Dimebon News and Information

Study Shows Husbands Caring for Ailing Wives Are at Highest Risk

Caregivers who find their responsibilities highly stressful may be at increased risk for stroke, according to a new study.

The study, published in the journal Stroke, looked at 767 people who provide in-home care for an ailing spouse.

Those caregivers who said tending to their ailing spouse caused “a lot of strain” were 23% more likely to have a stroke compared with their caregiving counterparts who said they felt no strain regarding their responsibilities.

Stroke risk was most pronounced among men, especially African-American men, the study shows. While men were less likely to report high strain than women, those that reported high strain were at elevated risk for stroke.

Caregiver strain did not affect risk of heart disease in the new study. Previous studies have shown that caregiver stress can increase risk of depression and early death, but exactly how caregiving stress affects stroke risk, and why it doesn’t seem to affect heart disease risk, is not fully understood.

“Highly stressful caregiving can be chronic and include many difficult and uncontrollable stressors such as witnessing the suffering of a loved one, managing stressful behavior problems, financial strain, social isolation, and providing physically and psychologically demanding personal care tasks,”
write the researchers, who were led by William E. Haley, PhD of the University of South Florida in Tampa. “Caregiving strain can also interfere with other health behaviors such as exercising and getting proper rest.”

This is why caring for the caregiver becomes extremely important, Haley tells WebMD.

“One important kind of assistance is counseling, where the caregiver can learn new information and skills to help them be better prepared to manage their family member’s illness and their own stress,” he says. “Another kind of assistance is receiving more help in providing care from other family members, friends, or community agencies, or using respite care services.”

This can make a big difference as many caregivers shoulder all of the responsibility themselves. “Some caregivers also benefit from going to support groups,” he says. “Overall, research shows that caregivers benefit from programs that help them learn ways to feel better prepared to take care of their relative, to manage their own stress, and to get more day to day help in providing care.”

Recent reports suggest that latrepirdine (DimebonTM, dimebolin), a retired Russian antihistamine, improves cognitive function in aged rodents and in patients with mild to moderate Alzheimer’s disease (AD). However, the mechanism(s) underlying this benefit remain elusive.

AD is characterized by extracellular accumulation of the amyloid-beta (Abeta) peptide in the brain, and Abeta-lowering drugs are currently among the most popular anti-amyloid agents under development for the treatment of AD. In the current study, we assessed the effect of acute dosing of latrepirdine on levels of extracellular Abeta using in vitro and in vivo experimental systems.

Results: We evaluated extracellular levels of Abeta in three experimental systems, under basal conditions and after treatment with latrepirdine.

Mouse N2a neuroblastoma cells overexpressing Swedish APP were incubated for 6 hr in the presence of either vehicle or vehicle +latrepirdine (5pM-5uM). Synaptoneurosomes were isolated from TgCRND8 mutant APP-overexpressing transgenic mice and incubated for 0 to 10 min in the absence or presence of latrepirdine (1uM or 10uM).

Drug-naive Tg2576 Swedish mutant APP overexpressing transgenic mice received a single intraperitoneal injection of either vehicle or vehicle or vehicle + latrepirdine (3.5mg/kg). Picomolar to nanomolar concentrations of acutely administered latrepirdine increased the extracellular concentration of Abeta in the conditioned media from Swedish mutant APP-overexpressing N2a cells by up to 64% (p=0.01), while a clinically relevant acute dose of latrepirdine administered i.p.

led to an increase in the interstitial fluid of freely moving APP transgenic mice by up to 40% (p=0.01). Reconstitution of membrane protein trafficking and processing is frequently inefficient, and, consistent with this interpretation, latrepirdine treatment of isolated TgCRND8 synaptoneurosomes involved higher concentrations of drug (1-10 uM) and led to more modest increases in extracellular Abetax-42 levels (+10%; p=0.001); of note, however, was the observation that extracellular Abeta x-40 levels did not change.

Conclusions: Here, we report the surprising association of acute latrepirdine dosing with elevated levels of extracellular Abeta as measured in three independent neuron-related or neuron-derived systems, including the hippocampus of freely moving Tg2576 mice.

