By the time you finish reading this article a few more people will be officially suffering from Alzheimer's disease.
Here is a startling perspective.
It is not unusual for a person working on Wall Street (New York) to spend a total of three hours a day commuting to and from work. Many of these people live on Long Island, in Connecticut and New Jersey.
There are 180 minutes in three hours. There are 10,800 seconds in three hours.
While these people are commuting to and from work each day, another 154 persons are diagnosed with Alzheimer's.
Each day, 1,232 people are diagnosed with Alzheimer's.
Each week, 8,634 people are diagnosed with Alzheimer's.
A recent Harris Interactive poll showed that more than 100 million Americans have been touched by Alzheimer's. More than 33 million Americans are worried about Alzheimer's disease.
Startling numbers.
Alzheimer's disease is a death sentence. Brain death. A typical person takes from 5-20 years to die. It is not unusual for the disease to take more than a decade to kill someone.
When most people think about Alzheimer's they think about a person losing their memory. Persons that know someone suffering from Alzheimer's disease watch them lose their ability to brush their teeth, take a shower, put on their cloths, go to the bathroom, and eat.
They await the worse day of them all -- the day the person suffering from Alzheimer's won't know them. Or anyone for that matter.
Alzheimer's disease is sinister and ugly.
If you don't know someone directly or indirectly that is suffering from Alzheimer's you will soon. It might have happened while you were reading this article.
By Bob DeMarco, Alzheimer's Reading Room
Wednesday, January 27, 2010
Monday, January 25, 2010
Discovery Of Compounds That Help Protect Nerve Cells
Scientists at Duke University Medical Center have found some compounds that improve a cell's ability to properly "fold" proteins and could lead to promising drugs for degenerative nerve diseases, including Huntington's disease, Alzheimer's disease and Parkinson's disease.
Misfolded proteins in nerve cells (neurons) are a common factor in all of these diseases. The Duke team has identified many new chemicals that activate a master regulator to increase the supply of "protein chaperone" molecules that help fold proteins properly.
The scientists further explored one of the candidate molecules to activate the master regulator of chaperone gene expression, Heat Shock Factor 1 (HSF1), to learn whether it would work in model systems of Huntington's disease, a devastating neurodegenerative disease of protein misfolding.
They were able to show that the molecule stimulated protein chaperones in cells and in an animal system. The damage to early-state rat neurons was much lower in cells pre-treated with the HSF1 activator, and damage to the neurons of fruit flies that had a Huntington's-like disorder was also greatly reduced.
Previous studies suggested that elevating the abundance of protein chaperones is effective in treating cell and animal models of Huntington's and Parkinson's diseases. This work provides a new approach to address the root cause of these diseases -- protein misfolding. Earlier attempts had used heat shock and other approaches that stress a nerve cell in order to produce more chaperone molecules, but at a cost of damaging the cell to save it.
"The advantage of our screen is that it identifies molecules that can elevate the levels of chaperones without inducing cellular stress and that don't inhibit a key protein chaperone called Hsp90 that is needed for cells to function normally," said senior author Dennis J. Thiele, Ph.D., Professor of Pharmacology and Cancer Biology. "We found a creative way to identify new molecules that can activate the body's natural protein folding machinery."
The research was published in the Jan. 19 online issue of PLoS Biology.
Lead author Daniel Neef, Ph.D., says they used genetically altered yeast to find compounds that might aid chaperone development. The scientists took yeast with a deleted HSF1 (master regulator) gene and inserted the related human HSF1 gene. These yeast, however, still weren't able to activate human HSF1 on their own, and in effect, died. They needed an additional molecule to make human HSF1 become active
The team put these "humanized yeasts" into wells and started testing compounds that would provide the missing link. In several of the wells, if the compound worked, the yeast started multiplying. "Out of over 12,000 compounds tested from chemical libraries, about 50 compounds worked," Neef said. The team decided to explore one of these compounds (HSF1A) in further experiments.
"The humanized yeast-based screening results in our study provide a way to identify new classes of small molecules, small enough to penetrate the blood-brain barrier to work in neurons, in flies as well as in humans," Thiele said. "These small molecules may be effective therapies in neurodegenerative diseases caused by protein conformational disorders such as Huntington's, Alzheimer's and Parkinson's disease."
The scientists found that HSF1A could stimulate more protein chaperones and reduce the protein misfolding. They showed that adding a small amount of HSF1A to the developing rat neurons kept the proteins dissolved throughout the cell, rather than clumping visibly as speckled areas (as seen under microscopes).
"We enhanced the cells' viability by four or five times by pre-treating them with this molecule," Neef said. "Otherwise, the cells would have died."
They used fruit flies with Huntington's disease for experiments to prove that the principle would work in an animal. Adding HSF1A to the fly's food produced more chaperone molecules in their neurons. This suggests that the molecule could travel from the fly's stomach into its circulation and cross a barrier to the fly brain.
In the key experiment, the Huntington's disease flies received either their usual food or food plus HSF1A. Those with untreated food developed eyes with dying photoreceptor neurons and lacking the normal red color. Those that ate HSF1A went on to have normal-colored eyes, indicating a repair had taken place, just by eating food laced with the promising compound.
Michelle Turski, now with Stanford University, was a co-author of the study. The work was supported by grants from the National Institutes of Health.
Source: Mary Jane Gore
Duke University Medical Center
Misfolded proteins in nerve cells (neurons) are a common factor in all of these diseases. The Duke team has identified many new chemicals that activate a master regulator to increase the supply of "protein chaperone" molecules that help fold proteins properly.
The scientists further explored one of the candidate molecules to activate the master regulator of chaperone gene expression, Heat Shock Factor 1 (HSF1), to learn whether it would work in model systems of Huntington's disease, a devastating neurodegenerative disease of protein misfolding.
They were able to show that the molecule stimulated protein chaperones in cells and in an animal system. The damage to early-state rat neurons was much lower in cells pre-treated with the HSF1 activator, and damage to the neurons of fruit flies that had a Huntington's-like disorder was also greatly reduced.
Previous studies suggested that elevating the abundance of protein chaperones is effective in treating cell and animal models of Huntington's and Parkinson's diseases. This work provides a new approach to address the root cause of these diseases -- protein misfolding. Earlier attempts had used heat shock and other approaches that stress a nerve cell in order to produce more chaperone molecules, but at a cost of damaging the cell to save it.
"The advantage of our screen is that it identifies molecules that can elevate the levels of chaperones without inducing cellular stress and that don't inhibit a key protein chaperone called Hsp90 that is needed for cells to function normally," said senior author Dennis J. Thiele, Ph.D., Professor of Pharmacology and Cancer Biology. "We found a creative way to identify new molecules that can activate the body's natural protein folding machinery."
The research was published in the Jan. 19 online issue of PLoS Biology.
Lead author Daniel Neef, Ph.D., says they used genetically altered yeast to find compounds that might aid chaperone development. The scientists took yeast with a deleted HSF1 (master regulator) gene and inserted the related human HSF1 gene. These yeast, however, still weren't able to activate human HSF1 on their own, and in effect, died. They needed an additional molecule to make human HSF1 become active
The team put these "humanized yeasts" into wells and started testing compounds that would provide the missing link. In several of the wells, if the compound worked, the yeast started multiplying. "Out of over 12,000 compounds tested from chemical libraries, about 50 compounds worked," Neef said. The team decided to explore one of these compounds (HSF1A) in further experiments.
"The humanized yeast-based screening results in our study provide a way to identify new classes of small molecules, small enough to penetrate the blood-brain barrier to work in neurons, in flies as well as in humans," Thiele said. "These small molecules may be effective therapies in neurodegenerative diseases caused by protein conformational disorders such as Huntington's, Alzheimer's and Parkinson's disease."
The scientists found that HSF1A could stimulate more protein chaperones and reduce the protein misfolding. They showed that adding a small amount of HSF1A to the developing rat neurons kept the proteins dissolved throughout the cell, rather than clumping visibly as speckled areas (as seen under microscopes).
"We enhanced the cells' viability by four or five times by pre-treating them with this molecule," Neef said. "Otherwise, the cells would have died."
They used fruit flies with Huntington's disease for experiments to prove that the principle would work in an animal. Adding HSF1A to the fly's food produced more chaperone molecules in their neurons. This suggests that the molecule could travel from the fly's stomach into its circulation and cross a barrier to the fly brain.
In the key experiment, the Huntington's disease flies received either their usual food or food plus HSF1A. Those with untreated food developed eyes with dying photoreceptor neurons and lacking the normal red color. Those that ate HSF1A went on to have normal-colored eyes, indicating a repair had taken place, just by eating food laced with the promising compound.
Michelle Turski, now with Stanford University, was a co-author of the study. The work was supported by grants from the National Institutes of Health.
Source: Mary Jane Gore
Duke University Medical Center
Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors
Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion on the basis of patient symptoms or caregivers' concerns and is prone to be missed or delayed. We conducted a systematic review of the literature to ascertain the prevalence and contributing factors for missed and delayed dementia diagnoses in primary care. Prevalence of missed and delayed diagnosis was estimated by abstracting quantitative data from studies of diagnostic sensitivity among primary care providers. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient, caregiver, provider, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and seemed to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but seems to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.
By Bradford, Andrea MA; Kunik, Mark E. MD; Schulz, Paul MD; Williams, Susan P. MD; Singh, Hardeep MD, MPH
By Bradford, Andrea MA; Kunik, Mark E. MD; Schulz, Paul MD; Williams, Susan P. MD; Singh, Hardeep MD, MPH
Should Dad Still Be Driving?
Most people remember learning to drive and the feeling of independence it gave them. This is much of the reason it is so hard for an older adult to give up driving. When addressing the issues of driving with a parent, it is important to understand why driving is important to them. Is it an independence issue? Is it because they need transportation to appointments and errands? Is it an issue of control over their life? If transportation is the concern, then having alternative options to assist them in getting to appointments, the grocery store and other errands will be critical. If independence or control is the issue, it may be helpful to point out that this is not about taking away their independence or control, it is about their safety and equally important, the safety of others on the road. Many times older adults are less concerned about their own safety and well being than they are of the safety and well being of others, especially children.
This issue may be better received if presented by a person in a position of respect, such as a physician or an attorney. Another option is for a comprehensive assessment by a Certified Care Manager. In addition to assessing and making recommendations about the client’s current functional level, the appropriateness of their living environment and their overall safety, the Care Manager can assess driving safety and alternatives to driving. Many times information which will not be well received by the older adult is better delivered by a neutral third party than it is from a family member, especially a child.
By Heather Frenette, RN, MSN, CMC
This issue may be better received if presented by a person in a position of respect, such as a physician or an attorney. Another option is for a comprehensive assessment by a Certified Care Manager. In addition to assessing and making recommendations about the client’s current functional level, the appropriateness of their living environment and their overall safety, the Care Manager can assess driving safety and alternatives to driving. Many times information which will not be well received by the older adult is better delivered by a neutral third party than it is from a family member, especially a child.Friday, January 8, 2010
Dealing with Difficult Behavior Caused by Dementia and Alzheimer's
By Bob DeMarco
I often get asked question about how I deal with my mother when she evidences erratic behavior.
I read these six coping strategies for dementia-related behavior problems some time ago. Dr. Peter Rabins is a renowned Johns Hopkins neurologist. He touches on the following behaviors: outbursts, agitation, aggression, wandering, vocalizations, hoarding and hiding things, and inappropriate sexual behavior.
