Category Archives: Caregiving – Dementia

Delirium (from hospitalization or illness) accelerates memory loss

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This press release out of Beth Israel Deaconess Medical Center (bidmc.org) in Boston will be of interest to those dealing with dementia.

The press release reports on a study that:

“…confirms that an episode of delirium rapidly accelerates cognitive decline and memory loss in Alzheimer’s patients. … Delirium often develops in elderly patients during hospitalization or serious illness, and this acute state of confusion and agitation has long been suspected of having ties to Alzheimer’s disease and other dementias.”

The press release is copied below.

Robin
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www.bidmc.org/News/InResearch/2009/April/DeliriumandDementia.aspx

Delirium Accelerates Memory Loss in Patients With Alzheimer’s Disease
Acute state of confusion and disorientation often complicates hospitalizations for patients with dementia
Beth Israel Deaconess Medical Center, Boston, MA
Press Release
Date: 5/4/2009

BOSTON ­ Delirium often develops in elderly patients during hospitalization or serious illness, and this acute state of confusion and agitation has long been suspected of having ties to Alzheimer’s disease and other dementias. Now a study led by researchers at Beth Israel Deaconess Medical Center (BIDMC) and Hebrew Senior Life confirms that an episode of delirium rapidly accelerates cognitive decline and memory loss in Alzheimer’s patients. The findings are reported in the May 5 issue of the journal Neurology.

“The cognitive rate of decline was found to be three times more rapid among those Alzheimer’s patients who had had an episode of delirium than among those who did not have such a setback,” according to lead author Tamara Fong, MD, a staff neurologist at BIDMC and Assistant Scientist at the Institute for Aging Research, Hebrew Senior Life. “In other words, the amount of decline you might expect to see in an Alzheimer’s patient over the course of 18 months would be accelerated to 12 months following an episode of delirium.”

Alzheimer’s disease is an irreversible, progressive form of dementia that gradually destroys a person’s ability to carry out even the simplest of tasks, and affects as many as 4.5 million individuals in the U.S. according to figures from the National Institute on Aging. There is currently no cure for Alzheimer’s disease.

Delirium, on the other hand, is a potentially preventable condition, which often develops following a medical disturbance, surgery or infection and is estimated to affect between 14 percent and 56 percent of all hospitalized elderly patients.

The investigators performed a secondary analysis of data gathered from 408 patients examined between 1991 and 2006 at the Massachusetts Alzheimer’s Disease Research Center (MADRC). Over this 15-year period, MADRC staff conducted a number of memory tests on patients. Testing was done on at least three occasions, separated by intervals of approximately six months. Seventy-two of the participants developed delirium during the course of the study.

In their final analysis, the authors found that among patients who developed delirium, the average decline on cognitive tests was 2.5 points per year at the beginning of the study; following an episode of delirium, decline nearly doubled to 4.9 points per year.

“Although each dementia patient declines at his or her own individual rate, the results of our study tell us that this rate can increase three-fold following an episode of delirium,” says Fong. “As an example, suppose an Alzheimer’s patient begins with mild symptoms, such as forgetting appointments or details of conversations, but over a period of the next 18 months, loses the ability to identify relatives, becomes lost while driving familiar routes, or can no longer balance a checkbook or manage financial transactions. This same patient, were he or she to experience an episode of delirium, might experience this same rate of decline in only 12 months.”

While further investigations are needed to determine the mechanism behind this turn-of-events, Fong explains that delirium may, in fact, be a key link in a chain of events that results in injury to brain cells. “Older patients may be at greater risk of developing delirium ­ particularly in the hospital setting ­ because they tend to have less ‘reserve’ or ability to compensate in settings of increased stress. Consequently, infections, new medications and other stressors put the patient at risk for delirium.”

All elderly patients, but particularly patients who have already been diagnosed with Alzheimer’s disease, can benefit from a number of preventive measures if they are hospitalized, notes Fong.

“As much as possible, it’s important to try and orient the patient to his or her surroundings [i.e. frequently remind the patient that he or she is in the hospital], to allow for as much uninterrupted sleep as possible by not waking patients to take vital signs or do blood draws at night, and to get patients out of bed and walking as soon as their medical condition allows,” notes Fong. Also, important, she adds, is to avoid use of unnecessary medications.

