For the past month at Compass on the Bay, local musician, Doug Robinson has been creating individualized listening programs for each of the residents, based on their own favorite music, responses to songs and recollections. In addition, he encouraged residents with a musical past to play at his keyboard.

At the age of fourteen, Gloria Tyrol performed in a piano concert at Carnegie Hall in New York City. Hours of practice led to her playing Malaguena from Suite Andalucia by Ernesto Lecuona, with great composure and precision.

Now, more than sixty years later, she is a resident at Compass on the Bay, coping daily with memory loss associated with dementia. She is reluctant to play at the piano, perhaps fearing the loss of perfection in her original pieces.

However, with great pride, she played her own famous piece from Carnegie Hall in one of the recent Music Focus groups with Doug Robinson. Placing her fingers on the keys, the memories began to flow along with the music, as she shared her experience and recollections from her original concert.

At Senior Living Residences, innovative programming is measured in individual accomplishments. Re-playing an important concert, remembering your past and connecting with your own self with pride is a true measure of innovation.

The guidelines issued by the National Institute on Aging and the Alzheimer’s Association, break the disease into three distinct stages. The stages are preclinical Alzheimer’s disease, mild cognitive impairment due to Alzheimer’s disease and Alzheimer’s dementia. Preclinical, a newly recognized stage describes a time when a person appears healthy, but has amyloid deposits occurring in the brain, a noted hallmark of the disease. Researchers believe this occurs ten years before the onset of symptoms and can be identified by sensitive scans. The guidelines also officially recognize mild cognitive impairment as part of the disease. These stages will not be used in clinical diagnosis at this time, but in the research setting.

Finally, the guidelines expand the criteria for dementia, including impairment in visuals/special function, judgment and reasoning. The former guidelines only recognized declines in memory functions.

The new guidelines will assist researchers in discovering interventions at the earliest stage of this disease, the preclinical one. It is believed the preventative measures and treatments would be most effective at that point in the disease course as compared to later in the illness.

The Reconnections Program is a curriculum-based adult learning program with courses focused on the residents’ past and present interests and developed to elicit an engaged response. The program gives residents a multitude of ways to re-connect with their past experiences, re-engage with past learned materials and benefit form the joy of learning.

This month residents are engaging in the following Reconnections program:

New Year Customs, Traditions and Celebrations: In cities the world over, the new year is marked and celebrated. Get out your list of resolutions as we delve into the ancient Roman’s first New Year’s festivities and the role Julius Caesar played in our current tradition. Travel the globe and discover cultural customs for marking the turning of the calendar page.

Destination California, Popular Sites and History of the Golden State: Discover all that the “Golden State” has to offer, from sweeping views of the Pacific Ocean, to the majestic Redwoods, and the heat of Death Valley. Retrace the dramatic population changes brought about by the Gold Rush of the 1800’s and visit the states current tourist cited “most popular” destination cities.

Heroes, History and Tales: World leaders, brave soldiers, everyday citizens, who do we count among our heroes? Join us as we discuss the qualities of a hero, review individuals marked as heroes historically, and name individuals who are recognized today.

America’s Inventions: Innovations and Pursuit: What inventions stand out in history? What inventions have changed our daily lives? Learn to play the glass armonica as we explore the inventions of Benjamin Franklin, discover how Leonardo DaVinci protected his plans, discoveries and “modern day” inventions. Turn on the lights and imagine the “lab” of Thomas Edison. Tell us about your own invention idea as we explore this innovative field.

Animals in Our Lives Then and Now, People and their Pets: Depicted on the walls of tombs, “pet” ownership dates back to the ancient Egyptians. Learn about the historical role that animals played in the lives of the ancient Egyptians and trace their role, through time, to current day. What has changed in this current period of pet ownership and what roles do animals play in our lives today, that they have not in the past?

