DSA Blog on Dementia and Brain Health: May 2016

Saturday, May 28, 2016

What Causes Dementia?

We don't know exactly. What actually causes dementia is a difficult question. There are an infinite number of factors that singly or in combination may increase risk for, or are associated with having dementia. To add to the mind-boggling complexity, each of us are the outcome of a unique collection of genes, lifestyle behaviors and environmental exposures.

Similar to the word “cancer” the word “dementia” is an umbrella term that includes many kinds of dementia. And again, similar to cancer, the dementias share certain characteristics such as memory loss, but also have ones specific to a particular type of dementia. For example, Alzheimer disease tends to have a slow progression and vascular dementia tends to progress with bursts of increased disability.

In the case of early-onset Alzheimer disease, the answer might be less complicated than it is for other kinds of dementia. Scientists have identified genes that appear to cause the kind of dementia that strikes people younger than 65-years of age. People who have early-onset dementia genes can pass the trait on to their children. However, even these findings open the door to more questions. Do the early-onset genes actually cause the disease or do they increase risk to the extent that makes having early-onset dementia a given. Perhaps the relationship between genetics and this form of dementia involves other genes and factors, that in combination, cause early-onset dementia.

Genetics may or may not play a role in the onset of other kinds of dementia. For example, approximately 15 to 40 percent of people who have frontotemporal lobe degeneration have a family history that includes at least one other relative who also has or had this kind of dementia. However, only 10 percent of these individuals have a form of the disease attributable to specific genes. This means that for 90 percent of cases, scientists have yet to discover genes that increase risk for having Frontotemporal lobe dementia.

Although one cannot change their genetics, it is possible to reduce risk for dementia by modifying certain lifestyle behaviors.

There are many lifestyle behaviors that appear to increase risk for dementia. Some of these include obesity, high blood pressure, smoking, diabetes, and lack of regular exercise. Social isolation, not having meaningful friendships, also appears to increase risk for dementia. Another risk factor is not having the mental stimulation that comes with acquiring new skills and knowledge.

The good news is one can choose to reduce the likelihood of dementia by losing weight, eating a healthy diet, refrain from or stop smoking, exercising, as well as by attending community center activities or taking classes at a local college or university.

Unlike behavioral changes, it’s difficult to impossible to avoid environmental risk factors. While one can make efforts to avoid environmental toxins such as second-hand smoke, it’s not possible to avoid to the fumes that come from car exhaust or from certain kinds of building materials.

Over the past 50 years, there has been a dramatic change in the 10 leading causes for death. Deaths caused by acute infectious diseases and accidents have given way to lingering diseases such as cancer and dementia – both of which tend to occur later-in-life. Therefore, for many people, advanced age is their biggest risk factor for having dementia.

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice, please consult your doctor. www.DementiaSociety.org

Money Does Matters

For many families, finances and the cost of dementia care can be one of their greatest worries. Families hope there are sufficient assets to meet the expenses for the next four to 10 years. According to a Care.com Usage and Attitude Family Caregiver survey, in 2014, over 50 percent of families spent more $5,000 per year to cover out-of-pocket expenses. The same survey reveals that seven percent of survey respondents report having spent more than $50,000 per year to cover the costs of their loved-one’s care.

Talking about personal finances is often difficult. To make these initial family discussions go as smoothly as possible, invite an elder-care lawyer, a financial advisor, or a geriatric care manager to guide discussion and offer their expertise. The goals of this and ensuing conversations are to define needs and expenses, and based on this information, develop a realistic financial plan.

Dementia care is more than house utilities and groceries. Home expenses also include rent or mortgage payments, house maintenance, home and car insurance, as well as assorted federal, state and local taxes. Dementia care also involves the out-of-pocket deductibles and co-pays associated with the diagnostic procedures and treatments for dementia and any other medical conditions your loved-one may have. Do not overlook the expenses of such things as personal care supplies, equipment rental and purchases, adult day care and assisted living fees.

Sadly, circumstances may be one where your loved-one has neither the sufficient savings nor income to pay for the services he or she needs.

