Slowing the progress of Alzheimer's

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How to Slow the Progress of Alzheimer's Disease -- 5 things that can help your parent maintain independence
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By Paula Spencer, Caring.com senior editor

Quick summary

The memory loss and other cognitive changes of Alzheimer's disease can't be reversed. But there are some proven ways to delay further decline, at least over the short term. A summary:


Mental Activity

A growing body of research indicates that stimulating the brain has the power to slow the progress of Alzheimer's, particularly in the early stages. Healthy elderly adults who are mentally active were 2.6 times less likely to develop dementia, according to the Rush Memory and Aging Project, an ongoing longitudinal study involving more than 1,200 older people.

What you can do:

Encourage your parent to participate in activities she finds pleasurable, especially those that engage the mind: reading, writing, playing the piano, working crosswords or puzzle books, playing games such as chess, or even learning a language. Present your parent with fresh materials or plenty of opportunities.

Local senior centers and adult daycare programs are more than just a way to "pass the time." They excel at providing stimulating activities, including group storytelling, music, art, and games.

Some research suggests that activities are especially protective when they involve interacting with others. Healthy people who are socially active tend to have fewer memory problems than those who are more reclusive.

Give your parent help around the home, but avoid relieving your parent of all her customary responsibilities. Participating in daily chores can be a form of mental workout, too.

The catch with mental stimulation:

It's important that your parent find the activity pleasurable. If she finds studying Spanish or learning to use a computer frustrating because of existing cognitive declines, don't push it.

Also avoid formal mental "exercises" or memory drills. They may stress your parent, causing symptoms to worsen.

Too much social activity can also be stressful. Outings are best when low-key (small dinners as opposed to, say, big parties) and last under two hours.


Daily Life Modifications

Simplifying your parent's living environment and providing the tools to assist her existing memory can help her maintain independence longer. This has the benefit of reducing stress and slowing further decline.

What you can do:

Find ways to minimize any tasks your parent may worry about. For example, you could arrange electronic bill paying, hire a lawn service, enlist a young neighbor to handle her laundry, or cancel subscriptions to magazines she never reads. Help her keep her home free of piled-up newspapers, old mail, and other clutter. Look into electronic reminder systems, note-keeping systems, or commercially available tools that can help to prop up a faulty memory.

The catch with daily life modifications:

Be sure to make changes gradually. Too many abrupt changes -- removing all the clutter from a messy home in one sweep, for example -- can be disorienting and stressful to someone with Alzheimer's and hasten her decline rather than slowing it.


Routine and Familiarity

The stimulation of fresh ideas can have positive effects, but too much change in your parent's life can be confusing and disorienting. Familiarity is very important to someone with Alzheimer's disease. The stress of having to cope with sudden or significant change can make symptoms worse. (Note: Stress doesn't cause Alzheimer's, but it has been shown to worsen symptoms in those already affected.)

What you can do:

Try to give your parent's day a regular rhythm, with meals, sleep, outings, and bathing happening at about the same times each day. Schedule all doctors' appointments at roughly the same time if you can, such as first thing in the morning or right after lunch. It's not unlike the way a new parent organizes the day around a baby's sleep-wake cycle.

The catch with routines:

A good routine is one that's healthy to begin with. Examples of negative routines worth trying to change: If your parent is staying awake later and later and rising later, or if she has dropped all former social connections and rarely sees anyone.


Vitamins and Herbs

Scientists are investigating several different dietary additions for people with dementia. Two of the most promising areas:

• Antioxidants

A clinical trial showed that vitamin E helps slow down mental impairment in people with Alzheimer's. Vitamin E is an antioxidant, which helps protect cells against damage. It's now being researched in conjunction with B vitamins.

A large 2005 study found that healthy people who consumed more than 400 micrograms (the recommended daily amount for adults) of folate, a B vitamin that occurs naturally in many foods, cut their risk of developing Alzheimer's in half. This slowing of cognitive decline is being looked at to see if it's also true once decline has started.

• Ginkgo biloba

This herb, traditionally used in Chinese medicine, comes from the dried leaves of the gingko (maidenhair) tree. It's sometimes called the "memory herb," after findings that it appears to help slow down cognitive decline for some people in the early stages of Alzheimer's disease. To date, research studies making this claim have been criticized, however, and a randomized clinical trial sponsored in part by the National Institute on Aging and the National Center for Complementary and Alternative Medicine is underway, to be completed in late 2009.

What you can do:

Encourage your parent to inform her primary-care doctor about any supplements and herbs she has been taking, and their dosages, and do so yourself if she doesn't. Bring the bottle so the doctor can see exactly what's being taken. Too much vitamin E, for example, can cause gastrointestinal problems and other side effects, and can be fatal to people with heart disease.

In general, the best way to get important vitamins and minerals is to consume them from their natural food sources. A recent study found that Alzheimer's patients who most closely followed a Mediterranean-style diet (high in vegetables, legumes, cereals, fruit, fish, poultry, dairy, and monounstaturated fats -- and low in saturated fats) lived an average of 1.3 years longer than those who consumed a Western diet (higher in saturated fats and meats, lower in vegetables).

Try to make sure that your parent is eating a diet low in saturated fats and rich in vitamins E, C, and B. Older people's diets often lack fresh fruits and vegetables (such as citrus, berries, and leafy green vegetables), legumes (beans), whole-wheat or fortified bread, and nuts and seeds.

Take a close look at your parent's eating habits. People with memory problems often slack off on cooking because even the familiar steps, as well as managing cutlery, become too challenging.

The catch with vitamins and herbs:

The one thing scientists agree on concerning memory loss and supplements is that more research
is needed. No single "magic bullet" has been found to stop memory decline in its tracks, and no
supplements should be taken by people with Alzheimer's without medical supervision.


Medications

Five FDA-approved drugs are used to delay the symptoms of Alzheimer's disease or prevent them from becoming worse for a limited time.

What you can do:

Talk to your parent's doctor about which drugs might be appropriate. For mild to moderate Alzheimer's, cholinesterase inhibitors -- such as Aricept (donepezil), Exelon (rivastigmine), and Razadyne (galantamine), formerly called Reminyl -- may be prescribed. These medications help keep the enzyme acetylcholinesterase from reducing acetylcholine, which affects mental capabilities and muscle control. The drug Cognex (tacrine hydrochloride) was prescribed in the past, but is no longer recommended.

For moderate to severe stages, the drug Namenda (memantine) is also used. This drug is an N-methyl-D-aspartate (NMDA) receptor antagonist, which regulates glutamate (a chemical messenger in the brain that's associated with learning and memory).

The catch with medications:

Not every drug works for all patients. And each involves possible side effects and interactions with other drugs your parent may be taking. Talk to your parent's doctor about whether any of these medications is a good fit.


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