• Is your loved one able to keep the house and yard as clean as before? Do you notice laundry piling up? Do the floors, furniture and bathrooms need to be cleaned?
• Is your loved one able to retain personal cleanliness? Can your Mom or Dad shower and bathe regularly without help? Has personal hygiene changed?
• Has your loved one fallen behind on bills? Is old mail piling up? Do you notice clutter that was never there before?
• Is your Mom or Dad able to manage their medical care, schedule and remember regular appointments? Can they explain and follow through with medical recommendations?
• Are medications in order? Do you know if your Mom or Dad is taking his or her medications as prescribed? Can they name their medications and their use?
• Has your loved one been repeating themselves?
• Does your loved one interact in a socially appropriate manner for light conversation, and yet if the conversation becomes more complex, they do not follow or respond appropriately?
• If you have one parent that you are worried about, does the other parent often answer for them?
• Does your loved one frequently misplace items? Do you ever find items in an unexpected place?
• Is your loved one still cooking proper nutritious meals every day? Is he or she maintaining a healthy weight and getting some form of exercise?
• Do you worry about your loved one’s safety when alone and cooking?
• What is the condition of the items in the refrigerator? Are food items adequate in supply and not expired by date or appearance?
• Has your Mom or Dad lost interest in day to day activities and social activities? Does your loved one make excuses why they don’t participate with friends or engage in social events or church activities?
• Do you think your loved one feels isolated or lonely?
• Does your loved one forget your recent visits or calls?
• Does your loved one seem to be withdrawn, fearful or depressed? Has his or her manner or character changed?
• Has your loved one’s driving ability diminished? Have you questioned if they should still be driving? Has your loved one become lost while driving a familiar route?
• Has your loved one experienced a crisis situation recently such as a hospitalization or an episode of wandering away from home and not remembering how to get back?
• Does your loved one deny any problems or refuse to discuss the situation, even though you may have answered “yes” to several of the above items?

It is estimated that over 65% of those with dementia will wander at some point, so it is critical for caregivers to monitor their loved ones and be alert for any signs of wandering (see below). However, it is often difficult to balance one’s need for a degree of personal freedom with the necessity of protecting him or her from the dangers of wandering. When a person with Alzheimer’s disease does begin to wander, it is important to recognize the confusion and help him or her refocus on real-life tasks.

According to the Alzheimer’s Association, a person may be at risk for wandering if he or she:

• Returns from a regular walk or drive later than usual
• Tries to fulfill former obligations, such as going to work
• Tries or wants to “go home” even when at home
• Is restless, paces or makes repetitive movements
• Has difficulty locating familiar places like the bathroom, bedroom or dining room
• Checks the whereabouts of familiar people
• Acts as if doing a hobby or chore, but nothing gets done
• Appears lost in a new or changed environment

The Alzheimer’s Association also provides a list of tips to aid those with Alzheimer’s who are susceptible to wandering and their caregivers:

• Encourage movement and exercise to reduce anxiety, agitation and restlessness
• Ensure all basic needs are met (toileting, nutrition, thirst)
• Involve the person in daily activities, such as folding laundry or preparing dinner
• Place color-matching cloth over doorknobs to camouflage
• Redirect pacing or restless behavior
• Place a mirror near doorways. The reflection of a person’s own face will often stop him or her from exiting the door.
• Reassure the person if he or she feels lost, abandoned or disoriented .
• Enroll the person in MedicAlert + Safe Return.
• Inform your neighbors and local emergency responders of the person’s condition and keep a list of their names and telephone numbers.
• Keep your home safe and secure by installing deadbolt or slide-bolt locks on exterior doors and limiting access to potentially dangerous areas.
• Never lock the person with dementia in a home without supervision.
• Be aware that the person may not only wander by foot but also by car or other modes of transportation.

MedicAlert and Safe Return:

Keep your loved one safe by knowing the risk factors for wandering and enrolling in MedicAlert® + Alzheimer’s Association Safe Return®, the Alzheimer’s Association’s 24-hour nationwide emergency response service for individuals with Alzheimer’s or related dementia that wander or who have a medical emergency.

