Depression in Parkinson's Patients


Depression is one of the most common non-motor symptoms of Parkinson’s Disease, with up to 60 percent of patients being affected during the course of the disease.

Causes and symptoms of depression:

Depression is a mood disorder in which mixed feelings of sadness, loss, and hopelessness are experienced, interfering with quality of life. Depression can have different causes, including psychological, biological, and environmental. In people with Parkinson’s disease, the principal cause of depression is thought to be an imbalance in certain neurotransmitters that regulate mood.

Motor and cognitive symptoms of Parkinson’s disease may be intensified by depression and researchers have found that treating depression can improve the motor symptoms of the disease as well as the quality of life.

Different people may experience symptoms of depression in different ways and severity, from mild to severe. However, some are common, such as feelings of guilt, worthlessness or helplessness, thoughts of death or suicide, decreased interest or pleasure in activities, poor attention and concentration problems, sleep disorders, feeling slowed down or restless inside, pessimism or self-blame, changes in appetite, low energy or fatigue and ongoing aches and pains, headaches and/or digestive problems.

People with Parkinson’s disease also may experience

anxiety and stronger symptoms of pessimism and restlessness.

Managing depression in Parkinson’s disease

Some medicines may make people with Parkinson’s disease more prone to depression and some symptoms of the disease itself may overlap with the symptoms of depression.

People with Parkinson’s disease should be aware that depression may be a common symptom in the course of the disease, and be prepared to share their feelings with their healthcare providers.

As different people may experience different symptoms of depression, the best management solution is a tailored combination of medication, exercise, and social support.

Antidepressants are commonly used to help manage depression, and include selective serotonin reuptake inhibitors (SSRIs) .Different people may react differently to the same medication. Therefore, if a treatment does not work in one patient, another one, or a combination of two, may be indicated.

Counseling or psychotherapy is a treatment option for people with depression and is used in combination with medication and an inexpensive way to improve mood and  symptoms of depression. Yoga, Tai-Chi, stretching, and walking are examples of exercises that may be beneficial in people with Parkinson’s disease.

* Parkinson’s News Today – June 2017, Maria Joao Almeida

The Memory & Aging Center of NJ offers a research study to evaluate the effectiveness of an investigational drug pimavanserin as combined therapy in adults with Parkinson's disease whose depression is not adequately controlled with current treatments.

September is Alzheimer's Awareness Month

September is Alzheimer's Awareness Month.  In the United States, one person every 65 seconds is diagnosed with Alzheimer's Disease.   The Memory and Aging Center of New Jersey is offering free memory screenings.  Throughout the month, every Tuesday and Thursday between 10am-3pm, we will be offering free memory screenings at our office.   We are located at 20 Hospital Drive, Suite 12, Toms River, NJ 08755.   Please call 732 244-2299 to schedule your appointment.

Simple Eye Test Could Detect Alzheimer's

A team of researchers in the U.S. believe that a simple eye exam may be able to screen patients for Alzheimer’s disease long before they exhibit symptoms or signs of dementia.

“The eye can really serve as a model for studying neurodegenerative diseases,” Dr. Gregory Van Stavern, professor of ophthalmology and visual sciences at Washington University in St. Louis, told CTV News. “And we can access the eye a lot easier than we can access the brain.”

Scientists know that Alzheimer’s and dementia can begin to take root in the brain up to two decades before symptoms such as memory loss or mood changes become obvious. And while simple tests currently exist for the early discovery of diseases such as colon cancer and diabetes, there is nothing comparable when it comes to Alzheimer’s. Today, only tests such as spinal taps or PET scans can detect Alzheimer’s in its earliest stages.

“You can imagine those are invasive tests,” Van Stavern said. “They’re expensive and very difficult to apply to the general population.”

In a new study, Van Stavern and a team of researchers used a relatively simple exam to study the eyes of 30 seniors. Although none of their subjects exhibited symptoms of Alzheimer’s, PET scans and/or spinal taps had previously revealed that 17 of them were at risk of developing the disease in the future due to elevated levels of brain plaque.

Through the eye exams, which use a technology similar to what is already found in many eye doctors’ offices, the researchers discovered that those 17 had thinner retinas -- the part of the eye that converts images into signals for the brain -- as well as fewer blood vessels in their retinas than the other research subjects, signalling less blood flow in the eyes and brain.

Dr. Rajendra S. Apte, who also teaches ophthalmology and visual sciences at Washington University, co-authored the study.

“What we wanted to examine was whether we could use the eye as a window to the brain,” he told CTV News.

“The finding that there were abnormalities in the blood vessels in the eye so early in disease was very surprising,” he added. “So this tells us that there are things going on very early in disease that we should be looking for even in the brain.”

Although more research needs to be done to definitively prove a link between the state of one’s retinas and Alzheimer’s, if verified it could mean that the disease can be detected earlier and easier, thus improving treatment and patient outcomes.

“Since these pathologic changes in Alzheimer’s disease begin about 20 years before dementia develops, it means practically by the time someone develops dementia there is so much loss of neural tissue that the medications, the treatments are not very effective,” Van Stavern explained. “There’s a push now to start intervening early in the preclinical stage with medications… So the idea would be using a test like this, which is non-invasive, as a way of screening people who might be at risk for Alzheimer’s disease.”

Meanwhile in Canada, a Montreal-based company called Optina Diagnostics believes they have developed another test for detecting Alzheimer’s via a relatively simple, but somewhat different, type of retinal examination. The company, which is currently conducting clinical trials in collaboration with McGill University in Montreal and Sunnybrook Hospital in Toronto, is hoping to receive regulatory approval for its test in 2019.

The development of such quick, inexpensive and non-invasive eye tests are welcome news to Alzheimer Society of Canada CEO Pauline Tardif.

“Any disease modifying therapies that might be developed in the future will be most effective at the very, very early stages of the disease,” she told CTV News. “And if we can have… diagnostic tools such as this through the retina, that’s really exciting.”

