September 2010

PTSD and Dementia. A study generated by the Veterans Administration has shown that individuals who have been diagnosed with posttraumatic stress disorder are twice as likely to develop dementia. The study, however, was primarily limited to males. Based on this finding there is a belief that PTSD might be associated with accelerated brain aging. It was not clear from the study whether appropriate treatment of PTSD can prevent this risk of dementia.

The modified Mini mental status examination. The mini mental status examination for years has been the most often used tool to aassess the severity of dementia. However, recently Dr. Rosia Hafiz has found that the mini mental status examination is dependent on patient education. One particular item on this examination was especially impacted. For example, he thought that it would be better to have a person recite the days of the week backwards then to subtract seven from 100 or spell the word "world" backward. Surprisingly, this examination has not been revised over the years. The suggestion that it may not be accurately diagnosing dementia is something worth studying.

Cataracts and antidepressants.Patients taking selective serotonin reuptake inhibitor antidepressants have a 15% higher risk of cataracts. The study, however, compared people who take this type of antidepressant to people who do not. While the study did not prove a causation between the two, there does seem to be some relationship. It should also be noted that some of the older tricyclic antidepressants were also linked to an increased risk of cataracts. The next time you go to your physician asking for an antidepressant make sure you discuss all the potential side effects.

August 2010

The Top 10 Safer Supplements

The last couple of months we've been talking about substances that you should avoid, even though you can easily obtain them over the counter or the Internet. We have also talked about their potential for severe side effects and even death.

This month we will talk about the substances that have potential benefit, but still need to be taken with caution and only after consultation with your physician. Any chemical that you ingest may affect you individually, particularly if you are taking other medications. Thus, it is essential that you consult your physician to make sure that even the safe supplements are safe for you. Here are the top 10.

Fish oil or Omega three fatty acids. This supplement appears to be effective in reducing triglyceride levels. Therefore, it should be effective for decreasing the risk of heart attacks, stroke or vascular disease. High doses however can increase the badcholesterol. It can also thin your blood and affect high blood pressure medications. Sometimes it can cause upset stomach and diarrhea. It is derived from cold water fish and can have an oily aftertaste.

Cranberry extract. Urologists have used this for years with the belief that it can prevent recurrent urinary tract infections. Large amounts however can cause upset stomachs and diarrhea. It may also affect anyone who is taking blood thinners.

Vitamin D. The supplement appears to be helpful in preventing osteoporosis. Therefore, it can decrease bone loss in people, particularly those taking steroids. Large amounts may cause headache, nausea and fatigue. Side effects are quite rare. It can also interact with certain medications such as birth control pills and heart medications.

St. John's wort is often used for depression. While effective, it can cause insomnia, anxiety, headache and dizziness. You can also develop a skin sensitivity if you are exposed to sun. This medication is highly interactive with a variety of other medications, so be sure to consult your physician.

Calcium. Calcium is effective in combination with vitamin D in treating bone loss and osteoporosis. It is also been reported to be effective in premenstrual syndrome. Common side effects are mild such as belching and gas. Calcium can decrease the effectiveness of certain drugs including thyroid medications and antibiotics.

Glucosamine sulfate. This supplement is particularly effective for reducing osteoarthritis of the knee. It may also help reduce osteoarthritis elsewhere. However, it can cause nausea, heartburn and diarrhea. People have also complained of headache whenon this medication. Glucosamine can affect other blood thinning agents.

Lactase is an enzyme that helps produce gastrointestinal problems inthose people who cannot tolerate dietary products. Thus far no side effects have been reported. There have also been no drug interactions reported.

Psyllium. This is a fiber preparation that can reduce constipation and softens stools. It can also help people who have mild to moderately high cholesterol. Since it works on the G.I. system it can also cause gas, pain, diarrhea and nausea. There are rare people who have serious or allergies to this, so consult your physician. It also has interactions with a variety of medications and can cause low blood sugar.

