Sundowning may prevent people with dementia from sleeping well. It may also make them more likely to wander. Sundowning is a common cause of caregiver burnout.

Symptoms of Sundowning

Sundowning is experienced by up to 20% of people who have Alzheimer’s disease or other kinds of dementias.

People who sundown may become more:

• forgetful
• confused
• delirious
• agitated
• anxious
• restless

People with sundowning often have trouble sleeping. They may:

• pace the floor
• wander
• yell
• become combative

Sundowning typically peaks during the middle stages of Alzheimer’s. It diminishes as the disease progresses.

Some studies show that sundowning is associated with:

• faster cognitive [thinking] decline
• more rapid disease progression

What Causes Sundowning?

The causes of sundowning are not well understood.

Some research suggests that sundowning may be related to changes to the brain’s circadian pacemaker. That’s a cluster of nerve cells that keeps the body on a 24-hour clock.

Studies in mice suggest that neurochemical changes in the brain that are characteristic of Alzheimer’s disease may play a role. Researchers found that older mice make more of an enzyme that’s associated with anxiety and agitation before they go to sleep than middle-aged mice do.

Several things may increase the risk for sundowning. These include:

• pain
• fecal impaction (serious type of constipation)
• poor nourishment
• being on too many medications
• infection
• noisy and disruptive sleeping environment

Treatments for Sundowning

Ways to reduce the severity of sundown syndrome include:

Increase Daily Activity. Being more active during the day may help Alzheimer’s patients sleep better at night. Caregivers should:

• Discourage daytime naps.
• Encourage exercise, like walking.
• Encourage hobbies that get dementia patients up and moving.

Monitor Diet. Caregivers should take these steps to improve dietary habits:

• Limit caffeine and sugar to the morning hours.
• Plan an early dinner.
• Keep snacks light before bedtime.

Seek Medical Advice. A health-care provider can help look for physical problems like pain, infections, or bladder problems that may be contributing to nighttime confusion and agitation. They should also regularly review prescription medications to make sure they are still needed.

Light Therapy. Exposure to bright lights during the day may reduce some sundowning symptoms, especially when used in combination with exercise, like walking.

Change Sleeping Environment. Allow the patient to change bedrooms or to sleep in a favorite chair or couch. Keeping the room partially lit may also help to reduce confusion when a person wakes during the night into a seemingly unfamiliar environment.

Provide Calm Reassurance. Gently reorient the patient to where he is and what time it is. Avoid arguing and offer reassurance that the patient is alright.

Source: WebMD

It’s very common for people who have dementia to wander off on their own.

When that happens, frantic family members have to search for them, and call the police if they can’t find them.

But there’s now another option.

Technology — in the form of shoes that have GPS tracking — is beginning to revolutionize how caretakers keep tabs on their loved ones who sometimes wander.

Joann Johnston, whose husband, Bill Johnston, has Alzheimer’s disease, said the shoes give her peace of mind. “When I lost him, you, you kind of panic,” she said.

“I had been leaving him and going to the bank and say, ‘OK, go in, drink your tea and wait for me, and I will come back.’ And he would do that,” Joann Johnston explained. “(But one time) I spent a little longer in the grocery store and got back maybe 45 minutes later, and I looked in McDonald’s and he wasn’t there. I opened the bathroom door and hollered ‘Bill.’ No answer.”

Bill Johnston, who is 83 years old, had wandered away toward a main highway.

Joan Johnston recalled, “I looked over — was looking all around the parking lots and the shopping center, across the street from McDonald’s I saw him. … He couldn’t remember when I would be back. When I wasn’t there the he said — ‘Well where is she? I’ll just walk home.”‘

She picked him up and brought him home.

Bill Johnston is one of an estimated 5.3 million Americans who suffer from Alzheimer’s disease, and wandering is one of the most common symptoms.

According to the Alzheimer’s Association, many will wander at least once during the progression of the disease, and many, three or more times which, Quijano noted, can make shoes loaded with GPS technology a literal life-saver, and ease the burden often placed on primary care-takers.