CTV Medical News 8/29/18



For the first time in history, researchers have found medicine that can reduce the risk of memory loss and dementia in your golden years. Even better, most forms of the treatment are available in safe, inexpensive generic formulations.

The twist? These drugs have been around for decades, since they’re widely used to lower blood pressure and ward off heart disease.

As the population ages, the incidence of cognitive impairment and dementia has surged. One in six women over the age of 55 and 10 percent of men are expected to develop dementia before they die. Alzheimer's disease, the most common type, affects more than 5 million Americans and is the sixth leading cause of death in the country. And while the drug industry has spent billions of dollars trying to slow down memory loss once it begins, the efforts have been largely unsuccessful. Until now.

The Systolic Blood Pressure Intervention Trial, or Sprint, was begun in 2010 to see if aggressively lowering blood pressure would reduce a range of health complications, including heart disease and dementia. The heart disease portion was halted five years later because the benefits were overwhelming. Researchers continued to track the cognitive function of 9,361 participants in a separate analysis called Sprint Mind through June.


The results, presented at the Alzheimer’s Association International Conference in Chicago, found that those who initially received intensive blood pressure control were 19 percent less likely to develop mild cognitive impairment than those who had more relaxed hypertension goals. The risk of developing either cognitive impairment or dementia was 15 percent lower, while dementia rates alone weren’t significantly different in the study.

“People may do all the right things and still develop dementia, but this may give them more time.”

“What is good for your heart is not only good for your heart, but also good for your brain,'” said Jeff Williamson, the lead researcher and chief of gerontology and geriatric Medicine at Wake Forest School of Medicine.

The researchers weren’t particular about what drug regimen the patients used, as long as they got to their goals. Those in the intensive treatment arm were expected to get below 120 mmHg, the upper number in a blood pressure reading, while those in the standard treatment group aimed for 140 mmHg.

Williamson compared the findings to car tires: “You want to have the right pressure,” he said. “If it’s too high or too low, the tires can wear out quickly. With blood pressure, if it’s too high, the walls of the arteries can endure damage.”

The findings will allow people to take action in their own lives to lower their risk, with specific goals to aim for, said James Hendrix, director of global science initiatives at the Alzheimer’s Association. Many people aren’t at recommended blood pressure levels, he said, and evidence that better control helps the heart and the brain may push them into action.

“People may do all the right things and still develop dementia, but this may give them more time,” he said. “It may give another five or 10 years with a healthy brain.”



Alzheimer's disease greater in females, researchers speculate

Last week, at the Alzheimer's Association International Conference in Chicago, a group of researchers presented research findings on the gender differences in Alzheimer’s causation. They speculated that women might be getting Alzheimer’s and dementia more commonly than men and the reason behind this has not been clearly understood. Estrogen or the female hormone could be the key, the researchers state.

The authors state that there are 50 million people worldwide who are living with dementia and Alzheimer’s disease and most of these are women. In the United States, of the 5.7 million people with Alzheimer’s, two thirds are females. Alzheimer’s is a twice common diagnosis among women over 60 years rather than breast cancer, they add. Alzheimer’s is the sixth leading cause of death in the US and in the UK and Australia too, Alzheimer’s kill more women compared to heart disease.

One of the studies presented at the conference has noted that more number of births in a woman is associated with a lower risk of dementia. Women who have given birth thrice or more times have been found to have a 12 percent lower risk of cognitive decline compared to women who have given birth only once. The study looked at nearly 15,000 women before coming to this conclusion. The study from Kaiser Permanente however adds that women who have had failed pregnancies have a greater risk of cognitive decline with women who have had three or more miscarriages being at a 47 percent greater risk of dementia. The study looked at age of menarche, menopause, female hormones and their associations with dementias.

They accessed the women’s medical records between 1964 and 1973 and then again from 1996 to 2017. Not only births, miscarriages, menarche and menopause, they also obtained other data such as stroke, diabetes, high blood pressure, heart disease etc. explained Paola Gilsanz, a staff scientist at Kaiser Permanente who co-led the study. This fortified the study results she added. The results also showed that women who were fertile between ages of 21 and 30 years had a 33 percent higher risk of dementia compared to women who were fertile for a longer period. Late menarche beyond age of 16 years was tied to a 31 percent greater risk of cognitive problems compared to girls who started at 13 years, the study found. Authors caution that this was an observational study and it really does not tell one how the female hormones might be affecting the brain yet.

University of Illinois psychology and psychiatry professor Pauline Maki is presenting the latest study at the conference. She said that age has been the biggest Alzheimer’s predictors till date and it has been thought that women are more at risk of dementias because they tend to live longer. She added, “No one was paying attention to what was going on in the female brain throughout a woman's life.” Presenter Carey Gleason of the Wisconsin Alzheimer's Disease Research Center added that they found it difficult to obtain research grants to look at effects of estrogen on Alzheimer’s. This has changed over the years they note.

Another study presented by Gleason explored the recent studies that looked at cognitive functions in women who were getting a hormone replacement therapy (HRT) after menopause. Earlier studies conducted in large number of women has shown that HRT containing estrogen and progesterone can raise the risk of stroke, blood clots, breast cancer and dementia among the women. The Women's Health Initiative after their initial discouraging results on HRT came up with new interpretations after a decade saying that they had initially included only elderly women. According to Gleason, younger women taking HRT may not be at risk of dementia but the elderly women on the drugs definitely are. Diabetics of any age however are at a greater risk. She explains that concrete conclusions are still awaited with HRT and dementia risk.

According to numbers from the Alzheimer’s Association, in 2018, Alzheimer’s along with other forms of dementia could cost the United States $277 billion in direct costs and this includes $186 billion in Medicare and Medicaid payments. The organization says that by 2015 the cost would rise to $1.1 trillion with one in every three Medicare dollar being spent on this condition.



Helping People with Dementia Stay Physically Active


ACTIVITIES FOR ANY DAY - 6 HEALTHY TIPS to help you stay active with Alzheimer's, along with physical activities to do.