“Twenty percent of all elderly patients who develop delirium go on to experience complications, whether it’s a prolonged hospital stay, a move to a rehabilitation center or long-term care facility, or even death,” notes Fong. “Our current study now shows that delirium can also adversely impact the state of cognitive decline in patients with Alzheimer’s disease. Because up to 40 percent of delirium episodes can be prevented, taking steps to avoid delirium could result in significant improvements.”

This study was funded, in part, by grants from the Massachusetts Alzheimer’s Disease Research Center, the National Institute on Aging, and the Alzheimer’s Association, and the VA Rehabilitation Career Development Award.

Study coauthors include BIDMC investigators Edward Marcantonio and Sharon Inouye; Hebrew Senior Life investigators Richard Jones, Peilin Shi, James Rudolph, Frances Yang and Douglas Kiely; and Liang Yap of Massachusetts General Hospital.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks in the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is a clinical partner of the Joslin Diabetes Center and a research partner of the Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.

 

Dementia and suicidal behavior (literature review)

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This may be of passing interest to those dealing with dementia.

This abstract is about a literature review of any evidence for an association between dementia and suicide. The British authors state: “Overall, the risk of suicide in dementia appears to be the same or less than that of the age-matched general population but is increased soon after diagnosis, in patients diagnosed with dementia during hospitalization and in Huntington’s disease. Putative risk factors for suicide in dementia include depression, hopelessness, mild cognitive impairment, preserved insight, younger age and failure to respond to anti-dementia drugs.” The authors note that more research is needed on this topic.

Robin

International Psychogeriatrics. 2009 Apr 16:1-14. [Epub ahead of print]

Dementia and suicidal behavior: a review of the literature.

Haw C, Harwood D, Hawton K.
St Andrew’s Hospital, Northampton, U.K.

ABSTRACT

Background: While dementia is more common in older people and suicide rates in many countries are higher among the elderly, there is some doubt about the association between these two phenomena.

Methods: A search of the major relevant databases was carried out to examine the evidence for this possible association.

Results: The association between dementia and suicide and also non-fatal self-harm did not appear strong but many studies have significant methodological limitations and there are few studies of suicide or self-harm in vascular, frontotemporal, Lewy body and HIV dementia where such behavior might be expected to be more common. Rates of self-harm may be increased in mild dementia and are higher before than after predictive testing for Huntington’s disease. Overall, the risk of suicide in dementia appears to be the same or less than that of the age-matched general population but is increased soon after diagnosis, in patients diagnosed with dementia during hospitalization and in Huntington’s disease. Putative risk factors for suicide in dementia include depression, hopelessness, mild cognitive impairment, preserved insight, younger age and failure to respond to anti-dementia drugs. Large, good quality prospective studies are needed to confirm these findings.

Conclusions: Further research should be undertaken to examine how rates of suicide and self-harm change during the course of the illness and vary according to the specific sub-type of dementia.

PubMed ID#: 19368760 (see pubmed.gov for this abstract only)

Getting Support – Go through your list of friends, etc.

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Although this advice for caregivers was written by someone whose husband has Alzheimer’s Disease, I think her advice on going through your list of friends (and identifying who can do something, who can listen, and who prefers to continue on as if nothing has happened) is a useful approach for all caregivers. This is perhaps a good exercise for those diagnosed with a neurodegenerative disorder too.

Robin

http://www.thealzheimerspouse.com/CaregivertipsHowe.htm

Alzheimer’s Association
SUGGESTIONS FROM A CAREGIVER – Support, Part 1
By Elizabeth (Betsy) Howe, M.B.A

Dealing with dementia in a loved one can be overwhelming at times, or most of the time. Not only do we have our own lives to conduct, we are trying to do the best we can for our loved one. All the time we are also grieving the loss we both are undergoing. You about get used to one level of effort and things change and get harder.

As caregivers we are advised to reduce stress, keep a life of our own not involved with caregiving, exercise, and eat properly. The focus of this article is reducing stress. The caregiver’s key to reducing stress and keeping THEIR sanity is …. support support support …and the most important…SUPPORT.

Many articles tell us that if we don’t take care of ourselves we can, and do, become statistics ourselves. We die earlier than our non-caregiving peers, or worse yet, before the loved one we are caring for.

One of the useful things I’ve been advised to do is make a list of all my friends, family and acquaintances. Next to each name I indicate what role they can play in reducing my stress level through support in three categories:

1. ‘D’ goes next to the names of those who can be counted on to ‘Do’. There are and will be things we inevitably will need done or need help doing or leaning to do ourselves.

