When It’s Not Dementia

There are several physical conditions that could be associated with the same symptoms. These include thyroid disease, nutritional deficiencies, adverse reactions to medications, depression—even a brain tumor.

“These conditions should be ruled out, through blood tests or other medical tests, before you have a neurocognitive workup,” says Barbara (Bobbi) Kolonay, RN, BSN, MS, CCM, president of Holistic Aging – Options for Elder Care, a life care management firm in Pittsburgh, Pa.

Kolonay makes a distinction between rapid-onset versus non-rapid onset of memory loss and confusion. Except where noted, the conditions listed below are non-rapid onset and have several symptoms that mimic Alzheimer’s disease or other forms of dementia. They are among the possibilities that should be ruled out prior to consideration of neurocognitive causes.

Thyroid Disease

There are two types of thyroid disease: hypothyroidism (an underactive thyroid) and hyperthyroidism (an overactive thyroid). Several of the symptoms are similar to those of a neurocognitive disorder. “Any time that someone presents with what is perceived to be confusion or possible memory loss, they should always have their thyroid checked,” said Kolonay, adding that there are simple tests to do so. Other symptoms include fatigue, mood swings, weight gain, and muscle or joint pain.

Nutritional Deficiencies

“There are a few different kinds of nutritional deficiency,” Kolonay says. “The most common is a B12 deficiency. It’s possible that you could be taking B12 but just not absorbing it sufficiently. The name for that is pernicious anemia, and it has very similar symptoms to Alzheimer’s disease.”

Among the symptoms, some of which are not common with Alzheimer’s, include fatigue, headaches, tingling sensations in the head and feet, balance problems, tiredness, and confusion. There is a simple test to determine the body’s B12 level, and if a deficiency is determined, it can be remedied through B12 injections.

Another deficiency that can mimic Alzheimer’s or other forms of dementia is a reduced thiamine level. This is a common condition among alcoholics; it can be remedied by abstention from alcohol, modification of diet, and medications to boost the thiamine in the body.

Brain Tumor

When a patient has symptoms of memory loss or confusion, a CT scan or MRI may be warranted to rule out the possibility of a brain tumor. “A physician will know, based on the symptoms the patient is presenting, whether to do one of these tests,” Kolonay says. “The average non-medical person is not likely to recognize potential brain tumor symptoms. People could be minimizing what they are seeing and think that family member is experiencing older adult confusion.”

Normal Pressure Hydrocephalus (NPH)

Normal Pressure Hydrocephalus (NPH), a condition in which there is an increase in pressure on the brain caused by a build of cerebrospinal fluid, occurs most often among older adults.

NPH has the potential for being misdiagnosed as a form of dementia since there are overlapping symptoms. However, Kolonay says NPH presents differently. “People who have NPH will lose bladder control initially, whereas you don’t see that with Alzheimer’s or other neurocognitive issues until close to the end,” she says, adding that NPH is also characterized by a hesitant type of gait.

“If caught early, NPH is very simply rectified by putting in a shunt or a small tube from the brain to the heart,” Kolonay reports.

Medications

Side effects of various medications may also mimic the signs of Alzheimer’s disease or other neurocognitive disorders. “Some of them may cause memory problems, appetite problems, or sleep disturbances,” says Kolonay, noting that many of these drugs fall into the category of anticholinergic drugs.

Kolonay suggests consulting the website Aging Brain Care (ABC), which has compiled a list of widely prescribed drugs that have strong negative side effects for the aging brain. The ABC’s Anticholinergic Cognitive Burden scale provides a ranking of these drugs on a scale of 1 to 3. According to that scale, among drugs that should be avoided by older individuals are: Benadryl, the common over-the-counter antihistamine; the antidepressant Paxil; the heart drug digoxin; the blood thinner warfarin; the painkiller codeine; and the steroid prednisone.

Depression

“The symptoms of depression can sometimes mimic the symptoms of a neurocognitive disorder,” Kolonay says. “If you treat the depression, the symptoms will subside—even in a person who has a neurocognitive disorder in addition to depression.” Kolonay cautioned that if depression goes undiagnosed, medications that are given for other conditions—perhaps to treat behavioral issues, for example—may actually worsen the depression.