SAMe. The supplement has been reported to reduce depression, pain and the symptoms of osteoarthritis. It can cause G.I. upset, headache, sweats, dizziness and nervousness. This supplement also can have a bad effect for people who take medications for Parkinson's. It also can react with narcotic pain relievers. A common toxic reaction can be caused with people who take over-the-counter cough suppressant dextromethorphan can occur.

As you can see even these so-called safe supplements can have significant side effects, particularly if you are taking certain medications. To be truly safe you have to consult your physician and discuss the use of any of these supplements before you take them.

July 2010

Supplements You Should Avoid

Last month we talked about the many supplements on the market that are potentially dangerous. They can cause side effects that range from diarrhea to skin changes to cardiac arrhythmias and even death This month we will talk about the most dangerous of these supplements that are easily accessible over-the-counter or through the Internet. Some of these substances contain compounds that have been known for years to be dangerous.

Here are just a few supplements that you should avoid. Remember before taking any supplement or medication consult your physician.

Any supplement that has silver in it may be unsafe. These silver compounds are often touted to have healing powers for skin, fatigue and even AIDS. However they can cause blue skin, nerve problems and even death.

Aconite is another compound that is alleged to have healing properties for people who have arthritis. However, this chemical may cause nausea, vomiting, low blood pressure, cardiac arrhythmias and even death.

Chaparral is another supplement that is alleged to have healing properties inpeople who have colds or infection. It is even been publicized to have positive effects in people with cancer. However, it can cause severe liver damage and kidney problems.

Lobelia is another compound that is alleged to have benefits for folks who have chronic cough, asthma or bronchitis. Nevertheless, it can be quite toxic causing low blood pressure, coma and even death.

Germanium reportedly can help with infections, pain, liver problems, heart disease and even AIDS and cancer. However it has been known to cause kidney damage and death.

Country Mallow, which sounds so safe, is often used by individuals who have allergies, asthma and bronchitis. However it may cause heart attacks, arrhythmias, strokes and death.

Comfrey  has been alleged to help with cough, menstrual periods and cancer yet it may cause cancer and liver damage. The FDA has advised manufacturers to remove this from any of their products.

Coltsfoot has been reported to help with cough and sore throat and bronchitis. It also can cause liver damage and cancer.

These are just a few of the supplements that can be quite dangerous. There are supplements out on the market that can be effective and have only a limited amount of side effects. Even with these supplements you will need to consult your physician to make sure that you do not have any condition or are taking any medications that may be affected by the supplements. We will talk more about the good supplements next month.

June 2010

Dangerous Supplements

In these difficult financial times older folks are always trying to save a dollar. It is understandable that spending money on a doctor's visit and a prescription can be costly. That is one of the reasons why doctors are seeing an increase in over-the-counter supplements being used by older individuals.

We are being constantly bombarded by radio and television ads singing the praises of these supplements Many of these supplements are alleged to have healing properties. Since they are being sold over the counter we assume that they are effective and safe. However, it has been known that many of these compounds do not work and are quite unsafe. In fact, hospitals are now required to ask patients which supplements they may be taking in order to avoid any potential catastrophes

 Many of these supplements are alleged to have numerous healing properties, including helping conditions from joint disease to cancer. The truth is that many of these compounds just do not work and can be downright dangerous. The general public is often not aware that these supplements are not approved by the FDA. Many of the factories where these chemicals are produced have never been inspected. In fact there are more than 50,000 dietary supplements available and over 10% of them have been linked to safety concerns or problems with quality. More importantly, approximately only a third of these compounds have scientific evidence that supports their effectiveness or their safety. Some of these compounds contain chemicals that have been known for years to be harmful.

Before you take any supplement consult your doctor or pharmacist. Do not accept supplements from your friends or family members without discussing them with your physician. When you are taking a legitimate and approved product, use it as specified on the label. Do not assume that taking more is better. If you are having problems with any supplements ormedications that you are taking contact your doctor immediately. Remember every person has their own individual makeup. That means you can respond differently to medications and supplements. So before you take anything check with your physician

.
Next month we will outline the most dangerous supplements available.

