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A Forgotten Element of Exercise for Seniors – The Voice
In past postings I have talked a good deal about the importance of exercise for seniors who need care...
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September 19, 2013
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We have heard forever that carbohydrates are a major source of added (and unwanted) body fat, but dementia? So, when I came across this research, I thought to myself that well, there always is a New Year's resolution about dropping weight by decreasing sweets and grains, but if a person also can reduce the long term risk of dementia, why not get on board? Well, it turns out that a doctor named Perlmutter has been documenting a wide range of medical literature that shows a link between blood glucose levels and risk for dementia. It seems that as early as 2005, researchers were finding a link between blood glucose levels and brain atrophy and cognitive decline. I won't get into all the technicalities, but it seems to follow a path back to increased body inflammation and free radicals and "oxidative stress." Okay, I said I would not get into technicalities. But you see a lot of the familiar language on real problems on the loose in one's bloodstream. And this is not in the radical fringe of medical journals. As recently as last summer, researchers reporting in the New England Journal of Medicine showed that continuous elevated blood sugar levels as measured by HbA1C were associated with higher risks for dementia. Reading between the lines, diabetics whose long term sugar levels are not in good control are not just at risk for diabetic retinopathy and other vascular compromise, but their brain function also may suffer. All of that said, researchers do not show a direct causal relationship between elevated blood sugar levels and dementia. So, let's retrace some of the steps. Increased carb consumption does lead to elevated blood glucose levels. People with elevated blood sugar levels also have been shown to have elevated heart event risk as well as immune issues. And we encourage people to lower their carb intake to improve heart health and immune system health. The author of the most recent research also points out that there are no experimental trials that show using seat belts reduces casualties, yet we accept that we ought to buckle up. So, at the end of the day, you need to draw your own conclusions. And maybe unlike the seat belt analogy, we can say that we all should practice moderation in our carbohydrate consumption. And that is not something you would see driving safety advocates offering. "Use seat belts in moderation?" So here are some medical citations for those who want to see the research. For your brain's sake, read what you will and draw your own conclusions:
1. Enzinger C, Fazekas F, Matthews PM, et al. Risk factors for progression of brain atrophy in aging. Neurology. 2005;64:1704-1711.
2. Crane PK, Walker R, Hubbard RA, et al. Glucose levels and risk of dementia. N Engl J Med. 2013;369:540-548.
3. Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A. 2011;108:3017-3022.
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@creativecaremanagement.com.
September is Alzheimer’s Awareness Month, and this is the second of four posts we’ll offer on the subject. A fair number of folks have a right to be disappointed that we don’t yet have a cure for Alzheimer’s Disease (AD) or at least some way to effectively slow the disease. Right now, there are nearly three thousand clinical trials underway that are focused on preventing, slowing or curing Alzheimer’s Disease, but there has been no success yet. I’ll talk about that in a later post this month, but better and earlier diagnoses of this dreaded condition are worth a lot to the families that need to adapt to a loved one with Alzheimer’s Not that long ago, the only definitive way to diagnose Alzheimer’s disease was following the patient’s death when an autopsy could reveal the telltale signs of this scourge. One contribution that researchers have made is in helping families and loved ones of a potential Alzheimer’s patient to better and earlier sort out when Alzheimer’s may be showing itself. Mayo Clinic has published an extraordinarily long list of “tells” of AD that include:
- Difficulty in remembering, planning, concentrating and problem-solving;
- Confusion or problems in seeing tasks to their conclusion;
- Visual, spatial and navigational difficulties;
- Word-finding and judgment problems; or
- Changes in personality, social engagement or other behaviors.
