CALMING ALZHEIMER'S AGITATION WITH CITALOPRAM

A drug intended to treat depression has been found to reduce agitation in people with Alzheimer's disease. The drug, citalopram (Celexa), appears to be a safer alternative to the traditional antipsychotic medicines used for agitation. Doctors typically prescribe antipsychotics after nondrug treatments, such as behavioral therapy, fail to calm patients.

In a randomized clinical trial reported in JAMA (volume 311, p. 683), Johns Hopkins scientists studied 186 people, average ages 78-79, with Alzheimer's who had symptoms of agitation such as emotional distress, irritability, aggressive behavior, verbal or physical outbursts and restlessness.

They gave about half the patients citalopram with gradually increasing doses up to 30 mg. The remaining patients received a placebo. Participants in both groups, and their caregivers, received counseling as well. After nine weeks, 40 percent of the patients in the citalopram group showed marked improvement in agitation symptoms, compared with 26 percent in the placebo group. Caregivers of patients who received citalopram also reported less stress.

The risks - Citalopram, however, does have some risks; the FDA advises people over 60 to avoid doses above 20 mg. Citalopram been associated with abnormal heart rhythms and a mild decrease in cognitive function. Some study participants who took citalopram also reported anorexia, diarrhea, falls and upper-respiratory infections. Yet, lower doses are still thought to be safer than antipsychotic drugs, which have been associated with stroke, heart attack and death.

The study authors say the next step is more research to determine whether the drug is as effective in doses of 20 mg over a longer period. They also recommend that doctors assess patients individually to determine drug doses, based on factors like the patients' severity of agitation, cardiovascular health and cognitive function.

(Source:  John Hopkins Health Alert, 30 June 2014)

SAT/5JULY14 Caregivers Monthly Sharing Session and Talk on Dementia Care Titled "Beyond Diagnosis ... What Next??"

TO:  All Caregivers, 

ADFM National Caregivers Support Network will be having it's July Monthly Caregivers Sharing and Talk on Dementia Care Titled "BEYOND DIAGNOSIS ... WHAT NEXT ??" by Mr Willie Kwa from UK.

Day / Date :  Saturday, 5 July 2014

Time :  2.30pm to 5.00pm

Venue :  ADFM PJ Daycare Centre, No. 6, Lorong 11/8E, 46200 Petaling Jaya.

Objective: How being a Caregiver who is prepared, knowledgeable, supported and in good psychological and physical health ultimately provide the best care !!.  It will be a very interactive talk to allow more interaction from the caregivers with the Speaker.  

Facilitator's Profile:

Willie Kwa is a Malaysian from Taiping and ex distant caregiver to his late dementia Mom. 

Willie is a retired Nurse in UK with over 40 years extensive nursing care experience for people with mental health issues, in particular relating to older people, and with special interest in caring people with various forms of dementia.

He is a member and volunteer with the Alzheimer's Society (UK) for over 30 years in areas of raising awareness of dementia and care issues.   

His experience includes managerial operational responsibility for a 70 beds hospital service for older people with mental health difficulties. Commissioned and managed new services consisting of community, day care centers and in-patient care units.  

Presently, Willie is with private sector giving care to old people with various health problems including all aspects of mental health and dementia care.

COMPULSORY REGISTRATION:  

Kindly register early by click on -> Registration Form and return the completed form to jenny@adfm.org.my or fax to: 03 7960 8481. 

Further inquiries, feel free to call Jenny at 016 608 2513 / 03 7931 5850 or email jenny@adfm.org.my.

From:  ADFM National Caregivers Support Network

June 2014  

BRAIN-HEALTHY EATING PLAN

Are there dietary eating plans that are both heart- and brain-healthy?

Recent research strongly suggests that dietary changes -- in particular, the adoption of a Mediterranean-style eating plan -- can help prevent the onset or else slow the rate of cognitive decline. The Mediterranean diet consists of foods traditionally consumed by people living along the coast of the Mediterranean Sea.

Over the past decade, a number of studies have linked the Mediterranean diet with a reduced risk of cardiovascular disease, diabetes and hypertension. For example, an important Spanish study on the Mediterranean diet, published in the New England Journal of Medicine, found a 30 percent reduction in heart attacks, strokes and cardiovascular deaths in high-risk people who consumed the Mediterranean diet, compared with those eating a "low-fat diet." That's similar to the risk reduction seen with statin drugs.

Not surprisingly, foods that are good for your heart are also good for your brain. A study published in the Annals of Neurology reported that among 2,258 participants (average age 76), those who closely followed the Mediterranean diet had a 40 percent lower risk of Alzheimer's disease than those with the least adherence after four years. Partial observation of the Mediterranean diet proved to have benefits, too, reducing the risk by 15 percent.

The Mediterranean diet may also keep those who have mild cognitive impairment (MCI) from progressing to Alzheimer's disease. A recent study published in the Archives of Neurology reported that among people with MCI, the risk of developing Alzheimer's over a four-year period was 48 percent lower for those who adhered strictly to a Mediterranean diet. Those who adhered moderately to the diet had a 45 percent lower risk.

The Mediterranean diet is characterized by:

•  smaller portion sizes than a Western diet.

•  a focus on fresh rather than processed foods.

•  a high intake of plant-based foods, such as vegetables, fruits, legumes and whole grain.

•  moderate amounts of nuts, olive oil and fish, which are high in healthy monounsaturated and omega-3 fats.

•  moderate consumption of wine, typically with meals.

•  regular consumption of skinless poultry and low-fat dairy in smaller portions.

•  infrequent consumption of meat, which is high in saturated fats, and sweets.