People with dementia often exhibit behaviors that are frustrating, embarrassing, and sometimes even dangerous to the caregiver and others.
These may include angry outbursts, agitation, aggression, wandering, vocalizations, hoarding or hiding things, and inappropriate sexual behavior. For many caregivers, these difficult behaviors are the most challenging and exhausting aspect of caring for a person with dementia.
Unfortunately, the available medications to treat Alzheimer’s disease have little effect on behavioral problems.
In their groundbreaking book on Alzheimer’s caregiving --The 36 - Hour Day -- Peter Rabins, M.D. (author of the Johns Hopkins Memory White Paper), and Nancy Mace discuss the six R’s of managing difficult behavior in people with dementia. They are:
* Dementia Strategy 1 -- Restrict. First, calmly attempt to get the person to stop the behavior, especially if the behavior is potentially dangerous.
* Dementia Strategy 2 -- Reassess. Consider what might have provoked the behavior. Could a physical problem (toothache, urinary tract infection, osteoarthritis) be behind the agitation or anger? Is a particular person or the noise level in the room triggering the negative reaction? Could the time of day and fatigue be contributing to the problem?
* Dementia Strategy 3 -- Reconsider. Put yourself in the dementia patient’s shoes. Try to imagine what it must be like to not understand what is happening to you or to be unable to accomplish a simple task. Consider how frustrating or upsetting the current situation or environment might be for a person with dementia.
* Dementia Strategy 4 -- Rechannel. Try to redirect the behavior to a safer, less disruptive activity. For example, if the person constantly disassembles household items, try finding simple unused devices, such as an old telephone or a fishing reel, that can be taken apart and put back together repeatedly. For someone who hoards or hides things, put away valuables and replace them with an array of inexpensive items. Distraction often works well to curtail disruptive repetitive behaviors and restlessness. For example, try asking the person you’re caring for to “help” with simple tasks, such as holding spoons or potholders while you cook.
* Dementia Strategy 5 -- Reassure. The demented person’s brain injury and the resulting confusion and frustration can lead to anger, anxiety, and outright fear in certain situations. Calmly reassure the person that everything is okay and that you will continue to take care of him or her.
* Dementia Strategy 6 -- Review. After an unsettling experience with your loved one, take time to review how you managed the problem and what you might have done differently. Think about what may have triggered the problem, how it might have been avoided, and what you might try the next time a similar situation arises. It also helps to create a patient-friendly environment. This might include soothing music in the background; pictures, words, or arrows to help orient the person in the house; or a secure place to sit outside or walk in the backyard.
Source John Hopkins Health Alerts
I often get asked question about how I deal with my mother when she evidences erratic behavior.
I read these six coping strategies for dementia-related behavior problems some time ago. Dr. Peter Rabins is a renowned Johns Hopkins neurologist. He touches on the following behaviors: outbursts, agitation, aggression, wandering, vocalizations, hoarding and hiding things, and inappropriate sexual behavior.
People with dementia often exhibit behaviors that are frustrating, embarrassing, and sometimes even dangerous to the caregiver and others.
These may include angry outbursts, agitation, aggression, wandering, vocalizations, hoarding or hiding things, and inappropriate sexual behavior. For many caregivers, these difficult behaviors are the most challenging and exhausting aspect of caring for a person with dementia.
Unfortunately, the available medications to treat Alzheimer’s disease have little effect on behavioral problems.
* Dementia Strategy 1 -- Restrict. First, calmly attempt to get the person to stop the behavior, especially if the behavior is potentially dangerous.
* Dementia Strategy 2 -- Reassess. Consider what might have provoked the behavior. Could a physical problem (toothache, urinary tract infection, osteoarthritis) be behind the agitation or anger? Is a particular person or the noise level in the room triggering the negative reaction? Could the time of day and fatigue be contributing to the problem?
* Dementia Strategy 3 -- Reconsider. Put yourself in the dementia patient’s shoes. Try to imagine what it must be like to not understand what is happening to you or to be unable to accomplish a simple task. Consider how frustrating or upsetting the current situation or environment might be for a person with dementia.
* Dementia Strategy 4 -- Rechannel. Try to redirect the behavior to a safer, less disruptive activity. For example, if the person constantly disassembles household items, try finding simple unused devices, such as an old telephone or a fishing reel, that can be taken apart and put back together repeatedly. For someone who hoards or hides things, put away valuables and replace them with an array of inexpensive items. Distraction often works well to curtail disruptive repetitive behaviors and restlessness. For example, try asking the person you’re caring for to “help” with simple tasks, such as holding spoons or potholders while you cook.
* Dementia Strategy 5 -- Reassure. The demented person’s brain injury and the resulting confusion and frustration can lead to anger, anxiety, and outright fear in certain situations. Calmly reassure the person that everything is okay and that you will continue to take care of him or her.
* Dementia Strategy 6 -- Review. After an unsettling experience with your loved one, take time to review how you managed the problem and what you might have done differently. Think about what may have triggered the problem, how it might have been avoided, and what you might try the next time a similar situation arises. It also helps to create a patient-friendly environment. This might include soothing music in the background; pictures, words, or arrows to help orient the person in the house; or a secure place to sit outside or walk in the backyard.
Source John Hopkins Health Alerts
Tuesday, January 5, 2010
Are You Prepared For An Emergency?
By Heather Frenette, RN, MSN, CMC, Chief Operating Officer
The Sun Valley Group, Inc.
Arizona Care Management
In the past, most Americans lived their lives without any emergency plans. Times have changed. Fear of another terrorist attack, an increase in crime and more children living away from their parents has caused us to look more closely at contingency plans. Although many people have a Medical or Financial Power of Attorney in place, most people do not have a basic plan in place for other types of emergent situations. Do you have food, water, batteries and other emergency supplies available for a catastrophic event? Do you have a plan for the more common types of crises seniors face?
What would those who depend on you do if you got hit by a bus, or had a stroke? What would you do if your spouse were unable to take care of him or herself? These situations happen every day, and most of us do not have a plan in place. Unfortunately, without a plan these emergencies often become a crisis and families end up making quick, uninformed decisions to deal with the crisis. Those who have planned ahead and put a plan in place are usually able to make better decisions because they have more time, information and resources.
All of us have preferences for handling emergencies, our finances, medical decisions, legal matters and end of life choices. The problem is that we often do not discuss our preferences with anyone, even our spouse, children or Power of Attorney. These issues can be difficult to discuss, so often we just avoid the topic all together, tell ourselves we will deal with it “tomorrow” or assume our loved ones or nominated Power of Attorney will know our wishes and be able to make decisions the way we would have wanted. Unfortunately, if you do not discuss these topics, your loved ones will not have the information necessary to make the choices you would have made if you had been able to do it yourself.
If you or your loved one are uncomfortable talking about these issues, consider having an independent third party talk to you and your loved one. A Certified Geriatric Care Manager (GCM) can be a valuable assistance for discussing these topics. GCMs are independent, knowledgeable about resources available in the community and will know the questions to ask to gather important information for the contingency plan. Some of the topics a GCM will address include Medical such as current medical providers, current medical conditions, current medications and allergies. Secondly, legal, such as location of legal documents, they will verify that the people nominated in legal documents have a copy of the document and are willing to serve if needed. Thirdly, end of life, such as feelings about death, importance of dying at home, feelings about Hospice, burial and cremation and funeral/memorial preferences. Be specific! Fourth, emergency assistance, such as whom will be called first/second in the event of an emergency, Is there someone local who can assist if family lives far away? Lastly, financial, such as the location of bank/investment accounts, safe box and keys, financial documents and who is monitoring bank and credit card statements?
A great way to have an umbrella of these services would be to bring these needs to us. Our parent company, The Sun Valley Group, Inc., is a Professional Fiduciary Service designed to meet the needs of the incapacitated population. Our business is a vocation of compassion and caring, meeting clients' needs with consideration and dignity. Professional fiduciaries act by court appointment (guardian, conservator, trustee, personal representative) and as agents under powers of attorney. Being someone's fiduciary can be far more complex than just accounting for an individual's financial situation. The work can range from assessing the needs of the client, selecting a new home, buying furniture, and arranging for caregivers; to managing investments, controlling visitation schedules among warring family members, and handling burial arrangements. With Arizona Care Management all the needs listed above can be met.
Once you have a plan in place, share it with anyone who could be responsible for making these decisions. If you are geographically distant from the person(s) who will be acting on your behalf in an emergency, look for a local GCM who can be available for emergencies. GCMs are valuable because not only do they know the local resources, but they can also be available on an emergency basis to get things stabilized while the nominated agent is in route. The GCM can also take a proactive roll, making recommendations to help prevent potential crisis or monitoring unstable situations.
Whether you work with a GCM or do it yourself, take the time to put a contingency plan in place. It will give you and your loved one peace of mind knowing you have a plan in place for an emergency. You may never need it, but it is good to know it is there if you do!
Arizona Resource Links
http://www.sunvalleygroup.com/- Licensed Fiduciary
http://www.azcaremgt.com/- Certified Care Management
The Sun Valley Group, Inc.
Arizona Care Management
In the past, most Americans lived their lives without any emergency plans. Times have changed. Fear of another terrorist attack, an increase in crime and more children living away from their parents has caused us to look more closely at contingency plans. Although many people have a Medical or Financial Power of Attorney in place, most people do not have a basic plan in place for other types of emergent situations. Do you have food, water, batteries and other emergency supplies available for a catastrophic event? Do you have a plan for the more common types of crises seniors face?
What would those who depend on you do if you got hit by a bus, or had a stroke? What would you do if your spouse were unable to take care of him or herself? These situations happen every day, and most of us do not have a plan in place. Unfortunately, without a plan these emergencies often become a crisis and families end up making quick, uninformed decisions to deal with the crisis. Those who have planned ahead and put a plan in place are usually able to make better decisions because they have more time, information and resources.
All of us have preferences for handling emergencies, our finances, medical decisions, legal matters and end of life choices. The problem is that we often do not discuss our preferences with anyone, even our spouse, children or Power of Attorney. These issues can be difficult to discuss, so often we just avoid the topic all together, tell ourselves we will deal with it “tomorrow” or assume our loved ones or nominated Power of Attorney will know our wishes and be able to make decisions the way we would have wanted. Unfortunately, if you do not discuss these topics, your loved ones will not have the information necessary to make the choices you would have made if you had been able to do it yourself.
If you or your loved one are uncomfortable talking about these issues, consider having an independent third party talk to you and your loved one. A Certified Geriatric Care Manager (GCM) can be a valuable assistance for discussing these topics. GCMs are independent, knowledgeable about resources available in the community and will know the questions to ask to gather important information for the contingency plan. Some of the topics a GCM will address include Medical such as current medical providers, current medical conditions, current medications and allergies. Secondly, legal, such as location of legal documents, they will verify that the people nominated in legal documents have a copy of the document and are willing to serve if needed. Thirdly, end of life, such as feelings about death, importance of dying at home, feelings about Hospice, burial and cremation and funeral/memorial preferences. Be specific! Fourth, emergency assistance, such as whom will be called first/second in the event of an emergency, Is there someone local who can assist if family lives far away? Lastly, financial, such as the location of bank/investment accounts, safe box and keys, financial documents and who is monitoring bank and credit card statements?