Rapid-Onset Conditions

In addition to the above non-rapid onset medical conditions, there are conditions that are characterized by rapid-onset memory loss and confusion. These, according to Kolonay, can include a variety of infections. One such common occurrence is a urinary tract infection (UTI).

“You can go from one day, when the person sees perfectly fine, to within 24 years the person is having severe symptoms,” Kolonay says. “There could be a rapid onset of memory issues, confusion, and sleep disturbances. In the majority of Alzheimer’s disease and other neurocognitive conditions, you’re going to see some problems with verbal skills. However, you usually don’t see that with someone who has rapid-onset memory issues when caused by a urinary tract infection. So, that is one distinction to be aware of.”

Another rapid-onset condition is delirium. “You’ll typically see this after an older person has had surgery and is in a post-op hospital setting,” Kolonay says. “They didn’t have the symptoms prior to being admitted. Since being admitted, they’ve had pain medications and anesthesia, loss of fluids, and are in an unfamiliar environment.”

Typically the delirium clears up once the patient is off the medications, getting enough fluids, eating normal food, and back in his or her regular environment.

Medical Evaluation

The protocol in the medical community is to order the blood work and other tests that will rule out the physical causes for memory loss and confusion before proceeding with neurological testing. “A family practice physician typically does not do this,” Kolonay says. “It requires a neuropsychiatric evaluation by a neuropsychologist or possibly a geriatric physician.”

If there is a neurological cause, it’s important to obtain a specific diagnosis. “Dementia is not a diagnosis; dementia is a category,” Kolonay stresses. “When you say someone has dementia, I use the analogy that it’s like saying someone has a car. There are many types of cars, and similarly there are many types of dementia.”

Alzheimer’s disease is the form of dementia that is most often cited, but other possible dementia diagnoses include vascular dementia, Lewy body dementia, Parkinson’s disease, Huntington’s disease, frontotemporal dementia, and several others.

“You really want to make sure you get the correct diagnosis,” concludes Kolonay, explaining that the diagnosis is critical in determining the appropriate treatment.

CHIME IN: Has your loved one experienced memory loss or confusion associated with a condition other than dementia?

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Reality therapy:

Interact with the person with dementia within his or her own frame of reference for the world, even if it has little to do with reality.

Validation therapy:

Encourage and validate the person’s view of reality rather than correcting or contradicting it by really listening and asking questions.

Redirection:

Be creative in redirecting conversation without contradicting or denying the person’s statements. Use any opportunity possible to try to elicit fond memories or remind the person of tasks or appointments.

Memory Cueing:

Use words and visuals to cue old or recent memories. For example, play CD’s of family events; place reminder notes in plain view; color code or number things in the order.

Successful communication:

One of the most successful approaches to reducing inappropriate behaviors is to communicate within the affected person’s frame of reference. Consider how your loved one sees the world and interact with respect for that “reality.”

It can also be helpful to engage the person in reminiscing about happier times by sharing memories and old photos; interactions that are focused on past times that the person might be able to recall may be less stressful than trying to communicate about current or recent events, which may not be accessible to the person.

Tips for communicating better:

1. Try to anticipate and address needs or concerns proactively.
2. Listen and communicate patiently; try to reduce the frustrations the person may feel from not being able to communicate effectively.
3. Use memory cues – verbal, visual, auditory – to help the person stay on track during conversations or day-to-day tasks. For example, place clothes prominently in plain sight, in the order in which they should be put on, or visually guide the person during dressing.
4. Write notes to the person to remind him/her to do routine tasks, and provide clear, written directions for accomplishing tasks.

Therapeutic activities help manage the symptoms of Alzheimer’s

Planning structured individualized activities that involve and interest the person with Alzheimer’s may reduce many of the more disturbing behavioral symptoms of AD, such as agitation, anger, frustration, depression, wandering or rummaging.

Holistic Aging’s Life Care Managers who work with Alzheimer’s clients on a regular basis can attest to the success when therapeutic activities focus on the person’s previous interests; cueing the person to old and recent memories while taking advantage of the person’s remaining skills minimizes the impact of skills that may be compromised.

