Go Purple- Help End Alzheimer's Disease!

The heart remembers...Today, September 21, 2012, is Alzheimer's Action Day- so put on your PURPLE and help to raise awareness for this devastating disease. Over 35 MILLION people worldwide and 5.4 MILLION Americans are living with Alzheimer's disease (AD). $200 BILLION will be spent in the US alone this year caring for people suffering with AD. This disease slowly invaded my amazing mother's brain, creeping along for over a decade, steadily pulling her away from our family. As we don our purple today, we stand together with every other family who has helplessly witnessed this "long goodbye". I hope and pray we are in the last decade without a cure or full prevention for Alzheimer's.

Significant memory loss is NOT a normal part of aging. Misplacing your keys, forgetting a friend's name at a chance meeting or not being sure why you walked in to a room are frustrating events- but usually a sign of a busy mind focusing on other things. Missing multiple appointments or bills, not knowing how to drive home from your neighborhood store or losing the ability to balance a checkbook (when that used to be a straightforward process) ARE worrisome signs.

Major advances are being made in understanding how Alzheimer disease affects the brain, and the sequence in which it progresses. The hope is to find a way to block that progression, and research dollars donated today will help scientists find that barrier.

BOTTOM LINE: If Alzheimer's disease has touched YOUR life, join in the fight to find a cure and start with wearing PURPLE today!

Why Visit Someone with Dementia?

Visiting a friend or relative with memory loss can be daunting. What will you say? What if she doesn't remember you? What if he is inappropriate? If you are taking your child, will she be nervous or scared around the other residents? What about the smell? There are so many potential barriers to a simple visit.

So, take a deep breath, and relax. PLEASE GO VISIT. Period. Perhaps I should change that- exclamation point is better- GO VISIT!! Or pick up the phone, and at least call, if they are able to talk on the phone. Ultimately, that friend or relative will have a better day if you visit. Whether they can carry on a full conversation with you about your high school high jinks together or they have no clue what you are talking about, they are human, complete with the full range of emotions that we all enjoy. Sadly, loneliness and boredom often occupy much of your time when you are suffering from memory loss. People treat you differently, talking to you as if you were less intelligent or perhaps deaf. Even if you don't catch a punch line, you can share a hearty belly laugh with someone.

So, here are a few suggestions for an easier visit:

1. Bring pictures, especially of you and your friend together.

2. Use technology- iPhones, iPads, and laptops are wonderful for sharing pictures or for finding images of special places and events (think the Grand Canyon or the Olympics) to chat about.

3. Music- again, the MP3 players are terrific for finding a tune or a snippit of a song.

4. Avoid food that requires utensils, but finger foods like french fries, or a small ice cream cone can be a delight to enjoy together if conversation is a challenge. (Obviously, check with your friend's caregiver for appropriate food choices.)

5. Consider a "Sunday drive". Often folks enjoy simply getting out and about for a short car ride. Pop on the radio or seasonal music and cruise around for a half hour. Yes, this is expensive in gas dollars, but often well worth the price for the sense of "escape" from the residence.

BOTTOM LINE: Visiting someone with memory loss (dementia) need not seem so stressful- relax, smile, hug, laugh...and your friend will, too. And hopefully, when we are the one with memory loss, our friends and families will return the favor.

Memory Loss Equals Alzheimers?

Alzheimer's disease (AD) should be simple to diagnose, right? How hard can it be for a doctor to decide if memory loss is a normal part of aging, or if it is severe enough to "count" as Alzheimer's? Well, if diseases only occurred one at a time, it might be simple. Unfortunately, as old Texas doc's say, when you itch, it's possible you've got ticks AND fleas. I find in family medicine, it's rare we see any disease state by itself, and Alzheimer's is no exception.

Many different issues can affect memory. Depression and/or anxiety very frequently preoccupy the brain so much that short term memory loss can be a predominant issue. Low thyroid levels can decrease memory. B12 deficiency is another cause. The list of medications that can affect memory seems to be growing each year as well.

