Tag Archives: dementia

Unnecessary Medication Use Associated With Dementia Diagnosis

Introduction to the study:

A recent study conducted at the University of Sydney has found that inappropriate and unnecessary medications seem to be routinely prescribed for newly diagnosed dementia patients. This longitudinal research study of 2,500 people was conducted in collaboration with the University of Kentucky and Yale University and published in the Journals of Gerontology: Medical Sciences.

Estimates of people currently living with dementia is approximately 50 million worldwide. In Australia the estimate is approximately 425,000 costing the country more than $15 billion per year and is currently the second leading cause of death.

Study and Conclusions:

The lead author, Dr. Danijela Gnjidic, NHMRC Dementia Leadership Fellow and Senior Lecturer from the Faculty of Pharmacy and Charles Perkins Centre at University of Sydney stated that “Our study found that following a diagnosis of dementia in older people, medication use increased by 11 per cent in a year and the use of potentially inappropriate medications increased by 17 percent”. She went on to say, “These medications are typically recommended for short term use but are commonly used long term by people with dementia,”

Some of the more common unnecessary and inappropriate medications are pain pills, sleep aids, depression medications and drugs for acid reflux referred to as proton pump inhibitors

A number of reasons were given to account for this including a lack of time in the patient and physician encounters, inappropriate guidelines, difficulty in setting goals with the patient and difficulty in the communication and comprehension of the patient.
She stated, “These findings are of major concern and highlight the importance of weighing up the harms and benefits of taking potentially unnecessary medications as they may lead to increased risk of side effects such as sedation or drowsiness, and adverse drug events such as falls, fractures and hospitalization.” She felt that increased efforts need to be made to support the recognition and potential use of medications that are inappropriate to minimize harm to patients.
Finally, Dr. Gnjidic concluded that “For Australians living with dementia and their caregivers (who commonly are responsible for managing medications for people with dementia), the key is to communicate closely with general practitioners, pharmacists and other health professionals to make informed decisions and to practice good medicine management techniques to minimize the risk of side effects.” Also, she commented that “Deprescribing unnecessary medications may improve an individual’s quality of life and can reduce unnecessary healthcare cost.”

Adapted by Paul Susic Ph.D. Licensed Psychologist from article at ScienceDaily: Dementia Diagnosis Linked to Unnecessary Medication Use dated Apr. 19, 2018

Story Source:

Materials provided by University of Sydney. Note: Content may be edited for style and length.

Journal Reference:

Danijela Gnjidic, George O Agogo, Christine M Ramsey, Daniela C Moga, Heather Allore. The impact of dementia diagnosis on patterns of potentially inappropriate medication use among older adults. The Journals of Gerontology: Series A, 2018; DOI: 10.1093/gerona/gly078

Long-term Care and Dementia

Long term care: Dementia and Cognitive Impairment

Long-term care residents experience various forms of dementia and cognitive impairment. Before discussing dementia among long-term care residents, it is important to distinguish between cognitive impairment and dementia. Cognitive impairment may or may not be severe enough to be referred to as dementia. It all depends upon which cognitive areas have been affected. Some long-term care residents who have mild head injuries or focal strokes may have cognitive impairment restricted to very specific areas of the brain. These residents may be unable to recognize familiar objects (agnosia) or may not be able to name familiar objects (aphasia), yet their memory is often intact. As long as their memory is normal, we would not usually consider these long-term care residents to have dementia.

According to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM- IV) which is used by mental health clinicians to diagnose psychological disorders, memory and one of four or more other areas of cognitive functioning must be impaired before an individual will be considered for a diagnosis of dementia.

Dementia used to be considered to be a strictly progressive, irreversible disease process for both long-term care residents as well as community-based elderly. Now, dementia is recognized as having a much more variable course which may mean being progressive, static, or remitting. The course that it takes or the way symptoms may be manifested usually depends on its cause. Long-term care residents exhibit all of the many forms of cognitive impairment. Alzheimer’s disease is progressive and irreversible, and worsens over a period of many years. Strokes are also irreversible, but not necessarily progressive. Cognitive impairment due to depression is very common among long-term care residents, and is very reversible when appropriately treated with antidepressants and/or psychotherapy. Complete remissions are common when cognitive impairment is caused by problems such as depression, medications, hydrocephalus, infections, toxic conditions or metabolic disorders among long-term care residents.