More information

Wandering – Preparing For and Preventing It (2 pages)
Wandering: Who’s at Risk? (2 pages)

Those with memory loss live in a different reality from our fast paced, noisy lives. Theirs is slow, quiet, and based in the remote past which is a predictable place in its familiarity of people and routines. They cannot sustain staying in the present; it is too difficult and confusing. Retreat into the past with your loved one and you will have a better than good visit!

• Plan a time limit on your visit that you are comfortable with – as few as 15 to 20 minutes can make for a good visit.
• Slow down your pace and your mind before entering your loved one’s space.
• If possible, turn off background noises, such as the TV and music, when having a conversation.
• Identify yourself each time. If he or she doesn’t know who you are, introduce yourself by your first name, “Hi Mom. Brad, your son, is here to spend some time with you.” It may take a full minute for your loved one to orient to you being there and to recognize who you are.
• Address one topic at a time. Don’t jump from subject to subject, especially in mid-sentence. Processing information is slowed in the brain of a person with Alzheimer’s. Sometimes it takes a full minute or longer for the brain to accept a message, make some sense of it, and formulate a response.
• Plan a task to be accomplished while you’re there, such as a short walk with easy, slow talk (you’ll probably carry most of the conversation), reading a story, listening to music together, or giving your mom a manicure.
• Communicate positive feelings through quiet hand holding, a light back rub, or a hand resting on the back or forearm. Always approach your loved one from the front before touching so he or she isn’t startled.
• Talk slowly and simply. Avoid complex concepts and repeat information as necessary to be clear.
• Avoid arguing with your loved one’s perceptions of things and don’t correct your loved one when he or she is wrong. Sometimes saying nothing works best. You always lose an argument with a confused person!
• Avoid long explanations, e.g., why your loved one must do something.
• Enjoy being in his or her world. Do not reality-orient or correct his or her memories or perceptions of things.
• Avoid questioning and quizzing. Avoid questions asking what, who, when, and especially why. Questions that can be answered “yes” and “no” are best.
• When asking a person with dementia to make a decision, offer only two choices, either of which is acceptable. More than that is too much for the brain to deal with now. For example, “Do you want to walk with me now, or talk together first?”
• Know that your presence alone brings peace and comfort to your loved one!

Relating to those with memory loss can often be challenging. It’s helpful to keep in mind that their behavior is their way of staying in touch with what is going on to feel in control of their lives. We understand that. The personal caregivers and Social Program Directors in our Memory Support Neighborhoods are trained in the habilitation method of memory care with a focus on maximizing the independence of each resident, as well as creating positive emotional experiences using all of the techniques and tips outlined here.

TIPS COMPLIMENTS OF

Beverly Moore, RN CS, Alzheimer Coaching Services, 617-233-1145

Living in silent anxiety, these seniors are often mistakenly viewed as being able to maintain their daily needs at home alone. Additionally, many individuals with mild memory loss live in “traditional” assisted living and senior housing communities yet are not receiving specialized memory care. In Massachusetts, for example, almost 30% of seniors living in “traditional” assisted living apartments have a medical diagnosis of Alzheimer’s or related dementia.*

In reality, without specialized treatment for the symptoms of their memory loss, anxiety increases and cognitive function declines more rapidly. Often, individuals suffer from increased isolation and depression.

