Sleep, Memory, and the Brain

Dan commented on the contraindications of Namenda plus Aricept. Since many of us are on the both of these agents, would you mind giving all of us more information which you obtained during the study in which you participated. We’d all appreciate it, I’m sure.   Thanks, Dan.

If you read my post the other day about my sleep deprivation for several and how it affected my brain, the following article explains in detail the reasoning behind this.

Sleep, Memory, and the Brain

When you’re sleep deprived, cognition is one of the first functions to decline. Shortchange yourself on sleep by staying up late, continue this night after night, and you ultimately shortchange your memory. And if the problem is not resolved, your memory — and your brain — will not be functioning in the best way possible.

In this excerpt from our Johns Hopkins Memory Bulletin, neurologists Marilyn Albert, Ph.D. and Guy McKann, M.D. answer questions about sleep and how it affects the brain and memory.

Q.  How much sleep does an adult need each night?

A.  As people get older, a decrease begins in both the total time sleeping and the amount of time spent in the stage of sleep associated with dreaming. A newborn sleeps 16 hours per day. In contrast, the baby’s 30-year-old mother sleeps six hours per day (if she’s lucky), and only one quarter of this time, or two hours, is occupied by the deepest stage of sleep.

Starting in middle age (between 45 and 60), not only does the amount of sleep per night start to decrease, but also the character of sleep changes. People at these ages spend less time in the stage of sleep associated with dreaming and more time in the lighter stages.

As people get older, they are more likely to shift the time when they sleep, some going to bed and to sleep earlier and waking up earlier. Others are the opposite, staying up late into the night and sleeping much of the day. When people are in their 80s, these changes are even more pronounced. Their total time asleep per day may be only six or seven hours, including time spent in daytime naps. Even though a person may take several naps a day, the total time sleeping in naps is rarely over an hour. The idea that older individuals should sleep soundly for eight to 10 hours is clearly wrong.

As a rule of thumb, one hour of sleep is required for two hours of being awake. As we get older, that ratio becomes closer to 45 minutes of sleep to each two hours awake. In other words, throughout the day you gradually accumulate a “sleep debt.” By the end of a 16-hour day, a younger person owes the “sleep bank” eight hours. In contrast, an older person has a sleep debt of only about six hours. By the end of a week, you may have accumulated a sleep debt of eight to 10 hours.

Q.  What are the effects of sleep deprivation?

A.  If you don’t allot enough time for sleep, you become sleep deprived. Besides being sleepy during the daytime, sleep-deprived people often have problems with their thinking. They are slower to learn new things, they may have problems with memory, and their ability to make judgments may be faulty, enough so that they may think they are really starting to “lose it” when the problem is really not enough sleep.

Elderly people do not recover from sleep deprivation as quickly as younger people. In experimental situations where people are kept awake for 24 hours, those in their 70s take at least a day longer to recover from their subsequent daytime sleepiness than younger people. Gender may also make a difference in the time it takes to recover from sleep deprivation; women seem to be able to recover faster than men.

True or False

Spring onions and shallots are exactly the same.

False. Shallots, or scallions, differ from other onions in that instead of having a single bulb, it divides into a cluster of smaller bulbs.


Sweet “16” Rolls Around Again!

sweet-16pa-drivers-licenseAnd they say Sweet 16 never comes around again! Well, someone is wrong. Today marks the beginning of a wonderful Happy New Year for me!

Just returned from Pittsburgh after seeing my neurologist for a regular checkup. He said, “You’re doing very well. It goes to show just how well the Aricept and Namenda works for people.” He was very pleased. And, surprise, surprise. I get to drive again but only with an “autopilot” on board. That’s fine with me. Just to feel 16, independent and to be able to get behind that wheel again. How do I describe it??!!

Other than sleeping difficulties, he sees a marked improvement since adding the Namenda to Aricept. I’ll continue the Klonopin for the REM sleep behavior disorder. For sleep he’s adding a small dose of trazodone. Thank gosh I don’t have to take Seroquel at this point. Will start the trazodone at 50-mg at bedtime and can increase it to 150-mg if necessary.

I’m not surprised with the trazodone. It’s a standard non-habit  agent for sleep. It is actually an antidepressant but the doses need to achieve an antidepressant effect are so high that the patient would be sleepy all the time. So, in essence, it is pretty much used now as an adjunct sleeper when trying to avoid drugs which produce tolerance. I feel comfortable with this since it’s something which I’ve prescribed over the years to hundreds of patients.

Oh, by the way. He truly thinks the Lewy Body Dementia Association is phenomenal!

Fact or Fiction?

In the 1960s, dung beetles were imported into Australia to reduce the number of cow dung pads.

