Help For Caregivers

It could be one of the most difficult challenges you’ll ever face. Caring for a loved one who has Alzheimer’s disease. Seventy percent are cared for at home, but that can be a confusing, even dangerous place. A new guide offers hope to thousands of families.

Frank and Therese have been married for 50 years, but for Therese, the memories are slowly fading. “It’s like a locomotive that’s going to run out of control, and it’s chugging along and chugging along,” says Frank.

Therese has Alzheimer’s disease, which makes simple tasks difficult. Her husband says she lives in a world of forgetfulness and confusion.

Mark, an author and architect, says, “You have to understand the disease, understand what the world looks like through their eyes and what it means.” Mark has designed a simple guide to make caregivers’ homes safer for Alzheimer’s patients. It’s called “The Complete Guide to Alzheimer’s Proofing Your Home.”

“The first problem we have in the bathroom is if you listen, the fan goes on, and that can be very agitating and upsetting for person with Alzheimer’s disease,” says Mark. To make the home safer, get rid of loud noises and slippery throw rugs. Buy passage locks for doors so that no one can be locked in or out of a room.

COMMON PROBLEMS IN THE HOME:

Closets: A big wardrobe creates too many choices, which often leads to confusion.
Mirrors: In the early stages of Alzheimer’s, mirrors encourage grooming. However, as the disease progresses, people with Alzheimer’s do not recognize their reflection. Some may think it’s a ghost or a stranger. During that stage, it’s best to cover or remove mirrors.
Black or dark-colored floor tiles and throw rugs: These may look like “holes” to someone with Alzheimer’s. As a result, walking across a checkered floor or a rug can cause terror.
TV: Violence on television can often seem real to people with Alzheimer’s. Some people believe what’s taking place on the television screen is actually taking place outside their door.

Aware now of the pitfalls in his home, Frank’s ready for the challenges ahead. “As a caregiver you become the crutch. You’re their safety valve. You’re the one that they need the most,” he says.

Another useful tip for caregivers is to put up signs throughout the house. This will help people with Alzheimer’s remember where things are kept.

Flower Power

Gardening has long been a popular way for many people to relax and ease the stresses of the day, but did you know it has even more benefits for people who are physically or mentally disabled? Meet a woman who found flowers can help where words can’t.

Picking flowers is a sure way to brighten Heather’s day. As an infant, Heather had kidney cancer. A chemotherapy overdose left her with a brain injury. Now horticultural therapy helps her enjoy life. “It makes me feel very good,” Heather says.

Every other week she joins other participants with brain injuries in this garden. Nancy runs the program. While gardening’s therapeutic roots go back to ancient times, Nancy says it was first used in this country for veterans returning home from war. “It’s very life-affirming, and I think that’s what gardens did for those folks and continues to do.”

This former clinical social worker, Nancy says plants work when words aren’t enough. She uses the therapy to treat people with developmental disabilities, Alzheimer’s disease, depression and drug addiction, but says anyone can benefit. “Just connecting with nature is so important for the soul and healing.” And science supports it. “There is a bit, but not enough”.

Gardening is also a great method for physical therapy since it works large and small muscles as well as motor skills.

New Insight Into Cardiovascular Disease

A seldom-measured amino acid that is circulating in your blood may be an indication of cardiovascular disease. It is called homocysteine, and an increasing number of physicians and researchers are acknowledging that high levels of the chemical are associated with heart disease and stroke.

A summary of 15 studies revealed that elevated homocysteine levels produced a 70 percent increase in the risk of coronary artery disease and a greater risk for stroke. Previous studies have shown connections with schizophrenia, Alzheimer’s disease, hypothyroidism and anemia.

However, the evidence is not conclusive. “Five other studies found no link between homocysteine and cardiovascular disease,” says Oklahoma City internist Dr. E. Randy Eichner, a member of the Editorial Board of The Physician and Sportsmedicine, “but six studies did find a relationship. I think the balance of scientific evidence favors a homocysteine/CAD link.”

Atlanta cardiologist Dr. John Cantwell agrees with Eichner. “I recognize it as a possible risk factor, but the only time I measure it is when a person has a family history of heart disease without the more obvious risk factors.”

Dr. M. Rene Malinow, professor of medicine at the Oregon Health Sciences University and one of the nation’s leading homocysteine researchers, says we don’t yet know for sure that it is a cause of atherosclerosis. “We will have to wait for the results of clinical trials, and that could take several years.” Adds Malinow, “Although it is a relatively new risk factor by itself, it is possible that a high homocysteine level combined with traditional risks, such as hypertension or smoking, is even more significant.

Even those who think homocysteine is related to heart disease are not sure why it may have a harmful effect. One theory is that, in elevated amounts, it irritates the inner lining of the arteries and could cause blood clots to form. There is even a possibility that homocysteine levels increase after a stroke, not before.

Prevention

The good news is that a high homocysteine count can be prevented or treated by getting adequate amounts of folic acid (folate). Cantwell tells patients who have high levels to take 0.4 mg of folic acid per day, as well as a multivitamin supplement that includes B6 and B12. A high intake of folate by itself can mask other medical conditions, including a type of anemia.

