Tuesday, July 28, 2015

Dr. Richard Taylor Goodbye My Friend.

It saddens me to tell you that my friend and cohort in this fight against Alzheimer's passed away on July 25, 2015.  It was not his Alzheimer's that took him but his additioal battle with throat cancer. I have known Richard since about 2005 when we met through our blogs on Alzheimer's. I feel the grief the family must fill, but I rejoice that my friend is finally free and able to be happy. I am a better person for having known him, although we did have sharp disagreements. Good Bye my friend and now you walk with the Lord, yes I am jealous.

Every year Alzheimer's claims the lives of over 500,000 people, about 1 every 67 seconds. Where is the real out cry against this. Not the establishment or those groups that placate them and feel a gentle approach is needed.  I suffer from the disease and say screw that idea, civial disobidence is the way, with loud marches, letter and fax campaigns and voting those out of office that do not want to fund research fully. How did AIDS get the money, what about the 60 mile marches for breast cancer. How did civil rights get attention and work to help make it a real part of our lives?

Richard was diagnosed in 2001 with this wonderful disease, Alzheimer's. He outlived the normal life span of 2 - 10 years, by 4 years. Maybe if he had not had Alzheimer's weakening his body and taking it's pound of flesh, he may have not gotten cancer. Food for thought.

God Bless & Keep You & This Country of Ours!
joe

Saturday, July 25, 2015

Alzheimer's or Dementia?



EXPERT

Alzheimer’s or Dementia: What’s the Difference?

Sunday, July 12, 2015

Illustration of the brain
Alzheimer’s disease is the most common type of Major Neurocognitive Disorder, formerly known as dementia. Learn more about the difference between Major Neurocognitive Disorder, Mild Neurocognitive Disorder, and the pre-symptomatic phase of Alzheimer’s disease.
Bill looked at his father, Walter, who for the third time was telling us about the great times he had in the army after he enlisted around 1950. Walter became a successful engineer who worked productively into his mid-70s. When he experienced increasing forgetfulness, he recognized the need to wind down his career. He moved into the friendly and stimulating environment of a local assisted living facility’s memory unit. His life there was a good one. His close family relationships continued. He enjoyed detailed memories of the past, but recent events no longer made a lasting impression on his mind.  Bill asked me, “What is my father’s diagnosis? Is he demented? Does he have Alzheimer’s disease? And what’s the difference between dementia and Alzheimer’s disease?”

Everything Changed in 2013

This question often comes up in a clinical interview, and up until recently the answer would have been that dementia is diagnosed when a person has a severe memory problem in addition to difficulty with language or another cognitive function, and that Alzheimer’s disease is the most common type of dementia. In 2013, though, everything changed.
The new psychiatric Diagnostic and Statistical Manual (DSM 5) renamed “dementia” as “Major Neurocognitive Disorder” and added a new, less severe category of cognitive difficulty called Mild Neurocognitive Disorder.
Major Neurocognitive Disorder is diagnosed when disturbance of a single cognitive ability is severe enough to interfere with independence and the disturbance is not caused by drug use, delirium, or various other medical or psychiatric conditions. The cognitive abilities that are tested for this diagnosis are:
  1. complex attention;
  2. language;
  3. executive function (which are skills that enable people to plan, organize, remember things, prioritize, or pay attention to tasks,  for example);
  4. visuospatial function (the visual  perception  of  spatial  relationships  among  objects;,
  5. memory; and
  6. social cognition.

Where Does Alzheimer's Fit In?

Alzheimer’s disease is the most common type of Major Neurocognitive Disorder, but it is only one of many possible causes. Vascular cognitive impairment, dementia with Lewy bodies, frontotemporal dementia, Parkinson’s disease, Huntington’s disease, HIV, traumatic brain injury, and other conditions each can cause severe cognitive changes.

Mild Impairment

Mild Neurocognitive Disorder (formerly called mild cognitive impairment or MCI), by contrast, is diagnosed when a less severe cognitive problem exists, manifested as difficulty with one of the six listed mental functions (listed above) that is significant enough to require compensatory activities, such as writing everything down in order to remember. Mild Neurocognitive Disorder, by definition, is not bad enough to rob a person of basic independence. The DSM 5 says that one possible cause of Mild Neurocognitive Disorder is Alzheimer’s disease, but it is only one of many medical or psychiatric conditions that can cause this clinical condition. In other words, Alzheimer’s disease can be present without Major Neurocognitive Disorder or dementia, and dementia can be present without Alzheimer’s disease.