Warmly………….David Thomas

(True. Their digging activity aerates the soil, sumultaneously releasing the nutrients in the dung to the soil).

Swallow This! Bittersweet Memory Pills


pill-bottleThis week I had three very good days in a row. So good that I overblogged on those days. Pam even said, “You’re spending a lot of time on the computer. Why don’t you take a break?” I felt well. So well that on this past Wednesday evening I began to ponder whether I really needed to take all these ‘memory pills.’ ‘Dementia pills.’ Nothing wrong with me. I don’t think I need to take them. I could go to work again. On those days you feel poorly, kick yourself a good one and get going. It’s all in your head (oops, excuse the pun).

So I mentioned it to Pam. A good mistake, I guess. Talking about tough love! The earth shook. The dogs barked. And the wind blew. I ended up stammering, “Yes, yes. I’ll take them and no, I didn’t stop taking them. I swear to God with both hands on the Bible.” Caregivers……..tough love does work!  My red face grin.  icon_redface

Later that evening, Chad said goodnight to which I responded, “I hope you don’t die tonight.” In my heart, I was trying and meaning to say, “OK. You have a good night and sleep well.” I walked into the bedroom. Again the earth shook. Pam told me how inappropriate my comment to Chad was. I wasn’t sure what she was talking about.

Evidence of lacking good judgment twice within hours of each other. Before going to bed, she said, “You really did stop your medicine, didn’t you?” I had to convince her that I didn’t. Whether it was poor judgment, word or phrase finding difficulty or just plain not thinking, it wasn’t the read David. Pam reminded me of my past couple of years and the symptoms I’ve shown. She reminded me of my abnormal SPECT scan.

And then the next morning — Thursday. I awakened having slept poorly. I was in a fog and feeling fuzzy. My gait was a little stiff and slow. Good morning, Lewy Body Dementia. I see you’re back. Reality smacked me in the face! With no sarcasm at all, Pam said, “Do you still want to go off the Namenda and Aricept?” I had no retort……..


Sunday October 26, 2008



Now you can understand my email address!

Check out the new category at the top of the page. It describes another side of me other than just being a physician — The Knitting Doctor.

I think knitting is one of those things I’ve always done which may have helped me more than I’ll ever know. Maybe it actually prevented me from developing Lewy Body Disease early on! It’s one of those visuospatial crafts which stimulates a certain part of the brain. And each and every craft works on a different part of the brain! So, get out the needles, the hooks, some thread, some yarn or some rope! Yes, rope. Making knots for all those boats and ships……..yes, they help to keep the brain active!

The little picture here is from Beth Brown-Reinsel’s book calledKnitting Ganseysshown on her Knittingtraditions website. I made this about 3 years ago for my nephew in New Hampshire. Ironically, his looks are very similar. I remember well having tremors at the time but I kept plugging along with the sweater just thinking that I needed to relax more. Little did I know Lewy was snaking his way in and I didn’t even know it. That is the time that I was the moderator for the Gansey List on Yahoo. 

For years, I knit on a daily basis. It was good for me. But………knowing what I know now………..I should have also been doing other hobbies and crafts along the way. Since each activity stimulates a unique portion of the brain, I had only been working on one of them. But this part of my brain is probably over developed since knitting is second nature to me. For the past 1-2 years, though, I lost some interest in knitting. Guess what? Yes, I just thought it was stress since I didn’t feel any depression. Looking back, I blamed every one of my symptoms of LBD to ‘stress.’ How pathetic that I didn’t know any better. But then no one around me did either. I now realize that I was suffering from apathy, a common symptom of dementia.

Since I’ve been on the Aricept and the Namenda, the apathetic days are fewer and fewer. I’ve been able to resume knitting but not as intensely as in the past. I am currently working on a pastel green reversible cable baby blanket. Big deal! Well, actually it is. I’m very happy that I can now knit again and look forward to continuing to do it for many years to come.

However, David, don’t get to complacent. There are other crafts and 120 other ways to increase my brain power. Let me think now. I’m able to resume the computer again…..another ingrained activity. I should probably review my Spanish which I learned during the 4 years living in Guadalajara, Mexico. But there isn’t anyone around here who speaks Spanish. I could review it on the web but it just isn’t the same as speaking another language in real life. Think now. You’ve added various puzzles to your list of new activities, thinking out loud with this blog. Guess I’ll take a look at that 120 list and see what might interest me. But, be careful. Don’t bite off more than you can chew. You have a tendency to want to do so much but then you get tired and feel guilty whenever you don’t immediately follow through with your own expectations.

