A new study suggests that symptoms of Alzheimer’s may be harder to detect in patients over the age of 80. The study tested the relationship between age-related brain shrinkage and Alzheimer’s correlated memory loss. It used just over 100 Alzheimer’s patients and 125 dementia-free people who were grouped by age.
These participants then underwent a series of brain tests with scans that looked at attention, information processing speed and memory.
“People in both groups had similar levels of overall cognitive impairment, but the pattern of changes associated with Alzheimer's disease seemed to be less noticeable in very-old patients than in the young-old”.
Compared to other younger patients, the immediate memory and processing speed in very old Alzheimer’s patients was less abnormal indicating that it may be harder to diagnose.
The study also demonstrated that 80+ Alzheimer’s patients had less thinning of certain areas of the cerebral cortex and cerebellum than the younger patients. This also supports the “hard to diagnose” conclusion because thickness of these brain areas decreases in everyone with age so the differences aren’t as noticeable.
A new study revealed that two commonly prescribed antidepressants for dementia patients are not better than a sugar pill for reducing depression symptoms in Alzheimer’s patients.
This study published in the Lancet tested Zoloft (sertraline) and Remeron (mirtazapine), which are both generic antidepressants that have generated more severe side effects than placebo. These side effects have led researchers to suggest that these types of medicine should be only used in dementia patients who cannot be treated in a simpler fashion.
The study only tested around 300 patients but was still the largest placebo-controlled trial to date on antidepressants in dementia patients.
More than one-fifth of the 35 million people around the world who have dementia have also been linked with depression symptoms, making this study immensely important. “Alan Manevitz, M.D., a psychiatrist at Lenox Hill Hospital, in New York City, agrees with the authors' conclusion that doctors should consider nondrug treatments before prescribing antidepressants to depressed dementia patients”.
This study is a key step forward yet it is surely not a final statement on the subject. It was a bit small and the findings weren’t diverse enough to apply to a large population of patients. Hopefully more progress will be made on this issue in the future.
Dementia is a reduction in brain function that occurs with certain diseases such as Alzheimer’s. It adversely affects memory, thinking, language, judgment, and behavior. Alzheimer’s is extremely common as it affects 13% of people over 65 and 50% over 85 years old. Extreme agitation and aggression are commonalities in patients with advanced dementia and can create extreme stress for loved ones as well as medical practitioners. These facts make new research increasingly important in the fight to help as many people as possible.
A new study concludes that ordinary painkillers may work more effectively than antipsychotic drugs to calm agitation in dementia patients. Normally, powerful antipsychotics are the primary medications prescribed but this treatment can cause strokes and even death. This new study led by Dag Aarsland treated over 300 patients with one of four different medications.
The patients treated with ordinary painkillers such as paracetemol showed a marked improvement leading researchers to conclude that “the intervention produced a clinically and statistically significant reduction in agitation and pain”. The scientists urged more studies to confirm their results but this definitely opens the door to newer and simpler treatments for dementia patients. Hopefully this is another key step in the path to helping every patient in their recovery.
 PubMed Health Definition, “Dementia”, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001748/
 Marlowe Hood, AFP, “For dementia, common painkillers may work best: study”, http://news.yahoo.com/dementia-common-painkillers-may-best-study-160607059.html
Previous articles both on this blog and other sources have indicated that genetics and age are the primary factors that contribute to Alzheimer’s and dementia but new studies show that there are other more surprising indicators as well.
The author of the study, Kenneth Rockwood concluded that “keeping up with your general health may help reduce the risk for dementia”. The study followed over 7,000 people who were older than 65 and cognitively healthy. It evaluated their conditions at both the five and ten year marks after the start of the study.
This study looked beyond the normal factors associated with Alzheimer’s and dementia. “Researchers evaluated the group based on an index that included 19 different health deficits frequently associated with aging...it was the first time an evaluation of dementia using non-cognitive factors has ever been done. After 10 years, 40 percent of the participants had died. Of the participants left, 607 had developed Alzheimer’s or some other form of dementia, while an additional 677 participants had developed some other cognitive problem. The remaining 883 participants who were cognitively healthy were the subject who scored lowest, or healthiest, on the initial health index evaluation. Those who had died or had developed dementia or Alzheimer’s were among patients who had scored highest on their initial health index evaluations. Researchers also found that each health problem a participant had, made him or her 3% more likely to develop dementia over those who didn’t have the same problems” .
