I just finished reading a very interesting book that was suggested by a couple of my clients. They are aware that I love cats. I recall the empty feeling that Pamela and I had between cats. Pepper, our cat of 22 years, died and we spent a year and a half without another cat. Our home lacked completion during that time. We are so pleased to have Gracie and Vanna add their energies to our home. Making Rounds with Oscar is set in a nursing home. David Dosa, the author of the book, and a special cat named Oscar are the two main characters in this memoir. David Dorsa is the attending physician at a nursing home in the northeast. Being classically trained, he begins by being skeptical about the ability of a resident cat, Oscar, to sense and to […]
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There is a strong belief among both the general population and medical practitioners that physical inactivity and poor diet are associated with cognitive decline as we age. Physical conditioning and diet are closely associated with cardiovascular health that, in turn, is associated with heart disease and stroke. Indeed, better physical condition as we age reduces some of the wear and tear of aging on the brain as evidenced by less atrophy and white matter disease with aging. Another recent study adds to the evidence that what’s good for the heart is good for the brain. The study (“Cardiovascular health through young adulthood and cognitive function in midlife, Annals of Neurology, 2013, 73: 170-179) followed cardiovascular health of participants over the course of 25 years starting age 18-30. The assumption was that those who maintained greater levels of cardiovascular heath would […]
I read yet another newspaper article on Alzheimer’s disease touting “early diagnosis.” Now that it is clear that brain changes of Alzheimer’s disease develop decades before there are symptoms, the push is to make a medical diagnosis well before there are any symptoms. Furthermore, if we pursue this strategy, many (based on current data as many as 30%) will be diagnosed who will never develop symptoms. We will instill fear and hopelessness needlessly. “Alzheimer’s disease’ a label that has no usefulness in the real world. Everyone with Alzheimer’s disease does not become demented. The label provides a false level of understanding along with an expectation that there is nothing that can be done. There are effective treatments for memory loss but they are not medical and therefore undervalued. Furthermore, a diagnosis should direct you to actions that tell you what […]
The second most feared medical diagnosis – next to cancer – is Alzheimer’s disease, the most common cause of dementia. What is Alzheimer’s disease? This not such an easy question to answer as it may seem. Ultimately, the diagnosis requires confirmation by autopsy or biopsy but even here the diagnoses is uncertain. A diagnosis is made by clinical criteria based on typical features. “Typical Alzheimer’s disease” mainly affects the elderly – onset over 65. Most often Alzheimer’s disease is “sporadic” – meaning there is no prior family history. The symptoms do not develop rapidly but rather come on slowly over the course of many years. The first sign of possible Alzheimer’s disease is short-term memory slips such as forgetting conversations, getting lost, or forgetting events. As the condition progresses there are deficits in skills in addition to memory such as […]
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I received a recent e-mail that asked me to stop putting “such doom & gloom out there.” I was surprised that my views are perceived as “doom and gloom.” The writer of the e-mail states “The research is out there that you can cure all of it by diet!” If only it were that simple. Alzheimer’s disease is not caused by faulty diet. Indeed, no one really knows what causes Alzheimer’s disease. Eating more healthy foods and portion control are a part of any good wellness plan. The best current advice from research of Alzheimer’s disease is to focus on fruits, vegetables, and fish. But eating such a diet will not cure all of our ills. There is no simple solution. There is no magic supplement or food. And isn’t it a form of blaming the victim to be so simplistic? The […]
I am a very practical person. The realities of everyday life and the needs of my forgetful clients keep my focus on short-term memory. Short-term memory is the ability to learn new information and works by the One Minute Rule (entries in the calendar, Post-It notes, alarms, taking notes). It is not like a muscle. You can’t exercise it to make it better. Short-term memory is essential to any program of memory improvement or maintenance. Managing short-term memory is necessary but not sufficient for treating Alzheimer’s disease. But memory is much richer than just short-term memory. Whereas short-term memory adds more threads and details to the tapestry of memory, long-term memory is the evolving tapestry of color, dimension, and passion that adds quality to life – even for those who are forgetful. Long-term memory does work like a muscle. The […]
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 […]
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 […]
You make careless errors. You are easily distractible, have poor concentration, and are forgetful. You are disorganized and often misplace items. You interrupt others, are easily frustrated, and have poor follow through on what you start. These symptoms interfere with your ability to work or engage in activities you enjoy. Do you suffer from Attention Deficit Disorder or do you have early Alzheimer’s disease? Or do you have something else? I have several cases a year where I am consulted by someone with these symptoms and asked about both the diagnoses and what to do to help. If you are older than 15 and the symptoms are new (were not present before the age of 12), you don’t have Attention Deficit Disorder and are very unlikely to have Alzheimer’s disease. If you are between 30 and 60, you probably do […]
