Woman with Alzheimer's

Alzheimer’s and dementia, both forms of memory loss, refer to a decline in mental ability to a point where independence, thinking, language and recognition are impacted. Memory loss and memory care are increasingly important topics as the elderly population of our country continues to grow. Unfortunately, in 2012 only $100 was spent on research for every $28,000 of care.

ElderBranch spoke to Dr. Catherine Madison, Director of Sutter Health affiliate California Pacific Medical Center’s (CPMC) Brain Health Center and Robert Sarison, Program Manager of CPMC’s Alzheimer’s residential care program to learn more about memory loss and memory care.

Context: Alzheimer’s and Dementia Statistics

According to the Alzheimer’s Association, one American develops Alzheimer’s every 68 seconds, but by 2050, the rate will increase to one American every 33 seconds. This disease is the sixth-leading cause of death in our country and one of the few that cannot be prevented, cured or slowed.

Approximately half ($210 billion) of memory care goes unpaid, with more than 15 million Americans providing unpaid care to memory loss patients.

Recent Discoveries in Memory Loss

Interconnection with Other Diseases

Newer Alzheimer’s research points to the fact that the pathological changes of Alzheimer’s disease are frequently intertwined with other neurodegenerative processes and vascular disease.
Given significant progress has been made with reducing vascular disease morbidity, Dr. Madison hopes this can influence dementia treatment as well, “It is hoped that with even more aggressive treatment of vascular risk factors that the onset of dementia could be delayed.”

Lifestyle Factors

Research has shown that healthy lifestyles can not only lower one’s risk of developing dementia, but can also help those who already have the disease in terms of maintaining their brain health.
The research supports regular physical activity (20-30 minutes of brisk exercise, at least five days per week), a Mediterranean-style diet (plenty of fruits and vegetables along with lean protein and omega-3 fatty acids), keeping the mind engaged and maintaining social ties.

Lowering Plaques in the Brain

Dr. Madison explains that in Alzheimer’s, there is accumulation of amyloid (type of protein) plaque and tangles in the brain, which is associated with inflammation and cell death. To date, strategies aimed at lowering the level of amyloid plaque in the brain have not achieved needed goals.

With the recent discovery of a genetic variation that lowers the accumulation of abnormal amyloid in the brain and appears to protect people from Alzheimer’s disease, researchers have more hope they are moving in the right direction with their efforts to bring success to anti-amyloid and amyloid-lowering approaches that have failed to date. This is a very promising discovery given the incredibly high cost of bringing a new drug to market ($3.7 – 11.8 billion per drug developed by major pharmaceutical companies).

The FDA recently approved Florbetpair, a marker compound that allows researchers to see amyloid protein in the brains of living persons. Using this marker, it is hoped that those at high risk for dementia can be identified early on and that the amyloid-lowering treatments that have been unsuccessful in later-stage patients may have some positive effect in early-stage candidates. However, this tool is quite costly and not readily available as insurance companies have not agreed to pay for its use.

Memory Care: Nursing Homes and Assisted Living Facilities

While research and development in the field of memory will continue, and hopefully yield breakthrough treatments in the near-term, for now, it is important to place equal emphasis on understanding how best to care for memory loss patients.

While some families cringe at the idea of long-term care, the right facility can help dementia patients maintain a better quality of life and give a family the peace of mind that they are doing what’s best for their loved one.

Evolution in Care

Robert points out that many of the “negative” behaviors associated with dementia actually stem from boredom and confusion, as the patient struggles to make sense of their world. Instead of relying on medication, these problems can be mitigated by promoting an environment where the patient is valued, appreciated and actively engaged. For example, laughter, humor and creative self-expression have all been shown to decrease negative behaviors and reduce the use of drugs needed to contain behavioral problems.

Long-term care facilities are moving away from institutional environments and more towards smaller living arrangements and programs which have a more home-like and community feel. This enables those with dementia to remain engaged with the community, feel valued and maintain a sense of purpose. As part of cultivating that home-like feel, residents may have tailored care-plans that address their unique histories, interests, and personalities.

Choosing the Right Facility

“People with dementia benefit most from a serene, aesthetically pleasing environment that offers a structured program of daily activities designed to provide cognitive stimulation and to meet the psycho-social and physical needs of the patients/residents,” says Robert.

He feels that programs that emphasize the use of expressive arts therapies (music, art, movement and play) are best as they permit both verbal and non-verbal forms of expression.

It is also important to look for facilities that facilitate the interaction between residents and their families. Family members are often looking for ways to connect with their loved one, but struggle to do so.

About Dr. Catherine Madison

Catherine Madison, M.D. is Director of California Pacific Medical Center’s Brain Health Center, part of the Sutter Health network.

About Robert Sarison

Robert Sarison, M.A., LMFT, is a licensed Marriage and Family Therapist and is a Registered Drama Therapist. He is also a licensed administrator of Residential Care Facilities for the Elderly.

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