The U.S. Food and Drug Administration has mandated that all enriched grain products be fortified with folate. Check the labels on cereal boxes. Most of them provide 25 percent of the daily folate requirement and many contain 25-35 percent of daily vitamin B6 and B12 needs. If you are eating a well-balanced diet, you probably don’t need the supplements.

Screening

Homocysteine screening is not very common. The American Heart Association is taking a very conservative position on the issue, saying that it’s too early to recommend general screening. Cantwell points out that the one-year cost of a folate and multivitamin supplement is approximately equal to the cost of a screening test.

Americans are well informed of the risk factors associated with heart disease. Sooner or later, a new one — elevated homocysteine levels — may be added to that list.

Folate is also good for unborn babies.

Who is at risk for Alzheimer’s?

We’re all at risk now by virtue of the fact that we are part of an aging population. It’s clear that the biggest risk for Alzheimer’s disease is aging. That’s why we know so much about it now. In this century the population is aging more successfully than ever before.

Alzheimer’s wasn’t as prevalent because we weren’t living as long?

Yes. At the turn of the century the average age life expectancy for males in some European cities was only 40 or 50-years-old. Now it’s 20 or 30 years more than that. So we didn’t see the population coming into the age that put them at risk for developing the disease.

Talk about the vascular connection

The connection has been known for a long time, ever since Alzheimer described the disease. There’s a small protein called amyloid that gets deposited in the brains of those that suffer from Alzheimer’s disease. There’s always been a question of how it causes the disease and if it has any normal functions. We started to look into that problem several years ago. One of the things we found was that when amyloid comes anywhere near blood vessels, it causes them to constrict and stay constricted. That was a novel finding, and there are several implications. This might be part and parcel of the Alzheimer process, that there may be a tendency of the vessels in the brain to close down and stay closed down. Of course that would have implications for delivering oxygen and nutrients to the nerve cells in the brain.

So this connection happens years before the amyloid?

Yes. One of the interesting aspects of this is that in full-blown Alzheimer’s disease you have aggregations of amyloid that precipitate out. They come out of solution and form plaques in the brain. Our findings occur with much lower concentrations. So the implication is some of the affects that we’re looking at occur many years early on before the disease really becomes full-blown and recognized in the way that we see it clinically.

Would you be able to see the vessels closed on an MRI or something?

I wish we could, but it’s very difficult to do that in humans. We have done animal studies that show that. The animals that produce too much amyloid do close their vessels, and they stay closed. That gives them significant problems.

Is this the same as somebody who has cardiovascular disease? If they have cardiovascular problems, would they be at a higher risk for Alzheimer’s?

If you have a little bit of Alzheimer’s and you have a little bit of cerebral vascular disease or even cardiovascular disease, those things can combine in a way that makes them both work. You can see individuals that have a slight amount of Alzheimer’s disease pathology and normally wouldn’t have any symptoms. If they have cerebral vascular problems on top of that, then they start to display symptoms.

People might see that and say, “If I had a heart attack, then I might be an Alzheimer’s patient later on.” Is that true?

If you have a heart attack then you usually have some form of atherosclerosis or some form of vascular disease. Quite often it extends to elsewhere in the body. Yes, that does put you at risk for increasing the expression of Alzheimer’s disease. In other words, it does put you at risk for having Alzheimer’s symptoms before you normally would if you just had Alzheimer’s alone.

Now that you understand this connection, where do you go from here?

What we’ve been working on for the last couple of years is finding out exactly why the vessels close down. To start with, we thought that it was mediated by free radicals. These substances increase with age and are generally thought to be bad news in a number of conditions. However, what we actually found out is the vessels close down because they began an inflammatory response. It’s the same as when you first scratch yourself the skin blotch is white because there’s an immediate inflammatory response. In fact, the blood vessels in the brain are doing something very similar when they come into contact with amyloid.

How would you treat this?

If we block the actual molecular mechanisms, the chemicals that are switched on inside cells, we can stop the effect. We’ve already demonstrated that in the experimental situation. Now what we have to do is demonstrate that in the clinic. That’s the next step.

Could drugs used for cardiovascular disease be used?

Yes. One of the first drugs we’ve investigated that blocks this effect in the experimental situation has been used for other conditions. It’s never been used for Alzheimer’s disease, but it has been used for cardiovascular disease. It’s that kind of drug that we want to test in a clinical situation.

What are those drugs?

We don’t have the full FDA approval to say.

Do antioxidants help?

As far as the vessel discovery is concerned, antioxidants mop up free radicals, and free radicals seem to make the situation much worse. That was one of the first things we found. So we’re not pursuing that in the clinic.

Using the cardiovascular connection as an identifier, it could be years before we see Alzheimer’s. How do you treat current Alzheimer’s patients if it’s already beyond that?

One of the other groups of patients that we look at are people that don’t have Alzheimer’s disease but are before that stage. They are memory-impaired but don’t have full-blown Alzheimer’s disease. If we follow a group like that, then we know that a certain percentage, quite a high percentage convert to Alzheimer’s disease every year. They would be an ideal population for us to give this medication to. That would be a much better intervention than waiting until folks have full-blown disease. That group is a target population for us.

