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

Got thirst?

I got thirsty today from working outside (not good). We trimmed, pruned, cut grass and mulched some leaves. Wow! What a great byline for the national nightly news! Applause But it was a lot of fun. Yea, Pam and I are both aching now…………where’s that aspirin??

The last week or so has been much better. In fact, it feels like I did all summer long. I’ve never been able to achieve my baseline since becoming ill but nonetheless I’m OK with that. This LBD truly is cunning, baffling and powerful! One day they will have an answer to all the mysteriousness of the symptomatic fluctuations of Lewy Body Dementia.

So back to being thirsty. I remembered blogging about dehydration last fall. Particularly with regard to the elderly. And in the winter……not just summer (whenever we think of dehydration the most). So I thought I’d cheat and repost it again since winter is right around the corner. Hope it is helpful to someone.

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Signs and Symptoms of Winter Dehydration in the Elderly and 8 Ways to Avoid Them

It’s Winter! Dehydrated? How could I be? Dehydration can occur anytime of the year. We think of summer time as being a time to avoid the sun as well as heat stroke and heat exhaustion. Here are some tips to keep you and your elderly loved ones well hydrated this winter. And to better health!

Dehydration can kill. It is crucial for anyone to stay properly hydrated but it is even more important for seniors who have other comorbidities as well as dementia like diseases. One of the reasons that the dehydration threat is higher for seniors is because of thinner skin that comes with aging. The thinner skin makes a person more prone to losing fluid. Another issue that makes seniors more open to fluid loss is their medications, some medicines can cause you to become easily dehydrated.

A wide array of medical issues can lead to dehydration. Considering that our bodies are made up of 50% to 65% water, this element is critical to virtually all our physical functions. Every organ and system of the body depends on water, so a shortage of fluid can naturally lead to serious health consequences. Dehydration is one of the most frequent causes of hospitalization among people over the age of 65. Worse, at least one study has found that about one-half of those hospitalized for dehydration died within a year of admission. Older people are at greatest risk for dehydration because the mechanism that normally triggers thirst becomes less sensitive with age. In addition, as we age, a lower percentage of our body weight is water, so dehydration can occur more rapidly. Those elderly individuals most vulnerable to dehydration live alone, especially when they are ill. In addition to fluid lost from fever from flu, or diarrhea from a stomach virus, sickness usually interferes with normal eating and drinking patterns.   We lose water in many ways.

  1. Breathing results in humidified air leaving the body
  2. Diarrhea is the most common reason a person loses excess water. A significant amount of water can be lost with each bowel movement. Worldwide, dehydration from diarrhea accounts for many of the deaths in children.
  3. Vomiting can also be a cause of fluid loss; as well, it makes it difficult to replace water by drinking it.
  4. The body can lose significant amounts of water when it tries to cool itself by sweating. Whether the body is hot because of the environment (for example, working in a warm environment), intense exercising in a hot environment, or because a fever is present due to an infection, the body loses a significant amount of water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk will generate up to 16 ounces of sweat (a pound of water).
  5. In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine and water then follows. Significant dehydration can occur. For this reason, frequent urination and excessive thirst are among the symptoms of diabetes.
  6. Burn victims become dehydrated because water seeps into the damaged skin. Other inflammatory diseases of the skin are also associated with fluid loss.
  7. The inability to drink adequately is the other potential cause of dehydration. Whether it is the lack of availability of water or the lack of strength to drink adequate amounts, this, coupled with routine or extraordinary water losses, can compound the degree of dehydration.
  8. One common side effect of many medicines is increased frequency of urination. You need to compensate for these additional lost fluids by drinking more than usual. Medications that often cause this problem are diuretics, blood pressure drugs, antihistamines and psychiatric drugs.
  9. The aging process can diminish our natural sense of thirst, but if you also suffer from incontinence, you may be reluctant to drink fluids throughout the day. Sipping often in small amounts is essential to avoid becoming dehydrated.

The body’s initial signs and symptoms of dehydration are:

  • Thirst
  • Decreased urine output. The urine will become concentrated and more yellow in color.
  • Fatigue
  • Headache
  • Dry nasal passages
  • Dry, cracked lips dry mouth the eyes stop making tears sweating may stop muscle cramps nausea and vomiting lightheadedness (especially when standing). weakness will occur as the brain and other body organs receive less blood.
  • Coma and organ failure will occur if the dehydration remains untreated.
  • Irritability & confusion in the elderly should also be heeded immediately.

