Research is increasingly showing the positive relationship between certain foods and brain health.  We all know Alzheimer’s is inherited; but what some of us don’t know is that studies are showing some foods can delay the onset of this dreaded disease.  Like fish.

For example, the Radiological Society of North America had their annual meeting recently in Chicago, and a presentation at that meeting illustrated the positive relationship between baked or broiled fish once weekly and good brain health; they demonstrated that eating baked/broiled fish cut the risk of developing memory problems.

“This is the first study to establish a direct relationship between fish consumption, brain structure and Alzheimer’s risk,” said Cyrus Raji, M.D., Ph.D., from the University of Pittsburgh Medical Center and the University of Pittsburgh School of Medicine. “The results showed that people who consumed baked or broiled fish at least one time per week had better preservation of gray matter volume on MRI in brain areas at risk for Alzheimer’s disease.”  (RSNA.org)

Gray matter is critical to good brain health.  If gray matter deteriorates, the brain shrinks and cognitive impairment, including
Alzheimer’s disease, results.

Direct Link Between Fish Consumption, Gray Matter and Alzheimer’s Risk

This study occurred over ten years, so it’s considered a long-term study.  Brain scans revealed the changes and lack thereof of the participants.  There is a scientific explanation for how and why fish consumption can delay Alzheimer’s.  “Specific areas of gray matter in the brain are smaller in people with Alzheimer’s because the disease slices away at these regions cell by cell,” says neuropsychologist James Becker, a senior author of the study. If you start out with stronger, larger brain cells, however, it will take longer before the disease destroys so many cells that behavior and thinking start to change“, Becker says.  The researchers reported that weekly servings of baked or broiled fish make brain cells in gray matter larger and healthier.

AARP’s report on the study said, “Although the study didn’t identify the specific kinds of fish participants ate, past research ties fatty fish such as salmon, mackerel and herring, which are rich in omega-3 fatty acids, to brain health. Scientists already know that eating these fish can protect the heart. It turns out that they also protect the brain. Fried fish, on the other hand, provides no such benefits. “Frying changes the chemical composition of the omega-3 fatty acids, causing them to break down so there’s less available,” says Becker.

So seniors, add at least one weekly meal that includes salmon or mackerel or herring–broiled or baked or poached (NOT fried)–to your diet for heart and brain health.

There is an enormous loss when a loved one begins checking out before dying. The occasion is demonstrated in a variety of forms, over a period of time, but when it becomes evident to the observer, it is too late to ask those last lingering questions that are now locked behind those eyes and in that mind that no longer functions well. It is sad.  It is painful.   The recognition comes that what once was able to be shared so readily is now cocooned in a dark somewhere, impossible to plumb. If it is there, it is behind locked doors for which there is no key.  Being able to say those remarkably precious words, “do you remember?” no longer applies.  An end to one journey and the start of another has begun. Alzheimer’s strikes again.

Paranoia, dementia, Alzheimer’s, other cognitive functions and inabilities begin to show their ugly face. They take the form of sheer forgetfulness of selected things at first, and then more generic, more and more.  Anger and paranoia are introduced toward and about persons for whom there is no logical reason to express or show anger or feel paranoia.  Not knowing how to do things, where things are kept, why things work the way they do, wandering down a familiar street lost and aloof become frequent occurrences.  How frightening, how troubling, how threatening.

The Pain of Loss

Why is my Mother being so mean?  She isn’t.  The part of her brain that heretofore produced pleasure and expressed pleasantness is now shutting down, claimed by the Alzheimer’s Thief. Why doesn’t she smile more?  There is no reason to smile.  The world has turned its back on her and everyone is whispering behind her back.  How tragic!  How overwhelming!  How utterly and painfully real for her!  Her brain chemistry is changing beyond human control.

Dad couldn’t remember who I was when I called him the other night.  Do you know how depressingly lonely that makes me feel?  Imagine the loneliness of the father.  It is a little like holding the hand of someone in a large pool, suddenly the connection begins to slip, the hand of one loses its firm grip, begins slipping away, until at last contact is felt only with the tips of the fingers. Then the hand slides away in the dark waters and there is no longer any connection, any contact, any feeling.

