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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

 

From Forbes: 

The overuse of antipsychotic drugs “is one of the most common and longstanding, but preventable practices causing serious harm to nursing home residents today,” Toby Edelman of the Center for Medicare Advocacytold the Senate Aging Committee last week.

She said these drugs are often used off-label (that is: for purposes other than the ones for which the FDA approved them) and that overuse both costs Medicare hundreds of millions of dollars and harms patients.

Last year, an investigation by the federal Department of Health & Human Services inspector general found that 14 percent of nursing home residents were prescribed anti-psychotics but 8 in 10 were off-label, and, thus, not for treatment of mental illness.

Still, this is not a simple issue. Sometimes, aides cannot provide basic hygiene for dementia patients without the use of these meds. Patients can be too violent or agitated for an aide to change their diaper or bathe them.

Edelman said the Center is not opposed to all uses of these medications but rather wants nursing facilities to try other solutions first.

Alternatives to drugs can be time consuming and may require special skills. For example, a patient may react poorly to a specific aide—not because the aide is not competent but because there is something about her that triggers agitation. A nursing home can figure this out and make adjustments. But it takes time and training.

Similarly, many Alzheimer’s or other dementia patients resist being given a shower, so bed baths may reduce agitation and be more appropriate. Yet, this too requires taking the time to understand why the patient or resident is uncomfortable and finding a better solution.

Alternative therapies, such as music and other non-pharmacologic solutions, may also work, although we need more evidence-based research to know for sure.

Dr. Jonathan Evans, the incoming president of the American Medical Directors Assn., urges that caregivers learn ways to better understand why a patient’s behavior changes and to address the causes. But, for too many facilities, it is easier to give a patient a pill.

This fall, the Consumer Consortium for Advancing Person Centered Care and the UCLA Luskin School of Public Affiairs, with the support of the U.S. Senate Committee on Aging, will hold a forum on non-drug interventions for people with dementia. The goal will be to develop consensus best practices for the use of non-drug alternatives. (Full disclosure: I serve as an unpaid member of the leadership council of the consortium’s parent organization).

This initiative follows an Aging Committee hearing last fall on the issue. The use of anti-psychotics is an important and complex issue. This is an opportunity for medical professionals, nursing facilities, researchers, and consumers to work together to find cutting-edge ways to care for dementia patients in the safest and most effective ways possible.


Link to Forbes here.

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We're really into dogs this week. More and more we're hearing of dogs being used for therapy, helping people with TBI's and, now, helping those with dementia. They truly are man's best friend.


From Care 2:

You’ve heard of guide dogs for the blind and the disabled. How about a trusty Golden Retriever or lab to guide your loved one with dementia? That’s the premise being tested in Scotland.
Alzheimer’s Scotland and Dogs for the Disabled are working together on a “guide dogs for the mind” experiment, which was conceived by design students at the Glasgow School of Art. The first dogs will be assigned to four couples in Scotland this September. In each couple, one of the pair has mild dementia.
“People in the early stages of dementia are still able to live a relatively normal life, and dogs help to maintain routine,” Joyce Gray of Alzheimer’s Scotland told The Independent.
The dogs are trained to respond to sound triggers. The sounds prompt them to perform care tasks. For example, a dementia guide dog might wake the person with dementia up in the morning, deliver a bite-proof bag of medicine, or deliver notes to fix a meal, while leading the master to the proper cupboard.
Walking a dog provides both exercise and social benefits, too. In one test, developers found that someone with mild dementia who was walking a dog had far more community engagement, with people smiling at and talking to him than when he walked alone.
Pet therapy for Alzheimer’s patients is an idea that’s been around awhile. Animals have been found to lower anxiety and stress, encourage communication, improve mood, and lower blood pressure, for example. Animals — even robotic ones, along with furry toys and dolls — are often used in formal programs for Alzheimer’s patients in the later stages. What’s different with the dementia guide dogs is that they play an active role in patient care.
What gets trickier: What will happen to the dog-master relationship as Alzheimer’s progresses and the person with dementia can no longer read notes, or risks eating the dog food instead of his own. (The test is being conducted with caregiving couples, for now.) But ideally, this innovative idea helps prolong independent living for those who have relatively mild cognitive deficits.
Read more at Care 2.

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This is such an inspirational story, as are most that deal with service dogs. The loyalty and assistance provided by these incredible animals is moving and remind us that humankind is not the only species that can demonstrate love, dedication, and even nobility. I'm so happy that Matthew and Shadow found each other.


