How many people suffering from Alzheimer's go missing each day?...
By Bob DeMarco
Alzheimer's Reading Room

Subscribe to the Alzheimer's Reading Room
Enter Your Email Address

How many person with Alzheimer's wander each day? I have never seen this number reported.

An educated guess -- around 125,000 in a year. However, as far as I can tell, there are only about 30,000 reported cases in a year. So the range in any given day is between 82 and 342. A sobering thought.

Current statistics indicate that about 60 percent of persons suffering from Alzheimer's will wander. This makes the potential pool around 3,000,000 individuals.

It is likely that only a small fraction of those that do wander get reported.

My guess is that many who wander don't get far. As a result, they are found quickly and only locale residents get involved.

But what about those that don't get found quickly?

• Of those found within 12 hours, 93 percent survive. Seven percent don't. So, about one in 14 don't make it home alive.
• Of those lost more than 24 hours, only a third survive. That is a sobering statistic.
• Of those lost more than 72 hours, only 20 percent survive. One in five. Sobering.

-----------------
Once, while I was living in New York, my mother said she was going to the store to buy some lottery tickets. When she didn't return after more than an hour, my heart started pumping. I started to worry.

I went outside looked around and started thinking about what I could do. To be honest, I was stumped. If I called the police would they help, or would they tell me it was too soon to take action?

What were the odds that if I started walking around looking for her that I would find her?

Even if I decided to start looking for her, where would I look first? Did she take a key with her when she went out? I didn't think she did (she didn't).

As another hour went by I was getting ready to panic. Should I call the hospital? Police?

Magically there she was walking down the street. I asked her, where were you? She told me she went and got a cup of coffee and then a manicure. I shrugged and told her she needed to tell me me where she was going when she went out.

Keep in mind this episode took place in New York. A place that was foreign to my mother.

This all happened at least two years before my mother was officially diagnosed with dementia. I am now convinced that she did get lost. Can I prove it? No.

I can tell you this, she was starting to scrape her feet on the ground. A tell tale sign that I believe is one of the most important signs of mild cognitive impairment or the early onset of dementia.

I remember when this happened my heart was beating fast. I remember being in a total state of confusion -- what should I do? What was I going to do if she didn't show up? I felt helpless.

I wonder what it is like when a person suffering from Alzheimer's goes missing? I really can't imagine what it must feel like. Or can I?

-----------------
For at least a couple of years my mother kept saying over and over -- let's move back to south Philadelphia. My mother was born in south Philadelphia. When my mother would say this, I would be stupefied. This was before I got my brain hooked on Alzheimer's.

At the time my mother was saying this, she had lived in Florida for over 25 years, and it was more than 50 years since she had last lived in south Philadelphia.

Later on I learned that people suffering from Alzheimer's want to go back -- back home. It doesn't matter if they are at home. They yearn to go home.

I get emails all the time from readers telling me they are being driven nuts because their loved one wants to go home.

A word to the wise is sufficient.

When they start saying this get your eyes and ears open. They might decided to try and make it home on their own -- they are ready to wander.

-----------------
Most Alzheimer's sufferers that wander get found within a mile and a half of their home. These wanderers are often on foot. Nevertheless, finding them is like looking for a needle in a haystack.

When they wander they rarely ask for help. They don't tell anyone they are lost. They don't responds to shouts (people shouting their name). And in most cases, they don't leave any physical clues that will help you find them.

It just amazes me that someone suffering from Alzheimer's can wander off and become invisible.

It happens.

-----------------
How hard it is to find someone that has Alzheimer's when they start wandering -- Elderly Woman with Dementia Found after Wandering Around All Night.

In Frederick, Maryland, a woman suffering from Alzheimer's wandered away from her home. The police organized a posse of 50-60 police and civilians to look for her. They also had four civilian K-9 search and rescue groups looking for her. After about 10 hours, they finally found her huddled up against a piece of plywood. The temperature was under 30 degrees.

This might amaze you. They found her on a property adjacent to her home. In an area that had been searched several times. The only thing I can conclude is that she was walking around and 60 people and 4 dogs couldn't find her until she finally settled down in one spot. It is like looking for a needle in a haystack.

Think about this. This was a wonderfully well organized effort by the Frederick police department and it still took ten hours to find a person that was probably never far from home.

Go figure.

-----------------
Last night, I put on the movie Rocky. When Rocky was running down Ninth Street, the market area in south Philadelphia, I said look mom south Philly. She looked up and said, let's move back to south Philly.

UH OH, I better keep my eyes and ears open. She might get the urge to go back home. She might decide to go for it.

This remeinded me that I need to keep my eyes on my needle in the haystack.

Please keep this in mind.

More About the Alzheimer's Reading Room

• 60 Good Reasons to Subscribe to the Alzheimer's Reading Room
• Alzheimer's CareGiving -- Insight and Advice
• Test Your Memory for Alzheimer's (5 Best Self Assessment Tests)
• Communicating in Alzheimer's World
• Worried About Alzheimer's Disease -- You Should Be
• What is Alzheimer's? What are the Eight Types of Dementia?
• Does the Combination of Aricept and Namenda Help Slow the Rate of Decline in Alzheimer's Patients
• Alzheimer's Disease Statistics
• Is it Really Alzheimer's or Something Else?
• Ten Symptoms of Early Stage Alzheimer's
• Ten Tips for Communicating with an Alzheimer’s Patient

Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 1,810 articles with more than 89,500 links on the Internet. Bob resides in Delray Beach, FL.