Andrew Carle, executive in residence of senior housing at George Mason University, saw a need to curb wandering and reached out to a California company that makes shoes with GPS systems. They partnered on a model for the elderly.

“(Primary caretakers are) afraid to even turn their back on their loved ones for two or three minutes or even to go to the bathroom for a few minutes, because they’re afraid when they come out, they may be gone,” Carle said. “And this technology can really help them and gives them a chance of locating them.”

Seeking ways to control Bill Johnston’s wandering, Joan Johnston and son Alan Johnston were led to George Mason University and Carle, who offered them a pair of shoes to test.

“We discussed it and we decided to try these shoes out on him,” Alan Johnston said. “And (we) thought this would be a good match and kind of went from there.”

A computer programmer, Alan Johnston takes care of the technological side of things for his parents.

“The shoes give you more control,” Alan Johnston said. “My mom can call me immediately and I can give her immediate feedback on his location.”

Carle said, “We’re trying to maximize the odds that they’re going to have this technology on them and the best location is to put it in shoes.”

Joan and Bill Johnston hope it will make their lives easier. The philosophy Joan lives by? “You take it day-by-day and moment-by-moment and try not to plan too far ahead,” she said. “I don’t plan more than a day ahead of time. And you take it, today.”

Carle also worked closely with a company in New Jersey Aetrex, on the shoe.

The GPS shoes can be ordered now here.

SOURCE: CBS NEWS

Alzheimer’s disease spreads in a predictable pattern like an infection, going from one brain cell to another along linked circuits known as synapses, researchers say.

The findings, published in the online journal PloS One, suggest that blocking the process early on may keep the disease from spreading.

Brain effect: This computer graphic shows a slice of the brain of an Alzheimer patient (left) compared with a normal brain (right). The Alzheimer’s brain is considerably shrunken

‘This is a phenomenon that is increasingly recognised and potentially very important,’ said Dr Samuel Gandy, of the Mount Sinai Alzheimer’s Disease Research Center in New York.

‘If we understood this process, we could potentially arrest progression at an early stage.’

Imaging studies in people have suggested that Alzheimer’s spreads from region to region in the brain rather than popping up spontaneously in different areas, but the evidence was not strong enough to say for sure.

‘Everyone talks about Alzheimer’s ‘spreading’, but there really has not been a standard theory,’ study authors Dr Karen Duff and Dr Scott Small from the Columbia University Medical Center in New York, said.

‘In the past, we have asked many of our colleagues in the field of Alzheimer’s research what they mean when they say ‘spread’. Most think that the disease just pops up in different areas of the brain over time, not that the disease actively jumps from one area to the next,’ they said.

‘Our findings show for the first time that the latter might be true.’

More than five million Americans and 465,000 people in the UK suffer from Alzheimer’s, a brain disease that causes dementia.

Despite costly efforts, no drug has been found that can keep the disease from progressing.

There is currently no cure for Alzheimer’s, which is a progressive condition and most common in people over 65

For their study, the team used mice that were genetically engineered to accumulate deposits of tau in a key memory center of the brain known as the entorhinal cortex, which is where that toxic protein starts to deposit in people.

Their aim was to map the progression of tau, an abnormal protein that forms tangles of protein fibers in the brains of people with Alzheimer’s disease.

The team analysed the brains of the mice periodically over a period of 22 months to see how the disease progressed.

They found that as the mice aged, the abnormal human tau spread along a linked pathway, traveling from the entorhinal cortex to the hippocampus to the neocortex, areas of the brain needed to form and store memories.

That pattern closely follows the progression of Alzheimer’s as it passes through various stages in people, Dr Duff said.

The team also saw signs that tau moved from brain cell to brain cell across synapses, connection points that allow nerve cells to communicate.

The researchers think those findings suggest new strategies for diagnosing and treating Alzheimer’s disease.

‘First, it would suggest that imaging tools that can detect entorhinal cortex dysfunction will be particularly helpful in diagnosing the earliest stages of the disease,’ they said.

‘More importantly, it might suggest ways of improving treatment.

