Exercise Program for Dementia

Exercise may benefit the Alzheimer’s patient by improving both symptoms and quality of life. For the same level of brain deterioration, physically active people exhibit higher levels of cognitive functioning than sedentary people. It is thought that physically active people have a ‘cognitive reserve’ that is used when other areas of the brain are damaged.

An exercise routine may decrease the severity of symptoms of dementia as well as lead to increased mobility and independence. An exercise routine for the elderly should be composed of four components:

  1. Aerobic exercise
  2. Strength training
  3. Balance training
  4. Flexibility exercises

All training programs should be entered into gradually and only after checking with his/her physician.

An aerobic training program, improves cardiovascular health as well as brain health. It is associated with decreased risk of stroke and the related dementia. Physical activity may also decrease the beta-amyloid proteins leading to decreased amyloid plaque and decreased disruption between neurons. For maximum health benefit, 30-minutes of aerobic activity should be performed most days of the week. This need not be intense and the participant should be able to talk throughout. The 30-minutes can be split into smaller, 10-minutes segments if that is more desirable. When beginning a training program, you can start with intervals as short as 5-minutes and progress.

Strength training programs combat the loss of muscle mass associated with aging. It can improve independence, mobility, and balance. Daily tasks (e.g. getting out of bed, getting out of chairs, climbing stairs) become easier with increased strength. Ideally, 10-15 repetitions of 8-10 exercises should be performed 2 or 3 times per week. The resistance should be great enough that each set of repetitions is difficult to complete. Resistance may be applied with bands or tubing, light weights, or even cans of food. If the sets are completed easily, the resistance should be increased.

Balance exercises can be performed almost anywhere. Balance is position specific so both standing balance and sitting balance should be targeted. With improved standing balance, there is decreased risk of falls and fractures. Standing on one-leg, with or without assistance, will help improve standing balance. Sitting balance can be improved by sitting on a chair, couch, or balance ball, with the lower back straight, and lifting an arm or a leg into a different position. Also, chair stands can be included. The more unstable the sitting surface is, the more difficult the exercise will be. More advanced exercises such as backwards walking and leaning can be gradually added into the program.

Flexibility exercises are best performed with the aid of a personal trainer, training partner, or care giver. Flexibility exercises can improve back pain and shoulder pain and increase range of motion.

There are certainly challenges in starting and keeping a patient in an exercise program. However, older adults are among the most willing to begin exercise programs as they are more aware of health issues. With dementia patients, there may be additional challenges as the disease progresses. However, there are many techniques that may help combat challenges that arise. The improvement in functioning and quality of life should make the challenges worthwhile.

Published research related to this topic:
American College of Sports Medicine Position Stand. Exercise and Physical Activity for Older Adults.
Mazzeo, R., Cavanaugh, P., Evans, W. et al.
Med. Sci. Sports Exerc. 1998: 30(6): 992-1008.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9624662&query_hl=25

Exercise and activity level in Alzheimer’s disease : A potential treatment focus.
Teri L., McCurry, S., Buchner, D., et al. J.
Rehab. Research and Development. 1998: 35(4): 411-419
http://www.vard.org/jour/98/35/4/teri.pdf

 

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Hearing Loss Linked to Cognitive Decline, Impairment

Medscape News
Jan 23, 2013

written by Pauline Anderson

Older adults with hearing loss have a rate of cognitive decline that is up to 40% faster than the rate in those with normal hearing, according to results of a new study. Those with hearing loss also appear to have a greater risk for cognitive impairment.

“I would argue going forward for next 30 or 40 years that from a public health perspective, there’s nothing more important than cognitive decline and dementia as the population ages,” said lead author Frank R. Lin, MD, PhD, assistant professor, otolaryngology, geriatrics, and epidemiology, Johns Hopkins University, Baltimore, Maryland.

“So from a big picture point of view, identifying factors that are associated with cognitive decline and dementia are important, in particular those factors that are potentially modifiable.”

Although the study did not find a significant association between hearing aid use and rate of cognitive decline, Dr. Lin is convinced that addressing hearing loss could have an impact greater than just improving quality of life.

The study was published online January 21 in JAMA Internal Medicine, formerly known as Archives of Internal Medicine.

National Neurological Diseases Surveillance System Act

Great news! Congress has heard your requests and the House of Representatives unanimously passed H.R. 1362, the National Neurological Diseases Surveillance System Act! This system will provide researchers and epidemiologists with a coordinated system of health data on neurological diseases and should fuel further research into neurological disorders like LBD. To make this data system a reality, the Senate must now take action on S. 1273. Please urge your Senators to support Senate passage of S. 1273 this Congress. Click here to tell Congress about LBD today!

The Affects of Food on the Brain: Observations of a Care Giver by Sue Higgins

Thank you Susan for contributing to today’s post. We appreciate it.