2. ‘L’ goes next to the names of those who can be counted on to ‘Listen.’ We need people we can talk to, even if we end up saying the same things over and over. I suggest, if possible, you find one or two you can literally call 24/7.

3. ‘C’ goes next to the names of those who prefer to ‘Continue on’ as if nothing has happened. They prefer not to talk or hear about the nasty things going on in our lives and the life of our loved one. BUT they are willing to continue to be our friend. These people are essential for those times when we just want to ‘get away’ and pretend to be like everyone else (non-caregivers).

Think about those you know in all avenues of your life – work, professional associations, family, friends, church. Be sure to include all people you know. You might be surprised at the number of potential support people you have. Don’t forget to think about those who know/ knew your loved one. Often they will be happy to support your loved one by supporting you.

Keep your list in a notebook or on your computer or electronic planner so it’s easy to find and add to. If you are extremely lucky you will have one or two people who are all three- D, Land C! Just try not to ‘bum out’ any one person. If they can support you in more than one category, it’s easy to do. You are in this for the long haul and need ‘D’, ‘L’ and ‘C’ support long term.

I am finding that those of us actively involved in caregiving truly CARE for each other as well as our loved one. Sometimes helping someone else is a stress relief for me! Be open to new friendships with those you meet through various support groups, such as the Lincoln Alzheimer Association Young Onset Support Group that meets twice a month and has activities periodically.

Don’t forget the Alzheimer’s Association 24/7 Helpline, 1-800-272-3900, or [email protected] as someone to ‘Listen’ but also provide helpful suggestions. I prefer the phone if I have immediate issues involving my loved one and want to know how to handle something that’s going on right now. They have trained personnel with whom you can speak.

Even if you have a great local counselor or psychologist with whom you are working, the local professionals aren’t generally available 24/7. If you are looking for something that is not so immediate, the email address is a good bet.

Dr. Gott: Seroquel not advised for elderly

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I know some of you read Dr. Gott. Here’s another MD’s opinion about Seroquel (quetiapine). Of course your MD’s opinion may be different!

http://www.montereyherald.com/health/ci_11525837

Ask Dr. Gott: Seroquel not advised for elderly
Peter Gott
Updated: 01/22/2009

Dear Dr. Gott: Please give your opinion on Seroquel being prescribed to a patient with dementia. I’ve heard it is a dangerous drug when given to the elderly, as it can cause death. Should this drug be given long term?

Dear Reader: Seroquel is a medication used to treat conditions such as bipolar disorder. It is not approved for behavioral problems related to dementia. Black-box warnings for elderly patients with a dementia-related psychosis indicate an increased risk of serious side effects, including pneumonia, heart attack, stroke and death.

The product is available in doses from 25 milligram to 300 milligram tablets or capsules by prescription only. When the drug is prescribed for the elderly, the recommended initial dose is 25 milligrams daily. Contraindications are noted for people with a history of hypertension, stroke, thyroid disorder, diabetes, high cholesterol, seizures or heart attack.

Side effects include fever, sweating, uncontrolled muscle movements, severe headaches, visual and gait disturbances, and more. Be sure to speak to the prescribing physician should any symptoms occur.

Seroquel XR extended-release tablets contain black-box warnings because of an increased mortality rate in elderly patients with dementia. XR is indicated for treatment of schizophrenia, a name given to a group of mental disorders in which a patient loses touch with reality and is unable to think or act in a rational manner. The condition is often treated with tranquilizers and specific drugs to lessen the degree of depression.

Extended-release tabs are not recommended for the elderly. Adverse reactions include dry mouth, dizziness, orthostatic hypotension, constipation, a feeling of sedation and more.

There are a number of interactions with this drug. Be sure to advise your physician of medications you are taking to ensure there will not be a negative response should he or she choose to prescribe Seroquel XR.

The long-term effectiveness (more than six weeks) has not been fully evaluated. All prescribing physicians should re-evaluate patients on a regular basis.

You are correct that the drug can be dangerous for elderly patients with dementia. I can only hope the prescribing physician fully researched all the options before prescribing it and that the dose is a reasonable one.

All patients regardless of age who are treated with antidepressants or antipsychotics for any condition should be monitored carefully for negative alterations in behavior, especially during the early stages of a new medication. Family and caregivers must be observant and should report those changes accordingly.

If you continue to have unanswered questions and have the legal right to be involved with the care of the individual in question, return to the prescribing physician with a list and request answers. If you are dissatisfied, seek a second opinion.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Write to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, N.Y. 10016.

