Now, researchers in Spain have discovered that adding two healthy fats to the basic “Mediterranean Diet” each day will boost your brain health even more. In the study, people who consumed extra virgin olive oil and a handful of nuts daily were less likely to show the early signs of dementia than those who stuck to the basic Mediterranean diet. The nuts used in the study were walnuts, almonds and hazelnuts and the olive oil was specifically “extra virgin”.

“Our findings support increasing evidence on the protective effects of the Mediterranean Diet on cognitive function,” Miguel Martinez-Gonzalez of the University of Navarra in Spain and colleagues reported in the Journal of Neurology, Neurosurgery and Psychiatry.

The study volunteers, aged 55 to 80, were all at high risk of heart disease because of diabetes, a family history of the disease, high blood pressure, unhealthy cholesterol levels — or they were overweight or smokers. They were randomly assigned to either add more extra-virgin olive oil to their daily diets, a daily handful of the mixed nuts, or just a standard diet with advice to cut fat. Such “randomized” studies are considered more powerful, because people don’t choose which diet to adopt — and so other outside factors don’t interfere with the results.

Maggie Fox, Senior Writer for NBC News interviewed the study author, Mr. Martinez-Gonzalez, and provides a good synopsis of why researchers believe that that adding olive oil and nuts to the diet might protect the brain.

Olive oil and nuts could reduce damaging inflammation, Martinez-Gonzalez said, because they contain monounsaturated fats, which are better for artery health than the saturated fats found in butter, meat and lard. These foods are also high in fiber and vitamin E, as well as minerals. Walnuts are rich in omega-3 fatty acids. Some other studies have suggested that extra virgin olive oil — which is cold-pressed and unrefined — might fight the beta amyloid “plaques” found clogging the brains of Alzheimer’s patients. “A third mechanism may be that an improvement in vascular health leads to better brain blood flow,” Martinez concluded.

In closing, we know that all of the nutrients found in the Mediterranean Diet foods protect against the oxidative damage that can cause heart disease, cancer and Alzheimer’s. Various studies have shown little benefit from taking vitamins alone, but this large-scale Spanish study shows that a combination of healthful foods and nutrients does seem to have an effect on overall brain health.

For more information, read the NBC News article

Our frequent guest blogger,  Nancy Emerson Lombardo, PhD, Creator of the Memory Preservation Nutrition® Program also wrote about this study recently on her Brain Health Blog.

So how is mental capacity determined with regard to legal matters?

As a threshold, when a client initially meets with an attorney, the attorney must determine whether or not the client has the requisite mental capacity necessary to reasonably articulate his or her wishes concerning their legal affairs. Testamentary capacity is a legal term that refers to one’s ability to be of sound mind in reference to altering or creating estate-planning documents.

Unfortunately, legal testamentary capacity or competence is not a black-and-white determination.

In general, the requirements of testamentary capacity are fairly simple. The testator must meet only this minimal test at the moment the estate-planning documents are executed. Therefore, documents may be valid even if the testator is in the midst of delusion immediately prior to and subsequent to execution, as long as the testator possesses the requisite testamentary capacity at the moment of execution. So, even if the testator does not recall signing the document the day following execution, it does not invalidate the document if the testator understood it when he or she signed it.

The mere existence of the onset of dementia does not preclude the signing of estate-planning documents, provided that the necessary criteria for mental capacity are met. However, the drafting of, or revisions to, current estate-planning documents should be considered in the early stages of dementia.

The attorney’s duty to confirm a client’s testamentary capacity exists in every estate-planning matter, and confirmation is usually determined while conversing with the client.

The attorney should inquire further at the first sign that the client may not have testamentary capacity.
It is important to confirm that forgetfulness is not a sign of a larger capacity issue, because not every forgotten fact or misstatement results from incapacity.

Clients may exhibit varying degrees of lucidity depending upon factors such as time of day, location of the meeting, and the presence or absence of family members. Attorneys should attempt to schedule the appointment at a time and in a place in which the client is likely to be functioning at their highest level.

