Fall Book Reviews

Time to do a few book reviews. Just click on the book cover for those that we recommend and you can go right to Amazon to order them. They are also available in the LBD Book Corner along with many other LBD-related books on our website. Please know that we receive a small fee for anything you order from Amazon via our blog or website. It all goes towards maintaining our work.


Confidence to Care: A Resource for Family Caregivers Providing Alzheimer's Disease or Other Dementias Care at Home by Molly Carpenter. $10.68. Published by Home Instead, this book is an example of that company has continually supported good caregiving and the family caregiver. It provides many suggestions for dealing dementia symptoms including behavioral ones like delusions. It’s one detraction is that it is short: 40 of the 160 pages were left blank to be used as a journal. While we consider journaling a necessity, we wouldn't recommend that you do it in another book! However, its price is also low, especially for a reference book. Also available in Kindle, but we don't recommend buying reference books in Kindle form. You want to write in the margins and use book mark tabs, etc. in a reference book!

Going Gentle Into That Good Night by Sandra Ross. Kindle, $6.99. Ross tells a heartfelt account of her journey, but we cannot recommend this book. 1) Poor editing detracts from the readability. 2) Where some books are too clinical, this one does not provide enough background information. 3) Worst of all, Ross sees respite for the caregiver “tantamount to abandonment.” We believe that without respite, caregivers can become irritable, ill and unsafe with their charges paying the price. We could overlook the first two but a recommendation against a basic caregiver need is not acceptable.


Fatal Tide (Book 3 of the East Salem Trilogy) by Lis Wiehl and Thomas Nelson. Kindle: $17.44, MP3 CD: $10.79, and Hardcover: $18.36. This is a suspense fiction with a complex plot involving angels and demons. The only reason we post it here is that one of the protagonists (Tommy) has a father (Arnie) with LBD. While LBD doesn’t play a large part in the story, the authors did excellent research and portrayed the symptoms well. Even it's Kindle price is high for a non-reference book, but the writing itself is quite good and if you like this kind of novel, it would be worth looking for in the library.

Dementia with Lewy Bodies and Parkinson's Disease Dementia: Patient, Family, and Clinician Working Together by J. Eric Ahlskog, $31.19. We had great hopes for this book but reviewers don’t support those hopes. They report that it is too clinical and lacks new information. Even more condemning, it advocates the use of drugs almost exclusively and does not give much space to non-drug solutions. With LBD, where drugs can be so damaging, this is enough to recommend against this book, especially considering the high price.

Making the Connection Between Brain and Behavior, Second Edition: Coping with Parkinson's Disease by Joseph Friedman. $15.38. Instead of the above book, we recommend this book that is half the price and provides better information. Although it is directed to the Parkinson’s community, anyone dealing with LBD can also profit from reading it. While Dr. Friedman comes from a movement perspective, he is also a member of the LBDA Scientific Advisory Council. Dr. Friedman adds enough explanations to help a person understand without getting overly clinical and boring. He addresses behavioral symptoms such as hallucinations, anxiety and much more in a compassionate way with many vignettes to help the reader relate.

LBD & Nutrition-6: Coffee and Tea

This is the last of our blogs on nutrition and its effect on LBD. We seldom think of coffee or tea as “nutrition,” yet, they do contain a variety of substances that may be helpful with dementia.

Caffeine is an alkaloid produced by several plants. It is in the coffee most Americans drink every morning. Lesser quantities are also in black tea, colas and chocolate.
Belief: Drinking coffee delays dementia.

• Fact: True, but impractical. Drinking three to five cups of coffee a day may decrease the risk of dementia. Healthy people who drink this much coffee are less likely to progress into MCI, or may not progress as quickly as they otherwise would. Those who already have MCI will not progress into dementia as quickly either.   Reference
• Concern: This much coffee per day may cause other health problems such as increased blood pressure and heartburn. It is a stimulant and when consumed too close to bedtime can interfere with sleep. It is also a diuretic which can interfere with hydration.

Quercetin. (kwer-se-ten) This nutrient is found in apples, onions, blueberries, red grapes, cranberries, green or black tea and red wine.
Belief: Quercetin improves cognition in persons with PD.

