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October 4, 2012
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We do a lot of postings on dementia, in no small part because adults rank it as their number one concern, just above running out of money or dying. I have again asked our Vice President, Steve Steiber, Ph.D., to talk to us about what we may not know - but should know - about the evolving science around Alzheimer’s disease and treatment options. Steve has over twenty years of experience as a consultant to the pharmaceutical and biologic industry prior to joining us at Creative Care Management. He reports in this post on what may be a "light at the end of the tunnel we call Alzheimer's disease. What is the first thing you learn when you are admitted to a hospital, and this can be for outpatient or inpatient procedures? ONE SIZE DOES NOT FIT ALL! That applies to Alzheimer’s disease as well. There has been no blockbuster fix for Alzheimer’s, to date, but on closer examination of how people with different genes or with different make-ups respond, scientists are finding they react differently to medications. We already have seen this in cancer treatment, and it is a broad and promising side of medical care called genomics…sometimes called pharmacogenomics when referring to medicines and nutrigenomics for foods or supplements. When physicians look to a person’s specific genes, they can find people who may respond a lot better than someone without those genes. They call it “personalized medicine,” and it is showing some real promise. Let's start with a clinical failure that may actually be something else altogether: tramiprosate (an antiaggregation of amyloid agent). Earlier this year results from a phase 3 clinical trial (this is the final phase for a drug to be up for possible approval by FDA) for tramiprosate showed no appreciable improvement, on average, for Alzheimer’s subjects in the trial versus those on placebo. I said, “On average.” When scientists later looked more closely at the genetic makeup of patients in the trial, they found that those patients with two copies of the APOE4-gene had markedly better results than those with only one or no copies of this gene. Scientists are reassessing how these patients and those with the APOE3 gene respond, especially since these latter are at greater risk for developing Alzheimer’s disease. Worth a second look, for sure. I also mentioned nutraceuticals. In a European study some time ago, there seemed to be some promise for vitamin D as a protective agent against Alzheimer’s. As scientists looked specifically at the patients with two copies of the APOE4 gene and taking vitamin D, they found those patients had better memory scores than those on placebo or without the gene. Vitamin D in the absence of the two gene copies did not seem to do as well. Scientists are also looking more closely at omega-3, what we sometimes refer to as fish oil (it is only in the fish oil, because that is where it is stored after fish eat the algae that contain the omega-3). And there are multiple types of omega-3, two of which are particularly “brain-healthy.” Scientists have a couple challenges here. One, the brain’s absorption of the healthy omega-3 takes a few years, and there also is a difference in the genes I mentioned above. This may take longer to get good evidence, but it also is promising. There also is research into limiting environmental risk for developing Alzheimer’s that is linked to both the APOE4 gene and the presence of pesticides like DDT and its metabolic cousin, DDE. While DDT has been banned in America for some time, its metabolite, DDE, is still around. Preliminary research suggests that it is not just the DDE or just the APOE4 gene, but the presence of both that is associated with higher incidence of Alzheimer’s. While these early findings will not tell you what to ask your physician about diet or medications, it is a cautionary note for all who live in or near agricultural regions. The lesson learned again is that we likely have just begun to tap the genotypic profiles that may lend themselves to less versus more risk or less versus more success. The oncology field has begun to get better and better results in their fights across a number of cancer types by paying attention to genes that can predispose individuals to either greater risks or to better outcomes. It just may be that Alzheimer’s disease can follow the same model. Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com
As a geriatric care manager, we have knowledge of Alzheimer’s Disease and its progression, less about its causes and its treatment, but we cannot know Alzheimer’s like a patient with the condition can. I recently was introduced to the writings of an “expert” who has gained his insights by being an Alzheimer’s patient since he was first diagnosed with dementia which has been presumed to be Alzheimer’s at age 58. Now 65 years old, Richard Taylor, Ph.D., a psychologist, has written a book titled Alzheimer’s from the Inside Out, and he issues a monthly newsletter on the subject. The following is an excerpt from his most recent newsletter. For those who are caregivers or family members of a patient with Alzheimer’s, this may offer some sense of living with the condition from the patient’s point of view:

“I am Richard, an individual living with the symptoms of dementia, probably (maybe) of the Alzheimer's type. This is my monthly newsletter for February, the month of my birth (Chicago, Illinois/Jackson Park Hospital 4:30 PM), at least that is what my Mom told me. This really isn't a newsletter; it's more like a report of what's happened to me in the past 30 or so days. It is sort of like my book, Alzheimer's From the Inside Out, except this newsletter is free and without charge (at least for now). It will soon be published in five languages - the newsletter that is. Through it, I have made and maintained friends with kindred spirits all over the world.

We all share more than a failing memory and slipping cognitive skills. We all want to know as much about what we "have" as possible. We all want to understand the research that is going on. We all to a greater or less degree are hoping for a cure - whatever the hell that means to each of us- within our lifetime, affordable to our families, with side effects that are significantly less than the symptoms of dementia with which we now live, and oh, by the way, could it reverse at least some of the more intrusive symptoms of this or that form of dementia.