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Plan the holiday from the prospective of the person with dementia’s world, which is as normal to them as yours is to you. Stop using reason and logic to bring them into your world rather enter their reality so that you can both embrace the holidays together. With careful thought and advance planning you and your loved one will be able to share a meaningful holiday season.

Holidays with Dementia. What to Consider during the Holidays:

Noise and Activity Level

A person who is mentally confused often responds negatively to the usual loud noise and high activity of the holidays.

• Have a plan for someone to leave with them early, if necessary.
• Plan a smaller gathering or celebration earlier in the day may make the day more successful.
• Allowing them just to be an “observer” is often less stressful.
• Prepare a quiet area in advance; excessive stimulation can lead to anxiety, irritability, and exhaustion.
• Monitor facial expressions throughout the day as they often mirror underlying emotion. Fidgeting, hand wringing, picking at clothing or skin, pacing, and general restlessness are common signs of agitation.

Goals

Think about what you wish to achieve from your holiday activities and interactions

• What are ways the person can safely participate in holiday preparations, such as helping you hang decorations, wrap gifts, and prepare food?
• Streamline your traditions; have a family meeting to discuss ways to simplify the event.
• Run through celebrations and rituals of years gone by and determine what to keep and what new traditions to add.
• Schedule visits at your loved one’s best time of day. People who have dementia tire easily, especially as the disease progresses. Your loved one may respond better to late morning or early afternoon visitors vs. evening

Movement

Exercise or movement of any kind is always helpful to decrease anxiety that may be more prevalent with the change in routine occurring around the holiday.

• Tai Chi shows potential to enhance cognitive function, balance, and energy in older adults. I recommend this DVD as Mark Johnson has been teaching Tai Chi and Qigong for over 45 years and knows the philosophy behind the exercise.
• Regular walking, or movement of any kind can have an immediate, positive effect on many behaviors
• Dance and sing to some Christmas music

Reduce embarrassment

People with cognitive disorders are vulnerable to embarrassment, especially in the earlier stages of the disease.

• Never start a sentence with “Remember”…, “Don’t you remember”…, or “I just told you that.”
• If incontinence is a problem, be discreet.
• It is extremely important to provide dignified care no matter how advanced the disease is; they are adults with a disorder, not a child.
• Don’t remind them of what they don’t remember – remember for a successful holiday you are looking at it from the prospective of someone who has dementia.

Gifts

When giving gifts plan to help unwrap the person’s present for them; explain and show the purpose of each gift.

Potential Gift Ideas:

Simple to manage on-off clothing

These can be jogging suits or sweat pants, make sure the head has ample room and the arms are not tight. Bending the older adult arm in a small arm space can be quite an ordeal, even painful to maneuver. Look for shoes with Velcro closure or self tie laces; avoid buttons or zippers on all clothing.

Pictures of family members

These Pictures are enjoyed and provide a meaningful focus of conversation with staff if the person is in a facility or others providing home support. It is helpful to label photographs with the names and relationships of those pictured as this helps start the conversation. Name retrieval seems to be a common thread in forgetfulness and the person may find this embarrassing, not to remember family members names.

Music of their generation or soothing meditation music

Here is an article I wrote on creating a personal play list on an iPod’s with the older adult: See the benefits of Music for those with dementia here.

Calming Aromatherapy

A diffuser and bottle of 100% pure organic Lavender essential oil (Lavandula angustifolia) are great gifts and have many benefits.Learn more about the Science of Aromatherapy here.

Hand held shower

This can make bathing on a shower chair much easier. Also, some people with cognitive disorders dislike water on their face, and the hand held shower head allows for greater flexibility.

A Bird feeder with bird seed

This gift is one that that keeps on giving. Place the feeder outside a window the person relaxes at. It also can create a sense of worth, as the person may take on the responsibility assuring the birds are fed.

Remember

People with dementia may not recognize the event or holiday as it passes by. However, even the most impaired person will feel the love of family gathering and included in the gift you gave. Maintaining (or adapting) old family rituals and traditions during this holiday season help all family members feel a sense of belonging and identity. For an individual with dementia, this link with a familiar past is reassuring , builds self-esteem, and allows them to reminisce:  “Look at the beautiful family I created!”