‘The implication of our study is that if it were possible to ‘treat’ Alzheimer’s when it was first detected in the entorhinal cortex, this would prevent spread,’ they said.

They likened the approach to treating cancer early, when it is still in one spot, and not waiting until it has spread.

The study may bring a new focus to diagnostics and treatments that focus on tau, rather than amyloid, the protein that causes plaques to form in the brain.

Current imaging agents used with PET scanners can identify amyloid deposits in the brain, but not tau.

Most late-stage Alzheimer’s drugs, including Eli Lilly and Co’s solanezumab, and Johnson & Johnson and Pfizer’s bapineuzumab, take aim at amyloid, which accumulates silently 15 to 20 years before signs of dementia appear.

Admission

• Is there a waiting period for admittance?
• What are the admission requirements?

Fees and financing

• Are fees competitive?
• Have fees increased significantly in the past few years?
• Is the fee structure easy to understand?
• What are the billing, payment, and credit policies?
• Are there different costs for various levels or categories of services?
• Are the billing and accounting procedures understandable?
• Does the nursing home reveal what services are covered in the quoted fee and what services are extra?
• What governmental financing options are accepted (such as Medicare, Medicaid, Medicare Supplemental Insurance, Supplemental Security Income, and others)?
• When may a contract be terminated? What is the refund policy?

Needs assessment

• Is there a written plan for the care of each resident?
• What is the procedure for assessing a potential resident’s need for services? Are those needs reassessed periodically?

Professional staff

• Do the nurses, social workers, and administrators have geriatric experience and/or education?
• Are staff members available to meet scheduled and unscheduled needs?
• Do staff members seem to genuinely enjoy working with the residents?
• Do staff members treat residents as individuals?
• Is staff available to assist residents who experience memory, orientation, or judgment losses?
• Does a doctor or nurse visit the resident regularly to provide medical checkups?
• Do residents appear happy and comfortable?
• Do residents, other visitors, and volunteers speak favorably about the nursing home?
• Are residents clean and adequately dressed?
• Are the rights of residents clearly posted?

Facility design

• Do you like the appearance of the building and its surroundings?
• Is the decor attractive and home-like?
• Is the floor plan easy to follow?
• Do doorways, hallways, and rooms accommodate wheelchairs and walkers?
• Are elevators available?
• Are handrails available?
• Are shelves easy to reach?
• Are carpets secured and floors made of a non-skid material?
• Is there good natural and artificial lighting?
• Is the residence clean, odor free, and appropriately heated/cooled?

Medication and health care

• What is the policy regarding storage of medication and assistance with medication?
• Is self-administration of medication allowed?
• Who coordinates visits from a physical, occupational, or speech therapist if needed?

Services

• Is staff available to provide 24-hour assistance with activities of daily living, if needed? Daily activities include:
• Dressing
• Eating
• Mobility
• Hygiene and grooming
• Bathing, toileting, and incontinence
• Using the telephone

Room features

• Are rooms for single and double occupancy available?
• Is a 24-hour emergency response system accessible from the room?
• Are bathrooms private? Do they accommodate wheelchairs and walkers?
• Can residents bring their own furnishings? What may they bring?
• Do all rooms have a telephone? How is billing handled for long-distance calls?

SOURCE: WebMD

GREAT FALLS, VA.— When doctors told Carol Blackwell that her husband — her best friend and the love of her life — had Alzheimer’s disease, they assured her “a cure was just around the corner.”

Bob Blackwell was 64, recently retired from the CIA as an analyst on the former Soviet Union and Europe and still functioning normally. “He was brilliant then.”

That was five years ago.

“Here we are, and there’s no cure and no promise of a cure,” Carol says, sitting in her family room, eyes wet with tears.

She is Bob’s primary caregiver, and the last couple of months have been “tough,” she says. There are days when Bob doesn’t know she’s his wife. “I’ve been through a lot of grieving,” she says. “I know it’s too late for a cure for Bob, the disease has moved into too many parts of his brain, but I’m praying for my children and grandchildren. We have to find a cure.”