The Alzheimer's Action Plan  
300 Tips for Making Life Easier

Original content Bob DeMarco, the Alzheimer's Reading Room

Alzheimer's Reading Room

“Anti-amyloid therapeutic drugs represent a valid approach to treating Alzheimer’s disease, but their inability to accumulate in the brain has limited their usefulness,” says Greengard, who is head of the Laboratory of Molecular and Cellular Neuroscience.

“The development of compounds that work like Gleevec, but have the ability to pass the blood-brain barrier and target GSAP, could revolutionize the treatment of this disease.”
A version of the cancer drug Gleevec could form the basis of a new class of drugs that block the development of brain-damaging plaques in Alzheimer's disease.

The latest study shows ?-secretase activating protein (GSAP) increases the production of beta amyloid. Blocking the protein in genetically engineered mice kept Alzheimer's brain plaques from developing.

In Alzheimer’s disease, the problem is amyloid-?, a protein that accumulates in the brain and causes nerve cells to weaken and die. Drugs designed to eliminate plaques made of amyloid-? have a fatal problem: they need to enter the brain and remove the plaques without attacking healthy brain cells.

A new breakthrough from the laboratory of Nobel Prize winner Paul Greengard, however, suggests that treatments modeled on the blockbuster cancer drug Gleevec could be the solution. The findings are reported in the September 2 issue of the journal Nature.

Gleevec, it turns out, has the unique ability to bind to a protein that triggers the production of amyloid-? plaques.

The new research from Greengard’s lab shows that this protein, called ?-secretase activating protein (GSAP), dramatically and selectively increases the production of amyloid-? peptide, which makes up the senile plaques found in the brains of most people with Alzheimer’s. GSAP works through a mechanism involving its interactions with ?-secretase, an enzyme that chops up the amyloid precursor protein, a large molecule produced naturally in the body and found in many different types of cells.

“Alzheimer’s disease is a devastating disorder for which there are no satisfactory treatments,” says Greengard, Vincent Astor Professor and director of the Fisher Center for Alzheimer’s Research at Rockefeller. “Our findings reveal that ?-secretase activating protein is a potential target for a new class of anti-amyloid therapies.” Greengard won the 2000 Nobel Prize in Physiology or Medicine for research into how neurons communicate.

Scientists have been searching for ways to reduce amyloid-? production in Alzheimer’s patients by blocking ?-secretase, but most ?-secretase inhibitors also block the cleavage of an important immune system molecule called Notch.

Notch plays a pivotal role in the development of blood-forming organs and the immune system. Earlier research by Greengard and his colleagues showed that Gleevec, a drug used to treat leukemia and gastrointestinal stromal tumors, successfully inhibited the ability of ?-secretase to form amyloid-? without affecting the Notch pathway.

In the new study, led by Gen He, a research associate in Greengard’s lab, the researchers showed that GSAP stimulates production of amyloid-? in cell lines, and that reducing GSAP reduces amyloid-?. The researchers also looked at GSAP’s action in a mouse model of Alzheimer’s disease. They knocked down the gene that codes for GSAP using RNA interference, and found that levels of amyloid-? as well as plaque development decreased. Biochemical studies showed that Gleevec reduces amyloid-? production by binding to GSAP and preventing its activation of ?-secretase.

Unfortunately, the Gleevec molecule does not cross the blood-brain barrier, the gatekeeper that prevents some substances in the blood from entering the brain. Greengard, however, believes that it will be possible to design drugs that target GSAP but do not have this limitation.

“Anti-amyloid therapeutic drugs represent a valid approach to treating Alzheimer’s disease, but their inability to accumulate in the brain has limited their usefulness,” says Greengard, who is head of the Laboratory of Molecular and Cellular Neuroscience. “The development of compounds that work like Gleevec, but have the ability to pass the blood-brain barrier and target GSAP, could revolutionize the treatment of this disease.”

Good coverage of this research in the New York Times -- Finding Suggests New Aim for Alzheimer’s Drugs
_____________________

Nature 467: 95–98 (September 2, 2010)
Gamma-secretase activating protein is a therapeutic target for Alzheimer’s disease
Gen He, Wenjie Luo, Peng Li, Christine Remmers, William J. Netzer, Joseph Hendrick, Karima Bettayeb, Marc Flajolet, Fred Gorelick, Lawrence P. Wennogle and Paul Greengard

Subscribe to the Alzheimer's Reading Room
Enter Your Email Address

More About the Alzheimer's Reading Room

• 60 Good Reasons to Subscribe to the Alzheimer's Reading Room
• Alzheimer's CareGiving -- Insight and Advice
• Test Your Memory for Alzheimer's (5 Best Self Assessment Tests)
• Communicating in Alzheimer's World
• Worried About Alzheimer's Disease -- You Should Be
• What is Alzheimer's? What are the Eight Types of Dementia?
• Does the Combination of Aricept and Namenda Help Slow the Rate of Decline in Alzheimer's Patients
• Alzheimer's Disease Statistics
• Is it Really Alzheimer's or Something Else?
• Ten Symptoms of Early Stage Alzheimer's
• Ten Tips for Communicating with an Alzheimer’s Patient

Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 1,810 articles with more than 89,500 links on the Internet. Bob resides in Delray Beach, FL.

The Alzheimer's Action Plan  
300 Tips for Making Life Easier

Original content Bob DeMarco, the Alzheimer's Reading Room

Lori La Bey of Alzheimer’s Speaks is one of the Authors in the new book “Life Choices”.    The title of  Lori’s story is  
A Caregiver’s Nightmare:  Mirror Image 
 The formal book launch will take place in Las Vegas October 30th.  If you are going to be in Vegas at that time we would love to see you.  More details to come in the future.
 