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It is important to obtain an accurate diagnosis of what type of dementia you have to maximize benefits from treatment and understand more about prognosis and symptoms. Our staff at Holistic Aging are very familiar with all the types of dementia and will frequently discussing our findings with the doctor to get the correct diagnosis.

Although at present there’s no cure for the varying types of dementia, there are ways you can slow it down and maintain mental function if it’s diagnosed in the early stages.

A Life Care Manager can help people with dementia:

• get the correct diagnosis
• develop a support system to prepare and plan for the future
• encourage the person with dementia to take an active role in their condition
• customize a plan of care to meet the individual’s needs. It’s important to remember that everyone experiences dementia and its progression in their own way.
• offer suggestions to allow the person with dementia to be able to lead active and fulfilled lives
• coach the family and care providers on ways to communicate with people with dementia
• assure a safe environment
• improve the symptoms and slow the progression of the disease
• cope with changes in behavior
• offer recommendations when driving becomes a concern
• monitor money management and financial safety
• familiar with methods to recommend when the person will not accept help

Life Care Managers are familiar with strategies and resources to ensure that proper care is provided whether in the home or facility setting. As a Life Care Manager, our goals are to ensure that a patient may function at the highest level of independence, in the least restrictive living environment as long as possible, while recognizing changes and modifications to the plan of may need to be made along the way.

If you would like to schedule an appointment with a Life Care Manager, contact us today!

References

What Is Dementia? Symptoms, Types, and Diagnosis. (2017, December 31). Retrieved from https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis.

Written by:
Barbara Kolonay, RN BSN MS and
Jennifer Ilconich, BS MA CCC-SLP

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“My mom repeats the same story over and over again, but she never forgets to go to Sunday services.”

“Dad misplaces things all the time but is still walking a mile every day.”

This is frequently how adult children express their concerns that their parent could have some type of memory issue when contacting Holistic Aging, A Life Care Management practice located in Pittsburgh PA, for assistance. Often, families readily acknowledge and respond appropriately to physical illnesses. Unfortunately, they also frequently fail to respond to dementia warning signs. Busy primary care practitioners (PCP) fail to recognize the early signs of cognitive decline.  During the typical 15 minute office visit, many patients conceal symptoms or deny their existence.

The Statistics

More than a third of people over age 70 have some form of memory loss, according to a national study by a team of researchers at Duke University Medical Center, the University of Michigan, the University of Iowa, the University of Southern California and the RAND Corporation. The group performed the first population-based study to determine the number of people who have some form of cognitive impairment, with and without dementia. These findings illustrate that nearly every family will be faced with caring for a family member that has some type of memory impairment. As a Life Care Manager, we need to assist families in improving the quality of life for this growing population.

Many people mistakenly use Dementia as a synonym for Alzheimer’s disease. Dementia is an umbrella-like term that can be described as any brain syndrome that causes multiple cognitive deficits, similar as saying when someone has a fever and you do not know the cause.

We will concentrate on the dementia’s most common in the elderly:

• Alzheimer’s Disease which accounts for 50-70% of all dementia cases
• Vascular Disease, which accounts for 15-20% of dementia cases and includes anything diagnosis that disrupts blood high to the brain
• Lewy Body Disease, which accounts for up to 20% of dementia cases

Family Warning Signs of Dementia

Families need to differentiate normal aging from Dementia. Changes in ordinary capability and attitude among the elderly are among the best warning signals that further cognitive screening should be performed.