Here are some easy remedies and ways to prevent dehydration:

  1. As is often the case in medicine, prevention is the important first step in the treatment of dehydration.
  2. Fluid replacement is the treatment for dehydration. This can include: water, juice, soups and clear broths, Popsicles, Jell-O, ice cream, milk, puddings, decaffeinated beverages, Kool-Aid, nutritional drink supplements (Ensure, Boost, Sustacal, Resource and instant breakfast drinks), and replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)
  3. Reduce or eliminate dehydrating beverages such as coffee, tea and soft drinks (unless decaffeinated). But even decaffeinated drinks can contribute to dehydration. Beware of alcohol intake too. Alcoholic beverages increase risk of dehydration because the body requires additional water to metabolize alcohol and it also acts as a diuretic.
  4. If you drink the unhealthy beverages, you need to add even more water to you daily total. The dehydration caused by those drinks must be compensated for by increasing the water.
  5. Eat lots of fruits and vegetables. Most have a high water content.
  6. Drink water all day long in small amounts. It is not good to suddenly gulp down 64 ounces of water. You can fill a 24-32 ounce tumbler in the morning, refill it by late morning and refill again for the afternoon. Consume that by 5 PM. Most people need to start limiting fluids 1-3 hours before bedtime.
  7. Individuals with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss. Acetaminophen or ibuprofen may be used to control fever.
  8. If an individual becomes confused or lethargic; if there is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed. Call 911 for any patient with altered mental status – confusion, lethargy, or coma.

Remember that the lack of a sense of thirst is not a reliable indicator of the need for water. You need water long before you feel thirsty.

Warmly………….David

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.

Talking, Holding, Listening and Just Being There

Someone left a comment saying, “You can also play randomized 4×4 and 6×6 games online at http://www.webkendoku.com.”

Sounds like KenKen is starting to catch on!

Well, now. There’s something I have to get off of my chest. For years during my practice, I tended to avoid working with the elderly and particularly those with dementia. And I didn’t know why. Part of me now wonders if it was related to some unconscious fear of getting it someday.

However, in retrospect, I realize that I never had any supervisors, professors and mentors during my training who emphasized working with the elderly. Because I always wanted to “help” patients, I had the erroneous thought that I couldn’t help the elderly.

Now I feel that I missed out on ministering to an important population. If only I knew then what I know now. It’s not just about giving them a drug and making the dementia disappear overnight. It’s about holding their hand. Talking to them. Just being with them without saying anything. Or listening to their “babbling nonsense.” Now I realize their “nonsense” was sensical and not just babbling. Yes, most of it was that there was no time to do that. Making rounds, talking with family members, doing endless paperwork, etc., makes it difficult to spend the time we’d like to give to patients. But, I could have made time. I did it for other patients and took that extra step. Now I regret that I missed out on giving so much to those who needed it the most.

But it’s not too late. We all have opportunities to help them. It’s the little things. Not just giving them pills and elixors. It’s treating them as real people who haven’t died. People who are still alive inside with feelings, emotions and needs. Just like everyone else. Just like children, they aren’t always able to make their needs known. But we hold babies and children even if we don’t know for sure what their need truly is. Why don’t we do that with the elderly?

Ok. I’ve admitted a fault from the past. I can’t change it. But I admit to it. As the expression goes. “If I only knew then what I know now and to be able to do it all over again.” Yes, it would be different. But life doesn’t work that way. It just helps us to now realize that we can do it over again but in the present!

Warmly…………..David

Taking Namenda? Should I take Robitussin or Robitussin DM?

Well, today is the day I raise my dose of Namenda from 15-mg up to 20-mg. I’m supposed to take 10-mg twice daily. Since I’ve had a robust response to this drug overall, I’ll be very curious to see how the increased dose will work.

 

Are you taking Namenda? The prescribing information and package insert for Namenda contains this statement: The combined use of Namenda with other NMDA antagonists (amantadine, ketamine, and dextromethorphan) has not been systematically evaluated and such use should be approached with caution.

DM stands for dextromethorphan. DXM is another abbreviation for it. It is a cough suppressant which is chemically related to codeine. It isn’t addictive and it doesn’t work for pain though. It’s an active ingredient in over 120 nonprescription cough and cold medications. When used in normal doses it is usually OK. It’s a good over the counter agent for coughing, etc. Most people don’t have any problems so I’m not intending for the average person to stop using it or to scare anyone. It is usually safe in the 15- to 30-milligram dosages recommended for treating cough or colds. It is a very good agent when used safely!

This is the drug that teenagers are now abusing and getting “high” from. In high doses (100-milligrams or more), it can cause a mildly euphoric and stimulating effect similar to that of ecstasy. At even higher doses, the drug’s “stoning” effect increases and hallucinations may occur. The highest plateaus are characterized by ELABORATE HALLUCINATIONS AND OUT-OF-BODY EXPERIENCES. During such out-of-body experiences, users perceive a complete disconnection from their body and surroundings, WITH NO AWARENESS OF WHAT THEY ARE DOING (OR HAVING DONE TO THEM).