From lenconnect.com, the web site of The  Daily Telegram:


(Adrian, MI) Matthew Varnum’s life, and that of his entire family, changed on Feb. 12, 2006, when he was driving home on Beecher Road after dropping his brother-in-law off near Hillsdale and, in veering over to the side of the road to avoid an oncoming car swerving into his lane, ended up going off an embankment and into Bean Creek.
He was knocked unconscious for some 81⁄2 hours, during which time searchers missed finding his car because it was in the creek. When he awoke, Varnum, who at the time was Berean Baptist Church’s youth pastor, was able to dial 911, and soon found himself in a helicopter on the way to Mercy St. Vincent Medical Center in Toledo.
Although at first he appeared to have simply a mild concussion, it soon became clear to him, his wife, Jenny, and their three children, Stella, Matthew Jr. and Noella, that something far more serious was going on.
Routine tasks took much longer to perform. He couldn’t focus and had symptoms including intense migraines, dizziness and nausea. He also began having what are called “syncope episodes,” in which he blacks out and falls to the ground, and periods of confusion that cause him to wander off and get lost.
Two and a half years and countless physicians, hospitals, clinics and treatment centers later, he was finally diagnosed by a doctor in Ypsilanti with a TBI, or traumatic brain injury. Varnum got a service dog shortly thereafter that didn’t work out, but he and his wife saw the benefits of a dog and decided to try again with a puppy they could train and bond with. Enter Shadow, Varnum’s now 16-month-old service dog.
The Daily Telegram interviewed Varnum by email about his experience with Shadow. An edited version follows.

Matthew Varnum plays with his service dog, Shadow. 

Q. What type of dog is Shadow?
A. Shadow is a Shiloh shepherd. They are bigger, stronger-boned, more intelligent and more mild-mannered than the typical shepherd. We got him when he was 9 weeks old, and from that time to this, we have become best of friends.
Q. What does Shadow do for you?
A. Besides the proven benefits of a dog’s calming companionship, Shadow has a couple of main jobs. First, when I pass out, he stays with me and attempts to wake me up by licking my face or nudging me.
We hope to train him to alert others by barking when he sees me go down, so that if I am in a different room, others will know immediately that I need help. Secondly, if I do start to get confused and wander, he would be able to help keep me home or take me home. Also, he would be a great deterrent to someone trying to harm me when I’m wandering, since during these fugue episodes, I don’t know where I am or what is going on.

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From The New York Times:

He was a 27-year-old former Marine, struggling to adjust to civilian life after two tours in Iraq. Once an A student, he now found himself unable to remember conversations, dates and routine bits of daily life. He became irritable, snapped at his children and withdrew from his family. He and his wife began divorce proceedings.

This young man took to alcohol, and a drunken car crash cost him his driver’s license. The Department of Veterans Affairs diagnosed him with post-traumatic stress disorder, or P.T.S.D. When his parents hadn’t heard from him in two days, they asked the police to check on him. The officers found his body; he had hanged himself with a belt.

That story is devastatingly common, but the autopsy of this young man’s brain may have been historic. It revealed something startling that may shed light on the epidemic of suicides and other troubles experienced by veterans of wars in Iraq and Afghanistan.

His brain had been physically changed by a disease called chronic traumatic encephalopathy, or C.T.E. That’s a degenerative condition best-known for affecting boxers,football players and other athletes who endure repeated blows to the head.

In people with C.T.E., an abnormal form of a protein accumulates and eventually destroys cells throughout the brain, including the frontal and temporal lobes. Those are areas that regulate impulse control, judgment, multitasking, memory and emotions.

That Marine was the first Iraq veteran found to have C.T.E., but experts have since autopsied a dozen or more other veterans’ brains and have repeatedly found C.T.E. The findings raise a critical question: Could blasts from bombs or grenades have a catastrophic impact similar to those of repeated concussions in sports, and could the rash of suicides among young veterans be a result?

“P.T.S.D. in a high-risk cohort like war veterans could actually be a physical disease from permanent brain damage, not a psychological disease,” said Bennet Omalu, the neuropathologist who examined the veteran. Dr. Omalu published an article about the 27-year-old veteran as a sentinel case in Neurosurgical Focus, a peer-reviewed medical journal.

The discovery of C.T.E. in veterans could be stunningly important. Sadly, it could also suggest that the worst is yet to come, for C.T.E. typically develops in midlife, decades after exposure. If we are seeing C.T.E. now in war veterans, we may see much more in the coming years.

So far, just this one case of a veteran with C.T.E. has been published in a peer-reviewed medical journal. But at least three groups of scientists are now conducting brain autopsies on veterans, and they have found C.T.E. again and again, experts tell me. Publication of this research is in the works.

The finding of C.T.E. may help answer a puzzle. Returning Vietnam veterans did not have sharply elevated suicide rates as Iraq and Afghan veterans do today. One obvious difference is that Afghan and Iraq veterans are much more likely to have been exposed to blasts, whose shock waves send the brain crashing into the skull.

“Imagine a squishy, gelatinous material, surrounded by fluid, and then surrounded by a hard skull,” explained Robert A. Stern, a C.T.E. expert at Boston University School of Medicine. “The brain is going to move, jiggle around inside the skull. A helmet cannot do anything about that.”

Dr. Stern emphasized that the study of C.T.E. is still in its infancy. But he said that his hunch is that C.T.E. accounts for a share — he has no idea how large — of veteran suicides. C.T.E. leads to a degenerative loss of memory and thinking ability and, eventually, to dementia. There is also often a pattern of depression, impulsiveness and, all too often, suicide. There is now no treatment, or even a way of diagnosing C.T.E. other than examining the brain after death.

While the sports industry has lagged in responding to the discovery of C.T.E., and still does not adequately protect athletes from repeated concussions, the military has been far more proactive. The Defense Department has formed its own unit to autopsy brains and study whether blasts may be causing C.T.E.

