Scientists are getting closer and closer to a critical milestone in diagnosing Alzheimer’s patients. They are extremely close to succeeding at creating a blood test to screen people for the disease.
Currently, Alzheimer’s is diagnosed only after people start having memory problems or unexpected change in behavior. They then undergo an in-depth medical interview, a memory assessment test and occasionally an MRI to look for brain shrinkage. The problem is that these processes are overly expensive and impractical for routine use.
That’s why two recent studies are being hailed around the medical world as a large step forward in Alzheimer’s research. Australian researchers reported a few weeks ago that their blood tests showed more accuracy than ever seen before when tested with over 1000 patients. “The test correctly identified 83 percent of people with high amyloid levels and correctly ruled out 85 percent of people without this condition”.
The other study used blood tests to screen for autoantibodies (special markers in blood) and showed even better experimental results. “The blood test correctly detected Alzheimer's disease in people already diagnosed with the devastating brain disorder with 96 percent accuracy, according to the researchers. The test could also distinguish who didn't have the disease from a control group of non-affected adults with 92.5 percent accuracy”.
This research is a huge step forward but the scientists cautioned spectators saying that there is still a long way to go. Let’s hope that future studies like these continue to show as exciting and ground-breaking results.
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
In the United States more than 700,000 people suffer a stroke every year, and about two-thirds of these individuals survive and require rehabilitation. Rehab aims to help these survivors reach the best quality of life and become as independent as possible. Reaching this goal requires an understanding of the important elements of recovery at home which will be discussed here.
As briefly mentioned in a previous post, therapy at home has recently been found to be a more effective treatment method than high-tech intervention. Duncan’s 2011 study regarding stroke patients concludes that “patients given the treadmill intervention were also found to be at higher risk for falls when started early, making in home therapy safer”. Another study directed by Nancy E. Mayo (PhD, associate professor at the school of physical and occupational therapy at McGill University) decisively concludes that “home is the best place for stroke rehabilitation” and “going home…empowers the survivor and the family to take charge of the care”. Given these facts, patients need to understand the steps they can take to even further improve their rehabilitation process.
Here are a few tips for improving your post stroke recovery at home according to the National Stroke Association:
- Ask your doctor to arrange a home visit by an occupational therapist, who is trained to help you regain your independence
- Adjust or add lighting throughout your home to decrease glare and help you see better
- Keep telephones within easy reach
- Write out emergency phone numbers in large font and keep them in several easy to find locations
- Accept help with chores such as cleaning, making meals and errands
- Install sturdy handrails and grab bars in your bathroom to prevent injury
- 40% of stroke survivors suffer serious falls within the first year of recovery at home, use these tips to prevent that:
- Move extra furniture out of the way
- Clear paths to important rooms like the kitchen, bathroom and bedroom
- Move electrical wires out of walkways
- Wear non-skid shoes and avoid slippery surfaces
- Install handrails for support when going up and down stairs
Following this advice in addition to consulting an occupational and physical therapist can make post-stroke recovery an easier process for those faced with the circumstances.
 National Institute of Neurological Disorders and Stroke. “Post-Stroke Rehabilitation Fact Sheet”. http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm
 Kathleen Blanchard, RN. “At home physical therapy safer than high tech stroke rehabilitation”. http://www.emaxhealth.com/1020/home-physical-therapy-safer-high-tech-stroke-rehabilitation
 ”Home Is the Best Place for Stroke Rehabilitation”. May 5, 2000. Medscape Medical News. http://www.medscape.com/viewarticle/411846
 National Stroke Association. “Recovery After Stroke: Managing Life at Home”. http://www.stroke.org/site/DocServer/NSAFactSheet_ManagingLifeatHome.pdf?docID=994
Physical therapy is centered on identifying and maximizing the quality of life and movement potential of patients in treatment, prevention and rehabilitation. There are many different settings where physical therapists can treat their patients including hospitals, schools, nursing homes and private homes. This article will focus on the home setting and outline the benefits of taking that approach.
Many recent studies have described the home-based therapy approach as safer, more efficient and more effective in comparison to other strategies. According to Dr. Pamela Woods Duncan’s (PhD, PT, professor in the Doctor of Physical Therapy Division at Duke University) 2011 NIH-funded study about stroke patients, “home-based intervention is more accessible, more feasible, and it was also associated with fewer risks”. In a similar study, “Young and Forster found that home physiotherapy [was] more effective and resource-efficient than day hospital-based rehabilitation”.
Outside of stroke patients, the benefits of in-home therapy are also clear for the elderly. Researchers from the Yale School of Medicine concluded that “the decline of frail elderly people living at home can be slowed, if not prevented with a home-based physical therapy program”. This makes sense because favorable treatment outcomes depend to some extent on patients following therapy instruction and the elderly are more likely to do so with one-on-one care at home.
Other benefits of physical therapy in the home include:
- “Improved compliance by not missing treatment sessions
- Therapists can evaluate a patient in their real natural environment
- Patient's don't have to travel to a clinic thus making it more time efficient
- Privacy for the patient and their family
- Eliminate disruptions from other clients, phone calls, etc.