May 2010.

Low Blood Sugar and Increased Dementia Risk .

Elderly people who have type II diabetes often have a difficult time controlling their blood sugar. It was recently found in a study conducted Dr. by Rachel Witmer PhD that older persons with diabetes have a 2.39% increase in the risk of dementia if they had an episode of hypoglycemia or low blood sugar. This was found after conducting an analysis of the Kaiser Permanente diabetes Registry. If you suffer with type II diabetes please consult with your physician to make sure that you control your blood sugar so that it neither becomes too high or too low.

A Nutritional Supplement That May Prevent Memory Difficulties.

DHA or Docosahexaenoic acid has been found by the Martek biosciences Corp. of Columbia Maryland to improve performance on a memory test in older individuals who have mild, age-related memory difficulties. It should be noted that this is only one study. It would be premature to recommend the general use of this nutritional supplement. We will try to keep you updated about this possibly significant finding in the months ahead.

Psychiatric drugs Increase the Risk of Falling.

Sedatives, benzodiazepines and antidepressants have been found over the last several years to increase the fall risk of older individuals. A recent study out of the University of British Columbia in Vancouver confirmed what has been known for quite some time. However, the most important finding in their study claimed that antipsychotic medications, which are often used in the elderly, did not significantly raise the risk of falling. Ithas long been thought that this antipsychotic drug class also increase the risk of falling. This finding will now bring some controversy as to whether antipsychotics are safe to use in the elderly at least related to this one risk factor. The bottom line is that any medication in the elderly can have significant side effects. If you are an older individual or someone who cares for an older individual, make sure that there is a clear reason to use any medication in the elderly.

April 2010.

Is their driving dangerous?

Here are three tips that can help you determine whether your older parent is no longer safe to drive. First check their car for any new damage. Dents, scrapes and dings could be a sign that they are unable to navigate their car safely. If you notice them, ask about them. Second, be observant. See if they lose their bearings or seem lost, even if someone else is driving. Finally, make up an excuse so that you will be the passenger while they drive. First-hand observation of their driving technique can be very revealing. Use the information you find from the above to begin the discussion about them giving up the keys. You'll find much more information on helping the dangerous older driver in my book, Elder Interventions.

Diagnosing Depression in the Elderly.

Appetite, energy and sleep are three areas that can signal depression. A decrease in appetite or weight loss without any medical cause is often related to depression. A decrease in energy level that cannot be explained by medical illness is another indicator of depression. A change in an older persons normal sleeping habits is often seen in the depressed individual. This can be difficulty falling asleep or staying asleep. At times depressed older individuals will sleep excessively. Remember, depression in older persons can be treated successfully. See your physician for more information. Additional signs of depression and the numerous treatments available for depression are outlined in my book, Elder Interventions.

Alcoholism and the Elderly.

The excessive use of alcohol in the elderly is a growing problem. Older persons can use alcohol as a way to decrease anxiety or lighten depression. Some just enjoy drinking. However, as one gets older the liver is less efficient in metabolizing alcohol, leading to higher blood levels. Thus it is easier for an older person to become intoxicated which carries numerous complications including falls and confusion. For more information on identifying the elder alcoholic and providing interventions, check out my book, Elder Interventions.

March 2010.

 Be safe rather than sorry.

People are often uncertain as to when they should get help for their parents who may be suffering emotional or cognitive problems. If you have any concern, err on the side of safety. Older persons should be evaluated fully if there is any change in their thinking or functioning. This is particularly important if the change is abrupt. Many of the causes for these disturbances can be treated effectively. More importantly, changes in behavior, thinking or functioning can sometimes be related to life-threatening conditions. So, please, have your loved one evaluated medically at the first sign of any such change.

Sense less  is senseless.