Frankly, I was hesitant to write this column. Some veterans and their families are at wit’s end. If the problem in some cases is a degenerative physical ailment, currently incurable and fated to get worse, do they want to know?

I called Cheryl DeBow, a mother I wrote about recently. She sent two strong, healthy sons to Iraq. One committed suicide, and the other is struggling. DeBow said that it would actually be comforting to know that there might be an underlying physical ailment, even if it is progressive.

“You’re dealing with a ghost when it’s P.T.S.D.,” she told me a couple of days ago. “Everything changes when it’s something physical. People are more understanding. It’s a relief to the veterans and to the family. And, anyway, we want to know.”

Link to The New York Times.

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From CBS News:

Exercise not only keeps your body fit, but it can also keep an aging mind in shape.

A new study published on April 23 in the Archives of Internal Medicine shows that using a senior's exercise program - especially those that focus on resistance training - may be able to slow dementia. Exercise improved executive cognitive processes of selective attention, conflict resolution and associative memory, and problems in these areas are "robust predictors" of mild cognitive impairment that lead to dementia, the researchers said.

"There is much debate as to whether cognitive function can be improved once there is noticeable impairment," study author Dr. Teresa Liu-Ambrose, principal investigator with the Centre for Hip Health and Mobility and the Brain Research Centre at Vancouver Coastal Health and University of British Colombia, said in a university press release. "What our results show is that resistance training can indeed improve both your cognitive performance and your brain function. What is key is that the training will improve two processes that are highly sensitive to the effects of aging and neurodegeneration - executive function and associative memory - functions which are often impaired in early stages of Alzheimer's disease."

"There is much debate as to whether cognitive function can be improved once there is noticeable impairment," study author Dr. Teresa Liu-Ambrose, principal investigator with the Centre for Hip Health and Mobility and the Brain Research Centre at Vancouver Coastal Health and University of British Colombia, said in a university press release. "What our results show is that resistance training can indeed improve both your cognitive performance and your brain function. What is key is that the training will improve two processes that are highly sensitive to the effects of aging and neurodegeneration - executive function and associative memory - functions which are often impaired in early stages of Alzheimer's disease."
Dementia is a blanket term for a group of cognitive disorders that usually involve memory impairment, according to the Centers of Disease Control and Prevention. Alzheimer's disease is perhaps the most common form of dementia, with 5.3 million Americans currently living with the disease. It is the sixth leading cause of death in the U.S. and the fifth leading case in people 65 and older. It usually develops in people who are 60 and older. Starting at age 65, the risk doubles every five years.

Continue reading and watch video.

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From USA Today:


The co-chairman of a congressional task force on brain injury has asked Defense Secretary Leon Panetta to account for potentially thousands of troops who suffered concussions in Iraq or Afghanistan before 2010 and were never diagnosed or treated.


Rep. Bill Pascrell, D-N.J., cited a USA TODAY story published Thursday that reported enhanced efforts to diagnose brain injury that were implemented in 2010. As a result of the new procedures, a record number of the wounds have been identified while the patients were still in the war zones. Last spring, 16 troops per day suffered traumatic brain injuries in combat, most of them mild and due to blast exposure, Pentagon data show.


"Despite this progress, I remain concerned that soldiers who could have been injured in theater before this policy took effect in June 2010 could continue to slip through the cracks," Pascrell wrote in his letter to Panetta.


The Pentagon would not comment on the letter.


"It's standard department practice not to comment on congressional correspondence," spokeswoman Cynthia Smith said. "We'll respond to the congressman as appropriate."


Better Tests Find Record Concussions Among U.S. Troops


Link to USA Today.

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From The Navy Times:



Nursing schools and professional nursing organizations will add coursework and training opportunities on military-related injuries and illnesses under a White House-led initiative to improve health care for former troops and their families.
On Wednesday, First Lady Michelle Obama and Dr. Jill Biden, wife of Vice President Joe Biden, plan to unveil an agreement with 150 nursing organizations and 500 nursing schools to educate nurses on combat-related injuries such as post-traumatic stress disorder and traumatic brain injury.
The effort, part of the White House’s Joining Forces campaign, aims to reach 3 million nurses on the “front lines of health care,” Joining Forces Director Navy Capt. Bradley Cooper told reporters Tuesday.
“With nurses … present in literally every community in America, they’ll be positioned to make a significant and positive impact on our veterans and their families for the long term,” Cooper said.
The effort means nurses will be trained to recognize the signs of combat-related stress and traumatic brain injury as well as mental health disorders such as combat-related depression, officials said.
“The goal is to raise awareness among every nurse throughout the country to recognize the signs and symptoms and lower the stigma of getting care,” said Amy Garcia, chief nursing officer for the American Nurses Association.
The White House estimates that 300,000 Iraq and Afghanistan veterans suffer from traumatic brain injury, PTSD or other combat-related mental health issues, such as depression.
About half have sought care from the Veterans Affairs Department, leaving about 150,000 former service members seeking civilian care, Cooper said.
Joining Forces is a campaign designed to raise awareness of the needs of military personnel, veterans and their families. It was launched a year ago this week.
Obama and Biden will unveil more details on the new initiative when they speak Wednesday at the University of Pennsylvania School of Nursing.
In January, Mrs. Obama announced a similar pledge by 135 medical schools to educate future physicians and increase research on what are commonly referred to as the “invisible wounds” of war — PTSD and TBI.
Garcia said no federal funding is being used for the effort.
According to Garcia, one out of every 100 Americans is a nurse. Many don’t work in fields where they would be exposed to head injury or behavioral health disorders. Educating all nurses on these injuries and illnesses would lead to better veterans’ care, she said.
“We want to make sure they understand about new treatments and new science so they can make appropriate referrals,” Garcia said.
The professional education and training opportunities that will be offered through the initiative will be voluntary, she added.
Link to the Navy Times.