What happens then? Sometimes families are able and willing to pay the difference--and sometimes not. Long-term care insurance is expensive, must be purchased well before need, and is not long-term in the sense of “forever care.” Often families must resort to state and federally-funded programs.

Medicare, parts A, B, and D and most private insurance policies pay only for expenses not related to having dementia. However, your loved-one may be eligible for dementia coverage under one of several Medicare Special Needs Plans or “SNPs.”

There are other avenues worth exploring – all of which have specific eligibility requirements. Some of these are: Medicaid, a program that helps very low income people get the healthcare they need and the Program of All-Inclusive Care for the Elderly (PACE) that provides comprehensive medical services to Medicare and Medicaid enrollees.

The United Stated Veterans Administration (VA) offers a broad range of services to help veterans who have dementia. To take advantage of the various VA programs and services, the veteran must be enrolled in the VA healthcare system. While the veteran does not have to have a service-related injury to receive dementia benefits, the veteran must have an honorable or a general discharge.

Other strategies to supplement your loved-one’s income include a Home Equity Conversion Mortgage (reverse mortgage), the conversion of certain kinds of life insurance into long-term care insurance, as well as borrowing against the value of a life insurance policy. Disability insurance is another resource when dementia makes employment no longer possible.

Community not-for-profit organizations offer many helpful services that can range from household repairs and yard maintenance to elder daycare programs and caregiver respite grants. Sliding scale fees are another not-for-profits feature. Therefore, your loved-one will have to meet eligibility criteria, to receive a reduced rate.

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

Understanding Behaviors and Emotions

Some people find the loved-one in their care almost seems like a stranger - perhaps morphing from a kind and helpful person to a combative and vulgar one. Other times, dementia seems to magnify personality traits. When this happens people often say, it’s my father only “more so.”

Though difficult, do try to remember it is the disease and not the person who is responsible for these worrisome, and sometimes embarrassing, changes to his or her temperament.

Dementia alters and destroys brain structures. The consequences of the damage include loses in the ability to accurately process and relay information. Another outcome is the inability to control emotions such as anger and censor impolite and socially inappropriate behaviors. Because of the progressive nature of dementia behavioral changes tend to worsen with time.

Emotional blunting, or the inability to express verbal and non-verbal feelings, is another characteristic of having dementia. The inability to express needs and feelings can make people who have dementia angry, combative, and sometimes violent. Many people who have dementia experience depression.

Dementia can also affect sexual behaviors in ways that are often unpredictable. Some people who have dementia cannot understand that it is impolite to touch or expose their private areas in public or make unwanted or inappropriate sexual advances.

There are many simple ways to reduce the incidents and intensity of these difficult-to-manage behaviors. However, first consider other reasons for your loved-one’s difficult behaviors. Drug interactions and side effects may intensify dementia symptoms, cause hallucinations, as well as intensify agitation and combativeness. Others explanations for uncharacteristic behaviors and emotions can include pain, fatigue, over stimulation, as well as other medical problems such as a bladder infection.

There are many strategies you can use to prevent or diffuse your loved-one’s outbursts. Perhaps the most important one is communication. Do not argue with your loved-one, remind them of what they have forgotten, or ask probing questions to assess their memory. Use supportive language to affirm you are listening, respecting his or her concerns, and responding in an appropriate manner. For example, it is better to respond to fearful, but unlikely true incident is to say, “I’ll look into it” rather than “don’t be silly.” Sometimes all it takes to is a calming hug or a kind and supportive touch.

Distraction and redirection is another useful way to diffuse anger or sexually aggressive behaviors. Give your loved-one a snack, go for a walk, point-out a pretty flower or talk about the weather.

Sometimes your loved-one’s behavior is more than you can handle. When this happens, calling the Crisis Intervention Team, rather than 911, may be the best option. The Crisis Intervention Team, (CIT), refers to the police officers in your community who have special training in how to manage a variety of behavioral, drug-related, and mental health crises.

