dementia

A fascinating article in the Montreal Gazette describes how people living in Health Central Park nursing home in Florida have had their brains, mobility, and social lives jump-started by a simple gadget: the iPad. The hope is that the iPad and other digital tablets could become a mainstream treatment device for people with Alzheimer’s disease and other types of dementia.

“It came to us as a happy accident,” said Judy Skilton, Health Central Park’s director. “What started out as one resident’s curiosity about … an iPhone turned into something that is helping them spell, track items, make choices and read words. It’s amazing.”

How can the iPad help nursing home residents? Let me count the ways:

1. The iPad’s swipe and touch-screen capabilities makes it accessible to people whose hands have atrophied, or who have disorders such as arthritis or Parkinson’s disease, which can make it difficult or even impossible for the individual to type or even use a mouse.
2. It is small, lightweight, and looks like a piece of paper, which makes it nonthreatening for those who might be unwilling to use a computer.
3. It is small enough to be used by people with even severe mobility problems.
4. It has applications that allow individuals to communicate visually with family members who live far away.
5. It has game apps that test a person’s memory, cognitive skills, and hand-eye coordination.
6. It has iTunes capability, which allows an individual to play familiar music, or to watch television shows in the privacy of one’s room.
7. It has a camera and photo albums, which can allow a resident to take pictures to share with others…and to look at pictures of family functions that they may not be able to attend. In that way, nursing home residents can remain a part of family.
8. It has calendar and timer applications that can remind a person to take medication, or time a particular activity.
9. It can be used to test a person’s functioning and mobility, which help residents and their caregivers understand how they are progressing in terms of daily living skills and general movement abilities.

According to the article:

Recreation-therapy assistant Marian Yandle said the Talking Tom Cat app, which features an animated feline that repeats what it is told, encouraged a 99-year-old resident to drink her fluids.

“She watched the cat drink a cup of milk. Then she took her own cup and drank her fluids. We were very excited,” Yandle said. “She also likes the music app and sings to Shirley Temple’s ‘On the Good Ship Lollipop.’ She knows all the words.”

Something so simple…an animated cat helped an elderly nursing home resident drink her own fluids. That’s as close to a magic as we get in real life!

To read the full article in the Montreal Gazette, click here: iPad helps elderly remember, socialize

Today, September 21, 2011, is World Alzheimer’s Day. Every year on September 21st, Alzheimer associations across the globe unite to recognize World Alzheimer’s Day, and this year is no exception.

World Alzheimer’s Day is a day that unites opinion leaders, people with dementia, their carers and family, medical professionals, researchers and the media from all around the world.

Having a globally coordinated awareness day sends a strong message to governments and policy makers alerting them to the fact that dementia is a serious health issue that will have serious implications for services and health systems around the world as the world’s population grows older. In addition, by focusing on a different message each year, the day can be used to educate and challenge people’s misconceptions about dementia.

Plus, having a special day  provides an opportunity for Alzheimer associations around the world to gain recognition and credibility for the work they do, placing themselves in a stronger position to influence opinion leaders and governments.

The theme of World Alzheimer’s Day for 2011 is “Faces of Dementia.” People with Alzheimer’s disease don’t look “crazy” or “out of their minds.” They look like your next door neighbor…your grandmother…or someone at the grocery store.

Today is a day to pay tribute to those who represent the “Faces of Dementia” in all parts of the world.

For a larger version of the “Faces of Dementia” poster, click here: World Alzheimer’s Day 2011

Here in North Carolina, as in many other southern states, we have a higher-than-average risk of cardiovascular disease, leading medical experts to call the band of high-risk states “the Stroke Belt.” Why? Well, no one really knows for sure.

There are a few theories: That people in the south share some genetic susceptibility… that southerners don’t recognize or treat hypertension… that the rural nature of the south means fewer doctors and less-available medical care… that southerners have a distinctive high-fat, fried-food diet that contribute to cardiovascular disease. Regardless of why, the fact remains that stroke is a greater risk for southerners.

Now, a new study suggests that in addition to stroke, people in the stroke belt may also have a greater risk of memory loss and general cognitive decline. Even when all other factors are taken into account, people in the Stroke Belt show an 18 percent greater risk of

According to an article in The New York Times:

None of the people with cognitive decline in the study had had detectable strokes. But some experts believe their memory problems and other mental issues could be related to the same underlying risk factors, including lifestyle patterns that contribute to hypertension, high cholesterol, diabetes and obesity…..

“This should be a very strong alarm signal,” said Dr. Gustavo C. Roman, who leads the neuroepidemiology section of the American Academy of Neurology and was not involved in the study. The finding suggests that “if you want to keep your marbles, you need to control your blood pressure, excessive weight and other risk factors for stroke.”