- Following surgery, having a therapist come to the home may eliminate complications of driving a car or having to negotiate dangerous obstacles on your way to an outpatient clinic.”
Although in-home physical therapy is not for everyone, it is an option that merits consideration. If you’re the type of person who wants to stay close to home with your friends and family while still receiving quality care, then this may be the perfect option for you.
 Kathleen Blanchard, RN, “At home physical therapy safer than high tech stroke rehabilitation”, http://www.emaxhealth.com/1020/home-physical-therapy-safer-high-tech-stroke-rehabilitation
 Jau-Hong Lin, Ching-Lin Hsieh, Sing Kai Lo, Huei-Ming Chai, and Long-Ren Liao, “Preliminary Study of the Effect of Low-Intensity Home-Based Physical Therapy in Chronic Stroke Patients”, Kaohsiung J Med Sci 2004;20:18–23
 “Physical Therapy Benefits Elderly”, The New England Journal of Medicine, 2002;347:1068-1073, http://www.selecthomecare.net/index.php/our-services/physical-therapy/therapy-benefits.html
 Brad Gilden, DPT, MSPT, CSCS has been practicing orthopedic and sports physical therapy over the past six years, “Benefits of In Home Physical Therapy”, http://ezinearticles.com/?Benefits-of-In-Home-Physical-Therapy&id=82678
Picture from: http://www.smarterlivingestate.com/physical-therapy-treatment-for-chronic-low-back-pain/
Patient compliance with medication post-hospitalization is a vital concern to all hospital personnel because it can dictate the final outcome of treatment. There have been a variety of studies on this subject which all indicate a growing gap between patient compliance and original discharge orders.
One study among the elderly (age 65+) concluded that “64% used at least one medication that was not ordered by the physician at discharge, and 73% failed to use at least one medication according to the way it was ordered. Of all drugs ordered at discharge, 32% were not taken at all”. From these statistics it is clear that medication compliance is one aspect of healthcare that currently needs improvement.
Another more recent study suggested that: “patients do not feel adequately prepared to participate in their post-hospital care. The brief period immediately before discharge may not be an ideal time to convey new and complex information to older patients, as pain, anxiety, sleep deprivation, or delirium may limit receptivity or new learning”. This study concludes that medication compliance can be improved by system quality improvement activities such as receiving more feedback from patients after discharge or having nursing care outside the hospital. Similarly, a recent New York Times article citing Michael Wolf, an associate professor of medicine at Northwestern University, suggested a universal medication schedule. Wolf called it a “ridiculously simple [and] incredibly basic idea” which could solve medication compliance problems for good.
Improving medication compliance after discharge should be a larger focus for healthcare professionals because it directly affects patient safety, quality of care and cost.
 Beers MH, Sliwkowski J, Brooks J. “Compliance with medication orders among the elderly after hospital discharge”. Hosp Formul. 1992 Jul;27(7):720-4
 Eric A. Coleman, MD, MPH; Jodi D. Smith, ND; Devbani Raha, MS; Sung-joon Min, PhD. “Posthospital Medication Discrepancies”. Arch Intern Med. 2005;165:1842-1847
 Paula Span. Author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.” NYT. “A Dose of Confusion”. http://newoldage.blogs.nytimes.com/2011/06/15/a-dose-of-confusion/#more-9327
Image from: http://www.senior.com/health/prescription-drugs/medication-safety-for-seniors/
Anxiety can be an important factor in determining outcomes of recovery both during and post-hospitalization. Several studies suggest that there is a direct correlation between increased anxiety and poorer treatment outcomes.
This is especially true in the context of cardiac cases as “studies show that anxiety is independently associated with a higher risk of in-hospital complications in patients”. Moser’s study concludes that “interventions that increase patients' perception of control may help diminish the link between anxiety and poorer outcomes”. Some interventions will require the one-on-one care of a nurse and many companies stand ready to provide those services to those who need it. In addition, there are many common methods for reducing anxiety including:
- Talk to a friend or family member. These people are not replacements for professional help, but they can be there to listen when you need them. Sometimes letting off a little steam can help.
- Exercise. Taking a walk or riding your bike allows your body to release endorphins, which contribute to feeling good and reducing stress.
- Reduce your caffeine intake. Caffeine is a stimulant and that is the last thing a person suffering from an anxiety disorder needs.
- Laugh. Nothing reduces stress like laughing. If you walk around feeling miserable, you will be miserable, but if you laugh life seems better.
- Take ten minutes and relax. Do something relaxing: take a hot bath, read a book, listen to music, anything to make you forget for a few moments about your anxious feelings.
In order to increase the chances of a future event-free survival (especially in the context of heart conditions), reducing patient anxiety is a must. The ideas above should aid in this process but for serious concerns, please get in contact with a doctor.
 Debra K. Moser, RN, DNSc, “’The Rust of Life’: Impact of Anxiety on Cardiac Patients: Relationship Between Anxiety and In-Hospital Complications in Patients With AMI”, American Journal of Critical Care. 2007;16(4):361-369
 “What are some steps for reducing anxiety?”, http://www.allaboutlifechallenges.org/reducing-anxiety-faq.htm