How do you recognize someone who might have MCI? Look for these early symptoms:

• Forgetting to take medications as prescribed by the physician
• Difficulty maintaining a proper nutritionally balanced diet
• Increased difficulty with executive functioning, which includes losing or forgetting to pay bills, not being able to balance the checkbook, missing appointments, difficulty with decision making, and poor judgment in emergency situations
• Forgetting names and places and getting names of relatives confused (such as mixing up mothers and daughters)
• Increased anxiety
• Losing short-term memory, which often is noticed by repetitious stories

Senior Living Residences’ communities provide a supportive nurturing environment for individuals experiencing a wide range of memory issues with programming that actually treats the symptoms of their memory loss. Our innovative and extensive treatment program includes a specialized brain-healthy diet, a curriculum-based learning program designed specifically for individuals with memory loss, extensive staff training and resident case review by a Boston University School of Medicine Alzheimer’s clinician, and more.

The latest research is suggesting that treatment interventions, such as ours, may actually slow the progression of Alzheimer’s disease, minimizing the cognitive decline of seniors.

*According to Massachusetts Executive Office of Elder Affairs 2008 data, almost 30% of seniors living in “traditional” assisted living apartments in our state have a medical diagnosis of Alzheimer’s or related dementia. EOEA, 2008 Annual Report, Assisted Living Resident Aggregate Information

Researches at UCLA followed 169 study participants diagnosed with Mild Cognitive Impairment (MCI), the stage between the cognitive decline associated with normal aging and the more serious changes associated with Alzheimer’s disease. Over a three year period, they took pictures of the brains of the individuals in the study, using sophisticated imaging and noting subtle changes over time.

After three years, the researches observed that the individuals who converted from MCI to Alzheimer’s disease showed changes in the hippocampus of the brain, specifically a 10-30 percent atrophy. The early changes noted in the brain imaging appeared before participants reported any decrease in functional ability related to Alzheimer’s disease.

Lianna Apostolova, senior author, of the study’s related paper and a member of the UCLA Laboratory of Neuro Imaging stated, ““We feel this is an important finding because it is in living humans.” She went on to say, “Now we have a sensitive technique that shows the ‘invisible’ – this is, the progression of a disease before symptoms appear.”

www.nature.com/.../n1s/full/jcbfm2009170a.html

As with Alzheimer’s disease, there is no simple way to reach a diagnosis of Mild Cognitive Impairment (MCI). Individuals who notice symptoms associated with MCI, including forgetting appointments and details of recent events or conversations as well as frequently repeating conversations and information, should speak to their physician.

During the diagnostic process, one can expect to be asked a number of questions about noted changes, history of symptoms and a family health history. In addition, the physician may ask to speak with a family member or close friend, to ask about observation of symptoms.

From there, a number of tests will be conducted to eliminate other potential causes for memory loss including: a complete physical exam, blood tests, an evaluation for depression or other mental illness, brain imaging, and a neuropsychological assessment.

The process is very involved, but once completed offers a clear picture of what is causing memory changes. It is important to note that not all memory change is caused by Alzheimer’s disease. At times, memory loss may be caused by an acute condition that can be treated. Also, as researchers learn more and more about memory loss, recognition of the earliest changes in cognition will lead to the most effective treatment.

Among scientists and many lay people, it is well known that beta-amyloid is a destructive force to nerve cells in people suffering from Alzheimer’s disease. Beta-amyloid builds up in the brain, clumping in neurons and forming damaging deposits knows as plaque. This plaque is one of the hallmarks of Alzheimer’s disease.

In the disease process, the beta-amyloid damages and eventually kills neurons, brain cells. Many research studies have focused on the damaged nerve cells in trying to understand this process towards seeking a possible prevention and treatment.

In this new study, researchers from UCF looked at smaller amounts of beta-amyloid and its effect on healthy nerve cells. The scientists found that this more moderate exposure to the beta-amyloid has an effect on the cells, preventing the normal transfer of electronic signals in the brain.

The discovery is important in that it provides evidence that changes are occurring in the brain well before there are any noted changes to memory or behavior, that is, symptoms of the disease. This information may be valuable in the quest for a treatment that works in the earliest stages of the disease, suitable for an individual with the mild cognitive impairment.

More research is needed to fully understand the role of beta-amyloid in Alzheimer’s disease as well as potential treatments.