The thing all those risk factors have in common is that they can affect blood flow, causing less blood to reach the brain. Without blood, the brain can’t get the oxygen and nutrients it needs to function properly. In the short term, this can mean simple memory loss, but in the long term, it can mean cognitive decline and dementia.

According to a physician quoted in The New York Times, it is a question of taking care of your body and health:

“Those behaviors that prevent stroke likely will prevent some but not all of the things that cause cognitive decline,” said Dr. Joseph P. Broderick, chairman of neurology at the University of Cincinnati Neuroscience Institute, who was not involved in the study. “If you buy a car and you take great care of it, it still ain’t the same 15 years later. But if you don’t ever change the oil and your basic engine grinds down, in five years you can’t drive it and it won’t last very long.”

The goal, then, becomes one of change–changing our health habits for the better, changing the way we take care of our human engine. It’s difficult, but the possibility of living out our final days in a nursing home because of dementia is even more more difficult to contemplate.

To read the Annals of Neurology article, click here:  Incident cognitive impairment is elevated in the stroke belt

To read the article in The New York Times (much more reader-friendly), click here: In the ‘Stroke Belt,’ Erosion of Memory Is More Likely Too

New research published in the online issue of the Archives of Internal Medicine shows that smoking heavily can cause effects on the the brain decades later.

The researchers followed more than 21,000 people for an average of 23 years. Of those, 5,367 people were diagnosed with some form of dementia, including Alzheimer’s disease and vascular dementia. After adjusting for a number of other factors, analysis showed that people who smoked more than two packs a day had double the risk of dementia, compared with nonsmokers. That’s right–double. In some cases, it was more than double.

In addition, the researchers found that heavier smoking is associated with a greater dementia risk–the risk of dementia increased with each additional cigarette smoked. These results were found for both men and women, and for all different race groups.

At HensonFuerst, we handle cases of nursing home abuse, and many nursing home residents are there because they have dementia. As the researchers write in the article:

The large detrimental impact that smoking already has on public health has the potential to become even greater as the population worldwide ages and dementia prevalence increases.

Think of it this way: Every smoker has the ability to change the course of his or her life…by quitting. Dementia is not an easy road for the person who has it, or for their loved ones and caregivers. You don’t have to wait until November to plan your own Great American Smokeout—how about March 1, or March 2, or March 3? Or, set a date of your own choosing. Quitting smoking may be the most difficult, but most rewarding thing you ever do.

To read the abstract for this article, click here: Archives of Internal Medicine

The National Football League (NFL) has issued new guidelines about concussion diagnosis during games. Basically, team doctors will use a new standardized assessment protocol on the sidelines if concussion is suspected. This tool allows immediate evaluation of injury so that athletes with concussion or other serious brain trauma so that players can be removed from the game.

The new concussion protocol combines a symptom checklist, a limited neurologic examination (including a cognitive evaluation), and a balance assessment.

According to an article on Bloomberg.com:

“This tool provides a standardized format for evaluating head injury that medical staff can use on the sideline,” Margot Putukian, chairwoman of the NFL’s Return-to-Play Subcommittee and head team physician for Princeton University, said in the statement. “It incorporates the most important aspects of a focused exam, so that injury is identified and athletes with concussion and more serious head and spine injury can be removed from play.”

Maybe it’s just me, but it seems remarkable that this relatively simple, standardized test hasn’t been incorporated earlier. Or perhaps it’s a sign that the NFL is now finally willing to recognize that concussions are dangerous. According to an article in The Atlanta Journal-Constitution, Falcons general manager Thomas Dimitroff agrees that the protocol is a welcome change:

“It takes a little bit of the gray area out of it in my mind,” Dimitroff said. “It makes sure that we have some checks and balances. I think it’s positive for both sides …. I remember that many years ago when we were saying, ‘you have to go back in there no matter how you feel,’” Dimitroff said. “Now, I think we are just playing a lot smarter. I think that’s good.”

We think that’s good, too. Better a little caution, a missed game or two, than more cases of dementia or player suicides. All brain trauma is potentially serious. If the protocol is actually used, all football players could have Golden Years that are actually, well… golden.

Palliative care is treatment intended not to heal, but to relieve symptoms so that the patient feels better. Despite the fact that it is an important part of treatment, especially for people with incurable disorders, palliative care is not well understood by most people, including those who need it. For people with a terminal illness, palliative care is also known as “hospice care.” That’s one reason why some people don’t even want to talk about the possibility of palliative care, even though it doesn’t mean that a patient is “giving up” or resigning himself to terminal illness. So I repeat:  Palliative care is about helping people feel better and providing them a better quality of life. It can be provided throughout the course of the disease along with regular medical treatment.