These are not definitive, but medical professionals also have become far more adept at neuropsychiatric exams that can quantify the verbal and cognitive difficulties that can be the hallmarks of AD. And the technical ability to link this information with far more precise diagnostics using cerebrospinal fluid markers and imaging techniques applying MRIs, CT scanning and PET Scanning makes earlier and more accurate diagnoses possible. These diagnostic techniques also are important elements in clinical trials to demonstrate the efficacy of new therapies in development. To date, no one has been able to bring home the prize, a therapy that physically shows improvement both these biomarkers and actual cognition. We certainly have seen a therapy like Aduhelm fall down on cognitive testing when it seemingly was addressing the underlying physiology of Alzheimer’s dementia. But we are getting closer, and I’ll talk about some of those thousands of clinical trials and where we may see the first glimmers of real hope to make this scourge a chapter of history. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
Fetch! Come! Sit! Stay! Remember! So, I've given away that I’m a dog owner rather than a cat or other pet, but the commands here underscore findings from research reported at a recent meeting of the American Academy of Neurology. In short, the researchers from the University of Michigan reported that pet owners preserved their cognition better than non-pet owners in a six year study that followed 1,369 people who started with an average age of 65. Cognitive decline was slower for older adults who had pets. It has long been observed that pet ownership (some say that this is the other way around) is associated with lower rates of depression. The researchers here decided to delve into a potential relationship between pet ownership and cognitive decline in a large scale University of Michigan study called the Health and Retirement Study (HRS). Of the 1,369 people in this study, 53% owned pets and a majority of these were long term pet owners. People whose cognition was impaired at the outset of the study were excluded from the research. As the researchers followed both pet owners and non-owners, they found a statistically-significant advantage in the cognition measured among the owners. They also found that longer term owners had the edge over everyone else in cognitive retention. Those study subjects who were Black or college-educated or male had a more pronounced positive effect on cognition. While the researchers go on to say that this is not a cause and effect study, the findings favoring pet owners were statistically meaningful. Although the researchers stop short of advising all older adults to rush out and purchase a furry companion, they do point to additional positive effects of pet ownership. Other studies have demonstrated that pet ownership can mitigate loneliness and depressions. Still other research among military veterans not only improved the mental health of those with PTSD and worked to lessen depression as well. I would also add that the study found this positive effect on participants who were responsible for the care and maintenance of their pets. That is, just having a therapy animal show up regularly will not have the same cognitive benefit as hands on pet care and maintenance. Part of pet maintenance are the two or more daily walks for the pet and the owner if this is a dog. Let’s face it: the walks are good for more than cognition if both the furry friend and the owner put in the steps every day. Back to not using this study as a platform for advocating pet ownership. The authors did recommend that the data were sufficiently strong that they could strongly encourage that older adults with pets be supported in keeping their pets. Taking a pet from an older adult who may require alternative housing arrangements should not be considered without also considering how the pet and owner can be supported together. Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, 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. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
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This is the first in a series of posts on dementia in advance of the release of my new book, "How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia." It will be released in July through Family Solutions Press of Los Angeles and available from Amazon. We will keep you up to date on details. Count slowly from one to sixty-seven…one thousand one, one thousand two, one thousand three…by the time you reach one thousand sixty-seven, one more person in the United States will have been diagnosed with Alzheimer’s disease. In fact, one in three Americans ultimately will die with Alzheimer’s disease. And when we interviewed nearly three dozen Professional Care Managers in 2016 and 2017 dementia was the most common issue they dealt with among their clients– more than 66% of their cases. There have been new diagnostic breakthroughs and some pharmacological, nutritional and other ways that have proposed to help slow the progression of this disease, but the fact is that they have no substantial or durable effect. Alzheimer’s remains the only disease in the top ten causes of death in the United States that cannot be prevented, cured or slowed. Dementia is a category that includes about 100 specific cognitive conditions. Generally speaking, most dementias are diagnoses of exclusion. That is medical talk for the fact that one narrows down what a person is manifesting by successive steps of eliminating other possible explanations for a behavior. For instance, a medical work-up when dementia is suspected will include a review of all the medications a patient may be taking. Some medications have a pronounced effect on a person’s memory, noteworthy among them most of the sleep aids such as diphenhydramine, or Benadryl. Yet, this typically results in memory lapses that will recede if the medication is stopped. Doctors now also talk about “risk factors” for dementia that they place into three major categories. The first they tie to “body composition.” Simply put, what physicians have noted is that people with more fatty tissue, or a higher Body Mass Index (BMI), is associated with more amyloid deposits on the brain, a precursor of Alzheimer’s. The second set of risk factors center on “inflammatory processes.” Increased blood levels of sugar and cholesterol are associated with higher risk of dementia as well as heart disease…something of a double hit. Finally physicians also look at how well a person scores on “cognitive tests.” Dementia often is thought of as forgetfulness, but it really is the inability to process information and make a retrievable memory. They have cognitive tests that can measure that, one of which they call the Mini-Mental Test. A person’s cognitive health also is enhanced by creative pass times like playing a musical instrument, taking adult education or actively engaging in stress reduction. In my book, we cover what we know about dementia, what can be done to stave off the effects of dementia and most importantly what caregivers can do for their loved ones with dementia and for themselves. 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.

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A Forgotten Element of Exercise for Seniors – The Voice

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