Pain relievers: do they or do they not prevent Alzheimers?

Previous studies have reported that pain relievers such as the anti-inflammatory drugs (NSAIDs) may prevent the onset of Alzheimer’s disease. This study by American researchers, however, shows a different story.

The researchers looked at 2,736 members of Group Health, an integrated healthcare delivery system, who did not have any form of dementia when they were enrolled in the study. The average age of the study group was 75 years. The researchers then tracked these patient for 12 years, monitored their use of NSAIDs, both as prescription and over-the-counter (OTC) drugs, and their likelihood of developing dementia especially Alzheimer’s disease.

In the study group, 351 participants had a history of heavy NSAID use at the start of the study. Over the follow up period, another 107 participants became heavy NSAID users. “Heavy use was defined as having prescriptions for NSAIDs at least 68 percent of the time in two years.”

The results of the monitoring for dementia gave the following results:

• 476 participants developed Alzheimer’s disease or dementia during the study period.
• Heavy NSAID users were 66% more likely to develop dementia compared to those who use little or no NSAID.

According to study author Dr. Eric B. Larson, executive director of Group Health Center for Health Studies.

“Although we hoped to find a protective effect, there was none. Thus, for this age group, there’s no basis for taking NSAIDs to prevent Alzheimer’s disease. Our study in this quite elderly population showed more risk of dementia with NSAIDs, especially when used heavily.”

The study results indicate a need to re-evaluate earlier research findings that suggested that NSAID use can delay or even prevent onset of Alzheimer’s disease.

There were, of course, key differences between previous studies and this study. For one thing, the study participants in this study are on average older. This could have a big influence on the results considering that dementia and Alzheimer’s disease are basically an elderly disease, even though there are cases of early onset.

NSAIDs such as Ibuprofen are available over-the-counter are popularly used as anti-fever drugs and pain relievers. In the older population, NSAIDs, marketed in the US as Advil, Motrin and Aleve, are used as pain relievers especially among those who suffer from arthritis. Recently, the US FDA has issued new labelling requirements for OTC drugs including NSAIDs, which should provide warnings about safety, including interaction between NSAIDs and alcohol.

 

Photo credit: stock.xchng

               

Your brain needs good cholesterol, too!

It is well-known that high blood cholesterol levels are not good for the heart. Is is also quite known that high levels of low-density lipoproteins (LDL) - the bad type of cholesterol - can build up and block arteries and adversely affect cardiovascular health.

What is not so well-known is the fact that low levels of high-density lipoproteins (HDL) - the good type of cholesterol - is linked to memory loss and increased risk for dementia. This is according to a study by European researchers.

It seems that cholesterol levels are important not only for heart health but for brain health as well.

The study followed up 3,673 people as part of the long-term Whitehall II study involving British civil servants. The results showed that low levels of HDL cholesterol are associated with diminished memory by age 60. No link was found between memory loss and levels of total cholesterol and triglycerides. The use of statins to manage cholesterol levels did not seem to have an effect.

According to lead author Dr. Archana Singh-Manoux of the French National Institute for Health and Medical Research (INSERM, France) and the University College London (UK)

“Memory problems are key in the diagnosis of dementia. We found that a low level of HDL may be a risk factor for memory loss in late midlife. This suggests that low HDL cholesterol might also be a risk factor for dementia.”

The mechanism behind this link between HDL cholesterol and dementia risk is not so clear but the following hypotheses are proposed:

• HDL cholesterol blocks the formation of beta-amyloid.
• HDL cholesterol may affect memory in relation to its role in maintaining vascular health.
• HDL cholesterol could influence memory through its -inflammatory and antioxidant.

HDL cholesterol… serves several vital biological functions. It helps clear excess cholesterol from the blood; assists nerve-cell synapses to mature; and helps control the formation of beta-amyloid, the major component of the protein plaques found in the brains of Alzheimer’s patients.

Dementia usually occurs in people 65 years or older. Alzheimer’s disease is the most common form of dementia. In the developed world where a large proportion of the population are elderly, dementia is becoming a major - and costly - health concern. The monitoring of HDL cholesterol (and not only LDL cholesterol!) should therefore be encouraged - for the heart as well as for the brain.