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From Scope, published by the Stanford School of Medicine:

A new report from the University of North Carolina shows that catastrophic brain injuries among football players appear to be rising, especially among high school students. The Health Blog reports:
While the number of kids with these brain injuries is small – 13 out of about 1.1 million high-school players – it’s the highest tally since the National Center for Catastrophic Sports Injury Research at UNC started collecting the brain-injury stats in 1984, says Dr. Frederick Mueller, the center’s director and an emeritus professor of exercise and sports science.
Mueller says brain-injury rates dropped sharply after head-first tackles and blocks were banned for high school and college play in 1976. But the injury numbers have been ticking up. Defensive backs take the brunt of these catastrophic injuries, accounting for 34.6% of the 324 recorded between 1977 and 2011, the report says. Over the same time, tackling and “tackling head down” accounted for 40.7% and 19.1%, respectively, of the injuries.
In the report (.pdf), researchers make several recommendations to reduce, and hopefully eliminate, serious brain injuries such as subdural hematomas. Their recommendations include:
  • Preseason physical examines for all participants. Identify during the physical exam those athletes with a history of previous brain or spinal injuries – including concussions.
  • Athletes must be given proper conditioning exercises that will strengthen their necks in order to be able to hold their heads firmly erect while making contact during a tackle or block. Strengthening of the neck muscles may also protect the neck from injury.
  • Coaches and officials should discourage the players from using their heads as battering rams when blocking, tackling, and ball carrying. The rules prohibiting spearing should be enforced in practice and games.
  • It is important, whenever possible, for a physician to be on the field of play during game and practice. When this is not possible, arrangements must be made in advance to obtain a physician’s immediate services when emergencies arise.
Research is underway at Stanford to advance medical understanding of concussions in football. In that study, researchers equipped Stanford football players with high-tech mouthpieces to determine what types collisions cause concussions and whether there are any positions or plays associated with a greater risk of traumatic brain injuries.

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From the Abbotsville Mission Times:

A brain injury can change the direction of one's life, and that new road often leads to prison.

Recent studies show that a large segment of U.S. prison inmates - an average of 80 per cent - have had brain trauma before they became embroiled with the law.

The Canadian experience is the same, said John Simpson, with the Fraser Valley Brain Injury Association.

A former insurance case manager for ICBC, Simpson is a passionate advocate for brain-injured people, and an educator.

Since 1991, he has volunteered at B.C. prisons, supporting inmates and providing in-service training for prison staff on how to recognize signs of brain injury.

The men he's met in prisons are "truly the walking wounded," he said.

"The vast majority have no visible signs of a brain injury. They look perfectly normal on the outside but only when you begin talking to them you see some have speech difficulties, behavioural or cognitive problems."

At the request of inmates and staff at Mission Institution, he is in the process of re-establishing a brain injury support group at the federal penitentiary. There are already 10 men signed up, he said.

Brain injury effects vary from person to person, but generally alter behaviour, memory and cognitive skills such as communication.

Medication can help, but in support groups inside or outside of prison, members receive encouragement, empathy and help from each other, said Simpson.

Through countless interviews, he's found many inmates had multiple concussions starting in childhood.

"An awful lot stems from child abuse, from step-parents," he said, as well as from accidents and sports injuries. The results lead sufferers down the same road, however.

"They did poorly in school, they got in the wrong crowd, they started using drugs and their behaviour spiralled downward," he said.

Their judgment is impaired, so they don't consider the consequences.

For Simpson that means, "you don't need bigger and better prisons. You need bigger and better programs in the community."

The FVBIA struggles with dwindling funds, as grants shrink or are redirected to other causes, he said.



