Chronicles of our Memory Care: A Caregiver’s Note to Her Own Future Caregivers

 

The knowledge and wisdom adquired during years spent caring for a loved one, are gifts that caregivers treasure for the rest of their lives. Or, at least, for as long as they can remember them.

In her wisdom, Janet, who cared for both her parents, knew darn well that her own memories might not live as long as herself. So she wrote notes to her loved ones, should one day they too need to care for her and learn about her thoughts.

Today, Janet lives at Villa Alamar, our memory care community. Her memories have indeed been robbed by a relentless neurological disease, but her notes now serve to soothe and reassure her family, as they do all they can to keep her safe, comfortable, and content. Although she can no longer express her thoughts and wishes, her notes provide them with guidance as to what kind of care she wants for herself, as well as permission to decide what needs to be done on her behalf.

In her own words, here is a snippet of her message:

“Since both my father and mother have had Alzheimer’s Disease I leave this request regarding me, personally, to my family:
If I start to lose my mental abilities, please be patient with me. Care for me with integrity, doing whatever YOU feel is best for yourselves and for me, then remind me tenderly, with love… šŸ˜‰ … that I MUST TRUST you.
It is my desire never to live with my children, but to live and die on my own, in my “own home”, be it my home, an apartment, an Assisted Care facility if I can afford it, whatever…”

And for further encouragement, she also wrote:

“Old folks are not stupid, they are just old. There is a lot of wisdom and humor and love in an old person. Don’t overlook that.
No matter how tedious it may seem, no matter how difficult it can be, caring for an aging parent is a good thing. It is more about who you are than what you are doing. You will take from the experience a wisdom and a tenderness of heart that is priceless, so be that kind of person, just be careful not to lose yourself in the process….”

Thank you Janet. We shall all strive to be that kind of person you need us to be, for you and for all those whose care has been entrusted to us.

Caregiver: Are you Prepared for an Emergency?

By Luciana Mitzkun,
Community Services Director

Santa Barbara residents are no stranger to disasters: Weā€™ve had fires, floods, earthquakes, mudslides, tsunamis, oil spills, tornadoes, and even a hurricane! In addition to community disasters, there are also possible personal emergencies that could happen to all of us, such as falls, accidents, or an unexpected health event.

If you are a caregiver for a person with dementia, any one of those situations could suddenly restrict your ability to provide care. A common trip-and-fall can potentially result in being in a cast for 6 weeks! Should you be temporarily incapacitated, have you planned for uninterrupted care for your loved one?

Anticipating and preparing for what to do in case of an emergency is the key to overcome adversity with minimum disruption to the continuity of care. Every caregiver should have a contingencyĀ plan for careĀ ready to be put intoĀ place should the need arise.

A good emergency care plan should include provisions for immediate temporary placement in a memory care community, such as Villa Alamar. These facilities can become a second home for dementia patients, where they can be safely housed while receiving assistance with every activity of daily living in a nurturing and socially stimulating setting. Having your loved one comfortably placed in a memory care home would allow you to fully attend to your own emerging needs without having to also attend to the many tasks of direct caregiving.

Temporary placement in a residential care facility is commonly referred to asĀ respite care. Not every memory care home offers respite, we do, and not every home that does offer respite care has beds available when you need one. To maximize your chances of finding respite care should you need it, make sure you follow these steps ā€“ and do it beforeĀ an emergency happens:

  1. Identify a suitable memory care home. Memory care homes come in all shapes and sizes, some are particularly appropriate for your loved one, some are not. Research available homes, visit them in person, talk to the administrator. Make sure the home is secured, equipped with wandering prevention systems and that it offers plenty of activities that are engaging and stimulating for a person affected with dementia. Ask about their nursing team, caregiver per resident ratio, and length of shifts of their care staff. Prefer a home that offers a team of caregivers with longevity in their positions and a long history of caring for dementia patients: staff stability and experience matter.
  2. Request a nursing assessment. Once the home is identified, ask the administrator for a nursing assessment. TheĀ nursing team should meet with you and your loved one to review all information regarding medical and social needs. This assessment will help confirm the appropriateness of the services provided for your loved one. It could also result in recommendations for additional services and care strategies.
  3. Ask the doctor for a report. You will need a physicianā€™s report in hand forĀ placement ofĀ any kind, permanent or temporary. In California, the Health and Human Services Agency requires a form 602A (easily downloadable on the web) with a valid test for tuberculosis (TB) signed by the doctorĀ within 1 year of placement. As there are many doctor visits throughout the year, there are many opportunities for you to renew this form.Ā  Make sure you always have a current 602A with TB test.
  4. Keep current prescriptions signed by the doctor. For residential care, all medications must be accompanied by signed orders from the doctor, including details about dosages and frequency, which are required even for medications that are bought over the counter (such as Tylenol and supplement vitamins). These days where everything is in the computer, this requirement is not as easy to fulfill as one would think it would be! Get in the habit of collecting written prescriptions at every visit with the doctor, and every time there is a change in the medication, and keep them current and handy with your other placement documentation.
  5. Collect copies of required documents. In a folder, with the 602A and signed prescription orders, keep copies of the following: photo identification, Medicare card, and insurance cards. If applicable, also add copies of power of attorney, health care directive, and POLST (Physician Ordered Life Sustaining Treatments).
  6. Prepare an overnight bag. You may want to have an overnight bag prepared in advance with essential toiletries and clothing enough to last for 3 days. The care home should be able to provide incontinence supplies as needed, although you are welcome bring your own. Other items that should accompany your loved one include: All current medications (in their original bottles), adaptive devices (cane, walker), corrective devices (eyeglasses, hearing aids), items of personal comfort, and items of personal interest. All items should be marked with the personā€™s name. DO NOT include any valuables such as cash, jewelry, irreplaceable mementos, or anything that has intrinsic or emotional value.
  7. Share your contingency respite plan with a trusted proxy. Identify a family member or a trusted friend to assist you in case you need help. Share the knowledge of your plan and the location where the above items are stored with them, so they could quickly assess the bag and documentation when needed.