Carol will be paying close attention to government meetings today and Wednesday in Washington where Health and Human Services officials are gathering with other medical experts to discuss the framework for the first national plan to fight the disease. The No. 1 goal stated in the early draft of the National Alzheimer’s Project Act is to prevent and effectively treat Alzheimer’s by 2025. Although the funding levels have not been determined, disease experts compare the multi-agency federal approach of NAPA to the wars on heart disease and cancer.

Alzheimer’s, which is a form of dementia that causes progressive loss of intellectual and social skills, is the only disease among the top killers for which there is no prevention, cure or treatment that will slow its progression.

“I think the potential impact of this plan is huge,” says Ron Petersen, chairman of the NAPA non-federal advisory council and director of the Mayo Clinic’s Alzheimer’s Disease Research Center.

“Given the economic problems, it’s a bit of a challenge, but this is our chance to make a bold statement.”

President Barack Obama signed NAPA into law last January. Experts have spent a year formulating the framework for the plan, and the final draft is due later this month or early February.

Source: APP.com

Date: Friday June 8, 2012
Time: 9:00am to 2:00pm

Hosted by:
Shore Meadows Rehabilitation & Nursing Center,
231 Warner Street Toms River NJ

Presented by Keynote Speaker

Dr. Joshua Shua-Haim MD FACP AGSF CMD
Professor of Medicine

FREE Educational & Informative Symposium
Back by Popular Demand!

Alzheimer’s Disease:
The Disease With Two Victims
With Dr. Joshua Shua-Haim, Professor of Medicine

• Shore Meadows Rehabilitation & Nursing Center,
231Warner Road, Toms River, NJ

Providing Free Respite Care for your loved one during the event
with pre-registration 732-942-0800

Limited Seating Call for Reservation

Telephone: 732-657-3757

The Alzheimer’s Academy Presented by

The Haven at Shorrock Gardens Care Center
National Memory Screening Day November 17, 2011
Free Memory Screenings 9:00am until 1:00PM and Presentation 1:00PM

Join us at The Haven at Shorrock Gardens Care Center on
Thursday, Nov 17^th for Free Memory Screenings
9:00am until 1:00p

Dr. Joshua Shua-Haim MD FACP AGSF CMD Professor of Medicine-UMDNJ-RWJ

1:00pm FREE Educational & Informative Forum:
The Latest Treatments & Advances In Alzheimer’s Disease
With Dr. Joshua Shua-Haim, Professor of Medicine

 The Haven at Shorrock Gardens Care Center
75 Old Toms River Road, Brick NJ

Please RSVP to 732-451-1000 ext. 510

~

In Dr. Shua-Haim’s capacity as one of the most experienced authorities on Alzheimer’s disease (AD), he was instrumental in the formulation of the C-ADAT (Caregiver’s – Alzheimer’s Disease Assessment Tool).  The C-ADAT organizes a large amount of information using accepted assessment tools into a one-page table.  It builds upon the work of Barry Riesberg, M.D., who along with other prominent researchers in the study of AD, developed a global deterioration scale (GDS), which describes the deterioration of function in patients with AD according to performance standards.  Also designed as a functional assessment tool for patients with AD by Dr. Riesberg, et al., the FAST staging describes the functional staging of AD as though it was a reversal of the normal development of the individual from infancy through adulthood.  To formulate the C-ADAT table, Dr. Shua-Haim incorporated these two functional assessment tools for AD along with two other tools that assess daily activities and function of the elderly patient, in general.

Dr. Shua-Haim developed this invaluable tool in response to healthcare professionals’ and family members’ desire to understand the many facets of Alzheimer’s disease.  The C-ADAT table organizes and condenses all of the research into a format that can be easily understood and utilized by anyone who provides care to a patient with AD.  Additionally, in 2003, Dr. Shua-Haim, Dr. Lee and Juanita Smith conducted a study to validate a modified version of the C-ADAT tool.  Dr. Shua-Haim shares this modified version with all of the caregivers who bring their loved ones to MAGA for treatment.  The modified C-ADAT incorporates cognitive, functional, behavioral, prognostic and therapeutic information on patients with AD.  It is a great asset for geriatric professionals and family caregivers in order to better comprehend the nature and progression of Alzheimer’s disease.  After becoming familiar with the modified C-ADAT, many caregivers find the job of handling those with AD to be more manageable and far less stressful.