The DSM-IV criteria for cognitive impairment in various types dementia include:
A. Impairment in recent and long-term memory.
B. One or more of the following:
1. Aphasia (language disturbance)
2. Apraxia (impaired ability to carry out motor activities despite intact motor function)
3. Agnosia (failure to recognize or name objects despite intact sensory function)
4. Impairment in executive functioning, including planning, organizing, sequencing, or using abstract reasoning.

C. These cognitive deficits must cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.

Some researchers have found that as many as 50% to 75% of residents in long-term care facilities have dementia. Of these, approximately half have Alzheimer’s disease and a quarter has multi-infarct dementia (caused by multiple strokes). The remaining one quarter of demented long-term care residents, have other types of dementia such as those due to head trauma, Parkinson’s disease, Huntington’s disease, Pick’s disease, as well as other diseases.

Some information provided by Psychosocial Intervention in Long-Term Care by Gary W. Hartz, Ph.D. and D. Michael Splain, LCSW

Additional information and web page by Paul Susic Ph.D. Licensed Psychologist (Health Psychology)

Dementia Symptoms and Diagnosis

What other dementia symptoms are there besides memory loss?

Dementia symptoms include additional problems besides memory loss. Individuals with dementia often exhibit difficulties in language, recognition, object naming, and motor skills. An abnormality of language referred to as aphasia, often occurs in individuals with vascular dementia which involves the dominant hemisphere. Because this hemisphere controls written, verbal, and sign language, these individuals may have significant dementia symptoms which affect their interacting with people in their environment. Individuals with dementia and aphasia may exhibit scarcity of speech, poor articulation and a telegraphic pattern of speech impairment (nonfluent , Broca’s aphasia).

This form of aphasia generally involves the middle cerebral artery with frequent paralysis of the right arm and lower face. Despite their difficulty with communication skills, individuals having dementia with non-fluent aphasia, usually have normal comprehension and a relatively good awareness of their language impairment. In addition to these dementia symptoms, these individuals often present with significant depression, anxiety, and frustration.

In contrast, when an individual’s dementia symptoms include fluent (Wernicke’s) aphasia, they may be quite verbose and articulate, although much of the language is nonsensical and includes multiple paraphasias as neologisms and clang (rhyming) associations. Whereas, when the dementia symptoms include nonfluent aphasias, they are usually associated with discrete lesions, fluent aphasia can result from such diffuse conditions as dementia of the Alzheimer’s type. Fluent aphasias, more commonly, occur in conjunction with vascular dementia which is secondary to temporal or parietal lobe cerebral vascular accidents (strokes). Because demented individuals with fluent aphasia usually have impaired comprehension, they may seem apathetic and unconcerned with their language deficits, if they are even aware of them at all. They usually don’t display the emotional distress of individuals with dementia and nonfluent aphasia.

The dementia symptoms of many individuals include an inability to recognize familiar objects. Agnosia is a feature of a dominant hemisphere lesion, which then involves altered perception despite normal sensations, intellect and language, although the individual cannot recognize familiar objects. This is in contrast to the dementia symptom of aphasia, in which the individual may not be able to name objects but can recognize them. The type of agnosia that an individual may have, depends upon the areas of the sensory cortex that is involved. Some demented individuals with severe visual agnosia cannot name objects presented to them, match them up with samples, or point to objects named by the examiner. Other individuals may present with additional dementia symptoms such as auditory agnosia, and may be unable to localize and distinguish such sounds as the ringing of a telephone.

Dementia symptoms may also include an inability to carry out selected motor activities despite intact functioning, sensory function and comprehension of the assigned task (apraxia). These individuals may display an inability to carry out such functions as brushing their teeth, chewing food, or waving goodbye when they have been asked to do so. The two most common forms of apraxia in individuals with dementia symptoms, are ideational and gait apraxia. Ideational apraxia is the inability to perform motor activities that require sequential steps, and results from a lesion in both frontal lobes or the complete cerebrum. Gait apraxia on the other hand, often seen in such conditions as normal-pressure hydrocephalus, is an inability to perform various motions related to ambulation. Also, it results from conditions that affect the part of the brain referred to as the cerebrum.