Photo credit: stock.xhcng

               

Hope and Help for the Holidays

It’s October and according to some retailers, the holidays begin now.

I don’t listen to the marketing hype, but when I am hosting Thanksgiving dinner (which I am not this year), I start thinking about the menu and planning in September. However, it’s hard logistically and emotionally to plan for the holidays when you are caring for someone who has Alzheimer’s disease.

By their very nature, the holidays cause us to look back. In most cases, celebrations and traditions of years gone by determine the tenor of today’s customs and rituals. For many of us, the holiday season begins with talking to our loved ones, planning where celebrations will be and what they will entail. We speak the plans for the upcoming holidays, but what we don’t say, what goes unspoken is the foundation upon which those plans are made. Here is where the friction comes in. Looking back is fine, but looking forward is scary. Your mom doesn’t remember the traditions that she couldn’t live without. Your dad is agitated by the very lights that he used to meticulously string on the Christmas tree; today, he couldn’t pour a cup of hot chocolate, much less man the omelet station for the traditional holiday brunch.

So, where does that leave you? I’m not sure, but I know where it left me. It left my heart aching for the past and sometimes dreading the future. It left me hanging on to old traditions and knowing that it was time to start new ones. It left me wondering how I could celebrate in a way that mom could enjoy without being scared, anxious or agitated.

In this series I’ll share my holiday experiences (some were nightmares) with the hopes that you can learn from MY mistakes. I’ll give you some do’s and some dont’s. I’ll hopefully inspire you to hold on to some old traditions, but encourage you to try some new ones as well.

So, let’s plan together as we approach the holidays. I’ll specifically reference Thanksgiving, Christmas and New Years, but it really doesn’t matter. The principles are the same for Yom Kippur or Purim.

I’ve learned, it doesn’t matter what our ethnic background or religious tradition. Alzheimer’s disease hurts all of us. It makes us all cry and it takes away a little of our past and our future as it creeps through the brains of our loved ones.

Look for upcoming posts on Hope (and Help) for the holidays. Do you have any tips for making it through the holidays? Please share.

               

Dementia and your cholesterol

When we speak of cholesterol, negative thoughts of blocked arteries and heart attacks come to mind. However, not all types of cholesterol are detrimental to our health. There are 2 main types of cholesterol in our body - the low-density lipoproteins (LDL) and the high-density lipoproteins (HDL). LDL cholesterol is considered to be “bad” cholesterol and is linked to atherosclerosis. LDL levels in our blood should therefore be kept low. HDL is deemed to be the “good” cholesterol and high levels of HDL in the blood may actually be beneficial and decrease the risk of heart attacks. HDL cholesterol plays important roles in several vital biological functions including clearance of excess cholesterol from the blood, assistance in the maturation process of nerve-cell synapses, and controlling the formation of beta-amyloid. Beta-amyloid is the major component of plaque deposits found in the brains of patients with Alzheimer’s disease.

A recent study demonstrated the role of HDL in the development of dementia. Low levels of HDL are linked to having memory loss in middle age and dementia later in life. The report is based on data collected by the Whitehall II study, a long-term health research study involving more than 10,000 British civil servants working in London. The study has been ongoing since 1985.

“Observing 3,673 participants (26.8 percent women) from the Whitehall II study, researchers found that falling levels of HDL cholesterol were predictors of declining memory by age 60.”

The research defined low HDL levels as less than 40 mg/dL and high HDL levels as 60 mg/dL or more. The researchers analysed blood-fat and memory data collected during 2 phases of Whitehall II. Phase 5 was conducted from 1995 to 1997 and involved study participants with an average age of 55. Phase 7 was conducted from 2002 to 2004 and involved participants with an average age of 61 years.

The main findings of study are as follows:

• At age 55, participants with low HDL cholesterol showed a 27 percent increased risk of memory loss when compared to those with high HDL.

• At age 60, participants with low HDL had a 53 percent increased risk of memory loss compared to the high HDL group.

• During the five years between phases 5 and 7, study members with decreasing HDL had a 61 percent increased risk of decline in their ability to remember words versus those with high HDL.