In order to curtail the potential of a contest, the attorney must determine if the testator has the requisite mental capacity. In the event that the testator has reduced mental capacity due to dementia, the attorney must be well-informed of the diagnostic steps and stages of the disease to determine testamentary capacity. Estate planners should include a standardized series of questions designed to confirm testamentary capacity in every estate-planning matter to ensure that they are fully focused on the question of capacity. These noninvasive questions provide probative evidence and also increase credibility to the attorney’s testimony in a subsequent litigation contesting the client’s capacity.

Typically, the attorney does not have the requisite skill to make definite capacity determinations in complex cases. As such, physicians and other health care workers should be engaged. Doctors and other medical personnel cannot personally make a determination as to whether or not an individual has testamentary capacity, since only a judge has the authority to render a person incompetent. However, they can provide a professional evaluation that will both help the attorney make this decision and provide significant evidence in the event of a subsequent incapacity challenge. As such, it is imperative for the drafting attorney to keep accurate and complete records of any evaluations.

In the event that the client has been deemed to not have the requisite testamentary capacity to execute their estate- planning documents and does not have a health care proxy and/or a durable power of attorney, a guardianship and/or conservatorship may be necessary.

• Guardian: a person appointed by the probate and family court to handle the personal affairs of an ‘incapacitated person’
• Conservator: a person appointed by the court to manage the estate of a protected person

Petitioning the court for a guardian and/or conservator is a potentially costly, time-consuming, and public process that should be avoided if possible. As such, if your loved one has been diagnosed with dementia, they should immediately contact an experienced estate-planning attorney.

It is essential that the individual making decisions relative to their estate-planning considerations have the testamentary capacity to do so. Oftentimes, the determination is a joint effort by attorneys and medical personnel to confirm the capacity of a client. Attorneys must ensure that additional measures are undertaken, especially with those inflicted with the onset of dementia, to reduce the likelihood of a contest.

Todd C. Ratner is an estate-planning, business, and real-estate attorney with the law firm Bacon Wilson, P.C. He is a member of the National Academy of Elder Law Attorneys and the Estate Planning Council of Hampden County; (413) 781-0560. Find him on LinkedIn

There have been amazing strides in the scientific community over the past 5-10 years with regard to understanding the cause of Alzheimer’s disease, developing more accurate methods of diagnosing it during life, and creating new treatments that may actually modify the disease course.  These advances have been possible due to the devotion and talent of the scientists, financial support for researchers (from the National Institute on Aging and other federally-funded agencies, private foundations such as the Alzheimer’s Association, individual philanthropists, and elsewhere), and the commitment and vision from industry (e.g., pharmaceutical companies, neuroimaging companies).  The technological advances in our ability to diagnose and treat the disease all start in the basic science laboratories where it typically takes many years of trial and error and numerous experiments to develop a procedure or medicine that can finally be studied in humans.  And that is now where we need everyone’s help.  To get new treatments or devices from the early stages of development in laboratories and in animals to FDA approval for use in human beings is a long and tremendously costly journey, with many “failures” along the way.  Believe it or not, one of the major costs of this journey, both in terms of money and time, involves recruitment of individuals to participate in the research. It always seems to be a surprise to people to hear about this. People seem to think that research centers are full of volunteer research participants and, therefore, there is no need for them to participate. This could not be further from the truth.  Even major medical centers with well-known Alzheimer’s disease research programs such as the BU ADC are in tremendous need for research participants.

What type of research is available?  There are many, many ways to get involved.  There are clinical trials to test new treatments for those with AD, and now there are actually clinical trials for mild cognitive impairment [MCI] or prodromal Alzheimer’s disease.  Soon there will be clinical trials for people who don’t yet have any symptoms but who show evidence (on special spinal fluid tests or PET scans) of having the brain changes of early Alzheimer’s disease.  However, there are also some studies that just focus on the caregiver.  Some studies involve only a one- or two-time visit to help develop new methods of diagnosing Alzheimer’s disease at even the pre-symptomatic stage of the disease.  Some studies address issues of everyday life and independent functioning.  Our “flagship” study, the Health Outreach Program for the Elderly (HOPE) involves an annual ½ day evaluation and is open to cognitively healthy individuals, as well as those with MCI or dementia, and provides participants and their doctors with feedback about how they are doing, as well as facilitates the participant’s involvement in other research studies.  And, we have just begun a new project associated with the HOPE study in which we are specifically recruiting individuals who played contact sports (e.g., football, hockey, boxing) in high school and college.  In other words, there is likely a research study to meet the interests of most people.  And, if there is not an appropriate study available today, it is likely that a new study will become available in a month or two that may be appropriate.