Insidious as the diseases of the mind are, those of us who are experiencing them with a loved one are likely to experience even more dramatic implications; we need to prepare ourselves, ready our own minds for what may lie ahead.

In one of my previous incarnations, serving as pastor in a retirement community, I came to know well numerous couples, one of whom went through the agonies of memory loss.  In one particular case, I recall the husband dedicating himself to 24/7 attentive care for his dear, precious and beloved wife. Through the struggle, he began to deteriorate in body, spirit and eventually predeceased her.  That is how wicked the Alzheimer’s-like diseases of the mind can be.  Like quicksand, it can draw everyone and everything into its vortex.  Knowing how and when and with what limits to be available to another is an important calculation.

There is no immunization against Alzheimer’s. Were it possible to get an annual inoculation, similar to the flu shot, to head off such an awful and sometimes inevitable eventuality, most of us would opt for that.  We would like not to go through the sheer inhuman experience of losing it.  We would choose to have our family not to have to traverse such a rugged and horrible road behind us.  Doing all possible, in the meantime, to savor what opportunities we have, to refine our ability to understand, and to be loving without exception will help us all to make it to the other side of the swamp, where imaginary demons and creatures no longer threaten our survival.

There is no “joy in Mudville,” as memory and brain activity begin to decline and fade.  Aging and cognitive impairment is an experience, increasingly made real, prompted as more and more of us grow older, but our mind doesn’t keep up. Oh, were it so that deterioration of mind and body weren’t so often so dramatic and difficult.  For some, who sustain their cognitive abilities, it isn’t.  They are able to keep relating, remembering, interacting in healthy and rational ways.  For others, there comes a void that removes the vitality and vigor making for a sadness and a deep chasm, difficult to bridge.

As time takes its toll, there are some hints at what can be attempted to keep the communication lines somewhat open.  Above all, patience and kindness are among the two most necessary and persistent of behaviors to contribute to as much interrelationship as can be enjoyed and achieved.

Attempting to reason will often result in discouragement and frustration.  Going along with the cognitive skills still left will require pretending that this is the new normal. It is really more than pretense, because it really is the new normal for your loved one.  Reversing the behavior is unlikely.  Getting occasional glimpses of the person she/he used to be will likely be the best there is.  Eventually, if/as the condition worsens, there will be less and less to enjoy or to find common ground regarding.

The Alzheimers’ Thievery

Sometime ago, a life long friend and I journeyed to visit a mutual friend with whom we had gone to school together since childhood.  She was in what is now called a “memory” care center.  We made the hour’s trip in the hope that some cognitive recognition could be enjoyed.  There was none.  Everything in her life had been locked out.  There was no glimmer of recognition, no word spoken, no flicker of recall, nothing.  Our being there, so far as we could detect, made no difference at all, except to us.  It was a deeply sad moment.  Our friend was almost literally “no more.”  She had slipped into that dark and silent world of the last stages of Alzheimers.

No matter what we may have tried, there was no retrieving her.  Reality was defined differently for her now.  And we could not be a part of it.

The futility of such a visit suggests that there may be no reason to even initiate such a call.  Maybe.  Maybe not.  For, doing so may mean more to the family and to you than anyone can assess. It may open our own eyes to be aware that lack of human interaction, while absent, may be replaced by some unknown stirrings that cannot be consciously plumbed.

So long as communication can be enjoyed, be sure to encourage it.  Whatever conversational topics are brought up, chase them until there is no more energy.  Whatever means for connecting, keep encouraging.  Don’t give up.

Progressive issues related to care needs prompt comparing the four cares available to seniors as their health issues require. If you are past 70, you likely have already had to consider one or the other or more of the four cares: assisted, skilled nursing, memory, or hospice.