A great way to have an umbrella of these services would be to bring these needs to us. Our parent company, The Sun Valley Group, Inc., is a Professional Fiduciary Service designed to meet the needs of the incapacitated population. Our business is a vocation of compassion and caring, meeting clients' needs with consideration and dignity. Professional fiduciaries act by court appointment (guardian, conservator, trustee, personal representative) and as agents under powers of attorney. Being someone's fiduciary can be far more complex than just accounting for an individual's financial situation. The work can range from assessing the needs of the client, selecting a new home, buying furniture, and arranging for caregivers; to managing investments, controlling visitation schedules among warring family members, and handling burial arrangements. With Arizona Care Management all the needs listed above can be met.
Once you have a plan in place, share it with anyone who could be responsible for making these decisions. If you are geographically distant from the person(s) who will be acting on your behalf in an emergency, look for a local GCM who can be available for emergencies. GCMs are valuable because not only do they know the local resources, but they can also be available on an emergency basis to get things stabilized while the nominated agent is in route. The GCM can also take a proactive roll, making recommendations to help prevent potential crisis or monitoring unstable situations.
Whether you work with a GCM or do it yourself, take the time to put a contingency plan in place. It will give you and your loved one peace of mind knowing you have a plan in place for an emergency. You may never need it, but it is good to know it is there if you do!
Arizona Resource Links
http://www.sunvalleygroup.com/- Licensed Fiduciary
http://www.azcaremgt.com/- Certified Care Management
Alzheimer's Disease Defined
Alzheimer's disease (pronounced Altz-hi-merz) is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking, and behavior. It is the most common form of dementia that affects over 4 million Americans. More than 100,000 die of Alzheimer's disease annually, which makes it the fourth leading cause of death in adults, after heart disease, cancer, and stroke.
Myths
By Alzheimer's Association
Myth 1: Memory loss is a natural part of aging.
Reality: In the past people believed memory loss was a normal part of aging, often regarding even Alzheimer’s as natural age-related decline. Experts now recognize severe memory loss as a symptom of serious illness.
Whether memory naturally declines to some extent remains an open question. Many people feel that their memory becomes less sharp as they grow older, but determining whether there is any scientific basis for this belief is a research challenge still being addressed.
Myth 2: Alzheimer’s disease is not fatal.
Reality: Alzheimer's disease has no survivors. It destroys brain cells and causes memory changes, erratic behaviors and loss of body functions. It slowly and painfully takes away a person's identity, ability to connect with others, think, eat, talk, walk and find his or her way home.
Myth 3: Only older people can get Alzheimer's
Reality: Alzheimer's can strike people in their 30s, 40s and even 50s. This is called younger-onset Alzheimer's. In 2009, it is estimated that there are as many as 5.3 million people living with Alzheimer’s disease in the United States. This includes 5.1 million people age 65 and over and 200,000 people under age 65 with younger-onset Alzheimer’s disease.
Myths
By Alzheimer's Association
Myth 1: Memory loss is a natural part of aging.
Reality: In the past people believed memory loss was a normal part of aging, often regarding even Alzheimer’s as natural age-related decline. Experts now recognize severe memory loss as a symptom of serious illness.
Whether memory naturally declines to some extent remains an open question. Many people feel that their memory becomes less sharp as they grow older, but determining whether there is any scientific basis for this belief is a research challenge still being addressed.
Myth 2: Alzheimer’s disease is not fatal.
Reality: Alzheimer's disease has no survivors. It destroys brain cells and causes memory changes, erratic behaviors and loss of body functions. It slowly and painfully takes away a person's identity, ability to connect with others, think, eat, talk, walk and find his or her way home.
Myth 3: Only older people can get Alzheimer's
Reality: Alzheimer's can strike people in their 30s, 40s and even 50s. This is called younger-onset Alzheimer's. In 2009, it is estimated that there are as many as 5.3 million people living with Alzheimer’s disease in the United States. This includes 5.1 million people age 65 and over and 200,000 people under age 65 with younger-onset Alzheimer’s disease.
Parkinson's Disease Defined
Parkinson's disease (PD) is a progressive disorder of the central nervous system, which affects more than one million Americans. Individuals with PD lack the substance dopamine, which is important for the central nervous system's control of muscle activity. Parkinson's disease is often characterized by tremors, stiffness in limbs and joints, speech impediments, and difficulty in initiating physical movement. Late in the course of the disease, some patients develop dementia and eventually Alzheimer's disease. Conversely, some Alzheimer patients develop symptoms of Parkinson's disease. Medications such as levodopa, which converts itself into dopamine once inside the brain, and depreynl, which prevents degeneration of dopamine-containing neurons, are used to improve, diminish, or reduce motor symptoms in PD patients, but do not correct the mental changes that occur.
Signs and Symptoms
By National Parkinson Foundation
The loss of dopamine production in the brain causes the primary symptoms of Parkinson's disease. The key signs of Parkinson's disease are:
Tremor (shaking)
Slowness of movement
Rigidity (stiffness)
Difficulty with balance
Other signs of Parkinson's disease may include:
Small, cramped handwriting
Stiff facial expression
Shuffling walk
Muffled speech
Depression
Who gets Parkinson's disease?
Parkinson's disease affects both men and women in almost equal numbers. It shows no social, ethnic, economic or geographic boundaries. In the United States, it is estimated that 60,000 new cases are diagnosed each year, joining the 1 million Americans who currently have Parkinson's disease. While the condition usually develops after the age of 65, 15% of those diagnosed are under 50.
Signs and Symptoms
By National Parkinson Foundation
The loss of dopamine production in the brain causes the primary symptoms of Parkinson's disease. The key signs of Parkinson's disease are:
Tremor (shaking)
Slowness of movement
Rigidity (stiffness)
Difficulty with balance
Other signs of Parkinson's disease may include:
Small, cramped handwriting
Stiff facial expression
Shuffling walk
Muffled speech
Depression
Who gets Parkinson's disease?
Parkinson's disease affects both men and women in almost equal numbers. It shows no social, ethnic, economic or geographic boundaries. In the United States, it is estimated that 60,000 new cases are diagnosed each year, joining the 1 million Americans who currently have Parkinson's disease. While the condition usually develops after the age of 65, 15% of those diagnosed are under 50.
Huntington's Disease Defined
Huntington's disease is an inherited, degenerative brain disease, which affects the mind and body. The disease usually begins during mid-life, and is characterized by intellectual decline, and irregular and involuntary movements of the limbs or facial muscles. Other symptoms of Huntington's disease include personality change, memory disturbance, slurred speech, impaired judgment, and psychiatric problems. Huntington's disease currently affects more than 25,000 Americans. The diagnostic process for Huntington's disease includes an evaluation of family medical history, recognition of typical movement disorders, and CAT brain scanning. A genetic marker linked to Huntington's disease has been identified on chromosome 4 and researchers are working on locating the gene itself. Although there is no treatment available to stop the progression of the disease, the movement disorders and psychiatric symptoms can be controlled by drugs.
Early Symptoms
By Huntington's Disease Society of America
Early symptoms of Huntington's Disease may affect cognitive ability or mobility and include depression, mood swings, forgetfulness, clumsiness, involuntary twitching and lack of coordination. As the disease progresses, concentration and short-term memory diminish and involuntary movements of the head, trunk and limbs increase. Walking, speaking and swallowing abilities deteriorate. Eventually the person is unable to care for him or herself. Death follows from complications such as choking, infection or heart failure.
HD typically begins in mid-life, between the ages of 30 and 50, though onset may occur as early as the age of 2. Children who develop the juvenile form of the disease rarely live to adulthood.
HD affects males and females equally and crosses all ethnic and racial boundaries. Each child of a person with HD has a 50/50 chance of inheriting the fatal gene. Everyone who carries the gene will develop the disease. In 1993, the HD gene was isolated and a direct genetic test developed which can accurately determine whether a person carries the HD gene. The test cannot predict when symptoms will begin. However, in the absence of a cure, some individuals "at risk" elect not to take the test.
Early Symptoms
By Huntington's Disease Society of America
Early symptoms of Huntington's Disease may affect cognitive ability or mobility and include depression, mood swings, forgetfulness, clumsiness, involuntary twitching and lack of coordination. As the disease progresses, concentration and short-term memory diminish and involuntary movements of the head, trunk and limbs increase. Walking, speaking and swallowing abilities deteriorate. Eventually the person is unable to care for him or herself. Death follows from complications such as choking, infection or heart failure.
HD typically begins in mid-life, between the ages of 30 and 50, though onset may occur as early as the age of 2. Children who develop the juvenile form of the disease rarely live to adulthood.
HD affects males and females equally and crosses all ethnic and racial boundaries. Each child of a person with HD has a 50/50 chance of inheriting the fatal gene. Everyone who carries the gene will develop the disease. In 1993, the HD gene was isolated and a direct genetic test developed which can accurately determine whether a person carries the HD gene. The test cannot predict when symptoms will begin. However, in the absence of a cure, some individuals "at risk" elect not to take the test.
Creutzfeldt-Jakob Disease Defined
Creutzfeldt-Jakob Disease (CJD) is a rare, fatal brain disorder caused by a transmissible infectious organism, probably a virus. Early symptoms of CJD include failing memory, changes in behavior, and a lack of coordination. As the disease progresses, usually very rapidly, mental deterioration becomes pronounced, involuntary movements (especially muscle jerks) appear, and the patient may become blind, develop weakness in the arms or legs, and ultimately lapse into a coma. The death of CJD patients is usually caused by infections in the bedridden, unconscious patient. Like Alzheimer's disease, a definitive diagnosis of CJD can be obtained only through an examination of brain tissue, usually at autopsy.
"In the early stages of the disease, CJD patients may exhibit failing memory, behavior changes, impaired coordination and/or visual disturbances. As the illness progresses, mental deterioration becomes more pronounced, and involuntary movements, blindness, weakness of extremities, and, ultimately, coma may occur. sCJD usually occurs later in life, and typically leads to death within a few weeks or months to one year following the onset of symptoms - in the United States, the mean age of death from sCJD is 67 years" Richard T. Johnson, M.D., Special Advisor to the National Institute of Neurological Disorders and Stroke.
There are three types of CJD:
By Creutzfeldt-Jakob Disease Foundation
Sporadic (sCJD)
Familial (fCJD) - Genetic
Acquired:
Iatrogenic Contaminated Surgical Instruments
Contaminated Dura mater transplant
Contaminated Corneal transplant
Contaminated Human Growth Hormone
Contaminated beef (vCJD)
The sporadic form (meaning from unknown cause) is the prevalent form in the US-85% of cases. More information can be found in the CJD pamphlet found on the website. As of August 2005 there are no known cases of endemic vCJD (ingestion of contaminated beef) in the U.S.
Diagnosis of CJD is very difficult and often happens through a process of elimination of other diseases. The diagnosis of CJD can only be confirmed through a brain biopsy or autopsy. Cerebral spinal fluid testing positive for the 14-3-3 protein is often used to confirm a possible diagnosis, this test, however, can be inconclusive.
"In the early stages of the disease, CJD patients may exhibit failing memory, behavior changes, impaired coordination and/or visual disturbances. As the illness progresses, mental deterioration becomes more pronounced, and involuntary movements, blindness, weakness of extremities, and, ultimately, coma may occur. sCJD usually occurs later in life, and typically leads to death within a few weeks or months to one year following the onset of symptoms - in the United States, the mean age of death from sCJD is 67 years" Richard T. Johnson, M.D., Special Advisor to the National Institute of Neurological Disorders and Stroke.