We often hear that many people are hesitant to come to the city and to a large medical center for research participation, often because of discomfort driving in city traffic or because of distance and cost.  However, many research studies at the BU ADC provide transportation for participants and study partners at no cost.  In addition, for some studies, like the HOPE study, participants can be seen at our satellite site in Bedford, MA or at the Boston Center for Memory in Chestnut Hill.  In other words, travel issues or concerns should never be the deterrent for participation.

Photo Credit: BU ADC http://www.bu.edu/alzresearch/research/

Participation in research is not merely an altruistic contribution to the scientific community’s critical work to eradicate Alzheimer’s disease, it also can provide important positive benefits to the participant.  These benefits include: a sense of empowerment by taking an active role in one’s own health care; a feeling of satisfaction that one is doing something to improve the health and well-being of the next and future generations; the potential of positive treatment outcomes with a new investigational drug other intervention; and a decreased sense of alienation and solitude by interacting with research staff who truly understand the disease and its toll on the patient, the caregiver, and family members. And, research participation fulfills that most important need for everyone touched by the disease: a sense of HOPE.  In fact, participating in research can almost be seen as a “treatment” in and of itself, in that the potential benefits described above can result in improved quality of life for the patient and caregiver alike.

Believe it or not, just ONE new research volunteer makes a tremendous difference in our mission.  A site like the BU ADC does not need hundreds of new research participants.  But every single new volunteer matters and matters a great deal.  In order for our center, and all other research centers, to make strides in our goal of quickly and cost-effectively developing successful treatments for Alzheimer’s disease we need your help.  Please think about participating in research if you or your loved one has Alzheimer’s disease or MCI. And, whether or not research participation is the right thing for you, please spread the word to make sure others affected by the disease know how important it is to participate in research. We need your help.

A version of this post appeared in the Fall 2011 Edition of the BU Alzheimer’s Disease Center Newsletter.

Photo Credit: Stltoday.com

The meaning of the Sanskrit word ‘yoga’ is ‘to join’ or ‘to unite’. The practice of yoga is known to form a union between the body, mind, and spirit. Having balance in these three areas often brings balance into the rest of one’s life.

Yoga for those with Alzheimer’s disease is a safe, effective way for them to stay physically strong as well as mentally engaged. Often exercise can stimulate areas of the brain that remain otherwise unused. A chair yoga class is a great first step for anyone looking to build strength and stay sharp.

During a chair yoga class all poses and stretches are performed seated in a chair or standing and holding on to the chair. This gives participants a good base of support while allowing them to stretch and strengthen safely.

The following exercises are examples of chair yoga poses that are appropriate for those with Alzheimer’s and can even be used for their own personal practice.

Seated Spinal Twist – Begin seated in a chair with both feet flat on the floor. Inhale the arms up overhead. Exhale and twist to the right. Place the left hand on the right knee and reach to the right as far as is comfortable with the right arm. Hold for three breaths. Inhale the arms up overhead again and repeat to the left.

Twisting poses bring circulation into the spine, release tight back muscles, and center the mind.

Single Leg Hamstring Stretch – Begin seated in a chair with both feet flat on the floor. Extend the right leg straight out and place a yoga strap or belt around the ball of the foot. Gently pull the leg up to release the hamstring and calf. Hold for three breaths. Repeat on the left leg.

Hamstring stretches relieve lower back pain, ease tension on the neck, and can create an inward focus while practiced.

Neck Release – Begin seated in a chair with both feet flat on the floor and the hands resting on the thighs. Inhale, lift the chin and look up at the ceiling. Exhale and lower the chin to the chest. Continue like this for six breaths. Be sure to stay in a range of motion that is comfortable and to use slow controlled movements.

Neck stretches loosen tight neck muscles, relieve headaches, and create peace of mind.

Kim Vareika is the  owner of Vareika Yoga. She is also a fitness writer and the current National Holistic Health, and National Fitness and Yoga Examiner.