Literature has shown that the risk of dementia is much greater in patients who suffer hearing loss. Now there is a research study from the University of Michigan which found that older people who have vision problems, which ifleft untreated, have a much higher risk of developing dementia. This only seems logical. It has long been known that persons with dementia do poorly if one of their senses as impaired. It seems that the brain needs as much stimulation as possible to prevent its own deterioration. If you know an older individual who has some type of hearing or vision loss please see that they received prompt and effective treatment. See a physician for a proper evaluation and treatment. This will go a long way in reducing the risk of dementia.

Thanks for the memories.

Seeing a loved one lose their memories can be heartbreaking for family members. Here are a couple of tips to help older folks suffering from Alzheimer's retrieve some cherished memories. Play some music from their younger years. Often this will stimulate memories of a person suffering from general memory loss and generate poignant conversations regarding those memories. This is not surprising since the area of the brain that processes music is anatomically close to the memory area. Even people with severe memory loss will remember the lyrics of a song from decades ago when that song is played. Newer studies have shown that presenting an Alzheimer's patient with some artwork can also stimulate memories from the past. These interventions are easy to do and very rewarding for family members as well as the older individual.

February 2010.

 A study from the Albert Einstein College of Medicine finds that hypertension is linked to dementia in older women. It is not surprising that hypertension in both men and women can lead to a lack of blood flow in the brain which can cause dementia, particularly vascular dementia. Therefore, it is extremely important to work along with your physician to keep your blood pressure at normal levels.

Another study confirms what we have been telling older individuals for a number of years. Activities that stimulate the brain are beneficial for the prevention of dementia. However, an article from the Brandeis University notes that this does not work for everyone. It has been documented that those with a college degree do better in maintaining memory skills and are at less risk for dementia. A new finding shows that those with less schooling can compensate for their poor education by becoming involved in mental exercises such as word games, puzzles, reading and lectures. Individuals who engage in such activities had memory scores similar to people with more education. The bottom line is that mental exercises can protect against memory loss.



 January 2010

 Older women who take antidepressants have a higher risk of stroke and death when compared to those who don't. Specifically women using antidepressants had a 32% higher risk of death than nonusers. That same group had a 45% higher risk of suffering a stroke. Unfortunately the study could not clearly delineate how much of this was due to the medication and how much was due to the depression itself.

 Perhaps a safer treatment comes out of a study from the Tohoku University graduate school in Japan. They found that the group of people who drank four or more cups of green tea per day had a 44% less chance of suffering a depression. There were no reported side effects from the drinking of this tea. If you suffer from clinical depression discuss this as well as all treatment options with your physician.

December 2009

A study out of the Columbia University Medical Center of New York found that both the Mediterranean diet and higher levels of physical activities reduce the risk of developing Alzheimer's disease. They defined increased activity to be 1.3 hours of vigorous activity per week, 2.4 hours of moderate activity per week or four hours of light physical activity per week. It has long been known that the Mediterranean diet reduces the risk of cardiovascular disease. For a long time we have known that exercise and good nutrition can prevent a variety of illnesses.
This is just another example.

A study out of Duke University reported that people exposed to pesticides have a 70% increased risk of developing Alzheimer's disease. The study did not take into account duration or extent of exposure. In addition it did not prove a link between pesticides and dementia. However as any reasonable person would expect exposure to pesticides should be eliminated for a variety of health reasons.

November 2009

How can you prevent Alzheimer's disease, particularly if one of your parents has this illness. Researchers from the VU University medical Center in Amsterdam report that the gene for high blood pressure and the gene for an inflammatory markers have been strongly linked with the development of Alzheimer's. Therefore, if these individuals find that they have high blood pressure they should get treatment for their hypertension because it might help them from developing Alzheimer's disease. It was also pointed out that if middle-aged persons with a parent who has Alzheimer's take a nonsteroidal anti-inflammatory drug to counter the inflammatory changes in their bodies, this also may prevent Alzheimer's disease. Actually there has been a long-standing belief that the use of these anti-inflammatory medications can reduce Alzheimer's disease. This has not been definitively proven but I have known a number of physicians who take these medications just in case this proves to be true.

