Archive For: Healthy Aging

Dementia and Alzheimer’s: Updates from a Leading Geriatrician

Dementia and Alzheimer’s: Updates from a Leading Geriatrician

Senior Moments Or Something More?

As Baby Boomers continue the inexorable journey deep into their senior years, preserving cognitive function understandably tops the list of worries. While Alzheimer’s Disease and related dementias are seen in just 5% of people over 65, that number jumps to 30% for people age 85 and over. Questions abound: is forgetting a name a sign of normal aging or an indicator of a more serious memory disorder? Are any nutritional supplements or pharmaceutical treatments available that are proven to stave off memory loss? Most importantly, what steps can be taken to modify individual risk?

To better understand how to identify and manage dementia and Alzheimer’s disease, we asked one of the country’s leading experts, R. Sean Morrison, MD, for his informed perspective on this growing concern for seniors, their families and caregivers. A practicing geriatrician, palliative medicine physician and health researcher for almost three decades, Dr. Morrison has earned numerous awards and recognition for his work, and currently serves as the Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and as Director of the Hertzberg Palliative Care Institute.

Is memory loss an inevitable, natural sign of aging?

Dr. Morrison: The good news is that not all cognitive functions decline with age. The ability to maintain attention, language comprehension, usage, and vocabulary does not decrease. Knowledge learned years ago like how to ride a bike, or brush your teeth, also stays intact. Additionally, when you learn something new and can remember it, you won’t forget it any more rapidly than when you were younger.

The not so good news is that it will take greater effort to learn those new things; more attention, repetition and use of memory-enhancing strategies will be needed. The ability to multitask is also diminished, as processing information takes longer and reaction times are slower. People may experience poorer performance when working under time pressure, and find it more difficult to manipulate information in the brain, such as calculating a tip in a restaurant or figuring out a route to travel from one place to another.

How do you distinguish between a “senior moment” lapse in memory and a sign of Alzheimer’s disease?

Dr. Morrison: So many people experience that temporary inability to remember a name. But if you are able to recall things with a cue or can pick it out from a list of possibilities, that’s evidence of a problem with retrieval but not with storage. You can be reassured that it doesn’t indicate Alzheimer’s disease but a “senior moment” because the information has been successfully stored in your memory.

Is routine screening for dementia recommended in older adults?

Dr. Morrison: The U.S. Preventive Services Task Force does not recommend for or against routine screening, saying no interventions are proven to have a significant effect in people with earlier detected cognitive impairment. However, it is required as part of Medicare’s yearly assessments, and most primary care physicians consider dementia screenings an essential part of their annual wellness exam.

What types of screening tests do you recommend?

Dr. Morrison: At least a dozen tests are available, each with their own benefits and drawbacks. I recommend the following for their ease of use and proven sensitivity and specificity in diagnosing cognitive impairment:

  • Mini-Cog is a quick, three-minute evaluation. Patients are asked to repeat three words, draw a clock with hands at a specific time, and then recall the initial three words.
  • Memory Impairment Screen assesses free and cued word recall. Patients are read four unrelated words from four categories (e.g. Red Cross, saucer, checkers, telegram) and after a few minutes of diversion, asked to recall the words in 20 seconds, either with no prompting or cued by category.
  • Animal Fluency Test. Patients are asked to name as many animals as possible in a 60-second period.

Are there any risk factors for dementia and Alzheimer’s disease that can be controlled by patients?

Dr. Morrison: Quite a few risk factors are modifiable with lifestyle changes and non-pharmaceutical treatments. These include:

  • Address hearing and visual impairments, with eyeglasses, hearing aids and other assistance
  • Prevent and manage hypertension and diabetes
  • Maintain a healthy weight
  • Stop smoking
  • Seek treatment for depression
  • Prioritize regular exercise and physical activity
  • Avoid social isolation
  • Explore cognitive training

The best advice I can give to people in their 50s to 70s looking to prevent or delay progression of dementia and Alzheimer’s disease: exercise, exercise, exercise and rigorously control your blood pressure.