Driving and dementia is a tremendously complicated and emotionally fraught issue for both patients and their families. Although Alzheimer’s disease and other degenerative dementias result in the progressive impairment of the cognitive skills necessary for safe driving and ultimately require driving retirement, there is great individual variability in how and when these disorders affect driving abilities. Some individuals with mild dementia drive safely for some period of time, while others are unsafe to drive soon after the onset of symptoms. The issue is further complicated by loss of insight that accompanies dementia progression, which may prevent an individual with dementia from making objective decisions about when limiting or stopping driving is necessary.

Deciding when an individual with dementia must reduce or stop driving can be one of the most stressful issues faced by individuals with dementia and their family members, often described as a struggle with the balance of personal independence and public safety. Driving allows individuals to independently stay engaged and connected to friends and family, enjoy an active lifestyle, and spontaneously meet their daily needs. In fact, today it appears that many baby boomers who are entering retirement are more active than previous generations. For many, however, driving is not merely a means of transportation, but, rather, a major aspect of overall independence, autonomy, and freedom. Therefore, as might be expected, driving cessation is associated with a reduction in out-of-the home activity for the retired driver and can cause depression, feelings of isolation, and loneliness. Driving cessation is considered by many to be one of the most significant and deeply personal losses they will face.

Due to the lack of routine screening or other mechanisms for detecting poor driving in older persons with cognitive impairment in Departments of Motor Vehicles, physicians and other health care professionals are often expected to be the ones to make recommendations to patients and their families about driving cessation. However, physicians often feel that they do not have adequate guidelines or assessments that they can use in the office to determine when patients are unsafe to drive. Additionally, physicians are concerned about harming the relationship with their patients and damaging the sense of trust, and may worry about the legal liability of their recommendations. While some physician guidelines advocate referring patients for a formal driving evaluation, physicians may be hesitant to recommend on-road driving assessments because they are expensive (~$500), not readily available outside of urban areas, and not covered by Medicare. Additionally, the progressive nature of dementia necessitates frequent re-testing, further reducing feasibility.

Ultimately, it is the family members who assume the primary responsibility for recognizing and addressing unsafe driving in their loved ones. However, they are left to face this daunting responsibility with few resources to assist them on how to initiate conversations, make decisions about driving cessation, and ultimately enforce these decisions.

There are several important issues that may prevent family caregivers from actively guiding the transition of their loved one from driver to passenger.

• fear of angry or agitated responses from the driver
• feelings of guilt and discomfort in taking away independence from their loved one
• anxiety about how transportation needs will be met (especially true for many older female caregivers who traditionally let their spouse do the driving)
• lack of knowledge about how to determine when driving safety is compromised
• lack of support from other family members in initiating conversations or taking action

Although driving cessation for individuals with dementia is such a difficult and emotional issue for everyone involved, there are several resources available that can help, such as At the Crossroads. In addition, the local chapter of the Alzheimer’s Association offers wonderful guidance as well as support groups for dementia caregivers and for early stage dementia patients. For people, interested in having an on-road driving evaluation, one excellent resource is the DriveWise Program at the Beth Israel Deaconess Medical Center. My group here at the Alzheimer’s Disease Clinical and Research Program (ADCRP) at BU School of Medicine and Boston Medical Center can also conduct office-based clinical evaluations of the cognitive skills necessary for safe driving. The important thing to remember for those dealing with this difficult issue is that you are not alone.

More resources on Driving and Dementia can be found here on the BU ADC site.

De-stressing your body not only makes you feel better, but it can enhance your interactions with others. Caring for a loved one can be a major cause of stress, and learning to diffuse this tension can allow you to continue giving them the love and care they deserve. Try these stretches the next time stress gets the best of you.

