Age-based cognitive decline, eespecially Alzheimer’s disease, can have a devastating impact. No one wants to go through it themselves or watch a loved one turn into a stranger. Luckily, new research offers insight into the disease and hope for those at risk, and new technology is making long-term memory care facilities more secure and comfortable than ever before. Local experts weigh in on the latest in prevention and care.
early onset
Alzheimer’s symptoms tend to manifest when people are in their 70s or older, but in some cases, the disease strikes decades earlier. According to SLUCare geriatric psychiatrist Dr. George Grossberg, cases that develop before age 65 are classified as early onset, typically found in patients in their 40s or 50s. “We don’t yet fully understand what goes into the causality of Alzheimer’s, and the same is true for early onset cases,” he says. “We do know that genetics and heritability are huge factors. If a first-degree relative like a parent or sibling develops the disease early, then there is a concern.”
Since the probability of developing early onset Alzheimer’s is genetically loaded, it can seem like a hopeless situation. One cannot, after all, change family health history, but Grossberg wants the families of individuals with early forms of the disease to know there are things they can do to reduce risk. He notes that there are a variety of factors contributing to the disease, and while some cannot be modified, many can be controlled. Saint Louis University created the Center for Healthy Brain Aging to help people reduce their chances of developing it and other types of dementia. “Nothing is guaranteed, but growing evidence indicates that lifestyle modification may lower risk or delay development of the disease,” Grossberg notes. There are three areas to focus on, he says.
how to lower risk or delay development
>> activity: It’s important to stay active in a multitude of ways, according to Grossberg. Physical activity is good for the brain. Exercising your brain through mental activity and staying social also is beneficial. “Don’t become a couch potato or hermit,” he says. “Go for daily walks, do puzzles, play cards and engage with others.” He adds that remaining spiritually active if you already are can be helpful, too.
>> diet: “We know there are certain healthy diets that decrease the risk for Alzheimer’s disease,” Grossberg explains. Research shows a Mediterranean diet—fish, vegetables, fruits, olive oil, red wine, and not much red meat or processed food—is effective.
>> cardiac health: “What’s good for the heart is good for the brain,” Grossberg says. He notes that a recent study revealed that controlling blood pressure can reduce the risk of Alzheimer’s in older adults by 20 percent. Getting other cardiovascular risk factors like cholesterol and diabetes under control also can have big benefits, and the same goes for avoiding risk factors like smoking.
signs to look for
Grossberg says family members and friends are typically the first to notice if a loved one has developed early onset Alzheimer’s.
>> Personality changes such as becoming more irritable, withdrawn or depressed
>> Difficulties with well-developed skills such as struggling to balance a checkbook or suddenly messing up familiar recipes
>> Changes in executive brain functions such as planning and decision making
targeting plaques
While genetics and age are confirmed factors in the development of Alzheimer’s disease, less is known about other elements that may put you at risk. Evidence suggests a key process that triggers the disease is the alteration of a brain protein called amyloid-beta. Pieces of the protein clump together to form plaques, and it’s believed that the plaques may block cell-to-cell signaling at synapses and have other negative impacts. Grossberg says researchers have been working on a number of treatment strategies that focus on these plaques. “Until recently, nothing had been successful, and confidence in the amyloid theory lessened,” he explains. “But at the Alzheimer’s Association International Conference this summer, our pessimism was tempered by the announcement that a new drug, BAN2401, may significantly reduce plaques in the brain.”
BAN2401 is a monoclonal antibody that targets amyloid-beta. In a study of 800 patients with mild cognitive decline, those who received the highest dose of BAN2401 had a 30 percent slower progression of their symptoms than participants who received the placebo. Grossberg notes that the slower progression was paired with about 80 percent of plaque buildup being destroyed over 18 months of treatment. “There is still a lot that is unknown,” he says. “Removing the plaque did not reverse decline; it slowed and reduced it. It’s unclear if BAN2401 or something similar could be used to stop the progression of Alzheimer’s or other dementia in people who are at risk, or if continued improvement will come with continued treatment. More study is needed, but the findings showed targeting plaque may be worthwhile and reignited hope in the research community.”
long-term care
Caring for individuals with Alzheimer’s comes with a unique set of challenges and requirements. Linda DeSmet, family care coordinator at Provision Living at West County, says it can be difficult for long-term care facilities to find activities that engage the different stages of memory loss. She also notes that it can be a challenge to help individuals feel secure. “People with dementia are living in a different time,” she explains. “For example, residents may be worried that their parents are looking for them and may become agitated or try to leave. You need to find creative solutions to make them safe and secure.”
Along with concerns about activity, the risk of falling increases with Alzheimer’s. “Pacing is common with the disease,” says Allison Dolan-Boschert, AGPCNP, BSN, RN, nurse consultant with Dolan Memory Care Homes. “People want to walk around, but they lack the safety awareness necessary to prevent falls and injury.” Keeping pathways uncluttered and removing obstacles like stairs are important. Janis McGillick, director of community engagement with Dolan, also recommends doing a safety evaluation to understand individuals’ patterns and potential threats. “For example, if the patient regularly gets up in the night, make adjustments accordingly,” she says. “Freedom of movement is instinctively a challenge. Engagement and diligence make the difference between a safe environment and an unsafe one.” DeSmet adds that it’s crucial for memory care facilities to monitor falls as closely as possible because residents may not remember what happened.
There are resources in place to help you find the right care environment for your loved one. McGillick recommends checking with the Alzheimer’s Association for recommendations and helpful checklists. She also says it’s important to tour facilities with someone else to get a second opinion. If you have a loved one with memory loss who isn’t ready for a long-term care facility, Dolan-Boschert suggests consulting with Memory Care Home Solutions. The nonprofit sends occupational therapists to people’s homes, offering recommendations for making them safer places to live.
safety
Many long-term care facilities are going high-tech with memory care. Here are just some of the ways they’re using technology to keep residents safe.
>> motion-activated lights: Dolan places motion-activated lights under residents’ beds and along the hall to the bathroom to reduce nighttime falls, according to Dolan-Boschert.
>> personal tracking: Some long-term care facilities use individual trackers to eliminate wandering, but that’s not the only way technology can be used to keep residents safe. Dolan is currently testing the use of Fitbits to monitor heart rates, activity levels and sleeping patterns, according to Dolan-Boschert.
>> infrared cameras: Provision Living offers the option of having infrared cameras installed in residents’ rooms. The camera system is HIPAA-compliant and maintains privacy while monitoring gait and balance. The system informs staff if there are any changes or the resident falls. “Staff are alerted immediately, and the camera allows them to see exactly what happened,” DeSmet says, adding that the monitoring system also can let them see changes in heart rate or respiration.
>> alarms and buzzers: These can help keep doors and exits secure, but that’s just the beginning of their usefulness. Dolan puts individual buzzers on residents who recently had a hip fracture or other injury that impedes movement. “They may not remember that they can’t bear weight,” McGillick explains. “The alarms let staff know they’ve gotten up.” She adds that it’s a temporary precaution because too many alarms or buzzers going off could agitate or trigger residents.
>> music: “Listening to music has a wonderful impact and is tied to memory,” McGillick says. “Providing residents with iPods programmed with songs they or their families have selected gives them comfort and stimulation.”
>> medication distribution: McGillick says Dolan uses a system that provides staff with residents’ pictures and a list of their medications at distribution time, greatly reducing medication errors.