There are several steps in arranging for a respite stay, therefore it would be very difficult to complete themĀ  all at once, specially while immersed in an emergency event. Start now.

After completing these 7 steps, you are prepared for a quick placement in case of emergency. Hopefully, there will be no emergency, although things do not always happen as expected. It is best to be prepared.

On a happier note, keep in mind that a short stay in a memory care home may also be used to accommodate a fortunate event. Many caregivers have used the respite stay at Villa Alamar to take a well-deserved break, to attend a reunion out of town, to visit with friends and family, or to travel abroad. Having a respite plan in place may also offer you peace of mind to take more breaks from caregiving, knowing that your loved one is safe, comfortable, and content in his home away from home.

The cost of a respite stay is close to that of a 3-star hotel. At Villa Alamar it is available at $350 per day, although in our area, you may find it for up to $450 per day. Fortunately, there are grants that may help you pay for some of these costs. Your pre-selected care home can help you find some of these programs. Also, contact the local office of the Alzheimerā€™s Association (805-892-4259)Ā and theĀ Coast Caregiver Resource Center (805-569-8950 ext. 1)Ā for additional information on respite grants.

If you would like more information about respite options and availability at Villa Alamar, please contact me, Luciana at 805-682-9345.Ā 

Do not wait for an emergency. Organize your respite care strategy now and allow our community to be there for you and your loved one, should you need assistance.

Chronicles of our Memory Care: The Man in the Screen

 

If you do not have dementia, it may be hard to understand what goes on in someone’s mind after memory, perception, and reasoning become impaired.

As dementia progresses, loved ones often struggle to get those answers from patients who can no longer articulate their thoughts in sentences. Their words and feelings keep flowing in unrelated segments, as if they were slices of wisdom that run crisscrossing in tangled pathways. Sometimes we grasp a glimpse of the true nature of their momentary state, only to realize that that thought is already gone, and the person has already moved into another mysterious realm of their minds.

Occasionally, however, a patient with dementia expresses themselves with such clarity and brilliance that it ushers us into a clear understanding of what their minds are experiencing. And it can be amazing!

Such a moment happened recently, while one of our residents was walking around and around our community. Villa Alamar is designed to promote safe ambulation, with tree-lined paths that flow in and out of the home, allowing open passage for a continuous strolling, whether it is day or night. Residents can always be seen walking or lounging, enjoying nature in our beautiful gardens, in the safety of our community.

It was towards the end of the day, a time when the condition known as sundowning compels memory care residents to move and go, going to places only they know where. Mr. Kline was going. And in his going he went on and on, until he stopped by one of our caregivers to announce:

ā€œI am in a movie scene that keeps repeating itself,ā€ Mr. Kline said, ā€œand the movie never ends.ā€

Not waiting for any reply, he resumed his walking. And going on he went, the star of his own movie.

Story by:
Luciana Mitzkun

CAREtrends: New Drug for Alzheimer’s Receives FDA Approval

Printable Article
Printable in Spanish

Written by Luciana Mitzkun

On July 6th, after years entangled in controversy, Leqembi (generic name lecanemab), a drug believed to mildly slow down the progress of Alzheimerā€™s in its very beginning stages, has finally received full approval from the Food and Drug Administration (FDA).

Not a cure: It cannot reverse symptoms; it cannot restore previously lost memories or brain functions. The benefits of its use are restricted to a modest decrease in the speed with which new symptoms appear. And of benefit only to patients in the very early stages of Alzheimerā€™s disease.

Nevertheless, itā€™s approval is being regarded as a breakthrough in the treatment of Alzheimerā€™s disease: The second of its class to receive FDA approval, the drug developed by the partnership between Eisai and Biogen laboratories, targets the amyloid plaques in the brain which are partially associated with the disease (although their causation factors, if any, are still poorly understood). Other previously approved Alzheimerā€™s drugs, such as the largely prescribed memantine and donepezil, target brain functioning with the intent of counteracting the dementia-related symptoms of the disease.

 

Who should consider this new treatment?

Not all patients with mild cognitive impairment or early-stage dementia will qualify for this treatment, only those with confirmed presence of amyloid plaques in the brain. Research data indicates that patients who do benefit from the treatment show a cognitive decline slowed by up to 27 percent over 18 monthsā€”roughly, a 6-month delay in symptom progression. On the road of progressive dementia, it is the equivalent of easing the foot on the accelerator.