When my mother first noticed significant memory issues at the age of 61, she was convinced she had Alzheimer's. I literally laughed when she told me her concerns...We had no family history of early or even late onset dementia. She had recently started a medication known for impairing memory (Digoxin.) As her medical workup progressed, I was relieved to find out she had not only that medication as a possible cause, but literally every cause I listed above- B12 deficiency, hypothyroidism and depression. I felt confident that as we addressed each of these problems, her memory would improve. In many cases, that would have been true, but unfortunately for Mom, she did indeed have underlying Alzheimer's, which took roughly another two years to fully decipher.

If you are concerned about memory loss, please make an appointment with your family physician to address your concerns. Head to the Alzheimer's Association website and review the 10 Warning Signs of Alzheimer's. Until those biomarkers for AD become more refined, physicians will not have a quick or simple answer, but a thorough history and exam, combined with possible neuropsychiatric testing, will take us a long way in the right direction.

BOTTOM LINE: Memory loss can have many different causes, and these causes can and frequently do overlap.

Independence Day, Indeed!

July 4th is a wonderful day in America, filled with family celebrations, picnics and fireworks. We are so fortunate to live in a country that allows us so many freedoms! In our family, this day has additional significance, as today marks the 8th anniversary of my mother's independence from Alzheimer's Disease. As we once again visited her grave today, surrounded by the incredible beauty of the wildflowers and the snow-capped mountains, I looked around the cemetery and wondered how many other lives represented there were affected by this disease.

Did you know we have over 5.3 million Americans living with Alzheimer's? Chances are good that you either have a family member or friend affected. We have medications that can improve some behavioral and cognitive functions in people with dementia, but none yet that can stop or cure it. With our aging population, it is clear that this disease alone will consume a progressively larger chunk of our healthcare dollars.

Check out the Alzheimer Association website, and consider participating in a local Memory Walk or other fundraiser.

BOTTOM LINE: Let's celebrate our country's independence today by thinking about the future of our aging population, and pro-actively working towards a cure for Alzheimer's.

iPads to Prevent Dementia?

When I speak about Alzheimer's disease, people often ask what they can do to help prevent this debilitating illness. Although scientists have looked at innumerable medical interventions such as hormone replacement (estrogen), ginkgo biloba, anti-inflammatory drugs (like ibuprofen), Vitamin E, and many others, we have yet to find the right answer. The best evidence medical trials today suggest that our primary prevention lies in all the health maintenance strategies that prevent heart disease, high blood pressure and diabetes- namely a healthy diet high in vegetables and fruits & low in "junk", plus regular aerobic exercise.

Additionally, many studies have shown some benefit from "cognitive activities", meaning brain exercises, through puzzles such as word games (crossword puzzles or word searches) or number challenges such as sudoku. Is there a way technology might help? Why not? I believe the act of learning new skills in any format will help, regardless of whether it is an old-fashioned crossword puzzle from the Sunday paper, or learning to use... well, yes, an iPad. Let me say now that no, I do not have stock in Apple, though perhaps I should. And, I'm sure any electronic tablet will fit the bill. That being said, let me share our family's personal experience.

We gave my mother-in-law (who looks amazingly younger than her actual age, which I am not allowed to reveal) an iPad 2 for Christmas so that we could "face time" (video chat, for those uninitiated) with her, which would feel more intimate than just a phone call. Although she is very educated (a former RN), she has never had a computer or a cell phone, so we were uncertain how much use she would get beyond this function. May I brag that she is now texting like a teen? She is able to read and follow her favorite blogs, listen to Bible verses, enjoy interactive Rosaries, and best of all, "chat" with us throughout the day. We can text her pictures on the spot, and engage her in our daily lives more easily. As she is eagerly learning these new skills, I can picture those neurons firing up like crazy, and I have to think that her brain is reveling in the new stimulation.

BOTTOM LINE: You're never too old to learn a new skill, and when you do- your brain will thank you!

Thank You, Glen Campbell

Many diseases have the face of a celebrity- we think of Michael J. Fox for Parkinson's, or Katie Couric (on behalf of her husband) for colon cancer. Although President Reagan had Alzheimer's, I don't think there is as strong of a link there. Alzheimer's is the disease we don't want to talk about. It's just too uncomfortable, right?