Caregivers can help people with dementia be more active and stay safe:

  1. Be realistic about how much activity can be done at one time. Several 10-minute "mini-workouts" may be best.
  2. Help get the activity started or join in to make the activity more fun.
  3. Find time in the morning for exercise.
  4. Break exercises into simple, easy-to-follow steps.
  5. Choose comfortable clothes that are suitable for the weather and appropriate shoes that fit well.
  6. Make sure both you and the person with dementia drink plenty of water when exercising.

Some physical activities to try:

  • Take a walk together.
  • Do simple tasks around the house, such as sweeping and raking.
  • Work in the garden.
  • Play music and dance.
  • Exercise with videos made for older people. Try the sample workout on NIA's free Go4Life DVD.
  • Throw a soft rubber exercise ball back and forth.
  • Lift weights or household items such as soup cans.
  • Use resistance bands, which you can buy in sporting goods stores. Be sure to follow the instructions.

Quick Tip

Try being active together. Physical activity and exercise are good for caregivers, too!

Everyday Fitness Ideas from the National Institute on Aging at NIH
Helping People with Dementia Disease Stay Physically Active

National Institute on Aging
National Institutes of Health
U.S. Department of Health & Human Services
Go4Life is a registered trademark of the U.S. Department of Health

These Lifestyle Changes May Help Protect the Brain As You Age

1. SHORE UP YOUR HEART - Of all things you can do, reducing the risk of heart disease has the strongest evidence of benefits for the brain.  That means treating hypertension, high lipids, cholesterol, obesity and Type 2 diabetes.

2. EMPHASIZE EXERCISE - Physical activity reduces the risk and severity of cognitive decline.  Aerobic exercise has been shown to grow the volume of certain brain regions that tend to shrink during aging.

3. LEARN NEW THINGS - Engaging intellectually with the world across a lifetime, through activities like writing letters and reading, has been linked in brain autopsies to better cognitive health in old age.

4. BE SOCIAL - Richer social lives are associated with higher levels of cognition.  Loneliness, conversely, is connected with poorer brain health.

5 TREAT DEPRESSION - Depression is middle age - which is when it is most prevalent - is linked to twice the risk of cognitive decline, though its not clear if that's a cause or an effect.

6. SLEEP WELL  Studies have found a relationship between poor sleep and cognitive decline and Alzheimer's.  Improved sleep may reduce these risks.



Parkinson's Disease Dementia

Parkinson's Disease Dementia

Parkinson's disease dementia is an impairment in thinking and reasoning that eventually affects many people with Parkinson's disease.

About Parkinson's disease dementia

The brain changes caused by Parkinson's disease begin in a region that plays a key role in movement. As Parkinson's brain changes gradually spread, they often begin to affect mental functions, including memory and the ability to pay attention, make sound judgments and plan the steps needed to complete a task.

The key brain changes linked to Parkinson's disease and Parkinson's disease dementia are abnormal microscopic deposits composed chiefly of alpha-synuclein, a protein that's found widely in the brain but whose normal function isn't yet known. The deposits are called "Lewy bodies".

Lewy bodies are also found in several other brain disorders, including dementia with Lewy bodies. Evidence suggests that dementia with Lewy bodies, Parkinson's disease and Parkinson's disease dementia may be linked to the same underlying abnormalities in brain processing of alpha-synuclein.

Another complicating factor is that many people with both dementia with Lewy bodies and Parkinson's disease dementia also have plaques and tangles— hallmark brain changes linked to Alzheimer's disease.

Parkinson's disease is a fairly common neurological disorder in older adults, estimated to affect nearly 2 percent of those older than age 65. The Parkinson's Foundation estimates that 1 million Americans have Parkinson's disease. It is estimated that 50 to 80 percent of those with Parkinson's disease eventually experience Parkinson's disease dementia. 

What percentage of people with Parkinson's develop dementia?

An estimated 50 to 80 percent of those with Parkinson's eventually experience dementia as their disease progresses. The average time from onset of Parkinson's to developing dementia is about 10 years.

Parkinson's disease dementia is a decline in thinking and reasoning that develops in someone diagnosed with Parkinson's disease at least a year earlier. Common symptoms include:

  • Changes in memory, concentration and judgment
  • Trouble interpreting visual information
  • Muffled speech
  • Visual hallucinations
  • Delusions, especially paranoid ideas
  • Depression
  • Irritability and anxiety
  • Sleep disturbances, including excessive daytime drowsiness and rapid eye movement (REM) sleep disorder

Please call the Memory & Aging Center for more information on our current Parkinson's study.

Memory and Aging Center of NJ Alzheimer's Symposium

Join us on Friday, September 29th from 10am-2pm at the Brick Township Public Library* for a complimentary symposium for caregivers and family members.  In conjunction with Alcoeur Gardens Assisted Living, Dr. Ashok Patel will discuss Normal Aging vs. Alzheimer's Disease as well about caring for an Alzheimer's patient along with the newest medical research being conducted on the disease. 

Free Brunch will be served.  Registration is free but is required by calling (732) 290-2273.

* Brick Township Library 301 Chambersbridge Road, Brick, NJ.


Using the Right Vocabulary with Dementia Patients

Sticks and stones may break my bones but names will never hurt me” – so goes the old saying, a child’s mode of defence against bullies in the playground.

But the fact is that words do hurt. Quite apart from obvious insults, language can be a subtle but insidious weapon – especially when it comes to older people.

19-year-old care worker: I hope perceptions of growing old will change

There is a stigma associated with old age, but I feel more comfortable around the people I care for than my fellow teenagers

People with dementia don’t always have the ability to make witty comebacks to a “sticks and stones” remark. All the more reason to equip ourselves with the right vocabulary in the first place. Here is my advice:

‘She’s a wanderer’

It may seem an innocuous word but it’s a label and, as such, is disrespectful, because it totalises the person being talked about. Other similar words to avoid are “poor feeders” and “wetters”.

‘He’s losing his marbles’

Again, this is considered a lighthearted remark, but put yourself in that person’s position. Is this a kind thing to say about someone who is experiencing memory loss, confusion and personality change? For the same reason, words like “dippy”, “mad” and “demented” are offensive.