What is even less well known is that palliative care is available for people with dementia. Currently, 72% of palliative care programs provide care to dementia patients; just 15 years ago only 21% provided care to dementia patients. These programs can help relieve pain, shortness of breath, fatigue, nausea, eating difficulties, sleep problems, and other symptoms. But according to a study published in the November 2010 issue of the Journal of the American Geriatrics Society, despite the availability of palliative care, dementia patients are not receiving the services that could help them out. The obstacles to receiving this type of care include inadequate insurance coverage, expired home health benefits, and lack of information about when palliative care is appropriate and how to access those services.

“While it is heartening to see that most of these [hospice and palliative care] programs provide care for patients with dementia, there are many, many more who need this care than are receiving it. Education and policy efforts should focus on communicating with families and providers about palliative care, supporting caregivers who often are frustrated in their efforts to improve quality of life for a loved one with dementia, and reforming reimbursement structures to provide coverage earlier in the disease when patients have high needs but are not hospice eligible,” said study author Alexia M. Torke, M.D., M.S., assistant professor of medicine and geriatrics at Indiana University School of Medicine. [as reported in ScienceDaily]

People with Alzheimer’s disease and other forms of dementia have a tough road ahead of them. So do their families. We love the idea that dementia patients are finally getting the kind of care that can make their lives a little easier, but we would like to see this become a standard part of dementia care. Why does it have to be so difficult to get palliative care? Isn’t it a basic human right to have the worst of our suffering relieved as much as possible? We fear that this is another case of agism. The elderly in America are generally treated as though they are disposable, so an elderly person with dementia really has no voice.

It’s sad. But it’s something we, as a society, can change. Studies like this are the first step.

To read the whole ScienceDaily article, click here: ScienceDaily

To read an abstract of the original article, click here: Journal of the American Geriatrics Society

To read more about how HensonFuerst Attorneys work to protect the rights of people in nursing homes and assisted living facilities, visit our website: http://www.lawmed.com/

Someone once said that the difference between an optimistic resolution and a futile pipedream is two days. (Bah-DUM-bum)

Resolutions are fueled by New Year’s Eve toasts, but dashed in the cold light of January reality. Despite estimates that about 97% of all resolutions fail, between 40 and 45% of Americans keep the faith and make New Year’s resolutions year after year after year. This year, scientific research tells us that there may be a new reason to make (and keep) a resolution:  Regular exercise can slow the aging process and reduce the risk of dementia, diabetes, and some cancers.

An article published in the December 2010 issue of IJCP, the International Journal of Clinical Practice, reviewed 40 papers and found that exercising is one of two behaviors most likely to affect health (the other is smoking). We’ve heard this same information for years, but somehow when it gets puts together in one giant review paper, it feels more real and more powerful.

Everything is made better by exercise, from physical appearance to overall health to longer life (with better quality of life in the end years).

…those who exercised showed greater brain activity in memory-related regions than those who were sedentary. The results suggest that physical activity promotes changes in the brain that may protect high-risk individuals against cognitive decline, Including development of Alzheimer’s disease.

“Our study suggests that if you are at genetic risk for Alzheimer’s disease, the benefits of exercise to your brain function might be even greater than for those who do not have that genetic risk,” says [J. Carson Smith, an assistant professor of health sciences at UWM].

Good luck!

Resources

ScienceDaily: Importance of Exercise for Those at Special Risk for Alzheimer’s Disease

ScienceDaily: Regular Exercise Reduces Large Number of Health Risks Including Dementia and Some Cancers, Study Finds

There was a story on National Public Radio (NPR) today about the growing concern over concussion in youth sports. This is a topic that has been in the news (and in our own blogs) this entire year, and it shows no sign of going away. Thank heaven! The more voices that join the chorus of concern, the healthier our children will be now, and in the future.

According to the story, concussions are now the second most common injury in kids’ sports. And due to more sports opportunities and a greater emphasis on performance, the hits are not only more frequent, but harder than ever before. On the scientific side, we now know that concussion is not a simple, benign bump on the head. As described by NPR:

Concussions used to be described as a brain bruise, but doctors now like to say that it’s a problem with the brain’s function, a problem that can’t be detected by MRI or CT scan. When the brain suddenly slams to a stop, the brain’s neurons all fire at once. That surge of energy temporarily messes up the brain’s electrical and chemical signal system, making it hard to think straight.

After kids suffers a concussion, doctors recommend that they rest their brains as well as their bodies. They are sidelined from sports until cleared by a doctor, and they need to cut back on everything that requires complex thought including playing a musical instrument and even texting. Once their brains are healed, kids are asked to ease slowly back into their usual routine.