Some information from DSM-IV-TR Mental Disorders: Diagnosis, Etiology & Treatment by Michael B. First and Allan Tasman

Additional information and webpage By Paul Susic Ph.D. Licensed Psychologist

Dementia Symptoms and the Executive Functioning of the Brain

Dementia Symptoms and Executive Functioning:

Dementia symptoms related to impairment of executive functioning, involve the ability to think abstractly, plan, initiate and carry out complex behavior. On mental status examination, individuals with these dementia symptoms display problems coping with new tasks. Activities such as subtracting serial sevens may be impaired in these individuals with dementia.

In addition to the diagnostic features of the dementia symptoms already mentioned, these individuals display other identifying features that often prove problematic, poor insight and judgment are common in dementia, and often cause individuals to engage in dangerous activities or make unrealistic and relatively grandiose plans for the future. Visual-spatial functioning may be impaired in these individuals, as well as their ability to construct a plan and carry it out. Rather than trying to intentionally harm themselves, more commonly they unintentionally harm themselves due to carelessness, undue familiarity with strangers, and disregard for the accepted rules of conduct. Emotional lability is a dementia symptom frequently seen in pseudobulbar palsy after cerebral injury, which can be particularly frustrating for caregivers, as well as the occasional psychotic features such as delusions and hallucinations. Changes in their environment and daily routine can be extremely frustrating for individuals with these dementia symptoms, sometimes with their frustration being manifested in violent behavior.

The mental status examination, in conjunction with a complete medical history, and collateral discussions with family members or other informants, is essential to the evaluation and differential diagnoses of individuals with dementia symptoms. The findings on the mental status examination may vary depending upon the etiology of the dementia. In general, symptoms seen on the mental status examination, regardless of the etiology, are related to the location and extent of the brain injury, individual adaptation to the dysfunction, premorbid coping skills and psychopathology, as well as the concurrent medical illnesses.

When you are evaluating dementia symptoms, the most significant abnormality is usually related to disturbance of memory, (especially primary and secondary memory). Confabulation (filling in the gaps of memory, when not remembering specific information) may be present as the individual attempts to minimize their memory loss. Disorientation and altered levels of consciousness may also occur, but are generally not seen in the early stages of dementia that is not complicated by delirium. Affect (facial expression) may also be impacted as in the masked faces of Parkinson’s patients, or in individuals with the more expansive affect and labile mood of pseudobulbar palsy following cerebral injury. The affect of individuals with hepatic encephalopathy is often described as blunted and apathetic. A lack of inhibition can sometimes be seen in individuals with conditions such as tertiary syphilis, and occasionally the effects of some medications can even precipitate mania.

Some information from DSM-IV-TR Mental Disorders: Diagnosis, Etiology & Treatment by Michael B. First and Allan Tasman

Additional information and webpage By Paul Susic Ph.D. Licensed Psychologist

Memory Loss and the Dementia Diagnosis Page #2

Memory loss and recent memory:

Memory loss related to recent memory (secondary memory) is frequently referred to as short-term memory loss. The anatomic site of dysfunction for immediate memory is believed to be the limbic system. Individuals with a lesion in this area may have little difficulty repeating digits immediately, but experience memory loss related to a rapid decay of these memories. Sometimes, within minutes, an individual with a lesion in the limbic system may be totally unable to recall the digits or even that the test has even been administered. Thus, immediate memory involves memory loss or inability to recall information that was previously registered by the primary memory. Clinically, to test recent memory, an individual may be asked to remember three objects by an examiner. They will then be distracted for three to five minutes and will then be asked to recall the previously registered three objects. Sometimes, the examiner may give a demented individual a clue (such as “one of the objects you missed was a color”) and the individual will then correctly identify the object. If this occurs, memory testing should be scored as “three out of three with a clue” which is considered to be a slight impairment. Giving clues to an individual with memory loss associated with their immediate recall is pointless, because the information has not been registered in the first place. Wernicke-Kosakoff syndrome is an example of a condition in which immediate recall may be intact, while recent memory has been impaired.

Memory loss related to remote (tertiary) memory:

Memory loss associated with long-term memory or what may be referred to as remote memory, is usually associated with memories from the past. Remote or long-term memory capacity is believed to be relatively unlimited, with such memories believed to be permanently retained. Accessed tertiary memories are slow and the anatomical dysfunction and long-term memory dysfunction is to believed to be in the association cortex. In the early stages of dementia, long-term memories or remote memories usually remain intact. This type of memory loss is usually tested by instructing the individual to remember personal information or material from the past. An important factor that may influence an individual’s ability to remember may be whether the memory had some personal significance. An example may be that a woman who worked as a seamstress may remember many details related to her occupation, but not recall the names of the past three presidents, or some of the major cities in the United States. Thus, an individual’s memory loss of significant past information is an ominous finding. Collateral data from informants such as family members is essential in the proper assessment of memory functioning. In summary, problems with immediate and short-term memories are frequently impaired in individuals with dementia, while long-term or remote memories are often spared until much later in the course of the disease.