Well, hat's off to singer Glen Campbell & his wife. Mr. Campbell gave a televised interview last night to openly talk about his experience of memory loss and his diagnosis of Alzheimer's Disease. I loudly applaud his public acknowledgement of this relentless disease. I hope that his singing tour will bring increasing awareness to this incredibly common disease. Right now, over 5 million Americans suffer from Alzheimer's disease. I love that Mr. Campbell is highlighting how music memory is something that is preserved...often beyond when the person suffering the memory loss no longer recognizes their family. I have bittersweet memories of singing Christmas carols with my mom- her not skipping a beat nor stumbling on words that I couldn't recall- and she only knew me as a "nice friend," not her youngest daughter.

What's my take-home message here? If you have a loved one with Alzheimer's memory loss, and you struggle to get them to interact with you, consider a song. Old commercials, school fight songs, traditional carols, hymns or anthems are all good choices. I have found in my personal experience that often once the person begins singing, it often "gets the juices flowing" enough that they are able to carry on a conversation (where they were not interested or able when you began your visit.)

BOTTOM LINE: Hitting a communication wall with someone struggling with Alzheimer's? Try a tune!

PS. I recommend sites like ElderSong- a wonderful source for music geared to trigger memories! ( I have no financial interest in this company, but have purchased many sing-along CDs and videos from them.)

Visiting Someone with Memory Loss

Visiting a friend or relative with memory loss can be daunting. What will you say? What if she doesn't remember you? What if he is inappropriate? If you are taking your child, will she be nervous or scared around the other residents? What about the smell? There are so many potential barriers to a simple visit.
So, take a deep breath, and relax. PLEASE GO VISIT. Period. Perhaps I should change that- exclamation point is better- GO VISIT!! Or pick up the phone, and at least call, if they are able to talk on the phone. Ultimately, that friend or relative will have a better day if you visit. Whether they can carry on a full conversation with you about your high school high jinks together or they have no clue what you are talking about, they are human, complete with the full range of emotions that we all enjoy. Sadly, loneliness and boredom often occupy much of your time when you are suffering from memory loss. People treat you differently, talking to you as if you were less intelligent or perhaps deaf. Even if you don't catch a punch line, you can share a hearty belly laugh with someone.
So, here are a few suggestions for an easier visit:
1. Bring pictures, especially of you and your friend together.
2. Use technology- iPhones, iPads, and laptops are wonderful for sharing pictures or for finding images of special places and events (think the Grand Canyon or the Olympics) to chat about.
3. Music- again, the MP3 players are terrific for finding a tune or a snippit of a song.
4. Avoid food that requires utensils, but finger foods like french fries, or a small ice cream cone can be a delight to enjoy together if conversation is a challenge. (Obviously, check with your friend's caregiver for appropriate food choices.)
5. Consider a "Sunday drive". Often folks enjoy simply getting out and about for a short car ride. Pop on the radio or seasonal music and cruise around for a half hour. Yes, this is expensive in gas dollars, but often well worth the price for the sense of "escape" from the residence.
BOTTOM LINE: Visiting someone with memory loss (dementia) need not seem so stressful- relax, smile, hug, laugh...and your friend will, too. And hopefully, when we are the one with memory loss, our friends and families will return the favor.

Alzheimer's Disease- Why So Hard to Diagnose?

Alzheimer's disease (AD) should be simple to diagnose, right? How hard can it be for a doctor to decide if memory loss is a normal part of aging, or if it is severe enough to "count" as Alzheimer's? Well, if diseases only occurred one at a time, it might be simple. Unfortunately, as old Texas doc's say, when you itch, it's possible you've got ticks AND fleas. I find in family medicine, it's rare we see any disease state by itself, and Alzheimer's is no exception.

Many different issues can affect memory. Depression and/or anxiety very frequently preoccupy the brain so much that short term memory loss can be a predominant issue. Low thyroid levels can decrease memory. B12 deficiency is another cause. The list of medications that can affect memory seems to be growing each year as well.