Although the overall benefits may be considered by some experts to be not clinically significant, the treatment could delay new dementia symptoms long enough to allow patients a few additional precious months with their families.

Patients who are already in the mid-to-late stages of Alzheimerā€™s do not qualify for the treatment, neither do those affected with other progressive forms of dementia, such as Lewy body, vascular, or frontotemporal dementia.

 

How much does it cost?

The treatment is indeed expensive. Medicare will cover the $26,500 annual cost of the drug Leqembi, as long as patients and providers participate in data collection registries tracking the drugā€™s performance.

In addition to the costs of the drug itself, patients can incur thousands of dollars a year in co-insurance costs related to the every-other-week infusion procedures, which are required for the administration of the drug (no, Leqembi is not in pill form). Amyloid PET scans and APOE4 genetic tests are needed to determine eligibility and individual safety levels of the treatment. There are also costs associated with the continuous scans and other tests needed for the monitoring of potential side effects throughout the treatment.

 

Side effects? Yes.

A potential side effect named amyloid-related imaging abnormalities (ARIA), has been linked to the use of lecanemab. The condition, which involves brain bleeding, brain swelling, or a combination of the two, is found present in about 2 in 10 people receiving the drug and most cases are either asymptomatic or resolved quickly with proper treatment. During the trial, however, three patients died of it. People who carry a specific gene version called APOE-Īµ4 are at a higher risk for ARIA.

Considering the evidence of brain-bleeding associated with lecanemab, it is not recommended for people who take strong blood thinners, such as Eliquis or Xarelto. Reactions to the infusion itself can also happen, affecting over 25% of patients.

 

Should I qualify for the treatment and be willing to take the risks, can I take it?

This treatment may not be readily available to all who qualify and want itā€”and can afford it.

Doctors must first screen their patients for eligibility, which requires complex imaging tests or a spinal tap to confirm the presence of amyloid in the brain. Infusion-provider sites must be equipped to provide the every-other-week treatment. Imaging centers will also need to offer regular brain scans for the monitoring of side effects during treatment.

It will take some time for most health centers to organize all the components required to provide such complex treatments, and rural area patients may have to travel long distances to access providing facilities.

 

The $64.000 question: Is it worth it?

Only you can decide if treatment with Leqembi is worth pursuing. The side effects, costs, inconveniences, and personal commitment to the treatment regimen requirements are high, with few promises of actual beneficial outcomes. But for many newly diagnosed patients, any easing in the speed with which the disease progresses, however fleeting, is worth the risk.

Each patient should confer with their doctors and loved ones, consider all the risks, costs, and potential benefits of the treatment, and allow their own personal wishes and philosophy of care to guide them.

We, in the memory care community, will continue to support our friends and families affected with Alzheimerā€™s whichever course of treatment they select for themselves.

 

Is this the future in treatments for Alzheimerā€™s?

There are additional anti-amyloid monoclonal antibody drugs being currently investigated and going through the FDA approval process, such as donanemab which is being developed by Eli Lilly. The data on donanemab has so far shown it to be slightly more effective than lecanemab, especially when considering Tau, the other main protein related to Alzheimerā€™s disease, as a secondary biomarker.

The current course of international research indicates that the treatment for Alzheimerā€™s in the foreseeable feature will be short of a cure. More likely, treatments will be composed of a cocktail of drugs targeting both the Amyloid and Tau proteins, with the intention of delaying the appearance of symptoms.

In a disease that robs us of precious time, more effective treatments may buy us some time until one dayā€”dare I wish for it?ā€”there is a cure. For now, delaying Alzheimerā€™s symptoms, even if only for a few months, may be an incredibly savvy approach to outlasting the disease, after all.

Luciana Mitzkun is a Memory Care Specialist, author of Ahead of Dementia (also in Spanish) and Ahead of Memory Loss, both available on Amazon.Ā For more about Lucianaā€™s work, visit AheadofDementia.com

Luciana serves as the Community Services Director at Villa Alamar, a model residential memory care community in Santa Barbara, California. VillaAlamar.com

 

Chronicles of our Memory Care – Jake’s World

Jake’s World

By Luciana Mitzkun Weston,
Villa Alamar Community Services Director

Hallucinations occur frequently in patients with advanced dementia, but they are not necessarily scary. They often take the place of a comforting friend, helping to ease anxiety and making sense of times spent immersed in confusion.

Such is the case with Jake, who seems to be living in his own world, which is populated with friends of his own choosing, and who are always there to support him. It is difficult to witness exactly what takes place in Jakeā€™s world, but we know it is a soothing and reassuring world for him.

It was on a spring Sunday that we got a rare glimpse into that exclusive world. Jake was lounging in the patio, absorbing the gentle warmth gifted by the afternoon sun, that he enjoys so much. As usual, he was engaging in on-and-off conversation with Jakeā€™s World people. Our own world kept passing him by, seemingly unnoticed.

That was until JoAnn, who was on her way to visit another resident, took notice of Jake and stopped to greet him.

ā€œHello, Jakeā€, she said with a large smile. ā€œItā€™s really nice to see you!ā€

Jake appeared startled and disoriented. He stared right at her.

ā€œThere is a beautiful woman in front of me”, he said to his Jakeā€™s World friend. “And she is talking to me! What should I do?ā€

JoAnn giggled.