 
 
Lori La Bey
of Alzheimer’s Speaks
and Senior Lifestyle Trends
 
 
 
                    

By Bob DeMarco
Alzheimer's Reading
Room

This research interests me. First, my mother's triglycerides have been high for at least 20 years.

Of all the doctors we had, not a single one has ever suggested medication. In addition, my sister has diabetes. On top of the that, my mother's mother had diabetes and died at a young age.

I have also mentioned previously how my mother started scraping her feet on the ground about ten years ago. Next, she started walking slower and slower.

Finally, when I first came to Delray Beach my mother was falling down often. Once she fell and broke her finger. Another time I found her lying in the parking lot and she was unable to get up. She was shaking like a leaf.

Older adults with diabetes who have high blood pressure, walk slowly or lose their balance, or believe they're in bad health, are significantly more likely to have weaker memory and slower, more rigid cognitive processing than those without these problems, according to a new study published by the American Psychological Association.

These three health factors stood out from more than a dozen suspected to shape how Type 2 diabetes is frequently shadowed by cognitive impairment, including dementia.

An analysis in September's Neuropsychology stresses that although these factors might not actually cause cognitive problems, their presence can warn doctors that such problems may exist or soon develop.
"Awareness of the link between diabetes and cognition could help people realize how important it is to manage this disease--and to motivate them to do so," said co-author Roger Dixon, PhD, of the University of Alberta.
Type 2 diabetes has been found by other researchers to nearly double the risk of dementia and Alzheimer's disease, said Dixon, who studies how health affects cognition in aging. As diabetes becomes more common, this heightened risk could dramatically hike the number of older people with dementia – a double whammy of serious chronic disease. Among people older than 60, the U.S. prevalence of Type 2 diabetes is more than 23 percent, according to the National Institute of Diabetes and Digestive & Kidney Diseases. The Canadian prevalence is nearly 19 percent, according to the Public Health Agency of Canada.

An analysis of older Canadians living in British Columbia -- 41 with Type 2 diabetes (ages 55-81) and 458 matched healthy controls (ages 53-90) -- found that systolic blood pressure (the top number, or maximum pressure on artery walls during a single heartbeat), a low combination score for gait and balance, and a patient's own reports of poor health all played a statistically significant role in the relationship between diabetes and cognitive impairment relationship.

In other words, higher but still normal blood pressure, slower gait and shakier balance, and/or reporting one's self to be in bad health regardless of actual problems boosted the likelihood that someone with Type 2 diabetes had impaired cognition. The relationships were linear: For example, the worse the balance, the higher the likelihood of cognitive problems, as measured by mental speed (reaction time, switching time and perceptual speed), mental control and flexibility (executive functioning), and recall of recent learning (episodic memory).

The results highlight factors that may work indirectly, gradually and cumulatively to make older diabetics more likely to develop dementia. Researchers tested 13 different variables in all, in the areas of general fitness, emotional health, subjective and functional health, and lifestyle activities.

Mediating Factors

Because diabetes and hypertension often go together, Dixon said he was not surprised that high systolic blood pressure accounted for one-third to one-half of significantly worse scores on four tests. That finding, said the authors, suggests that diabetes and cognition may be connected via diabetics' vascular problems. For example, diabetes and hypertension may both play a role in a larger metabolic syndrome that includes high blood sugar and insulin resistance.

However, the other two factors raised new questions. Combined gait and balance had the greatest influence, accounting for between 32 percent and 62 percent of performance on seven cognitive tests. Diabetes might affect the specific nerves that control gait and balance, the authors wrote, or more broadly affect the overlapping brain areas that support both gait-balance and cognition.

Like blood pressure, what people said about their health accounted for about one-third to one-half of performance on five different cognitive tests. Negativity about one's health could reflect related factors such as stress or depression, which did not, in this study, directly mediate between diabetes and cognition. Self-reported health is "an important indicator of ways in which a cluster of health-related beliefs and behaviors can modulate the effect of this disease on cognitive adaptation," Dixon said.

"It's important to pay attention to the health beliefs of older adults, not because they are necessarily accurate or valid indicators of specific health status, but because they might track overall health," Dixon said.

Type 2 diabetes in adults accounts for 90 percent to 95 percent of all diagnosed cases of diabetes, according to the National Institute of Diabetes and Digestive & Kidney Diseases.

###
Article: "Testing Covariates of Type 2 Diabetes-Cognition Associations in Older Adults: Moderating or Mediating Effects?" G. Peggy McFall, MSc, and Bonnie P. Geall, BSc, University of Alberta; Ashley L. Fischer, BSc, Simon Fraser University; Sanda Dolcos, PhD, and Roger A. Dixon, PhD, University of Alberta; Neuropsychology, Vol. 24, No. 5.