Alzheimer’s Begins Years before Symptoms are Apparent

The DSM 5’s new definitions followed a series of very influential articles published by Alzheimer’s disease researchers in 2011. These experts encouraged us to recognize Alzheimer’s disease as a disease pathology rather than as a clinical syndrome. In other words,  to understand that the effects of Alzheimer’s disease on the brain begin many years before memory loss or behavioral changes become apparent. The 2011 expert statement defined three stages of Alzheimer’s disease. The dementia (Major Neurocognitive Disorder) phase is only the final stage. Earlier symptoms are recognizable in a symptomatic, pre-dementia phase (Mild Neurocognitive Disorder). With amyloid PET scanning or various other biomarker measurements, doctors can also determine the presence of Alzheimer’s disease pathology in the brains of people with no apparent clinical symptoms. This is the asymptomatic, or pre-symptomatic phase of Alzheimer’s disease.
The illustration below shows that Alzheimer’s disease can manifest itself with clinical symptoms ranging from none to major.  Alzheimer's, however, is not the only cause of Major Neurocognitive or Mild Neurocognitive disorders.
The Relationship of Alzheimer’s Disease to Neurocognitive Disorders

A Diagnosis and an Important Question

When Walter was examined further in our clinic, we decided that his memory troubles were indeed the result of Alzheimer’s disease. He had Major Neurocognitive Disorder and we were unable to identify any other medical or psychiatric disorder that could be responsible for his condition. An amyloid PET scan of Walter’s brain would likely have showed accumulation of beta amyloid, the disease-associated protein found in the brains of people with Alzheimer’s. Bill asked, “What about me? Will I get Alzheimer’s disease?”
What we know now from biomarker research allows us to answer Bill’s question in a way that would not have been possible for past generations. We can tell Bill that he definitely does not have dementia, and that if he has Alzheimer’s disease it is in the pre-symptomatic stage. Occurrence of the disease in his father puts Bill at a small increased risk, so we’ll watch him in the future. For the present, we’ll encourage him to adopt a brain-healthy lifestyle that includes management of chronic medical diseases, stress reduction, healthy eating habits, adequate sleep, plenty of physical activity, engagement with others, and cognitive stimulation. Of course, this brain healthy lifestyle is a good prescription for all of us!



The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for personalized advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product or therapy. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.

These articles do not imply an endorsement of BrightFocus by the author or their institution, nor do they imply an endorsement of the institution or author by BrightFocus. 

God Bless & Keep You & This Country of Ours!
joe

Tuesday, July 14, 2015

Vitas HealthCare Advance Directive for Alzheimer's Patients

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We hear about the importance of having advance directives (ADs) in place in the event that we are permanently unconscious, or when illness becomes terminal and we are no longer able to make decisions on our own. We urge young, healthy people to think now about what they might want under those circumstances, to talk about it now with loved ones and to write it down now in a state-approved form.

ADs are of particular importance for persons with dementia, because nearly all dementias are

progressive. Therefore, individuals with dementia can be expected to decline to a state in which they can no longer communicate their treatment wishes. They are then dependent upon caregivers, family, surrogates and physicians to make their healthcare decisions. 
Ideally, anyone who is diagnosed with Alzheimer’s disease has long ago completed an AD, or does so soon after diagnosis. But reality is never ideal. And even if healthcare decisions are written down in black and white, what of the other decisions that may need to be made throughout the life of a person with Alzheimer’s? When is the patient competent? When is he/she not? Generally, a person is considered legally incapacitated when two doctors have tested and examined the patient and completed certificates of incompetency.

When There Is No Advance Directive

When there is no AD and family and professionals are assessing the competence of a person with Alzheimer’s, the Alzheimer’s Association urges “the least restrictive alternatives”—in other words, choose to protect the person’s right to make his/her own decisions whenever possible.
The Association endorses other principles that protect what it calls “respect for authority”:
·                            The wishes of a person with dementia should be considered whenever possible and until safety becomes an issue.
·                            Diagnosis of Alzheimer’s disease alone is not an indication of incompetence.
·                            Competent people have a right to reject any medical treatment. Many people with mild or moderate dementia retain this right, and it should be protected.
·                            A person with Alzheimer’s disease may lack capacities to drive, handle financial affairs or live independently in the community, but retain the capacity to make competent decisions about place of residence and medical care at the end-of-life.
·                            Appointing a legal guardian for specific tasks, such as financial affairs, might allow a person with Alzheimer’s disease to maintain a degree of independence over other matters.
·                            Being uninhibited, remiss about hygiene, inclined to mishaps or unable to keep things tidy does not indicate mental incompetence.
·                            It may be appropriate to appoint a legal guardian to make decisions about property or finances, for example, yet leave other decisions—perhaps personal care, food, shelter and medical care—to the person with Alzheimer’s disease. 