After a moment, Jake says: ā€œI donā€™t know who she is, but she knows my name! She is wearing a red dress. What should I say?ā€

By now JoAnn was flattered and thoroughly amused.

ā€œHello?ā€– he ventured.

JoAnn sat by Jakeā€™s side and started talking about the beautiful weather. Jake received her attention well, but throughout the encounter, JoAnn could tell that there were more than just the two of them in that conversation. And she was OK with it.

CAREtrends: Helping Seniors Reduce Fall Risk

Accidental falls are the leading cause of injuries among older adults in the United States, accounting for nearly two-thirds of all injuries seen in our emergency rooms.

According to the Centers for Disease Control and Prevention (CDC), an average of 4.8 million adults 65 and older receive emergency care for fall-related injuries annually.Ā  Nearly 30,000 older adults die each year as result of a fall. Women are nearly twice as likely as men to suffer injuries from falls. Among fall-related injuries seen in emergency departments, fractures were most common, followed by internal organ injuries (including concussions), contusions, lacerations, and sprains.

Falling can have devastating consequences for anyone, but particularly for seniors. Physical injuries related to falls can require hospitalization, surgery, and a long recovery time, impacting seniors’ overall health and wellbeing. Seniors who have fallen and suffered injuries may need help with daily activities, impacting their ability to live independently. The cost of medical treatment and care following a fall can be expensive, leading to additional financial strain for seniors and their families.

Seniors are at higher risk of falling due to a combination of factors, including age-related physical and cognitive changes, chronic health conditions, and environmental factors. As we age, balance and mobility tend to decline due to natural changes in the body, such as reduced muscle strength, flexibility, and sensory function. Seniors are more likely to have chronic health conditions such as arthritis, diabetes, or heart disease, which can affect their physical function and increase their risk of falling. Visual and hearing impairments can affect seniors’ ability to perceive their surroundings and react to potential hazards. Many seniors take medications that can cause dizziness, drowsiness, or other side effects that increase the risk of falling. Additionally, seniors who have fallen previously may become more fearful of falling, which can lead to a decrease in physical activity and muscle weakness, further increasing their risk of falling.

By understanding these factors, we can plan on taking steps to prevent falls, which is essential for maintaining health, independence, and quality of life regardless of our age.

We can all take several steps to reduce our risk of falling, including:

  1. Stay physically active: Regular physical activity, including exercises that focus on strength, balance, and flexibility, can help improve mobility and reduce the risk of falls. Additionally, it is found to improve blood flow to the brain and also help reduce the risk for cognitive decline as we age.
  2. Review and adjust medications: Seniors should talk to their doctor or pharmacist to review their medications and ensure they are not taking any medications that can increase the risk of falling. Blood-pressure medications, in particular, should be monitored regularly.
  3. Get regular vision and hearing exams: Poor vision and hearing can increase the risk of falls. Regular exams can help detect and address any issues.
  4. Make the home safer: Remove tripping hazards such as throw-rugs and clutter, install grab bars and handrails in bathrooms and stairs, ensure adequate lighting, and make sure cords are out of the way. Motion-activated night lights are a great way of making the mid-night walk to the bathroom safer.
  5. Wear appropriate footwear: Make sure that shoes fit well, provide good support, and have nonslip soles. Avoid walking around in loose socks.
  6. Use assistive devices: Assistive devices such as canes or walkers can support balance and help prevent falls. Collapsible walking sticks, the ones used on trails by hikers, are wildly popular and can be found in a variety of fashionable colors.
  7. Be mindful of surroundings: Be aware of surroundings and take time when moving around, especially when getting up from a seated or lying position.

By taking these steps, we can all reduce our risk of falling, support our independence, and enjoy a healthier lifestyle.

Chronicles of our Memory Care – The Sparrow

The Sparrow

By Luciana Mitzkun Weston,

Villa Alamar Community Services Director

People with Alzheimerā€™s can present us with candid moments of such purity, that are both stunning and enlightening. They have so much to give!

One such moment usually happens when I encounter “Rose”. Some days I run into her as I make rounds in the community; some days she comes into the office and stands in front of my desk, beckoning attention and smiling.Ā No matter how busy I am on the phone or computer, I always pause and acknowledge her presence.

“There you are, my beautiful lady”, I greet her cheerfully, wrapping her petite face in my hands.

For the two years she has lived in our memory care community no friends or family members have ever visited her, an absence that even in her advanced stage of Alzheimerā€™s she has not failed to notice. “Itā€™s hard being all by yourself,” she once told me with a long, sorrowful sigh.

Her deep wrinkles soften, enjoying the touch.

“Did I ever sing to you?” she asks, her knees bouncing, almost unable to contain her excitement.

“Would you do me the great honor of singing to me?”Ā I ask.

On cue, eyes on mine, she releases the most angelical soprano voice in a perfect pitch:

“I sing because Iā€™mĀ happyyyyy,
I sing becauseĀ IIIā€™m free,
for his eyes are aĀ sparroow
And I know heā€™s watchingĀ meeeeeeā€¦”

Delighted with her own performance, smile sparkling with pride, she waits for her merited ovation.