(Source:  John Hopkins Health Alert, 23 June 2014)

BRAIN SCANS: A NEW TOOL FOR TREATING DEPRESSION

Treating depression can be challenging for clinicians, with no way of knowing how a patient will respond. But brain scans taken before treatment may help predict which treatment is best for an individual patient, according to a study published in JAMA Psychiatry (Volume 70, page 821).

In the study, researchers used a positron emission tomography (PET) scanner to obtain images of the resting brain in 63 people, ages 18 to 60, with depression. They then compared brain activity of patients who were successfully treated with that of those who saw no improvement. Participants had been randomly assigned to either 12 weeks of antidepressants or 16 weeks of psychotherapy.

Based on the PET imaging, activity in the area of the brain known as the anterior insula - responsible for such things as decision-making, emotions and body cues (such as hunger and cravings) - appeared to be able to predict which depression treatment would elicit a patient's response: cognitive behavior therapy or escitalopram (Lexapro). Low activity in the insula was associated with a better chance of successful treatment with cognitive behavior therapy and failure with escitalopram, while high activity in the insula correlated with successful treatment using medication and failure with therapy.

Takeaway - If further research supports these findings, it may mark the beginning of more individualized medicine.

(Source:  John Hopkins Health Alert, 27 May 2014)

ARE YOU GETTING THE BEST TREATMENT FOR YOUR DEPRESSION?

A recent survey of 1,318 older adults receiving care for depression, anxiety or other mental disorders found that doctors frequently don't discuss key aspects of treatment with their patients.

Here's a checklist of six topics your provider should discuss with you. A doctor who is being thorough will:

1. Discuss different treatment options. Antidepressants and psychotherapy are common treatments for depression, but they are not the only choices. For example, depending on your age, physical health, medical history and severity of depression, other treatments -- including lifestyle changes such as diet and exercise, brain stimulation therapies, or alternative medicine treatments -- might be effective. In the survey, one-third of respondents said their doctor had not discussed treatment options.

2. Work with you to decide which treatment would be best. Patients who receive a depression treatment they prefer are more likely to get better within the first three months than those who receive a treatment their doctor chooses. If your doctor suggests a treatment you are not comfortable with, it is essential to let him or her know immediately.

3. Explain possible side effects. Depression treatments are generally safe, but most have the potential to cause unwanted effects, ranging from relatively mild problems such as dry mouth and nausea to more serious concerns, including weight gain, insomnia or sexual difficulties. In the survey, 38 percent of respondents said their doctor did not provide information on side effects.

4. Tell you what to do if you feel worse. Few depression treatments work immediately; for example, antidepressants typically take four to six weeks or longer to take effect. Your doctor should explain what you should do if you begin to feel worse. Do not stop taking any medication unless your doctor tells you to.

5. Explain how long treatment will take. Before beginning any treatment, your doctor should give you an estimate of how long you might need to continue treatment based on his or her experience with other patients receiving similar treatments. For example, depending on how often you've experienced episodes of depression, your doctor may want you to continue taking antidepressants for one to three years after your symptoms go away, or even indefinitely.

6. Follow up with you within a few weeks to see how you are doing. Almost half of survey respondents said their doctor did not contact them within a few weeks to see if the treatment was working. On your first visit, ask your doctor exactly when and how he or she will be contacting you to check your progress.

(Source:  John Hopkins Health Alert, 17 June 2014) 

When the Diagnosis Is Dementia: How to Cope

When you reach age 65, you have a one in 10 chance of developing dementia during your remaining lifetime. Clinicians are now making a concerted effort to diagnose dementia in the early stages when patients may still have the capacity to understand the disease's course and to make important decisions about future care and interventions.

Being told you have an incurable disease that slowly robs intellectual functioning can take an emotional toll. Adjusting to a diagnosis at any stage of dementia is a complex, evolving process for the person diagnosed and his or her family. You may experience mixed feelings and a range of reactions, including:

·         Loss of Self

Dementia poses a threat to personality and character. Understandably, dementia's symptoms, such as forgetting faces and struggling to express yourself, can leave feelings of loss, uncertainty and frustration. Experiencing acute grief and mourning your loss of self-identity is common.

·         Unawareness

Most individuals with Alzheimer's disease aren't aware they have impaired memory and thinking. For others, unawareness increases as the disease progresses. This suggests that unawareness is part of the brain disease in some individuals.  Arguing with them or repeatedly demonstrating to them that they're forgetful won't help and is likely to upset them more.

·         Denial

Other individuals outwardly deny or ignore the diagnosis of dementia but seem to be aware from their behavior that they have a problem. Research suggests that this reaction can sometimes be a self-monitoring strategy in an attempt to be seen by others as a person, not an object, and maintain self-esteem.

·         Relief

Certain individuals and their loved ones report feeling relief upon hearing the diagnosis of dementia. The anxiety of not knowing what's causing symptoms like forgetfulness can be a tremendous burden. A diagnosis can confirm suspicions that dementia is the cause and legitimizes the need for support and therapeutic interventions.

·         Secretiveness or Embarrassment

It's common for individuals to be reluctant to reveal their dementia diagnosis for fear of how others might perceive them. As a result, these individuals are often tempted to stop seeing friends or family members and become socially isolated - outcomes that are clearly undesirable, since studies show that maintaining social connectedness is key to coping with the psychological impact of a dementia diagnosis.

·         Anxiety, Anger, Sadness or Depression

These are all normal reactions. Demoralization is especially common in the disease's early stages the same way it is when grieving any other loss. Behavioral therapy or counseling may ease feelings of anxiety and depression if they interfere with everyday functioning.

(Source:  John Hopkins Health Alert, 9 June 2014)