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Esther Heerema, MSW

Alzheimer's/Dementia Blog


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Would You Want to Know if You Were Going to Get Alzheimer's?

Sunday May 25, 2014

Recently, researchers presented information about a blood test that was able to fairly accurately predict if someone would develop Alzheimer's disease in the next two to three years. The test measures levels of lipids in a person's blood and was approximately 90% accurate in its predictions.

If this test is further developed and repeated with accurate results, some day it could be easily available for the public to use.

While this is a step forward for researchers, we need to consider the ramifications of such as test, before it is available.

First, there are personal preferences. Some people are planners and like to organize things ahead of time, while others like to enjoy each day for what it is, without worry of future problems.

Second, in addition to how different personalities may handle this type of news, there's also the question of how insurance companies, health care providers, employers and others may respond.

I've laid out some more thoughts on this issue here: The Pros and Cons of a Predictive Alzheimer's Test

Margie's Tribute to Her Mother with Alzheimer's Disease

Saturday May 10, 2014

A while back, a reader wrote to me about the loss of her mother. I asked her if  she would be willing to share her journey of watching her mother battle dementia, and she said she would. Her hope was two-fold: one, that by reading her story, others would know that they weren't alone and they wouldn't despair in the depths of the disease. Her other motivation was simply- she also wanted to tell others how much she loved her mother, and that she missed her.

In light of Mother's Day, here's her three-part story:

Alzheimer's from a Daughter's View: Part 1

Alzheimer's from a Daughter's View: Part 2

Alzheimer's from a Daughter's View: Part 3

Related Reading

Role Reversal: When You Have to Parent Your Parent

Adult Children: How to Have "The Talk" with Your Parents

In Sickness and in Health: Caring for a Spouse with Dementia

Does Alzheimer's Affect Men & Women Equally?

Sunday April 20, 2014

Do you know the statistics regarding who (men or women) develops Alzheimer's disease? A common sense guess might be that half of people who get dementia are women and half are men, but common sense is wrong here. Or, perhaps you're aware that the average lifespan for a women is longer than for a man, and you guess that the breakdown is 55% women to 45% men. Closer, but not there yet.

The truth? Two-thirds of people who develop Alzheimer's or a related dementia are women- a two-to-one ratio. That's a significant difference, and one that recently has been highlighted by advocacy groups.

Why? We don't have the full answer yet, but a recent study conducted by researchers at Staford University School of Medicine added some insight to this dilemma. This past week, they published research in the Annals of Neurology that demonstrated that women with the  ApoE4 gene (a gene that increases your risk of developing Alzheimer's) were significantly more likely to develop Alzheimer's than men with the ApoE4 gene. Men with the ApoE4 gene still showed an increased risk of Alzheimer's when compared to those without this gene, but women with the gene had a much higher risk than men.

Why Does This Matter?

In addition to understanding that women are more at risk for dementia than men, this latest discovery that the ApoE4 gene significantly increases the dementia risk for women identifies new areas for research on what triggers Alzheimer's to develop and, eventually, how we can treat and prevent it.


Related Reading

Is Alzheimer's Disease Inherited?

The Statistics of Alzheimer's: Who Gets It?

Women and Alzheimer's Disease: A Higher Risk & More Likely to Serve as a Caregiver

Young Children + People with Alzheimer's Disease = Victory

Sunday April 13, 2014

Have you ever seen the reaction of someone with dementia when a young child comes near? This is one of my favorite interactions to observe. Why? Because the vast majority of time, the dementia takes a back seat to the presence of the child. For me, the type of interactions I witness between someone with Alzheimer's disease and with children is one of those victorious moments in the battle against dementia.

Alzheimer's disease, Lewy body dementia, vascular dementia and other types of dementia rob abilities, memories, words and so much more. But for many people, their reactions to kids remain or even intensify. Although not every person with dementia loves babies and young children, most derive great joy from watching babies smile, listening to the giggles of a two-year old, playing a game with a preschooler or hearing a 5 year-old sing a song.  That joy is why I love to watch these interactions, and why I count them as victories over dementia.

Related Reading

Therapeutic Benefits of Young Children for People with Dementia- Here's an article I wrote recently that looks at the research behind these benefits, the challenges associated with arranging intergenerational interactions and some suggestions on how to facilitate them.

Alzheimer's Disease + Makeup Tattoo = Victory- This is one of my earliest blogs, and I love the idea it highlights. If you haven't read it, it's worth your time, in my humble opinion. It's another one of those victorious moments I describe above.

Doll Therapy for People with Dementia- Here's another recent article on how dolls can be helpful for some people with Alzheimer's disease and other types of dementia.

Vitamin D: Good for More than Just Your Bone Health

Sunday April 6, 2014

When it comes to vitamin D, most of us are familiar with the thought that it's helpful in keeping our bones strong. But did you know that it has many other benefits as well?

