Family Care

I finally got around to reading a book that one of my clients gave me a couple of years ago – My Stroke of Insight by Jill Bolte Taylor, 2006, Plume: New York, http://www.drjilltaylor.com. Dr. Taylor is a Neuroanatomist who had a stroke on December 10, 1996 when in her mid 30s. There are two types of stroke. One is caused by blockage (infarction) of blood vessels in the brain, the other caused by bleeding (hemorrhage). Hers was the latter caused by the rupturing of an abnormal blood vessel structure, ateriovenous malformation, which she didn’t realize she had until it bled. Her recovery took 8 years – don’t believe the 6 month rule. The stroke left her completely disabled – unable to walk, talk, read, write or recall much of her life. Although the book is an excellent, approachable, personal, […]

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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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There are many stressors that confront us such as divorce, dementia, death, illnesses, caregiving, injury, retirement, addictions, and/or neurological disease.  Managing the emotions and behavioral changes required to move forward requires effort, persistence, emotional support, and saying the “right” things to yourself.  This is the foundation of resilience. Self talk  (“psyching oneself up”) as psychotherapy and self-help was popularized by Albert Ellis as “rational emotive therapy” and is broadly discussed today as “cognitive behavioral therapy.”  The underlying assumption is that the dialogues you engage in with yourself are the foundation for behavioral change and managing difficult emotions. Consider the statement “I can’t do it.”  Or sometimes others will try to help by pointing to someone who made the change you are seeking but you say to yourself “He/she can do it but that doesn’t apply to me.”  For example, “I […]

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When do you move a person with memory loss from their home to a greater level of care?  This is a very complicated and subjective decision.  Let’s start by assuming the person is living at home with a family member and memory loss is still mild to moderate.  Furthermore, assume they have lived in the same house and neighborhood for at least 5-10 years.  All of their friends and routines are well established and over learned.  In short, there are few surprises and little need to learn much that is new.  Life runs mostly on long-term memory.  The best place to be is at home and in familiar locations with lock-step routines.  Minimum care is needed.   As the memory loss and confusion builds the decision will become more and more the role of the primary caregiver and family. This is […]

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Stress is a pervasive condition that affects our mental and physical functioning.  The term covers both situations that we may call “stressful” such as being told we have cancer or Alzheimer’s disease, caregiving for someone with dementia, or having to give a speech or our reaction to the stressful event such as racing heart, dry mouth, or worry.  Stress can be “negative,” as in being sued, having a car accident, or getting divorced, or “positive,” as in taking a vacation, getting married, or winning the lottery.  Stressors vary in terms of duration, intensity, novelty, and type.  The ranges of stressors includes threat of death, threat of bodily injury, illness, grief, divorce, grief, moving, night shift work, commuting, and noise. The formal study of stress started with the seminal book The Stress of Life by Hans Selye that was published about […]

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How does caregiving unfold over time?  Diseases such as Alzheimer’s disease evolve over time – usually decades.  The person who is forgetful can manage early changes in memory.  But as the disease progresses, there is an increasing need for external guidance, prompts, and caregiving as the problems extend beyond just forgetfulness.  There are seven general stages of memory loss per the global deterioration scale.  The following presents general needs for care at each stage. Stage one – normal.  This is the stage that we all hope to stay.  There are the typical “senior moments.”  No caregiving is needed. Stage two – forgetfulness.  In this stage there is minor consistent forgetfulness and the person in this stage is typically aware that there are changes.  There may be an incident or pattern that raises minor concerns.  There is no need for caregiving […]

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There is treatment for Alzheimer’s disease.  Realistically, Alzheimer’s gives ample time to be proactive.  It is a slowly progressive neurological disease that unfolds over the course of several decades. Treatment involves being proactive rather than reactive.  These are the steps we all need to take beginning now. Assessment.  We all have wellness plans that are managed through annual physicals with our physicians.  We need to include annual memory assessment by a memory expert as a part of this plan.  The assessment should, at the minimum, thoroughly assess short-term memory by means of a challenging, standardized memory test and be administered by a memory expert. Treat short-term memory before it changes.  We seem to lose track of the fact that we took notes in school to manage short-term memory.  It never worked like a muscle.  It takes time, focus, and effort […]

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Does taking a multivitamin/mineral supplement help prevent or delay cognitive decline?  In 2012, Mayo Clinic Health Letter (March 2012) reviewed well-conducted research concluding that many vitamins and minerals that we used to think prevented diseases may not help after all.  Furthermore, there are consistent findings that under some circumstances vitamins and supplements may cause harm – even use of a multivitamin in those who are well nourished may slightly increase the risk of premature death. A recent editorial, “Enough is enough: stop wasting money on vitamin and mineral supplements,”  in the Annals of Internal Medicine (2013, 59: 851) pushed the issue even further.  The journal published three articles presenting data that indicate no benefits from a multivitamin/mineral supplement in well-nourished adults. A review of primary prevention studies focused on community dwelling adults with no nutritional deficiencies.  There was no clear […]

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In 2004 the best available research indicated that supplementation with vitamin E slowed Alzheimer’s disease.  A major clinical trial at the time indicated that taking 2000 IU of vitamin E per day delayed placement in care facilities by several months compared to placebo.  By the way, treatment with selegiline (a type of antidepressant) produced the same effect.  Another study at the time demonstrated that eating a diet high in vitamin E was correlated with higher mental function in men and women aged 65 – 100.  Hence, many were taking high doses of vitamin E and supplementation was the standard of care for Alzheimer’s disease. However, there were concerns regarding such a high dose of vitamin E as it produced side effects such as potentiating the effects of anticoagulants such as aspirin and Coumadin and increasing bruising and risk of bleeding.  […]

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One way to understand progressive changes resulting from dementia is to compare them to the changes that occur as a result of human development.  Dementia unfolds as reverse development.  As a general rule, those skills we learn later in life (e.g., managing investments, complex technology, doing a checkbook, and writing poetry) decline earlier than those learn earlier in life (e.g., toileting, dressing, and language).  The major difference is that as we develop from infancy, we constantly learn new skills and information.  The opposite is true for most dementias.  Learning new skills becomes increasingly difficult or impossible.   Those who are demented must be managed based on skills that are already there and those skills progressively deteriorate.  Dementia is a backward moving target. The good news is that we can learn a lot about managing dementia by understanding and using principles of […]

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