‘How long has he been suffering from dementia?’

People with dementia aren’t “sufferers”. Of course they suffer at times, but they don’t want dementia to define them. Instead of describing someone as a “dementia sufferer” or “dementia patient”, try using “person with dementia” or, better still, “person living with dementia”.

‘She’s an empty shell’

Actually, she isn’t. Not only is there lots going in that brain, but this makes the assumption that people living with dementia can’t feel pain or emotion. They can.

‘Where are you from, love?’

Beware of apparently friendly conversation. Asking someone with dementia seemingly basic questions such as where they live, where they were born or whether they’re married can cause them a lot of distress if they can’t remember. Instead, let them take the lead and don’t be afraid to enter into their universe. If they talk about their deceased wife as if she’s still alive, go with the flow and turn it into a chat. And don’t patronise people, by calling them “love”, “dear” or any other term of endearment. Use their preferred name.

Kate Swaffer, who has written about her own journey with dementia, has a few more tips on her blog:

  • Don’t remind people with dementia of the death of a loved one or pet.
  • Don’t talk about them to someone else in front of them.
  • Don’t say “I’ve just told you that”.

The stigma of dementia is learned. Children are frequent visitors to care homes, often visiting relatives, and communication comes naturally to them. We find that children, with no prejudice or preconceptions, talk openly, patiently and respectfully.

How to care for a person with dementia

Whether it’s sticking to routines or working with positive memories, there are ways care workers can really help people with dementia, says Caroline Baker


Read more

For many of us, finding the right language to use around people with dementia – and other mental health conditions – is difficult. It’s so hard to negotiate that many people often don’t bother. But that’s not teaching anyone anything, nor is it building important bonds between people with dementia and their carers, care workers, friends and family.

One of my colleagues sums it up perfectly: “Labels are for tins, not people.”

Let’s start seeing the person, not the illness.

Join the Social Care Network for comment, analysis and job opportunities, direct to your inbox. Follow us on Twitter (@GdnSocialCare) and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to us at

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs.

Happy 241st Birthday America!!

The Story of the Fourth of July

The Declaration of Independence

We celebrate American Independence Day on the Fourth of July every year. We think of July 4, 1776, as a day that represents the Declaration of Independence and the birth of the United States of America as an independent nation.

But July 4, 1776 wasn't the day that the Continental Congress decided to declare independence (they did that on July 2, 1776).

It wasn’t the day we started the American Revolution either (that had happened back in April 1775).

And it wasn't the day Thomas Jefferson wrote the first draft of the Declaration of Independence (that was in June 1776). Or the date on which the Declaration was delivered to Great Britain (that didn't happen until November 1776). Or the date it was signed (that was August 2, 1776).


So what did happen on July 4, 1776?

The Continental Congress approved the final wording of the Declaration of Independence on July 4, 1776. They'd been working on it for a couple of days after the draft was submitted on July 2nd and finally agreed on all of the edits and changes.

July 4, 1776, became the date that was included on the Declaration of Independence, and the fancy handwritten copy that was signed in August (the copy now displayed at the National Archives in Washington, D.C.) It’s also the date that was printed on the Dunlap Broadsides, the original printed copies of the Declaration that were circulated throughout the new nation. So when people thought of the Declaration of Independence, July 4, 1776 was the date they remembered.

In contrast, we celebrate Constitution Day on September 17th of each year, the anniversary of the date the Constitution was signed, not the anniversary of the date it was approved. If we’d followed this same approach for the Declaration of Independence we’d being celebrating Independence Day on August 2nd of each year, the day the Declaration of Independence was signed!


How did the Fourth of July become a national holiday?

For the first 15 or 20 years after the Declaration was written, people didn’t celebrate it much on any date. It was too new and too much else was happening in the young nation. By the 1790s, a time of bitter partisan conflicts, the Declaration had become controversial. One party, the Democratic-Republicans, admired Jefferson and the Declaration. But the other party, the Federalists, thought the Declaration was too French and too anti-British, which went against their current policies.

By 1817, John Adams complained in a letter that America seemed uninterested in its past. But that would soon change.

After the War of 1812, the Federalist party began to come apart and the new parties of the 1820s and 1830s all considered themselves inheritors of Jefferson and the Democratic-Republicans. Printed copies of the Declaration began to circulate again, all with the date July 4, 1776, listed at the top. The deaths of Thomas Jefferson and John Adams on July 4, 1826, may even have helped to promote the idea of July 4 as an important date to be celebrated.

Celebrations of the Fourth of July became more common as the years went on and in 1870, almost a hundred years after the Declaration was written, Congress first declared July 4 to be a national holiday as part of a bill to officially recognize several holidays, including Christmas. Further legislation about national holidays, including July 4, was passed in 1939 and 1941.


Tips for Dementia Caregiving

1) Start with a Good Feeling Each Day

Caregivers have a profound influence on the

emotional state of individuals with Alzheimer's.

A University of Iowa study further supports an inescapable

message: caregivers have a profound influence -- good or bad --

on the emotional state of individuals with Alzheimer's disease.

Patients may not remember a recent visit by a loved one or having been neglected by staff at a

nursing home, but those actions can have a lasting impact on how they feel.

The findings of this study are published in the journal, Cognitive and Behavioral Neurology.

UI researchers showed individuals with Alzheimer's clips of sad and happy movies. The patients

experienced sustained states of sadness and happiness despite not remembering the movies.

"This confirms that the emotional life of an Alzheimer's patient is alive and well," says lead

author Edmarie Guzmán-Vélez. Despite the considerable amount of research aimed at finding new

treatments for Alzheimer's, no drug has succeeded at either preventing it. Against this backdrop,

this study highlights the need to develop new caregiving techniques aimed at improving the wellbeing

and minimizing the suffering for the millions of individuals afflicted with Alzheimer's.