Some information from DSM-IV-TR Mental Disorders: Diagnosis, Etiology & Treatment by Michael B. First and Allan Tasman

Additional information and webpage By Paul Susic Ph.D. Licensed Psychologist

Dementia: What are the different diagnoses?

Dementia overview:

Dementia disorders are characterized by the development of multiple cognitive deficits (including memory loss) but are differentiated on the basis of the etiology (i.e. Dementia of the Alzheimer’s type, Dementia due to Pick’s Disease, Dementia due to Parkinson’s Disease, Dementia due to Huntington’s Disease, Vascular Dementia, Dementia due to HIV disease, Dementia due to Head Trauma, dementia due to other general medical conditions, substance-induced persisting dementia, and dementia due to multiple etiologies). The first information presented in this section will be related to general dementia information.

Dementia diagnosis:

Dementia as it is defined in the DSM-IV-TR is a series of disorders which are characterized by the development of multiple cognitive deficits (including memory loss) that are due to the direct effects of a general medical condition, the continuing effects of a substance, or multiple etiologies. Dementias share some common features but are basically classified according to their believed etiology. The cognitive deficits must be to the degree that they interfere significantly with an individual’s occupational or social functioning. Also, the deficits must show a progressive decline from the individual’s previous higher-level of cognitive functioning and must not be the result of delirium. However, delirium may be superimposed on a dementia and both may be diagnosed if the dementia diagnosis is evident previous to the development of the delirium. Dementia is a chronic disease that typically occurs even though an individual has clear sensory abilities such as hearing and vision. If it is believed that an individual’s consciousness is somewhat clouded, they will usually receive a diagnosis of delirium. Another factor essential to the diagnosis of dementia, is the presence of cognitive deficits that include memory impairment in a least one of the following cognitive abnormalities: aphasia, agnosia, apraxia, or a disturbance of executive functioning.

Memory functioning in the dementia diagnosis:

A dementia diagnosis will require testing of memory abilities. The memory function is usually divided into three different departments that can be easily evaluated during a mental status examination. These three departments of memory functioning include immediate recall (primary memory), recent memory (secondary) and remote memory (tertiary).

Immediate recall is characterized by a limited capacity to remember things that one has been exposed to recently. It is believed that the anatomic site of destruction of immediate memory is the reticular activating system resulting in an inability to register new information. Immediate or primary memory can be tested in several ways including asking an individual to remember three words in a row and asking the individual to repeat them in the same order. This inability to immediately register new information accounts in part for an individual’s confusion and the frustration an individual may feel when confronted with unexpected changes in their daily routine.

Some information from DSM-IV-TR Mental Disorders: Diagnosis, Etiology & Treatment by Michael B. First and Allan Tasman

Additional information and webpage By Paul Susic Ph.D. Licensed Psychologist

Alzheimer’s Brain: What are some of the degenerative changes?

Alzheimer’s brain: Changes do occur.

In the Alzheimer’s brain nerve cells stop functioning, lose connections with each other and ultimately die. The death of neurons in key parts of the Alzheimer’s brain causes those areas to shrink and results in substantial abnormalities in memory, thinking and behavior.

The Alzheimer’s early symptoms are derived from the destruction of neurons in particular parts of the Alzheimer’s brain controlling memory, especially the hippocampus (which is why the early signs of Alzheimer’s are related to memory impairment). As nerve cells in the hippocampus of the Alzheimer’s brain break down, short-term memory fails and the ability to do familiar tasks begin to decline as well.

The disease begins to attack the cerebral cortex which is responsible for some of the higher memory functions, such as language, reasoning, perception and judgment. Sometimes, unwarranted emotional outbursts (known as catastrophic reactions), and disturbing behaviors such as wandering and episodes of extreme agitation may appear after the early symptoms of Alzheimer’s appear.