The Importance of Legal Documents

It is important to plan for the incompetence of advanced dementia via legal documents, many of which vary according to the state in which the person lives. The most common include:
·                            Advance directives: Oral and written instructions about one’s future medical care, including the naming of a healthcare agent and acceptable life-sustaining procedures, in case one is unable to speak for oneself. It can take the place of two individual documents: the living will and the durable power of attorney for healthcare (also referred to as healthcare power of attorney, healthcare proxy and appointment of a healthcare agent).
·                            Living will, which establishes one’s wishes concerning end-of-life care, the use of life-support systems and the treatments one does and does not want.
·                            Durable power of attorney for healthcare, which assigns decision-making authority on medical matters to a particular person if one is no longer competent.
·                            Estate will, which describes how one’s property will be dealt with after death.
·                            Plans for one’s future care needs.
·                            Research directives to allow one’s participation in research studies.

An Advance Directives Specifically for Alzheimer’s Patients

In the last several years a new advance directive has been developed allowing people coping with Alzheimer’s disease and dementia to document what their lives will be like when they are no longer competent. Called the “Alzheimer’s Disease and Dementia Mental Health Advance Directive,” it is legal in some states.
It’s value, however, is not in its legality, but in its comprehensive look at life with Alzheimer’s. Issues include where you will live, how to finance your care, changes in an intimate relationship, when to stop driving and how pets will be cared for. Filling it out sends a message: I do not want another’s judgment substituted for my own. Whether or not the document is legal in your state, it is a clear guideline for loved ones.
A two-page “Values Worksheet” at the end of the six-page AD helps people think through their options. It can be filled out and shared with family, serve as a springboard to discussions or work literally as a worksheet.

Questions of Competency

By documenting your desires and care goals when you are well enough to make decisions, you remove a burden from your loved ones and exert more control on future decisions. Early documentation also prevents questions later about whether you had the capacity to make the directive when you did. (You cannot make any directive after you become incapacitated.)
If the person with Alzheimer’s is no longer competent and has completed no directive, decisions generally fall to the spouse. If that person is not able to do the job, decisions fall to the oldest child. A better approach than asking any one person to be responsible is for the whole family to talk about the person with Alzheimer’s, how he lived and what he believed in. General agreements about what he would want help avoid family rifts when a difficult decision—like resuscitation or feeding tubes—must be decided.
We have the right to make our own healthcare decisions—even when we have Alzheimer’s disease. Making advance directives is not only a gift to loved ones, it’s a gift to the person with Alzheimer’s.


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God Bless,
joe

Tuesday, June 16, 2015

Of Late

I have heard some noise about a study in Australia, where APPARENTLY they claim to have reversed and "cured" some with Alzheimer's. Since this has been very sparce I wonder about it. I will try and get more info and post what I find out.
I am always suspect of this kind of stuff.

Well off hunting I shall go, with blazing speed, you know slow. That is me today and trying to put a post together is difficult. Wife sys when you think of something write it down. Then put ideas together in a post. Easy for her to say, by the time I go to write it down I forget have of it.. I just cleared my desk of so much junk. That is a problem, I write it down in my own language and then look at it and wonder what the hell.

Life sucks now, I keep taking these trips to the floor and out of bed again.  All part of the process Nice thig I am forgetting a lot out of the past. Hell remembering this morning is a job. I have a new cat, got her from the pound about year ago, see how fast I remember to share things. She is a calico colored persian. We took her because she was 13, no one wanted her with her health problems. So she is with us and healthier and even is finally beginning to learn how to play. She has dementia forgets things quickly, fits in perfectly.

God Bless & Keep You & This Country of Ours!
joe

Saturday, June 13, 2015

Study on Alzheimer's request.

Following is an email I received requesting help.
_____________________________________________________________________________


It is only with the help of people who participate in clinical trials that we can learn more about
Alzheimer's disease and help find effective treatments. There is the satisfaction of knowing that you
are helping others and potentially future generations. As a study participant in a clinical trial,
Alzheimer's patients and their caregivers have access to a healthcare team who may help you
understand Alzheimer's better. Currently three studies are underway to investigate whether a research
drug called idalopirdine, given in addition to the Alzheimer's medicine, donepezil, rivastigmine or
galantamine, improves brain functioning in areas such as memory, thinking and reasoning. It is
important to note that idalopirdine has already been tested in clinical studies with promising results.
To find out more click here: http://alzheimersstudy.com/24.htm



God Bless & Keep You & This Country of Ours!
joe