Although further research is needed in this area, it is clear that by improving general health people should be able to lessen the likelihood of having to deal with Alzheimer’s or dementia later in life.
 Nadia Kounang, “General health may tell your Alzheimer's risk”, http://thechart.blogs.cnn.com/2011/07/13/general-health-may-tell-your-alzheimers-risk/?hpt=he_c2
A growing problem in nursing home care is the over-medication of patients. This is an issue that has existed for many years but it is now just coming to the forefront of many healthcare discussions.
A recent study by a team of University of South Florida researchers discovered that “71 percent of Medicaid residents in Florida nursing homes were receiving a psychoactive medication…even though most were not taking such drugs in the months before they moved in”. This illustrates the large degree to which nursing homes are over-using medication.
Many speculate that this practice of over-medication is being used by nursing homes in order to stop patients from requiring extra attention and making them less of a hassle to their care-takers. This problem has been compounded by the fact that only half of nursing homes provide weekly patient consultations with mental health experts which means medication has been overused because it is simpler when patients are suffering.
This can cause several problems as the FDA “says elderly people with dementia face a higher risk of death when treated with such drugs”. It also can cause your loved ones to act differently and show increased confusion about their surroundings and in their interactions with others.
There are several potential solutions to this scary situation including attending federally required nursing home quarterly care planning conferences. This will allow you to have a voice in your loved one’s treatment which is crucial to changing this practice of over-medication.
An even more direct solution would be pursuing nursing home alternatives like private healthcare companies. These companies such as Hotelrecovery guarantee you the best care for those you love while avoiding the institutional constraints of nursing homes.
 Paula Span. The author of the recently published “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions”. “Overmedication in the Nursing Home”. New York Times. January 11, 2010. http://newoldage.blogs.nytimes.com/2010/01/11/study-nursing-home-residents-overmedicated-undertreated/
 AP. “Gov't warns on use of psych meds in nursing homes”. http://old.news.yahoo.com/s/ap/20110509/ap_on_he_me/us_nursing_homes_overmedication
Faced with patients who would try to "escape" nursing homes for homes where they had lived many years ago, a German elder care organization found that missing Alzheimer's and dementia patients often were found at bus stops, as their still-functioning long term memory told them they could get home by taking a bus.
Rather than dealing with the police, a nursing home in Dusseldorf tried a radical approach: They installed a fake bus stop.
Residents were delighted with the autonomy they were given, and staff could intercept patients as they waited for a bus that would never come. The now-famous experiment was replicated at other nursing homes in Germany, and became a prime example of "redirecting," a strategy for dealing with Alzheimer's patients who cannot be reasoned with.
In a recent edition of the New York Times' New Old Age blog, a similar tale of redirecting is recounted. A woman in a nursing home is obsessed over the "theft" of a red box and gray suitcase, to the point that she cannot be distracted from her obsession. Family members and staff try to reason with her, but find that it is to no avail. Finally, a family member brings a red box and suitcase to her room and tells her that he's found them. She is once again at peace.
Those with Alzheimer's often cannot be "taught," as their often irrational behaviors are due to the loss of brain tissue. Rather than arguing with a loved one with Alzheimer's to no avail, experts recommend "redirecting" the situation to bring peace and comfort to the situation.
Here are some examples of redirection from the New York Times and a handout from the Alzheimer's Association:
- A loved one expresses a desire to go to a childhood home that's 3,000 miles away. Instead of listing the reasons why a multi-state trek is difficult or impossible, the caregiver says that the trip is OK but that he needs to get dressed first. Often, the small delay will be enough time that the original intent for getting dressed will be forgotten.
- If someone with Alzheimer's says they want to travel somewhere, often a short walk will satisfy their curiosity.
- If a person with Alzheimer's asks for a friend or relative who died years ago, don't remind them of the death. Say something like, "I'm sure he'll be here any minute," or "I'm sure he's fine."
As the Alzheimer's Association states, "Wait for an opportunity to redirect and always talk positively about the future. Remember, you can never win an argument with an Alzheimer’s patient."