(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/pubs/journals/releases/neu-24-5-547.pdf)

Contact: Dr. Roger Dixon at rdixon@ualberta.ca or (780) 492-5850.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 152,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

Subscribe to the Alzheimer's Reading Room Enter Your Email Address
More About the Alzheimer's Reading Room

• 60 Good Reasons to Subscribe to the Alzheimer's Reading Room
• Alzheimer's CareGiving -- Insight and Advice
• Test Your Memory for Alzheimer's (5 Best Self Assessment Tests)
• Communicating in Alzheimer's World
• Worried About Alzheimer's Disease -- You Should Be
• What is Alzheimer's? What are the Eight Types of Dementia?
• Does the Combination of Aricept and Namenda Help Slow the Rate of Decline in Alzheimer's Patients
• Alzheimer's Disease Statistics
• Is it Really Alzheimer's or Something Else?
• Ten Symptoms of Early Stage Alzheimer's
• Ten Tips for Communicating with an Alzheimer’s Patient

Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 1,810 articles with more than 89,500 links on the Internet. Bob resides in Delray Beach, FL.
The Alzheimer's Action Plan  
300 Tips for Making Life Easier

Original content Bob DeMarco, the Alzheimer's Reading Room

Let’s just have a nice cup of tea: The story of a community working together to raise awareness about dementia and funding for much-needed support services....By Cass Alexander
Alzheimers New Zealand

In the midst of a hectic conference, where I was seen with a mobile phone in each ear, organising television crews and frantically answering journalists’ questions about a new dementia drug subsidy, I was approached by the calm-looking president of Alzheimers Marlborough.

Diane Johnson grabbed me, while I grabbed an on-the-run muffin and a cup of coffee and said, “Cass, we’ve got something big we think would do wonders for publicity during Awareness and Appeal Week. Something really big.”

She promised to fly me across the Cook Straight (the stretch of the Pacific Ocean which divides New Zealand’s North and South islands) to tell me more about this ‘something big,’ at a later date.

I think I caught her say something about ‘tea caddies’. In my already over-active mind was an image of Tiger Woods pushing a whole lot of trays with tea cups and saucers.

But then when I told someone about Diane’s proposal a few days later, I was informed a tea caddy looked something like this:

And that’s when I realised I’d seen them all over the place, in opportunity (thrift) shops, at my grandmother’s house, even lurking at the back of the cupboards at home as dusty relics from previous tenants.

When I cleared my desk at work and called Diane, she informed me a local chap in Blenheim, Marlborough (the beautiful wine country at the top of New Zealand’s South Island), by the name of Graham Brooks had around 2,000 tea caddies stored in boxes in his chicken coop.

“Graham thinks it might be the largest collection in the world,” Diane told me.He had trawled through the online community of tea caddy collectors (!) and surmised his collection might just top them all.

Graham had been collecting for 35 years, after his mother-in-law gave him a caddy for Christmas and then another for his birthday.

A friend visited his house and said, “you’ve got a great collection of caddies there” and suddenly, those few gifts plus the few more Graham had collected amounted to a collection and from there, Graham made the conscious decision to be a caddy collector.

He brought caddies back from Australia, Europe, America, even Jamaica. At his house (where he also has collections of Girls Annuals, cigarette cases and Charles Dickens original editions), Graham told me a story about working for a mate in Brisbane, Australia, fixing an air conditioning unit in a mall, where he discovered a shop full of caddies – “There were about 500 or 600 of them, I reckon. I purchased the big ones and got out quick,” he said. Later, he discovered the tea caddy shop had burnt down.

Traditionally, local Alzheimers New Zealand organisations throughout the country host a campaign called “Cuppa for a Cause” as part of Awareness and Appeal Week.

These “cuppas” bring people together for a hot beverage in exchange for a donation, which goes back to helping people with dementia and their families. This year for their “cuppa”, Graham suggested to the ladies at Alzheimers Marlborough they might want to have something for people to look at as a draw card while they sipped their cup of tea.

Alzheimers Marlborough got to work, booked space at the historic Blenheim Club (established in 1903 – and that is historic, for New Zealand), called in a favour from Wellington antiques specialist Peter Wedde, made up posters, contacted the local radio stations for promotion and appealed to organisations in the community to supply refreshments for the opening night.

Then Graham decided to take it one step further. He sent off details of the collection to Guinness World Records, suggesting he may just have the largest collection. At 1,815 caddies, it did turn out to be the largest collection in the world -- he’s just awaiting official verification now.

What began as a grand idea came to fruition, culminating in a room full of caddies open to the public after committee members, friends and partners spent hours unpacking box upon box, counting caddies in the process.
“The collection looked massive after only 500 caddies had been unpacked. As long as Alzheimers Marlborough got some money out of it and people saw it, that’s the most important thing. The world record bit was to help generate publicity for the cause,” said Graham. The opening night, where the display was debuted with a ribbon-cutting ceremony, was a great success, with over 100 guests in attendance. Peter Wedde, who opened the ceremony, told tales of days gone by, with giggles and clapping from the crowd, many of whom remembered the personalities and idiosyncrasies of small town life in the 1960s.

Amongst the collection was even an unopened box of tea from the same issue Sir Edmund Hillary took up Mount Everest.

A tea caddy box from an issue Sir Edmund Hillary took up Mount Everest
After opening night, the collection was on display for the whole of Awareness Week (12-18 July 2010) so people could have a cup of tea and a lamington (a sponge cube coated in chocolate or raspberry icing and coconut) for seven bucks, or see the display only for two.

Lamingtons
Radio New Zealand’s Jim Mora, of the “Afternoons” show caught up with Graham about the collection and interest in the story escalated as far as Los Angeles. Local papers, the Marlborough Express and Marlborough Midweek covered the event and its lead-up extensively and turned up on opening night to celebrate with the team.

Events like this don’t just come out of thin air. None of it could have happened without strong local involvement and an existing awareness in that community of what dementia is, how it affects people and what Alzheimers Marlborough does to make peoples’ lives easier.

Some of the profile building in the Blenheim community was due to ten years worth of fundraising for Alzheimers Marlborough’s purpose-built dementia facility, the first of its kind in New Zealand.