Even in normal individuals, especially the elderly and those with dementia, it can also cause confusion, impaired judgment, loss of coordination, paranoia, excessive sweating, psychosis, brain damage, rigid muscle tone or involuntary muscle movement and decreased ability to regulate body temperature, which can lead to heat stroke. Other side effects can be severe dizziness, anxiety, restless feeling, or nervousness, slow, shallow breathing, dizziness, nausea, seizures, panic attacks, and addiction, coma and death, blurred vision and/or slurred speech, numb fingers or toes, dry mouth, itchy skin, irregular heartbeat and high blood pressure.

The take home message is this. Individuals with dementia already have a lot of the above symptoms. And they are more sensitive and susceptible to them when taking the DM form of Robitussin. If you are not sure whether to take this or not, please check with your physician.

DXM products are known in the street as Skittles, Red Devils, Robo (from Robitussin) or Triple C’s. The high that dextromethorphan produces is called “robotripping” or “skittling.”

Robitussin is one of the brand names for guaiphenesin. It is usually the main ingredient in many of the “tussin” drugs. It is a common over the counter  drug which dissolves thick mucus sold over the counter and usually taken by mouth to assist the bringing up (“expectoration”) of phlegm from the airways in acute respiratory tract infections. The active ingredient in Mucinex and Robitussin is guaiphenesin. So, Robitussin becomes Robitussin DM when dextromethorphan is added to it.

Guaiphenesin also comes in tablets which are easier to take. I try to avoid the thick liquid cough syrups. Bitter tasting medicine!

By the way, when it comes to these old fashioned medications, I personally prefer the generics. They are much cheaper and just as effective as the brand names. Only my opinion.

Now, that I am on Namenda, I’ll have to be cautious this winter. I’ve always relied on the long-acting form of dextromethorphan for my coughs such as Delsym. Never had much luck with the regular dose of dextromethorphan which is in the Robitussin DM form. Guess I just try a small dose of it when I need it in order to make sure all is well.

(I have no financial interest in any of the above mentioned medical products).

David

Signs and Symptoms of Winter Dehydration in the Elderly and 8 Ways to Avoid Them

It’s Winter! Dehydrated? How could I be? Dehydration can occur anytime of the year. We think of summer time as being a time to avoid the sun as well as heat stroke and heat exhaustion. Here are some tips to keep you and your elderly loved ones well hydrated this winter. And to better health!

Dehydration can kill. It is crucial for anyone to stay properly hydrated but it is even more important for seniors who have other comorbidities as well as dementia like diseases. One of the reasons that the dehydration threat is higher for seniors is because of thinner skin that comes with aging. The thinner skin makes a person more prone to losing fluid. Another issue that makes seniors more open to fluid loss is their medications, some medicines can cause you to become easily dehydrated.

A wide array of medical issues can lead to dehydration. Considering that our bodies are made up of 50% to 65% water, this element is critical to virtually all our physical functions. Every organ and system of the body depends on water, so a shortage of fluid can naturally lead to serious health consequences. Dehydration is one of the most frequent causes of hospitalization among people over the age of 65. Worse, at least one study has found that about one-half of those hospitalized for dehydration died within a year of admission. Older people are at greatest risk for dehydration because the mechanism that normally triggers thirst becomes less sensitive with age. In addition, as we age, a lower percentage of our body weight is water, so dehydration can occur more rapidly. Those elderly individuals most vulnerable to dehydration live alone, especially when they are ill. In addition to fluid lost from fever from flu, or diarrhea from a stomach virus, sickness usually interferes with normal eating and drinking patterns.   We lose water in many ways.  

  1. Breathing results in humidified air leaving the body
  2. Diarrhea is the most common reason a person loses excess water. A significant amount of water can be lost with each bowel movement. Worldwide, dehydration from diarrhea accounts for many of the deaths in children.
  3. Vomiting can also be a cause of fluid loss; as well, it makes it difficult to replace water by drinking it.
  4. The body can lose significant amounts of water when it tries to cool itself by sweating. Whether the body is hot because of the environment (for example, working in a warm environment), intense exercising in a hot environment, or because a fever is present due to an infection, the body loses a significant amount of water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk will generate up to 16 ounces of sweat (a pound of water).
  5. In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine and water then follows. Significant dehydration can occur. For this reason, frequent urination and excessive thirst are among the symptoms of diabetes.
  6. Burn victims become dehydrated because water seeps into the damaged skin. Other inflammatory diseases of the skin are also associated with fluid loss.
  7. The inability to drink adequately is the other potential cause of dehydration. Whether it is the lack of availability of water or the lack of strength to drink adequate amounts, this, coupled with routine or extraordinary water losses, can compound the degree of dehydration.
  8. One common side effect of many medicines is increased frequency of urination. You need to compensate for these additional lost fluids by drinking more than usual. Medications that often cause this problem are diuretics, blood pressure drugs, antihistamines and psychiatric drugs.
  9. The aging process can diminish our natural sense of thirst, but if you also suffer from incontinence, you may be reluctant to drink fluids throughout the day. Sipping often in small amounts is essential to avoid becoming dehydrated. 