Having the CIT there to help with unmanageable or threatening behavior can prevent a difficult situation from escalating to something worse. The CIT can also accompany you and your loved-one to the medical facility. Be sure to include the phone number of your local CIT in your list of emergency phone numbers.

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

What is Neuroplasticity?

Put simply, neuroplasticity is the brain’s ability to change and grow throughout time, dependent on its environment. The brain is a sensory driven organism. This means that it thrives and survives and functions based on the input it receives. The brain essentially is a relay station, the information coming in influences the information going out.
So we want to make sure our brain is wired in the best way possible.

There is a brilliant quote from neuroscientist Santiago Ramon y Cajal that said, “Any man can, if he so desires, become the sculptor of his own brain.”

Cajal said that at the turn of the last century when most everything we knew about the brain came from head to toe physical examination. In fact, Cajal was one of the first people to really study brain cells under a microscope. The conventional wisdom at that time was that your brain was hardwired and what you had at birth was how your brain would be the rest of your life.

In recent years we have learned that the brain is capable of change. Neuroplasticity is the key concept for everything we talk about in regards to brain training.

The picnic game exercise is just one of many examples. The game is played with two or more people. It starts out by the first person saying something like “I’m going on a picnic and I’m bringing an apple,” or something that starts with the letter A. The second person says they’re going on a picnic and they’re going to bring an apple and something else that starts with the letter B.

The game continues on with each person reciting the items in the list and then adding an item that starts with the next letter of the alphabet. When you expand it out through the alphabet and you get to the letter Z it can actually be rather complicated.

There are two points to this game – improvement in working memory and short term memory, which are very well connected. Short term memory is where you hold onto a piece of information for a brief period of time. If that information is worth committing to long term memory, it will be based on repetition or importance. Repetition is somewhat obvious where you do something over and over again until it becomes learned (e.g. playing a guitar).

Importance is related to something happening that has significant impact. For example, if someone was hit by a car in a hit and run accident and they got the license plate number as the car drove off.
The picnic game exercises primarily working memory and secondarily, short term memory. Working memory helps you hold onto small amounts of information while you are attending to something else, and is often the first aspect of memory impaired in certain types of dementia.

Contributor Author: Dr. Michael Trayford is a Board Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For more information, please visit www.ApexBrainCenters.com/memory.

Get Moving

The phrase “Get moving” can mean something different for each of us. For some people it means getting up, walking on the treadmill, going for a bike ride or walking the dog. Unfortunately, for other people it means getting up, going to the bathroom and going back to the couch. So there is certainly a need to put this concept in perspective.

When it comes to proper brain function, movement is absolutely critical. Think about somebody you know that isn’t very mobile. They might be sedentary because they are bed ridden, have mobility issues or it might just be that they are plain lazy. Do their brains work as well as someone who is active, getting out and about all the time?

The bottom line is that movement is essential for appropriate brain function.

Chances are that you’ve heard the term “If you don’t use it, you lose it.”

The brain essentially is a relay station for sensory information. When we don’t have appropriate sensory information going into the brain from our muscles, joints, balance system and more, it starts to wear away and degenerate more rapidly than it should. In time it can cause the brain not to perform to its highest potential as you could imagine.

The brain is stimulated by nerve fibers from several different sources. This includes senses like vision and hearing, as well as other sources. The nerve fibers that carry information from muscles and joints are by far the largest nerve fibers that supply the brain with the greatest amount of information. If you are inactive, you are cutting out your greatest amount of input to the brain.

This will in turn reduce the efficiency of the output from the brain. This can manifest itself as physical problems, mental and emotional problems, cognitive and thinking problems, and memory decline.

To stimulate the brain, you don’t need particularly intense activity. You can start out small. It might be going to the gym, taking a walk in the woods or on your streets. Just so long as you’re getting out there and getting moving.

Developing the habit of regular activity starts you building a foundation to explore other exercises and more intense activities that can have an even more significant positive impact on brain health.

Eat Your Breakfast

Eat your breakfast is one of those things we’ve all been told by our parents and even our grandparents. Of course, there is something to be said for the value of putting calories into your body each morning and the positive impact it has for the brain.

