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October 1, 2013
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In the Caregiver's Words

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Not everyone has the genes to put them at risk for Alzheimer’s Disease. Not everyone has a lifestyle that could put them at risk for other forms of dementia or cognitive decline. But did you know that everyone’s diet…or more specifically, dietary deficiencies…can place them at risk for cognitive decline. This is one of those cases where the data are impressive. Scientists have been following over 100,000 men and women (in comparable numbers) since the late 1970s and early 1980s. In the 2010s they revisited these individuals a series of seven surveys of diet and health. Ironically, the foods that may be most delightful in the colors they add to a culinary presentation are also the ones that can most give a boost to everyone’s brain power. The scientists found that flavonoids, the part of the plants biochemical make up that offers the colors that “pop” in the produce section of the store, are aggressive protection against the forgetfulness or confusion that often are associated with advancing age. This was not one of those studies that show what happens when one group was given flavonoids and the other wasn’t – an experimental design – but the research had a large enough sample and followed these 100,000 people for a long enough time to offer a strong foundation for conclusions. In short, what we eat can affect our brain’s cognitive health, and other scientists were sufficiently impressed that the research was published in the journal Neurology. The specific elements that contributed to this “brain health” were part of what are termed flavonoids like the beta carotene in carrots or flavone in strawberries or anthocyanin in apples and other produce. The more flavonoids that people in the study consumed the less their cognition declined. (Flavonoids include flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, polymeric flavonoids, and proanthocyanidins.) The beneficial foods extended beyond strawberries and carrots to include bananas, oranges, grapefruit, celery and peppers…basically look for a brightly colored vegetable or fruit, and you have a cognitive reward. The positive impact of these foods included better short term memory or recall, ability to process and follow instructions, better engagement in group conversation, easier navigation of familiar places or just plain less forgetfulness or confusion. Pretty good reward for maintaining a healthy diet! The scientists go so far as to recommend starting the healthy diet as early as possible, because it is never too early to have a sharp brain. The downside? Well, the scientists found that some of our less favorite foods also are good for our brains: winter squash, raw spinach, onions and brussels sprouts. Perhaps this is a reminder that we should plan our meals with the less desirable vegetables to be followed by a healthy and tasty desserts with strawberries or apples or peaches? 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.
September is Alzheimer’s Awareness Month, and this is the third of four posts we’ll offer on the subject. I have been hoping to post with a subject line like “First Cure for Alzheimer’s Disease.” I would settle for “First Effective Treatment for Alzheimer’s Disease.” Sadly, neither of these seem even close to what we can expect anytime soon. But as I noted in an earlier post, there are nearly 3,000 clinical trials in progress on various tests, predictors or treatments of Alzheimer’s Disease. And 172 of these trials represent 143 therapies under investigation. Tests and biomarkers are almost as important as treatments. These studies will help to identify the condition earlier in patients as well as help scientists to better understand the disease progression. They can then more effectively investigate a cure or a way to at least slow the progression of this diagnosis that most people fear more than death itself.
Thus far, the only FDA-approved therapies have been very limited in slowing the progression of Alzheimer’s disease, and the most recent approved therapy has been so ineffective that Medicare will not even approve reimbursement for its use. Here is a brief overview of what have been the approved medical treatments for Alzheimer’s:
- Aduhelm (aducanumab) claims to reduce beta-amyloid plaques in the brains of Alzheimer's patients, but the final conclusions from the clinical trials have been contested.
- Aricept (donepezil) is able to claim that it can slow the cognitive progression of Alzheimer’s and modestly improve confusion, memory and awareness.
- Exelon (rivastigmine) claims to address the memory loss of both Parkinson’s and Alzheimer’s.
- Namenda (memantine) claims to treat the moderate to severe confusion of Alzheimer’s disease, but it is to be used in combination with one of the other agents.
- Namzaric (donepezil and memantine) combines an extended release form of Namenda as well as Aricept in one pill to address the symptoms each addresses individually.
- Razadyne (galantamine) claims to improve the ability to think and even remember by increasing brain levels of acetylcholine, a beneficial enzyme.
So far, these treatments have not been very effective or effective for very long. Most of them tend to focus on beta amyloid and tau tangles, and this whole concept has come under fire, of late. The contention is that early research setting this premise for treatment may have been based on doctored evidence. More to follow on that controversy at some point, but other controversies have created their own firestorms. With approximately 6 million people already diagnosed in America, you can imagine how much is being invested in finding an effective treatment. When there is good news, we will get it to you as soon as practicable. 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.
What do hearing aids, exercise, support groups and travel have in common? They all are ways that individuals suffering from Alzheimer’s Disease, specifically, or dementia, generally, can fight these diseases’ progression. Even more important, they help to fight the personal isolation that accompanies these frightening conditions.