For this behavioral study, Guzmán-Vélez and colleagues invited 17 patients with Alzheimer's and 17

healthy participants to view 20 minutes of sad and then happy movies. These movie clips triggered

expected emotions: sorrow and tears during the sad films and laughter during the happy ones.

Five minutes after watching the movies, participants took a memory test to see if they could recall

what they had just seen. As expected, the patients with Alzheimer's retained significantly less

information about both the sad and happy films than the healthy people. In fact, four were unable to

recall any factual information about the films, and one patient didn't even remember watching any


Before and after seeing the films, participants answered questions to gauge their feelings. Patients

with Alzheimer's disease reported elevated levels of either sadness or happiness for up to 30

minutes after viewing the films despite having little or no recollection of the movies. Quite strikingly,

the less the patients remembered about the films, the longer their sadness lasted. While sadness

tended to last a little longer than happiness, both emotions far outlasted the memory of the films.

The fact that forgotten events continue to exert profound influences on patients' emotional life

highlights the need for caregivers to avoid causing negative feelings and to try to induce positive


"Our findings should empower caregivers by showing them that their actions toward

patients really do matter," Guzmán-Vélez says. She suggests simple things that can have a

lasting emotional impact on a patient's quality of life and subjective well-being, such as:

Frequent visits

Social interactions





Serving patients their favorite


1 SOURCE: University of Iowa Health Care

Dementia: A Group of Symptoms

Dementia: A Group of Symptoms

By Rachel Schindler, MD | Sep 4, 2014

By now most people have heard of the word dementia. But do you know exactly what it is? It is a gradual loss of mental abilities such as memory, thinking, language, judgment, and usually accompanied by changes in behavior. Dementia isn’t simply occasional forgetfulness, but a problem in the brain that is severe enough to interrupt normal daily activities.

Where many people get confused is when they think dementia is a disease in and of itself. In fact, dementia is the result of a disease, brain disorder, or injury. It is not a disease, but a range of symptoms that tell us a disease or condition is causing physical changes in the brain.

A good way to think about this is to draw a parallel between dementia and another symptom like itching. This may seem odd at first, but the comparison is actually quite helpful. For instance, like dementia, itching can be mild or severe, can cause a minor problems at first or can turn out to be a very serious issue. Itching can be the symptom of a number of diseases or conditions that are treated very differently. For example, itching may be a symptom of psoriasis, allergies, kidney disease, poison ivy or even lymphoma. Each of the underlying causes is treated very differently from the others. Treatment of the symptom, in this case itching, may make it better.  But the goal is to discover and address the underlying cause. So, like itching, it can help to think of dementia as a cluster of symptoms that indicates something is happening in the brain, though it does not tell us exactly what.

Types of Dementia

There are several types of dementia, caused by different underlying conditions. The most well known types of dementia include Alzheimer’s dementia (AD), Parkinson’s disease dementia, and Lewy Body dementia. But there are also types of dementia caused by vascular disease (such as strokes) and Frontotemporal dementia, which is caused by the breakdown of nerve cells in particular regions of the brain.

Early Signs of Dementia

If you recognize any of the following early signs in yourself or a loved one, it is important to speak with your doctor. You can then work together to find out what is causing your symptoms, including obtaining some tests or possibly finding a doctor who specializes in diagnosing and treating dementia:

  • Forgetfulness that hinders your ability to get through the day: This can include asking about the same thing repeatedly, especially if it was just learned; this is  different from sometimes forgetting names or dates and remembering them at a later time
  • Growing challenges in planning or solving problems: This might include being unable to concentrate, focus, or follow directions.   The difficulties are ongoing, and not just occasional errors.  They might occur, for example,  when balancing a checkbook, paying the bills or following a familiar recipe
  • Difficulty completing tasks that used to be easy:  Examples include getting lost while driving on a familiar route or  needing help to use the settings on a microwave which were used independently before
  • Confusion about what season it is, or the passage of time: Forgetting the date, time and location can occur; this is different from temporarily thinking it is Wednesday when it is Thursday
  • New problems with words, speaking or writing to the point that joining a conversation is difficult: This is different from sometimes having trouble finding the “right” word

The very presence of any symptom, if it is more than just a minor, passing issue, means that it is time to get to a doctor to find out what is going on. There are different types of dementia with different causes.  Some are even reversible, for example as with certain vitamin deficiencies or hormonal imbalances.  In those not reversible, treatment may help with symptoms.   An earlier diagnosis may also help patients and families learn as much as they can about the illness and what needs and choices may be anticipated.

Rachel Schindler, MD is a physician/scientist who leads the strategy for Neurosciences in the Clinical Sciences group at Pfizer’s Global Innovative Pharmaceuticals Medicines Development Group.  She is the founder and former Director of the Neurobehavior and Memory Disorders Program at University Hospital at Stony Brook.

Alzheimer's Patients Are Not Zombies

I saw a woman lose her mind, right in front of me, and then get it back, right in front of me.

Just like that.

We were talking about her life, hertypical day, when I asked her about Doug. "Who’s Doug?" she replied. I didn’t answer but, like one of my patients, I repeated myself: "How's Doug?" Again she replied, “Doug?”

This time, I answered, “Doug, your husband.”

Open-mouthed, she was surprised, even scared, like she’d seen a ghost. “I have a husband?” He came back to her like an old friend. “Of course, Doug, my husband. Oh, my…” She’d forgotten him, right in front of me. She begged me not to tell him she had forgotten him.

I’ve been wondering if I should have pushed her. Or maybe I should have dropped my line of questioning. I could have gotten away with that. White-coated and armed with my clipboard in my exam room, I wield authority. I could’ve simply moved on to another topic and she’d have gone along to get along. I could have lied or created some kind of imaginary “Doug.”

There comes a stage of Alzheimer's disease when people no longer recognize the ones they love: their spouses, friends and children. They may ask for long-dead relatives. They may ask to go home, when in fact they are home. The crushing fear of this produces a dangerous metaphor for the disease: patients become a kind of living dead or, in a word, zombies.