• Fact: Not yet proven. This member of the flavinoid family of plant-based compounds has recently been shown to have a cognitive enhancing effect on PD in rats.   Reference.
• Concern: While this report is hopeful, much research is still needed to support the belief that Quercetin is useful for humans.

Green tea is made from the steamed and dried leaves of the Camellia sinesis plant, native to Asia. It is available everywhere tea is sold.
Belief: Drinking green tea lowers the risk of dementia.

• Fact: True. Green tea protects brain cells from toxins and is associated with a significantly lower risk of cognitive impairment.  Make it a part of your daily fluid intake. It contains quercetin, which may be why it is effective against dementia.

Belief: Drinking green tea calms you down and helps you concentrate.

• Fact: True. It contains the amino acid L-theanine, which calms and aids with concentration.   Reference

Belief: Green tea contains some caffeine and is therefore a mild stimulant and diuretic.

• Fact: False. There is a small amount of caffeine in green tea but not enough to counteract the calming qualities of L-theranine. The amount of caffeine is also not enough to make green tea a diuretic. Therefore, it is as good as water for hydration.  Reference.

Bottom line: Green tea is probably a better choice for a healthy beverage than coffee or black tea and caregivers should consider adding it to their loved one's meals. However, a moderate amount of either black tea or coffee is not likely to be particularly harmful, especially if drunk early in the day.

LBD & Nutrition-5: Fatty Acids

We tend to lump all fats together as “bad.” However, we now know that certain types of fats are necessary for good health. Fatty acids, produced when “good” fats are metabolized, perform a multitude of services for the body. They may even improve cognition.

Source:  Fish, especially salmon, or fish oil supplements are best.  A less powerful type is also found in vegetable and plant products such as flax seed, leafy green vegetables, nuts and seeds, broccoli and cauliflower, winter squash and dry beans. Omega-6 is even less helpful. It can be found in plant oils such as corn, soybean and sunflower oil as well as nuts and seeds. It is less helpful but still better than the saturated fats from animals sources.

Belief: Omega fatty acids help with digestion, decrease infections and improve blood pressure, all systems that can be affected by LBD.

• Fact:  True. There is scientific support that these fatty acids help with the digestion of fat-based vitamins, boost the immune system and lower triglycerides, the “bad” fats which can raise the risk of several other diseases, such as diabetes, stroke and heart disease. Reference

Belief: Omega-3 fatty acids combat dementia.

• Fact: Partially true. Scientific studies about this nutrient’s effect on dementia are mixed. Its value in supplements is questionable but its value in food is supported.  Reference

Coconut oil contains a type of fatty acid also found in palm kernel oil. MCT (medium-chain triglyceride) is used extensively in South Asian countries and can be bought from online health food stores. MCT supplements can also be bought separately.

Belief: The ketones produced when coconut oil is metabolized provide an alternate energy to the brain’s cells, thus moderating the damage caused by dementia. Reference

• Fact: Not yet proven. Although there are many personal stories that ingesting coconut oil decreases dementia symptoms, there is no scientific support for this theory. However, coconut oil is a food source for omega-3 fatty acids, and as such, may have some effect, both direct and indirect upon dementia. (See omega-3 fatty acids, above.)
• Concern: It is apparently important to buy non-hydrogenated virgin oil from organic coconuts. This increases the cost. Although MCT is available as a supplement, fatty acid supplements in general have not proven to be very effective.

Food is usually a better source of fatty acids than supplements. Switch from saturated fats like butter to unsaturated ones like margarine and olive oil. Add nuts to your diet by including them in casseroles and vegetables. Have fish once a week or more.

LBD & Nutrition-4: Water-Soluble Vitamins

This week the blog is about something that at first blush doesn't have much to do with dementia of any kind. However, because LBD increases stress and impairs the immune system, these vitamins are useful and should be considered as a daily supplement.  Unlike the fat-soluble supplements discussed last week, these water-soluble vitamins are excreted in the urine. Excess water-soluble vitamins are not stored in the liver nor do they  build up to toxic levels when taken in amounts of more than the body can metabolize at the time. While food is still the best source of these nutrients, supplements can usually be taken safely in normal doses.