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Alex Karras, the former Detroit Lions standout who starred in the 1980s sitcom “Webster” - and whose wife says is now suffering from dementia - has joined hundreds of ex-NFL players suing the league over concussion-related injuries.
Karras, who also played the horse-punching Mongo in the 1974 movie “Blazing Saddles," is the lead plaintiff in a lawsuit filed Thursday in federal court in Philadelphia on behalf of him and 69 other former NFL players.
The suit  the 12th concussion-related complaint filed against the NFL by the Locks Law Firm in Philadelphia, now representing about 700 former NFL players alleges that the league didn’t do enough to warn players that they risked permanent brain damage if they played too soon after a concussion, and that it concealed evidence about the risks for decades.
The suits claim that plaintiffs suffer from neurological problems after sustaining traumatic impacts to the head.
Karras, 76, of California, “sustained repetitive traumatic impacts to his head and/or concussions on multiple occasions” during his NFL career, and “suffers from various neurological conditions and symptoms related to the multiple head traumas,” the latest lawsuit says.
“Alex suffers from dementia but still enjoys many things, including watching football,” his wife and “Webster” co-star Susan Clark said in a news release Thursday. “But dementia prevents him from doing everyday activities such as driving, cooking, sports fishing, reading books and going to big events or traveling.
“His constant complaint is dizziness  the result of multiple concussions. What Alex wants is for the game of football to be made safer and allow players and their families to enjoy a healthier, happier retirement.”
Karras entered the league in 1958 from the University of Iowa. A four-time Pro Bowl selection, he was a defensive lineman 12 seasons for the Lions, ending his career after the 1970 season.
The players are seeking financial compensation, punitive damages and payment for medical monitoring and treatment, according to Locks Law Firm founding partner Gene Locks. Eventually, he hopes the suits will prompt the NFL to pay for monitoring and treatment for all former NFL players, regardless of whether they’re part of lawsuits.
“(The NFL) had knowledge they didn’t share with the players and didn’t add the knowledge to the playing rules to protect players” from head injuries, Locks said by phone Friday. “What we want is for the league to stand up and be counted, and examine everyone and provide medical benefits to everyone.”

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From DelmarvaNOW.com:


Improved battlefield diagnosis has led to a record number of concussions detected among U.S. troops fighting in Afghanistan and Iraq last year, with an average of 16 inflicted each day last spring, according to newly released Pentagon figures.


It was the highest pace for traumatic brain injuries of any period in 10 years of combat, according to data provided to USA TODAY. Brain injuries caused by the concussive force of a nearby blast are among the most commons wounds troops suffer.


American casualties in Afghanistan this spring are already ticking higher as the traditionally heavier summer fighting months approach, military statistics show.


Although there was an alarming increase last year in buried-explosives attacks on U.S. foot patrols in Afghanistan — where most of the casualties occurred last year — scientists believe the rise in diagnosed brain-injury cases was due largely to more aggressive efforts at detecting the wound.


"I do think that does account for the increase," says Army Col. Jamie Grimes, national director of the Defense and Veterans Brain Injury Center, which conducts brain injury research.


The number of traumatic brain injuries, the large majority of which were mild concussions, suffered each year by U.S. troops in Iraq and Afghanistan, 2005-2011:


As a consequence, experts fear that there were countless brain injuries missed when there were far more casualties during 2005 through 2007. Combat deaths then were twice the annual rate last year.


"You're probably talking about maybe thousands of (undiagnosed) people," says Dave Hovda, director of UCLA's Brain Injury Research Center, who has worked with the military on brain treatment. "Either we didn't know about, or we didn't capture them early enough to protect them so they wouldn't develop (more serious) problems."

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From USA Today:

Cases of dementia — and the heavy social and financial burdens associated with them — are set to soar in the coming decades as life expectancy and medical care improve in poorer countries, the World Health Organization says.
Some 35.6 million people were living with dementia in 2010, but that figure is set to double to 65.7 million by 2030, the U.N. health agency said Wednesday. In 2050, it expects the number of dementia cases to triple to 115.4 million.

Most dementia patients are cared for by relatives, who shoulder the bulk of the current estimated annual cost of $604 billion, WHO said.
In its first substantial report on the issue, the agency said the financial burden is expected to rise even faster than the number of cases.

"The catastrophic cost drives millions of households below the poverty line," warned the agency's director-general, Margaret Chan.

Dementia, a brain illness that affects memory, behavior and the ability to perform even common tasks, affects mostly older people. About 70 percent of cases are believed to be caused by Alzheimer's.

In the last few decades dementia has become a major public health issue in rich countries. But with populations in poor and middle-income countries projected to grow and age rapidly over the coming decades, the agency appealed for greater public awareness and better support programs everywhere.

The share of cases in poor and middle-income countries is expected to rise from just under 60 percent today, to over 70 percent by 2050.

So far, only eight countries — including Britain, France and Japan — have national programs to address dementia, WHO said. Several others, such as the United States, have plans at the state level.

WHO said a lack of proper diagnosis is one of the obstacles to better dementia treatment. Even in rich countries more than half of dementia cases are overlooked until the disease has reached a late stage.
Link to USA Today here.

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From the Digital Journal:


New classification system reveals TBI more common than previously believed.


Recent research by the Mayo Clinic found that traumatic brain injuries, or TBIs, are more common than previously believed. The study used a new classification system to categorize TBI and found that the model used by the Centers for Disease Control (CDC) may be missing two-thirds of all brain injuries.
traumatic brain injury occurs when there is a blow to or puncture of the skull. These types of injuries may be relatively mild, like a concussion, or severe, as the injuries sustained by former Representative Gabby Giffords last year. Over a million Americans suffer a TBI every year. Symptoms of a TBI include dizziness, nausea, numbness of the extremities, headache, restless confusion, irritability, aggression, personality changes and unconsciousness. The young and old are especially susceptible to TBI and men tend to suffer more brain injuries than women do.
Though exhaustive research has been done on the effects TBIs have on patients, few studies have focused on the prevalence of TBIs. The Mayo Clinic study pulled data from the Rochester Epidemiology Project, which collected decades of TBI data from Olmsted County, Minnesota. Researchers found that 558 of every 100,000 people are afflicted by a TBI and that 60 percent of these injuries are not identified as TBIs by the CDC's standard categorization system.
Mayo's new tool, known as the Mayo Traumatic Brain Injury Classification System, labels TBIs as "definite," "probable," or "possible" to accommodate the wide range of symptoms TBI patients can present. Researchers note that even mild TBIs can have negative effects, like reduction in sensory-motor function and decrease in communication skills, thinking and awareness.
The new findings have prompted the CDC to make efforts to restructure their classification system to reflect the improvements the Mayo tool has made. If you or a loved one have suffered a TBI brain injury, please contact an experienced personal injury attorney, who will review the circumstances surrounding the injury and provide details about any compensation to which you may be entitled.
Link to the Digital Journal:

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I couldn't find a way to read the complete article in the Journal of Neurotrauma without paying, and believe me, it's expensive. This abstract will have to do for now.

From Science Codex:

As the population ages in western countries, traumatic brain injury (TBI) resulting mainly from falls is on the rise among the elderly, introducing new complications and treatment challenges, according to an article in Journal of Neurotrauma, a peer-reviewed journal from Mary Ann Liebert, Inc. The article is available free on the Journal of Neurotrauma website.

Nino Stochetti and colleagues from University of Milan and San Raffaele Hospital, Milan, and San Gerardo Hospital, Monza, Italy, reported that one in five patients in a series of adult TBI cases was 70 years of age or older. Increasing age is a predictor of worse outcomes in TBI, mainly due to a higher likelihood of bleeding in the brain, the presence of other chronic diseases, medication use, and diminished capacity for brain repair with age. However, early intensive interventions can produce good results, conclude the authors in the article "Traumatic Brain Injury in an Aging Population."

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Although this article focuses on the homeless population of Juneau, Alaska, its content is likely more universal than that. One of Jack's primary concerns is the extent of TBI's in the homeless population, and you will see that this study found 49% of the homeless respondents had suffered a head or brain trauma. There is no reason to believe that this is an isolated situation.


From the Juneau Empire


The recently concluded survey of Juneau’s homeless community provided some startling insight into that population through the use of numbers, and the trials many of its members face on a daily basis.
The first figure that jumped off the page is 74. That’s the percentage of Juneau’s homeless population the study identified as vulnerable — that is, having a high likelihood of premature death.
Twenty is the average number of fewer years of life a homeless person will have compared to someone with a home, according to a release from the Juneau Homeless Coalition. The diseases that lead to so much premature death are numerous, the release states, but include mental health issues, substance abuse, diabetes, heart disease and brain injury. Twenty-three percent visited the emergency room three or more times in a three-month span.
More than half — 55 percent — of Juneau’s homeless are Alaska Native. That figure grows to 60 percent when looking at the 3 out of 4 Juneauites considered part of the vulnerable homeless subgroup. Nearly 90 percent of respondents have a history of substance abuse and 55 percent have a history of mental illness.
Taken together, those first six numbers reveal the extent to which this issue reaches far beyond advocacy and care groups for the homeless. First responders, mental health professionals, health care providers and Native groups — tribes, corporations and alliances — are all directly involved with addressing this community’s concerns. Among those that work with this concern on a daily basis are the Juneau Police Department, Capital City Fire and Rescue, Bartlett Regional Hospital, SEARHC and Rainforest Recovery Center. In short, this isn’t just the Glory Hole’s problem or the Juneau Homeless Coalition’s problem. This touches everyone —including the taxpayers that fund some of the above concerns — and everyone will need to be part of the solution.
Other numbers reveal there are conditions and circumstances outside a person’s control that lead to homelessness. Forty-nine percent of respondents have suffered a head or brain trauma. One serious traumatic brain injury, or a series of lesser ones, can lead to increased risk for memory loss, a diminished ability to reason, communication difficulty and emotional disorders including depression, aggression and social inappropriateness, according to the Centers for Disease Control and Prevention. . To be sure, not every person who suffers a TBI has all, or even any of those symptoms. But those that do have those problems caused by a history of head injury would have obvious problems in obtaining and holding a job, participating in help programs or possibly even expressing a need for aid. This difficulty functioning would present problems for anyone, but for a person living paycheck-to-paycheck, or without a large network of family and friends, it can be the difference between a roof or rain over a man or woman’s head at night.
Finally, perhaps the most eye-opening number is 32. That’s the percentage of Juneau’s homeless people who are veterans. That’s compared to national veteran population of a bit more than 9 percent. When just looking at Juneau’s vulnerable homeless, that figure jumps to 37 percent. These figures show how society has a long way to go to make good on the implicit promise we make to our servicemen and women — you lay your life on the line for us, and, along with our gratitude, we’ll compensate you for your service while you wear the uniform and after you take it off for the last time. As a military town, Juneau simply must do a better job of ensuring our men and women in uniform don’t go from the deck to destitution.
Solutions to the problems presented and pointed out by the survey will come in time. But the numbers do show this issue is one that affects us all, and is not one we can make disappear by telling our most vulnerable citizens to “get a job” or by blaming them for events that very likely were beyond their control. Part of the answer will be realizing there are things that can be done to alleviate the problem, but blaming people for being homeless isn’t one of them.