So people who already have it might not benefit from this?

It’s generally recognized that once you’ve had the disease for five or six years then there’s very little that medical intervention can do now. The real target populations are those folks that are in the very early stages of Alzheimer’s disease or who would develop Alzheimer’s disease in the next several years. Right now those are the groups that we are actively recruiting into our study.

How do you identify those people?

We have sophisticated memory screens that give evaluations. These evaluations look at every aspect of memory and distinguish those effects that are truly pathological from those that are simple forgetfulness, which we all suffer from in one form or another.

Will you identify whether or not the amyloid is present?

We can’t detect amyloid in the brain. There’s no known way for us to do that at this stage. What we have to do is identify individuals who have memory impairment but don’t have full-blown Alzheimer’s disease and recruit those into our studies knowing that the largest majority of those will in fact develop the disease over a four- or five-year-period.

If I know somebody in my family who has it, what are my chances of developing Alzheimer’s?

One’s risk for the disease is definitely increased if you have a family history. However, the reality of that statement is it’s such a prevalent disorder, if most of us look far enough into our family histories we’ll find a case of Alzheimer’s disease. That’s just another way of saying that as we get to be 80 or 90 we’re all at risk for the disease. However, if you have a strong family history in addition to age, your risk is increased still further.

Are men or women more at risk?

Men and women are equally at risk for the disease. Men tend to die from other things before they get Alzheimer’s disease. So there’s an imbalance in the absolute numbers in the population. If you just take 100 women and 100 men, they’re equally at risk for the disease as they age.

News Source: Ivanhoe Newswire – 1999

A healthy diet may help improve mental funciton

Eating a healthy diet may help protect against dementia as people age, according to a new study.
Researchers from the National Research Council in Milan, Italy studied more than 1,600 men and women over age 70. Participants were questioned about the types of food they ate and took a test to determine their level of mental function. Researchers then evaluated the diets of the individuals and separated them into groups based on mental function.

After evaluating the data, researchers found that a balanced diet with low levels of saturated fat and cholesterol is linked with a lower risk of mental decline. While they are unsure how a healthy diet protects from mental decline, researchers hypothesize antioxidants play a key role. Potent antioxidants such as vitamins C and E are crucial in clearing up free radicals from the body. Researchers say studies also show omega-3 fatty acids may be helpful. Previous studies have shown the ability of omega-3 fatty acids to protect against Alzheimer’s disease.


USANA Vitamins fish oil Supplement USANA BiOmega provides advanced and guaranteed levels of EPA and DHA, two long-chain omega-3 fatty acids important for memory and learning.

In the current study, researchers also found moderate alcohol intake to be associated with better mental function. Researchers say while it may be that moderate drinking habits and good health generally go together, other research that shows moderate alcohol intake is associated with reduced risk of stroke may also mean it has a positive benefit on cognitive capabilities.

Dementia can occur at any age but is more common after age 65. Researchers emphasize dementia is not a normal part of the aging process. According to the San Francisco Alzheimer’s and Dementia Clinic, Alzheimer’s disease is the most common type of dementia. It typically occurs after 65 years of age and affects 4 million adults. Alzheimer’s Disease is the fourth leading cause of death in the United States. From onset until death, the disease generally lasts from 3 to 18 years.

SOURCE: European Journal of Clinical Nutrition, 2001;55:1053-1058

Diets high in vitamins C and E may lower the risk of Alzheimer’s disease

Researchers at the Erasmus Medical Center in the Netherlands examined the relationship between antioxidant intake from food and the development of Alzheimer’s. They found that participants with a high intake of certain antioxidants were less likely to develop Alzheimer’s.

The study consisted of 5,395 participants age 55 and older, who were free of dementia and had reliable information on their dietary habits. Of the participants examined between 1990 to 1993 and re-examined between 1993 to 1994 and again between 1997 to 1999, 197 developed dementia, 146 of whom had Alzheimer’s.

In a related study, researchers examined the association between Alzheimer’s and antioxidant intake from foods among people living in a biracial community in the United States. Their results support the findings that vitamin E from food may reduce the risk of Alzheimer’s but did not find the same association with other antioxidants.

Scientists from Rush-Presbyterian St. Luke’s Medical Center in Chicago studied 815 people, ages 65 and over who didn’t have Alzheimer’s. They found that the risk for participants in the top fifth of intake of vitamin E was lower by 67 percent compared to people in the lowest fifth of intake.

According to information given in the accompanying editorial, about 360,000 new cases of Alzheimer’s are reported in the United States each year. Previous studies suggested a link between the intake of certain antioxidants and the risk of Alzheimer’s disease.

Researchers caution that more studies need to be done to define the potential effects of antioxidants on Alzheimer’s. In the two studies, preclinical illness may have been a factor influencing dietary reporting by participants and only vitamins intake from food and supplements were analyzed.

SOURCE: Journal of the American Medicine Association, 2002;287:3223-3229, 3230-3237