Unfortunately, what happens all too often is that people get caught up in their lives and sometimes give in to the temptation to skip breakfast. For some people it’s usually just a factor of being too busy. People are rushing out the door to get to work on time, drop off the kids or running late for an appointment.

There’s another segment of people that consciously choose to skip breakfast because they think it will help them lose weight. Their intuition tells them that skipping breakfast will give them a slimmer body shape, but, in fact, it’s actually working against them.

Several different things happen when you eat breakfast in the morning. One of the primary benefits is that it gets your metabolism started. It also sets the tone for the day.

Your brain needs a constant and steady source of fuel. It cannot store sugar, its primary source of fuel.

If you are going from say 8 o’clock at night until noon the next day without eating anything then the brain is without adequate fuel for most of that time. When this happens, the brain makes the inference that there isn’t adequate food available. When the brain goes into a state of crisis it starts to act to preserve its most valuable source of energy, which is fat.

The brain goes into a catabolic response, where it starts to break down protein structures and muscle mass in the body. Unfortunately, this is a very expensive process, which requires a lot of energy just to break down and use the protein. Not to mention, the accelerated loss of valuable muscle mass that tends to decline as we age anyhow.
The end result is that your body stores fat while making you feel more sluggish. Most people, especially men will deposit fat around the midsection and the neck.

The bottom line is that it doesn’t take much to wake up five minutes earlier to grab something quick for breakfast. When you’re first developing the habit of eating breakfast, it doesn’t have to be a big meal. Getting your metabolism started and providing energy for the brain doesn’t require a lot of fuel.

Even something simple like eating a piece of fruit or a hard-boiled egg while you’re going out the door is better than nothing at all.

Friday, May 20, 2016

Dementia is Not a Specific Disease

Many people are under the impression that Alzheimer Disease (AD) and dementia are different conditions. In fact, AD is a type of dementia. In addition to AD, dementia also includes types such as vascular dementia, frontotemporal dementia, and dementia with Lewy bodies.

Many people, particularly those who are very old, have mixed dementia or dementia that is caused by more than one kind of brain disease.

AD is currently considered the most common kind of dementia. Researchers estimate that as many as 5.5 million people living in the United States have this type of dementia.*

Although scientists have found various genetic and environmental factors that may increase the likelihood of having AD, age is the most important risk factor.

In the United States, about 1 out of every 20 men and women between the ages of 65 and 74 have AD.* The frequency for this disease nearly doubles every five years beyond age 65. Researchers believe that nearly half of all people older than 85 may be in various stages of the disease.

Vascular dementia, accounting for 12 to 20 percent of all dementias, is the second most common age-related dementia.* Unlike the gradual progression of AD, the onset of vascular dementia symptoms are often abrupt and may occur when a heart attack or a stroke dramatically reduces blood flow to or through the brain.

Vascular dementia can also have a slow progression. This happens when the accumulative damage of transient ischemic attacks - often called TIAs - cause many small areas of brain damage and, eventually, noticeable symptoms. The descriptive name “multi-infarct dementia” is the term healthcare providers use to describe this kind of vascular dementia. Multi-infarct dementia is the most common type of vascular dementia.

Each type of dementia has specific signs and symptoms. For example, memory loss, confusion, and difficulty in performing what was once familiar and easy tasks are early symptoms of AD. In contrast, the early symptoms of frontotemporal lobe degeneration (FTD) are poor coordination, tremors, and difficulty in using and understanding written and spoken the language. Memory loss is another aspect of FTD but occurs much later in the course of the disease. Ultimately, however, memory loss is a symptom that all forms of dementia have in common.

Examples of other types of dementia include dementia resulting from Traumatic Brain Injury (TBD); Wernicke-Korsakoff Syndrome (WKS); Normal Pressure Hydrocephalus (NPH); Chronic Traumatic Encephalopathy (CTE); Creutzfeldt-Jakob Disease (CJD), and others.

Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice, please consult your doctor. www.DementiaSociety.org

*https://www.alz.org/facts/downloads/facts_figures_2015.pdf (accessed May 5, 2016)

Make No Assumptions

At one time or another, everyone forgets where they left the car keys, blanks-out on a word or name, or cannot remember why they went to the kitchen. Is our forgetfulness simply the result preoccupation, a “senior moment,” or is it something much worse?

It’s easy to leap to conclusions. It’s considerably more difficult to take the next step and talk to your family, a close friend, a religious or spiritual advisor, or your doctor about your deepest and darkest worries.

Your family and friends will probably say something non-committal and suggest that you make an appointment to see your doctor. A religious or spiritual advisor will probably have some comforting words and encourage you to speak with your doctor. Your doctor will recommend that you undergo a complete medical exam.

Your medical history comprises the first portion of your exam. Your doctor will ask if you smoke, drink, or have ever had a head injury or a concussion. He or she will want a list of the medications you take and the daily dosage. Your doctor will want to know your surgical history--dates, type and if you experienced complications.

The doctor will also give you a check-list of various diseases and conditions that you or a close relative may have or have had. Some of these include: diabetes, psychiatric disorders, high blood pressure, migraine headaches, thyroid disease, epilepsy, strokes or heart disease. In other words – come to your appointment prepared with a list of the important information that most people do not remember in sufficient detail.

Next, your doctor will listen to your heart and lungs and then begin the usual prods and pokes. One aspect of your physical exam may be different from the ones you have experienced before. Because you are concerned about memory difficulties, your doctor may administer a series of simple tests to evaluate: your cognitive functions--the ability to think, learn, and remember as well as your executive functions--the ability to plan, organize, strategize, and pay attention to detail. Together the medical history and the physical exam provide the clues your doctor needs to take the most appropriate next steps.

Based on the results of your complete medical exam, your doctor may say “everything looks good.” However, don’t jump to conclusions if your doctor suggests that you undergo further tests. Just try to remember that ruling out Alzheimer Disease or any other of the dozen or so kinds of commonly encountered dementia is difficult. Yes, “it’s easier said than done.”

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

It's Not Bad Luck

Believing it may bring bad luck, many people resist getting their legal and financial affairs in order for as long as possible. However, it’s not having taken care of these matters that will bring bad luck to you and your immediate family. And, as with all complicated family transactions, communication is the key to success (hopefully) without stress.

The power of attorney (POA) is a legal document where you designate a person - family member, friend, or another individual such as a lawyer, the right to act in your behalf. As is true for many legal procedures, the details vary from state to state. However, granting a POA to a designated individual involves a lawyer, a witness, and a notary.

While your doctor appreciates hearing your concerns, he cannot respond to comments or discuss a loved-one’s condition without having a copy of the health POA on file. This document assures the doctor, as well as other healthcare providers, that the named individual has the authorization to receive confidential information and to make medical decisions on your behalf.

A second POA document gives a designated person permission to sign checks, deposit or withdraw money from your bank accounts, or interact with businesses on your behalf. Similar to the medical POA, the banks and businesses must have a copy of the POA on file before there can be an exchange of information or documents. It is best to designate the same person on both POA documents.

Only people who are demonstrably competent to make well-founded decisions may sign POA papers. If this is not the case, a family member, may feel it is necessary to file a request with the courts to become your guardian and conservator – a lengthy, expensive, and emotionally exhausting process. People who have early-stage dementia usually have the capacity to make decisions and therefore are capable to sign power of attorney papers.

With regard to personal finances, it is important to develop a comprehensive plan that both conforms to applicable state and federal regulations as well as parallels the stipulations of your POA documents. The comprehensive plan makes it possible for a family, or another designated person, to manage your finances in the case of infirmity. Upon death, your designee has immediate access to your accounts and thereby makes it possible for him to pay bills as well as to meet other expenses.

A similar plan should be applied to the management of any stocks, bonds, and certificates of deposit you may have. Trusts and annuities are other areas for exploration as are life and long-term care insurance policies.