Lamingtons were donated by the Elite Food Group ,the teabags donated by Bell Tea Company, the Blenheim Club gave the group a discount for hosting the event, Peter Wedde did a big favour for his old stomping ground....the list goes on.

Then there were the husbands of the “Alzheimers Marlborough girls” who knocked up shelves, drove vans, blew up balloons, made cups of tea.

It just goes to show, when a community bands together, amazing things can happen.

Collector Graham Brooks and antiques dealer Peter Wedde with some of the collection
Cass Alexander is the media advisor with Alzheimers New Zealand. She has been in the role just over a year and works from New Zealand’s capital city, Wellington. Prior to this, in another not for profit role, Cass worked for the American Field Service (AFS), organising publicity and writing publications. She has also worked in various roles in London and Ireland.

Subscribe to the Alzheimer's Reading Room
Enter Your Email Address

More About the Alzheimer's Reading Room

• 60 Good Reasons to Subscribe to the Alzheimer's Reading Room
• Alzheimer's CareGiving -- Insight and Advice
• Test Your Memory for Alzheimer's (5 Best Self Assessment Tests)
• Communicating in Alzheimer's World
• Worried About Alzheimer's Disease -- You Should Be
• What is Alzheimer's? What are the Eight Types of Dementia?
• Does the Combination of Aricept and Namenda Help Slow the Rate of Decline in Alzheimer's Patients
• Alzheimer's Disease Statistics
• Is it Really Alzheimer's or Something Else?
• Ten Symptoms of Early Stage Alzheimer's
• Ten Tips for Communicating with an Alzheimer’s Patient

The Alzheimer's Action Plan  
300 Tips for Making Life Easier

Original content Cass Alexander, the Alzheimer's Reading Room

By Bob DeMarco
Alzheimer's Reading Room

Yesterday I wrote -- Dotty Says, Bobby Says.

You might have noticed that since early May Dotty has not had a lot to say. When you see Dotty Says in the title box it means that Dotty is more engaged. More connected to the world.

For those of you that have been here, you know that when Dotty was in the 6-18 week period during the Dimebon clinical trial she became very engaged. The more I think about it and compare that period to the last six plus years the more it astounds me.

To be clear, during that period Dotty's memory did not come back. Bits and pieces of her personality did come back. Because she was more lively and "more there", there was a very subtle improvement in her memory. For me. Well, I thought I had the old Dotty back during that period. Not all of her, but enough that she seemed like a pretty good version of her old self.

Her memory. Was Dotty's memory just a little tiny bit better because she was happier and more engaging? I think so.

Shortly after Pfizer (PFE) Medivation (MDVN) canceled the Dimebon clinical trial, Dotty became very ill. This happened around May 17. She couldn't get out of bed, she couldn't walk, and she was "not there". It happened over night.

Was it the come down from the Dimebon? The withdrawal? Or did Dotty just get sick?

There is no answer to this question.

Dotty didn't have a high fever, nor did she have the dreaded urinary tract infection. She did get a chest Xray, a series of blood test, and a CT scan of her stomach/pelvic area. The CT scan looked suspicious but inconclusive. She was given an antibiotic as a precaution to pneumonia and after a week she started to get better.

It won't help or change anything to speculate on the cause.

Now, in the last two weeks Dotty has a lot more energy. You heard her on the CinchCast and you saw the two recent pictures I put up yesterday.

This time around the glass is half full and half empty.

At first, Dotty's new found energy was driving me crazy. She is getting into everything. Moving things around. Throwing my mail in the trash. Telling me she wants to get a job. Complaining constantly that she can't get anything to eat. Telling me she is going to walk to the store so she can get something to eat. Most of this energy is falling on the negative side.

Now to my point here.

Yesterday after I posted Dotty Says, Bobby Says, I took a good hard look at the pictures. I was stunned. Take a look at this picture of Dotty that was taken the Sunday before last.

Dotty at the Banana Boat -- Last Week
Does that look like a 94 year old woman with moderate to severe Alzheimer's disease? Look at her face. She looks pretty good to me. I said to her smile, she did. Also notice the nice bright light. Bright light is very important for people that have Alzheimer's.

Frankly, I am surprised looking at that picture now. I don't remember Dotty being overly happy or "so much more there" at the time. But that look on her face, well it paints a very different picture.

This is the second picture I put up.

Dotty fooling around with me. Nice hat?
Notice Dotty is laughing. I was laughing with her. I put that bag on her head and decided I needed a picture of it. That was a pretty hearty laugh for a person with Alzheimer's.

Late yesterday afternoon Dotty and I went out to run some errands. Our third stop was Walmart. Dotty stayed in the car on stops one and two. As we pull into Walmart, Dotty says, "this will surprise you, I am going in with you".Yes, I was surprised. I mean it was the first time in many years where Dotty announced she was going to do something and actually did it. The usual conversation is Dotty announcing that she is going to do something -- tomorrow or next time.

From May until recently, Dotty and I were not doing a whole lot of anything. This started because when she became ill she was too weak to do anything. For the first couple of weeks she was in a wheelchair.

I guess you could say I am conflicted right now. Dotty is doing some things that drove me crazy in the beginning. Like opening the refrigerator door and leaving it open why she tries to decide what she is going to do.

For example, she had it open for about ten minutes while she was trying to make herself a sandwich late at night. She didn't get out what she needed. She made the sandwich right in the refrigerator with the door open. With the refrigerator alarm beeping away. I suppose she doesn't hear it, or, she doesn't know what it means.