Most of us, with aging parents have had to go through acquainting ourselves with beyond home care services.  Eventually signs indicate the need for more attentive care for persons previously able to live alone and get along quite well.

It is the better part of wisdom to have anticipated this likelihood, to have done necessary homework, cooperatively, and to be ready for that visit to the physician when the recommendation is given for identifying the care need of choice.

ASSISTED CARE:  ordinarily is the first level of beyond the home care to be given consideration.  While it would seem this is the easiest of the four, quite the contrary is the case.  Because some independence is being surrendered, coping with the trauma of having to adapt is sometimes quite difficult.  Assisted care means living in a residential facility within which levels of care are offered; nursing aids can help with tidying the room, dressing/undressing the resident, laundry, meals and personal care depending upon what the resident requires.  With careful and deliberate planning, careful evaluation, spending some time visiting the options, the new resident may find the experience pleasant and enjoyable.

SKILLED CARE: is the second level of identified care needs.  This comes at the time when the individual is less and less capable of taking care of daily routines, e.g. bathing, dressing, taking meds, even getting in and out of bed.  Mobility is ordinarily, but not always, influenced.  Safety issues are of paramount concern. Here, it is necessary to be aware of the professional and trained quality of care available for the specific needs of the resident to be.  Skilled nursing care is found in nursing homes and centers in almost every community.

MEMORY CARE: is the new kid on the block, which is made necessary by the sheer numbers of persons who experience major dementia or Alzheimer’s.  This option becomes critical and absolutely necessary when an individual has been diagnosed with these conditions.  The patient requires 24/7 attentive care and the security of a locked environment. This level of care might be compared to Intensive Care in a hospital, in that there is a regimentation of attention that is constantly required and provided.

HOSPICE CARE: is the final level of care offered today; it may be in a hospice facility or in the patient’s home.  This level is necessitated for those who are near death, and require the necessary comfort and care that accompanies the state of their condition.  Palliative care focuses on keeping our loved ones comfortable in their final days. Patients entering hospice are within six months of death.  Hospice programs are offered in almost every community in the country.

Each of these circumstances presents a thorough examination of the individual’s needs, requirements, expectations. Primary care physicians are involved to give their ‘orders’ for the level of care the resident requires.  Cost will be a factor.  Credentials will need to be verified.  Recommendations need to be sought.  If necessary, interviews of staff can be made.  It is no small matter to entrust a loved one to the care and keeping of an institution.

• First, hypertension is the most important risk factor for strokes which can lead to dementia by destroying brain tissue. This is called vascular dementia and after Alzheimer’s, it is the second most common kind of dementia.  Chronic hypertension can cause strokes, and sometimes it results in several small strokes.  These little strokes create brain damage that begins to accumulate and vascular dementia results.  And we all know senior friends who had a stroke (just one) that caused a lot of brain damage that resulted in dementia.
• Hypertension also creates memory issues, primarily from a stroke.  High blood pressure causes damage to arteries and veins that carry blood to our brain; this damage generates plaque buildup, inflammatory cells, cholesterol and other items in our blood vessels.  If a plaque erupts, it can travel through arteries and end up at a spot where the size of the plaque is larger than the diameter of the blood vessel.  The blood cannot get past this point and a blood clot begins forming.  Sometimes the clot cuts off the blood supply to the brain; if it does this in the area that contains the memory function, the cells die and dementia results.  The Hopkins report tells us, “About one third of people who suffer a stroke develop serious cognitive problems that interfere with their ability to perform daily activities.”
• High blood pressure also effects the part of the brain that lies below the surface, called ‘white matter’.  White matter is simply nerve fibers that transmit messages between brain cells and a surrounding ‘myelin sheath’ that acts as insulation.  People who have high blood pressure also have white matter issues; this is likely because hypertension impairs blood flow and keeps nerve fibers from getting oxygen and nutrients they need to survive.  The myelin sheath then starts to decay and MRIs will show that decay as bright white spots.  These white spots account for some dementia in seniors, especiallky if the white matter has changed a lot.  
• When brain cells don’t get nutrients and oxygen, they can no longer do their job.  If blood flow to the memory part of the brain (hippocampus) is impaired, cells shrink and die off.  This will obviously effect brain function.
• Finally, high blood pressure can cause issues with the blood-brain barrier, the ‘helmut’ that surrounds the brain.  When this happens, toxic material enters the brain and begins to accumulate.  One of the toxic items is beta-amyloid, that sticky protein that is associated with Alzheimer’s) and when that happens, Alzheimer’s disease has begun.