We often associate dementias with older adults and the stereotypic confusion that can characterize the individuals with the diagnoses. But it is not just a condition of older adults as the recent public disclosure of The University of Tennessee women’s basketball coach, Pat Summit, highlights. Ms. Summit is just 59 as she goes public with her diagnosis, and it helps others to understand that it can happen as early as 30 and 40 years of age. Younger onset Alzheimer’s Disease technically speaking is the manifestation affecting those under age 65, and there are 250,000 new cases in America every year. Yet, there are ways to fight the downward spiral of dementia.
1. Hearing aids may seem an unlikely fix for dementia. Yet, it is simplybecause hearing aids enhance the clarity of communication and therefore the connection between dementia patients and others that they help alleviate the isolation and bolster memory. When dementia patients can hear more clearly, that connection also helps calm the anxiety that they may otherwise feel when living in a world that is confusing. Hearing aids cannot “cure” dementia, but they can help a patient navigate more confidently.
2. Exercise can be a helpful boost as well as it improves the blood flow and releases calming endorphin into the bloodstream. For a variety of medical conditions, health care providers often talk about the role that “performance status” plays in a patient’s ability to cope. Being more fit helps dementia patients cope just as being fit also helps cancer patients while they fight a tumor or surgical patients as they recover from a procedure.
3. I had mentioned the importance of being connected for a person with dementia of whatever sort. Support groups become the new circle of friends who can truly understand what it is like. This is common across a whole host of medical predicaments from grieving widows and family to returning wounded warriors or recovering cardiac or orthopaedic surgery patients. Somebody else who has been there understands what co-workers, friends or even family cannot quite fathom.
4. Travel is a bit of all these. It is a way to have fresh new experiences that challenge a patient cognitively. When a person experiences what should be familiar settings like home as frighteningly unfamiliar, it can be reassuring to share travel experiences to strange and different places that – well – everyone will find strange and different as well.
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.
Everyone who is a caregiver to an elder or other person with special needs has to be an advocate also. In my first blog posting, I spoke about what a geriatric care manager does on behalf of the elder or their families, and one of the principal duties is to advocate on behalf of our clients. In this posting, I offer a few of the ways that all caregivers can advocate on behalf of their loved one to assure the best healthcare and quality of life.

As an advocate for an elder, you need to be more than just the person who gets an older parent to and from a provider’s health care appointment. As long as the elder confirms that you can attend the appointment, you can be present, and you should use that opportunity to take notes and ask questions.
1. As an advocate, you will want to be as knowledgeable as
  
  possible about any medical issues that affect your loved one, and that includes
  
  asking questions of physicians and others as well as doing searches
  
  on-line. And be organized. Write your questions down before an
  
  appointment, and don’t be shy about asking them. If you don’t understand
  
  the answer, ask for clarification. It is the responsibility of a caregiver
  
  to be a “knowledge partner” in the health care of a loved one.
2. As an advocate, another important function you can provide is
  
  continuity of care. On an ongoing basis, attend all visits to the elder’s
  
  primary care physician as well as any specialists they may see. Ask
  
  questions when a health care provider observes something or makes an assessment
  
  that may conflict with what another physician has said or is at odds with what
  
  you have observed day to day. And this latter part is key. Because a
  
  caregiver or a geriatric care manager can be there day to day, they will see
  
  things that a health care provider may not observe at an annual or semi-annual
  
  visit. Speak up.
3. As an advocate, the records you keep may not be medical files like a health care provider’s office keeps, but as a caregiver you become the central depository of everyone’s information and inputs. Keep current on all prescriptions as well as over the counter drugs your loved one may be taking. And have that information – or a distillation of it – available when you meet with providers. And you may also have to be the one to discreetly let a provider know if your loved one is unable or has been unwilling to comply with prescriptions or other directions.
The common thread here for all of this advocacy is that a caregiver should not – and a geriatric care manager – will not keep quiet. Ask questions, provide information and be persistent if you feel you are not being heard.