Five years ago, I would have gone into the kitchen. Moved her out of the way. Closed the refrigerator door. And tried to explain to her that you can't leave the door open. This of course would have bent Dotty out of shape. She would likely throw the sandwich on the floor and head for her bed.

The result of my behavior and her behavior -- a stomach ache for me and anger and unhappiness for her. Unhappiness all the way around.

This time around, I just let Dotty get her sandwich and I did not step foot into the kitchen. I just stood back and thought to myself -- this is the lesser of two evils. And, this is how you have to operate in Alzheimer's World whether you like it or not.

Dotty got her sandwich and didn't run for the covers. I was a bit bent out of shape for a bit, but I didn't feel like the world was spinning out of control. The entire episode was over in a matter of minutes; instead of the hours of anguish we both use to experience.

Right now, I can only assume that the big doses of activity, socialization and bright light are having a big positive effect on Dotty's energy and awareness levels.

You could say I am relearning something I learned before about Alzheimer's caregiving. You have to live your life -- all of it. I think I forgot this for a few months. Or maybe I was just disappointed and stopped thinking.

I'll keep you posted. I have no idea what is going to happen next. I do know this, weather permitting we are going to the Bananna Boat this weekend. I have to get a recorder to go with my camera.

You comments and insights are welcomed.

My name is Bob DeMarco, I am an Alzheimer's caregiver. My mother Dorothy, now 94 years old, has Alzheimer's disease. We are back living our life that way we always had.

Subscribe to the Alzheimer's Reading Room Enter Your Email Address
More About the Alzheimer's Reading Room

• Alzheimer's Caregivers Advice and Insight (20 articles)
• Test Your Memory for Alzheimer's (5 Best Self Assessment Tests)
• Alzheimer's Disease Statistics
• What is Alzheimer's? What are the Eight Types of Dementia?
• Alzheimer's and Driving
• Alzheimer's Caregiving Dealing with Behavior

Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 1,810 articles with more than 89,500 links on the Internet. Bob resides in Delray Beach, FL.

The Alzheimer's Action Plan  
300 Tips for Making Life Easier

Original content Bob DeMarco, the Alzheimer's Reading Room

By Barbara Pursley

Memory loss is the first symptom we think about when it comes to the disease of Alzheimer’s; however, there is also a range of behavioral problems, too.

Damage to the frontal lobe is primarily responsible for behavioral changes such as loss of inhibitions. This can be distressing and embarrassing for the caregiver and the patient when the behavior is socially inappropriate, such as lack of modesty, sexual advances, and inappropriate touch. Mom became very uninhibited once the onset of Alzheimer’s began its course.

One early morning while drinking my coffee, the phone rang and I answered, “Hello.” The lady asked, “May I speak to Ms Pursley?” and I answered, “Speaking.”

I took a deep breath knowing it was the nursing home and anytime they called there had to be a problem.

After identifying herself, she said, “Your mother is adjusting to the nursing home, but she is having inappropriate sexual behavior. She flirts with the men, touches them in private places, pats them on their butts and gets in their beds. Also, she isolates herself from the women and wants to kiss all the men.”

This does not sound like my mother!

The nurse said, “Letting go of inhibitions is part of the disease. This morning I found your mother in Mr. Baker’s bed, an African American gentleman, who was sleeping in his recliner beside the bed. She refused to get up and told me, ‘I’m trying to be private. Leave us alone.’”

Mom was raised in a generation with prejudice influence and to hear of her flirting with Mr. Baker was quite humorous.

I hope I’m not supposed to take this seriously; however, it’s interesting how Alzheimer’s changes ones mind and inhibitions disappear. How wonderful if we never felt discriminated against because of our race.

Barbara Pursley was born in Galveston, Texas and is the author of EMBRACING THE MOMENT. Barabara attended Santa Monica College, studied photography, and worked as a commercial photographer before returning to Texas to care for her mother. Barbara also taught journal writing to women in Texas rehabilitation facilities. She put her God inspired journal entries and photographs into book form in 2009.

Subscribe to the Alzheimer's Reading Room
Enter Your Email Address

More About the Alzheimer's Reading Room

• 60 Good Reasons to Subscribe to the Alzheimer's Reading Room
• Alzheimer's CareGiving -- Insight and Advice
• Test Your Memory for Alzheimer's (5 Best Self Assessment Tests)
• Communicating in Alzheimer's World
• Worried About Alzheimer's Disease -- You Should Be
• What is Alzheimer's? What are the Eight Types of Dementia?
• Does the Combination of Aricept and Namenda Help Slow the Rate of Decline in Alzheimer's Patients
• Alzheimer's Disease Statistics
• Is it Really Alzheimer's or Something Else?
• Ten Symptoms of Early Stage Alzheimer's
• Ten Tips for Communicating with an Alzheimer’s Patient

The Alzheimer's Action Plan  
300 Tips for Making Life Easier

Original content Barbara Pursley, the Alzheimer's Reading Room

Much has been made of the recent findings indicating that Alzheimer’s disease is partially genetically linked. Family members of those who suffer with dementia are faced with the possibility that they might also fall prey to the disorder as they age.