Vivimind for dementia (available OTC in Canada)

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This will only be of interest to those dealing with memory loss who are willing to obtain/try a supplement available over the counter in Canada.

There’s a psychiatrist who goes by the name “Dr. David,” who was recently diagnosed with Lewy Body Dementia. He studied in the SF Bay Area.

He blogs under the name “Knitting Doc.”  On his blog today (10/12/08), he posted about a new agent called Vivimind, recommended to him by a neurologist at the University of Pittsburgh. Vivimind is based on homotaurine.

Here’s a link to the blog post and most of the text:  (I think the last two paragraphs are from Vivimind marketing materials.)

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http://knittingdoc.wordpress.com/2008/1 … r-12-2008/

Knitting Doc Blog
Post October 13, 2008

I told you in the last post about a new agent on the market for dementia! I present this info with tongue in cheek and only after serious thought and consideration. But there’s more.

On my recent visit with my neurologist, Oscar L. Lopez, M.D., several weeks ago, he informed me of a new chemical agent called VIVIMIND™. He said he was very familiar with it and “you should look into it on the Internet. It’s just now being released as an OTC (Over the Counter) agent in Canada. Gosh, what was I supposed to think? I’m really not one to take just any substance which someone mentions just because ‘it’s supposed to be good’ or ‘Hey, this stuff really works.’ So, yes, I do believe in vitamins, minerals and other natural substances. But I like to make sure that I know what the substance is, what it does and to have some scientific evidence before ingesting it.

So here I was, leaving his office with the name of this drug written on a piece of paper. I didn’t know what to think. It this some new fad? Is this some kind of snake oil? I knew he was highly involved with dementia research, etc. as well as being affiliated with the University of Pittsburgh Medical Center’s Neurology Department. But was he really serious?? Pam and I talked about it on the way home. She felt very encouraged by it. As for me, I was the “doubting Thomas.” Yes, please excuse the pun!

Ok, David. At least be fair. So I did a Google search on Dr. Lopez. Gee whiz! He is very nice, warm, explains things, isn’t arrogant and snooty and he listens. And low and behold, there were hundreds of links for him! He definitely is more modest than one would ever expect.

All right then. Maybe I should take this a bit more seriously. I came home and looked up the Vivimind stuff of which I am showing some info a few lines below in this blog. After much discussion with my wife, a couple friend of ours and with me, I came to this conclusion. It could be nothing and if I get it I’d be spending a lot of $$$ on nothing. But if I don’t get it, I’ll always wonder later on down the road why I didn’t get it. Maybe it’ll prove to be something over the next few years. Maybe it’ll give me many more years with a better mind. After all, I’m taking Aricept and Namenda. Each of them has a different mechanism of action which works well when taken in combination. It sounds like the Vivimind could function in yet a 3rd way. But I vacillated day after day until I knew I had to make some kind of a decision.

The 180 mile trek to Niagara Falls is the closest part of Canada to us; I called some pharmacies there and asked one of them to hold the Vivimind for me. We decided to make a ‘day trip’ and left on Friday, October 10, 2008 with Pam’s friend, Darlene. Thanks to Lewy Land, I FORGOT to print out a map from MapQuest to the pharmacy. Needless to say we got lost and were able to see some beautiful scenery along the way. Any my bladder was about to give way. We were near some trees so………….let your imagination take over at this point. I guess Pam and Darlene got a real laugh as I was trying to walk fast — they said between my balance and gait problems and trying to hold things in, I looked like a ‘contorted’ person which would scare most people away. We need to use humor with this disease. All I could think of was “Oh God. I don’t want to get arrested in a foreign country. Please don’t let any police drive by!”

After getting some directions, we finally found the pharmacy and bought some of this ‘magic potion.’ And then left to visit the Falls.

We came home and went straight to bed…..fatigued to the max. So I took Saturday off from writing on the blog. I took the first Vivimind pill on Saturday morning. I will gradually increase the dose slowly with Dr. Lopez’ guidance.

After hundreds of millions of dollars invested and 15 years of rigorous scientific research, including clinical testing with over 2,000 individuals in 68 European, 50 U.S. and 17 Canadian medical centers, VIVIMIND™ is now available for consumers.

Welcome to a new generation of memory protection. For an aging population, VIVIMIND™ represents a breakthrough in one of the key consequences of getting older – memory loss. VIVIMIND™ is a science-based natural health product that has been shown to protect memory function based on the naturally occurring ingredient, homotaurine.

Dr. David