• Men and women did not differ significantly in the link between lipids and memory loss, so researchers combined data from both sexes for analysis.

• Total cholesterol and triglycerides did not show a link with memory decline.

• Using statin drugs to raise HDL and/or lower low-density lipoprotein (LDL or “bad” cholesterol) showed no association with memory loss.

In the industrialized world, where the population is aging, dementia is becoming a major concern. People 65 years or older are the ones who are usually affected. For a quick review of dementia, check this previous post.

 

Photo credit

               

Dementia, Alzheimer’s, the Elderly and Sex (part 3)

Okay, this is my last post on the whole dementia, Alzheimer’s and sex subject. But this subject really has me thinking about the rights of people with dementia.

Is a 14 or 15 year old any more able to give consent than a person with dementia?

Is it actually possible for caregivers to discuss this issue and come to a conclusion when the loved one is in the earlier stages of Alzheimer’s disease?

Should long term care facilities/nursing homes make provision for spouses or “friends” to have sexual relations?

How does the dynamic change is one person has dementia and the other does not? Does it matter if the affected person is a male or female?

Should families or facilities make arrangements for safe/clean sexual encounters between residents?

At what point, if any, should facility staff/management get involved in relationship between patients?

Was there a relationship prior to the dementia (as in the case of a spouse or a person who entered the facility for something other than dementia, but now has dementia)

What part do the persons past morals and values play in the decision?

Should the caregiver’s morals be considered?

I suppose all of these questions mean that it’s an area that must be carefully studied, that there are as many answers as there are individual situations. In many religious traditions, sex outside of marriage is forbidden. The “rule” is usually enforced for the young or for divorcees. Does it actually apply to the elderly as well?

Please, I’ll give you a virtual penny for your thoughts. What’s your opinion?

               

Alzheimer’s, Dementia and Sex (part 2)

Okay, so let’s finish this conversation.

Like I said the other day, if you want to see anyone on the caregiving spectrum from a teenager to an adult child blush-talk about their loved one’s sex life.

I mean, I am grown, have children of my own and have literally written the book on teen sexuality (Straight Talk, How Teens Make Wise decisions About Love and Sex, Review and Herald, 2000). Yet, I just can’t imagine my mom and dad uh…..er…..um….. well, you know…having (whisper) sex. And furthermore, I really wouldn’t want to have to make decisions about their sex lives, especially when they were in their golden years and one of them had already died - because that would mean that one of my parents was having sex with someone other than my other parent.

However, putting your head in the sand, and ignoring the issue isn’t going to make it go away. I’ll never have to consider such things, as both of my parents are now deceased. But YOU may and again, like other care concerns, it’s better to give the issue consideration now, before it becomes a major problem.

Honestly, when I first read the story of Dorothy and Bob in Slate, I was amused. However, as I read and considered the depth of Dorothy and Bob’s relationship and the obvious furor of Bob’s son, I realized that this is no laughing matter. Most importantly, when I read of Dorothy’s depression and despondency after the relationship was abruptly forced to an end by Bob’s son, It made me realize that this issue of seniors, dementia and sexuality is an area that must be given serious consideration.

Here are some questions to consider:

1. Can someone with dementia give consent?
2. What if the current behavior violates grandma’s long standing moral principles?
3. What if the relationship violates the primary caregiver’s morals or principals?
4. Do facility employees have a right to get involved?

In this situation, there may be more questions than answers. Personally, I’d want my family to make decisions for me based upon my life’s principles, morals and values up to that point. The problem is that if I had dementia, I wouldn’t be logical enough to understand my family’s possible “restrictions” on my desires.

It’s something to think about and seriously consider. My advice. Think about it now. Consider it before it becomes an emergency. Talk about it with potential long term care providers and be prepared. As baby boomers age and the number of people with Alzheimer’s disease and dementia increases as well. This won’t be interesting or amusing. It will just be another issue that caregivers consider as they battle, the monster, Alzheimer’s disease.

What do you think? Have you been forced to think about and consider your loved one’s sex life?

               

The link between dementia and “ministrokes”

Is there a link between dementia and ministrokes? This seems very likely, according to researchers who conducted studies on several people with dementia or cognitive impairment.

What is dementia?