When my mother first noticed significant memory issues at the age of 61, she was convinced she had Alzheimer's. I literally laughed when she told me her concerns...We had no family history of early or even late onset dementia. She had recently started a medication known for impairing memory (Digoxin.) As her medical workup progressed, I was relieved to find out she had not only that medication as a possible cause, but literally every cause I listed above- B12 deficiency, hypothyroidism and depression. I felt confident that as we addressed each of these problems, her memory would improve. In many cases, that would have been true, but unfortunately for Mom, she did indeed have underlying Alzheimer's, which took roughly another two years to fully decipher.

If you are concerned about memory loss, please make an appointment with your family physician to address your concerns. Head to the Alzheimer's Association website and review the 10 Warning Signs of Alzheimer's. Until those biomarkers for AD become more refined, physicians will not have a quick or simple answer, but a thorough history and exam, combined with possible neuropsychiatric testing, will take us a long way in the right direction.

BOTTOM LINE: Memory loss can have many different causes, and these causes can and frequently do overlap.

Medications, medications, medications!

Okay, it's obviously a play off of "location...location", but hey, if it gets your attention, then I've done my job! I want to say a few words about medications. First of all, to physicians. Many times we need to prescribe multiple medications for our patients. One is daily, another twice a day, and yet another may be before meals and bedtime. Before you know it, our patient is supposed to take a half a dozen pills per day (and then we wonder why they are "noncompliant"!)

In a perfect world, pills would not interact with each other or with meals, and they could be given once per day. In reality, many medications do not play well in the stomach together, and must be separated. What can we all do? Well, the basic pill box that has a separate compartment for each day is lovely. Don't feel you need to qualify for Medicare before you purchase one! I tell all my patients that there is a good reason "the pill" comes in a dispenser that is labeled by day. How many times have you wondered, "gee, did I take my pill today?" Well, the same is true for vitamins, calcium supplements, and prescription medications of all sorts.
Find a pill dispenser that works for you! If you have multiple medications, consider one that actually reminds YOU! There are wonderful contraptions that you can set up with a week or more of pills, and then an alarm will go off up to four times per day, letting you know that your pills are ready for you!

The picture above is the one I used for my memory-challenged father for several years with great success.

BOTTOM LINE: Don't rely on your memory- find a pill dispenser that works for you to simplify and increase your success with medication compliance!

You can find this pill dispenser at the online Alzheimer Store ; I have no financial ties to them, just really appreciate how this tool simplified MY life and improved my Dad's consistency with medications!

How 'Bout a Cookie?

It's tough to say goodbye and leave your kids at camp- and you KNOW they are going to have a blast, make new friends and have wonderful new experiences. How much more difficult is it to move your parent into a senior community? Regardless of whether or not your parent is moving into a "senior retirement community" or assisted living, or even skilled nursing, you worry about them much like sending your child to kindergarten or summer camp. Who will they sit with at meals? Will the others be kind to them? Will they participate in activities?

I pray for patience, love and kindness in the heart of every person who works with our elderly. I hope they look at each resident and picture their own mom or dad in that situation.

When your parent has dementia, there is the extra pain that each day may bring a fresh volley of questions- when am I going "home"? Where am I? And the separation begins anew each time.

I wish I had many words of wisdom to impart about how to make this easier. What worked with my Mom (who had Alzheimer's) does not necessarily work with my Dad (who has Parkinson's dementia.) I do know that engaging your parent in a simple activity that still captures their attention- perhaps a Seinfeld episode, an old musical DVD, enjoying a favorite snack, or perhaps dialing an old friend for a short conversation- creates a pleasant diversion when it is time for you to leave. Most staff in memory units are skilled in these diversions. Ask them for help!

BOTTOM LINE: Just as you might with a child, be creative with diversions at the end of visits with your memory-challenged parent.

Memories...like the corner of my...what was that word ?

Okay, have you ever had trouble finding a word? Or how about a name? Why did you walk in the room, anyway? Were you supposed to be checking e-mail, or did you sit down to look at your calendar? And, by the way, where the heck are the keys/remote/charger/phone??
Many of us have what we jokingly refer to as "senior moments". Something basic simply slips out of the grasp of our mind for the moment. Is it dementia? Do we have early onset Alzheimer's disease?