Applauding and cheering, I do not disappoint her. I compliment her on her beautiful voice and on her choice of a perfectly wonderful song.

“Rose, you make my day”, I tell her, “I just love to hear you sing!” She makes my day. I love to hear her sing.

I embrace her small frame and thank her profusely. Our lovely Rose, our sweet sparrow! She savors the compliments. Lit with glee, she glows like a little girl whoā€™s been given a special treat. I see so much joy in her little face, the pure joy of being. My heart swells with hers, drenched by her joy.

Spirits visibly lifted, still looking straight into my eyes, she asks: “Did I ever sing to you?”

To what I answer: “Would you do me the great honor of singing to me?”

And so, she does: “I sing because Iā€™mĀ happyyyyyā€¦

CAREtrends: New Findings on the Benefits of the MIND Diet for the Brain

As the baby boomer generation ages there is anĀ increased interest in all strategies to maintain a youthful body and a healthy mind. In particular, studies examining the potential benefits of the MIND diet for brain health and cognitive function have recently attracted a lot of attention. Here are some of their key findings:

  1. Reduced risk of Alzheimerā€™s Disease:Ā A 2015 study with 923 participants found that following the MIND diet was associated with a significantly lower risk of developing Alzheimer’s disease.
    This 4.5-year study from Rush University Medical Center researchers (including the creators of the MIND diet) showed that the MIND diet lowered the risk of Alzheimer disease by as much as ā€œ53% in participants who strictly followed the diet, and by approximately 35% in those who followed it moderately well.ā€ Lowered risks between 53 and 35% are impressive numbers. Although multiple subsequent studies conducted all over the world were able to corroborate the beneficial effects of this diet for the brain, no other study was able to observe benefits nearly as close to these findings. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532650/
  2. Better cognitive function: Recently, a 2023 UK study with 60,298 participants published in the BMC Medicine found that following the Mediterranean diet was associated with better cognitive function, including memory and executive function, in older adults. Specifically, in this on-going study that started recruiting in 2006, participants with the highest MedDiet adherence had 23% lower risk of developing dementia in comparison with those with the lowest level of adherence. This study created a sort of commotion in the care community not only because of its positive findings regarding the benefits of the Mediterranean diet on the brain, but also because it had a solid number of participants who were observed for a long period of time, which assures more validity to its sound methodology and conclusions.Ā  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-02772-3
  3. Lower levels of Amyloid Plaques:Ā In research conducted post-mortem on 459 participants and published in 2021, it was found that both the MIND and Mediterranean diets were associated with lesser levels of amyloid plaques, which is a hallmark of Alzheimerā€™s disease. Dietary components, including green leafy vegetables, fish, legumes,Ā butter (which came to researchers as a big surprise), and sweets, were also related to AD pathology. These relationships were more significant in those without an APOE-Īµ4 allele, a gene associated with increased risk for Alzheimerā€™s disease. https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.055679

Overall, these studies suggest that the MIND diet may be an effective way to improve brain health and reduce the risk of age-related cognitive decline and dementia. However, more research is needed to fully understand the long-term benefits of this dietary pattern.

What is the Mind Diet?

The MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay) is a dietary pattern that has been developed by Dr. Martha Clare Morris and colleagues at Rush University Medical Center, intended to help improve brain health and reduce the risk of age-related cognitive decline and dementia. It is a combination of two well-known diets, the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet, and focuses on including foods that are high in nutrients important for brain health. The MIND diet emphasizes whole plant-based foods and limits red meat, sugar, and foods high in saturated fats. It differs from the Mediterranean and DASH diets by specifying serving amounts of specific food groups that are associated with reduced inflammation. These include green leafy vegetables, nuts, berries, and fish.

Although the full effects of the diet on the brain is still not entirely understood, these are some of the mechanisms through which the MIND diet may benefit the brain:

Reducing oxidative stress: The MIND diet is rich in antioxidant-rich foods like berries, leafy greens, and nuts, which can help to reduce oxidative stress in the brain. Oxidative stress is a process that can damage cells and contribute to neurodegenerative diseases like Alzheimer’s.

Reducing inflammation: The MIND diet emphasizes the consumption of anti-inflammatory foods like fruits, vegetables, and whole grains, which can help to reduce inflammation in the body and brain. Chronic inflammation has been linked to a variety of neurological conditions, including Alzheimer’s disease.

Promoting healthy blood vessels: The MIND diet is rich in foods like leafy greens, berries, and nuts, which are known to promote healthy blood vessels. This can help to improve blood flow to the brain, which is important for maintaining brain health and function.

Supporting healthy brain aging: The MIND diet is rich in nutrients like omega-3 fatty acids, vitamin E, and folate, which are important for maintaining healthy brain aging. These nutrients have been linked to improved cognitive function and a lower risk of age-related cognitive decline.