Given the reported association of chronic latrepirdine treatment with improvement in cognitive function, the effects of chronic latrepirdine treatment on extracellular Abeta levels must now be determined.

Author: John SteeleSoong Ho KimJohn CirritoDeborah VergesJessica RestivoDavid WestawayPaul FraserPeter St George HyslopMary SanoIlya BezprozvannyMichelle EhrlichDavid HoltzmanSam Gandy
Credits/Source: Molecular Neurodegeneration 2009, 4:51

Typical Caregiver Is a Woman in Her Late 40s Taking Care of an Elderly Parent, Study Finds

About one in three adults in the United States cares for a loved one who is elderly, sick, or has special needs. And two out of three unpaid caregivers are women, a new report finds.

More often than not, caregivers are raising families and working outside the home in addition to caring for aging parents, chronically ill spouses, or children or grandchildren with special needs.

The report, commissioned by the National Alliance for Caregiving in collaboration with the AARP and the insurance group MetLife, resulted from interviews with nearly 1,500 caregivers chosen at random. Similar interviews were conducted in 2004 and 1997.

Some 65 million American adults are providing care to loved ones independent of traditional parenting roles, Elinor Ginzler, senior vice president of Livable Communities Strategies for AARP, tells WebMD.

She says the typical caregiver is a woman in her late 40s caring for a parent, most often her mother, who is in their late 70s or older.

“Caregiving is traditionally women’s work,” she says. “And women are usually juggling work and family responsibilities while they are providing this care.”

Old Age, Alzheimer’s Major Reason for Care

The survey found that:

• 70% of caregivers were taking care of loved ones who were 50 years old or older.
• Caregivers provided an average of 20 hours per week of care.
• Caregiving lasted an average of 4.6 years.
• Older care recipients generally needed help because of deteriorating physical health (76%). More than half (51%) still lived in their own homes and 29% lived in their caregiver’s home.
• Old age was cited as the main reason for needed care, by 12% of respondents, followed by Alzheimer’s disease (10%), mental or emotional illness (7%), cancer(7%), heart disease (5%), and stroke (5%).

Ginzler says nearly three out of four caregivers who responded to the survey had paid jobs outside the home, and two-thirds said they had missed work as a result of their caregiving responsibilities.

She says the findings highlight the need for more support services for caregivers.

AARP has long pushed for a $3,000 tax credit for caregivers, and 56% of the survey respondents ranked a tax credit as important to them.

Health Care Debate Includes Caregivers

The tax credit is not a part of the sweeping health care legislation now being crafted by Congress, but Ginzler says the bill under consideration does include provisions that would help family caregivers.

Among the most ambitious is the Community Living Assistance Services and Supports (CLASS) Act, authored by Sen. Chris Dodd (D-CT) and the late Sen. Edward Kennedy. The act provides for a national, voluntary insurance program to help Americans pay for long-term care.

Under the proposed plan, workers who do not opt out of the program would pay premiums through payroll deductions for disability and long-term care insurance.

The House version of the health care bill also provides additional funding for the National Family Caregiver Support Program, which aids family and community caregivers, Ginzler says.

Although more support services would help many caregivers, government and community assistance programs may elude many others, says Donna Schempp, who serves as program director for the Family Care Alliance.

That’s because many people don’t recognize themselves as caregivers, even though they are.

“A husband or wife who takes care of a sick spouse or an adult child who takes care of a parent may not think of him or herself as a caregiver,” she tells WebMD. “As a result, they may not think to look for resources that can help them.”

Even those who do seek help may not find the kind of support they need most, such as day care services or other resources aimed at easing the caregiver burden.

“Most caregiver support programs focus on teaching skills to improve patient care,” she says. “While this is certainly important, it is also important to teach caregivers the skills they need to take care of themselves during a very stressful time.”

By Kate Mulgrew

After the Alzheimer’s came, my mother could not know how shadows fell across our once ebullient family: our solidarity fractured, our tempers flaring in furious incomprehension, hearts breaking in mute despair.