Below is a list of signs of dementia:

• increased difficulty carrying out ordinary daily activities – initiation of getting dressed or preparing a meal from scratch
• poor or declining cognitive function
• deterioration in hygiene – no longer showering or changing clothes on a routine basis
• inability to fulfill normal responsibilities – leaving unopened mail, paying bills
• health changes – weight loss, incontinence, appetite changes, bruises suggesting a fall
• increased isolation
• loss of ordinary interest in social contacts, activities or hobbies, attitude changes including abuse of alcohol or drugs, reporting depression, unusual argumentativeness or suspiciousness

Diagnosing Dementia

According to the DSM-IV diagnostic criteria assessment for dementia a patient must have:
Memory Loss – inability to learn new information or to recall previously learned information and two or more of the following:

1. Aphasia: language disturbances
2. Apraxia: motor activity impairment although intact function
3. Agnosia: failure to recognize/identify items despite intact sensory functioning
4. Disturbances in Executive Functioning: planning, organizing, sequencing, initiation of tasks
5. Inability to function in a social or occupational setting

Testing Cognitive Function

There are many psychological tests to measure cognitive function. I use a combination of three tests as a concrete justification of the presumed diagnosis based upon observation and family history. By testing cognitive function, this can help determine if the dementia warning signs are there

1. MMSE:

The Mini-Mental State Exam is the most commonly used test for complaints of memory problems or when a diagnosis of dementia is being considered. It also serves as a base line for further testing. The MMSE test includes simple questions and problems in a number of areas: the time and place of the test, repeating lists of words, calculations such as spelling WORLD backwards, language use and comprehension, and basic motor skills. It is the standard test used to measure cognition. The MMSE is primarily used to determine if an older person has dementia of varying nature. In my experience, this test is not as accurate in assessment of the initial stages of dementia for people with a high intellectual ability.

2. Clock Test:

The clock test picks up on memory issues that the MMSE can miss. I personally find it a more reliable instrument as it can pick up executive function abnormalities. Executive cognitive dysfunction can precede the memory disturbances of dementia. People with executive cognitive dysfunction can have a normal Mini-Mental State Examination (MMSE) score but still have severe functional limitations. The clock test is a moderately sensitive and specific adjunct for detecting executive cognitive dysfunction.

Such disturbances result in difficulties with instrumental activities of daily living (e.g., bathing, dressing, cooking, shopping, driving and taking medications). They produce dissociation between volition and action; for example, patients do not lose their ability to dress but, rather, are unable to initiate these tasks or choose weather-appropriate clothes. Executive function involves the ability to think abstractly, and to plan, initiate, sequence, monitor and stop complex behavior. People with executive dysfunction have difficulty with managing the household finances, taking their medications with reminders, cooking a meal, and performing their activities of daily living, or ADL’s, independently. Detection is critical to the client’s safety and ability to remain living independently.

3. Trail Making Test:

The trail making test (TMT) is a short and convenient estimate of cognitive functions, principally attention and working memory. This test consists of two parts, Part A and and Part B. I usually administer the Part B in either oral or written form. The patient draws a line alternating between serial sequences of numbers and letters (1, A, 2, B etc.). The TMT is thought to require executive control, specifically, flexibility of thinking and greater demand for working memory. The Trail-Making Test B (TMT-B) is a neuropsychological test that may predict ability to drive safely in older adults. 

4. MoCA:

This is my go to test for a comprehensive profile. The Montreal Cognitive Assessment (MoCA) is a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Since the MoCA assesses multiple cognitive domains, it may be a useful cognitive screening tool for several neurological diseases that affect  even the younger populations.

Cognitive testing seems to provide concrete evidence to families that the person does indeed have the cognitive issues they were identifying as concerning. If the family desires further cognitive testing, I recommend a neuropsychological evaluation.

Treating Dementia

Once the dementia is identified, we work with the family to determine the best plan of care for the client in the following areas.

1. Medical Diagnoses:

Some diagnosis’s can mimic dementia symptoms. Assuring that medical issues such as thyroid disorders, B12 deficiency, uncontrolled hypertension, depression, are not contributing to a dementia diagnosis is imperative. Completing testing and blood work can rule out these underlying medical/psychological concerns.

2. Supportive Environment:

A home safety evaluation looks at environmental factors that could put the person with cognitive impairment at risk. These include poor lighting, uneven surfaces, hand rails on steps, grab rails in bathrooms, removal of dangerous/poisonous substances, heating and electrical. 

The kitchen can be a potentially dangerous place for someone who is not able to recognize the danger of a sharp knife or a gas stove left on. Therefore, it is essential to remove sharp instruments and if needed, remove the knobs to a gas oven. An environment with routine and structure as this assists in orientation and the feeling that they are safe and secure. We typically develop a medication distribution system that will assure proper adherence to prescribed medications. 