Most people do not have the time, inclination, or the skills to develop a comprehensive plan to protect their savings and other assets

You can accomplish some of these tasks, such as opening joint bank and checking accounts with the help of a bank associate. However, it’s imperative that you confer with the professionals who specialize in developing an individualized, comprehensive, and long term plan to create income should you become infirm as well as to supplement your social security or disability benefits. Other facets of your individualized financial plan include strategies to protect your assets, and eventually, your estate. Some of the professionals you may need to see include an estate lawyer, an accountant, a financial advisor, and an insurance underwriter.

Yes, it is true. Neglecting to care of these legal and financial matters long before needed guarantees a future of insurmountable difficulties for you and your loved-ones.

Source: Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

Don't Let Them Get to You

Modern life is filled with everyday nuisances that we all have to deal with. It might be someone cutting you off on the road, rude people in a store, or whatever the case may be. These nuisances that plague us on a daily basis, have the ability to influence our stress level.

This could manifest itself in many different ways; it could be anger it could be anxiety, fear, or worry.

When it comes to stress, we’re adding elevations of certain hormones in our body that cause our body to work a certain way. Somebody cuts you off on the road, our blood pressure goes up, breathing changes and your emotions can change very rapidly.

There are all these consequences and cascade of events that occur simply because somebody decided they wanted to get in front of you on a line or on the road. Some people can let that go pretty easily, but most people tend to get caught up in it.

Of course, letting go of some of these things is easier said than done. It takes practice. There are countless stressors you can encounter on a daily basis that can get to you; be it a rude cashier, somebody cutting you off on the road or a boss that’s yelling at you. Any one of these things can increase your stress level, which can affect a wide range of systems in the body, especially those related to brain health.

Activities like meditation, exercise and other forms of stress management can help you deal with the feeling of stress, fear and worry that has gotten too far out of hand due to these accumulated stressors. This is especially helpful for anger that has gotten too far out of hand. Neurofeedback is another great tool that can help people become aware of their stress reactions and to help them gain control over them.

There are many different tools and techniques to manage this immediate stress reaction. It takes practice and the first step is awareness. Simply being aware of your reactions to potentially stressful situations is enough to get you started on finding the method that works best for you.

Get Out in the Sun

Effective brain training requires a holistic approach that includes cognitive, physical, metabolic, and lifestyle factors that are related to brain health.

Getting out in the sun has several factors that are important for brain health and brain function. Many people are aware that there is a relationship between sun exposure and vitamin D.

There are five types of D vitamins. Each of them has a different role in the body. When your skin is exposed to sunlight, it produces a bioactive or readily available form of Vitamin D known as cholecalciferol.

Vitamin D doesn’t act like other vitamins. Some people say it shouldn’t be considered a vitamin because it acts as a pre-hormone. Vitamin D is used to synthesize many of the hormones that circulate through our bodies. If we don’t have adequate stores of vitamin D, we can’t form cholesterol appropriately, as well as other types of hormones that help the body and brain work efficiently.

It’s important to note, there are people in certain cultures that can’t absorb vitamin D very well, or can’t convert vitamin D into the appropriate source. There are also individuals that need to take vitamin D supplements.

There are also challenges for people that have had gallbladder removed. The gallbladder stores surplus bile created by the liver. One of the things this does is to help the body to digest fats. Vitamin D is a fat-soluble vitamin.

It’s critical to understand that if you’re having problems with vitamin D levels that there are things you can do about it. They are very easily measured. There are many different ways for you to get around that and it’s worthy of discussion with your health care provider as well as a healthcare provider that specializes in functional medicine. There are several different options such as pills, sublingual under the tongue, and topical forms of vitamin D supplements.

If you don’t have a medical condition influencing your vitamin D levels, then the best way to get the bioactive stores of vitamin D is to get out into the sun.

Now for those people that are living in climates that don’t get a lot of sun. However, it doesn’t take a long time 10, 15, or 20 minutes in direct sunlight can really help to boost vitamin D levels better than any pill ever could.

Be ever mindful of over exposure; always get an annual all-over skin exam by a dermatologist, and don’t forget the sunscreen!

Contributor Author: Dr. Michael Trayford is a Board Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For more information, please visit www.ApexBrainCenters.com/memory.