None of us knew how to watch this woman disappear, her features slowly masked with blankness, her supple body rigid and wooden, her absolute vividness obliterated by the heavy fog of her disease.

As those of us touched in some way by Alzheimer’s know too well, the emotional, social and economic burden of this disease is nearly unbearable — for individuals, for families and for our country:

• 5.3 million Americans are living with Alzheimer’s disease; a new case develops every 70 seconds.

• One in eight people aged 65 and older has the disease, and the risk is even higher for those over 85.

• Today, 9.9 million people are caring for a family member with Alzheimer’s.

• Alzheimer’s and other dementias cost Medicare, Medicaid and businesses $148 billion annually, a number that will grow quickly and substantially as baby boomers reach age 65.

Prevention. Cure. Hope. These are words seldom associated withAlzheimer’s disease. But groundbreaking scientific research and an opportunity for powerful collaborations could lead to discovery of the ultimate cure for Alzheimer’s disease: its prevention.

I know this is so because my friend Dr. Karen Hsiao Ashe, an internationally renowned Alzheimer’s disease researcher at the University of Minnesota, has developed a research road map that calls for bringing together a group of the world’s foremost laboratory and clinical investigators in the field to make prevention a reality by 2020.

This achievable goal adds “hope” to the vocabulary of Alzheimer’s disease and holds the promise that my children and yours will never suffer its hardship.

My son, Alec, is an artist like his late grandmother. His paintings are large and uncompromising, stunning in texture, original in design. He’s got the real thing. He’s got “it,” just as she had. But what if he also has something else, like the APOE-e4 gene, known to increase the risk of Alzheimer’s? What if he is in line to inherit this devastating disease?

What I could barely endure happening to my mother, I know I could not possibly endure happening to my son. So, like my friend Karen, I embrace prevention as the ultimate cure for Alzheimer’s disease. Anything short of that is too risky.

Karen is identifying the biological processes that occur in the earliest stages of the disease — long before symptoms appear — to develop cost-effective, widely available interventions. She compares Alzheimer’s disease prevention to the polio vaccine: “Had a vaccine not been developed for polio, hospital wards today would be filled with people needing artificial ventilators to breathe. Similarly, not only is treatment of Alzheimer’s likely to be less effective than prevention, it’s also likely to be 10 to 10,000 times more expensive,” she recently told Twin Cities Business magazine.

Karen and her colleagues are homing in on a promising possibility: a pill containing the molecular compound that could block the chemical chain reaction in the brain that leads to Alzheimer’s.

So what’s the holdup? Well, money, of course, and attitude, perhaps. Finding a treatment within the next 10 years that will prevent Alzheimer’s disease will require a major national investmentto bring together the scientists to develop an effective, safe and affordable way to block the disease.

According to Harry Johns, president and CEO of the Alzheimer’s Association, “No other disease causes so much suffering, is so certainly fatal, affects so many and drives so much cost with so little spent to overcome it.” Why is that? Johns names ignorance, age discrimination, stigma and denial as likely explanations.

My plea is deeply personal, but by 2050, Alzheimer’s will affect as many as 16 million Americans, and none of us will be able to deny the reality. We must fight mightily now to prevent the shadow of this disease from darkening the lives of our children and grandchildren. We must invest today in research that will most swiftly lead to the ultimate cure: prevention.

The opinions expressed in this commentary are solely those of Kate Mulgrew.

Alzheimer’s disease is not a normal part of aging. While many individuals experience some changes in memory as they grow older, the changes that occur because of Alzheimer’s are different. It is important to differentiate between normal aging and Alzheimer’s disease.

Early diagnosis can allow you to seek treatment as well as plan for the future. Here are 10 warning signs of Alzheimer’s disease, as outlined by the Alzheimer’s Association:

1. Memory changes that disrupt daily Life: These memory changes include forgetting recently learned information, important dates or events and relying heavily on others for information.

2. Challenges in planning or solving problems: Individuals have trouble developing or following a plan or working with numbers. They may lose track of monthly bills or be unable to follow a familiar recipe.

