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.

Drug overuse threatens nursing home residents. Routine prescribing of powerful medications occurs too often, our investigation finds

Last reviewed: December 2010


More than five years after the Food and Drug Administration warned that drugs routinely prescribed to nursing-home residents posed serious threats, including an increased risk of death, inappropriate use remains high, according to a recent analysis by the American Society of Health-System Pharmacists (ASHP). The project is part of a CRH Best Buy Drugs ongoing investigation of medication prescribed “off-label.”

The drugs in question, atypical antipsychotics, are approved by the FDA to treat bipolar disorder and schizophrenia. But they’re frequently used off-label to control agitation, aggression, hallucinations, and other behavioral symptoms in elderly patients with Alzheimer’s disease or other forms of dementia. There are no FDA-approved drugs to treat these behavioral symptoms, but doctors can legally prescribe any drug for any reason they deem appropriate.

But those medications—such as aripiprazole (Abilify); olanzapine (Zyprexa); quetiapine (Seroquel); and risperidone (Risperdal and generic)—pose substantial risks, especially to older people, that include diabetes, movement disorders (some permanent), pneumonia, stroke, weight gain, and even sudden cardiac death.

“There is limited evidence for the efficacy of these medications and evidence of significant safety risks,” says E. Ray Dorsey, M.D., an associate professor of neurology at the Johns Hopkins University School of Medicine. “In addition, many of the people receiving them have limited capacity to weigh the risks and benefits of taking them.”

According to FDA estimates, the rate of death among elderly dementia patients with behavioral problems who received antipsychotics was about 4.5 percent over the course of a typical 10-week controlled trial, compared with about 2.6 percent for a placebo group. This prompted the FDA to require black-box warnings—the strongest type—to be added to the labeling of atypical antipsychotic medications in 2005. The FDA broadened the warning in 2008 to include the labels on “typical” or older antipsychotics, including chlorpromazine (only available as a generic now) and haloperidol (Haldol and generic).

What measures should you try first?

In a study published in the 2010 Archives of Internal Medicine, researchers found that the use of antipsychotics often began during a patient’s first week in a nursing home. That suggests that behavioral interventions—the treatment of choice—are used minimally, if at all.

“The patient is scared and upset in a strange environment, and the caregiver may lack training in how to respond,” explains Kenneth Brubaker, M.D., a geriatrician and board member of the American Medical Directors Association (AMDA), a group of health professionals who work in nursing homes and assisted living facilities.

“I would advocate that a family member be present as much as possible during the adjustment period, because that’s the patient’s only contact with reality,” says Brubaker. “Having frequent phone conversations between patient and family help, as do looking through family photo albums together or compiling a DVD of the patient’s life story to remind them of the past.”

Frontline caregivers—who deal directly with residents with dementia-related behavioral problems—often have limited skills in using such approaches, Brubaker says. At those nursing homes, according to Brubaker, agitated new residents are likely to be quieted with antipsychotic drugs in lieu of family photos.

This off-label drug use report is made possible through a collaboration between Consumer Reports Best Buy Drugs and the American Society of Health-System Pharmacists. This is the18th and 19th in a series based on professional reports prepared by ASHP.

These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

http://www.consumerreports.org/health/best-buy-drugs/atypical-antipsychotics/the-basics/index.htm?EXTKEY=NB0CNT0H

My response to: Anyone have experience with Psychiatrists being used for LBD patient?

I received this email this morning from LBDcaregivers@yahoogroups.com. My response follows this copy of the email.

Anyone have experience with Psychiatrists being used for LBD patient   Posted by: "drh488" Wed Nov 18, 2009 3:17 pm (PST)

Today we had a Psychiatric nurse visit Mom. By the time she left, she had my mother so emotionally upset that she is ready to go back to a nursing home and die. She brought up things to my mother that happened 30 years ago and hasn’t been discussed in 20 years. Our battle with the outside caregivers has turned into a social worker telling us that WE have become Lewy body dementia. Our extreme efforts to make people understand the disease has taken the place of taking care our mother. Our mother does best when she has structured days. Up at 6, breakfast at 8, regis at 9, lunch at noon….etc. Anything out of that structure causes problems with her. This company sends occ. therapy, phys therapy, and a nurse. We have explained time and time again that our Mom needs structure. To no avail we wont here from them for 3-4 days then they call saying "We are on our way". Next thing you know, 3 people in one day unexpected. My sister is so frustrated. Psych nurse told my Mom that she has LBD, what it is and everything. Brought up old memories of my sister dying, my dad dying. Then she leaves with my mom all upset and my sister to deal with it. Psych nurse wont be back for 2 weeks. I’m calling my Mom’s neurologist tomorrow to see if she should be talking to this psycho nurse…no pun intended….It seems to me that it is more destructive than constructive.  Interested if anyone has had similar experiences Thank You

I felt appalled as I read this post. It goes to show that not all educated individuals use good old fashioned common sense. Even a small child realizes something isn’t right when they see someone being hurt and being in distress.

As an aside, I should mention that dementia is not only a neurological diagnosis but is also an official psychiatric diagnosis.

Unfortunately, in spite of being taught to first DO NO HARM to a patient, medical professionals don’t always have good common sense either. One doesn’t always learn certain things from medical, psychology and nursing books.

Having said this, there is not excuse for someone to get someone upset like this. Psychiatrists, psychologists and psychiatric nurses are taught that certain mental health diagnoses should not be treated with traditional psychotherapy such as schizophrenia and dementia. These disorders are treated with supportive psychotherapy, not with insight-oriented psychotherapy as described in the email.

What good does it do to dredge up the past with someone who has dementia? How can it be helpful? I certainly don’t know. However, if an individual unsolicitedly brings up past memories, that is fine. They can be dealt with in a supportive way whether positive or negative. And reminding someone of past positive memories can be therapeutic as well. But to stir up past memories in any of us against our will is certainly cruel in my opinion.

So, yes, this behavior is undoubtedly more destructive than constructive. Definitely confront the involved providers and request them to discontinue this type of communication and involvement. If it doesn’t stop, go to the next level, etc. If it continues, and if it is possible, go somewhere else! If it smells like a duck, quacks like a duck and walks like a duck then it is a duck………….

This makes me wonder. How many of all caregivers, professional and non-professional unwittingly aggravate and/or cause some of the argumentativeness, irritability and combativeness seen in the dementia population?

I’d be interested to hear of others’ thoughts and opinions.

Warmly………….David

A must read for caregivers — “A person immobilized by dementia has the potential to change a life with merely a glance or a touch”

A must read article for caregivers! This article brilliantly describes the stigma of being both elderly and having dementia. Yes, those of us with dementia can still have an impact of others. More

It reminds me so much of Louise Morse’s book, “Could it be dementia?

Warmly…….David

Insulin levels in the brain may be the key to understanding how some types of dementia progress

Now this concept sounds very plausible to me. Think of how you feel when your blood sugar drops. I’ll be eager to see if anything more comes of it. More…..

Warmly……….David

Sex and Dementia: Shrouded by Taboo

A man with Alzheimer’s and his wife of many years finish lovemaking when he rolls over and tells her, “You’d better hurry up and get your things because my wife will be home soon." ……….

This comes from a thought provoking article here. I believe this is a subject which needs to be addressed on many levels. Life doesn’t stop when someone becomes demented. All of our physiological needs persist throughout the course of our lives..

We all follow Maslow’s hierarchy of needs. Click on the picture to open it up. Notice that the red portion of the triangle is the foundation of our being.

Maslow

Physiological needs include:

 

Tell me what you think…………..David

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