There are three types of CJD:
By Creutzfeldt-Jakob Disease Foundation
Sporadic (sCJD)
Familial (fCJD) - Genetic
Acquired:
Iatrogenic Contaminated Surgical Instruments
Contaminated Dura mater transplant
Contaminated Corneal transplant
Contaminated Human Growth Hormone
Contaminated beef (vCJD)
The sporadic form (meaning from unknown cause) is the prevalent form in the US-85% of cases. More information can be found in the CJD pamphlet found on the website. As of August 2005 there are no known cases of endemic vCJD (ingestion of contaminated beef) in the U.S.
Diagnosis of CJD is very difficult and often happens through a process of elimination of other diseases. The diagnosis of CJD can only be confirmed through a brain biopsy or autopsy. Cerebral spinal fluid testing positive for the 14-3-3 protein is often used to confirm a possible diagnosis, this test, however, can be inconclusive.
Frontal Lobe Dementia Defined
Frontal lobe dementia typically affects patients at a very early age, and usually affects females more than males. In this type of dementia, there is no true memory loss in the early stages. Instead, there are changes in personality, ability to concentrate, social skills, motivation and reasoning. Because of their true nature, these symptoms are often confused with psychiatric disorders. There are gradual changes in one’s customary way of behaving and responding emotionally to others. Memory, language and visual perception are usually not impaired for the first two years, yet as the disease progresses and spreads to other areas of the brain, they too may become affected.
Frontal lobe dementia affects the part of the brain that regulated comportment, insight and reasoning. “Comportment” is a term that refers to social behavior, insight, and “appropriateness” in different social contexts. Normal comportment involves having insight and the ability to recognize what behavior is appropriate in a particular social situation and to adapt one’s behavior to the situation.
Symptoms of Frontotemporal Dementia
By Northwestern University, Feinburg School of Medicine
Impairments in social skills
- inappropriate or bizarre social behavior (e.g., eating with one's fingers in public, doing sit-ups in a public restroom, being overly familiar with strangers)
- "loosening" of normal social restraints (e.g., using obscene language or making inappropriate sexual remarks)
Change in activity level
- apathy, withdrawal, loss of interest, lack of motivation, and initiative which may appear to be depression but the patient does not experience sad feelings.
- in some instances there is an increase in purposeless activity (e.g., pacing, constant cleaning) or agitation.
Decreased Judgment
- impairments in financial decision- making (e.g., impulsive spending)
- difficulty recognizing consequences of behavior
- lack of appreciation for threats to safety (e.g., inviting strangers into home)
Changes in personal habits
- lack of concern over personal appearance
- irresponsibility
- compulsiveness (need to carry out repeated actions that are inappropriate or not relevant to the situation at hand.
Alterations in personality and mood
- increased irritability, decreased ability to tolerate frustration
Changes is one's customary emotional responsiveness
- a lack of sympathy or compassion in someone who was typically responsive to others' distress
- heightened emotionality in someone who was typically less emotionally responsive
Persons with this form of dementia may look like they have problems in almost all areas of mental function. This is because all mental activity requires attention, concentration and the ability to organize information, all of which are impaired in frontal lobe dementia. Careful testing, however, usually shows that most of the problems stem from a lack of persistence and increased inertia.
Frontal lobe dementia affects the part of the brain that regulated comportment, insight and reasoning. “Comportment” is a term that refers to social behavior, insight, and “appropriateness” in different social contexts. Normal comportment involves having insight and the ability to recognize what behavior is appropriate in a particular social situation and to adapt one’s behavior to the situation.
Symptoms of Frontotemporal Dementia
By Northwestern University, Feinburg School of Medicine
Impairments in social skills
- inappropriate or bizarre social behavior (e.g., eating with one's fingers in public, doing sit-ups in a public restroom, being overly familiar with strangers)
- "loosening" of normal social restraints (e.g., using obscene language or making inappropriate sexual remarks)
Change in activity level
- apathy, withdrawal, loss of interest, lack of motivation, and initiative which may appear to be depression but the patient does not experience sad feelings.
- in some instances there is an increase in purposeless activity (e.g., pacing, constant cleaning) or agitation.
Decreased Judgment
- impairments in financial decision- making (e.g., impulsive spending)
- difficulty recognizing consequences of behavior
- lack of appreciation for threats to safety (e.g., inviting strangers into home)
Changes in personal habits
- lack of concern over personal appearance
- irresponsibility
- compulsiveness (need to carry out repeated actions that are inappropriate or not relevant to the situation at hand.
Alterations in personality and mood
- increased irritability, decreased ability to tolerate frustration
Changes is one's customary emotional responsiveness
- a lack of sympathy or compassion in someone who was typically responsive to others' distress
- heightened emotionality in someone who was typically less emotionally responsive
Persons with this form of dementia may look like they have problems in almost all areas of mental function. This is because all mental activity requires attention, concentration and the ability to organize information, all of which are impaired in frontal lobe dementia. Careful testing, however, usually shows that most of the problems stem from a lack of persistence and increased inertia.
Picks Disease Defined
Picks disease accounts for 20% of the frontal lobe dementia cases and is identified under the microscope by abnormal particles called “Pick bodies”. Disturbances in personality, behavior, and orientation may precede and initially be more severe than memory defects. Like Alzheimer's disease, a definitive diagnosis is usually obtained at autopsy.
What is Frontotemporal Dementia ?
By National Institute of Neurological Disorders and Stroke
Frontotemporal dementia (FTD) describes a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain. Originally known as Pick’s disease, the name and classification of FTD has been a topic of discussion for over a century. The current designation of the syndrome groups together Pick’s disease, primary progressive aphasia, and semantic dementia as FTD. Some doctors propose adding corticobasal degeneration and progressive supranuclear palsy to FTD and calling the group Pick Complex. These designations will continue to be debated. As it is defined today, the symptoms of FTD fall into two clinical patterns that involve either (1) changes in behavior, or (2) problems with language. The first type features behavior that can be either impulsive (disinhibited) or bored and listless (apathetic) and includes inappropriate social behavior; lack of social tact; lack of empathy; distractability; loss of insight into the behaviors of oneself and others; an increased interest in sex; changes in food preferences; agitation or, conversely, blunted emotions; neglect of personal hygiene; repetitive or compulsive behavior, and decreased energy and motivation. The second type primarily features symptoms of language disturbance, including difficulty making or understanding speech, often in conjunction with the behavioral type’s symptoms. Spatial skills and memory remain intact. There is a strong genetic component to the disease; FTD often runs in families.
Is there any treatment?
No treatment has been shown to slow the progression of FTD. Behavior modification may help control unacceptable or dangerous behaviors. Aggressive, agitated, or dangerous behaviors could require medication. Anti-depressants have been shown to improve some symptoms.
What is Frontotemporal Dementia ?
By National Institute of Neurological Disorders and Stroke
Frontotemporal dementia (FTD) describes a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain. Originally known as Pick’s disease, the name and classification of FTD has been a topic of discussion for over a century. The current designation of the syndrome groups together Pick’s disease, primary progressive aphasia, and semantic dementia as FTD. Some doctors propose adding corticobasal degeneration and progressive supranuclear palsy to FTD and calling the group Pick Complex. These designations will continue to be debated. As it is defined today, the symptoms of FTD fall into two clinical patterns that involve either (1) changes in behavior, or (2) problems with language. The first type features behavior that can be either impulsive (disinhibited) or bored and listless (apathetic) and includes inappropriate social behavior; lack of social tact; lack of empathy; distractability; loss of insight into the behaviors of oneself and others; an increased interest in sex; changes in food preferences; agitation or, conversely, blunted emotions; neglect of personal hygiene; repetitive or compulsive behavior, and decreased energy and motivation. The second type primarily features symptoms of language disturbance, including difficulty making or understanding speech, often in conjunction with the behavioral type’s symptoms. Spatial skills and memory remain intact. There is a strong genetic component to the disease; FTD often runs in families.
Is there any treatment?
No treatment has been shown to slow the progression of FTD. Behavior modification may help control unacceptable or dangerous behaviors. Aggressive, agitated, or dangerous behaviors could require medication. Anti-depressants have been shown to improve some symptoms.
Dementia with Lewy Bodies Defined
Dementia with Lewy Bodies, first described in 1961, has been increasingly recognized over the past 5-10 years. Currently it is the 2nd most common form of dementia. Abnormal brain cells called “lewy bodies” are distributed in varying degrees throughout all areas of the brain. It is a dementia very similar to AD but may progress more rapidly. The main features of Lewy Body are (1) the development of features similar to Parkinson’s disease (2) fluctuation in the severity of condition on a day-to-day basis and (3) development of visual hallucinations and delusions.
Diagnosis
By Lewy Body Dementia Association
An experienced clinician within the medical community should perform a diagnostic evaluation. If one is not available, the neurology department of the nearest medical university should be able to recommend appropriate resources or may even provide an experienced diagnostic team skilled in Lewy body dementia.
A thorough dementia diagnostic evaluation includes physical and neurological examinations, patient and family interviews (including a detailed lifestyle and medical history), and neuro-psychological and mental status tests. The patient's functional ability, attention, language, visuospatial skills, memory and executive functioning are assessed. In addition, brain imaging (CT or MRI scans), blood tests and other laboratory studies may be performed. The evaluation will provide a clinical diagnosis. Currently, a conclusive diagnosis of LBD can be obtained only from a postmortem autopsy for which arrangements should be made in advance. Some research studies may offer brain autopsies as part of their protocols. Participating in research studies is a good way to benefit others with Lewy body dementia.
Diagnosis
By Lewy Body Dementia Association
An experienced clinician within the medical community should perform a diagnostic evaluation. If one is not available, the neurology department of the nearest medical university should be able to recommend appropriate resources or may even provide an experienced diagnostic team skilled in Lewy body dementia.
A thorough dementia diagnostic evaluation includes physical and neurological examinations, patient and family interviews (including a detailed lifestyle and medical history), and neuro-psychological and mental status tests. The patient's functional ability, attention, language, visuospatial skills, memory and executive functioning are assessed. In addition, brain imaging (CT or MRI scans), blood tests and other laboratory studies may be performed. The evaluation will provide a clinical diagnosis. Currently, a conclusive diagnosis of LBD can be obtained only from a postmortem autopsy for which arrangements should be made in advance. Some research studies may offer brain autopsies as part of their protocols. Participating in research studies is a good way to benefit others with Lewy body dementia.
Wernicke-Korsakoff Syndrome Defined
Wernicke-Korsakoff syndrome is a two-stage brain disorder caused by a deficiency of thiamine (vitamin B-1). Wernicke encephalopathy is the first, acute phase and Korsakoff psychosis is the long-lasting, chronic stage. The most common cause is alcoholism, but the syndrome can also be associated with AIDS, cancers that have spread through the body, very high levels of thyroid hormone, and certain other conditions.
Symptoms of Wernicke-Korsakoff
By Alzheimer's Association
•Confusion, permanent gaps in memory and problems with learning new information.
•Individuals may have a tendency to “confabulate,” or make up information they can’t remember; they are not “lying,” but may actually believe the invented explanation.
•Unsteadiness, muscle weakness and lack of coordination.
•Recent research suggests a genetic variation called APOE-e4 may be associated with a higher risk of Wernicke-Korsakoff in individuals who drink heavily. APOE-e4 is also linked to a higher risk of developing Alzheimer’s disease.