This troublesome metaphor often has innocent origins, as researcher Susan Behuniak explains in her essay, “The living dead? The construction of people with Alzheimer’s disease as zombies.” It pervades the ways we think about Alzheimer’s; see, for example, this blog or the TV preacher Pat Robertson's argument that divorce from an Alzheimer's patient is acceptable because the patient is a living death. Well-meaning caregiving guidebooks use it. Professional journals have articles such as “Hospice care for the living dead.”

The problem with the zombie metaphor, with thinking about the patient as a living dead, is that it limits our repertoire of emotions. We feel fear and disgust, emotions that in turn cause stigma, which describes a deliberate distancing and dehumanizing of a person.

Jews in Germany, homosexuals everywhere and, more recently, undocumented residents in the U.S.—when we stigmatize a group of people, we cease to care. The stigmatized become a threat, a burden. They’re put in ghettos, deported, even eliminated.

Persons with Alzheimer’s disease are called a “silver tsunami” that will bankrupt America. They feel a distancing from others. The public’s negative emotions are driven by the decline expected with Alzheimer’s disease. We hope for a cure, but hope is not a plan, and horror stories are for teenagers. We—autonomous grown-ups—need other ways of thinking about the disease.

This other way isn’t some fairy tale of unicorns and rainbows. Alzheimer’s, like other diseases that progressively destroy our brains, disrupts our ways of being, because its earliest symptoms are a loss in our capacity to exercise a cherished ethic: autonomy. We need to grow up, and think I’ve found a way we can do this in the stories of Alice Munro.

In her “In Sight of the Lake,” we meet Nancy. She’s bothered by memory problems. After a visit to her doctor (she came on the wrong date), she’s referred to a memory specialist in a neighboring town. To prepare for the visit, to avoid arriving flustered and late, she decides to drive to the town the evening before the visit, locate the office and so return the next day at ease over where she needs to travel.

She reaches the town, but she cannot find the doctor’s office. In her wanderings, she’s self-conscious of the troubles she’s having. She feels her world is coming apart. A child rides backwards on a bicycle, clocks are broken, a jewelry store sells junk. She resists asking for help, fearful that, once she’s out of earshot, people will “speculate” about her.

At story’s end, Nancy is in another place, in a bed in a nursing home. Sandy, one of the aides, is struggling to get her dressed in her nightclothes (Sandy calls it a “nightie”). Nancy is agitated. It has all been a dream.

Sandy says she’s acting like a chicken afraid it’s going to be “’et for dinner,” a politer way of saying Nancy’s acting not like a person who’s had a bad dream, but like a mindless bird, a chicken with its head cut off.

Reprinted- Forbes - Jason Karlawish is a Professor of Medicine, Medical Ethics and Health Policy, and Neurology at the University of Pennsylvania.

Memory & Aging Center Speaker Series

Speaker Presentation


MEMORY LOSS: Treatments, Studies & Medications
Speaker Dr. Ashok Patel
Board Certified Geriatric Psychiatrist from the
Memory and Aging Center of NJ

Join us for a FREE educational seminar presented by

Dr Ashok Patel, Board Certified Geriatric Psychiatrist from the memory and Aging Center of New Jersey on The Latest treatments, Studies and Medications for Memory Loss.


Tuesday, February 21st,  6pm

Brandywine at Reflections – Senior Living

1594 Route 88, Brick, NJ 08724

RSVP to Faithe or Maria by February 16th (732) 836-1400

Quick Facts....

Facts about memory loss:

  1. On average, Alzheimer’s disease is not diagnosed until three to five years after the onset of first symptoms.
  2. Experts believe that the early detection of memory loss, along with early intervention, provides the greatest opportunity to delay or stop additional damage to the brain.
  3. Understanding how memory changes as we age both in the presence and absence of brain disease can help us identify ways to make earlier diagnoses, identify risk factors of memory loss, and develop programs to prevent it.
  4. Memory loss affects our loved ones. Caring for someone with memory loss can increase the risk of depression and other health issues.

Early Signs and Symptoms of Alzheimer's Disease

Early signs and symptoms of Alzheimer's disease

Confusion and disorientation are common symptoms of Alzheimer's.

Early symptoms may be periods of forgetfulness or memory loss. Over time, a person may become confused or disoriented as to where they are in familiar settings, including in the home.

Other symptoms could include:

  • Changes in mood or personality
  • Confusion as to time or place
  • Difficulty with routine tasks, such as doing laundry, sweeping, or cooking
  • Difficulty recognizing common objects
  • Difficulty recognizing people
  • Frequently misplacing things

Aging can result in impaired memory, but Alzheimer's disease results in more consistent periods of forgetfulness.

Over time, a person with Alzheimer's may need more and more help with activities of daily living, such as brushing teeth, getting dressed, and cutting food. They may become easily agitated, restless, experience personality withdrawals, and have difficulty speaking.

According to the National Institutes of Health, the survival rate for a person with Alzheimer's disease is usually 8 to 10 years  after symptoms first appear. Because a person cannot care for themselves or they may not recognize the importance of eating, common causes of death include malnutrition, body wasting, or pneumonia.

When to see a doctor

Discussing the need for medical attention regarding memory changes can be challenging, but it is important to seek help to rule out other conditions. Other conditions that can cause dementia include a UTI  or a brain tumor.

Yes, Virginia there is a Santa Claus.....

Dear Editor -- I am 8 years old. Some of my little friends say there is no Santa Claus. Papa says ''If you see it in The Sun it's so.'' Please tell me the truth, is there a Santa Claus?

--Virginia O'Hanlon, 115 West 95th Street

Virginia, your little friends are wrong. They have been affected by the skepticism of a skeptical age. They do not believe except what they see. They think that nothing can be which is not comprehensible by their little minds. All minds, Virginia, whether they be men's or children's, are little. In this great universe of ours man is a mere insect, an ant, in his intellect, as compared with the boundless world about him, as measured by the intelligence capable of grasping the whole of truth and knowledge.

