World Alzheimer's Day 2009: Don't Forget To Remember

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This post is part of our Senior Health & Wellness Series and is dedicated to the 35 million people worldwide who have dementia and their caregivers.

Today, September 21st, is World Alzheimer's Day. It is currently estimated that if rates of Alzheimer's Disease (AD) continue to rise as they are now, by 2050 11-16 million Americans will have the disease. The purpose of the dedicated day is to both raise awareness of the disease's current state for lay people, medical communities, and members of congress, and to raise funds and create research-based guidelines to help combat the disease's current dismal progression.

Many people mistakenly view Alzheimer's as a normal part of aging -- perhaps because it has become so increasingly commonplace among our elderly (albeit increasingly younger elderly) population. The truth is that Alzheimer's is not a normal part of the aging process, and is a progressive disease that attacks the brain from the moment of onset until the individual's death.

Here are the 10 warning signs of AD, as issued by the Alzheimer's Association, and my own 2-cents on each:

1. Memory changes that disrupt your normal life. Normal memory loss with age is often confused with early symptoms of AD. The key to differentiating the two is to figure out whether or not the memory problem is primarily with recently learned information. An example of this sign would be someone asking you over and over for the same piece of information, because they are not remembering it after being told one or more times.Normal forgetfulness would be your loved one forgetting your birthday, but remembering it the day after. Or your grandmother calling you 3-4 names (in my case, even the dog's name) before remembering yours.
2. Challenges in planning or solving problems. This would be characterized by a sudden difficulty concentrating or problem-solving that was not present previously. An example - your relative suddenly cannot follow the steps of a recipe he/she has been making for years even after reading it over and over. Normal forgetfulness would be making innocent math errors balancing a checkbook.
3. Difficulty completing familiar tasks. Early stages of AD include difficulty completing daily routine tasks, such as driving to a familiar location or remembering the rules of a card game they formerly played often. Normal forgetfulness would be your grandmother needing help setting up an electronic device or using a new tv remote.
4. Confusion with time or place. People with AD have difficulty with the passage of time. They may forget where they are, or how they arrived there. Normal forgetfulness would be temporarily forgetting what day of the week it is, but remembering soon after.
5. Trouble with visual and spacial images. This one can be difficult to distinguish in early stages, as vision loss (a normal sign of aging related to physical alterations such as cataracts or weak muscles) can be an early sign of AD. A sign of AD-related visual problems would be a difficulty judging depth or passing by a mirror and not recognizing that it is a self-reflection.
6. New problems with words in speaking or writing. This is usually characterized by bizarre naming patterns, such as calling a watch a "hand-clock" or forgetting what one was talking about in the middle of a conversation. Normal aging would be occasional stumbling to find the right word, with eventual appropriate wording found.
7. Misplacing things and losing the ability to retrace steps.  People with AD may do bizarre things such as putting ice cream in the cabinet or toothpaste on their bread (more advanced stages). They often will accuse others of stealing as they are unable to recall their actions. Normal forgetfulness would be misplacing things such as reading glasses or tv remote once in a while.
   
8. Decreased or poor judgment. People with AD may make poor decisions that are uncharacteristic of them - for example, giving money to a telemarketer or random person. They also tend to decline in personal grooming habits.
9. Withdrawal from work or social activities. People with AD may avoid being social due to changes they've experienced in ability to complete tasks, forgetfulness, or skills. An example would be your grandmother quitting her knitting group because she no longer can complete the proper steps and was asked about it last time she attended.
10. Changes in mood or personality. People with AD can have severe mood and personality changes, often with increased fearfulness, anxiety, and suspicion of others. They often become easily upset if they are removed from their comfort zone. This is new behavior, and is different than someone who has always liked routine and done things a certain way.  This symptom in and of itself may indicate AD symptoms, or another underlying psychiatric condition, and should be looked at by a trained professional to differentiate.

So how do we stop it?

There are multiple large-scale studies in progress designed to pinpoint causes of AD and to optimally assist the medical and lay communities in formulating guidelines and lifestyle adjustments to help prevent the disease onset in the future. Here are some of the most commonly seen recommendations for prevention of Alzheimer's Disease and ways you can implement them in your and your loved ones' lives:

• Know your risk. The greatest known risk factor for Alzheimer’s is increasing age. Most individuals with the disease are 65 or older. The likelihood of developing Alzheimer’s doubles about every five years after age 65. After age 85, the risk reaches nearly 50 percent.  Another risk factor is family history. Research has shown that those who have a parent, brother or sister, or child with Alzheimer’s are more likely to develop Alzheimer’s. The risk increases if more than one family member has the illness. When diseases tend to run in families, either heredity (genetics) or environmental factors or both may play a role.  Scientists have identified genes which put people at greater risk for developing AD.  However, genetic testing is not recommended as only about 5% of cases of AD are shown to be "familial Alzheimer's Disease", meaning they were purely genetically predetermined and had almost no environmental influence.
• Stay Active. Multiple studies have linked exercise to cognitive health and prevention of cognitive deficits with age, including preventing and/or delaying Alzheimer's disease in those at risk. Most studies seem to point to exercise routines as having the greatest impact on cognitive health.  So, instead of killing yourself at the gym twice a week, take a brisk walk for at least 15 minutes 5 times per week, gradually increasing with time as you can.
• Dietary changes.  Researchers have noted for many years that Japanese people living in Japan have far lower rates of AD and dementia than Japanese who come to the US and adopt an American way of eating. Japanese living in Japan eat diets that are rich in grains, vegetables, and fish, while those living in America eat a diet far richer in calories and animal foods, and thus saturated fats. Other differences in disease patterns between Westerners and Asians--especially in breast, prostate, and colon cancers-- are consistent with the same finding. The same trend has been found in Africans vs. African-Americans, with (uncoincidentally) the latter having far higher rates of Alzheimer's  Rates of AD vary greatly around the world, with a probably link to the predominant diet in each area.  Researchers in the Journal of AD (June 2002) pointed out that diets rich in whole grains, vegetables, and fish significantly lowered the risk of the disease.  In a study titled "Mediterranean Diet and Cognitive Decline", published in Public Health Nutrition in 2004, the Mediterranean Diet -- characterized by whole grains, vegetables, monounsaturated fats from olive oil and red wine -- was associated with much lower rates of all types of cognitive decline and dementia, with the consumption of olive oil most predictive of these rates. This is likely connected to the antioxidant properties of olive oil which contribute to lower rates of inflammation.
  Another key point in prevention of AD and multiple other cognitive and metabolic disorders is the general maintenance of stable blood sugars. Without going into too many overwhelming details, this basically means keeping your blood sugar at a steady and controlled rate as much as possible by limiting our intake of processed, simple sugars and increasing our intake of lean proteins and complex carbohydrates (and fiber) which contribute to stabilizing blood sugars.
• Keeping an active mind. Studies show that those who keep learning throughout their geriatric years have significantly lower rates of AD than the general population. R.S. Jope, PhD, hypothesizes that this is because people who read a lot and continue to stimulate their mind generally have a surplus of neurons as a result (as compared to the general population).  When you have AD, lots of neurons are lost before any overt cognitive deficits are seen. Therefore, those who have more neurons will take longer to show features, and may be able to successfully delay the progression of the disease simply through this phenomenon. The other theory that many hold for this preventative measure is the "use it or lose it" concept when viewing the brain as a muscle.  Numerous studies support the theory that learning stimulates brain cells to produce more growth factors which keep neurons alive thereby increasing our ability to learn, retrieve memories, and form complex thoughts
• Quit bad habits while you still can.  Cigarette smoking after age 65 increases your risk of Alzheimer's by 79%. Caffeine is a tricky one, as moderate coffee drinkers have actually shown cognitive benefits compared to those who do not ingest caffeine. This is likely due to the antioxidant properties of the coffee beans themselves, not necessarily the caffeine content.  However, if caffeine is a primary or secondary source of other harmful habits such as insomnia, irregular sleep patterns, anxiety, or poor stress management, I'd advise you to lower your intake at least by 1/2 if you are approaching mid-life.  One possible remedy would be to switch to your favorite tea -- no matter which you choose the antioxidant benefits of tea are rich and the caffeine content is significantly lower than that of coffee.
• Get some sleep.  Your brain needs regular, restful sleep to process, store, and recall information. Nightly deprivation not only leaves you cranky and tired, but according to memory experts Dr. Andrew Weil and Dr. Gary Small, poor sleep can significantly damage your brain and central nervous system.   Reserve your bed for sleep (and sex), take a hot bath or engage in other pre-sleep relaxing routines, and dim the lights. Comfortable temperatures, and white noise machines can also signal your brain that it’s time for deep restorative sleep. When mental dialogs keep you awake, get up. Try reading or relaxing in another room for twenty minutes then hop back in. If this doesn’t work, consider discussing your stress levels with a mental health professional or utilizing stress management techniques such as Yoga, Meditation, or addressing those issues that are keeping your mind circling at night. 

Ways You Can Help The Cause:

• start a memory walk team
• use Facebook to spread awareness
• donate to the Alzheimer's Association
• volunteer with your community
• become an advocate

To those who have a loved one afflicted with this devastating disorder, you are not alone, nor are your actions unrecognized.  Be sure to gift yourself with the support and respite you need during your own struggle with this disease so that your efforts will not be in vain.

The best way to find yourself is to lose yourself in the service of others.
-Mahatma Gandhi

Andrea Adimando, APRN-BC, MSN is a Family Psychiatric Nurse Practitioner practicing in various settings throughout CT. Her interests include a holistic integration of traditional and naturopathic methods in the treatment of various psychiatric disorders, with a major focus on children with Autistic Spectrum Disorders and their potential for recovery. You can read her blog, Sound Mindfulness, here.

Yoga For Mind, Body, and Spirit

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Assisted Living Group Using Social Media to Combat Swine Flu

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Terrace Communities, a group of seven assisted living residences in Maine, New Hampshire, Vermont, and Florida, is using their community blog and discussion forums to share information and address resident and family concerns about the H1N1 flu virus. Corinne McCandless, VP of Residential Care for Terrace Communities, says that using the blog and discussion forums allows the company to get the word out fast about the latest information from the CDC and the company's plan to manage the potential threat. She adds, "We can dialog with residents and families right on our Website in real time. It keeps them in the loop and makes it easier for us to disseminate the information." You can view Corinne's blog post here. Learn more about how you can use social media for your senior living or eldercare services business at CareNetworks.com.