Research at the University notes that people who have been exposed to pesticides may have a 70% greater chance of developing dementia in later years. The study did not take into account the amount of exposure and does not necessarily prove a link but it does suggest that more study is necessary. It is safe to say that all individuals should avoid any exposure to pesticides for a number of reasons including this one.

October 2009

Humor and laughter to be quite healthy.  There are numerous scientific studies that show that humor and laughter can produce physical changes that lead to better health.  For example, laughter can reduce pain in patients by the release of internal opioids called endorphins.  Persons who are in good spirits can usually handle pain better.  Conversely, depressed patients have a hard time dealing with their pain. 

Laughter has been shown to lower blood pressure, reduce stress hormones, and increase muscle relaxation.  Laughter is especially useful in children in order to help them deal with their fears and nightmares.  There are a number of preliminary studies that suggest the laughter may decrease heart disease, migraines, allergies, ulcers and infections.  There is even a study that shows immune cells that fight cancer can be enhanced by laughter. 

So in order to benefit from humor and laughter watch funny shows or movies, especially before bedtime.  Falling asleep in a good mood can help make your personality more positive.  You can also share funny stories or jokes with other people. Read lighthearted books.  Try to be around upbeat or funny people.  And don't be afraid to laugh at yourself. 

Try the above tips over and over again until you develop that good sense of humor.  If it doesn't work, you might be depressed.  At that point, you should talk to someone or get professional help.

September 2009

Helping an Older Person Give up Their Car Keys

 Giving up the privilege of driving is one of the hardest decisions an older person must make.  The goal is to have the older person voluntarily give up his or her keys before an accident happens.  The key to achieving this goal is to have early regular conversations with the older individual long before there are any serious driving problems.  Ask them at what point would they give up their driving.  Keep the discussion general and nonthreatening.  In fact, weave this discussion about driving into your normal everyday conversation with your loved one.

 Make sure they understand that you want their health and safety to come first. You can never say too often that you are having this discussion because you care about them. 

 Politely educate the older driver about the warning signs that could cause safety problems.  You can find a list of warning signs if you go to Maryland MVA.com.  Organizations such as AARP and AAA have programs that can test the older persons driving skills.  There are links on their websites to these programs.

It is important to talk about the positive alternatives to driving.  Public transportation or driving with friends and relatives can save a great deal of money.  No longer do they have to pay for gas, taxes or insurance.  They can also make some money by selling their car.  Parking problems will no longer be an issue.  Most importantly, they will decrease anxiety of all who are concerned about them and increase the safety of those around them.

 In summary, start these discussions early and in a nonthreatening manner.  Assure them often that you care about their health and safety.  Discuss the warning signs of risky driving.  Talk about the positive alternatives to driving.  For more details, check out the section on dangerous driving in my book, Elder Interventions.  It will give you more tips, especially concerning the older individual who absolutely refuses to give up their keys in spite of their hazardous driving.

Summer 2009. 

Chronic pain is fairly common in those 65 years and older.  Up to 50% of the elderly population and up to 80% of those in nursing homes have problem with pain issues.  Complicating matters even worse is the fact that a number of elderly people have problems with communication because of illnesses such as strokes, dementia and delirium.  These people have a difficult time telling health care providers about their pain.  Hospitals now routinely have scales that rate the pain for their patients.  This helps physicians and nurses recognize pain that requires proper treatment with medication. In many cases of chronic pain depression plays a significant role.  People who are depressed often feel higher degrees of pain.  Not surprisingly antidepressants are often used in conjunction with pain medications to relieve suffering. Do not hesitate to discuss this with your family doctor. For those who have tried working with their physician and are still unable to obtain relief, there are pain clinics affiliated with most major hospitals that can help with complicated pain disorders. 