Luckily, preventative measures have been identified. Some people with the genetic proclivity to have Alzheimer’s disease never manifest the disease. Here are the environmental factors that contribute to Alzheimer’s disease and the steps a currently healthy individual can take to reduce their odds of developing dementia

Mom, with a steady flow of intravenous fluids and now heavy duty antibiotics, is finally showing improvement. • Her kidney function is at a 2.2, down from 4.8 so she officially is out of renal failure. • Her white blood count is almost normal.• Neurology consulted and Mom had a CT scan. She did not have a seizure. Instead, since her blood pressure was so low, her brain did not receive enough blood and her body went into “tremors.” • Her blood pressure is normal.• She still has diarrhea and this is the main concern. Infectious Diseases consulted and she is now on Vancomycin, the strongest antibiotic for this type of infection. If this doesn’t work, she would need surgery. But everyone is hopeful the antibiotic will kill the c.diff.Mom is highly susceptible to dehydration and this is going to be the main concern going forward. Anyone with a parent or loved one in a nursing facility knows that keeping a resident/patient hydrated in that environment is a huge issue.Before Mom went into the hospital for this third time, we had bought a portable non-breakable water bottle for her with a built in straw. She liked it and drank a bit more, but the bottle when full was too heavy and cumbersome to carry. When I’m with her at the home, I push fluids. The rest home does their best as well. But she just isn’t getting enough. Any ideas or suggestions? I feel truly desperate about this. If we can’t keep her hydrated, chances of her being hospitalized again are almost guaranteed. And the bigger concern for me…does this mean changing her from a rest home to nursing home is on the horizon? I believe at the nursing home, they are able to administer IV fluids whereas at the rest home, they are not. But I’m not quite sure about this.And it looks like taking her home is becoming less likely. But that is a blog for another day.

By Carole B. Larkin
Alzheimer's Reading Room

Previously I wrote -- Alzheimer's Caregiving Avoiding the Urinary Tract Infection (Part Four).

Now let's move on to Incontinence.

Incontinence is usually a part of Alzheimer’s and other dementias because many times in the diseases the portion of the brain that controls our “muscle memory” gets damaged and slowly dies.

When that portion of the brain gets damaged, the brain can no longer send the signals needed to make muscles work as they are supposed to. That includes the muscles serving the bladder and the sphincter.

If the brain doesn’t send the message to contract and hold urine and feces in then you have a problem that takes special attention and consideration.

Incontinence is a process (usually), not an overnight change. The results of periodic incontinence can be proactively addressed and the problem can be solved or lessened. However, the caregiver must be willing to make a serious concerted effort to solve the problem.

Each person has their own urinary/bowel pattern (as Bob calls it) or rhythm (as I call it).

It generally calls for voiding urine every two hours or so and voiding fecal matter an average 2-3 times a day. (Higher numbers for men I think. Don’t ask me why. I don’t know!).

You can determine your loved one’s rhythm by just paying attention to when they go daily and writing it down in a log. The pattern will show up after a week or so. Then, the answer is, take them to the bathroom just before it’s time.

You do this consistently, religiously, every day, and it eventually becomes a pattern itself. You do this in spite of the
“I don’t have to go now response.”
Or, if it’s a, battle, don’t ask! Try
“Mom come here. I have something to show you,”
while you are at the bathroom door. Then when she’s in the room, show her something in there like a magazine or some other item she will be interested in and close the door.

You are either inside with mom or not, depending on what mom will tolerate. If she needs help undressing, you are inside the room. Likewise, if she needs help wiping after urinating (from front to back) you are inside, if she needs help wiping after a bowel movement, you are there --to make sure she is clean.

Some other ways to get mom to the bathroom at the appropriate time are: taking a walk around the house for exercise and ending up in front of the bathroom door while saying
“Well, look where we are! Let’s try to go!” The above is is called a toileting schedule in the eldercare business.

In some cases you might have to offer a "bribe" to get someone to cooperate. The goal is to establish a pattern, so anything that helps accomplish the goal is worth it.

Some people need to be distracted while on the toilet, to keep them sitting there instead of jumping up before they go. Give them something to hold in their hand like a washcloth.

If they keep jumping up, ask or help them to sit back down again the first few times. If nothing happens, ok maybe they don’t really have to go. Try again later. Some people shouldn’t be distracted with anything while sitting there. After a few trials, you’ll know what your mom needs.

When the problem occurs at night, set an alarm for every 3-4 hours to wake you so that you can take mom to the bathroom. Soon enough you will know what her voiding schedule is during sleeping hours.

To make it easier, you may want to put a toilet chair next to her bed.

I don’t recommend using the same toilet chair as a shower seat, because when you do, you are actually saying to them that it is ok to urinate and/or defecate in the shower, by providing them the tool to do it in.

Likewise, starting incontinence underwear because it’s convenient for YOU, really says to them, it’s ok to go in your pants. Use them when it’s clear that the problem is lack of “muscle memory”, and try not to use them before except in unusual situations, like travelling.

I’m sure that some of you have other tricks that work with mom to head off incontinence and UTI’s.

Let’s hear from you.

Also Read
Alzheimer's Caregiving : Dealing with Bladder Infections and Urinary Incontinence (Part One)

Alzheimer's Caregving: The Role of Communication and Basic Understanding in Solving Incontinence Problems (Part Two)

Alzheimer's Caregving: How Cranberry Juice Fights Bacteria that Cause Urinary Tract Infections (Part Three)

Alzheimer's Caregiving Avoiding the Urinary Tract Infection (Part Four)
Carole Larkin MAG, CMC, DCP, EICS is a geriatric care manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. ThirdAge Services LLC, is located in Dallas, TX.
Subscribe to the Alzheimer's Reading Room
Enter Your Email Address

More About the Alzheimer's Reading Room

• Alzheimer's Caregivers Advice and Insight (20 articles)
• Test Your Memory for Alzheimer's (5 Best Self Assessment Tests)
• Alzheimer's Disease Statistics
• What is Alzheimer's? What are the Eight Types of Dementia?
• Alzheimer's and Driving
• Alzheimer's Caregiving Dealing with Behavior

The Alzheimer's Action Plan  
300 Tips for Making Life Easier

Original content Carole Larkin, the Alzheimer's Reading Room

Here are a few tips/tricks that may help you avoid the dreaded UTI -- Urinary Tract Infection.....By Carole B. Larkin
Alzheimer's Reading Room

First, I am not a doctor, nor am I a nurse. I am an experienced Geriatric Care Manager and a woman. Over the years, I had more conversations with urologists and their nurses about urinary tract infections (UTIs) than I care to remember.