Ensuring that helpful information is accessible to the client. A large white board with a calendar of daily/weekly events can help reassure the person. Posting of emergency numbers or setting the phone to pre-dialed numbers is also helpful. Physical activity is important as it helps prevent disruptive behavior or agitation. • Avoid excessive stimulation but not to the point of isolation. Encourage continued mental activity including hobbies and current events.

3. Help with Managing Finances:

This is the time for the Durable POA to assume responsibility for managing the person with dementias finances. Direct debits, direct deposits of income and on-line checking helps the job of the POA not be overwhelming. The POA may want to have the mail forwarded to their address to avoid the mail getting lost or misplaced in the home of the person with dementia. It is recommended to keep a detailed record of all financial transactions completed when acting as the POA and to share this information with another family member to avoid any potential problems with family members or the person with dementia may feel people are stealing from them.

4. Outside Help:

Most persons with dementia will resist in home help as they do not have the insight into their need for assistance. I recommend starting with a slow introduction of a medically supervised caretaker into the home that a Life Care Manager has developed a plan of care for the caretaker to follow. Never hire someone directly without direct supervision for a client with dementia.

If the caretaker was a good match, they will develop a relationship so that the person with dementia looks forward to the visits and assistance. The caretaker can assist with personal needs, light housework, meal preparation, laundry, providing meaningful activities, taking the person out, assuring the client takes their medication as scheduled; all dependent on the individual needs of the client. Health Insurance does not cover the cost for in-home care so if the client is low income, there are entitlement programs that may pay for their services.

5. Security:

The person with dementia could wonder outside and forget to close the door, may have problems finding their way home, or lock themselves out and become confused and afraid. The following are good options to help prevent those scenarios. 

• Medical Alert Bracelets inscribed with the diagnosis of dementia and have a number to call for emergencies
• Good to have a space set of keys at the neighbors
• Advise the local police that the person has dementia and if there is a sutable window or door which can be opened from the outside
• Purchase an alert that signals an alarm when a door or window opens
• Although persons with dementia frequently cannot utilize a cell phone, it is a good device to track the wear location of a person using the Google map tool or other method.
• The alarms that require pushing a button on a necklace or arm bracelet are of little help with a person with dementia as the person does not remember how to use it.

6. Medications:

Alzheimer’s drugs might be one strategy to help you temporarily manage memory loss, thinking and reasoning problems, and day-to-day function. Unfortunately, Alzheimer’s drugs don’t work for everyone, and they can’t cure the disease or stop its progression. Over time, their effects wear off.

• The Food and Drug Administration (FDA) has approved two types of drugs specifically to treat symptoms of Alzheimer’s disease.
• Cholinesterase inhibitors : Donepezil (Aricept), Galantamine (Razadyne), Rivastigmine (Exelon)
• Memantine (Namenda) 

 The decision to try one of these drugs should be based on whether any potential benefit is worth the cost, and the risk of side effects.

• Avoid the use of antipsychotics.  In November 2015, the American Geriatrics Society’s evidence-based update of its Beers Criteria for “potentially inappropriate medication use in older adults” stated unequivocally that that antipsychotic medications should be avoided for older people, “except for schizophrenia, bipolar disorder, or short-term use as an antiemetic during chemotherapy.” Citing “increasing evidence of harm associated with antipsychotics and conflicting evidence on their effectiveness in delirium and dementia, the rationale to avoid was modified to ‘avoid antipsychotics for behavioral problems unless nonpharmacological options (e.g., behavioral interventions) have failed or are not possible, and the older adult is threatening substantial harm to self or others” Thus, there is a very limited category of people for whom the drugs could be appropriate.

7. Planning for the Future:

Because dementia is usually progressive it is essential to plan for the future. When it is time to move out of the home to a more supportive environment, professionals with expertise in dementia care can make the best decision. This decision depends on many factors such as severity of the disease, behavioral issues, finances, home environment, family availability, and presence of other physical or psychological disorders impacting on the dementia. The final stages of dementia are one of the most difficult to manage in a home environment. This is especially so if associated behavioral issues arise.