Symptoms of Wernicke-Korsakoff
By Alzheimer's Association
•Confusion, permanent gaps in memory and problems with learning new information.
•Individuals may have a tendency to “confabulate,” or make up information they can’t remember; they are not “lying,” but may actually believe the invented explanation.
•Unsteadiness, muscle weakness and lack of coordination.
•Recent research suggests a genetic variation called APOE-e4 may be associated with a higher risk of Wernicke-Korsakoff in individuals who drink heavily. APOE-e4 is also linked to a higher risk of developing Alzheimer’s disease.
Normal Pressure Hydrocephalus Defined
Normal pressure hydrocephalus is an uncommon disorder, which involves an obstruction in the normal flow of cerebrospinal fluid. This blockage causes a buildup of cerebrospinal fluid on the brain. Symptoms of normal pressure hydrocephalus include dementia, urinary incontinence, and difficulty in walking. Presently, the most useful diagnostic tools are the neuroimaging techniques (i.e. MRI). Normal pressure hydrocephalus may be caused by any of several factors including meningitis, encephalitis, and head injuries. In addition to treatment of the underlying cause, the condition may be corrected by a neurosurgical procedure (insertion of a shunt) to divert the fluid away from the brain.
Education and Support
By Hydrocephalus Association
Hydrocephalus is a chronic neurological condition characterized by an increased volume of cerebrospinal fluid (CSF) within spaces inside the brain. While there's no known cure for hydrocephalus, the future holds promise. Recent research gives great hope that we may one day find a cure. In the meantime, gradual advances in technology as well as diagnostic and treatment protocols are helping more and more people with hydrocephalus to lead full and active lives.
Although hydrocephalus (hi-dro-sef-a-lus) is not yet a household word, it is NOT uncommon and you are not alone. Over a million people of all ages currently live with hydrocephalus in the United States, though it occurs all over the world. Hydrocephalus knows no socioeconomic, gender or ethnic boundaries. Of every 1,000 babies born in this country, one or two will have hydrocephalus. It is the most common reason for brain surgery in children, but it can also be diagnosed in any decade of life. Experts estimate that hundreds of thousands of older adults have normal pressure hydrocephalus (NPH), which often goes undetected or is misdiagnosed as untreatable dementia, Alzheimer’s or Parkinson’s.
Education and Support
By Hydrocephalus Association
Hydrocephalus is a chronic neurological condition characterized by an increased volume of cerebrospinal fluid (CSF) within spaces inside the brain. While there's no known cure for hydrocephalus, the future holds promise. Recent research gives great hope that we may one day find a cure. In the meantime, gradual advances in technology as well as diagnostic and treatment protocols are helping more and more people with hydrocephalus to lead full and active lives.
Although hydrocephalus (hi-dro-sef-a-lus) is not yet a household word, it is NOT uncommon and you are not alone. Over a million people of all ages currently live with hydrocephalus in the United States, though it occurs all over the world. Hydrocephalus knows no socioeconomic, gender or ethnic boundaries. Of every 1,000 babies born in this country, one or two will have hydrocephalus. It is the most common reason for brain surgery in children, but it can also be diagnosed in any decade of life. Experts estimate that hundreds of thousands of older adults have normal pressure hydrocephalus (NPH), which often goes undetected or is misdiagnosed as untreatable dementia, Alzheimer’s or Parkinson’s.
Mild Cognitive Impairment Defined
Mild cognitive impairment (MCI) a condition in which a person has problems with memory, language, or another mental function severe enough to be noticeable to other people and to show up on tests, but not serious enough to interfere with daily life.
Because the problems do not interfere with daily activities, the person does not meet criteria for being diagnosed with dementia. The best-studied type of MCI involves a memory problem and is called “amnestic MCI.”
Symptoms
By Mayo Clinic staff
The forgetfulness of normal aging is minor. You misplace your car keys or lose your car in the parking garage. Perhaps you can't remember the name of a former co-worker when you meet unexpectedly at the grocery store. This is nothing to worry about.
But red flags should go up if you start forgetting things you typically remember, such as doctor's appointments or your weekly pinochle game. This happens to everyone now and then, but if a pattern develops, it could be a symptom of mild cognitive impairment.
Commonly used criteria for a diagnosis of mild cognitive impairment are:
■Deficient memory, preferably confirmed by another person
■Essentially normal judgment, perception and reasoning skills
■Largely normal activities of daily living
■Reduced performance on cognitive tests, compared with other people of similar age and educational background
People with mild cognitive impairment may also experience:
■Depression
■Irritability
■Anxiety
■Aggression
■Apathy
Because the problems do not interfere with daily activities, the person does not meet criteria for being diagnosed with dementia. The best-studied type of MCI involves a memory problem and is called “amnestic MCI.”
Symptoms
By Mayo Clinic staff
The forgetfulness of normal aging is minor. You misplace your car keys or lose your car in the parking garage. Perhaps you can't remember the name of a former co-worker when you meet unexpectedly at the grocery store. This is nothing to worry about.
But red flags should go up if you start forgetting things you typically remember, such as doctor's appointments or your weekly pinochle game. This happens to everyone now and then, but if a pattern develops, it could be a symptom of mild cognitive impairment.
Commonly used criteria for a diagnosis of mild cognitive impairment are:
■Deficient memory, preferably confirmed by another person
■Essentially normal judgment, perception and reasoning skills
■Largely normal activities of daily living
■Reduced performance on cognitive tests, compared with other people of similar age and educational background
People with mild cognitive impairment may also experience:
■Depression
■Irritability
■Anxiety
■Aggression
■Apathy
Monday, January 4, 2010
Study: Ginkgo biloba has no effect on Alzheimer's, dementia
By Elizabeth Weise, USA TODAY
The popular botanical ginkgo biloba does not improve memory nor does it prevent cognitive decline in older people, according to the largest and longest scientific study ever undertaken to look at the supplement.
An extract derived from the ginkgo tree, ginkgo biloba has been touted since the 1970s by the supplement industry and others as an aid to improving memory, cognitive impairment, dementia and Alzheimer's disease. Ginkgo extract has been used in traditional Chinese medicine for more than 500 years, according to the American Botanical Council.
SUPPLEMENTS: DHA gets mixed reviews in memory studies
ALZHEIMER'S INDEX: Video, latest news, what you need to know
BLOG: Living with Alzheimer's: Handling Christmas
The study finding is "disappointing news," says Steven DeKosky, dean of the University of Virginia School of Medicine and the study's senior author. The only positive thing the researchers found is that ginkgo appears to be safe, he says.
The results are from the Ginkgo Evaluation of Memory study, funded by the National Center for Complementary and Alternative Medicine, a center of the National Institutes of Health. The randomized, double-blind and placebo-controlled study was conducted at six medical centers and involved more than 3,000 people between ages 72 and 96 for seven years. The report is in today's Journal of the American Medical Association.
The first set of results from the study, published last year, found that a twice-daily dose of 120 milligrams of ginkgo biloba extract was not effective in reducing the incidence of Alzheimer's dementia or dementia overall.
This new paper looked at the same results to see if ginkgo biloba extract had any effect on cognitive decline in older adults, specifically memory, visual-spatial construction, language, attention, psychomotor speed and executive function. It found no effect.
"It just continues to show that in properly designed, placebo-controlled studies, we can't seem to find an effect for ginkgo biloba," says Lon Schneider, an Alzheimer's and gerontology expert at the University of Southern California. The size of this study is larger than all previous ginkgo biloba studies combined, he says.
Douglas MacKay, vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a supplement industry trade group, disputes the study's findings.
"There is a large body of previously published evidence, as well as ongoing trials, which suggest that ginkgo biloba is effective for helping to improve cognitive impairment in older adults," he says.
U.S. sales for ginkgo biloba were $99 million in 2008, down 8% from 2007 but still placing it the 8th most popular herb and botanical that the Nutrition Business Journal tracks.
The popular botanical ginkgo biloba does not improve memory nor does it prevent cognitive decline in older people, according to the largest and longest scientific study ever undertaken to look at the supplement.
An extract derived from the ginkgo tree, ginkgo biloba has been touted since the 1970s by the supplement industry and others as an aid to improving memory, cognitive impairment, dementia and Alzheimer's disease. Ginkgo extract has been used in traditional Chinese medicine for more than 500 years, according to the American Botanical Council.
SUPPLEMENTS: DHA gets mixed reviews in memory studies
ALZHEIMER'S INDEX: Video, latest news, what you need to know
BLOG: Living with Alzheimer's: Handling Christmas
The study finding is "disappointing news," says Steven DeKosky, dean of the University of Virginia School of Medicine and the study's senior author. The only positive thing the researchers found is that ginkgo appears to be safe, he says.
The results are from the Ginkgo Evaluation of Memory study, funded by the National Center for Complementary and Alternative Medicine, a center of the National Institutes of Health. The randomized, double-blind and placebo-controlled study was conducted at six medical centers and involved more than 3,000 people between ages 72 and 96 for seven years. The report is in today's Journal of the American Medical Association.
The first set of results from the study, published last year, found that a twice-daily dose of 120 milligrams of ginkgo biloba extract was not effective in reducing the incidence of Alzheimer's dementia or dementia overall.
This new paper looked at the same results to see if ginkgo biloba extract had any effect on cognitive decline in older adults, specifically memory, visual-spatial construction, language, attention, psychomotor speed and executive function. It found no effect.
"It just continues to show that in properly designed, placebo-controlled studies, we can't seem to find an effect for ginkgo biloba," says Lon Schneider, an Alzheimer's and gerontology expert at the University of Southern California. The size of this study is larger than all previous ginkgo biloba studies combined, he says.
Douglas MacKay, vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a supplement industry trade group, disputes the study's findings.
"There is a large body of previously published evidence, as well as ongoing trials, which suggest that ginkgo biloba is effective for helping to improve cognitive impairment in older adults," he says.
U.S. sales for ginkgo biloba were $99 million in 2008, down 8% from 2007 but still placing it the 8th most popular herb and botanical that the Nutrition Business Journal tracks.
Huge wave of dementia cases coming, warns report
By CTV.ca News Staff
So many Canadians are expected to develop Alzheimer's disease and dementia in the next 30 years that a new case will develop every two minutes unless preventive measures are taken, a new report says.
The report, released Monday by the Alzheimer Society, says the prevalence of dementia will more than double in the next 30 years.
By 2038, almost three per cent of Canada's population will be affected by dementia, and about 257,800 new cases will be diagnosed per year.
Today, dementia costs Canada about $15 billion a year; those costs could soon increase by 10-fold.
"If nothing changes, this sharp increase in the number of people living with dementia will mean that by 2038, the total costs associated with dementia will reach $153 billion a year," David Harvey, principal spokesperson for the Alzheimer Society project called "Rising Tide: The Impact of Dementia on Canadian Society," said in a statement.
That amounts to a cumulative total of $872 billion over the 30-year period.
Much of the increase in cases can be attributed to the "greying" of Canada. With Canadians living longer and baby boomers aging, there is expected to be a spike in many chronic diseases that come with age, such as heart disease, arthritis and cancer.
But the expected rising rates of dementia are not just about demographics; poor lifestyles also play a role.
It's been well documented that regular physical and mental exercise can delay the onset of dementia, which includes Alzheimer's disease and other progressive diseases that destroy brain cells. For that reason, the report recommends that all Canadians over 65 without dementia increase their physical activity by 50 per cent.
