In April 2010, a consensus panel convened by the NIH was unable to draw any firm conclusions about the association of any modifiable risk factor with Alzheimer's disease. Although the panel acknowledged the difficulty of establishing clear cause-and-effect relationships, newspaper headlines mistakenly said there's nothing anyone can do to slow or prevent Alzheimer's dementia.
For Brigid Reynolds, MSN, ANP, clinical coordinator of the Georgetown University Medical Center's Memory Disorders Program in Washington, DC, the panel's findings reflected a very different message. "It's important to remember that researchers have not given up on demonstrating the link between Alzheimer's prevention or disease modification and healthy lifestyle options like exercise, nutrition and cognitive stimulation," she emphasized. "I've been in this field for a long time and I am not discouraged by the lack of evidence supporting that link, because long-term studies of that nature are difficult to sustain and expensive to conduct."
In fact, Reynolds explained, "Prevention is the area where the greatest progress is underway. We understand that pathological changes in the brain occur much earlier than the onset of clinical symptoms. Genetic markers, spinal fluid analysis, MRI and other imaging studies are helping us to identify those individuals at greatest risk of developing Alzheimer's. If we can identify and treat individuals prior to the onset of clinical symptoms, we may be able to prevent or slow the onset of dementia."
Reynolds provides pragmatic advice to patients and families who come to Georgetown. "We discuss healthy lifestyle interventions like eating a well-balanced diet, getting adequate rest, and maintaining an active social life where they are cognitively and physically engaged," she said. "We encourage them to participate in activities they enjoy, but caution them that once these activities become frustrating, it's time to stop."
Best Possible Function
Kathleen Houseweart, MBA, manager of geriatric services and coordinator of the Memory Disorders Clinic at Sarasota Memorial Health Care System, Sarasota, FL, shared a similar perspective. "We can't know what diseases we'll develop in our senior years, but what we can do is make sure our bodies and minds are at the best possible functional level as we age," she noted. "We know that many symptoms of dementia don't show up until much later in life. If your brain functions as well as it can at every point in your life, you may not live long enough to see those effects."
Mild cognitive impairment, or MCI, describes individuals who have lost cognitive abilities, but have not yet developed dementia. "In the past, we found that half of those with MCI converted to dementia within 5 years," Houseweart stated. "More recently, studies are saying only one-third of those people convert. How did we change that? I believe we educated people in a way that allowed them stay healthier and more engaged."
Houseweart has encouraging news for individuals with MCI, who still have the capacity to take ownership of their own health. "I tell them, 'What's good for your heart is good for your brain," she explained. "That means taking care of yourself with heart-healthy exercises, eating well and staying active with things you enjoy. Engage in cognitive exercise, which can be as simple as conversing with friends and family or as complex as learning a new skill. I remind them that alcohol is a brain toxin and people with MCI need every cell they have to maintain their independence. If you already have cognitive changes, don't drink regularly."
Stepping Into Their Worlds
As clients trickle into the Evergreen Memory Center in Wilmington, DE, a program of Christiana Care Health System, staff members join them in a social hour. "We have newspapers lying around and encourage them to talk about items of interest," said director Honey Woods, RN. "One man read the word 'war' on a headline and started talking about World War II. Before long, the ladies were talking about nylons with seams up the back. We step into their worlds when they can no longer step into ours."
Evergreen clinicians encourage crossword puzzles, word-finding puzzles and games like dominoes that force clients to use their brains in a different and stimulating way. "We do arts and crafts every day, laminating their work so they can take it home to use as a placemat or making it into a refrigerator magnet," Woods noted. "Afternoon entertainment covers everything from chair Pilates to basketball coin toss throws and golf. We engage in singing and dancing, giving them a chance to sing the words to songs from the '40s and '50s, and get some exercise by dancing along."
Specialized memory programs like the one at Evergreen provide plenty of cognitive stimulation and physical exercise. "Our clients go home tired and sleep through the night," said Woods. "Sundowning can be a pretty tough experience, especially in the winter months. We're recommending that families consider purchasing day lights to use in the home and keep sundowning at bay."
Thirty days after a client is enrolled in the Evergreen program, staff and family members sit down together. "We discuss healthy lifestyle choices that keep the individual as physically and socially active as possible," said Woods. "We emphasize that diet is an important component of keeping brains healthy. Plenty of dark green vegetables and fruits, along with a low fat, low cholesterol diet can reduce the risk of stroke and brain cell damage. We encourage them to continue the stimulation on the weekend, engaging the individual in folding laundry, putting dishes away, ironing or gardening activities that promote a sense of self worth."
Jane Eareckson-Helm, MA, CCC-SLP, of Christiana Care Visiting Nurses Association, cares for older adults whose dementia or other medical problems keep them homebound. In the home setting, she noted, it's very important to customize care plans to reflect the client's stage of dementia. "We want to get a handle on the person's strengths and use those as a means of compensation for the deficits," she said. "We talk with family about who the person was before the illness, and find out their favorite hobbies and what makes them happy. We encourage families to do things every day to make the person happy, whether that's a backrub, a fresh flower or '40s music."
Sandy Keefe is a frequent contributor to ADVANCE.