Tangles and plaques in the Alzheimer’s brain:

Amyloid plaques and neurofibrillary tangles are some of the hallmarks of the changes that take place in the Alzheimer’s brain. Although, these changes may only be confirmed at autopsy, they are found in virtually every patient with Alzheimer’s disease. At the present time, it is not clear whether these abnormal deposits are the cause or byproduct of the disease process in the Alzheimer’s brain, although researchers have now come to understand how plaques and tangles are formed. The increasing knowledge in the area of Alzheimer’s disease has helped with new attempts to block the underlying disease process that may lead to their buildup. The eventual success of these strategies may ultimately provide the basis for prevention or treatment in the future, if these plaques and tangles are determined to be the cause of Alzheimer’s disease.

Amyloid plaques are known to develop in areas of the Alzheimer’s brain related to memory, and are believed to be a mixture of abnormal proteins and nerve cell fragments. They may develop from beta-amyloid, a protein that breaks off from a larger amyloid precursor protein. Beta-amyloid is formed when the amyloid precursor protein that is embedded in the cell membrane is broken down for disposal. Enzymes called secretases split the protein in two and form the beta-amyloid fragment in the Alzheimer’s brain.

Cleaving Enzymes?

Research into the Alzheimer’s brain has recently identified secretases as one of the “cleaving” enzymes. They are believed to cut amyloid precursor proteins in a place that cause beta-amyloid to become insoluble and form deposits in the brain of the Alzheimer’s patient. Investigators are now beginning to suspect that by blocking the activity of beta secretases you may prevent the production of undesirable forms of beta-amyloid. Current experiments are now underway to prove this hypothesis. It is still a mystery however of what happens to the beta-amyloid segment once it separates from the amyloid precursor protein, and why it may lead to these changes in the Alzheimer’s brain.
Neurofibrillary tangles are the other major pathological change characteristic of Alzheimer’s disease. These tangles are composed mostly of the protein tau, and are twisted, hair-like threads that remain after the collapse of the neuron’s internal support structure, which are referred to as microtubules. In healthy neurons, microtubules carry nutrients from one destination to another similar to railroad train tracks. Tau seems to serve as supporting “railroad ties”, but in the Alzheimer’s brain the protein becomes hopelessly twisted and disrupts the function of the microtubules. This defect is believed to clog communication within nerve cells, and eventually lead to cell death.

What is the deal with Pinl?

Alzheimer’s researchers are not sure why tau goes awry, but some of the more recent findings are beginning to state that Pin1 may play an important role in keeping the tau intact. When Pin1 binds to an altered tau in experiments, the protein begins to function as it should and microtubule assembly is restored. Also, researchers have began to find substantially lower levels of Pin1 in Alzheimer’s brains as contrasted to healthy subjects. While the significance of these findings is not certain, the presence of an enzyme such as Pin1 may help to maintain or restore the proper function of tau, and prevent the formation of neurofibrillary tangles. This possibility raises the hope that therapies might be developed in the future to keep tau functioning in the Alzheimer’s brain.

Neurotransmitters in the Alzheimer’s brain.

Another characteristic of the Alzheimer’s brain is a reduction in the level of certain neurotransmitters that are necessary for healthy brain functioning. Acetylcholine is produced in the brain by cholinergic neurons, which is a neurotransmitter that is believed to be crucial to memory and learning. These neurons are in abundance in the hippocampus and the cerebral cortex, which are two regions of the Alzheimer’s brain most ravaged by the disease. (As is true for the plaques and tangles, it is not known currently whether neuronal loss in these parts of the brain is a cause or an effect of Alzheimer’s disease.)

As the disease continues to progress in the Alzheimer’s brain, acetylcholine levels drop dramatically and dementia becomes more pronounced. The levels of serotonin, norepinephrine, somatostatin, and GABA, which are neurotransmitters involved in many aspects of brain functioning become diminished in at least half of the patients with Alzheimer’s disease. Such imbalances may lead to depression, aggression, insomnia and other mood and personality changes.

Some information from The Johns Hopkins Medical Guide to Health After 50

Additional information and webpage by Paul Susic Ph.D. Licensed Psychologist

Cause of Alzheimer’s Disease: What is it really?

Cause of Alzheimer’s disease overview:

The true cause of Alzheimer’s disease has still not been determined in spite of all the tremendous advances in understanding the disease process which has been developed over the past decade. It is believed by many experts that the cause of Alzheimer’s disease may be related to a single factor in many cases, while others state a variety of factors may interact in various ways to promote the disease. Being elderly is still the strongest risk factor in predicting Alzheimer’s disease, along with individuals with Downs Syndrome, a family history of dementia, and the presence of a specific form (e4) of the gene that develops into a certain protein called apolipoprotein E, or APOE.