When the home is no longer a safe place for the patient with dementia, the next step is to look for an assisted living that specializes in the care of those with a diagnosis of Alzheimer’s or dementia. You want to choose a dementia specific units that is equipped to handle all the physical, environmental, behavioral and psychological issues associated with end stages of dementia using primarily behavioral measures vs. primarily medication management. It’s important to recognize that Assisted livings/Personal Care Homes are not licensed to provide medical oversight.

End of Life Issues need to be addressed early on when a diagnosis of Alzheimer’s disease or dementia is determined. Families need to determine a long range plan including how they will manage the final stages of the disease. Treatment should maintain comfort rather than prolong life. Hospice should be consulted early on to assist in the management of this life limiting illness. This provides much needed support to the client and family. Beyond that it assures the final stages of this disease maintain dignity for the client and family.

If you are seeing dementia warning signs and have reasons to believe that your loved one has Dementia or Alzheimer’s Disease, contact us today to set up a meeting!

Bobbi (Barbara) Kolonay RN BSN MS CCM
Certified Holistic Nurse
President of:
HOLISTIC AGING & OPTIONS FOR ELDER CARE
4284 Route 8 Ste #103
Allison Park PA 15101
P: 412-486-6677
F: 412-486-6687

www.HolisticAging.com

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Coconut oil is composed predominantly of medium chain triglycerides (MCT). MCT oil is an easy way to get large concentrations of certain MCT. It usually contains C8, C10 or a combination of the two. The theory behind MCT potentially improving cognition is based on ketone bodies produced by metabolized coconut oil. Neurons in the brain use these ketone bodies for fuel, thus improving cognitive function.

The Results of MCT:

Definitive science and clinical evidence for using coconut oil is related to findings noted on PET scans in people diagnosed with Alzheimer’s disease (AD). The brain of these individuals with AD demonstrated a decreased absorption of glucose (the food for the brain). These same PET scan show that areas of the brain affected by Alzheimer’s readily take up ketones as an alternative brain fuel source. MCT produce ketones, which act as an alternative energy source for the brain and can therefore improve brain function. Whereas ketogenic diets can be useful for dementia and Alzheimer’s patients, it is difficult to get them to adhere to this restricted diet.

Coconut oil, which is is 60% medium chain triglycerides (MCT) can serve as an alternative energy source in the brain. As stated before, they produce a ketogenic effect. Patients with memory impairment showed significant improvement in memory after receiving oral supplementation with MCT. The treatment produced higher ketone levels in the blood (Reger et al., 2004). Higher plasma levels of ketones like β-hydroxybutyrate directly correlate with higher performance in memory scores during this study (Reger et al., 2004). Adding coconut oil or MCT oil to the diet has the advantage of being cost effective, easy to implement, socially acceptable and generally safe from significant side effects. Quality MCT oils contain either 100% caprylic acid (C8), 100% capric acid (C10) or a combination of the two.

The Research on MCT:

Dr. Mary Newport popularized the use of both coconut oil and MCT oil for treating Alzheimer’s disease. As a neonatal physician, she was familiar with the use of MCT oil in newborns. When her husband developed early-onset Alzheimer’s, she fed him MCT oil and coconut oil with some success. She’s now an outspoken advocate for the use of MCT and coconut oil for neurological disorders beyond dementia including Down syndrome, ALS, Parkinson’s and Huntington’s. Here is an interview with Dr. Mary and Steve Newport about Steve’s recovery from Alzheimer’s disease by eating Coconut Oil.

In the following video, you can listen to a panel discussion with five medical doctors regarding the problem of insulin resistance and the damaging effects of a high carbohydrate diet on Alzheimer’s disease, and how coconut oil can be effective in treating Alzheimer’s disease.