…some schools are trying to do a better job of monitoring student athletes by taking a page from the NFL’s playbook. Last year, Churchill High School in Potomac, Md., started assessing student athletes’ memory and reaction time with the online ImPACT test, the same test used in the NFL, to see how their brains work.

“If there’s a potential concussion and they retest, we look for abnormalities,” says Dave Kelley, the athletic director at Churchill. “If they perform poorly on memorization or don’t react as quickly, that may show signs of a brain injury.” Kelley has benched eight or nine students in the past 18 months whose second tests suggested a concussion. [from the NPR story]

These measures sometimes seem like overkill to parents and coaches who grew up in a time when athletes were encouraged to “walk off” the pain and disorientation of a concussion. But studies have shown that concussions—especially multiple concussions—greatly increase the risk of permanent brain damage. In the long run, concussions may even lead to premature dementia and even death.

The brain injury attorneys of HensonFuerst believe that there’s no such thing as “too much” concern about kids’ concussions. A child has one brain to last a lifetime…how crazy is it to risk permanent injury for the sake of a game?

RESOURCES

To read or listen to the NPR story, click here: NPR Concussion Story

To read our blogs about concussion and other brain injury topics, click here: HensonFuerst TBI blog

You can also read more about traumatic brain injury on our dedicated web page: HensonFuerst TBI website.  If you have questions, HensonFuerst has answers.

Also, the U.S. Centers for Disease Control and Prevention (CDC) has developed a concussion awareness campaign called “Heads Up Youth Sports.” To see the Heads Up informational poster, click here: Heads Up Concussion Poster

According to an article in The New York Times, the National Football League (NFL) is not sticking to their new policy of protecting players from concussion and head injury.

One player was tackled square in the face with the helmet of an onrushing opponent. Another, fighting for one last yard, took a polyurethane bash to the head. Still another player spent 10 minutes mostly motionless among dozens of praying players before medics carried him away on a stretcher after a helmet-to-helmet hit. [from The New York Times]

No flags were thrown for these controversial hits…all hits were deemed legal…and all of the hits probably caused traumatic brain injury to the players involved.

But the N.F.L.’s recent movement toward eliminating particularly dangerous tackles suggests that some of the collisions like those seen Sunday night could be forbidden as early as next season. Given how youth and high school football tend to follow the N.F.L.’s lead, the changes could affect more than just professionals.

Football is a violent sport, and players of all ages are encourage to “hit hard.”  Any serious move toward protecting players’ brains would require pulling back from the level of violence, and it’s not clear that anyone is willing to do that. It’s a $9 billion business, and fans live for televised clashes. Still, research has shown that multiple concussions (also known as mild traumatic brain injury, or MTBI) can lead to neurologic dysfunction, early dementia, and even death.

We’ve seen the outcome of head trauma, and we firmly believe that no game…no sport…no job should encourage—tacitly or explicitly—the kinds of activities that regularly cause concussion or more serious brain injuries. The NFL created pretty posters about concussion and vowed to take a tougher stance on head-hits. Thus far, this has all been nothing but “wah-wah-wah” background noise that everyone is ignoring.

According to Dr. Thom Mayer, medical director for the players union:

“Anything that can be done to improve the safety of our players really should be done, short of stopping playing the game.”

We agree. Hey…what if there were a fine against the team owners every time a player got a concussion during the course of a game? Hitting the big guys in their wallets wouldn’t be as painful as a head-hit, but it might at least start a serious discussion of how to stop the injuries.

Just food for thought.

To read the full article in The New York Times, click here: Big Hits, No Flags

November is set aside to officially recognize a trio of related causes. It is National Alzheimer’s Disease Awareness Month, National Family Caregiver Month, and Long-Term Care Awareness Month.

As many as 5 million people in the United States have Alzheimer’s disease and related dementias. According to the North Carolina Division of Aging and Adult Services, more than 1 million adults in North Carolina are caring for an older person. And more than 40 percent of NC family caregivers take care of someone with a memory disorder, such as Alzheimer’s disease, which is now the fifth leading cause of death in the United States.

This month, state leaders and communities are working to raise awareness of the tremendous burden the disease takes on the person suffering from the disease, as well as their friends and family members.

In addition, November is a time to recognize that about 70 percent of people over age 65 will require some long-term care services at some point in their lives. Because Medicare and private health insurance don’t pay for much of long-term care, it’s important to plan ahead for possible future care needs.

To find out more about these special November recognition topics, check out these resources:

North Carolina’s Project C.A.R.E. (Caregiver Alternatives to Running on Empty)

North Carolina Publications and Resources for Alzheimer’s Disease

North Carolina Family Caregiver Month Events

the Presidential Proclamation of National Alzheimer’s Disease Awareness Month

National Clearinghouse for Long-Term Care Information