How are the symptoms frequently experienced by people with dementia – sleep disturbance, mood disorders, agitation – best addressed?

Dr. Morrison: There are a number of non-pharmaceutical interventions that have proven effective. Use adaptive clothing and assistive devices to help eliminate distress around bathing and dressing. Create a reassuring familiar structure to the day with a regular routine and activities. Optimize the sleep environment with a comfortable temperature, the right amount of light, a warm milky drink and a bath or shower before bed; avoid stimulating medications, drinks containing caffeine and alcohol, and exercise too close to bedtime. Pharmaceutical treatments can also be considered, including antidepressants to improve cognition and ameliorate agitation and aggression, and melatonin and melatonin antagonists to help with sleep disorders. Of note: medications such as benzodiazepines (BZD), non-BZD hypnotics, mood stabilizers and antipsychotics are no longer routinely recommended as side effects can outweigh possible benefits.

Are there any benefits to nutritional supplements or appetite stimulants?

Dr. Morrison: Nutritional supplements can help with weight gain in patients with anorexia or cachexia (‘wasting’ syndrome) but have no meaningful impact on survival. And while appetite stimulants such as cannabinoids and steroids are often given to help patients with dementia, there is no consistent data regarding their safety and efficacy.

What medications are available to treat or stop the progression of dementia?

Dr. Morrison: Until last year, only four medications were approved for treatment of dementia and Alzheimer’s disease, showing only a minimal to modest improvement in cognition. In 2021 a fifth drug was launched – aducanumab – a monoclonal antibody designed to reduce amyloid protein in the brain. Its fast-track approval was quite controversial as the clinical benefits of the drug were not proven during trials, which were stopped early as a result, and some severe side effects were observed. Interestingly, some researchers are now rethinking the idea that targeting amyloid protein plaques will eliminate Alzheimer’s disease, and instead exploring Alzheimer’s as a disease of inflammation. This could be the next fascinating line of research.

How a Memory is Made

Memory begins to form by giving attention to the information received through your senses. Anything that interferes with your ability to pay attention, such as hearing impairment, will affect the formation of a sensory memory. Successful integration of sensory memories into your working memory enables you to temporarily store, organize and manipulate information. These memories are then encoded into long-term memory and finally put into permanent storage.

 

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In a Pickle and Looking for a New Summer Activity?

In a Pickle and Looking for a New Summer Activity?

Try Pickleball, the Country’s Fastest-Growing Sport

Tired of the same ‘ole routine every summer but find yourself in a pickle and looking for a new summer activity? Well, according to American Council on Exercise (ACE), you might want to consider pickleball.

As everyone from your next-door neighbor to ACE will attest, pickleball is extraordinarily popular. Its rapid rise to ubiquity can be attributed to a number of factors, ranging from easily learned rules and minimal equipment needs to intergenerational appeal and abundant opportunities for socializing.

This blend of badminton, tennis and table tennis can be adjusted to suit the intensity and competitiveness of the players, making it simple enough for beginners but fast-paced enough for more fit or skilled participants.

All of which is to say that if you haven’t yet considered picking up a pickleball paddle and the light, whiffle-like plastic ball, summer 2022 might be the perfect time to do so.

“Pickleball doesn’t require the skill of tennis, so it is easily adapted by most, and provides all the benefits of movement, including calorie burning and enhanced functional capabilities,” says Dr. Cedric Bryant, ACE president and chief science officer.

Already a favorite sport in retirement communities, pickleball has swelled to include more than 4.8 million players in the U.S. – almost double the number from five years ago – earning it the title of fastest-growing sport in 2021 and 2022. According to the Sports and Fitness Industry Association, the spike has been fueled by people ages 54 and younger looking for a friendly yet competitive and lively sport.

“People who play are generally having so much fun they don’t realize how much exercise they’re actually getting,” says Laura Gainor, spokesperson for the USA Pickleball Association.

