The Whitworths of Arizona, bringing science to you in everyday language.

Friday, October 25, 2013

Dementia's Three Fears

Three things high on the list that many people at risk for dementia fear are losing their driver’s license, losing the ability to handle their own finances and placement in a nursing home. At the center of these is losing one’s independence and the feeling of no longer being in control of one’s life. These fears are all valid. Dementia does increase a person’s dependence on others. It can take away the ability to drive safely if at all while removing the ability to comprehend the dangers involved. It can take away the ability to make sound decisions while increasing impulsivity so that unsound, sometimes disastrous actions occur before someone intervenes. It can make residential placement necessary, while removing the ability to understand why.

How can you avoid these catastrophes? How can you make the transitions to dependence less painful? The answer is that sometimes you can’t. And especially you can’t if you aren’t aware that there’s a problem—or if you resist the idea even in the present of obvious warning signs. Dementia can sneak up on families and do its damage before anyone acknowledges there is a problem at all. We all want to think our loved ones—and ourselves as well--will maintain reasonably good cognitive functioning well into old age. It’s easy to see LBD’s “good days” and “showtime” as the norm and make excuses for the confusion of its “bad days.” It’s easy to overlook the warning signs as the mistakes “anyone makes once in a while.”

But the price for that is losing the chance to prepare, to make plans while the person at risk still can have input. Without that input, later decisions will be harder for the caregiver to make and for the loved one to accept. Without recognition of what the future might bring, caregivers make promises they can’t keep and their loved one feels blindsided.

Some people deal with warnings of dementia by denying it. They insist that nothing is the matter and therefore, no changes need to be discussed. Some face the possibility of dementia head on and look for ways to fight it, even to cure it. Neither of these extremes works well. The first fails because we can only deal with problems we admit are present. The second fails because we can’t fight an incurable disorder like dementia. We have to accept it and then flow with it, adapting to maintain functioning as long as possible.

Prepare for what might happen in the future--the earlier, the better. Caregiver, loved one and anyone else who needs to be should be involved. Have conversations what the red flags are for unsafe driving and financial decisions or that home care has become unsafe—and what to do once they appear. How can a person give up their driver’s license with dignity? Who should be in charge of financial, legal and medical decisions if needed? What alternatives to home care are best?

These decisions made and documented well ahead of time allows the caregiver to know how to proceed and enables their loved one to accept the necessary changes more easily. They may not like the changes, but they will feel some ownership of them. This is true even if they no longer remember the discussion. It is still there somewhere in their subconscious. Over and over, caregivers have supported this with their stories.

Sunday, October 20, 2013

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.

Friday, October 11, 2013

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.

Friday, October 4, 2013

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.