Yes, Virginia, there is a Santa Claus. He exists as certainly as love and generosity and devotion exist, and you know that they abound and give to your life its highest beauty and joy. Alas! how dreary would be the world if there were no Santa Claus! It would be as dreary as if there were no Virginias. There would be no childlike faith then, no poetry, no romance to make tolerable this existence. We should have no enjoyment, except in sense and sight. The eternal light with which childhood fills the world would be extinguished.

Not believe in Santa Claus! You might as well not believe in fairies! You might get your papa to hire men to watch in all the chimneys on Christmas Eve to catch Santa Claus, but even if they did not see Santa Claus coming down, what would that prove? Nobody sees Santa Claus, but that is no sign that there is no Santa Claus. The most real things in the world are those that neither children nor men can see. Did you ever see fairies dancing on the lawn? Of course not, but that's no proof that they are not there. Nobody can conceive or imagine all the wonders there are unseen and unseeable in the world.

You tear apart the baby's rattle and see what makes the noise inside, but there is a veil covering the unseen world which not the strongest man, nor even the united strength of all the strongest men that ever lived, could tear apart. Only faith, fancy, poetry, love, romance, can push aside that curtain and view and picture the supernal beauty and glory beyond. Is it all real? Ah, Virginia, in all this world there is nothing else real and abiding.

No Santa Claus! Thank God! he lives, and he lives forever. A thousand years from now, Virginia, nay, ten times ten thousand years from now, he will continue to make glad the heart of childhood.

"Sniff Test" Can Enhance the Accuracy of Diagnosing of Alzheimer's

Tests that measure the sense of smell may soon become common in neurologists' offices. Scientists have been finding increasing evidence that the sense of smell declines sharply in the early stages of Alzheimer's, and now a new study from the Perelman School of Medicine at the University of Pennsylvania published today in the Journal of Alzheimer's Disease confirms that administering a simple "sniff test" can enhance the accuracy of diagnosing this dreaded disease.

The sniff test also appears to be useful for diagnosing a pre-dementia condition called mild cognitive impairment (MCI), which often progresses to Alzheimer's dementia within a few years.

Neurologists have been eager to find new ways to identify people who are at high risk of Alzheimer's dementia but do not yet show any symptoms. There is a widespread consensus that Alzheimer's medications now under development may not work after dementia has set in.

"There's the exciting possibility here that a decline in the sense of smell can be used to identify people at risk years before they develop dementia," said principal investigator David R. Roalf, PhD, an assistant professor in the department of Psychiatry at Penn.

Roalf and his colleagues used a simple, commercially available test known as the Sniffin' Sticks Odor Identification Test, in which subjects must try to identify 16 different odors. They administered the sniff test, and a standard cognitive test (the Montreal Cognitive Assessment), to 728 elderly people.

The subjects had already been evaluated by doctors at Penn with an array of neurological methods, and according to expert consensus had been placed in one of three categories: "healthy older adult," "mild cognitive impairment," or "Alzheimer's dementia." Roalf and his team used the results from the cognitive test alone, or combined with the sniff test, to see how well they identified subjects in each category.

As researchers report, the sniff test added significantly to diagnostic accuracy when combined with the cognitive test.

For example, the cognitive test alone correctly classified only 75 percent of people with MCI, but that figure rose to 87 percent when the sniff test results were added. Combining the two tests also enabled more accurate identification of healthy older adults and those with Alzheimer's dementia. The combination even boosted accuracy in assigning people to milder or more advanced categories of MCI.

"These results suggest that a simple odor identification test can be a useful supplementary tool for clinically categorizing MCI and Alzheimer's, and even for identifying people who are at the highest risk of worsening," Roalf said.

Prompted by prior studies that have linked a weakening sense of smell to Alzheimer's, doctors in a few larger dementia clinics already have begun to use smell tests in their assessments of elderly patients. Part of the reason the practice has not yet become common is that the tests that seem most useful take too long to administer. Roalf and colleagues are now trying to develop a briefer test that works as well as the longer ones.

"We're hoping to shorten the Sniffin' Sticks test, which normally takes 5 to 8 minutes, down to 3 minutes or so, and validate that shorter test's usefulness in diagnosing MCI and dementia—we think that will encourage more neurology clinics to do this type of screening," Roalf said.

Roalf and his laboratory also plan to investigate whether protein markers of Alzheimer's, which are present in the olfactory region of the brain before dementia occurs, can be detected in nasal fluid to provide an even earlier warning of the disease process.

Studies suggest that a high proportion of older adults who have cognitive impairment are not identified as such, in part due to lack of adequate screening.

 Journal reference: Journal of Alzheimer's Disease 

Provided by: Perelman School of Medicine at the University of Pennsylvania

Memory Loss and Dementia

When is memory loss associated with dementia?

Memory loss is often one of the first signs of dementia, especially Alzheimer's disease. Initially, memory lapses may be mistaken for the normal forgetfulness that often increases as people grow older, or when they become stressed. However, in someone with dementia it will gradually become clear that the memory problems are becoming more severe and persistent. This will often be more apparent to family and friends than to the person themselves. Memory loss will also be accompanied by changes in the way the person thinks, behaves and feels. This can make it even more difficult to cope with everyday life.

Memory loss affects each person differently, as do all aspects of dementia. For example, some people with dementia retain certain skills for much longer, while others need assistance earlier on. A person may recall a surprising range of facts or experiences, especially memories from earlier in their life, but may forget recent events or familiar situations.

Memory loss in dementia

People with dementia will often experience difficulties with their memory, which interfere with their day-to-day activities. This memory loss is often due to damage in a part of the brain called the hippocampus, which plays a very important role in day-to-day memory. Damage to different parts of the brain will affect different kinds of memory.

While memory loss affects everyone differently, many people with dementia experience problems with the following:

  • forgetting recent conversations or events
  • struggling to find the right word in a conversation or forgetting names of people and objects
  • losing or misplacing items (eg keys or glasses) around the house
  • struggling with familiar tasks, eg making a cup of tea
  • forgetting appointments or anniversaries
  • taking medication (eg not remembering whether a regular dose has been taken)
  • getting lost in familiar surroundings (such as the neighbourhood they live in) or on familiar journeys (eg to the shops)
  • recognizing faces (even of those closest to them).