 

 

Here are some of the key ingredients in the MIND diet:

    1. Leafy greens: Kale, spinach, and other leafy greens are high in nutrients like folate and vitamin E that are important for brain health.
    2. Poultry: The MIND diet recommends poultry like chicken and turkey, but encourages limiting consumption of red meat.
    3. Fish: Fatty fish like salmon, mackerel, and tuna are high in omega-3 fatty acids and are recommended at least once per week.
    4. Whole grains: Whole grains like brown rice, quinoa, and whole wheat bread are recommended over refined grains.
    5. Beans: Legumes like lentils, chickpeas, and black beans are high in fiber and nutrients that are important for brain health.
    6. Nuts: Walnuts are specifically recommended due to their high levels of omega-3 fatty acids, which are important for brain health.
    7. Berries: Blueberries and strawberries are specifically recommended due to their high levels of flavonoids, which have been shown to improve brain function.
    8. Other vegetables: The MIND diet recommends including a variety of other vegetables, such as broccoli, carrots, tomatoes, and sweet potatoes.
    9. Olive oil: The MIND diet recommends using olive oil as the primary source of fat.
    10. Wine: Moderate consumption of red wine is allowed, but it is not necessary to follow the MIND diet.

Overall, theĀ MIND diet emphasizes nutrient-dense foods that are high in antioxidants, healthy fats, and other nutrients that are important for brain health.

Conversely, the MIND diet recommends avoiding certain foods in order to promote brain health. The following are the foods to be avoided according to the MIND diet:

    • Red meat: Limit intake of red meat, including beef, pork, and lamb.
    • Butter and margarine: Limit the intake of butter and margarine, and replace them with healthy fats like olive oil.
    • Cheese: Limit the intake of cheese, especially high-fat cheeses like cheddar and brie.
    • Pastries and sweets: Limit the intake of pastries, cakes, cookies, and other sweets, which are typically high in sugar and unhealthy fats.
    • Fried and fast food: Avoid fried and fast food, which are often high in unhealthy fats, salt, and calories.
    • Whole milk: Limit the intake of whole milk, and choose low-fat or skim milk instead.
    • Alcohol:Ā Although moderate alcohol intake may have some health benefits, the MIND diet recommends limiting alcohol to one serving per day for women and two servings per day for men.

It’s important to note that while these foods may have negative effects on the brain, they should not be completely eliminated from the diet. Rather, they should be consumed in moderation and balanced with plenty of nutrient-dense foods, like fruits, vegetables, whole grains, lean proteins, and healthy fats, to support overall brain health.

Benefiting the Brain and BeyondĀ 

While the MIND diet is primarily focused on promoting brain health, it is also likely to have some benefits for gut health. The diet emphasizes the consumption of whole, nutrient-dense foods, including fruits, vegetables, whole grains, nuts, and lean protein sources. These foods are high in fiber, which is important for maintaining a healthy gut microbiome. Fiber helps to feed the beneficial bacteria in the gut, which can help to promote the growth of a diverse and healthy microbiome.

In addition, the MIND diet recommends limiting the intake of processed and high-fat foods, which can negatively impact gut health. These types of foods can disrupt the balance of the gut microbiome, leading to an overgrowth of harmful bacteria and a decrease in beneficial bacteria.

There is also a growing body of research that suggests that the gut microbiome is closely related to brain health. The gut and brain are connected through the gut-brain axis, which is a bidirectional communication pathway between the central nervous system and the enteric nervous system, which controls the function of the gastrointestinal tract. The gut microbiome plays a key role in the gut-brain axis by producing neurotransmitters, hormones, and other molecules that can affect brain function and behavior.

Studies have found that changes in the gut microbiome can affect brain function and behavior in both animal and human studies. For example, research has linked imbalances in the gut microbiome to conditions such as anxiety, depression, autism, and Parkinson’s disease. Some studies have also found that modifying the gut microbiome through probiotics, prebiotics, and other interventions can improve cognitive function, mood, and other aspects of brain health.

Overall, while the MIND diet is primarily focused on promoting brain health, it is likely to have some positive effects on gut health as well. However, it’s important to note that the gut microbiome is a complex and individualized system, and the specific effects of the MIND diet on gut health may vary from person to person.

By Luciana Mitzkun Weston,
Villa Alamar Community Services Director

CAREtrends: Music Programs in Our Memory Care

Ukulele Lulus shaking, moving, and delighting Villa Alamar residents

Among the many sensory-stimulating strategies we use to keep our Villa Alamar residents active and engaged, our music programs are of particular importance to our community.

Music can evoke memories and emotions from past experiences through associative memory. When we hear a familiar song, it can trigger memories and emotions associated with the time and place where we first heard the song. When we listen to music that elicits a strong emotional response, it can increase the release of hormones like adrenaline and cortisol, which can enhance memory consolidation and retrieval.

Through rhythmic entrainment, which is the synchronization of movement to a beat, music can help to consolidate memory and enhance recall. Music can also improve attentional focus. When we listen to music, it can help us to focus our attention and block out distractions, which can improve our ability to encode and retrieve information.

Singing or dancing, Carole McNeil always strikes the right chord!

In addition to benefits in memory, music can have a powerful impact on overall brain health including:

Reducing stress and anxiety:
Listening to music has been shown to reduce stress and anxiety levels, which can have a positive impact on overall mental health.

Boosting mood:
Music can also boost mood by increasing the production of dopamine, a neurotransmitter associated with pleasure and reward.

Improving sleep:
Listening to relaxing music before bed can improve the quality of sleep and reduce the amount of time it takes to fall asleep.

Helping with pain management:
Music can be used as a form of pain management, particularly for chronic pain. It has been shown to reduce the perception of pain and improve mood in patients with chronic pain conditions.