Right out of the starting block I want to say that Bob is spot on (oops, there I go again- sorry!) about E. Coli and cranberry juice.

E. Coli is one of the bacteria and/or viruses that cause UTI’s. There are others. Lucky us! Cranberry juice is the elixir of the gods when it comes to helping prevent or minimize the effects of a UTI.

For those like Dottie who find it poison, cranberry extract comes in pills; you’ll find them near the vitamins at your local pharmacy.

I was told that one reason cranberry works well is that it changes the PH in the urinary tract. (Those of you with swimming pools know what I mean by that!) Nurses out there, correct me if I misheard or misinterpreted that statement.

What if there were ways to stop a UTI before it happens, or at least cut down on the occurrence of UTIs? Wouldn't that be (as I like to say) "more better"?

E. Coli and other nastiness usually enter from outside the body. Women are particularly prone to infection because of the way that we are built. We have a couple of warm, moist environments (vaginal, rectal) located nearby which are lovely breeding grounds for nastiness. If we wipe ourselves the wrong way (meaning from back to front) we can stand a good chance of transferring nastiness from either area left over from not cleaning that area very thoroughly after an event (for example a bowel movement).

So for those of experiencing frequent UTIs, consider watching the way mom wipes herself after urinating or after a bowel movement. If you observe an obvious problem, try to train her to wipe the other way or right way.

Using adult incontinence wear or certain fabrics in underpants on mom may inadvertently be enabling conditions to incubate nastiness leading to UTI’s.

Plastic adult incontinence wear or polyester underwear holds body heat and moisture in, close to the body, thus creating great conditions to “culture” the bacteria needed for creation of infections. The answer? Use cotton or one of the new synthetic fabrics that “wick” moisture away from the body. Also, hold off on using adult incontinence wear as long as you possibly can. (More on that later!)

Another way UTI’s can start or restart is if your mom is not completely emptying her bladder when she urinates. This can easily happen if she is “rushed”.

Old urine, which may be infected, remains in the bladder to reinfect the new urine coming in. It can even travel up to the kidneys, where urine is made! So if mom has a series of UTI’s very close together, it could actually be reinfection from the original UTI over and over again.

Urologists and certain home health companies can actually train mom how to completely empty her bladder using “Kegel” exercises and biofeedback. Learn the procedure and reinforce the training given to mom after the therapy ends.

Remember, with enough repetition (practice) things can be learned and retained later in the disease than you think. But, it takes real effort on your part to keep at it.

Bob says, “Let me say this as clearly as I can -- you get to decide. Choose.”(To make the effort) Bob also says,” I am a turtle. I plod along at my own pace. When I am at my best I have my eye on the finish line. One step by one step, I plod right past all the rabbits I see on the road. I am a turtle.” I think the story was the hare and the tortoise; but what the heck- turtle, tortoise- close enough. So choose to be a tortoise. Persistence pays off!

The biggest cause of UTI’s is dehydration! It’s ironic, because the thought process of many older adults is,
“if I don’t drink much, then I won’t have to go to the bathroom very often, which is better because it’s a pain in the butt (sorry again!) to get up, get over to the bathroom, partially disrobe, and then go to the bathroom and then do it all in reverse, before I get to relax in my chair or bed again.”So they don’t drink fluids, which of course leads to dehydration, the leading cause of UTI’s and incontinence (at least in early and midstage Alzheimer’s.) So to prevent UTI’s you must be persistent in having mom drink fluids. Water is best, but among one of the hardest things to get some people to drink, so flavor it with Kool-Aid or something similar. I can’t tell you how many times my clients have ended up with UTI’s just because no one insisted that they drink!

Next time: The role of incontinence in the equation.

Carole Larkin MAG, CMC, DCP, EICS is a geriatric care manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. ThirdAge Services LLC, is located in Dallas, TX.

Also Read
Alzheimer's Caregiving : Dealing with Bladder Infections and Urinary Incontinence (Part One)

Alzheimer's Caregving: The Role of Communication and Basic Understanding in Solving Incontinence Problems (Part Two)

Alzheimer's Caregving: How Cranberry Juice Fights Bacteria that Cause Urinary Tract Infections (Part Three)
Subscribe to the Alzheimer's Reading Room
Enter Your Email Address

More About the Alzheimer's Reading Room

• Advice and Insight for Alzheimer's Caregivers (20 articles)
• Test Your Memory for Alzheimer's (5 Best Self Assessment Tests)
• Alzheimer's Disease Statistics
• What is Alzheimer's? What are the Eight Types of Dementia?
• Alzheimer's and Driving
• Alzheimer's Caregiving Dealing with Behavior

The Alzheimer's Action Plan  
300 Tips for Making Life Easier
Original content Carole Larkin, the Alzheimer's Reading Room