Dementias are a group of neurological disorders characterized by progressive decline of cognitive and brain functions. Dementias take different forms. The most well-known and most common form of dementia is Alzheimer’s disease. Other types include Lewy Body dementia, Creutzfeldt-Jakob and Parkinson’s disease. Some of these types can co-occur together resulting in a condition called mixed dementia.

Our mental capabilities decline as we grow older. However, in case of dementia, this mental decline can occur even in younger people and goes abnormally fast. In its later stages, the disease renders its victims incapacitated and incapable of carrying out normal daily activities.

What are “ministrokes?”

Ministrokes are also called transient ischemic attacks or silent strokes. The symptoms of transient strokes are temporary and often go away. Silent or asymptomatic strokes happen without the patients being aware of their occurrence and are associated with brain abnormalities are aneurysms. Hypertension and diabetes may also cause ministrokes

Because of their transitory or asymptomatic nature, ministrokes are more common than initially thought. Though they do not manifest in serious symptoms, multiple ministrokes present a real danger because “the cumulative effect reaches critical mass” and brain damage occurs.

Where is the link?

In one study, Dutch and American researchers discovered aneurysms, benign brain tumors and asymptomatic strokes using magnetic resonance imaging (MRI) in 2000 older adults. Their results indicate links between silent strokes, symptomatic strokes and dementia.

In another study, researchers of the University of Washington autopsied brains of patients with dementia and found evidence of damage to the small vessels in the brain which is indicative of injuries probably brought about by multiple small strokes.

Unlike previous studies on dementia, this recent study included patients from different ethnic groups and from a large range of educational and professional levels. It ran for over ten years, from 1994 to 2006. The study followed up 3400 participants with or without dementia or cognitive impairment. About a third of the patients died during this period and 221 autopsies were performed.

The study concludes that

“small blood vessel damage caused by hypertension and diabetes may be among the leading causes of dementia.”

These recent developments indicate a need for people to be more aware of the dangers of ministrokes. Most often, “silent” strokes may not be necessary silent. We need to recognize the symptoms, no matter how mild.

According to the American Stroke Association, signs of a potential stroke include:

• Sudden numbness or weakness of the face, arms, or legs, especially on one side of the body.
• Sudden confusion, trouble speaking, or trouble understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, and loss of balance or coordination.
• Sudden, severe headache with no known cause.

               

Alzheimer’s, Dementia and Sex

If you want to make a teenager or young adult blush, mention their parents having sex.

Let’s face it, there aren’t very many “children” be they teens, young adults, baby boomers or elderly who want to talk about their parents (aunts, uncles, grandparents) um….er……uh sex life.

Now, toss in dementia affecting one or both of the parties, and now you’ve really got something to talk about or not talk about.

I mean, first of all, what caregiver wants to think about, much less talk about their loved ones sex life? And then, who gets to make the decision as to whether the relationship continues? Let’s say John and Mary live independently, and one or both has dementia and they decide that they want to engage in a sexual relationship. Should their children or other family members get involved?  When the spouse is primary caregiver, it’s complicated too.  Can a person with dementia “consent?”

Another scenario. What if Joe and Martha (one or both have dementia) are in an assisted living facility or even a nursing home and they decide they want to be sexually active. Should the facility or family members have a say or just allow the relationship to go on?

Over the next two days, we are going to delve into this subject and discuss the pros and cons of dementia, dating and sex.

According to the CDC, Alzheimer’s disease has surpassed diabetes and is now the sixth leading cause of death. They say that 10million people will suffer from Alzheimer’s disease. So, in essence, what makes a cute kind of tongue in cheek story today could tomorrow necessitate careful thought, planning and possibly even policies regarding the sex lives of people living with Alzheimer’s disease.

There are many questions to consider, but the hardest part my be getting caregivers to add their loved one’s sex lives to the ever growing list of things to think about and handle as they battle Alzheimer’s disease.