Adequate levels of vitamin D have been associated with a lower risk of diabetes, certain types of cancer and muscle and bone pain. Of particular interest, vitamin D has also been connected with brain health. Low levels of vitamin D have been correlated with a higher risk of cognitive decline and with symptoms of mild cognitive impairment.

Research has also shown some possible benefit from using vitamin D to treat dementia as well, but more studies are needed to more clearly determine if adequate vitamin D slows down the symptoms of dementia or even improves cognitive functioning for a time.

Meanwhile, those of us who live in locations where we're not getting much of our vitamin D from the sun might want to make sure our diet contains enough of it from other sources.

Related Reading

How Vitamin D Helps Your Brain - The research behind the claims regarding vitamin D and your brain.

Vitamin D Shown to Be Important in Reducing Brain Plaques in Alzheimer's Disease - An earlier study I highlighted regarding the effects of vitamin D on the brains of people with Alzheimer's.

Reducing the Risk of Dementia - A link to several articles on how to reduce your risk of developing Alzheimer's and other kinds of dementia.

Friendships- Good for Your Heart and Your Brain?

Sunday March 30, 2014

I recently wrote an article about the benefits of social interaction, specifically outlining what research says about how friendships and the act of socializing and interacting with others impacts our risk of developing dementia. Here's the article: Does Social Interaction Prevent Dementia?

As I reviewed data for that article, I found some interesting research that was published in the journal Psychosomatic Medicine. The short version of the research is that after 15 years of studying more than 2000 participants' cognitive status and administering socialization questionnaires, researchers determined that social interactions reduced the risk of dementia. But, more significantly, they found that the quality of these social relationships- not the quantity of them- was the key factor in the reduction of the risk for dementia. Thus, not only should you spend time with others, but it can make a difference- even years from now- with whom you spend time with and how that time is being spent.

So, consider this a gentle nudge to prioritize in the busyness of life and be intentional about developing strong friendships with others. Those kinds of relationships require time and energy, but the benefits are significant, both for the present- in terms of quality of life- and for the future- in a decreased risk of Alzheimer's disease and other kinds of dementia.

Related Reading

How to Meet New Friends - Friendless? About.com's friendship expert provides some suggestions of where to start if you find yourself wanting to make friends with others.

Fact or Myth? Do Crossword Puzzles Prevent Dementia? - Love crossword puzzles? Find out if they benefit your brain or are just a fun way to pass the time.

How to React when a Friend or Family Member Tells You She Has Dementia - Here are a few suggestions on how to be a supportive friend or family member when dementia strikes.

10 Things Not to Say To Caregivers - Have a friend who's a caregiver? These tips may help you avoid some of the common mistakes as you're trying to encourage your friend.

Coping with the Challenges of Being a Long-Distance Caregiver

Sunday March 23, 2014

Ask caregivers about the ups and downs of their role, and you'll hear a variety of responses. In addition to a list of challenges, you may also hear some positives, including the feeling that it's a privilege and that they wouldn't want to have it any other way. What you probably won't hear is the phrase, "It's easy."

There are many reasons being a caregiver can be a challenge, and not the least of these is living far from the person who is receiving the care. Caring from a distance can involve guilt feelings, emergency trips, worry, time off work, disagreements with siblings, unfamiliarity with the resources that may be available and increased financial stress. And that's not an all-inclusive list.

Let's be honest, here. There are no "3 Easy Steps to Stress-Free Long Distance Caregiving- Guaranteed!" (said in an overly-enthusiastic sales pitch voice.) There are, however, some ways to decrease the challenges associated with caring from a distance.

One of those is to pro-actively become familiar with the resources of that community at a time of your choosing, rather than in the middle of a crisis. Too often, the demands of life encourage us to put off the tasks that aren't required for the moment. Think- "tyranny of the urgent." We're juggling several different roles and what doesn't need to be done today, doesn't get done today. But when things fall apart for our loved one and she's not able to care adequately for herself anymore, trying to figure out an emergency plan for increased care or services on the fly is not fun. Taking the time to outline these possibilities before we're in that position can provide a sense of direction when the crisis does occur.

So, call your loved one's Area Agency of Aging or Alzheimer's Association. Ask for some information about home health care agencies, sub-acute rehabilitation facilities (in case a fall and hip fracture occur), assisted living facilities, nursing homes and the local Meals on Wheels program. Gather these resources before they're needed, and conduct your research on facilities at a time of your choosing. Perhaps you may never need the information, but even then, the peace of mind that comes from having some basic plans in place is well worth it.

For more suggestions on how to manage the challenges of long-distance caregiving, here's the complete article:

Challenges and Tips for Long-Distance Caregivers

Also, please feel free to comment below with any suggestions or specific challenges you may be facing in long-distance caregiving.