The body’s initial signs and symptoms of dehydration are:  

  • Thirst
  • Decreased urine output. The urine will become concentrated and more yellow in color.
  • Fatigue
  • Headache
  • Dry nasal passages
  • Dry, cracked lips dry mouth the eyes stop making tears sweating may stop muscle cramps nausea and vomiting lightheadedness (especially when standing). weakness will occur as the brain and other body organs receive less blood.
  • Coma and organ failure will occur if the dehydration remains untreated.
  • Irritability & confusion in the elderly should also be heeded immediately. 

Here are some easy remedies and ways to prevent dehydration: 

  1. As is often the case in medicine, prevention is the important first step in the treatment of dehydration.
  2. Fluid replacement is the treatment for dehydration. This can include: water, juice, soups and clear broths, Popsicles, Jell-O, ice cream, milk, puddings, decaffeinated beverages, Kool-Aid, nutritional drink supplements (Ensure, Boost, Sustacal, Resource and instant breakfast drinks), and replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)
  3. Reduce or eliminate dehydrating beverages such as coffee, tea and soft drinks (unless decaffeinated). But even decaffeinated drinks can contribute to dehydration. Beware of alcohol intake too. Alcoholic beverages increase risk of dehydration because the body requires additional water to metabolize alcohol and it also acts as a diuretic.
  4. If you drink the unhealthy beverages, you need to add even more water to you daily total. The dehydration caused by those drinks must be compensated for by increasing the water.
  5. Eat lots of fruits and vegetables. Most have a high water content.
  6. Drink water all day long in small amounts. It is not good to suddenly gulp down 64 ounces of water. You can fill a 24-32 ounce tumbler in the morning, refill it by late morning and refill again for the afternoon. Consume that by 5 PM. Most people need to start limiting fluids 1-3 hours before bedtime.
  7. Individuals with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss. Acetaminophen or ibuprofen may be used to control fever.
  8. If an individual becomes confused or lethargic; if there is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed. Call 911 for any patient with altered mental status – confusion, lethargy, or coma. 

Remember that the lack of a sense of thirst is not a reliable indicator of the need for water. You need water long before you feel thirsty.  

[This Article was written for Ezine Articles]

 

David

What is Lewy Body Dementia?

The following is extracted from the Lewy Body Dementia Association website:

Lewy body dementia (LBD) is a progressive brain disease and the second leading cause of degenerative dementia in the elderly. The clinical name, “dementia with Lewy bodies” (DLB), accounts for up to 20% of all dementia cases, or 800,000 patients in the US. Over 50% of Parkinson’s disease patients develop “Parkinson’s disease dementia” (PDD), which accounts for at least 750,000 patients. (PDD is also a Lewy body dementia.)

Other names for the Lewy body dementias are:

  • Lewy body disease (LBD)
  • Diffuse lewy body disease (DLBD)
  • Cortical Lewy body disease (CLBD)
  • Lewy body Variant of Alzheimer’s (LBV)(LBVA)
  • Parkinson’s disease with dementia (PDD)

In the early 1900’s, while researching Parkinson’s disease, the scientist Friederich H. Lewy discovered abnormal protein deposits that disrupt the brain’s normal functioning. These Lewy body proteins are found in an area of the brain stem where they deplete the neurotransmitter dopamine, causing Parkinsonian symptoms. In Lewy body dementia, these abnormal proteins are diffuse throughout other areas of the brain, including the cerebral cortex. The brain chemical acetylcholine is depleted, causing disruption of perception, thinking, and behavior. Lewy body dementia exists either in pure form, or in conjunction with other brain changes, including those typically seen in Alzheimer’s disease and Parkinson’s disease. 

Horn of Plenty

–Mark L. Madden

When a music student brought his French horn to my shop for repair, he complained that the instrument “felt stuffy” and he couldn’t blow air through it. It’s not unusual to find partial blockages in brass instruments if small items get lodged in the tubing, but when I tested the instrument, the horn was completely blocked. After much probing and prodding, a small tangerine dropped out of the bell. “Oh,” said the musician when I handed him the fruit. Seeing the bewildered look on my face, he explained, “My mom used the horn for a cornucopia in a Thanksgiving centerpiece.”

 

David

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