Enhancing social bonding:
Playing music with others can enhance social bonding and create a sense of community, which can have positive effects on mental health.

Aiding in rehabilitation:
Music therapy has been used to aid in the rehabilitation of patients recovering from stroke, traumatic brain injury, and other neurological disorders. It has been shown to improve motor function and cognitive abilities.

Music has been found to have additional therapeutic benefits for people living with dementia. A study published in the Journal of Alzheimer’s Disease in 2018 found that music therapy can improve cognitive function, mood, and quality of life in patients with Alzheimer’s disease and other forms of dementia.

At Villa Alamar, these are some of the reasons that motivate our daily music programs:

The Ukelele Lulus make every one feel like they are a member of the group. There is non-stop laughter when they visit us!

  1. Improving mood and emotional well-being: Our musical programs help to stimulate positive emotions and memories, which can improve mood and emotional well-being for our residents. They also help to reduce agitation and anxiety, which are symptoms often associated with various forms of neurological disorders.
  2. Stimulating communication and social interaction: We use music to facilitate communication and social interaction between our residents, caregivers, and family members. We often sing our greetings to our residents, which brings their focus into the present and elicits a singing response, which immediately lightens up the mood for the entire community.
  3. Encouraging physical movement: Music can also encourage physical movement, such as dancing or tapping along to the beat, which can help to improve motor function and balance. When we notice our residents tapping right along with the music, even when they canā€™t speak, we know they are engaged and enjoying the moment.
  4. Promoting reminiscence and storytelling: Music can stimulate memories and encourage those living with dementia to reminisce and share stories from their past, which can be a source of comfort and connection. Our travels and story telling programs rely heavily on music to bring those wonderful memories back to live.
  5. Reducing need for medication: Studies have shown that music therapy can reduce the need for medication in people with dementia, particularly for symptoms such as agitation and anxiety. The results of our musical programs certainly corroborate those findings, as we see the positive effects in mood and positive feelings ripple long after the programs are over.

Overall, music can be a powerful tool for improving the quality of life for people with dementia, and an integral component of our care strategy. Our music programs are a valuable complementary approach to the management of dementia symptoms, in addition to the other sensory stimulating strategies we implement at Villa Alamar.

As always, friends and family members are encouraged to join us for the programs we provide every day of the week. Please check our current calendar of activities and come join the fun!

CAREtrends: Highlights From the Alzheimerā€™s Association International ConferenceĀ® 2022

By Luciana Mitzkun, Villa Alamar Community Services Director

Scientists, researchers, clinicians, and care practitioners from all over the world converged into San Diego this August for the Alzheimerā€™s Association International ConferenceĀ® 2022.

The excitement in the air was palpableā€”researchers were eager to share their findings and connect with other professionals and scholars. The event provided unparalleled networking opportunities to support collaborations and the exchange of ideas.

The sheer logistics of bringing together 5,000 dementia professionals for a week-long meeting to share their work and accelerate dementia research was quite impressive. Conference attendees had to prioritize their specific interests so as to attend as manyĀ  of the 500 podium presentations and 150 oral sessions as possible, and viewing as many of the nearly 3,000 poster presentations, in the time between nine plenary sessions. Most of the information presented was being made available for the very first time.

As a dementia care professional, I attended this yearā€™s conference with an interest in learning the directions that the research is taking and the new findings that can be of significance to the families and patients I serve in Santa Barbara. Faced with a devastating disease, caregivers and affected families are eager to receive good news. And looking at the trove of information presented with their interests in mind, I would classify it in four basic areas: prevention, diagnosis, treatment, and symptom management.

 

Preventionā€”All data points to the wisdom of reducing your risk!

There were plenty of new findings confirming the benefits of prevention strategies in delaying the on-set of the disease, slowing the development of symptoms, and mitigating their severity.

The bulk of the research focused on vascular strengthening strategies, and the consensus is on exercise!

We have known that physical exercise has the potential to slow down the progression of the disease for quite some time, but researchers are also demonstrating reduction in the presence of the proteins Ī²-amyloid and Tau (which are associated with Alzheimerā€™s disease) in the brains of those who exercise (Carmichael, et al.). A team from Vancouver, Canada (Noseworthy, et al.) found that exercising outdoors has even greater wellness and cognitive benefits!

In an Indonesian study (Vidyanti, et al.) batik workers who had been exposed to heavy metals showed improvement in cognition utilizing specific exercises to stimulate left/right movements.

Researchers are also focusing on building cognitive reserves, as in strengthening the brain itself. One study from the University of Indiana (Manchella, et al.) surprisingly foundĀ  that social bridgingā€”defined as networking with persons of different social groups, races, or religionsā€”creates resilience against cognitive decline and it increases the size of the brain, particularly in the amygdala and left frontal lobe.

The message is clear: To fortify your brain and reduce your risk of developing Alzheimerā€™s, find some form of physical exercise you enjoy doing, give preference to outdoor activities, and do it with friends or others in the community. A shout out to all our pickle-ball friends: Carry on!

 

Diagnosisā€”Tests are now available!

In the absence of a conclusive test tool, clinicians have relied mostly on symptom observation and brain imaging to formulate a diagnosis of Alzheimerā€™s, incurring a high incidence of misdiagnosis.