Margo and Stein………….you guys were a breath of fresh air yesterday! Thanks for visiting us. We love you guys. You and your family have been a Rock of Gibraltar to me over the years. Margo, I remember so clearly the first time we met. I wanted to interview you to be my administrative assistant when I opened up my private practice right out of residency training. It seems like this past week but it really was in 1982. That’s why you still seem so young to me. Happy Birthday this week. You are still in your 40s to me. You hold your age of 70 uncommonly well!! You’re so energetic, vibrant and full of life! I used to think that 70 was ‘old.’ Now I know better.

It’s been a quiet low key day today. atching football, knitting and playing with the dogs. Pam is tired. We just found out that both her potassium and iron are both low. I’m worried about her. I remember when the joke was just to give someone some “Geritol.” I don’t know if they even sell that stuff anymore. Those were the days~~

Enough for today.


Friday October 24, 2008

Bizarre. Yes, dreams can be. Last night I dreamed that I was ‘somewhere’ with a bunch of people. During the gathering, I had a moment of severe confusion and disorientation. It lasted for a long long time in the dream. Now that’s a new type of dream I’ve never experienced before. Go figure.

I’m getting weary of all the political ads. Can’t wait until Election Day is over. Seems like it’s been a long drawn out affair. I’m sure most people have already decided so let’s get it over with. Have been watching MSNBC, CNN, etc. The anchor folks so to have run out of things to say. They’re now down to what kind of clothes people are wearing and how much they cost! Aren’t there more important things in life?

We’re having friends (Margo and Stein) visit us from Pittsburgh tomorrow. They are dear and closer to us than some family members. Funny how ya can choose your friends but not your family! It’ll be a very nice day in spite of the rainy forecast for the weekend. Stein is so witty I don’t know if I’ll be able to keep up with him. Margo’s brother-in-law is suffering from Alzheimer’s disease. I think he’s also on Namenda and Aricept.

Speaking of that. I’m really noticing a positive difference since adding the Namenda to the Aricept. My sleeping pattern had been terrible for the past 3-4 years. I noticed an improvement after taking the Namenda for about 4-5 weeks. Am sleeping better than ever right now. And the Vivimind. That’ll take awhile. Am taking 10-mg daily for 1 month and then I’ll increase it to 2 tabs/day. My understanding of it is that it’ll take much longer to notice any results. Fortunately, I haven’t had any side-effects from any of the 3 of them.

I spoke with Angela Taylor this week. She’s the Chair of the Science Committee and on the Board of Directors of the Lewy Body Dementia Association (LBDA).  What a lovely, caring and smart lady! How lucky we all are with her running the ship. Thank you, Angela, for your interest. You perked me up and encouraged me and you didn’t even know it.

Am looking forward to reading Dr. Tom Grayboys’ book – Life in the Balance. I put in a request to the birthday fairy. She’s coming soon.

I just discovered a new game called KenKen. Never heard of it before. Haven’t tried it yet but it sounds like it’ll be another way of working the brain.

OK, David. Give the computer a rest and do something else today. It’ll stimulate your brain.


Learn to Listen — Opportunity sometimes Knocks Softly

Today’s Suggestions



Ø  Learn to listen.  Opportunity sometimes knocks very softly.


Ø  Never deprive someone of hope; it might be all he or she has.


Ø  Pray not for things, but for wisdom and courage.



OK then. I received the diagnosis of Lewy Body Disease at the University of California San Francisco (UCSF) at the Aging and Memory Center in October 7, 2008. Then………..whoa! What is going on here? I think they have the wrong diagnosis. I know these Docs are smart but maybe they’re making a mistake. But then I didn’t remember much about being evaluated anyhow. Pam, Francine and Stacy — 2 awesome friends like family members) had to keep reminding me what had happened. The Drs. told me that I could no longer drive. WHAT?? You can’t do that to me. Don’t ever take my car from me. Don’t ever tell me I can’t drive. You’re taking away my lifeline…….please, no. And, of course, you can’t go back to work until January 2008. So I just figured I’d have to take several months off and then somehow the ‘rest’ would help and then everything would be just fine. Pam had already been told that I could not ever work again and that I couldn’t practice medicine again. But somehow I didn’t know that. Maybe I forgot. Maybe I wanted to forget. Maybe I went into deep denial. Maybe, maybe, maybe. Finally, it began to sink in little by little. Even though I didn’t remember each and every detail, Pam was patient and kept explaining over and over what the situation was about. But how would we survive? How could we pay the mortgage? How could I ever not practice medicine again? I worked too hard to get that license I told myself. Just maybe, some more time would help and I could still do something as a physician. My options were clear. Either voluntarily surrender my medical license back to the Medical Board of California or to place it in an inactive status. Well guess what? I haven’t been able to do either one yet. My license expires at the end of November of this year. After all this time — 1 year later I am now ready to let it go. I’m feeling real teary right now as I type and as I think about this. It hurts so badly. I feel I’ve lost my life. Why is this being taken from me at such a young age? Now I can’t help people anymore. I know I still can but it has to be in a different way. I’m slowly learning that at least 1 way is to blog. So I feel hopeful but yet am fighting not to cry right now. I already can see how writing all this out is already helping. But the pain is still there. And no. For some reason I’m not angry at anyone for all this. Not even God. I know He allows things to happen if life and then when He closes one door, He opens up another one. We just don’t know why but all this could be a blessing in disguise. How that is I have no idea right now. I know I have to accept my diagnosis and how my life has changed. I am working on it each day. I guess I’ve accepted it more than I thought. How do I know? One of the ways I know is that it’s OK to give up my medical license now. I’ve struggled with whether to surrender it or to place it in ‘inactive’ mode which would allow me to re-activate it later and begin to practice medicine again. Now I know that can’t happen and never will happen (at least not in the traditional approach we all have in our minds). So I’m now getting my paperwork in order to go ahead and turn my license in on a voluntary basis. David, do you realize how grateful you should be that you didn’t cause any harm to any patients? Wow! The good Lord did protect people from any possible errors and mistakes I could have made. Like writing an incorrect prescription, forgetting names of medicines, dosages, etc. I am so fortunate in this regard. Thank you, Lord.