"Prevention is where we need to be starting," Harvey told Canada AM.
"We know that healthy eating and active living are antidotes to dementia."
The "Rising Tide" report calls on government to fund more health promotion to remind Canadians of the benefits of a healthy lifestyle.
"This intervention would reduce the number of people diagnosed with dementia, resulting in a reduction in the pressure on long-term care facilities, community care services and informal caregivers," the report says.
Need for national strategy
Just as important, Harvey says, is the need for Canada's health care system to adapt to accommodate the projected rise in dementia cases.
"Dementia is one of the leading cases of disability amongst older people," Harvey said, noting that the flood of dementia expected in the next 30 years could overwhelm emergency rooms and hospitals.
His group's report calls for more support for informal caregivers -- generally, family members -- who tend to be the ones who care for patients with dementia in the early stages of the disease.
"There are services that can be put in place to support caregivers, and also economic and financial support for caregivers," he said.
By also providing caregivers with skill-building and support programs, caregivers struggling with the overwhelming emotional and financial hardships of providing care may feel better equipped to care for their loved one.
That could go far to delay admission of patients into long-term care facilities, thereby lessening the burden on the health care system.
The report also suggests assigning "system navigators" to each newly diagnosed dementia patient and their caregivers. These case managers would help families navigate the health system to find the right social services for their loved one depending on their stage of dementia.
Some facts about dementia:
The symptoms of dementia include a gradual and continuing decline of memory, changes in judgment or reasoning, mood and behaviour, and an inability to perform familiar tasks.
Dementia can strike adults at any age, but has traditionally been diagnosed in people over 65. However, symptoms start much earlier, and an increasing number of people are being diagnosed in their 50s and early 60s.
Age is the number one risk factor for dementia
Alzheimer's disease, the most common form of dementia, accounts for approximately 64 per cent of all dementias in Canada.
Other related dementias include Vascular Dementia, Frontotemporal Dementia, Creutzfeldt-Jakob Disease and Lewy body Dementia.
There is no known cure for dementia. However, some medications can delay progression of the disease.
Researchers are confident that within five to seven years, there will be treatments that attack the disease process itself, not just the symptoms.
So many Canadians are expected to develop Alzheimer's disease and dementia in the next 30 years that a new case will develop every two minutes unless preventive measures are taken, a new report says.
The report, released Monday by the Alzheimer Society, says the prevalence of dementia will more than double in the next 30 years.
By 2038, almost three per cent of Canada's population will be affected by dementia, and about 257,800 new cases will be diagnosed per year.
Today, dementia costs Canada about $15 billion a year; those costs could soon increase by 10-fold.
"If nothing changes, this sharp increase in the number of people living with dementia will mean that by 2038, the total costs associated with dementia will reach $153 billion a year," David Harvey, principal spokesperson for the Alzheimer Society project called "Rising Tide: The Impact of Dementia on Canadian Society," said in a statement.
That amounts to a cumulative total of $872 billion over the 30-year period.
Much of the increase in cases can be attributed to the "greying" of Canada. With Canadians living longer and baby boomers aging, there is expected to be a spike in many chronic diseases that come with age, such as heart disease, arthritis and cancer.
But the expected rising rates of dementia are not just about demographics; poor lifestyles also play a role.
It's been well documented that regular physical and mental exercise can delay the onset of dementia, which includes Alzheimer's disease and other progressive diseases that destroy brain cells. For that reason, the report recommends that all Canadians over 65 without dementia increase their physical activity by 50 per cent.
"Prevention is where we need to be starting," Harvey told Canada AM.
"We know that healthy eating and active living are antidotes to dementia."
The "Rising Tide" report calls on government to fund more health promotion to remind Canadians of the benefits of a healthy lifestyle.
"This intervention would reduce the number of people diagnosed with dementia, resulting in a reduction in the pressure on long-term care facilities, community care services and informal caregivers," the report says.
Need for national strategy
Just as important, Harvey says, is the need for Canada's health care system to adapt to accommodate the projected rise in dementia cases.
"Dementia is one of the leading cases of disability amongst older people," Harvey said, noting that the flood of dementia expected in the next 30 years could overwhelm emergency rooms and hospitals.
His group's report calls for more support for informal caregivers -- generally, family members -- who tend to be the ones who care for patients with dementia in the early stages of the disease.
"There are services that can be put in place to support caregivers, and also economic and financial support for caregivers," he said.
By also providing caregivers with skill-building and support programs, caregivers struggling with the overwhelming emotional and financial hardships of providing care may feel better equipped to care for their loved one.
That could go far to delay admission of patients into long-term care facilities, thereby lessening the burden on the health care system.
The report also suggests assigning "system navigators" to each newly diagnosed dementia patient and their caregivers. These case managers would help families navigate the health system to find the right social services for their loved one depending on their stage of dementia.
Some facts about dementia:
The symptoms of dementia include a gradual and continuing decline of memory, changes in judgment or reasoning, mood and behaviour, and an inability to perform familiar tasks.
Dementia can strike adults at any age, but has traditionally been diagnosed in people over 65. However, symptoms start much earlier, and an increasing number of people are being diagnosed in their 50s and early 60s.
Age is the number one risk factor for dementia
Alzheimer's disease, the most common form of dementia, accounts for approximately 64 per cent of all dementias in Canada.
Other related dementias include Vascular Dementia, Frontotemporal Dementia, Creutzfeldt-Jakob Disease and Lewy body Dementia.
There is no known cure for dementia. However, some medications can delay progression of the disease.
Researchers are confident that within five to seven years, there will be treatments that attack the disease process itself, not just the symptoms.
How to decide if your family needs a geriatric-care manager
By Anya Martin
DECATUR, Ga. (MarketWatch) -- The holidays should be a joyful time of homecoming for families, but sometimes those visits also reveal that elderly parents are more frail or more forgetful than before. Discoveries like these may suggest that it's time to consult a geriatric-care manager.
When Nancy Gratzel's mother had a sudden change in her health requiring placement in a nursing home, Gratzel and her four siblings found themselves overwhelmed by the complex paperwork to qualify for Medicaid coverage. So they turned to Stephen Mielach, a geriatric-care manager based in their community of Toms River, N.J.
Now Mielach also shares a power of attorney with Gratzel to assist her 88-year-old father, now living on his own, with bill-paying -- a task that his wife used to perform exclusively. Her father appreciated the help and began to look forward to Mielach's visits, she said.
"To me, that was a good use of my parents' money which we were going to have to spend anyway [to meet Medicaid qualifications]," Gratzel said. "It afforded me the opportunity to direct my energy towards nicer things, helping my mom adjust to the facility and my dad to living at home alone. They had been married 67 years."
While most seniors and their families do not go so far as to assign power of attorney to geriatric-care managers, members of this growing profession can assist not just with money matters but also with navigating the often complicated decisions about what care is best for mom, dad or another relative.
Sometimes they help resolve a short-term challenge such as Mielach did initially for Gratzel's mother or they may provide assistance over a period of months or years. Sample tasks range from vetting home health aides to assessing whether a senior is able to remain at home or needs to relocate to an assisted-living community or nursing home. They may also accompany seniors to medical appointments and ensure they receive the prescribed follow-up such as lab tests and radiology scans or find contractors and coordinate bids for home repairs, for instance.
Or when a senior has no spouse or children, a geriatric-care manager may take on even more responsibilities to fill that void.
"For people who have family, I become the expert in the family," Mielach said. "For those with no family, I become family for hire."
Boomers' aging parents spur demand
The profession of geriatric-care manager has been around for decades but really has taken off in the past 10 years as the baby boomers increasingly became long-distance caretakers of elderly parents, said Joyce Gray, a Philadelphia-based certified geriatric-care manager who serves on the board of the National Association of Professional Geriatric Care Managers, the industry's trade association. The group's membership has grown from 50 to 2,000 since its 1985 founding.
"There are a lot more older people who don't have someone locally to look after them," Gray said. "The baby boomers also are more used to paying for services and expecting high quality and results."
Another change Gray has noticed is that more people are contacting her proactively rather than in the middle of a crisis such as a broken hip or an Alzheimer's diagnosis, she said.
A decade ago, Ron Fatoullah, a New York-based certified elder law attorney, rarely recommended that his clients consult a geriatric-care manager. Now he refers at least one-third to see one, if only to validate that seniors and their family are making the appropriate care and financial decisions for their health and happiness.
"I have to know that my client is placed in the right facility, and if they're going to be at home, that it's the proper environment with all the safety features they need," Fatoullah said. "The care management assessment heavily dictates how I do my legal work."
Most geriatric-care managers come to the profession from nursing, social work or a handful of other fields related to geriatrics or long-term care, according to NAPGCM.
Before launching his geriatric-care management practice 20 years ago, Mielach, a licensed clinical social worker, was director of social work at a hospital. During that time, he became an expert in tracking down relatives of seniors who were admitted to the hospital and did not have obvious family members. Those responsibilities eventually led to him becoming a court-appointed guardian when no relatives could be found, and he realized that he enjoyed not just the detective work but the chance to improve people's lives.
Mielach even accompanied one New Jersey woman with dementia across the country to move into a New Mexico assisted-living community near close friends.
He also sometimes serves as a health proxy, a legal status which allows him to make medical decisions based on a previous consultation as to the seniors wishes, he said. In a recent example, a client of 12 years had a stroke which robbed her not just of mobility but the ability to speak, and Mielach had to inform the EMS team that she did not want to be taken to the hospital.
"I always go into detail about what values you have so if a situation comes up, I can make decisions consistent with your values," Mielach said. "But in 20 years of doing this, I have never been so confident that someone did not want treatment as with this woman."
Some geriatric-care managers may also agree to a lump sum for a particular service. For example, Mielach charges between $1,000 to $5,000 to research and prepare a Medicaid application, depending on the complexity involved.
While health insurance policies do not cover care-management services, some long-term-care policies do.
How to find a care manager
In the past, finding a geriatric-care manager was very much through word-of-mouth referrals, and asking a hospital discharge planner, psychiatrist or elder law attorney for suggestions in your community is still one good way to start, Gray said.
One red flag would be care managers who say they got into the field after helping their own relative but don't have much other experience or have not committed the time to get professional training, Gray said.
You should also be sure to ask for references, and most care managers will offer a free 20- to 30-minute telephone interview so families can get a sense of how they work, their fee schedule and whether their personality is a good match, she added.
"It's important to have a sense of trust right from the start that you can work with this person and that your mother, father, aunt, uncle can work with them, too," Gray said.
More questions to ask include whether the geriatric-care manager is part of a solo or group practice and who covers for them if they are away, she added. Are they available 24 hours a day and on weekends, because that is when many falls and other health crises occur?
Finally, don't hire anyone who accepts financial rewards from nursing homes, home health agencies or other providers. Such practices are directly in conflict with NAPGCM's ethical standards and suggest that the geriatric-care manager may not have a seniors best interests at heart, Gray said.
DECATUR, Ga. (MarketWatch) -- The holidays should be a joyful time of homecoming for families, but sometimes those visits also reveal that elderly parents are more frail or more forgetful than before. Discoveries like these may suggest that it's time to consult a geriatric-care manager.
When Nancy Gratzel's mother had a sudden change in her health requiring placement in a nursing home, Gratzel and her four siblings found themselves overwhelmed by the complex paperwork to qualify for Medicaid coverage. So they turned to Stephen Mielach, a geriatric-care manager based in their community of Toms River, N.J.