Vitamin B Complex (Folic acid, B6 and B12): These vitamins can be found in fish, poultry, meat and dairy sources.

• Belief: These vitamins help to prevent or slow dementia.
• Fact: True, but impractical. These water-soluble vitamins help in the formation of red blood cells and in the maintenance of the central nervous system, and appear to lower the levels of an amino acid associated with dementia. Studies have shown that large doses of these three vitamins together can decrease confusion, reduce depression and slow MCI.   Reference 
• Concern: The large dosage required makes obtaining an adequate amount from food impractical. Therefore supplements must be used. In addition, injections provide better results than oral supplements, making this a difficult and possibly impractical effort for the average person.
• Belief: These vitamins help to reduce stress, which in turn reduces dementia symptoms.
• Fact: True. A daily oral dose of these water-soluble vitamins has been shown to significantly decrease workplace stress, confusion and depression.  It is reasonable to believe that it would also reduce stress in other areas of one’s life as well. Reference.  
• Belief: Taking Vitamin B12 will prevent dementia.
• Fact: False. It has been known for some time that a deficiency in Vitamin B12 decreases the brains ability to metabolize neurotransmitters and can cause dementia. However, taking Vitamin B12 alone as a preventive measure does not help.   Reference.

Vitamin C: This water soluble vitamin is found in most fruits, green leafy vegetables, broccoli, chestnuts, soy beans and low fat yogurt.

• Belief: Taking Vitamin C lowers your risk of dementia.
• Fact: Not yet proven. This vitamin was associated with a lower risk of dementia in one small study. That study needs to be replicated, preferably with a larger number of subjects before it can be accepted as fact. Reference.
• Belief: Vitamin C is helpful in reducing the infections that occur so often with LBD and which in turn, increase LBD symptoms.
• Fact: True. It has long been known that Vitamin C is associated with the maintenance of a healthy immune system, and therefore is helpful in reducing infection.

While taking supplements of these vitamins is comparatively safe, anyone dealing with LBD should always remember that this disorder makes the whole digestion system sluggish and that drug sensitivities can occur at any time. Larger than normal doses are discouraged without a Lewy-savvy physician's supervision.

LBD & Nutrition-3: Antioxidants

Antioxidants are the body's scavengers, they combat free radicals—unstable molecules that can injure healthy cells and tissues. Lewy bodies are generated when healthy proteins are “misfolded” or damaged. It is possible that removing free radicals decreases that damage.

However, this possibly positive result does not come without dangers. Many antioxidants are fat-soluble vitamins which cannot be excreted in the urine. Taken in larger doses than the body can use, the excess is stored and can become toxic, causing liver damage or other problems.

Vitamin A: Found in most fruits and vegetables, some nuts, dairy products, and tuna.

• Belief: Vitamin A prevents free radicals from turning healthy protein cells into Lewy bodies.
• Fact:  Not yet proven. Vitamin A may be helpful with other disorders but there is still no scientific evidence that this vitamin is helpful in preventing dementia.
• Concern: This vitamin is fat-soluble and therefore, dangerous in the large amount of supplements often recommended.

Beta carotene: A vitamin A precursor can be found in most fruits and vegetables, some nuts, dairy products and tuna.

• Belief: As with Vitamin A, beta carotene combats dementia.
• Fact: Not yet proven. One small study found beta carotene levels lower in people with dementia than in those without dementia. This same study also found that a higher intake of this nutrient by healthy people was associated with a lower risk of later dementia.   More research is needed before this belief can truly be supported.
• Concern: Beta carotene is fat-soluble, and therefore can be toxic when taken as supplements in larger than recommended doses.

Vitamin D:  Small amounts can be found in fatty fish such as herring and tuna. It is also added to many dairy products and sold as supplements.

• Belief: Vitamin D is called the Sunshine Vitamin because just a few minutes of sunshine per day will provide adults with all they need.
• Fact: False. This is true for younger people. However as people age, their skins become less efficient, resulting in vitamin D deficiencies.

• Belief: As an antioxidant, vitamin D decreases the risk of dementia.
• Fact: True. Recent research supports this belief.  