The Take Away:

Neuro-cognitive diseases have devastating effects and are incurable. There is a the lack of therapeutic alternatives and the relative absence of effective medications and adverse drug effects. These issues give us an urgent need for effective therapies. The five drugs currently used for treatment are supportive or palliative rather than curative or disease-modifying therapies. These drugs do not appear to alter the final outcome of the disease either. MCT offer neuro-protective benefits for a wide range of diseases including dementia, Alzheimer’s, Parkinson’s, stroke, epilepsy, and traumatic brain injury. “While more research certainly needs to be done in this area as well, I see no reason not to incorporate coconut oil in your diet, or the diet of a loved one who is exhibiting symptoms of brain degeneration. Coconut oil has so many profound health benefits; it’s not going to do any harm.”— Dr. Mercola

If you have any questions about incorporating coconut oil or MCT oil for dementia into your loved one’s daily routine, contact us today!

References

Neurobiol Aging. 2004 Mar;25 (3):311-4. Effects of beta-hydroxybutyrate on cognition in memory-impaired adults. Reger MA Henderson ST, Hale C, Cholerton B, Baker LD, Watson GS, Hyde K, Chapman D, Craft S.

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What is Dementia? Dementia is defined by the National Institute of Health as: the loss of cognitive functioning (thinking, remembering, reasoning and behavioral abilities) to such an extent that it interferes with a person’s daily life and activities. These functions can include: memory, language skills, visual perception, problem solving, self-management, the ability to focus or pay attention, and the ability to control emotion and impulse.

What are the Different Types of Dementia?

Dementia is an umbrella term used to describe a range of conditions which cause changes and damage to the brain. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these types of disorders

Alzheimer’s Disease

AD is the most commonly heard of diagnosis. Although a true cause it not currently known, brains of people with AD are found to have small abnormalities. The so-called, amyloid plaques and tau tangles, formed in the brain and found in specific locations throughout, are two distinguishing hallmarks of Alzheimer’s Disease Dementia.

Symptoms: AD begins slowly, it first involves the parts of the brain that control thought, memory and language. Over time, symptoms get worse. People may not recognize family members or have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later on, they may become anxious or aggressive, or wander away from home. Eventually, they need total care.

Frontal Temporal Dementia

Also known as FTD, frontotemporal degeneration or Pick’s disease, is the most common dementia diagnosed before age 60. FTD is actually a group of diseases affecting the same brain regions. These include behavioral variant FTD, primary progressive aphasia (PPA), corticobasal degeneration, progressive supranuclear palsy, and FTD/ALS.

Symptoms: FTD brings progressive changes to personality, language, decision making, behavior, disinhibitions, impulsivity, impaired financial decision making, and language problems.

Lewy Body Dementia

Lewy body dementia is a general term and includes both Parkinson’s disease dementia (PDD) (in which Parkinson’s disease is first diagnosed but a year or more later includes dementia) and dementia with Lewy bodies (DLB) (which starts with dementia and is often misdiagnosed as Alzheimer’s disease, but may include Parkinson-like symptoms at the time of diagnosis or later).

Symptoms: LBD includes dementia, visual hallucinations and frequent variations in cognitive ability, attention or alertness. There are also changes in walking or movement, as well as a sleep disorder called REM sleep behavior disorder, in which people physically act out their dreams. LBD patients may also have a severe sensitivity to medications prescribed for hallucinations.

Other Types of Progressive Brain Disease

Vascular Dementia

These are disorders that affect the blood circulation in your brain. Proper control of blood pressure or vascular issues improves outcomes with this type of dementia.

Symptoms: Impaired judgment, decreased apathy, urinary changes, changes or difficulty with motor skills which may affect balance.

Normal-Pressure Hydrocephalus

NPH is caused by an abnormal build-up of cerebrospinal fluid (CSF) in the ventricles (cavities or spaces) of the brain. When people have NPH, they have an excess of cerebrospinal fluid because their bodies cannot properly drain and absorb the fluid, but the pressure in their brain remains normal.

Shunt surgery, which delivers cerebrospinal fluid from the head to the abdomen or heart, may help these symptoms.

Symptoms: This condition can cause walking problems including difficulty picking up your feet, shuffling, freezing, problems with bladder control trouble paying attention, short memory loss and changes in mood.

Questions?

If you are still asking yourself, “What is Dementia?,” or if you have any questions about caring for your loved one with Dementia, contact us today!

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