Alzheimer's Disease – Part 3

If you have a loved one or a parent that you are having difficulty with, forget about everything, and ask your parent if they wish to name you in their medical power of attorney. If they wish to name another sibling or a friend, don't get upset, but ask questions. Maybe the friend lives closer or communicates with your parent every day. Just maybe they trust a sibling more than you and the sibling lives closer. In this case, contact the sibling and inform them of the situation if they are not aware. If they have the medical power of attorney, then step back and let them act.

Yes, you may have good reason to be concerned about a parent, but unless the parent feels they have control, you may not get anywhere. Having a medical power of attorney is an important document and should be obtained while the parent can understand what the medical power of attorney means. Waiting until something happens, and your parent is unable to act on legal matters, may leave the door open to other siblings that may not have your parent's interest and wellbeing in mind, but their own interests.

This is my own opinion and I do not like it when other writers omit this from the discussion or leave it as the last item for discussion. This writer omits this entirely and focuses on other issues. Concern for older parents or aging relatives is a valid concern for a geriatrician as is their safety.

For better health and wellbeing in older adults or parents, it is not enough identifying the underlying health and life problems, although it is a key place to begin. It is understood that a difficult parent or older relative can cause immeasurable frustration and stress.

Dr. Leslie Kernisan lays out four actions that families can take when older parents or relatives are actively resisting help. To this I would add – are the proper legal documents in place and understood by everyone concerned. Here is her list:

#1. Consider the possibility of cognitive impairment. Do not assume that this is the cause, as the parent or older relative may be making health and safety decisions that you don't agree with or feel is wrong.

#2. Make sure you’ve heard and validated your parents’ emotions. This surprised me, but I realized that it is true. Logical arguments can often fail to convince people that we have emotional relationships with, such as parents or older relatives. All people care about having their emotions validated. People also want to feel connection, love, and self-worth.
Whether or not your parent or older relative might be cognitively impaired, it is crucial to remember this. If there is potential Alzheimer’s, it can be even more important to help a parent feel heard and validated because this will reduce stress and help the brain function better. If you can afford it, consider investing in a few sessions with a relationship therapist or another person trained to facilitate family conversations. It can be especially productive to work with someone experienced in helping families address aging issues, like a geriatric care manager

#3. Review your parents’ goals and what trade-offs they might be willing to make. Doctors want to prevent falls, injuries, illnesses, and new medical problems.

People with older parents or relatives generally want what their parents want – to live as long as possible. But, there can be real problems with this as they age. The older adults in our lives want autonomy and independence and this is when the conflicts happen and can cause real dilemmas.

There is usually no easy answer to this conflict. Once an older person becomes more vulnerable in body or mind, you cannot have perfect safety as well as perfect independence. When the trade-offs are identified and goals discussed, it’s usually possible to help everyone feel better.

Common goals of older adults include:

• Living in their own home for as long as possible
• Dictating the terms of their daily life
• Living their usual life for as long as possible
• Minimizing pain, illness and suffering
• Spending quality time with family and loved ones
• A good quality of life, which generally means more enjoyable activities and fewer stressful or burdensome activities.
  
  Safety is important, but don’t fall into the trap of assuming it should always be your family’s No. 1 priority. Because when faced with a trade-off between safety and autonomy, most older adults choose autonomy. This is especially true of people with dementia. An approach called “positive risk-taking” is now being advocated as a way to make communities more dementia-friendly.
  
  

#4. Distinguish what you need from what your parents or older relatives need. This is probably the most difficult part for the younger generation because they refuse to recognize what fear is driving them.

Some common underlying issues include:

• A need to minimize guilt
• A fear of conflict with other siblings
• A fear that a parent is going to decline further and require more help
• A desire to know that a parent is happy and comfortable
• A desire for control and for knowing what will happen next
• A fear that what is happening to our parents might eventually happen to us.
  