Click on the form below to download pdf of the Assessment Tool.

Click to Download pdf form

Aug. 3, 2011 — A new blood test for Alzheimer’s disease is 96% accurate at identifying the disease and can perhaps detect it even before symptoms such as memory loss appear, says the test’s developer.

”This is a simple test that has high accuracy and can be run from a single drop of blood,” says Robert Nagele, PhD, a professor of medicine at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine. He is also founder of Durin Technologies Inc., the company that is developing the test.

The research results on the new test are published online in PLoS ONE.

His test is one of numerous such tests under study, says Heather Snyder, PhD, a spokesperson for the Alzheimer’s Association, who reviewed the research results. “Many labs are looking at this. They are all in the very preliminary, very early stages. We all know we need an accurate, relatively noninvasive way to diagnose Alzheimer’s.”

Last month at the Alzheimer’s Association International Conference, Australian researchers reported good results for another blood test for Alzheimer’s under development. It works by determining the amount of amyloid plaque, associated with the disease, in people’s brains.

An estimated 5.4 million Americans have Alzheimer’s disease, the most common form of dementia, according to the Alzheimer’s Association.

Doctors use brain imaging, evaluation of behavior, psychiatric tests, and other means to diagnose the disease. None are highly accurate, and some are costly and not practical to use on a widespread basis, experts say.

The only definitive way to diagnose the disease is by direct examination of brain tissue after the patient dies.

New Blood Test for Alzheimer’s: How It Works

Nagele’s test looks for antibodies in the blood specific to the disease. Alzheimer’s is believed to start up to 10 years or so before symptoms are noticeable.

Before symptoms occur, these brain changes are under way, he tells WebMD. “Brain cells die and when they die, they pop, they explode, like a water balloon breaking.”

The contents of those dying cells spill partially back into the blood. “Your body makes antibodies against the cell debris,” he says. “We believe that happens so it can facilitate the cleanup of the cell debris.”

The researchers found thousands of these antibodies. “Many of these are related to the presence of the disease,” Nagele says.

Nagele’s team looked at blood samples from 50 people with Alzheimer’s disease and 40 without. They also looked at blood samples from 30 breast cancer patients and 29 with Parkinson’s disease, to be sure the test could be specific for Alzheimer’s.

“Parkinson’s and Alzheimer’s are very close in terms of their pathology,” Nagele says. “Neurons are dying in both cases.”

He wanted to see if the test could tell Alzheimer’s and Parkinson’s apart.

Overall, the tests identified 96% of those with Alzheimer’s correctly. It correctly identified 92.5% of those who didn’t have Alzheimer’s.

In the process, Nagele narrowed down the list of antibody biomarkers needed to detect Alzheimer’s disease to 10.

The hope is to detect the disease before symptoms appear, but Nagele stresses his team has not yet done that.

If all goes well, he is hopeful the test could be available within a year. Costs are difficult to estimate, but it could be about $200, he tells WebMD.

New Blood Test for Alzheimer’s: Perspective

Snyder calls the report exciting but also had many caveats. “I would call it preliminary,” she says of Nagele’s research. “It’s a small study and a small sample.”

As research on blood and other tests for Alzheimer’s progresses, Snyder says, the measures must be standardized so people get the same results regardless of where the test is performed.

That has been an issue, for instance, in some cerebral spinal fluid tests, also being studied to detect Alzheimer’s. “What we have seen, at least in cerebral spinal fluid [tests], is that it hasn’t held up across different labs,” she says.

She acknowledges some people may not want to know if the disease is in their future, but says knowing early has many advantages. “They can plan for their financial future, as well as their care,” she says. “They can participate in clinical trials. When we do have therapeutic options available, the ultimate goal would be intervention.”