 

Sue Higgins 

My mom’s illness is certainly a metaphor for life.  Her illness causes her to be off balance with outside influences adding an interesting twist to daily life. 

Each day, I make observations and adjust our routine as needed. All in an effort to provide my mom with more good days than not so good days… as we all know Lewy Bodies Dementia takes us all on a wild ride that is often scary.

What I have come to see is that all of us are conditioned to take a pill when we have some ailment; we can’t help believing in pills, it’s what we’ve been told for decades, "better health through chemistry." Only now, do I question the belief in pharmaceutical drugs to be the end all solution.

The prescription drugs that my mom had taken for so many years only masked her ailments, compounding them, making them worse. It was only when I began to pay attention, did I discover that the secret to my mom’s improving health is through nutrition.   We cut out the processed food and my mom was able to begin to get off all the band aid pharma drugs. 

Today, my mom is physically healthier than she’s been in decades.  Through nutrition and a good diet that I have listed below, my mom has more good days than not so good days.  We can’t ask for much more than that with her condition of Lewy Bodies Dementia.

Eating Healthfully

Food is the most important medicine that my mom has every day; it allows us to create a balanced state in her body and mind.  I’ve witnessed that nutrition in the elderly; especially a senior with Lewy Bodies Dementia can be the most challenging aspect of care giving.    Often as Care Givers we are left wondering, "what do I do now?" 

My answer to this question is usually found when I analyze and observe and analyze again.  Because of my need to analyze EVERYTHING and understand it, I’ve touched upon something very interesting.  First hand, I have witnessed the relationship between food and my mom’s mental state of being. She is clearer when she eats "REAL FOOD", food that nature provides.

I’ve made lots of observations about food and the behaviors it seems to create in my mom after she ingests the "food."  I put quotes around food because not all food on the supermarket shelves is created equally.  Most is poison to our bodies and will eventually lead us to the exit for Dementia Highway… this is my opinion which I have based on my observations with my mom who has what we believe to be, Lewy Bodies Dementia.

Following is a quick list of foods to avoid and the behaviors that I have observed which seem to be associated with the ingested food.

Behaviors Observed

Wild and Scary Hallucinations, night disturbances, sleepwalking, fright, wanting to go home, confusion amplified

Foods to Avoid

  • All boxed and processed foods 
  • Everything with ingredients that you can’t pronounce
  • All gluten
  • gluten free products with ingredients that you can’t pronounce (not all gluten free is good for you.)
  • Baking Soda and Baking Powder with Aluminum – this really messes up my mom for 3 days
  • All white food except cauliflower – this is very good for dementia (potato, white rice)
  • Eggplant – my mom goes on quite a hallucination trip when she eats eggplant, she sees wild animals mostly and scary people with floating heads.
  • All dairy – Lactose free seems to be OK.  Dairy typically causes my mom to have night disturbances with lots of sleepwalking and not knowing where she is … wants to go home when she eats dairy or any high animal fat content foods
  • Oatmeal that has been processed on machines that have processed wheat

Food to Eat

  • Anything that can grow in the ground that has not been treated with pesticides or Genetically Modified (GMO) – exception is white potatoes – these make my mom’s blood sugar go up high and she hallucinates and is way more confused. 
  • Eggplant causes her to hallucinate about wild animals and scary floating heads.
  • Organic Oats that have not been processed on machines with wheat (limit this because they can raise blood sugar.  I do put a 1/4 tsp fenugreek powder in the oatmeal which helps to keep my mom’s blood sugar from spiking and making her hallucinate.)
  • Lean meat and fish – we eat lots of chicken and fish
  • Legumes – these are good in moderation because they raise blood sugar too.  With legumes, serve asparagus because I’ve found it naturally lowers blood sugar. 
  • Herbs that lower blood sugar that I use when I cook complex carbohydrates like legumes… Bay Leaf and Fenugreek are the 2 that I’ve found to be most effective.
  • Herbs that appear to help with cognition – Rosemary, Thyme, Turmeric and Black Pepper together, Curcumin, Coriander, Oregano.  The nights that I cook a dish with lots of Rosemary, Thyme, Turmeric and Black Pepper, my mom seems to sleep better and the next day she is much happier about life.
  • Dark Chocolate
  • Fruit
  • Dark greens (kale, spinach, collard greens and arugula are awesome.)
  • Asparagus and Artichokes lower blood sugar and low blood sugar keeps hallucinations at bay
  • Garlic, lots of garlic

Substitutions

White Rice and Potatoes

  • In place of white rice, I serve brown rice or black rice.  We eat this in moderation only because rice makes my mom’s blood sugar go up and if it goes over 125, she starts to hallucinate. 
  • Quinoa grain is great.  My mom doesn’t have adverse reactions to this grain. 
  • Amaranth grain is OK.  My mom can only eat a little bit of this grain, otherwise she hallucinates.
  • Yams

Gluten Breads

  • Make your own gluten free bread.  I give a really good recipe here – My Daily Bread
  • Big leaves of lettuce make great wraps.  I wrote about it hereLettuce as a Wrap
  • I found that Gluten Free bread made with fruit juice is very good.  You can buy it at Whole Foods.  Tapioca bread is good too; I find it at Shaw’s.