  People being people, we all have a tendency to try to address our needs by wanting other people to do something differently, or by trying to keep things from changing. But as the relationship experts have been telling us for decades, the best approach is to accept that things change and to focus on what we can do differently. We shouldn't try to meet our own needs by controlling what others do.
  
  Even when you become informed, are thoughtful in your approach, and obtain the right kind of assistance, helping older parents through this stage of life will be a challenge. Of course, you will worry about them. And they will probably never be entirely free of reluctance to make changes and accept help.
  
  Some families get stuck in a rut of conflict and frustration, whereas others find ways to move forward more constructively. It might feel like an extra effort to do these things. But by investing in your ability to better navigate these difficult situations with your parents, your family will get closer to what we all want: less stress for ourselves and better quality of life for our parents.

Alzheimer's Disease – Part 2

You can support your loved one with Alzheimer's by learning more about how the condition progresses. There are seven stages in the progression of Alzheimer's and they don't always happen neatly or fit neatly into the seven stages. The symptoms might vary, but they can be a guide and help you plan for your loved one's care. The seven stages include:

Stage 1: Normal Outward Behavior. When your loved one is in this early phase, he/she won't have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether he/she has Alzheimer's. As the person moves into the next 6 stages, your loved one with Alzheimer's will see more and more changes in his/her thinking and reasoning.

Stage 2: Very Mild Changes. You still might not notice anything amiss in your loved one's behavior, but he may be picking up on small differences, things that even a doctor doesn't catch. This could include forgetting a word or misplacing objects.

At this stage, subtle symptoms of Alzheimer's don't interfere with the ability to work or live independently. Keep in mind that these symptoms might not be Alzheimer's at all, but simply normal changes from aging.

Stage 3: Mild Decline. It's at this point that you start to notice changes in your loved one's thinking and reasoning, such as:

• Forgets something he just read
• Asks the same question over and over
• Has more and more trouble making plans or organizing
• Can't remember names when meeting new people

You can help by being your loved one's "memory" for him, making sure he pays bills and gets to appointments on time. You can also suggest he/she ease stress by retiring from work and putting legal and financial affairs in order.

Stage 4: Moderate Decline. During this period, the problems in thinking and reasoning that you noticed in stage 3 get more obvious, and new issues appear. Your loved one might:

• Forget details about himself/herself
• Have trouble putting the right date and amount on a check
• Forget what month or season it is
• Have trouble cooking meals or even ordering from a menu

You can help with everyday chores and your loved one's safety. Make sure he/she isn't driving anymore, and that someone isn't trying to take advantage of your loved one financially.

Stage 5: Moderately Severe Decline. Your loved one might start to lose track of where he is and what time it is. He/she might have trouble remembering his/her address, phone number, or where he/she went to school. Your loved one could get confused about what kind of clothes to wear for the day or season.

You can help by laying out the clothing in the morning. It can help him/her dress by himself/herself and keep a sense of independence. If your loved one repeats the same question, answer with an even, reassuring voice. Your loved one might be asking the question less to get an answer and more just to know you're there.

Even if your loved one can't remember facts and details, he/she might still be able to tell a story. Invite your loved one to use his/her imagination at those times.

Stage 6: Severe Decline. As Alzheimer's progresses, your loved one might recognize faces but forget names. He/she might also mistake a person for someone else, for instance, thinking the spouse is his/her parent. Delusions might a set in, such as thinking he needs to go to work even though he no longer has a job. You might need to help him/her go to the bathroom. It might be hard to talk, but you can still connect with him/her through the senses. Many people with Alzheimer's love hearing music, being read to, or looking over old photos.

Stage 7: Very Severe Decline. Many basic abilities in a person with Alzheimer's, such as eating, walking, and sitting up, fade during this period. You can stay involved by feeding your loved one with soft, easy-to-swallow food, helping him/her use a spoon, and making sure he/she drinks. This is important, as many people at this stage can no longer tell when they are thirsty.

Please remember that as your loved one evolves into the later stages, some words may be hurtful. When this happens, do not get upset at your loved one, as they do not realize what they are saying.