Tomorrow. I’ll pick up and talk about what we suddenly had to do after I left the hospital with my so called ‘death sentence’ diagnosis. No, I know that’s not really the way to look at it. But I have to make some humor for myself.



New Data Highlight Positive Results of Namenda(R) (memantine HCl) Once-Daily Extended-Release Formulation

Results Presented at ICAD 2008 Highlight Significant Improvement in Cognitive Performance and Global Clinical Status in Patients with Alzheimer’s Disease –

CHICAGO, Illinois — PRNewswire-FirstCall — Forest Laboratories, Inc. recently presented positive Phase III data of a once-daily extended-release formulation of Namenda(R) (memantine HCl) at the 2008 Alzheimer’s Association International Conference on Alzheimer’s Disease (ICAD). The study evaluated the efficacy, safety and tolerability of an innovative, proprietary, 28 mg once-daily extended-release formulation of Namenda compared to placebo in outpatients with moderate to severe Alzheimer’s disease already being treated with a cholinesterase inhibitor (donepezil, galantamine or rivastigmine).

In the study, patients treated with once-daily extended-release Namenda experienced significant improvements in cognitive performance and global clinical status compared to those receiving placebo. Patients treated with once-daily extended-release Namenda also experienced significant improvements in verbal fluency and behavioral symptoms as compared to placebo. The results build on preliminary findings announced by Forest in February.

"While there is no cure or existing treatment to prevent Alzheimer’s disease, there are currently-available FDA-approved treatments, such as combination therapy with memantine and a cholinesterase inhibitor, which can alleviate symptoms by providing cognitive, functional, and behavioral benefits," said George Grossberg, MD, Director of Geriatric Psychiatry at Saint Louis University School of Medicine, and the lead investigator who presented the data. "These findings reinforce the safety, tolerability and efficacy of memantine in a newly-developed once-a-day formulation."

Marco Taglietti, MD, Executive Vice President and Chief Medical Officer at Forest added, "With this novel formulation, the efficacy and tolerability of Namenda is delivered in a more convenient, once-daily dose."

About Alzheimer’s Disease

Alzheimer’s disease is a progressive, degenerative disease of the brain and the most common type of dementia. Dementia is used to describe the progressive loss of cognitive, intellectual, or functional abilities. By 2050, the number of individuals age 65 and over with Alzheimer’s disease could range from 11 million to 16 million. Currently, all Alzheimer’s disease medications approved in the US other than Namenda belong to a class of agents called cholinesterase inhibitors.

About Namenda

Namenda (memantine HCl) is the first in a class of medications with a unique mechanism of action that focuses on the glutamate pathway, a target for the treatment of Alzheimer’s disease. Indicated for the treatment of moderate to severe Alzheimer’s disease, the FDA approved Namenda in October 2003 based on three studies of Namenda used alone or in combination with another Alzheimer’s disease drug. At present, the recommended dose of Namenda is 10 mg two times a day (20 mg/day).

Namenda is contraindicated in patients with known hypersensitivity to memantine HCl or any excipients used in the formulation. The most common adverse events reported with Namenda vs placebo (greater than or equal to 5% and higher than placebo) were dizziness, confusion, headache, and constipation. In patients with severe renal impairment, dosage should be reduced.

Until tomorrow………

Dr. David

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