White Flour

  • Soy Flour is a great substitute for white flour when used to coat chicken.  Here’s a recipe that I use often and my mom loves it.  Oven Fried Chicken
  • Quinoa flour has a nice flavor and often I use it in place of the soy flour.
  • Almond meal flour is really good for coating as well as making baked goods. 

If you are going to bake, make sure that you get baking soda and baking powder that doesn’t have aluminum in it.  This REALLY aggravates my mom’s condition.

Butter

  • Good quality olive oil.  It’s really good brushed on a piece of toasted gluten free bread.  Gluten free bread is always better toasted.
  • If I use butter, I make sure that it’s organic.  I use it sparingly.  I have observed that high fat meals cause my mom to hallucinate and have night disturbances.

Some links to recipes on my blog:

Sue’s 3-1-1 Base Dressing

Spinach Stuffed Chicken Breast

White Beans with Vegetables and Herbs on Red Lettuce

How I find a Word in my head? Oops! Pam fell down!

Thought I’d try to catch up a little bit today.

Overall, Pam has been doing a little bit better. The pain specialist has been working for over a year to find the right combination of meds for her. Finally, I think we have something. He’s managed to narrow it down to two meds. She has several conditions which we’ve managed to get a grip on over the last 4-6 months of evaluation. Each condition seems to have its own type of pain. Some of the types of pain she suffers from is neuropathic pain, radiculopathy and fibromyalgia all of which are relieved with Topiramate (brand name Topamax). He also needs to use a narcotic agent (unfortunately) to manage some of the other types of pain.

So, overall, we see some mild improvement. But, low and behold! After much protesting from me, last week she decided to go outside to get the mail. Yep, she slipped on the snow and ice in the driveway and fell on her knee! Gosh! How could I turn around and say, "I told you so." Well, I did, but only several days later when the time was right. Smile, smile.

Because of her osteoporosis, she has a 5-6X risk of bone fractures. I saw her go down and immediately pictured in my head of having to call an ambulance. Fortunately, she was able to get up. Needless to say, she is sore and bruised all over with a big ‘egg’ on her knee! I did take her for evaluation and no fractures!! But it sure doesn’t help deal with Mr. Arthur in her knee which many of us also have.

Some of my latest thoughts and insights have to do with language difficulty — expression and word finding.

  • difficulty finding the right words. I can remember a long medical terminology word but can’t always retrieve a simple word such as sofa, fork, etc.
  • I tend to use descriptions in place of words “that thing behind the house you sit on" instead of “patio or back porch”). Recently I couldn’t remember the word "fork" so I resorted to saying, "You know, that thing you stab into food."
  • occasionally have difficulty with some pronunciation; familiar words don’t sound right
  • sentences don’t sound right or are phrased incorrectly (don’t make sense)
  • have difficulty explaining a thought or idea
  • I rely on Pam and Chad to guess at the meaning of what I am trying to say
  • very frustrating when I have trouble say what I mean
  • Now I have a lot of trouble talking on the telephone unless it’s someone I know very well or from many years ago. I think part of it is that there are visual cues over the telephone.

One of the descriptions I was able to use with Pam recently was this. At times, whenever a word won’t come, it’s as though I can picture a long tunnel starting at the front of my head progressing to the back of my head. The tunnel gets more narrow and blacker as it goes to the back. At the back, sometimes there is nothing there, thus no word.

At other times, there is a vague dot or small object or small word which is incomprehensible. Sometimes I can visualize it slowly coming to the front of the tunnel. How far it comes up seems to determine whether I get the ‘word.’ Sometimes, I literally pause and wait for "it" to come forth. Sometimes, it will only come half way and then stops. This is actually more frustrating than if it is just totally blocked. Other times, it all comes forward with the right word but in "slow motion." That’s when I find myself talking and literally saying, "wait a minute." I just need some time for it to crawl up.

It seems very hard to describe all this. If someone can’t follow what I just said, I totally understand.

Enough for today. Just thought I’d share my perspective on word finding.

Warmly………..David

The Senility Prayer

Grant me the senility to forget the people I never liked anyway, the good fortune to run into the ones I do, and the eyesight to tell the difference.

Dementia Stages Can Be Detected and Gauged by the Mini Mental State Exam

Here’s a test for dementia stages.

These are at the bottom of that link:

Symptoms of Dementia and the Clock Test
Dementia Types and the Animal Test

 

These are widely used in medicine. I thought they would be a nice review for all.

David

 

 

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