In another pain related topic, the American Geriatric Society recommends that acetaminophen be considered for the initial and ongoing treatment of persistent pain, particularly musculoskeletal pain.  In addition it now recommends that NSAIDS and Cox 2selective inhibitors be used with extreme caution and only in highly selected individuals.  These two drug categories are often associated with gastrointestinal problems and an increased death rate.  The American Geriatrics Society guideline also recommends that opioid therapy be considered for patients with moderate to severe pain, particularly pain that causes functional impairment or a diminished quality of life.  However, using these drugs requires clinicians to frequently assess patients for the level of pain as well as the side effects.  If you are suffering from such pain please consult with your physician and stay well-informed.  Be sure to discuss any change in your status after taking these medications.

Very important.

  A recent study conducted by Dr. Angelo Volandes, an internal medicine physician with the Massachusetts General Hospital and the Harvard University medical school, involved showing elderly individuals who were considering advanced care planning a videotape of late stage Alzheimer's patients.  Those individuals who viewed the videotape were less likely to choose life-prolonging care than those individuals who just heard a verbal description of advanced Alzheimer's.  While individuals should be fully informed before making such important decisions, there is a troubling aspect about this type of study.  It appears to infer that people should see the worst-case scenario when making such decisions.  Would it not be better for patients considering advanced directives to see a variety of common late life scenarios?  Are there not elderly demented people who appear to be happy, carefree and still social even in late stages of their illness?  Are there not other positive late life scenarios that should be considered in these decisions?  As I stated above I believe that elderly individuals should be fully informed of all aspects of their later years, both positive as well as negative.  Elderly individuals should demand full information before making such decisions so that they would not be swayed by information that may be consciously or unconsciously biased. 

Opinion.  There is no doubt that we are involved in one of the most hotly debated issues of our time, healthcare reform.  I had the good fortune over the years to be involved with a number of the major entities dealing with this issue, entities that have been dealing with healthcare from a variety of different perspectives.  Older folks have made their voices heard.  They have paid into the system for many years and deserve to have the quality health care that they have earned.  Over the next several months I will be commenting upon certain aspects of this healthcare reform process.  I hope to clarify some of the issues as well as advocate for our older generation.  I welcome your comments and hope to stimulate a productive and accurate dialogue.

May 2009

In the past I have talked about how depression sometimes mimics Alzheimer's disease.  On the other hand patients with clearly documented Alzheimer's disease often suffer a secondary depression.  This depression can actually make the dementiaworse.  For example, it can cause decreased concentration and increased indecisiveness during a depressive episode.  Therefore, it makes sense that treating Alzheimer's patients who have depression may actually improve their dementia and consequently their quality of life. 

In a study from Rotterdam, Dr. Haag and his colleagues found that statins that are used to decrease cholesterol may decrease the risk of Alzheimer's disease.  This is one of a number of studies that have shown such a positive finding, however, there are other studies of cholesterol reducing drugs that are not so promising. This is another area where we just have to stay tuned.

  Here are some updated facts from the Alzheimer's Association.  Medicare pays out three times as much for individuals with brain diseases, averaging $15,000 per year compared with about $5,000 with no dementia.  The Association reports that 5.3 million Americans are currently living with Alzheimer's disease currently. 

April 2009

Researchers at the Columbia University medical center found that physical exercise strengthens a part of the brain involved with aging.  Recently they have identified a reason for age-related memory decline.  Elevations in blood glucose levels target a part of the brain, the hippocampus, implicated in aging. High blood sugar levels seems to affect this area of the brain.   It is believed that exercise helps the body better handle blood sugar levels.  

Over the last few years it has been found that antipsychotic medications, which are often used to decrease behavior problems, in elderly demented patients come with an increased risk of cardiovascular problems.  There are still very few studies that have come up with safer alternative medications to help with aggressive behavior.  Recently, however, there have been some preliminary findings that some of the anti-dementia drugs and antidepressants may decrease the agitation and aggressive behavior in elderly individuals with dementia.  Hopefully, this is an area that will receive more intensive investigation so that medications can be found to improve the quality of life in these brain impaired individuals. 

Sometimes elderly individuals use alcohol to treat anxiety and depression.  Unfortunately, just the opposite effect may happen.  Alcohol often increases anxiety and depression in the elderly.  Family members as well as professionals should be alert for alcohol use in elderly, particularly in those who suffer from anxiety and depression.  If that combination occurs, a comprehensive assessment by a physician should be arranged.  Screening should be performed as part of any routine mental and physical health exam.