"It's a very cumbersome process because you have to find all your parents' documents and follow the trail of their money over the past five years," Gratzel said. "I decided that my time constraints didn't allow me to attend to that. I commute to work, have long work days, and all my siblings are married with children and very active."
Now Mielach also shares a power of attorney with Gratzel to assist her 88-year-old father, now living on his own, with bill-paying -- a task that his wife used to perform exclusively. Her father appreciated the help and began to look forward to Mielach's visits, she said.
"To me, that was a good use of my parents' money which we were going to have to spend anyway [to meet Medicaid qualifications]," Gratzel said. "It afforded me the opportunity to direct my energy towards nicer things, helping my mom adjust to the facility and my dad to living at home alone. They had been married 67 years."
While most seniors and their families do not go so far as to assign power of attorney to geriatric-care managers, members of this growing profession can assist not just with money matters but also with navigating the often complicated decisions about what care is best for mom, dad or another relative.
Sometimes they help resolve a short-term challenge such as Mielach did initially for Gratzel's mother or they may provide assistance over a period of months or years. Sample tasks range from vetting home health aides to assessing whether a senior is able to remain at home or needs to relocate to an assisted-living community or nursing home. They may also accompany seniors to medical appointments and ensure they receive the prescribed follow-up such as lab tests and radiology scans or find contractors and coordinate bids for home repairs, for instance.
Or when a senior has no spouse or children, a geriatric-care manager may take on even more responsibilities to fill that void.
"For people who have family, I become the expert in the family," Mielach said. "For those with no family, I become family for hire."
Boomers' aging parents spur demand
The profession of geriatric-care manager has been around for decades but really has taken off in the past 10 years as the baby boomers increasingly became long-distance caretakers of elderly parents, said Joyce Gray, a Philadelphia-based certified geriatric-care manager who serves on the board of the National Association of Professional Geriatric Care Managers, the industry's trade association. The group's membership has grown from 50 to 2,000 since its 1985 founding.
"There are a lot more older people who don't have someone locally to look after them," Gray said. "The baby boomers also are more used to paying for services and expecting high quality and results."
Another change Gray has noticed is that more people are contacting her proactively rather than in the middle of a crisis such as a broken hip or an Alzheimer's diagnosis, she said.
A decade ago, Ron Fatoullah, a New York-based certified elder law attorney, rarely recommended that his clients consult a geriatric-care manager. Now he refers at least one-third to see one, if only to validate that seniors and their family are making the appropriate care and financial decisions for their health and happiness.
"I have to know that my client is placed in the right facility, and if they're going to be at home, that it's the proper environment with all the safety features they need," Fatoullah said. "The care management assessment heavily dictates how I do my legal work."
In the case of Gratzel's mother, all family members agreed she needed nursing home care. However, geriatric-care managers also can be valuable third-party referees, providing an impartial viewpoint to siblings or children and a parent with different opinions about what is best for the senior, Fatoullah said.
"I've seen a reluctance among seniors to want any care, and if a child mentions it, the parent may bite the child's head off," he added. "But some geriatric-care managers are very good with seniors and letting them know in a constructive way that they do need care."
A background in nursing or social work
Most geriatric-care managers come to the profession from nursing, social work or a handful of other fields related to geriatrics or long-term care, according to NAPGCM.
Before launching his geriatric-care management practice 20 years ago, Mielach, a licensed clinical social worker, was director of social work at a hospital. During that time, he became an expert in tracking down relatives of seniors who were admitted to the hospital and did not have obvious family members. Those responsibilities eventually led to him becoming a court-appointed guardian when no relatives could be found, and he realized that he enjoyed not just the detective work but the chance to improve people's lives.
Mielach even accompanied one New Jersey woman with dementia across the country to move into a New Mexico assisted-living community near close friends.
He also sometimes serves as a health proxy, a legal status which allows him to make medical decisions based on a previous consultation as to the seniors wishes, he said. In a recent example, a client of 12 years had a stroke which robbed her not just of mobility but the ability to speak, and Mielach had to inform the EMS team that she did not want to be taken to the hospital.
"I always go into detail about what values you have so if a situation comes up, I can make decisions consistent with your values," Mielach said. "But in 20 years of doing this, I have never been so confident that someone did not want treatment as with this woman."
Geriatric-case managers typically charge by the hour, and rates vary from $80-$200/hour depending on location, Gray said. Most also charge an initial assessment fee ranging from $300-$800, she added.
Some geriatric-care managers may also agree to a lump sum for a particular service. For example, Mielach charges between $1,000 to $5,000 to research and prepare a Medicaid application, depending on the complexity involved.
While health insurance policies do not cover care-management services, some long-term-care policies do.
How to find a care manager
In the past, finding a geriatric-care manager was very much through word-of-mouth referrals, and asking a hospital discharge planner, psychiatrist or elder law attorney for suggestions in your community is still one good way to start, Gray said.
Another option is to consult NAPGCM's nationwide directory at its Web site, http://www.caremanager.org/. As of January 1, 2010, all NAPGCM members are required to have at least one of four professional certifications: Care Manager Certified (CMC), Certified Case Manager (CCM), Certified Social Work Case Manager (C-SWCM) and/or Certified Advanced Social Work Case Manager (C-ASWCM).
One red flag would be care managers who say they got into the field after helping their own relative but don't have much other experience or have not committed the time to get professional training, Gray said.
You should also be sure to ask for references, and most care managers will offer a free 20- to 30-minute telephone interview so families can get a sense of how they work, their fee schedule and whether their personality is a good match, she added.
"It's important to have a sense of trust right from the start that you can work with this person and that your mother, father, aunt, uncle can work with them, too," Gray said.
More questions to ask include whether the geriatric-care manager is part of a solo or group practice and who covers for them if they are away, she added. Are they available 24 hours a day and on weekends, because that is when many falls and other health crises occur?
Finally, don't hire anyone who accepts financial rewards from nursing homes, home health agencies or other providers. Such practices are directly in conflict with NAPGCM's ethical standards and suggest that the geriatric-care manager may not have a seniors best interests at heart, Gray said.
Geriatric Care Manager's- Certifications and Services
By Heather Frenette, RN, MSN, CMC
"To families struggling with the needs of aging relatives, the geriatric care manager can be a godsend. This emerging breed of specialist can assess a senior's physical, social, and financial needs and stitch together a patchwork of services to address them."
BusinessWeek, "Sometimes You Need an Ace", By Susan Garland, July 12, 2004.
What is a Geriatric Care Manager?
A Geriatric Care Manager is a health and human services professional, such as a gerontologist, social worker, counselor, or nurse, with a specialized body of knowledge and experience related to aging and elder care issues. A Professional Geriatric Care Manager (PGCM) is a geriatric care manager who is a member of the National Association of Professional Geriatric Care Managers (GCM) and had committed to adhering to the GCM Pledge of Ethics and Standards of Practice. The PGCM assists older adults and persons with disabilities in attaining their maximum functional potential. The PGCM strives to respect t he autonomy of the individual and delivers care-coordination and support services with sensitivity to preserve the dignity and respect of each individual. In addition, the PGCM is an experienced guide and resource for families of older adults and others with chronic needs.
Do I Really Need a Geriatric Care Manager?
Before making the effort, step back a moment and try to determine whether you actually have a problem in which a professional geriatric care manager needs to be involved. Do you have time, inclination, and skills to manage the problems yourself? If you are not sure, ask your clergy, your doctor, a social worker, your financial advisor, or a trusted friend to help you decided if an elder care expert may be helpful in this situation. Enlisting the support of other family member to consult a professional is a good way to build a consensus on the solutions. Other questions that you may wish to consider are:
Are the problems that you or your loved ones are facing becoming larger and more complex than you can comfortably manage?
Are other demands and responsibilities now so great that you are not able to provide the desired level of supervision and attention to your loved one's problems?\
There are many places to find a care manager in your city or state. This website includes a searchable directory of professional geriatric care managers who belong to GCM. You may also want to check with local agencies or hospitals to obtain a list of local referrals. Health professionals and elder law attorneys are other excellent referral sources.
How Do I Benefit From Using a Care Manager?
Care management services are offered in a variety of settings. Professional Geriatric Care Managers (PGCMs) can serve the needs of their clients with the following services:
Short-term or on-going assistance for long distance caregivers or other requiring assistance.
Personalized and compassionate services focusing on the individual's wants and needs.
Accessibility: Care is typically available 24 hours a day; 7 days a week.
Continuity of care management by facilitating family communication, reducing the burden on families and preventing unnecessary expenditures.
Efficiency and flexibility based upon a client-centered approach eliminating bureaucratic constraints.
Cost containment by avoiding inappropriate placements, duplication of services, and crisis intervention to avoid hospitalizations.
Quality control: care management services that follow GCM's Standards of Practice.
Who Uses PGCM Services?
Individuals
Families
Banks and Trust Officers
Physicians and Allied Health Professionals
Attorneys
Hospitals
Social Service Providers
Gerontology Professionals
Senior Housing Communities
Professional Fiduciaries
Questions To Ask When Looking For a Geriatric Care Manager
People calling themselves care managers have many different backgrounds. Very few states have licensing for these professionals; however, many are licensed in their state in other fields. The professional organization (GCM) recognizes the following certifications as being a "Certified Care Manager": CMC, CCM, C-ASWCM and C-SWCM. These require testing and continuing education. It is important for the wise consumer to ask questions. Some of these include:
Are you a member of the National Association of Professional Geriatric Care Managers?
Are you certified as a care manager?
Do you hold other professional licenses or certifications?
How long have you been providing care management service?
Are you available for emergencies?
Does your company also provide home care services?
How will you communicate information tome?
Can you provide me with references?
Care managers do not specialize in all areas. When a care manager says he/she practices "care management", find out which matters he/she handles. You will want to hire someone who regularly handles clients in the area of your concern.
Care managers who primarily work with older adults bring more to their practice than an expertise in geriatrics. They bring knowledge of aging issues that allow them and their staff to overcome the myths relating to aging and to focus on the problems at hand. At the same time, they will bring an experience of working with resources in your community. They are more aware of real life problems, health and otherwise, that emerge as persons age and what tools are available to address them. They are tied into a formal or informal system of social workers, nurses, psychologists, elder law attorneys, advocates, and other elder care professionals who may be of assistance to you.
Once you have found a care manager...
When you have found an appropriate care manager, there will most likely be an on-site assessment. During the assessment, you will be asked to give the care manager an overview of the reason you are seeking help and introduce all the parties involved. Be sure to organize and bring all the information needed.
After you have explained your situation, ask:
What resources will it take to resolve this situation?
Are there any alternative courses of action?
What are the advantages and disadvantages of each alternative?
Who will be working with you?
How many professionals may be involved? What about off-hours and backup?
How are fees computed?
How is travel time and mileage handled?
How are services terminated?
Ask Questions First...
Ask lots of questions before choosing your care manager. Start with the initial phone call. Is the call professionally answered? If you leave a message, is it returned promptly? Of course, this is an indication of the kind of professional relationship you can expect. In addition to the above questions, you should also ask:
What are the primary services provided by this agency/business?
What other service does this agency/business provide?
How many care managers are there in this agency/business?
Is there a fee for the initial consultation and if so, how much is it?