Research into the cause of Alzheimer’s disease has focused on specific forms of the protein apolypoprotein E (APOE.), called APOE e4, which appears to play a role in the formation of amyloid plaques. Some experts into the cause of Alzheimer’s claim APOE e4 is linked with an increased risk of an earlier onset of Alzheimer’s disease. An individual with two copies of APOE e4 (which seems to be approximately 3% of the Caucasian population) may have a 50% chance of developing Alzheimer’s disease by the age of 80. However, just because you have an increased risk level, does not guarantee that you will later develop the illness. Also, the absence of APOE e4 in a blood sample cannot predict who will get Alzheimer’s disease. It is believed that a person can have APOE e4 and never get the disease.

Is the cause of Alzheimer’s disease related to gender?

While it is not believed that gender is a cause of Alzheimer’s disease, women are at a higher level of risk than men, along with several other illnesses such as the cardiovascular disorders, high blood pressure and heart attack, which are also possible risk factors in developing the disease. Other potential triggers that had been considered to possibly contribute to the cause of Alzheimer’s disease include immune system malfunctions, and endocrine (hormonal) disorders, slow-acting viruses and toxins.

What role does heredity play as a possible cause of Alzheimer’s disease?

While it is not considered to be the cause of Alzheimer’s disease, it is believed that heredity plays a significant role in its development. It is believed that a handful of Alzheimer’s disease patients (probably less than 3%) have a strong genetic predisposition to the disease. In some families, Alzheimer’s disease is carried as a dominant trait (which means that approximately half of the offspring will inherit the disorder) on one of three separate chromosomes (1, 14, and 21). Convoluting these findings however, is a recognition that in some families, genetic indicators are found both in Alzheimer’s disease patients and their families with no apparent symptoms. Therefore, environmental risk factors are believed to have a strong effect when combining environmental risk factors with an individual’s genetic makeup to either cause Alzheimer’s disease, or increase the chances that they may develop it. Also, the same causative factors seem to be recognized in the development of Alzheimer’s disease earlier in life. In a study of identical twins who share the exact same DNA, the age of onset of Alzheimer’s disease vary by as much as 15 years. In the future, we will probably need to study people of various different ethnic, racial, and social groups in order for scientists to discover the full range of additional risk factors. These findings could eventually provide new insights into the actual cause of Alzheimer’s disease or possibly what environmental factors may trigger underlying genetic predispositions.

Some information from The Johns Hopkins Medical Guide to Health After 50

Additional information and webpage by Paul Susic Ph.D. Licensed Psychologist

Caregiving for Alzheimer’s Patients: Is there a problem? By Paul Susic Ph.D. Licensed Psychologist

As found in the April, 2005 Senior Circuit

caregiving for alzheimer’s patientStress in various forms may be found among the caregivers of individuals with dementia. Many caregivers attempt to keep their loved ones at home for a significant period of time prior to placement in a long-term care facility. While this is admirable, it frequently also takes a toll on the person with the primary caregiving responsibility. Some studies have found that as many as 50% of caregivers of individuals with dementia may be clinically depressed and in need of treatment. High rates of caregiver burden (which is another term for the stress which is unique to the caregiving situation) are very common, with most caregivers being distressed by the disruptive memory and behavior problems that are typical to dementia patients (e.g. repetitive questioning, incontinence, night-time wandering) and frequently report needing help to cope with these daily challenges. Researchers have found that the combination of the physical demands of caregiving, plus the psychological distress involved, put caregivers at risk for developing their own significant health problems. For example, it is a well-known fact that caregivers are less likely to engage in preventative health behaviors (e.g. regular checkups), and some evidence an increased dysregulation of stress hormones (such as cortisol) and/or compromised immune system functioning, with either potentially leading to serious health problems over time. One major study found that stressed spousal caregivers were far more likely to die within a four year period of time when compared to non-stressed spousal caregivers or to those of non-caregivers, versus those of a similar age and socioeconomic level.

The most typical caregiver of a relative with Alzheimer’s disease or other forms of dementia (e.g. stroke related, or due to late-stage Parkinson’s disease) is a middle-aged woman caring for one or both of her parents (or in-laws). She is usually married, with teenage children and employed outside of the home. The next largest group of caregivers is the wives of the demented individuals, who are usually over 70 themselves.