Related Reading

How to Research and Choose a Nursing Home

Tips on Home Safety for People with Dementia

10 Things to Stop Doing if You're a Caregiver for Someone with Alzheimer's

10 Things Not to Say to Caregivers

Is There a Time When Alzheimer's Medications Should Be Stopped?

Sunday March 16, 2014

A friend of mine recently wrote to me with a question regarding her mother's medications. Her mom's caregivers had suggested that she consider reducing or discontinuing her mother's medication that she takes for her Alzheimer's disease. Her mom has been gradually declining in her overall functioning and they wondered if the medicine really was still benefiting her.

So, what should she do? How should she make this decision? What's the best course of action?

Others in this situation have struggled with these questions as well. Some have debated whether medications are really helpful in the later stages, or they become concerned that the medicine prolongs the late stages of Alzheimer's longer than they otherwise would last without the interventions, and they question if that is a good thing. Yet, they don't want to hasten the decline of their loved one or feel like they're giving up on him. There's also the dilemma of continuing a medicine that has the potential for ongoing side effects, drug interactions and cost, while providing questionable benefits.

Many of you have been there, in my friend's shoes. What suggestions or advice would you give her? Please feel free to share by commenting below.

For more information and to read a summary of what research has concluded thus far, here's the article I recently wrote on this topic: Should Alzheimer's Drugs Be Discontinued in the Late Stages?

Also, here's some more information about the treatment of Alzheimer's disease, including the medications that have been approved by the FDA to treat Alzheimer's: Treatment of Alzheimer's Disease


Dementia with Lewy Bodies vs. Parkinson's Dementia: Same or Different?

Sunday March 9, 2014

Parkinson's disease dementia and dementia with Lewy bodies... Are they the same thing?

I remember the first time I wondered about this question:  Were there two different disorders with two different names, or one disorder that could be called both PDD and DLB? This question came about as I was reading through the medical history of a patient and noticed that in some places in his chart he had a diagnosis of PDD, and in other areas of his records, his diagnosis was listed as DLB.

In asking other professionals, I discovered that opinions varied about the answer to my question. I found that some physicians felt strongly that PDD and DLB were really variations of the same disorder, while others debated if the two conditions were significantly different from each other.

I sought further clarification by researching the diagnostic guidelines on these disorders, and found that currently agreed upon criteria is different for PDD as compared to DLB, although they're both considered to be a type of Lewy body dementia. In other words, PDD and DLB are classified as separate diagnoses. They have sets of symptoms that are similar to each other, yet they also have some specific differences from each other.

Related Reading

What's the Difference between Parkinson's Disease Dementia and Dementia with Lewy Bodies? - How are these conditions different from each other?

What's the Difference between Alzheimer's Disease and Lewy Body Dementia? - Lewy body dementia has some similarities to Alzheimer's disease, so how can you tell them apart?

10 Things to Know about Parkinson's Disease Dementia - Here are 10 quick facts about Parkinson's disease dementia.

Study: Should Antidepressant Celexa Be Used for Agitation in Dementia?

Sunday March 2, 2014

Agitation- including restlessness, wandering, combativeness and calling out- is a common challenge in Alzheimer's disease and other kinds of dementia. So, what to do about it?

A study was recently published in the Journal of the American Medical Association, outlining a trial of the antidepressant medication citalopram (brand names: Celexa and Cipramil) to treat agitation in dementia. Here are the results, which are both positive and negative:

  • The participants who received citalopram showed a significant decrease in their agitation.
  • Caregiver distress, which is increased by agitation, also significantly improved.
  • However, those who received citalopram showed a decline in their cognitive ability over the 9-week course of the study, as well as an increase in cardiac issues associated with the medication.

So, while there was an improvement in the levels of agitation, which can be so distressing both for the person experiencing it and for those watching it, there are tradeoffs with the use of this medication, according to this study.

The Take-Away?

It's great to see the exploration of some different possibilities for the treatment of agitation, but this study does not throw me into the fan club yet. As caregivers, professionals, family members and friends, we collectively still need to improve in the use of non-drug approaches. I realize that not all agitation and distress can be solved without medications, and I've written about times and circumstances when medication is an appropriate, helpful and necessary treatment.

But- our mental approach to people with dementia, and our willingness to seek the cause of the behavior instead of just trying to make the behavior disappear, can make a world of difference.

Suggested Reading

To figure out what might be causing the behavior, review these possibilities and learn how you may be able to anticipate your patient or loved one's needs:

Understand that sometimes, difficult behaviors can be caused by loneliness and boredom:

When are medications appropriate? Glad you asked. Here are a couple of references for you:

Should Your Loved One with Dementia Really Be Taking Antipsychotic Medications?

Drugs for the Emotional and Behavioral Symptoms of Alzheimer's

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