• Belief: Vitamin D helps to make strong bones and keep them strong, important for people that are accident-prone, as is the case for many with Lewy body disorders.
• Fact: True. This vitamin promotes calcium absorption and works to keep bones strong.  It also helps to prevent osteoporosis, a common disorder with older women, which can also weaken bones and make them easier to break.
• Concern: Since this vitamin is less easy to find in foods, doctors may recommend a vitamin D supplement. Be careful not to take more of this fat-soluble vitamin than the recommended dose.

Vitamin E: This antioxidant is found in wheat germ, nuts such as almonds and hazelnuts, vegetable oils such as sunflower and safflower oils, and some green vegetables, such as spinach and broccoli.

• Belief: Vitamin E decreases the risk of developing dementia.
• Fact: Partially true. Since we reported on this vitamin in our 2010 book, this vitamin has been found to be helpful for long term prevention and may have a modest impact on the risk of developing dementia later in life.  
• Concern: The above pertains to vitamin E found in food only. The amount of this fat-soluble vitamin needed be effective in supplement form is toxic and can cause liver damage.

Coenzyme Q10 (CoQ10). This antioxidant can be found in organ meat (heart, liver), vegetable oils, fatty fish, and nuts. Broccoli, sweet potatoes and sweet peppers also contain moderate amounts of this nutrient.

• Belief: CoQ10 can slow down dementia.
• Fact: True, but impractical and possibly dangerous. There is some evidence that suggests this coenzyme may slow down but not cure Parkinson’s dementia.
• Concern: The amount per day required for effective treatment is too large to get easily from food. Supplements are generally used but they are expensive.
• Concern: A variety of diseases and drugs can interact negatively with CoQ10. For example, it decreases the effect of blood thinners. Also, it is fat-soluble. Be sure to talk to your doctor before adding this nutrient to your diet.

Next week: Water-soluble vitamins.

References:
Vitamin A: Dietary antioxidants and dementia 
Vitamin D: Vitamin D, cognition, and dementia.
Vitamin E:  Dietary Antioxidants and Long-term Risk of Dementia.
CoQ10: CoQ10 and Dementia.

LBD & Nutrition-2: Supplements in General

A balanced Mediterranean diet supplies most of the nutrition a person needs. A daily vitamin and mineral supplement is usually enough for anything that was missed. Except for that, it is best to use supplements sparingly, if at all. Researches agree that it is best to get needed nutrients directly from the foods for these reasons:

• Effectiveness. Nutrients in food are generally more effective in combating dementia than the same nutrients in supplement form.
• Regulation. Unlike prescription drugs or even OTC drugs, supplements are poorly regulated. There are no laws governing content. You can never be really sure the label is accurate. 
• Danger. Some supplements can be dangerous when taken in large amounts or taken with other drugs. For example, the amount of antioxidants thought to be useful against dementia is often larger than a normal diet would supply. However, supplements in  these large amounts can be toxic to the liver or other organs.
• Expense. Some supplements are both expensive and dangerous to use without a doctor’s guidance. CoQ10 is an antioxidant with the problems noted above. It can also conflict with prescription drugs a person is already taking. And finally, it is quite expensive.

There are only a few safe drugs even moderately useful in combating dementia and these are prohibitively expensive. Perhaps that is why beliefs abound about the benefits of various nutrients thought to improve cognition. Some stem from anecdotal reports, or personal stories. Others are supported with scientific evidence from clinical trials. These are studies with groups of people, some receiving the treatment and some getting placebos. Anecdotal reports do not provide adequate proof of a theory even when there are many such reports. Clinical trials provide better proof but still need to be replicated before their results are fully accepted, unless the studies are large and well-run.

Issue to be discussed more fully in later this blog series on nutrition:

• Antioxidants (anti-ox-i-dunts): These nutrients are thought to combat LBD by  destroying free radicals
• Water-soluble vitamins are fairly safe. The down side is that none of them specifically combat dementia. However, they may help to combat other problems like infection and stress, both of which can make LBD much worse. 
• Omega-3 fatty acids appear to boost the immune system and lower triglycerides or the “bad” fats. However, there’s a lot of confusions about which foods fit in this category. Other similar foods are Omega-6 fatty acids and are not so helpful. 
• Coffee and tea may not be “supplements” but they have also been touted to be helpful with dementia.