Let me reassure you that MOST of us do NOT. Sadly, there are a few that do. In fact, when my own Mom told me tearfully (when she was a mere 61 years old) that she and my father were concerned that she had Alzheimer's disease- I laughed. Seriously. I laughed, when indeed, I perhaps should have cried.

The truth is that my mother had several medical conditions that all could cause memory loss- and all were correctible. She had thyroid issues, B-12 deficiency, took a medication that caused memory loss and was a bit depressed. ALL of those conditions in and of themselves CAN cause memory loss sufficient enough to look like Alzheimer's disease.

The frustrating thing was that with my Mom, we were able to correct all of those issues, and yet the memory loss progressed.
If YOU have memory loss, PLEASE talk to your doctor about your symptoms. Have a physical and check blood work. Chances are good that you may simply have a medication side effect or a correctible metabolic issue. If, however, you DO have early dementia (such as Alzheimer's), starting medications sooner rather than later will absolutely slow the progression of your disease.

BOTTOM LINE: If you are having trouble with your memory, REMEMBER to schedule an appointment with your doctor TODAY!!

PS. It's the FIRST of the month! REMEMBER to change those AIR FILTERS!!!

Happy Memorial Day!

Today we celebrate the memory of all the hundreds of thousands of courageous men and women who have given their lives for our country, and for the pursuit of freedom in other countries. What an amazing gift we have received!

I wish we voted on Memorial Day, as I believe we'd have a much greater turn out...what other country freely and loudly complains about their government (local and nationally) and then doesn't show up to vote?? But I digress...

I would like to use today's theme to transition into some blog entries on MEMORY. Memory itself is an amazing gift, and one we typically take for granted until we notice something missing. Memory is not only about the past, but is the key to hope of future events as well.

Dementia- memory loss- affects over five million Americans today. As our society ages, those numbers will escalate further. If you do not have a family member or friend affected by dementia yet, you are unusual- count your blessings.

Bottom Line: Today, on Memorial Day, let's be grateful for the precious gift of memory.

Do I have Alzheimer's?

Do you forget why you walked in a room? Can't find your keys or the tv remote? Couldn't think of an old friend's name when you ran in to them at the store? RELAX- none of these episodes are unusual for a healthy, busy adult. Typically these things happen when you are stressed and simply not paying much attention to your task at hand.
What is concerning, then? Forgetting directions to the grocery store where you always shop; missing multiple appointments because you confused times/dates; being unable make change or figure out tips (when you could before) or not being able to name common objects (like a watch or a shirt.)
If you think you are having significant memory issues, please go and see your doctor! There are many causes of memory loss that are correctable, and even if you do have early Alzheimer's disease, we have good medicines that really slow the progression of disease.
CHECK OUT the Alzheimer's Association's "Ten Signs of Alzheimer's"
Bottom Line: Memory loss with Alzheimer's Disease can be distinguished from memory changes with normal aging; if you are concerned, go see your doctor!

Still Alice- a MUST READ

My mother passed away five and a half years ago after a twelve year struggle with Alzheimer's disease. Now, my father has dementia from Parkinson's disease (which for all intents and purposes looks Alzheimer's). Dementia- which means progressive memory loss- is tough on everyone. There is no "noble battle" aura like we have when people fight cancer. Friends often disappear, rather than increasing their presence. No one knows what to say. To quote my mom in a lucid moment, "It's not exactly FUN losing your mind!" Instead, our loved ones slowly, steadily slip away. It is absolutely heart-breaking.
Still Alice is a must-read for everyone, because if you don't yet have a friend or loved one suffering from Alzheimer's, odds are good that you will. Still Alice tells the story of Alzheimer's from the point of view of a young 50 year old Harvard neuropsychologist as she is diagnosed with and rapidly declines from early onset Alzheimer's. Although this is a fictional account, it is very accurate and insightful.
BOTTOM LINE: Pick up a copy of Still Alice today, read it, and pass it on.