Researchers have worked on new diagnostic tests, and a test that measures Beta Amyloid was approved this May by the FDA. Fugirebio, the makers of Lumipulse G Ī²-Amyloid Ratio (1-42/1-40), were present at the conference and expressed the hope that the test, which uses spinal fluid, will soon become standard of diagnosing for patients everywhere.

Also present at the conference were representatives from C2N Diagnostics. They are the makers of PrecivityADā„¢, another Ī²-amyloid test expecting full FDA approval soon. It uses a blood sample to identify whether a patient is likely to have amyloid plaques in the brain. Although it is already available in most of the country, PrecivityAD is not currently covered by private insurance providers, or by Medicare and Medicaid (MediCal in California).

Researchers are also developing tests for detecting the presence of Tau, which can be used to support a diagnosis of Alzheimerā€™s.

Although the development of these tests is a great advance in doctorsā€™ ability to provide patients with a reliable diagnosis regarding Alzheimerā€™s, it is unlikely that any single test will be conclusive on its own results. They must be used in connection with other biomarkers for a complete diagnosis, and the research community is still studying what their results imply in terms of prognosis for the progression of the disease. Over 400 studies were presented at this year’s conference on this topic alone.

 

Treatmentā€”New focus on sleep and inflammation

After years in trials where pharmaceuticals were found to be successful in reducing Ī²-amyloid in the brain but did very little to halt the progression of the disease, the scientific community seems to be shifting attention to other possible factors in the search for a treatment for Alzheimerā€™s.

While Ī²-amyloid and Tau continue to be the top targets for those studying treatment options, researchers are also looking at brain inflammation and its relationship with brain processes that happen during sleep.

It is during sleep that the brain cells diminish in size allowing for the fluid encompassing these cells to flow more freely through the brain, and in doing so carry away debris and waste created by normal brain operations, broken down particles of proteins including Ī²-amyloid. Brain waste that is not properly ā€œwashed awayā€ during sleep may clump and clutter, interfering with normal brain function. This brain-cleansing system is known as the glymphatic system and appears to be malfunctioning in Alzheimerā€™s disease patients.

The AlfaSleep project, in Barcelona, Spain, is studying how sleep deprivation and neuroinflammation may play a role in the association of sleep disorders and cognitive impairment.Ā 

On the other hand, a Dutch study is investigating how a reduction in the fluid found in the spaces around brain cells may leave less space for waste products to be cleared from in-between the cells.

An Australian study is looking at the extent to which inflammation is related to disease progression in patients before and after symptoms of dementia are present, and how inflammation levels can also be a biomarker for the disease (Cherbuin, et al.).

In addition, animal studies are looking for all kinds of possible triggers for inflammation, including COVID infection (Biose, et al.) and the common house dust mites (Sahu, et al.).

While a cure for Alzheimerā€™s still eludes the scientific community, researchers are leaving no stone unturned.

 

Symptom Managementā€”Guidelines for treating dementia-related agitation

For families and professionals in the field caring for patients with dementia, management of dementia-related agitation is a matter of great importance, although one that has been consistently overlooked by the scientific community.

In the U.S., where there are currently no drugs approved for agitation in dementia patients, doctors have used medication successfully to treat dementia-related agitation. This use, however, is off-label, and many clinicians are uncomfortable prescribing medications without guidelines. Family members are afraid of using medications because of their side effects, and patients are often left in a state of agitation and despair without the relief of pharmaceuticals. Caring for patients suffering from the behavioral and psychological symptoms of dementia (BPSD) is extremely difficult and it is driving up the costs of hospitalizations and residential care for dementia patients.

In a workshop addressing this lapse in treatment guidance, Dr. Jeff Cummings from the International Geriatrics Association presented a most valuable pharmacological algorithm, in which doctors will find guidelines in the use of pharmaceuticals while utilizing their own judgment and experience in determiningĀ  which course of therapy is the most appropriate for a patient. These treatments are not to be used in place of psychosocial interventions; rather, they are to be used in addition to non-pharmacological strategies, including the use of nature, socialization, music, arts, colors, and sounds.

Soon to be published, the proposed guidelines will provide clinicians with a much-needed roadmap on how to treat dementia patients with agitation while helping families better understand treatment options.

Looking at the problem from yet another angle, a study in Zurich has found that high concentrations of the stress hormone cortisol (found in the cerebrospinal fluid of dementia patients) are associated with the severity of neuropsychiatric symptoms and their persistence or worsening over time (Popp, et al.). This in itself can open a new venue of treatment and prevention for these symptoms.

San Diego was lit purple in support of Alzheimer’s

The Alzheimerā€™s Association has once again done an amazing job in bringing together so many brilliant minds invested in decoding the mystery behind this disease, and we are much closer to the solutions for these efforts. The 2023Ā  conference will be held in Amsterdam, and will be also available online.

 

 

 

Luciana Mitzkun is a Memory Care Specialist, author of Ahead of Dementia, Un Paso Adelante de la Demencia, and Ahead of Memory Loss. She is the Community Services Director at Villa Alamar, Memory Care in Santa Barbara, and a volunteer for the Alzheimerā€™s Association.