Brain Health Notes
Compiled by Michelle Steigleder, DFDC board member
MICHIGAN’S AGING BRAINS NEED MORE PROTECTION.
A poll by Scott Roberts, Ph.D. at the Alzheimer’s Association Michigan Chapter recently found that Michiganders over 50 years old want to prevent dementia, but about 50% don't know the everyday actions known to be important in preserving brain health. Are we in the same boat?
The key lifestyle factors for brain health are: preventing head injury, managing stress and treating depression, not smoking, controlling blood pressure and cholesterol, limiting alcohol, maintaining a healthy weight, addressing hearing loss.
The survey also asked how often 50+ year olds engaged in activities known to preserve brain function.Results: only 54% got 7+ hours of sleep, 48% did mentally stimulating activities, 40% ate a healthy balanced diet, and 36% got some form of physical activity including walking or stretching.
We need to smarten up!!
COULD NIGHTTIME LIGHT AFFECT BRAIN HEALTH?
New research from the University of Kentucky’s Sanders-Brown Center is shedding light on how everyday environmental factors and brain inflammation could influence sleep, circadian rhythms and Alzheimer's related changes. Recently published studies explored how dim light (e.g., from clock, night lights, windows,computers, phones,TVs, hallway and street lighting) negatively affects circadian rhythms and Alzheimer’s related brain changes. These findings suggest that artificial light at night is a potentially modifiable environmental factor that could influence Alzheimer’s Disease risk or progression.
Practical steps such as reducing unnecessary light exposure at night, keeping a consistent sleep schedule and supporting circadian rhythms are low risk strategies that align with current sleep hygiene.
HOW IS PAIN ASSESSED & MANAGED IN PATIENTS WITH DEMENTIA IN LONG-TERM CARE Pain is predominantly managed with drugs among patients with dementia in long-term care settings according to study results published in Frontiers in Pain Research. Results indicated that 100% of medical and nursing staff, and 95% of health care professionals used challenging behavior as an indicator of pain. Opioids were often used as a first-line treatment for pain management rather than nonpharmacological measures such as exercise, distraction, activities tailored to personal interests, musical therapy, and a more thorough investigation of other causes for the disruptive behaviors. In fairness to staff, high workload and time pressure were noted as barriers to extensive assessment of underlying causes of discomfort. An interesting note: this study was conducted in the Netherlands; a country far more dementia friendly than we are!
NEW RESEARCH ON LOW DOSE LITHIUM FOR ALZHEIMER’S?
H.J. Manji, M.D. professor at both Oxford University in the UK and Yale in the US published an interesting study in JAMA, Psychiatry using low dose lithium. “Lithium is unique because it can actually preserve or even reverse brain shrinkage. Authors of the study believe it can counter a
similar progressive decline in Alzheimer’s disease. The neuroprotective effects of lithium have been replicated numerous times by independent laboratories. The study DOES NOT suggest people start lithium therapy on their own especially since lithium can affect kidney and thyroid functioning and can interact with other medicines. These studies are viewed as a strong rationale for rigorous clinical trials. What makes this work particularly interesting is that lithium acts on several biological
processes central to Alzheimer’s disease, including protein clearance, mitochondrial function, and tau pathology. This multi-target profile is significant because Alzheimer’s is not a single pathway disease. Current available treatments target a single pathway, Tau protein.
DIET QUALITY & DEMENTIA RISK IN OLDER ADULTS WITH ALZHEIMER PATHOLOGY Yet another study points to the critical significance among diet and general health, brain health, and dementia risk. A 15 year study out of Sweden found greater adherence to a healthy diet was associated with reduced risk of dementia, including among participants with existing Alzheimer’s pathology. In the high risk group of people showing Alzheimer's markers low inflammatory diets were the most beneficial. Diet programs promoting the consumption of fruits, vegetables, nuts, whole grains AND discouraging consumption of processed and red meats and the consumption of sugar-sweetened beverages were recommended.
WHAT TO DO WHEN DEMENTIA PATIENTS LOSE INHIBITIONS
Embarrassing/inappropriate behaviors of dementia patients is called disinhibition. Disinhibition is one of the most distressing changes that can occur in persons with Frontal Temporal and Alzheimer’s dementia. Disinhibition can include inappropriately flirting with strangers, eating without stopping, and using coarse language including racial slurs. Disease in the frontotemporal lobe of the brain compromises behaviors related to language and behavior. Unfortunately, disinhibition only gets worse but in many cases is slowed down by another symptom of the disease, apathy.
Here are some key strategies:
1. Signs of disinhibition should be checked by your neurologist because adjustments to medication might be needed. UTIs and even dehydration can cause cognitive problems and need to be treated if present.
2. Carry a Companion Card which says something like: I’m caring for a person with dementia and who may behave in unusual ways. Please be patient . Check the Alzheimer’s Association website for samples of such cards.
3. Carry medical documents with the dementia diagnosis in case a person with dementia does something illegal such as shoplifting.
4. First thing–validate the feelings behind the inappropriate behavior before you try to coax the person in a different direction. There may be something bothering the person that they cannot verbalize. More important than correcting them is making them feel that you are on their side. Learn how to read body language and facial cues.
5. Prevent potential disrobing by making sure the person starts the day dressed in light clothing and has a cold beverage on hand. Sometimes they are just feeling too hot!! Disrobing is more common in summer.
6. In the home, caregivers should identify exit routes so they can remove themselves quickly if a patient becomes aggressive or threatening. Keep a cell phone handy to call for help if necessary.
It is important for caregivers to have a place to talk about such incidents. Caregivers benefit from well informed and understanding support groups.