• Neck circles – Sit up tall with your back straight and your shoulders relaxed down away from your ears. Begin to circle the head toward the left shoulder. Inhale around the back and exhale around the front. Use the breath to release tension from tight areas. Repeat toward the right shoulder.
• Rag doll – From a standing position fold forward and reach toward the toes. Allow your head and neck to relax, and allow gravity to lengthen the spine. Grab on to each elbow and gently swing the body side to side to loosen up the lower back.
• Reclined spinal twist – Lie flat on your back and pull the knees to the chest. Place both arms straight out at shoulder height. Lower the legs to the left all the way to the floor and turn the head to the right. Exhale as you allow your body to relax further into the twist. Repeat lowering the legs to the right and turning the head to the left.
• Legs up the wall – Lie flat on your back and bring your tailbone as close to the wall as is comfortable. Swing both legs up extended straight and rest the heels on the wall. Allow your circulation to flow back to the heart as you rest your legs and decompress the spine.
• Lower back circles – Lie flat on your back and pull the knees to the chest. Bring your hands to your knees and begin to circle the legs in one direction. Gently massage out the lower back muscles against the floor. Repeat in the other direction.
• Anxiety soother – Lie on your belly with the forehead resting on the back of the hands. Relax the shoulders away from the ears. Turn the feet out and rest them on the inner edges to open the hips. Breathe deeply into your belly and use each exhale to relax further into the floor.

Kim Vareika is the  owner of Vareika Yoga. She is also a fitness writer and the current National Holistic Health, and National Fitness and Yoga Examiner.

Alzheimer’s disease begins slowly. The most common early symptom of the disease is difficulty remembering newly learned information, because changes usually begin in the part of the brain that affects learning. Over time, the symptoms progressively worsen, and include disorientation; mood and behavior changes; deepening confusion about events, time, and place; unfounded suspicions about family, friends, and professional caregivers; increasingly serious memory loss; and behavior changes, including wandering away from home and difficulty speaking, swallowing, and walking.

Eventually the person will require total care. This can cause great stress on family members and loved ones.

Signs of Alzheimer’s disease may be more apparent to friends and family members because people afflicted may have difficulty recognizing that they have a problem. If one suspects a loved one is experiencing Alzheimer’s-like symptoms, it is imperative to have the loved one see a physician as soon as possible.

A diagnosis of Alzheimer’s disease puts a person and his family in a position where they face special legal and financial issues. Alzheimer’s planning includes medical and nursing care, housing options, financial management, estate planning, and asset protection, which may include Medicaid planning. All too often, individuals will hesitate making important decisions because of the slow progression of the disease. This is a mistake, because any delay can prevent that individual’s meaningful input while their cognitive impairments deteriorate.

Early detection of Alzheimer’s disease makes a difference both for the person living with the disease and the caregiver. Early detection enables an individual to:

• Plan for the future by making legal, financial and care decisions;
• Begin treatment and enroll in clinical studies;
• Seek support from others in the same situation; and
• Identify community resources that can help

If a person is diagnosed with early-stage Alzheimer’s disease, they will often have the legal capacity to execute the necessary legal documents to ensure that their wishes are followed. As such, an attorney that specializes in estate planning and elder law should be retained immediately. At a minimum, the legal documents that need to be put in place include:

• Health care proxy for health decisions
• Durable power of attorney for financial decisions
• Will for the orderly distribution of assets upon the person’s demise

It is also critical to discuss long-term-care financing options, which may include Medicaid planning, with the attorney.

In the event that the person can no longer make his or her own health or financial decisions and does not have a valid health care proxy and durable power of attorney, a guardian and/or conservator must be appointed by a court to make decisions. Anyone can petition the court to be a guardian or conservator, and the judge ultimately makes the decision as to who is appointed. The guardian and/or conservator has the legal authority to make decisions regarding the person’s care and finances. This is an expensive, time-consuming, and public process, which may be eliminated by having a health care proxy and durable power of attorney in place, which names the person that you want to serve.

Alzheimer's disease to cost United States $20 trillion dollars over next 40 years. | Source: www.Alz.org

Alzheimer’s is not only a financial drain to those afflicted, but to our nation’s economy. In 2012, the direct costs to American society of caring for those with Alzheimer’s will reach an estimated $200 billion, including $140 billion in costs to Medicare and Medicaid. The average per-person Medicare costs for those with Alzheimer’s and other dementias are three times higher than for those without these conditions. Medicaid spending is 19 times higher. Unless something is done, the costs of Alzheimer’s in 2050 are estimated to total $1.1 trillion in today’s dollars. Costs to Medicare and Medicaid will increase nearly 500%.