Perimeter Shopping

Perimeter shopping is a concept that more and more people are becoming aware of. During some of my lectures, I will ask people if they’ve heard of it. At first, I didn’t see a lot of acknowledgement, but now I see hands go up all over the place!

As the name implies, perimeter shopping is about going into the supermarket and you focus on buying foods from the outside aisles and cases.

The outside aisles of a grocery store are filled with fresh produce, meats and dairy. Almost all grocery stores are set up this way because it allows it allows convenient access to refrigeration and it allows the grocery store employees to restock fresh goods quickly.

These products like meat, milk, fruits and vegetables, haven’t been changed much from their source. So we call them whole foods. The term perimeter shopping is defining where whole foods are most likely to be found at the supermarket. There are implications of some things not necessarily being as healthy as they could be, but by and large whole foods are nutrient dense.

Access to whole foods and how they are included in your lifestyle can vary depending on where you live. People living in inner cities or in small rural communities tend to have a small selection of whole foods to choose from. In some areas, access to fresh produce might be limited by the season, or how often the produce is rotated, based on decreased demand. People that grew up in these areas often have more processed foods in their diet.

What makes this concept really important is that your brain is driven by energy. The brain essentially runs on sugar and oxygen. Sugar comes from the foods that we eat.

Processed foods, which tend to be found on the interior of the supermarket, are made either by breaking down whole foods, or ingredients extracted from whole foods. Most of these products incorporate chemical processes or chemical preservatives to extend their shelf life. As a result, processed foods tend to have less nutrient density and lower quality sugars. These are foods that you usually find in a box, can or a bag.

The further something is from the original source, or its original form, the harder it is for our body to break down and our brain to get adequate fuel from that food.

The whole foods found at the perimeter of the supermarket are the most efficient, readily available sources of fuel for our brains. If we intend to train our brain with any degree of success, we need to make sure that we have the proper gas in the tank.

Contributor Author: Dr. Michael Trayford is a Board Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. For more information, please visit www.ApexBrainCenters.com/memory.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice, please consult your doctor. www.DementiaSociety.org

Saturday, May 14, 2016

Having the Conversation

The doctor told me that, “Dementia is the cause for the changes we have all noticed.”

These are sobering words are ones that elicit conversation between loved-ones. The location could be an office where a counselor facilitates productive discussion. Or perhaps the best place is an informal one where coffee and cake creates an atmosphere of comfort and connectedness.

It’s hard to know where to begin. Some find it easiest let the conversation gradually drift from the weather to the emotional and practical aspects of dementia. Others prefer having the help of counselor to guide productive exchange.

People in the early stages of dementia may be the one who initiates discussion. He or she may start by addressing their fears of what they face as well as their distress of becoming a burden. He or she may have words to say about choosing the person who they hope will oversee their care as well as express the desire that dementia does not create ill-will between family members.

His or her thoughts about end-of-life care are another important topic. Here listening maybe more important than discussion. Listen to what he or she has to say about advance directives, comfort (palliative) care and hospice--the last stage of palliative care.

Conversation among-loved-ones will undoubtedly include more immediate wishes such as enjoying time together, taking bucket-list adventures, and the challenge of the “things I have always wanted to do” list. This is the time to create memories.

Sometimes families and same-sex couple and their families do not have the luxury of beginning conversation with a diagnosis of early-stage dementia. When this is the case, your loved-one may still have the capability to listen and perhaps make comments. Be sure to acknowledge his or her presence and, as much as is possible, engage them in the discussion.

Speaking with and among loved-ones is an ongoing process. Events occur that require reassessment. Family dynamics may have deteriorated and should be addressed before they worsen. It may be time to talk about the conflicts between personal views about death and dying and your loved-one’s advance directives. Or perhaps reassessment involves orchestrating a family gathering or a final adventure.

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

Knowledge is Power

To some people the phrase “knowledge is power” means learning the facts and talking to experts. Other people may feel the phrase describes mindfulness and self-determination.