  March 2009

Dr. Mark Rappaport, assistant professor in the Department of Psychiatry at the University of Toronto conducted a study which found that older drivers who were taking antipsychotic, benzodiazepines or antidepressants were at a significantly greater risk of a motor vehicle collision.  It was estimated that about 50% more accidents occur with older patients taking these medications.  The study was reported in a letter to the editor in the October 2008 issue of the Journal of American Geriatrics Society.  If you are taking these medications, please talk to your physician about the potential risks.

A comprehensive study published in the December 24/31  2008 Journal of the American Medical Association reported that nearly 1 in 25 older adults are at risk for a major drug interaction.  This is based on the fact that many elderly people combine over-the-counter medications along with their prescribed medications.  The bottom line is that the more medication one takes the more likely a serious side effect can occur.  Make sure your doctor knows all of the medications that you are taking, including over-the-counter medications and even herbal medications.  Doctors want to make sure that the medications you take are needed and are the safest possible.

Confusion in an older person can be caused by a fairly common medical disorder called hypothyroidism.  Sometimes it is very difficult to distinguish from Alzheimer's disease.  Patients with this presentation can have memory problems, paranoia and even agitation.  Before someone makes a diagnosis of Alzheimer's disease it is important to get a simple blood test to determine the thyroid function.

Speaking of the thyroid, elderly persons can also have depression with a low thyroid level.  This is sometimes called subclinical hypothyroidism.  The individual typically feels tired, depressed and unmotivated.  In more severe cases they could have memory loss and cognitive problems, again looking like Alzheimer's disease.  A simple blood test and proper treatment usually reverses the symptoms.

February 2009

It seems like every other month there is another study either stating that statin drugs, which lower cholesterol, either prevent Alzheimer's disease or do nothing with respect to the disease.  Given how these medications work, one thing seems to make sense.  Lowering cholesterol helps keep the arteries clear so that they can do their job of delivering blood into various parts of the body.  Blockages in these arteries are less likely to occur.  Therefore, there should be less of a chance for a stroke, a blockage of blood in the brain, which can cause a syndrome similar to Alzheimer's called vascular dementia.  This type of dementia usually occurs in a step-like fashion.  That means, instead of the slow but steady deterioration of Alzheimer's, in vascular dementia the individual's cognitive abilities typically decrease abruptly and usually in repeated acute episodes.  Between episodes there is not much deterioration.  Whether it is Alzheimer's, heart problems, or vascular dementia prevention is still the goal.  Talk to your physician about whether statin drugs make sense for you. 

There have been a number of large psychiatric studies over the last few years that question whether medications such as antipsychotic medications are useful in the elderly.  Many medications, including psychiatric medications, have side effects than that can be very serious in the elderly individual.  If an older individual has behavior or emotional problems, nonmedication interventions such as behavioral therapy, education, family therapy etc. should always be considered.  However, if the situation is particularly serious or the nonmedication interventions fail, medications can be helpful.  But here is the bottom line.  Older individuals need to be monitored regularly when they are on any kind of medication.  Make sure your physician schedules routine follow-up visits to monitor not only the positive but also potential negative effects of medications.  These additional visits will go a long way to ensure that you are taking the right medication. 

Do not be afraid to talk to your doctor.  It is true that doctors are busy and often hurried.  There are many good doctors out there who will take the time to listen.  Remember, you are just as important as any other patient.  If you feel your doctor is not taking the appropriate amount of time to hear your story, talk to him or her about it.  Don't ignore your problem.  Even a busy doctor can work something out, such as a longer appointment the next time or another appointment the next day.  The old saying, a squeaky wheel gets the grease, applies here.  Politely ask to be heard.