I have spent a lot of time this month thinking and writing about this. I am not a researcher; I am not a physician or a pharmacist. I am just, Richard, a tall guy with a beard who is living with the more and more intrusive and more insoluble symptoms of dementia with which I have to cope if I want to live a purpose full, joy filled, love filled, and complete life. Most times this is much harder than I want it to be. It's not fair, it's not right, it just is. So I most times try to cheerfully embrace today, live in it as fully as I can by myself, and live in it more fully as a result of the enabling support of my family and those who love/like me.

Welcome to my inner and outer world more and more defined by dementia, probably (maybe) of the Alzheimer's type.”

Richard

Please check out Dr. Taylor’s newsletter and more about his book on his web site Richard Taylor PhD

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.

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I have a small pillow in my living room that speaks to me. In stitched letters it says, "What? Chocolate is not a food group?" My family knows that one of my favorite "food groups" is chocolate, and I don't mean because I am on a health kick looking for the benefits of dark chocolate; I just like good, old-fashioned milk chocolate. But let me tell you that when I have a chocolate craving, my body may really asking me for something more than my brown, sweet treat.

There is a growing body of literature that explains many of our cravings as our body's signals for what it really wants; we just don't speak the language. We fail to translate the cravings in quite the way our bodies are trying to communicate. This has real implications if you have an older loved one for who you are a caregiver. As one ages the taste buds become less sensitive, and appetite wanes. And if you are taking your older loved one's interest in foods or cravings too literally as you listen, you may think you are satisfying their body's nutritional needs when, in fact you are not. Let me start with my own craving.
1. Chocolate. If your elder expresses a craving for chocolate, they may really be translating their body's need for magnesium, a very important electrolyte in the human body. While chocolate can offer some magnesium there are better sources. Chocolate is okay - thank goodness - but your body will benefit from a variety of magnesium sources such as certain vegetables, nuts and seeds. So if your elder has a regular craving for chocolate, try offering legumes, nuts and seeds to avoid the sugar and fats that accompany the magnesium in commercially-available chocolate.
2. Potato Chips. I see this in our household where a certain family member would prefer a bag of potato chips rather than a handful or two. So much for portion control. Potato chip craving may actually be an expression of an iron deficiency. This kind of deficiency triggers a craving for crunchy foods, and potato chips -while crunchy - come up short. Iron-rich alternatives include dark meats, fish, poultry and darker green vegetables. And this overlooks the huge intake of sodium that potato chips offer and nobody needs.
3. All of the Above. This is where the psychology gets interesting. Let's say your older loved one can still smell the peanuts that you just had, but they had been disciplined and translated their craving into having a portion of raw carrots. But a half hour later, they still can all but smell the peanuts and they cave in and subsequently gorge on the peanuts. They should actually feed some of their craving when it expresses itself, but in moderation. That still leaves room for the healthy foods they will eat later and moderates the caloric intake that has become such a national epidemic.
At the end of the day, it is about balance and understanding what our bodies are telling themselves. If you are that caregiver to an older loved one, don't become the food police, but perhaps there can be a role for a food translator to help them understand their own bodies' language when cravings make their voices heard.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@cr eativecaremanagement.com.
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Perhaps you’re thinking about ways to make caregiving easier in the next coming year. You may have read tips and advice about caregiving and creating care plans, especially if you follow this blog, but don’t know exactly what care managers do on a task by task basis. An elderly care plan should encompass all facets of a senior’s life. In days of old, care plans merely addressed pressing health concerns. Today, caregivers design care plans that include health, lifestyle and social dimensions, improving their residents’ quality of life across the board.

As a care manager, one of the goals I try to instill through CCM is providing assistance within the context of a senior resident’s accustomed environment. If the resident lives in a nursing home or care facility, the care plans should allow for home-like routines. A reliable Chicago senior care provider must also encourage healthy lifestyles that fit the resident’s beliefs and personal preferences.

Before actually preparing a care plan, we first observe the senior resident’s daily routine. We try to find out if there are tasks the resident prefers to avoid, e.g., picking up clutter, cooking a meal or bathing, and why the person avoids them. We also might prepare an ADL (activities of daily living) questionnaire for the senior and loved ones to fill out. The resident’s daily needs, lifestyle choices, hobbies and interests will be explored as well. In addition, we’ll about activities the resident would like to pursue, but currently cannot, because of a constraining physical or mental condition.

Once we have all the pertinent data from observation and needs assessment, we’ll go over these findings with the senior resident. They decide whether certain devices would be of help, especially in the performance of ADLs. Identified care needs, however, should be administered in such a way as to preserve the dignity of the resident and promote his independence as much as possible. Appropriate ways to encourage the patient to engage in a hobby and interact with others are considered too.

When the assessment is completed, they start identifying together short and long-term goals for the resident to work toward. Goals are written by both the care manager and the senior, and should have the patient's strengths and needs in mind. Throughout the entire process of goal setting, the senior gets the ultimate vote over specific objectives he or she deems worth striving for. After all, a geriatric care plan helps ensure that an aging individual continues to enjoy life. This is why it is so important to find reliable Chicago senior services only from established managers. Creative Care Management also makes sure to link seniors and their families with the appropriate local resources in Chicago for care providers and other needs.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.

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Senior Care in Action: 18 Tips for Preventing Indoor Falls

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