If  you or someone you love, has high blood pressure, be sure you/they get to their Primary Care Physician and begin treatment for it.  Treatment is very effective today; there is no reason anyone has to suffer from hypertension.  This kind of damage to the brain can be avoided.

The Shriver report says this horrific disease affects 10 million women annually.  That means that 10 million women either have the disease or are caring
for someone who has the disease.  Two-thirds of those who are diagnosed with Alzheimer’s are women.  Women make up sixty per cent of unpaid caregivers for people with Alzheimer’s.  The Shriver Report is based on a nationwide poll of 3118 people.

As Baby Boomers age, the numbers of those afflicted with the disease will increase.  The estimates place numbers of Alzheimer’s victims now at 5.3 million.  By 2050, that number will have grown to 16 million.

So what can seniors do to reduce the risk?  NIH (National Institutes of Health) experts don’t yet know what might reduce the risk of Alzheimer’s.   However, there are some things we senior citizens can do that certainly won’t hurt.  Those include:

• have good cardiovascular health (low blood pressure, low cholesterol, low BMI)
• consume omega-3 fatty acids
• commit to a daily exercise regimen 
• don’t smoke

Maria Shriver says, “I haven’t met one person who doesn’t say that exercise is going to be beneficial to you cognitively; anything that’s good for your heart is good for your brain.”

Her advice for now: “While they [researchers] debate it, just do it.” 

SCJ affirms Maria Shriver’s advice.  Take a look at some of Senior Citizen Journal’s articles about senior health and fitness for more information.

Katy Butler, a writer in Mill Valley, California, wrote the article published in the New York Times on June 20, 2010, about her parents.  Entitled What Broke My Father’s Heart, this poignant story describes the anguish she, her parents and her brothers endured through her father’s dementia, pacemaker installation and subsequent unnecessary emotional trauma.  The pacemaker wrecked the family’s life.  The tale calls to task the medical community, medical equipment corporations, and insurance companies who pay for medical equipment that is sold to elderly patients, many times without consideration for the unique life of the patient.

SCJ editors read the story, with interesting responses.  One editor reminded the others she had just been through the experience of helping her elderly father tell his cardiologist they would not be returning to him for any more medical care for her father; her father is very clear that he is ready to die.  As the physician attempted to talk them out of the decision, she firmly reminded him the patient (her father) was the one making the decision, and he had no choice but to accept it.

Another editor said this article highlighted the reason she is personally opposed to health care reform: it provides an avenue for all kind of medically questionable practices and procedures that just ups the cost of care.  She believes reform is too costly and is opposed to it on that basis.  She recognizes the greed of insurance and medical services industries is at play; she believes everyone in the country should have access to affordable health care; she just does not believe healthcare reform is the way to get there. 

But there is another issue here that, perhaps, may be the central one: In the face of the greed of the insurance and medical services industries, and because healthcare reform now means most citizens will have access to affordable health care, is it not time for senior citizens across the country to educate ourselves and take charge of our medical care, using physicians and nurses and nutritionists and medications and laboratory work and radiology testing as WE determine we want and need them?  

There is sometimes a delicate balance between following advice from medical personnel and following our own intuition about what we need to do to maintain good health and treat dis-ease.  Butler points out in her article that, had her father and mother made a different decision when his pacemaker was implanted, the outcome would have been significantly different.  The pacemaker wrecked their lives, and her story is a lesson for all of us.  If we leave control over healthcare decisions in the hands of the medical profession/industry, those decisions will benefit them first, and the patient second. Greed will prevail.