3. Difficulty completing familiar tasks: Those with Alzheimer’s are often unable to complete their usual daily tasks. They may get lost while driving to a familiar location or managing a budget.

4. Confusion with time or place: Individuals lose track of dates and time. They may become confused by what is not happening immediately, or forget where they are or how they got there.

5. Trouble understanding visual images or spatial relationships: Some individuals have difficulty reading, judging distance or determining color or contrast.

6. New problems with words: People with Alzheimer’s have a hard time starting or joining a conversation. They may stop mid-conversation and not know how to continue or may repeat themselves.

7. Misplacing items without being able to retrace steps: Items may be placed in unusual places and individuals will be unable to retrace their steps to find them.

8. Decreased or poor judgment: Those with Alzheimer’s may experience changes in decision making abilities, such as giving too much money to telemarketers or paying less attention to personal grooming.

9. Withdrawal from work or social activities: Someone with Alzheimer’s may become removed from hobbies, social activities or work projects.

10. Changes in mood or personality: People with Alzheimer’s can become confused, suspicious, depressed, fearful or anxious.

In study on mice, researchers were able to limit effects on brain

The low-density lipoprotein receptor may help reduce brain damage caused by Alzheimer’s disease, a new study suggests.

Accumulation of amyloid beta-protein (A-beta) plaques in the brain plays a major role in Alzheimer’s, and previous research has implicated apolipoprotein E (apoE) in the accumulation of A-beta plaques, according to background information in the study, published in the Dec. 10 issue of Neuron.

“Modulating the function of proteins that control apoE metabolism in the brain will likely alter the extent of amyloid deposition and ultimately affect the disease process,” Dr. David M. Holtzman, of the Washington University School of Medicine, said in a news release from the journal’s publisher. “We know that low-density lipoprotein receptor binds to apoE, yet its potential role in Alzheimer’s disease pathogenesis remains unclear.”

In the new study, Holtzman and his colleagues genetically engineered mice that overexpressed low-density lipoprotein receptor, or LDLR, in the brain and bred them with mice engineered to feature key brain changes associated with Alzheimer’s disease, including A-beta accumulation.

Overexpression of LDLR decreased brain apoE levels by 50 to 90 percent, resulting in significant reductions in plaque formation and neuroinflammatory responses, the researchers found.

“Our study clearly demonstrates the beneficial effects of LDLR overexpression in the brain on pathogenic A-beta aggregation and subsequent neuroinflammatory responses,” Holtzman said. “Given the results from these studies, the therapeutic potential of previously identified compounds and potential new agents, which regulate LDLR in peripheral tissues, merits additional testing in animal models of A-beta amyloidosis.”

A new perspective on Alzheimer’s disease — learn how it affects your family in a whole different way.

We as a society have spent so much money on trying to cure Alzheimer’s disease and have yet to come with anything concrete, it is Dr. Shabahangi’s belief that we need to focus on the care of these individuals and how we treat people them while we try to help them live in the “moment.”

Forgetting is an incredible human invention, you can learn to be in the moment, and sometimes it’s actually better when you do forget (especially when it concerns previous stress or trauma). When you are around people with Alzheimer’s disease you learn to be in the present, you talk about what is happening now, and not what has happened in the past.

It changes your entire perspective for you and your loved ones.

It’s not easy when a grandma doesn’t remember your name. It’s not easy when your 10-year-old laughs at your uncle or your 5-year-old is crying because grandpa doesn’t remember her gifts last Christmas.

What can you do to make sure that the younger generation understands those with Alzheimer’s and the elders who are forgetful are still included in your family celebrations?