Over the next four weeks this blog will all address each of the above subjects in much more detail. If you have comments or questions about any of these, be sure to speak up.

LBD & Nutrition-1: The Mediterranean Diet

Dementia drugs are only moderately effective in combating dementia. Behavior management drugs are actually dangerous with LBD. So what do you do instead? How do you combat this insidious, always encroaching, always progressing disorder? Physical exercise can slow it down—more than drugs, experts say. Staying socially and mentally active helps too. For years, many have insisted that eating a healthy diet also made a difference.

Now, researchers have specifically identified a Mediterranean diet, low in carbohydrates and rich in vegetables, fish and “good” oils as helpful. You may even want to add a little wine. The antioxidants, vitamins, minerals and fiber in these foods work together to protect against chronic disease, including dementia.

Foods in a Mediterranean diet include:

• Most vegetables, fruits, whole grains, nuts beans and a little wine.
• Limited starchy vegetables like corn, potatoes or peas. 
• Proteins sources such as eggs, cheese, yogurt, fish, and a little poultry but very little red meat like beef.
• Unsaturated fats such as extra virgin olive oil or canola oil instead of saturated fats like butter and bacon grease.
• Limited simple carbohydrates such as bread or pasta and sugar. 

Choose foods that are:

Fresh, or quick frozen. These retain their nutritional value best. Quick frozen can actually be better than fresh because they are processed at the most optimum time.

Unprocessed. Processed food will often include substances that are less healthy such as white flour or corn syrup. Labels should show no more than two items besides the food itself. For instance, clam chowder can have two ingredients besides the clams, vegetables and milk.

Raw, steamed or grilled. Boiling removes nutrients and frying adds saturated fats. Baking can also work as long as the oils from the meat drain away from the food.

Eating the above foods prepared in the above manners decreases the risk of getting metabolic syndrome, a cluster of risk factors for all chronic diseases: high blood pressure, high blood sugar, unhealthy cholesterol levels and abdominal fat. Most chronic diseases are risk factors for dementia.

This overview is only an introduction. For more information, find books about a Mediterranean diet and other related issues in the LBD Book Corner store.
There is more to a good diet than food. The following also help to keep dementia at bay:

Provide a relaxing atmosphere. The environment in which the food is eaten is important too. A pleasant, peaceful atmosphere helps to digest the food better. This becomes more important as Lewy advances. Avoid rushing, annoyance or distraction during mealtimes. Stress and distraction interfere with anyone’s ability to digest food. Add LBD’s more sluggish digestive system and its sensitivity to light, sound and feelings and these distractions can make eating very difficult if not actually dangerous.

Eat at the table as a family. Eventually, Lewy symptoms such as swallowing problems or a changed sense of taste, may make eating more of a chore than a pleasure. Therefore, do everything possible to foster a mood of relaxed enjoyment at meals. This includes making mealtime a family affair. Families who eat meals together tend to be more content.

Keep the focus on the food and the conversation. Soft relaxing music can help to set a calm atmosphere. Loud, intrusive or busy music or a television running in the background can be distracting, especially for the Lewy partner who already has attention deficits. Avoid arguments and even mild disagreements. Mild laughter is helpful but too much excitement is distracting.  Lewy can cause feelings of intense excitement to be interpreted as intense fear or anger or other negative feelings.

Nutrition. A balanced Mediterranean diet supplies most of the nutrition a person needs. A daily vitamin and mineral supplement is usually enough for anything that was missed. Except for that, it is best to use supplements sparingly, if at all. Instead, get the needed nutrients directly from the foods. First, nutrients in food are generally more effective in combating dementia than the same nutrients in supplement form. Secondly, unlike prescription drugs or even OTC drugs, supplements are poorly regulated. There are no laws governing content. You can never be really sure the label is accurate. Finally, certain supplements can be dangerous.

That said, the next few weeks will discuss some of the supplements thought to help with dementia. Let us know if there is a certain one you want to know about. We’ll do the research.

Zelman K. (2011) The Mediterranean Diet. WebMD. Edited August 16, 2011. www.webmd.com/food-recipes/guide/the-mediterranean-diet