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From The Clinical Advisor:

Most of us know saffron as that wonderfully, intense (and expensive) spice used to make risotto, pilaf and paella. Saffron is extracted from the dried stigma of the crocus flower (Crocus sativus). The saffron crocus is a sterile plant, as it cannot independently pollinate and reproduce. The plant is extremely difficult to cultivate, which is part of what makes the spice so expensive. Each crocus stalk grows 8 to 10 inches in height and produces up to four individual purple flowers. The flower has only three stigmas that yield the crimson powder that we know as saffron. 


BACKGROUND

Harvesting these stigmas is a very labor intensive effort, and it is estimated that 225,000 stigmas or 75,000 blossoms are needed to produce a single pound of saffron spice.


Saffron's use as a spice, dye and medicinal plant dates back to ancient Greece and southwestern Asia. Pictorial records produced 50,000 years ago, show colorful depictions of burnt-orange saffron strands being harvested from rich purple plants.

And a seventh-century Assyrian ruler compiled a botanical reference list for saffron in which he cited more than 90 illnesses that saffron was used to treat in classical times. Today, Iran produces over 90% of the world's supply of the spice. 



As a spice, saffron is known not only for its intense, 
yellow-orange coloration, but hay-like, sweet taste. Saffron, unbeknown to most, contains more than 50% of the USDA's recommended daily allowance of vitamin C, iron, and magnesium, and more than 30 % of the recommended daily phosphorus and potassium. 



SCIENCE
Saffron's standardized strength-of-evidence ratings are strongest for depression, Alzheimer's disease and premenstrual syndrome (PMS). The active ingredient in saffron that is believed to be responsible for health benefits is crocetin, a potent antioxidant and carotenoid. This compound has chameleon-like properties in that it acts different ways to meet the needs of differing conditions.

In Alzheimer's disease, crocetin appears to inhibit beta-amyloid (Abeta) protein fibrillogenesis, a hallmark of Alzheimer's destructive pathology. In inflammatory conditions, crocetin down-regulates the production and modifies the expression of pro-inflammatory cytokines and inducible nitric oxide-synthase levels. Crocetin also demonstrates possible antinociceptive activity. 


In a clinical trial comparing saffron to placebo in patients with mild-to-moderate depression, the saffron group out-performed the placebo group. The results, based on pre-and post-study scores on the Hamilton Depression Rating Scale, yielded a statistically significant level (P<0.001). Another study examined 40 adults with DSM-IV criteria, suggesting a major depressive episode. Patients were randomly assigned to receive either saffron or fluoxetine (Prozac) for an eight-week treatment period. At the end of the trial, both groups exhibited similar results, with each group demonstrating a symptom remission rate of 25% for both treatments.

In Alzheimer's disease, researchers have shown that the continuous cognitive decline is due, at least in part, to the abnormal deposition of Abeta protein in the brain cells. Research suggests that saffron may inhibit Abeta deposition. In a study of 46 patients diagnosed with mild-to-moderate Alzheimer's disease, randomized treatment with saffron or placebo was given for a 16-week period. At the end of the trial, participants receiving saffron treatment showed significant improvement over baseline testing on standardized cognitive tasks.

Continue reading.

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This is a little different from most of our posts, but it's a beautifully written piece that raises some of life's most difficult questions. In fact, I'm going to post it on both of our blogs, for while the topic of Alzheimer's certainly belongs here, other issues raised in this tale beg for discussion in Life Ethics.


One morning late last year I awoke from a dream about writing a book, and the storyline was detailed: an older woman, recently diagnosed with dementia, had enlisted  the help of a younger man, perhaps her son, to guide her on a hike into the mountains, where she intended to let herself die by exposure to the elements.  They had to hide the reason for their mission from her family, but were both convinced of the rightness of what they were doing.

It wasn’t a bad dream, on the contrary, I was quite intrigued about such a story because it linked two things that have long interested me – the right to die, and the looming pandemic of Alzheimer’s.  In fact, it seemed like a clear message to get the lead out and write about it.  And as if the message needed reinforcing, later that same day I had an experience that seemed coincidental at the time, and made the dream eerily prophetic in hindsight.

That afternoon, while driving to an appointment, my favourite Belgian spotted our neighbour Sophie walking along the road to the next village, a book tucked under her arm.  Although we hadn’t seen much of her in recent months, we knew she had been diagnosed with Alzheimer’s, and he was surprised to see her out alone.  When he stopped to ask if she was all right, she said she was on her way to meet her husband.
  
Unconvinced of her explanation, FB called me to ask if I could come and pick her up. 
Sophie didn’t blink an eye when I turned up.  Just in case she had the story right, I drove her around for a little while looking for her husband.  She chatted easily and issued a constant stream of almost expressionless directives, every short phrase with the same arc of inflection and always ending with my name.  Be careful at this corner, Deborah. Watch your speed, Deborah. Turn left at this intersection, Deborah.  You drive smoothly, Deborah.  Finally it seemed like the best thing to do was leave a phone message for her husband and go back to my house to wait for his call. 
   
