 100th anniversary of his death that helped me put Dr. Alzheimer in a broader context. It’s important to understand that the concept of “senile dementia” dates back thousands of years. Both Aristotle and Plato held the belief that old age is linked to inevitable memory failure. The concept of mental stimulation as neuroprotective is also not new. Cicero believed that keeping mentally active prevented […]

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What is a neuropsychological evaluation, what good is it, and how is it best done? Let’s start by making a distinction between testing and evaluation. Tests are rigid, standardized, formal measuring tools to determine things like mastery of information, placement in school programs, and outcomes for clinical trials of drugs. The test administrator needs to be consistent, neutral, not help, and not give feedback that may influence the results. Many neuropsychologists administer “tests.” On the other hand, an evaluation is more flexible. The interaction is less formal and can be modified to meet the needs and personalities of those needing evaluation. For example, memory evaluations start by observing whether the client is on time. Did he or she remember the paperwork? Can he or she find the office? Find their insurance cards? Know their birthdate? Remember a list of words? […]

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I was invited to participate in a panel discussion at Avow Hospice. The theme was “what are the three things that you want all of your clients to know.” This is an interesting challenge for two reasons. First, each panel member has only ten minutes to make their point, Second, as I have recently turned 70 and am rapidly approaching retirement, what do I need to know for myself as I am not immune to the complex cognitive and physical changes that accompany both normal, true senior moments, and abnormal aging, memory and physical loss. 1. We do not yet know what causes Alzheimer’s disease. A recent issue of the ARRP newsletter states that the problem is a lack of research funding. But the issue is more complex. Where do we put the money? Amyloid treatments are a bust despite […]

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The cholinesterase inhibitors like Aricept (i.e., donepezil, rivastigmine, and galantamine) have been available for treatment of dementias such as Alzheimer’s disease since the mid 1990s. These medications slow the progression of Alzheimer’s disease (in those who tolerate them) and discontinuing them after extended use may induce a rapid decline even in those so impaired that they are in skilled nursing facilities. Despite these facts, the cholinesterase inhibitors are often maligned, not used, or discontinued too soon because they do not produce dramatic effects and do not arrest or reverse decline. Although Alzheimer’s and similar dementias are classified as memory disorders, they actually have an impact on many brains skills or domains. In addition to memory, Alzheimer’s disease may produce impairments in attention, language such as word finding, visuospatial skills like drawing/handiwork, personality, mood, and/or executive functions. All of these skills […]

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Alzheimer’s disease and other progressive dementias are not the only cause of cognitive impairment. It is commonly known that as the heart goes, so goes the brain. An estimated 5 million Americans suffer from heart failure and this number is expected to double over the next 40 years (“Heart failure and cognitive dysfunction,” International Journal of Cardiology, 2014, 178, 12-23, PMID 25464210). Cognitive impairment is common in those with heart failure with a prevalence ranging from 25% to 75% with greater degree of heart failure associated with higher levels of cognitive impairment. Those in heart failure with a left ventricular ejection fraction of less than 45% are especially prone to cognitive impairment that is at least mild. Cognitive impairment may involve any one or all of several brain functions. These include attention, memory, executive function, language, speed of thinking, and/or […]

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Alzheimer’s disease does not develop suddenly. It emerges over the course of decades. There is a history of short-term memory loss that often dates back a decade before more obvious symptoms arise. Onset is subtle. How many of us have had senior moments? How do we know if they are benign or the hallmark of progressive cognitive decline? Changes are complex and differ across individuals depending on the region of the brain that is affected. One way to make sense of these complicated pathways is to have a category that reflects significant changes in memory that fall short of a dementia. The solution has been to create a category – diagnosis if you like – for individuals who have memory changes but are not demented. This is Mild Cognitive Impairment (MCI) (“Mild cognitive impairment and mild dementia: a clinical perspective,” […]

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