As the person's dementia progresses,  their memory will get worse. In the early stages, the person's long-term memory is often less affected. This is probably because older memories - which are thought about more often - become more firmly established and are more likely to be recalled than newer memories.

Memory also has an emotional aspect. Emotions influence what and how a person remembers and some memories can make the person feel a certain way. Memories can often be triggered by just one part of the memory, such as music or smell. People's emotional memory is affected much later on in dementia. Before this happens, people can often remember how they felt about something, even if they can't recall other details about it. For example, a person with dementia may not remember where or when they went on holiday, but they will remember how they felt when they were there.

There are some things that people with dementia may be able to recall for longer. These include:

  • things that happened long ago, especially in late adolescence or early adulthood
  • things that have been done many times, eg a route to school or work
  • things that have been rehearsed and practised over and over again, eg playing a musical instrument or dance steps
  • events or dates that made people feel strong emotions (eg births or marriage, or dates like September, 11 2001 or the assassination of John F. Kennedy)

The emotional impact of living with memory loss

Memory loss can lead to many practical difficulties for a person. It can also have a strong effect on how they and those supporting them feel. Everyone will react differently to their memory problems, but many people become frustrated or worried by them. They may lose self-confidence and be embarrassed by their difficulties. Memory problems can also lead to a person withdrawing from situations or stopping doing things they usually do. They may accuse others of having moved or stolen items they have misplaced. It is important to be aware of these difficulties and find ways to provide support. The following suggestions might help.

  • Encourage the person to talk about how they are feeling.
  • Support the person with any frustration they may be feeling, for example by talking through issues and looking for ways to manage them.
  • Support the person to cope with the difficulties they face on a day-to-day basis, rather than focusing on what may happen in the future.
  • Support the person to focus on what they can still do, and encourage them to continue doing these things.
  • Encourage the person to continue spending time with other people, and to take part in meaningful activities as much as possible.
  • At times, it may be best to change the conversation or activity to try and remove any frustration the person may be feeling. Do this sensitively - it is important not to undermine the person or dismiss their feelings.

Those supporting the person with dementia are also likely to feel a range of emotions due to the person's memory loss. Remembering that the person's difficulties are because of their dementia may help you to deal with these feelings.

There may be concerns that the person's memory loss will put them at risk. Using assistive technology products (eg a gas detector) can help to reduce the risk. If the person is able to make decisions, it is important that they are supported to do so . Very often, it is a case of balancing the risks against the benefits, and using this to find a suitable solution.

Supporting someone with memory loss

Forgetting recent conversations or events

People with memory problems will find it hard to store, and then remember, recent conversations and events. The part of the brain,  (the hippocampus) that allows new information to be processed may be damaged. This makes it harder for the person to form new memories and learn new information. The person may forget a conversation they've had, something they've recently done, or an appointment or plan. It is important to remember that the person isn't being difficult or ignoring you. Their brain hasn't kept the information, and so it may feel like the first time they've heard it. The following tips may help.

  • Avoid telling the person they have heard the information before.
  • Ask yourself whether it really matters if the person remembers a recent conversation or event. Forcing the matter can makes things worse.
  • Set up a regular routine. This can make it easier for the person to remember what is going to happen during the day.
  • Encourage them to use a diary or journal to record things that have happened. Pictures and words are useful tools. They can be used to remind the person what they have done, as a conversation starter.
  • Include cues and prompts, and try to give context, instead of asking vague questions. For example, 'It must be a while since breakfast. Are you hungry?' rather than 'Have you had breakfast?'
  • Consider using reminders such as sticky notes or a wall calendar for one-off tasks, and more permanent reminders for tasks the person does more often (eg keeping a note by the door for keys and wallet).
  • Focus on one thing at a time: giving the person too much information may be overwhelming.
  • Keep information simple, and repeat it often (if necessary).
  • Reduce distractions such as background noise.
  • Keep questions simple and specific, eg 'Do you want tea or coffee?' rather than, 'What would you like to drink?' This helps the person to make a choice by narrowing down options.

Struggling to find the right word

People with dementia may have difficulties finding the right word in a conversation. They may also struggle with remembering names of items or people. They may:

  • struggle to find the right word in a conversation (eg saying shoe instead of chair) or seem stuck because the word is 'on the tip of their tongue'
  • struggle to remember the meaning of words
  • forget people's names even if they know them well
  • forget the names of objects (eg knife, book, tree).

These difficulties can make it harder to communicate with a person with dementia. However, there are a number of ways to support conversation.

  • Give the person enough time to find the word, but try not to leave it so long that the person becomes embarrassed.
  • Consider the context of what the person is saying - this may give clues to the word they are trying to find.
  • Turn down background noise and try to make sure the environment is not too distracting.
  • Consider the time of day when the person is at their best. This may be in the morning when they have more energy.
  • Don't rush the person. If they feel stressed or under pressure it may make things worse. Be patient and don't complete the sentence for them.

Tips: supporting a person with dementia when they forget the names of objects and people

  • Try to find tactful ways to give the person reminders or prompts (eg 'Here's our neighbour, Bill').
  • Try not to put the person on the spot or say things that highlight they have forgotten the person's name (eg 'You must remember who this is?').
  • It's much harder for the person to remember names if they're tired or stressed. Try to wait until they're feeling a bit better.
  • Ask the person whether it would be helpful for other people to introduce themselves when they speak to them. This may depend on how the person feels about their difficulties and whether they are happy for others to know.
  • Use prompts, cues and context to help with naming items. The person may recognise something and what it is used for, even if they can't remember its name.
  • Consider using a 'memory book' or 'memory box' with photos and brief information on people (eg name, relationship) for the person with dementia to refer to.
  • Try not to visit places that are too busy, eg markets - the person may cope better in situations with fewer people.

Reprint:  Alzheimer's Association/UK