The answers to your questions will assist you in determining whether that particular care manager and agency/business has the qualifications important to you for a successful relationship. If you have a specific issue that requires immediate attention, be sure to inform the care manager of this during the initial telephone conversation.
Discussing Fees...
There are many different ways of charging fees and each care manager will choose to work differently. You will also want to know how often he/she bills. Some care managers bill weekly, some bill monthly, some bill upon completion of work. Ask about these matters at the initial conference and ask for them in writing, so there will be no surprises. If you don’t understand, ask again. If you need clarification, say so. It is very important that you feel comfortable in this area.
In addition to fees, most care managers will charge for out-of-pocket expenses. Out-of-pocket expenses may include charges for mileage, caregiving supplies, long distance telephone calls, and other such costs. Find out if there will be any other incidental costs. Note: There may also be additional fees if outside professionals are called into the case. It is imperative that the care manager receives approval to bring others in before the situation arises, if at all possible.
Be sure to discuss and make sure you have all questions answered before proceeding with an agreement for services. You should expect a written agreement including fees before the commencement of services.
Get It in Writing...
Once you decide to hire the care manager, ask that your arrangement be put in writing. The writing can be a letter or a formal contract. It should spell out what services the care manager will perform for you and what the fee and expense arrangements will be. REMEMBER— even if your agreement remains oral and is not put into writing, you have made a contract and are responsible for all charges for work done by the care manager and his/her staff.
Make It a Good Experience
A positive and open relationship between a care manager and a client is important to successful outcomes. The key to getting there is communication. The communication starts with asking the kinds of questions contained in this document. Use the answers to the questions as a guide not only to the care manager’s qualifications, but also as a way of determining whether you can comfortably work with this person. If your concerns are not responded to professionally and personally, if you don't like the answers to your questions, if you don't like the care manager's reaction to being asked all your questions, or if you simply do not feel relaxed with this particular person, DO NOT HIRE THAT PERSON. Only if you are satisfied with the care manager you have hired from the very start will you trust him or her to do the best job for you. Only if you have established a relationship of open communication will you be able to resolve any difficulties that may arise between the two of you. If you take the time to make sure you are happy and compatible right at the beginning, you can make this a productive experience giving you peace of mind and your family member the highest quality of life possible. You will thank yourself, and your care manager will thank you.
Certifications Endorsed by GCM:
CMC - Care Manager CertifiedNational Academy of Certified Care Managers (NACCM)800-962-2260 (Connecticut)
CCM - Certified Case ManagerCommission for Case Manager Certification847-818-0292 - Box 162 (Illinois)
The Commission for Case Manager Certification (CCMC) is led by elected commissioners who oversee the process of case manager certification. CCMC is nationally accredited and positioned as the most active and prestigious certification organization supporting the case management industry.
National Association of Social WorkersC-SWCM (Certified Social Work Case Manager)C-ASWCM (Certified Advanced Social Work Case Manager)800-638-8799, extension 409
The National Association of Social Work Specialty Certifications, available to CSWE-accredited degreed social workers only, provide a vehicle for recognizing social workers who have met national standards and possess specialized knowledge, skills, and experience. NASW is committed to assisting with the process of certifying social workers and working to emphasize the importance of employing social workers who have specialized training and experience.
"To families struggling with the needs of aging relatives, the geriatric care manager can be a godsend. This emerging breed of specialist can assess a senior's physical, social, and financial needs and stitch together a patchwork of services to address them."
BusinessWeek, "Sometimes You Need an Ace", By Susan Garland, July 12, 2004.
What is a Geriatric Care Manager?
A Geriatric Care Manager is a health and human services professional, such as a gerontologist, social worker, counselor, or nurse, with a specialized body of knowledge and experience related to aging and elder care issues. A Professional Geriatric Care Manager (PGCM) is a geriatric care manager who is a member of the National Association of Professional Geriatric Care Managers (GCM) and had committed to adhering to the GCM Pledge of Ethics and Standards of Practice. The PGCM assists older adults and persons with disabilities in attaining their maximum functional potential. The PGCM strives to respect t he autonomy of the individual and delivers care-coordination and support services with sensitivity to preserve the dignity and respect of each individual. In addition, the PGCM is an experienced guide and resource for families of older adults and others with chronic needs.
Do I Really Need a Geriatric Care Manager?
Before making the effort, step back a moment and try to determine whether you actually have a problem in which a professional geriatric care manager needs to be involved. Do you have time, inclination, and skills to manage the problems yourself? If you are not sure, ask your clergy, your doctor, a social worker, your financial advisor, or a trusted friend to help you decided if an elder care expert may be helpful in this situation. Enlisting the support of other family member to consult a professional is a good way to build a consensus on the solutions. Other questions that you may wish to consider are:
Are the problems that you or your loved ones are facing becoming larger and more complex than you can comfortably manage?
Are other demands and responsibilities now so great that you are not able to provide the desired level of supervision and attention to your loved one's problems?\
There are many places to find a care manager in your city or state. This website includes a searchable directory of professional geriatric care managers who belong to GCM. You may also want to check with local agencies or hospitals to obtain a list of local referrals. Health professionals and elder law attorneys are other excellent referral sources.
How Do I Benefit From Using a Care Manager?
Care management services are offered in a variety of settings. Professional Geriatric Care Managers (PGCMs) can serve the needs of their clients with the following services:
Short-term or on-going assistance for long distance caregivers or other requiring assistance.
Personalized and compassionate services focusing on the individual's wants and needs.
Accessibility: Care is typically available 24 hours a day; 7 days a week.
Continuity of care management by facilitating family communication, reducing the burden on families and preventing unnecessary expenditures.
Efficiency and flexibility based upon a client-centered approach eliminating bureaucratic constraints.
Cost containment by avoiding inappropriate placements, duplication of services, and crisis intervention to avoid hospitalizations.
Quality control: care management services that follow GCM's Standards of Practice.
Who Uses PGCM Services?
Individuals
Families
Banks and Trust Officers
Physicians and Allied Health Professionals
Attorneys
Hospitals
Social Service Providers
Gerontology Professionals
Senior Housing Communities
Professional Fiduciaries
Questions To Ask When Looking For a Geriatric Care Manager
People calling themselves care managers have many different backgrounds. Very few states have licensing for these professionals; however, many are licensed in their state in other fields. The professional organization (GCM) recognizes the following certifications as being a "Certified Care Manager": CMC, CCM, C-ASWCM and C-SWCM. These require testing and continuing education. It is important for the wise consumer to ask questions. Some of these include:
Are you a member of the National Association of Professional Geriatric Care Managers?
Are you certified as a care manager?
Do you hold other professional licenses or certifications?
How long have you been providing care management service?
Are you available for emergencies?
Does your company also provide home care services?
How will you communicate information tome?
Can you provide me with references?
Care managers do not specialize in all areas. When a care manager says he/she practices "care management", find out which matters he/she handles. You will want to hire someone who regularly handles clients in the area of your concern.
Care managers who primarily work with older adults bring more to their practice than an expertise in geriatrics. They bring knowledge of aging issues that allow them and their staff to overcome the myths relating to aging and to focus on the problems at hand. At the same time, they will bring an experience of working with resources in your community. They are more aware of real life problems, health and otherwise, that emerge as persons age and what tools are available to address them. They are tied into a formal or informal system of social workers, nurses, psychologists, elder law attorneys, advocates, and other elder care professionals who may be of assistance to you.
Once you have found a care manager...
When you have found an appropriate care manager, there will most likely be an on-site assessment. During the assessment, you will be asked to give the care manager an overview of the reason you are seeking help and introduce all the parties involved. Be sure to organize and bring all the information needed.
After you have explained your situation, ask:
What resources will it take to resolve this situation?
Are there any alternative courses of action?
What are the advantages and disadvantages of each alternative?
Who will be working with you?
How many professionals may be involved? What about off-hours and backup?
How are fees computed?
How is travel time and mileage handled?
How are services terminated?
Ask Questions First...
Ask lots of questions before choosing your care manager. Start with the initial phone call. Is the call professionally answered? If you leave a message, is it returned promptly? Of course, this is an indication of the kind of professional relationship you can expect. In addition to the above questions, you should also ask:
What are the primary services provided by this agency/business?
What other service does this agency/business provide?
How many care managers are there in this agency/business?
Is there a fee for the initial consultation and if so, how much is it?
The answers to your questions will assist you in determining whether that particular care manager and agency/business has the qualifications important to you for a successful relationship. If you have a specific issue that requires immediate attention, be sure to inform the care manager of this during the initial telephone conversation.
Discussing Fees...
There are many different ways of charging fees and each care manager will choose to work differently. You will also want to know how often he/she bills. Some care managers bill weekly, some bill monthly, some bill upon completion of work. Ask about these matters at the initial conference and ask for them in writing, so there will be no surprises. If you don’t understand, ask again. If you need clarification, say so. It is very important that you feel comfortable in this area.
In addition to fees, most care managers will charge for out-of-pocket expenses. Out-of-pocket expenses may include charges for mileage, caregiving supplies, long distance telephone calls, and other such costs. Find out if there will be any other incidental costs. Note: There may also be additional fees if outside professionals are called into the case. It is imperative that the care manager receives approval to bring others in before the situation arises, if at all possible.
Be sure to discuss and make sure you have all questions answered before proceeding with an agreement for services. You should expect a written agreement including fees before the commencement of services.
Get It in Writing...
Once you decide to hire the care manager, ask that your arrangement be put in writing. The writing can be a letter or a formal contract. It should spell out what services the care manager will perform for you and what the fee and expense arrangements will be. REMEMBER— even if your agreement remains oral and is not put into writing, you have made a contract and are responsible for all charges for work done by the care manager and his/her staff.
Make It a Good Experience
A positive and open relationship between a care manager and a client is important to successful outcomes. The key to getting there is communication. The communication starts with asking the kinds of questions contained in this document. Use the answers to the questions as a guide not only to the care manager’s qualifications, but also as a way of determining whether you can comfortably work with this person. If your concerns are not responded to professionally and personally, if you don't like the answers to your questions, if you don't like the care manager's reaction to being asked all your questions, or if you simply do not feel relaxed with this particular person, DO NOT HIRE THAT PERSON. Only if you are satisfied with the care manager you have hired from the very start will you trust him or her to do the best job for you. Only if you have established a relationship of open communication will you be able to resolve any difficulties that may arise between the two of you. If you take the time to make sure you are happy and compatible right at the beginning, you can make this a productive experience giving you peace of mind and your family member the highest quality of life possible. You will thank yourself, and your care manager will thank you.
Certifications Endorsed by GCM:
CMC - Care Manager CertifiedNational Academy of Certified Care Managers (NACCM)800-962-2260 (Connecticut)
CCM - Certified Case ManagerCommission for Case Manager Certification847-818-0292 - Box 162 (Illinois)
The Commission for Case Manager Certification (CCMC) is led by elected commissioners who oversee the process of case manager certification. CCMC is nationally accredited and positioned as the most active and prestigious certification organization supporting the case management industry.
National Association of Social WorkersC-SWCM (Certified Social Work Case Manager)C-ASWCM (Certified Advanced Social Work Case Manager)800-638-8799, extension 409
The National Association of Social Work Specialty Certifications, available to CSWE-accredited degreed social workers only, provide a vehicle for recognizing social workers who have met national standards and possess specialized knowledge, skills, and experience. NASW is committed to assisting with the process of certifying social workers and working to emphasize the importance of employing social workers who have specialized training and experience.
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