Dr. Shabahangi believes you can follow these steps to reach so acceptance and understanding, and hopefully, you’ll find peace and joy along the way for yourself as well:

• Be grateful. Holidays is the time to reflect and be thankful for having all the people in your life - those who are forgetful and those who are not.
• Be a good example. Model good behavior and inclusionary gestures for your children - they will notice and follow your lead. This is a great way to reduce fear in kids as it relates to Grandma’s forgetfulness. Explain that forgetfulness doesn’t = death.
• Be in the moment. Those with dementia have a single point of focus, so don’t dwell on “remember this” and “remember that.” It may trigger unpleasant awkwardness and sense of embarrassment, and disappointment in young children. Instead talk about the here and now - the food, flowers, weather, pet, etc.
• Be accepting. Alzheimer’s is not contagious, but a welcoming attitude towards those dealing with it, is. It may require some patients and that’s something to talk about with the younger members of your family.
• Be curious. There’s so much to learn from people with forgetfulness. They focus on one thing at a time&In fact, Alzheimer’s is like a Zen teacher who reminds you to stay with the moment. It’s a timely lesson for all of us, especially, during the busy holiday season.

Flo Wait, 76, and her husband, Ed, 68, of Abilene both had to make some changes when Flo became ill with dementia.

Ed is her major caregiver, and the family had to make some adjustments in their usual holiday traditions. He tends to his duty with kindness and patience, but their family circumstances are much different from what they knew in their native state of Vermont.

While most people may look at the ill person as being the only one who needs care, sometimes the caregiver needs help as well.

Studies show the average caregiver works at least 60 hours a week taking care of the person who ill. Most patients and caregivers are over 65 years of age — so the caregiver also may have some health problems.

While caregivers are coping with their problems, the holidays and family obligations sometimes add extra burdens to their lives.

Sherry Baker of Albany has been a professional caregiver for 25 years.

“One of the hardest things for some families is to understand their relative or the caregiver cannot celebrate the holiday as usual,” she said. Baker said it was difficult for some to believe their family members had undergone such a change.

Mindy Bannister, caseworker with the Alzheimer’s Association, met with a group of caregivers at the Southern Hills Church of Christ recently to help them cope with the holidays and make the season as happy as possible.

Bannister said the caregiver is sometimes filled with stress, disappointment and sadness during the holidays.

“Give them time to have a break while you fill in for them,” she said. “Or you might give them a gift certificate for a massage.”

Bannister urged caregivers to set limits, plan ahead and be flexible.

“Make time for yourself,” she said. “Remember, the patient needs you.”

After Flo became ill, Ed had to make some changes in their daily routine.

“I disabled the cook top on our stove for safety, but I can use the oven and the microwave,” Ed said. “I also had to have the house keyed to lock it from the inside.”

Ed said that Flo had wandered away a couple of times.

“She wears a safety return bracelet,” he said while showing one that he wears himself.

Bannister explained that caregivers often wear a bracelet in case of an accident.

“If there were to be a car wreck or some other accident and the caregiver was disabled, people would know that someone needed to care for the patient,” Bannister said.

“Talk to family and friends about holiday celebrations in advance,” Bannister told the caregivers. She urged caregivers to not take on too much and do only what they can reasonably manage.

Bannister urged friends to be mindful of the health of the caregiver as well as the patient, especially during the holiday season.

“People are sometimes afraid and don’t know how to help,” she said. Bannister said that a family member or a caregiver could send a letter to friends explaining the situation.

She said that caregivers were sometimes overlooked and needed to be involved in social groups along with their family member who has Alzheimer’s.

“Caregivers could use ready-made meals or gift certificates for the holidays,” Bannister said. “They also like CDs or books.”

She said one of the most important things was that caregivers need a listening ear and appreciation.

Jim Butler of Albany lost his wife, Brenda, to cancer and Alzheimer’s three months ago.

“She was ill with Alzheimer’s for four years,” he said. “Then she came down with cancer.”

Butler said they continued their tradition of Thanksgiving through 2008 at their house in Albany with all the family.

“We ordered most of the food,” he said. “My daughter and daughter-in-law chipped in and did much of the work

Butler said they had to put a lot of their holiday traditions on hold, and he had to cut back on some farming and ranching.

Butler is now a volunteer in the Alzheimer’s support group. He joined the group shortly before his wife died, and he will spend some time during the holidays helping caregivers and patients cope with the disease.

Butler said he planned to go right on with the holidays this year — although it will be different.