The difference for many of us now is that we have access to information—via the Internet—that provides information and education about every disease known to humankind.  Do we have all the information a physician has?  No.  Do our physicians have all the information available about treating every disease?  No.  The playing field is leveling out, and we senior patients have more control than ever before in history.

We can educate ourselves.  We can search for information, consult a variety of experts in addition to those in the medical profession, and we can decide which avenues we will take in treating healthcare issues we face.  We do not have to leave those decisions in anyone else’s hands.  Educating ourselves just may be the answer.

The Alzheimer’s Association, a national advocacy group for victims and their families, created a list of ten signs of Alzheimer’s last year.  In our efforts to support dissemination of critical health care news and information, SCJ presents that list with permission from the Alzheimer’s Association.  Be sure to check out the Alzheimer’s Association site for excellent information about the disease.

TEN SIGNS OF ALZHEIMER’S– NOTE:  This list is for information only and not a substitute for a consultation with a qualified professional.

____1. Memory changes that disrupt daily life. One of the most common signs of Alzheimer’s, especially in the early stages, is forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own. What’s typical? Sometimes forgetting names or appointments, but remembering them later.
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____2. Challenges in planning or solving problems. Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. What’s typical? Making occasional errors when balancing a checkbook.
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____3. Difficulty completing familiar tasks at home, at work or at leisure. People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. What’s typical? Occasionally needing help to use the settings on a microwave or to record a television show.
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____4. Confusion with time or place. People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there. What’s typical? Getting confused about the day of the week but figuring it out later.
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____5. Trouble understanding visual images and spatial relationships. For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not recognize their own reflection. What’s typical? Vision changes related to cataracts.
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____6. New problems with words in speaking or writing. People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”). What’s typical? Sometimes having trouble finding the right word.
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____7. Misplacing things and losing the ability to retrace steps. A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time. What’s typical? Misplacing things from time to time, such as a pair of glasses or the remote control.
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____8. Decreased or poor judgment. People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. What’s typical? Making a bad decision once in a while.
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____9. Withdrawal from work or social activities. A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. What’s typical? Sometimes feeling weary of work, family and social obligations.
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____10. Changes in mood and personality. The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. What’s typical? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.
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If you have questions about any of these warning signs, the Alzheimer’s Association recommends consulting a physician. Early diagnosis provides the best opportunities for treatment, support and future planning.
For more information, go to www.alz.org/10signs or call 877-IS IT ALZ (877.474.8259).

So why market Memory Workouts now?  Research is piling up everywhere that documents the value of exercising the brain as we age.  Studies have shown that losing memory in the senior years is not necessarily inevitable; in fact, the opposite has been demonstrated in some research.  The most famous study suggests lower linguistic ability in elders is correlated with greater risk for developing Alzheimer’s.  Conversely, higher linguistic ability in seniors carries less risk of cognitive impairment. 

What should senior citizens do to give their brains a workout?  That will depend upon what kind of activity is appealing to the individual.  Many seniors love to engage in the solitary activity of Sudoku or a 1000 piece jig-saw puzzle.  However, for others, that would be punishment.  But for the individuals who enjoy being alone, such activity stimulates the brain and facilitates good memory.

Senior Citizen Centers frequently advertise their clubs:  bridge, book reviews, Mah Jong or card games of any kind.  The inherent social nature of the activity contributes to senior health, and the activity itself contributes to brain stimulation that facilitates better memory functioning.  That’s a win-win for those who enjoy social activity! 

Travel to new places, whether a day trip or a holiday, can be highly enjoyable for elders.  Such travel that introduces new ideas, new information and new interaction with the environment can prove to facilitate cognitive functioning that holds off memory loss.

It is true that we cannot deny biology.  At this point in history, Alzheimer’s has no cure and no vaccine to prevent its process.  However, if some research shows that regular cognitive workouts keep the brain functioning better, it just makes sense to give your brain regular and active memory training that you enjoy.