Alzheimer's Disease – Part 1

Alzheimer's disease and diabetes do have a link. The Mayo Clinic recognizes this, as do a few other organizations. A few organizations reject the link and more state that the link is in question and acknowledge that the evidence is conflicted. New research suggests that those with insulin resistance or diabetes are at significantly higher risk of developing one of today's most devastating and incurable neurological disorders: Alzheimer's disease.

The connection between diabetes and Alzheimer's is yet another compelling reason for those who value their health to address issues of impaired insulin sensitivity before it is too late. Although diabetes is an epidemic, it is also preventable and reversible through strategies that incorporate dietary changes, lifestyle modifications, and nutritional supplementation.

Alzheimer's cost the US $130 billion in 2011 alone. One of the biggest risk factors is having type 2 diabetes. This kind of diabetes occurs when liver, muscle, and fat cells stop responding efficiently to insulin, the hormone that tells them to absorb glucose from the blood. The illness is usually triggered by eating too many sugary and high-fat foods that cause insulin to spike, desensitising cells to its presence. As well as causing obesity, insulin resistance can also lead to cognitive problems such as memory loss and confusion.

While medical researchers have yet to pinpoint a single cause of Alzheimer's disease, they have uncovered some of the basic biochemical processes that underlie the hallmark mental changes seen in Alzheimer's.

First, Alzheimer's sufferers exhibit a marked decline in levels of acetylcholine, a neurotransmitter (that is, a chemical messenger of the nervous system) that is vitally important to memory formation and retention in certain regions of the brain. Second, Alzheimer's patients demonstrate an accumulation of harmful beta amyloid deposits, or senile plaques, in the brain. Third, brain autopsies of Alzheimer's patients show signs of significant oxidative damage induced by free radicals. Finally, new research indicates that advanced glycation end products may also initiate this dreaded condition.

Feeding animals (in this case rats) a diet designed to give them type 2 diabetes leaves their brains riddled with insoluble plaques of a protein called beta-amyloid, one of the calling cards of Alzheimer's. We also know that insulin plays a key role in memory. Taken together, the findings suggest that Alzheimer's might be caused by a type of brain diabetes. If that is the case, the memory problems that often accompany type 2 diabetes may in fact be early-stage Alzheimer's rather than mere cognitive decline.

While declining levels of acetylcholine and formation of beta amyloid plaques in the brain are characteristic of Alzheimer's, oxidative damage and the accumulation of advanced glycation end products occur in both Alzheimer's disease and diabetes. These biochemical similarities may be a telling link between the two seemingly different diseases.

Scientists from Kaiser Permanente in Oakland, CA, reported that diabetic individuals with very poor blood glucose control experienced a dramatically increased risk of dementia and Alzheimer's. Their eight-year study, which tracked 22,852 patients, aged 50 or above with type II diabetes, sought to determine whether elevated glycosylated hemoglobin, a marker of long-term blood glucose control, correlated with an increased risk of dementia. They found that patients with very poor blood glucose control were more likely to develop dementia.

Researchers from the Mount Sinai School of Medicine in New York City discussed the link between diabetes-related toxins and impaired memory function. Advanced glycation end products (AGEs) are increased in people with diabetes, as well as in those with cardiovascular and kidney disease. They are also found in the brains of people with Alzheimer's, and laboratory findings suggest that AGEs may contribute to the formation of Alzheimer's plaques and tangles. The researchers evaluated nearly 200 cognitively healthy people aged 70 or older using tests of memory and thinking ability, and measured AGE levels in their blood. They found that those with the highest AGE levels fared significantly worse on six different tests than those with low AGE levels. This relationship could not be explained by factors such as gender, educational level, heart disease, or related conditions such as high blood pressure. The researchers concluded that dietary and lifestyle interventions to decrease advanced glycation end products in the blood deserve further study for preventing or delaying Alzheimer's disease.

Most of recent research points to a link between diabetes and Alzheimer's Disease. How firm this link is still is in doubt, but more evidence is now in the affirmative.