January 2009

According to Dutch scientist, Monique Breteler M.D. statin drugs that help lower cholesterol may be able to protect against Alzheimer's disease early in the process, particularly persons who have not shown any cognitive impairment.  This protective effect was observed regardless of the dosage or duration of use.  You should talk to your physician about the use of these medications. 

Elderly persons are often quite sensitive to a variety of medications.  If a physician prescribes antipsychotic medications for an older relative in order to manage their behavior, ask that they frequently review the use of this medication in order to limit any side effects, some of which may be serious.  In addition, they should examine the patient regularly to determine whether the patient still requires these medications. 

In the spirit of the new year, talk with your elderly loved ones about the goals that they have set for themselves.  Goals or resolutions should be realistic, achievable and meaningful.  No matter the age, older folks typically want to contribute.  Make it your resolution to help them with these goals.

*December 2008

A moderate amount of physical activity improved cognition in people 50 years or older who had mild memory impairment.  A study from the University of Melbourne suggested that people who were physically active are less likely than sedentary people to develop dementia in later life.

Praying significantly improves quality of life in nursing home residents with dementia and agitation according to a study of 28 nursing home residents by Lena G.  Smith Ph.D. from the University of New Mexico.  Just saying five minutes of prayer for five out of seven days a week was all that was needed for an improvement according to a number of measurements.

From the Duke University.  According to Dr. Donald Schmechel the experimental drug AL-108 works on tangles in the brain that are a diagnostic hallmark of Alzheimer's disease.  So far the drug has been safe and well tolerated.  The trials of the higher dose of this drug showed a trend toward better performance than either the low dose or placebo groups.  Significant differences appeared in individual measures of memory.  There was a 12% improvement over baseline.

 November 2008.

  The Johns Hopkins Bloomberg School of Public Health estimates that persons suffering from Alzheimer's will quadruple by the year 2050. Currently it is estimated that 26 million people are suffering from this disease.  This epidemic will impact enormously and perhaps overwhelm the healthcare system.  Severe Alzheimer's patients require structured living settings such as nursing homes or hospitals. It is imperative that research centers focus on treatments that could either cure, delay the onset or slow the progression of the disease.  We can only hope that the same passion for finding a cure for AIDS will prevail here.

Keeping fit may reduce brain deterioration in the early stages of Alzheimer's disease according to Dr. Jeffrey Burns.  His study suggests that exercising and keeping fit may reduce the risk for severe Alzheimer's disease.  Consult your physician for a proper exercise program.  Dr. Marge Coalman also produced a study that confirmed that exercise offers hope to people with dementia so that they can improve their condition.  Routine exercise in the elderly can make a huge difference. 

According to Krister Hakansson people who were married in mid to late life are less likely to develop Alzheimer's disease. Individuals who remain single face up to an eight fold increased risk of Alzheimer's disease.  It was felt that this is probably related to mental stimulation of living as a couple.  So staying together for better or for worse may mean that the better wins out. 

Hormone therapy may preserve cognitive functioning in memory and postmenopausal woman according to Mary Tierney.  While these studies are still in their early phases more research needs to be done regarding this potential treatment intervention. 

Continuous use of anti-dementia drugs is associated with decreased risk of death in Alzheimer's patients.  Individuals who took the medications for more than 70% of the time since being diagnosed with dementia lived an average three years longer than those who took them for shorter durations.  This, according to Dr. Susan Rountree, suggests that these drugs work better not only in helping cognition but also for survival.

  Heavy drinking and smoking are associated with an earlier age of onset about timers disease according to Dr. Roanjan Duara of the Mount Sinai medical center in Miami Beach.  Individuals were involved in heavy smoking and drinking tended to develop dementia six or seven earlier than those who did not.  Here we have another reason for stopping the nicotine habit and drinking in moderation. 

It is commonly known that when people do not sleep well they have a difficult time functioning the next day.  A recent study by a Alyssa Gamaldo indicated that difficulty falling asleep was associated with poor cognitive testing in 174 elderly individuals. This means that older individuals who do not sleep well have a difficult time thinking.  If you have sleep problems, consult your physician.  You may be losing more than just sleep.