               

Brain Games and Other Activities

This post discusses brain games and other activities that may delay the onset and reduce the impact of Alzheimer’s disease and dementias

I want to say off the bat that I am quite familiar with Alzheimer’s disease and I am fully aware that there is not a game around that will prevent it from running its course.  So, my intent is not to provide snake oil or false hope.  Brain activities such as video games, crossword puzzles, sudoku checkers and chess to name few do have thier place though.  They provide activity and exercise for the brain, they require hand eye coordination and they require more complex thought than does say listening to the radio or watching TV.  In addition, in all honesty, they might keep your loved one busy enough to provide you as a caregiver a few moments while you attend to dinner or take care of other responsibilities.

As a person who suffers with Alzheimer’s disease or other form of dementia, these games can provide a great escape.  doing theme related crossword puzzles or word-finds is a great way to relax and remember a time that was much more carefree and much less confusing than these days are.  Sudoku and chess are great games for those who are still able handle the complexities associated with those activities.

Although alzheimer’s disease and other types of dementia, such as vascular dementia initially present similarily with symptoms such as confusion, short term memory loss and difficulty handling day to day activities such as balancing a checkbook.  They differ widely in their progression and end result.  I will save the details for another post.  My point for today is that activity is good for all types of dementia.

Why activity is important:

Physical activity-Physical activity is as good for the brain as it is for the body. Exercise increases blood flow to the brain and creates an overall feeling of well being.  From a physical perspective, it strengthens the heart, muscles and combats extra pounds piling on.

Here are some things you can do to keep moving:

Walk

Take the stairs

Join an exercise class

Mental Activity-The brain needs exercise too. The Alzheimer’s Association of Canada endorses brain games.  You can click here for the entire article, but some of the activities they recommend are:

Crossword Puzzles

Reading and keeping up with current affairs

Computer games

So, no matter what you do, as you battle the monster, Alzheimer’s disease know that activity, whether physical or mental is a good thing!

               

Alzheimer’s and Dementia-The Differences

The terms dementia and Alzheimer’s are often used interchangeably.  In fact, dementia is not Alzheimer’s and Alzheimer’s is not dementia, although, they are certainly related.

For example, let’s say you your stomach is bothering you. You can’t eat much and it’s difficult to drink.  At first you shrug it off and hope you’ll lose a few pounds, but then you try to ignore it and finally attempt to soothe it with over the counter medicines, nothing works.  You call your Dr. and make an appointment. A couple of days later, you find yourself in the Dr’s office.  She asks you some questions, examines you and declares, “You have an acute pain in your stomach.”  You think to yourself, “Uh….duh……tell me something I don’t already know.”

Well, if you take your grandfather to the Dr. because he is acting strange, and has a set of symptoms that concern you, and the Dr. says, “He has dementia,” and sends you home.  It is akin to telling you he has a pain, which brings me to my main point.

Dementia is a SYMPTOM.  It is caused by something.  What you know after hearing the word is simply this. The symptomology that caused you to take your grandfather to the doctor is called dementia.  The “pain in the brain,” so to speak, is dementia.  What you need to know now is, what is causing the dementia?  You can click on the link for a detailed definition, but for now, here’s a simple one from Dr. David Roeltgen.

“Dementia is an impairment of thinking and memory that interferes with a person’s ability to do things which he or she previously was able to do.”  Dementia is NOT a part of the normal course of aging.

There are many causes/types of dementia, some of the common ones are:

Parkinson’s disease, Picks disease, brain tumor, alcoholism, Acute B12 defeciency, Hunington’s disease, depression, multi-infarct, and of course, Alzheimer’s disease.

Alzheimer’s disease: A progressive neurologic disease of the brain that leads to the irreversible loss of neurons and dementia. The clinical hallmarks of Alzheimer’s disease are progressive impairment in memory, judgment, decision making, orientation to physical surroundings, and language. A working diagnosis of Alzheimer’s disease is usually made on the basis of the neurologic examination. A definitive diagnosis can be made only at autopsy. (Definition adapted from medicinenet.com)

So, it’s important for you to ask questions, do some research of your own and then ask the doctor to do more tests to discover the CAUSE of the dementia.

Tomorrow, I’ll discuss Alzheimer’s testing and diagnostic measures.

In the meantime, I’ll give you a “virtual” penny for your thoughts. Or if you’d rather comment privately, feel free to contact me at:    http://battlingforhealth.com/contact  

Either way, I’d love to hear from you!

               

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