It was a cool afternoon: while the kettle boiled, I built up the fire.  Sophie commented on how well it caught: You make a good fire, Deborah. Oh that’s funny, I laughed, because my FB and I once had a ridiculous argument about the way I had laid the fire, not bothering with the small bits, and of course it didn’t take properly. He wanted to teach me how to do it in Boy Scout fashion and didn’t believe me when I said I knew all about the proper way to set a fire.  I’ll tell him on Wednesday that you know how to make a good fire, Deborah. (Sophie played boules every other week with a group that included FB, and if her dementia had robbed her of her ability to calculate the score, her enthusiasm for the game was unaffected).

When I set the tea tray down, she eyed the oatmeal cookies sceptically: They don’t look like anything a French person would eat, Deborah. I wasn’t offended: Sophie had a fine reputation as a sophisticated cook, and did not suffer inferior food with diplomacy. The back of the kitchen cupboard yielded a box of iconic French biscuits, but when I returned with them, Sophie was already into the second cookie. These are superb, Deborah. I’d like the recipe, Deborah. All told, she ate fifteen of them.

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If you missed this news when it first came out a few weeks ago, better check it out now. It's an eye-opener!


From The New York Times: 


Many people are unaware that dozens of painkillers, antihistamines and psychiatric medications — from drugstore staples to popular antidepressants — can adversely affect brain function, mostly in the elderly. Regular use of multiple medications that have this effect has been linked to cognitive impairment and memory loss.
Called anticholinergics, the drugs block the action of the neurotransmitter acetylcholine, sometimes as a direct action, but often as a side effect. Acetylcholine is a chemical messenger with a range of functions in the body, memory production and cognitive function among them.
The difficulty for patients is that the effect of anticholinergic drugs is cumulative. Doctors are not always aware of all of the medications their patients take, and they do not always think to review the anticholinergic properties of the ones they prescribe. It’s a particular problem for older patients, who are more vulnerable to the effects of these drugs and who tend to take more medicines over all.
Now a spate of new research studies has focused on anticholinergic medicines.
After following more than 13,000 British men and women 65 or older for two years, researchers found that those taking more than one anticholinergic drug scored lower on tests of cognitive function than those who were not using any such drugs, and that the death rate for the heavy users during the course of the study was 68 percent higher.
That finding, reported last July in The Journal of the American Geriatrics Society, stunned the investigators.
“So far we can’t tell why they are dying, but it wasn’t because they were sicker or older,” said Dr. Malaz A. Boustani, director of the Wishard Healthy Aging Brain Center and a scientist at the Regenstrief Institute, both in Indianapolis, who was one of the paper’s authors. “We adjusted for age, gender, race, other medications they were taking, other diseases and social status. We adjusted for everything we could, and that signal did not go away.”
He added: “These are very, very common drugs. That’s the scary piece.”
Dr. Chris Fox, a senior lecturer at Norwich Medical School at the University of East Anglia in England and the paper’s lead author, said he and his colleagues suspected that anticholinergics take a toll on bodily organs and systems like the cardiovascular system, although there are no studies confirming this.
Anticholinergics have also been implicated in the delirium that intensive-care patients frequently develop in the hospital. “Clinicians don’t think of them nearly as often as they should as a potential cause of cognitive problems,” said Dr. Wesley Ely, a professor of medicine at Vanderbilt University who studies neuropsychological deficits that occur after intensive care hospitalization.
Of the 36 million Americans 65 and older, at least 20 percent take at least one anticholinergic medication. A study by Dr. Boustani of nearly 4,000 older adults in Indianapolis found that those who had been using three or more possibly anticholinergic drugs consistently for 90 days or longer were nearly three times as likely to receive a diagnosis of mild cognitive impairment as those who had not taken anticholinergics.
“If you were taking one of the drugs we know is definitely an anticholinergic for 60 days, you doubled the odds of developing mild cognitive impairment” compared with a patient taking no anticholinergic medicines, Dr. Boustani said.
No association was found between chronic use of anticholinergics and dementia, however, even though mild cognitive impairment often precedes dementia. Dr. Boustani said the reasons for this were not clear.
Continue reading.

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Here's a short list of anticholinergics from the Center for Medical Consumers:
Is Your Drug an Anticholinergic?
Ask your pharmacist or doctor whether a drug you are taking is an anticholinergic. The usual advice—read the written material that comes with the drug—does not hold in this case. The much-abridged list of anticholinergics below came from a medical journal, but a spot check of the written information that comes with these drugs failed (with one exception) to mention the word anticholinergic.
Lomotil, Lofene, Logen, and many other drugs that contain atropine for diarrhea;
Detrol, Enablex, Trospium, Ditropan for overactive bladder;
Hyosol, Hyospaz for disorders of the gastrointestinal tract;
Prednisone Intensol, Sterapred for certain types of arthritis, severe allergic reactions, etc;
Bronkodyl Elixophyllin, Slo-bid, Theo-24 and other drugs containing theophylline for asthma, chronic bronchitis and other lung diseases;
Codeine for pain and inflammation. Sold under more than two dozen brand names and present in more than 30 combination products;
Xanax, Alprazolam Intensol for anxiety disorders and panic attacks; Valium and Diazepam Intensol for anxiety disorders, muscle spasms, and seizures;
OxyContin, Oxydose, Roxicodone for moderate to severe pain;
Capoten, or captopril, for hypertension and heart failure;
Lasix to reduce the swelling and fluid retention caused by various medical problems, heart or liver disease. It is also used to treat high blood pressure.

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