Although current Alzheimer’s treatments cannot stop the disease from progressing, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those afflicted and their caregivers. Early diagnosis and intervention methods are improving dramatically. Today, there is a worldwide effort to find better ways to treat the disease, delay its onset, and prevent it from developing. Roughly 90% of what we know about Alzheimer’s has been discovered over the past 15 years. The hope is that this better understanding will lead to new treatments.


Todd C. Ratner is an estate-planning, business, and real-estate attorney with the Springfield-based law firm Bacon Wilson, P.C. He is a member of the National Academy of Elder Law Attorneys and recipient of Boston Magazine’s 2007-2012 Massachusetts and New England Super Lawyers Rising Stars awards. He also serves as the co-chairperson for the Alzheimer’s Association Tri-County (Hampden, Hampshire and Franklin) Partnership; (413) 781-0560; tratner@baconwilson.com | Find him on LinkedIn

“Dementia” is a term that has replaced a more out-of-date word, “senility,” to refer to cognitive changes with advanced age. Dementia includes a group of symptoms, the most prominent of which is memory difficulty with additional problems in at least one other area of cognitive functioning, including language, attention, problem solving, spatial skills, judgment, planning, or organization. These cognitive problems are a noticeable change compared to the person’s cognitive functioning earlier in life and are severe enough to get in the way of normal daily living, such as social and occupational activities.

A good analogy to the term dementia is “fever.” Fever refers to an elevated temperature, indicating that a person is sick. But it does not give any information about what is causing the sickness. In the same way, dementia means that there is something wrong with a person’s brain, but it does not provide any information about what is causing the memory or cognitive difficulties. Dementia is not a disease; it is the clinical presentation or symptoms of a disease.

There are many possible causes of dementia. Some causes are reversible, such as certain thyroid conditions or vitamin deficiencies. If these underlying problems are identified and treated, then the dementia reverses and the person can return to normal functioning. However, most causes of dementia are not reversible. Rather, they are degenerative diseases of the brain that get worse over time. The most common cause of dementia is Alzheimer’s disease, accounting for as many as 70-80% of all cases of dementia. Approximately 5.3 million Americans currently live with Alzheimer’s disease. As people get older, the prevalence of Alzheimer’s disease increases, with approximately 50% of people age 85 and older having the disease. It is important to note, however, that although Alzheimer’s disease is extremely common in later years of life, it is not part of normal aging. For that matter, dementia is not part of normal aging. If someone has dementia (due to whatever underlying cause), it represents an important problem in need of appropriate diagnosis and treatment by a well-trained healthcare provider who specializes in degenerative diseases.

Photo Credit: alz.org

In a nutshell, dementia is a symptom, and Alzheimer’s disease is the cause of the symptom. When someone is told they have dementia, it means that they have significant memory problems as well as other cognitive difficulties, and that these problems are severe enough to get in the way of daily living. Most of the time, dementia is caused by the specific brain disease, Alzheimer’s disease. However, some uncommon degenerative causes of dementia include vascular dementia (also referred to as multi-infarct dementia), frontotemporal dementia, Lewy Body disease, and chronic traumatic encephalopathy. Contrary to what some people may think, dementia is not a less severe problem, with Alzheimer’s disease being a more severe problem. There is not a continuum with dementia on one side and Alzheimer’s disease at the extreme. Rather, there can be early or mild stages of Alzheimer’s disease, which then progress to moderate and severe stages of the disease.

One reason for the confusion about dementia and Alzheimer’s disease is that it is not possible to diagnose Alzheimer’s with 100% accuracy while someone is alive. Rather, Alzheimer’s disease can only truly be diagnosed after death, upon autopsy when the brain tissue is carefully examined by a specialized doctor referred to as a neuropathologist. During life, a patient can be diagnosed with “probable Alzheimer’s disease.” This term is used by doctors and researchers to indicate that, based on the person’s symptoms, the course of the symptoms, and the results of various tests, it is very likely that the person will show pathological features of Alzheimer’s disease when the brain tissue is examined following death. In specialty memory clinics and research programs, such as the Boston University School of Medicine’s Alzheimer’s Disease Center (BU ADC), the accuracy of a probable Alzheimer’s disease diagnosis can be excellent. And with the results of exciting new research, such as that being conducted at the BU ADC, the accuracy of Alzheimer’s disease diagnosis during life is getting better and better.