How can I relieve the stress of this burden?

The first thing that you can do is to realize that you do not have to do it alone. You should first seek the help of family members, church members or other supportive individuals to help or to least to allow you to take a break on occasion. Also, pay particular attention to self-care including eating right, taking time for exercise, sleeping as well as possible and getting regular physical checkups. It is important to understand that the physical status of the long-term caregiver may need to be assessed periodically, since the combination of long-term stress and limited self-care usually takes its toll on the physical health of the individual involved.

As with most circumstances in life, education is always important. Education related to specific disorders can usually be found by searching your local library, in the Yellow Pages or on the Internet. Organizations such as the Alzheimer’s Association provide opportunities for education as well as support groups for individuals sharing these same experiences.

Traditionally, caregivers have been referred to support groups for treatment in spite of their high-level of distress, due to the fact that they do not generally see themselves as ”patients” or “clients” needing help; rather they focus their attention on obtaining help for their spouse or loved one. The Alzheimer’s Association provides the largest number self-help groups for demented caregivers, with chapters all over the United States. They frequently have psychoeducational components along with support groups. There are no fees involved and you usually do not have to sign up for a specific number of sessions. However, a recent study compared support groups with a more structured skill building psychoeducational program and found the latter to be significantly better for improving mood, enhancing coping strategies and developing an improved ability to obtain additional help with the caregiving responsibility. Other studies comparing structured programming with support groups found similar results in teaching caregivers a variety of skills to better handle their negative emotions, the disruptive behaviors of their loved ones and becoming more empowered to cope effectively with this chronic stressful situation.

At the very least, take care of yourself, learn as much as you can about the related disorder, get some help and respite whenever necessary, get proper medical and mental-health assistance, and finally, ultimately recognize your limitations when you can no longer handle your loved one at home.

Woman Mentally Sharp Even at 115 Years Old

A Dutch woman who died recently at the age of 115 years old had a mind as mentally sharp as a much younger person until the day that she died, according to a new study. The study found that she had almost no evidence of Alzheimer’s disease, and concluded that Alzheimer’s and other forms of dementia are not necessarily inevitable as some had suspected.

Gert Holstege, a neuroscientist at the University Medical Center Groningen, in the Netherlands and lead researcher stated  “Our observations suggest that, in contrast to general belief, the limits of human cognitive function may extend far beyond the range that is currently enjoyed by most individuals.” The results of the study were published in the August issue of the journal Neurobiology of Aging. 

No Signs of Dementia:

The Dutch woman made arrangements to donate her body to science after her death when she was 82 years old, and later contacted Holstege when she reached the age of 111, concerned that her body may be too old to be useful for teaching purposes or scientific investigation. She was reassured by the neuroscientists that contrary to her belief, they were very interested in her due to her age. Holstege and his associates wrote in the journal article, “She was very enthusiastic about her being important for science.” Psychological and neurological examination were performed when she was 112 and 113 years old, and the results were essentially normal, with no signs of dementia or other cognitive problems. Her actual mental performance was above average for adults aged 60 to 75 years old. 

Her body was then donated to science when she died at the age of 115 years old. Holstege and his associates found no signs of atherosclerosis (narrowing of the arteries) and very few other brain abnormalities. Interestingly enough, the amount of brain cells was similar to that of what usually is expected in healthy people between the age of 60 and 80 years old. 
There was little or no evidence of Alzheimer’s disease. Neuroscientists found almost no beta-amyloid deposits, which are characteristic of individuals with Alzheimer’s. There were also very few “neurofibrillary tangles” which could have caused a significant level of mental impairment.

One hundred years old isn’t what it used to be.
Currently in the United States, there are approximately 80,000 centenarians (100 years of age or older) according to the Census Bureau. This number is expected to rise to more than 580,000 centenarians by the year 2040. 

According to a recent study of a man who lived to the age of 114, it was found that a combination of lifestyle and genes may play a role in longevity, although the recipe for a long life is not clearly identified at this point in time. However, as the number of people living beyond the age of 100 is steadily on the increase, researchers now say that the deterioration of the brain is not an inevitable aspect of aging.
Adapted from LiveScience article 155-year-old Woman’s Brain in Tip-Top Shape posted June 9, 2008 
Additional Information and webpage by Paul Susic MA Licensed Psychologist Ph.D. Candidate