For the individuals and families for whom dementia has entered their life, both interpretations are important. Learning about such things as the different types of dementia, ways to slow progression and to overcome challenges, as well as navigating the spectrum of legal issues and quality-of-life wishes creates a sense of empowerment. This approach enables good decision-making as well as makes it easier to converse with physicians and other healthcare professionals.

Internet research is a good place to start. Be sure to use key words that give you manageable number of hits. For example, the word “dementia” alone reveals 4.9 million results. Using a string of words such as “Lewy body, behavior, and medication” will improve the usefulness of your internet fact-finding efforts.

Determining the reliability of internet information is another issue. Government resources, such as the National Institute of Neurological Disorders and Stroke (http://www.ninds.nih.gov/disorders/dementias/dementia.htm) are the location of high quality patient and family-centered information. University medical centers, such as the University of California, San Francisco, Memory and Aging Center are another source of dependable information. (http://memory.ucsf.edu/) Medline Plus, (National Library of Medicine) can direct you to additional high-quality sites. (https://www.nlm.nih.gov/medlineplus/evaluatinghealthinformation.html)

Internet searches, though certainly an important aspect of your fact-gathering journey, cannot replace conversation. So, be sure to include a telephone in your arsenal of fact-finding tools. The local Agency on Aging, the Dementia Society of America, as well as nearby hospitals, university medical schools and Veterans Health Administration hospitals are examples of organizations where you will find experts. Use their webpage to find the contact information to the people best able to help you.

The mindfulness and self-determination is another way to interpret “knowledge is power.” Here, rather than facts, the emphasis is on self-reflection. Self-reflection can be something as simple as setting aside a few quiet and quieting moments each day for contemplation.

Acknowledge feelings such as anger, sadness, abandonment, and fear. Use your feelings both as an entryway to mindfulness as well as an incentive to discovering solutions to the challenges you face. Consider having a psychologist or a medical social worker guide you through this difficult period.

Keeping a hand-written or word-processed diary is another tool. At the end of the day, perhaps just before going to bed, set aside a few moments to write. Don’t worry about grammar, spelling or creating the perfect sentence. Just write. Pour your heart out. Document the events made your day especially good or unbelievably horrible.

Be sure to review your diary writings from time-to-time. Doing so will help you see past mistakes, appreciate progress, or give important insight to best next-steps.

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

Pause and take a Deep Breath

I cannot remember names or where I left the keys, people say I repeat myself and often seem confused. I must have dementia. It’s easy to leap to conclusions but considerably more difficult to speak to your doctor about your concerns. You fear stepping into your doctor’s office all but guarantees a diagnosis of dementia. However, a through medical exam may uncover other reasons, such as a bladder infection or medications that can explain why you are sometimes forgetful or confused.

Again, don’t jump to conclusions if your doctor suggests that you undergo further tests. Pause, take a deep breath, and tell yourself that ruling out dementia is not as easy as you may have assumed. At this point, your doctor may suggest that you get a second opinion from another physician or other kinds of healthcare professionals who specialize in diagnosing and treating memory disorders. And remember, you don’t need your doctor’s permission to seek advice from other clinicians. A good doctor will welcome your efforts. Without question, what you are doing for yourself is scary. No, it’s worse than scary. It’s deep-down frightening.

Take a deep breath. You don’t have to do this alone. A family member or a good friend can give the emotional support you need and, with your permission, can accompany you to your doctor appointments. In addition to the comfort of his or her presence, your family member or friend can be another set of ears (or your note taker) as you, in all probability, will be overwhelmed by a deluge of information.

Sometimes the news isn’t good. But before you occupy a permanent seat on the couch and wait for the inevitable, take a moment and take a deep breath. There are medications, as well as participation in activities such as dancing, yoga and tai chi, that can slow the progression of dementia. Keep in mind, there is a lot of good living ahead of you. Indulge, be active, do what gives you pleasure, and have good times with family and friends. Cherish the little things that enrich your life as well as the lives of others. This is a time to create memories.

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available on Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions or other forms of content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice, please consult your doctor. www.DementiaSociety.org