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.
The older people with whom I speak often talk about the things they don’t do so well anymore, and the one that tends to top the list is sleep. While it is not just older adults who have trouble either getting to sleep or staying asleep, it can be a chronic issue. And one for which some of the medicinal therapies available may just not be good options. Why not a prescription sleep aid or perhaps one of the over the counter options like Benadryl – also known as diphenhydramine? Well, older adults tend to already have a number of prescription medications they take for any number of issues like elevated blood pressure or COPD or even neurologic conditions that just may not interact well with sedative drugs. The older metabolism does not process an added medication as easily as a younger metabolism, and a medication may simply be more potent to an older adult than a younger one because their bodies just have less fluid by volume for processing another medication. The American College of Physicians has a number of recommendations for getting their targeted seven to eight hours of sleep a night, and these can be guidelines for us all. They suggest: • The first seems to be a no-brainer, but they recommend you keep light and noise to a minimum and have a comfortable bed and pillow; • Keep the bedroom quiet and relaxing; watch television in another room, and in fact do your reading or have your conversations in another room as well; • Avoid having a clock where you can easily see the time, because it will just distract you from letting drift off; • If you do not fall asleep in about 25 minutes, just get up and go to another room; if you wake in the middle of the night, reflect back on relaxing thoughts like long walks; • Be active during the day, especially outdoor activity, but do not schedule your activity within two to three hours of bed time; • Limit caffeine to earlier in the day, and do not consume alcohol close to bedtime (it may make you drowsy, but it also will wake you when its effect wears off); • If you smoke, quit…the nicotine is a sleep inhibitor – never mind that the smoking itself is just plain unhealthy; and • Eat balanced meals, but again, not too close to bedtime. The ACP has a complete booklet you can download from their site, and it includes a personal diary for any of you or your older loved ones who do have trouble sleeping. They recommend maintaining the diary for the recommended week and bringing it along to the next visit with the physician. Charlotte Bishop is an Aging Life Care Advisor, 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.
Okay, so it has been five days since you received that box of chocolates from your sweetheart on Valentine’s Day. And if you did not consume truly massive quantities of chocolate all at once, how do you feel? The answer is you should feel the calm that comes from lower blood pressure. This, according to a group of physicians headed up by Dr. Dirk Taubert who did a clinical study on generally healthy people who had elevated blood pressure to find out what happens to their blood pressure if they eat dark chocolate over a period of time. Very simply, they found that it statistically significantly lowered the people’s blood pressure. I bring this up because as a geriatric care manager, a lot of the clients I see have blood pressure that is above what it should be. And I can tell them that the doctors say they should have a diet that regularly includes some amount of dark chocolate. People with dietary restrictions, however, need to check with their physicians.

This dietary recommendation does not take the place of the other recommendations we routinely get from medical professionals about fruits and vegetables and maintaining reasonable portions, but it does offer us a chance for a “healthy” dessert. And the science in their clinical study is pretty solid. Most other studies that have cited the beneficial effects of chocolate have done that based on simply observing some people over time, but Dr. Taubert and his colleagues actually set up a clinical trial with a placebo group and all the customary scientific controls.

This study was particularly relevant to me as geriatric care manager because all the study subjects were 56 to 73 years old. Half the group received 30 mg daily of polyphenol-rich dark chocolate, and the other half of the adults got no polyphenol in their chocolate. Polyphenol is the stuff in dark chocolate that is supposed to confer the benefit. Well, 18 weeks later, Dr. Taubert and colleagues found what a lot of people have been claiming all along. Without any changes in their body weights or their lipid or glucose levels, the group who got the good stuff in their chocolate had their incidence of hypertension decline from 86% to 68%.

To add to the credibility of Dr. Taubert’s research, it was published in 2007 in the Journal of the American Medical Association. You can click on Cocoa Intake and Blood Pressure to see the article. But seriously, don’t eat chocolate just to lower your blood pressure. Do like I do: eat chocolate and savor the flavor.

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…and Happy Belated Valentine’s Day.

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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