At 44 x 20 feet, the pickleball court is one quarter the size of a tennis court, so it’s easier to keep the ball in play and achieve a brisk workout. According to ACE, pickleball may provide just what many middle-aged and senior adults are seeking – a safe and effective workout that yields long-term benefits and encourages lifelong participation.

A small research study recently conducted by the organization among people ages 40 to 85 showed that playing four 15-minute pickleball matches three days each week meets exercise intensity guidelines for improving and maintaining cardiorespiratory fitness. Study authors reported the positive impact on cardiometabolic risk factors, with participants experiencing favorable changes in cholesterol levels, systolic and diastolic blood pressure, and peak oxygen uptake after six weeks.

The smaller court also benefits older people or those who have problems with their joints, because less running is needed, resulting in less wear and tear on the joints. One cautionary note: Experts advise learning proper technique to prevent falls. As always, be sure to check with your healthcare provider before beginning any new physical activity.

“Take a few lessons to get started, and you’ll quickly ramp up,” assures Gainor. “After three to five games, you’ll have a very good understanding of how to play, and will become addicted to it shortly after!”

Take It Outside: Keep Moving This Summer

There’s no one-sport-fits-all approach, so if pickleball doesn’t appeal, find your inspiration in one of these activities, spanning the spectrum from low exertion to highly energetic:

  • Stroll through farmers’ markets or art fairs
  • Go produce picking at a local orchard
  • Forest bathe – immerse yourself in nature at a forest preserve
  • Gardening – remember to bend from your knees and waist rather than your back
  • Swim – use a variety of strokes to limber up your whole body
  • Disc golf – a low-impact way to challenge your coordination
  • Yard yoga – take your mat and routine outdoors
  • Hike, jog, run or cycle on an outdoor trail
  • Kayaking – for a vigorous upper body workout
  • Stand-up paddleboarding or Boga – challenging, board-based water workouts

Sources: American Council on Exercise, American Heart Association, USA Pickleball Association

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When Are the Best Years of Our Lives?

When Are the Best Years of Our Lives?

Best Happiest Years

Life’s Happiness Continuum Is there a predetermined peak age for happiness, before which our normal outlook is gloomy and melancholy and after which we slump back into these non-euphoric ways? When Are the Best Years of Our Lives? Studies Show Two Stages of Life Happiness Like trying to define why some people are born to...

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When Are the Best Years of Our Lives?

When Are the Best Years of Our Lives?

Happiness Continuum: When Are the Best Years of Our Lives? Is there a predetermined peak age for happiness, before which our normal outlook is gloomy and melancholy and after which we slump back into these non-euphoric ways? Like trying to define why some people are born to be joyful and others to play the role...

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Kidney Stones: Treatment & Prevention

Kidney Stones: Treatment & Prevention

This Too Shall Pass: Treating and Preventing Kidney Stones More common, frequently less painful and far more preventable than reputed, kidney stones have, thankfully, entered a new era of highly effective, noninvasive procedures. We bring you up to date on this eminently treatable condition. Q: Why do kidney stones happen? A: They form when substances...

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Kidney Stones: Treatment & Prevention

Kidney Stones: Treatment & Prevention

entered a new era of highly effective, noninvasive procedures. We bring you up to date on kidney stone treatment & prevention

This Too Shall Pass: Treating and Preventing Kidney Stones More common, frequently less painful and far more preventable than reputed, kidney stones have, entered a new era of highly effective, noninvasive procedures. We bring you up to date on kidney stone treatment & prevention Q: Why do kidney stones happen? A: They form when substances...

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An Update on the Measles Outbreak in the US

An Update on the Measles Outbreak in the US

What are the newest guidelines for measles vaccinations?
  • Adults with no evidence of immunity should get 1 dose of MMR. Immunity is defined as documented receipt of 1 dose, or 2 doses, 4 weeks apart if high risk, of live measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or birthdate before 1957.
  • High-risk people, including healthcare personnel, international travelers and students at post-high school educational institutions, should receive 2 doses.
  • Persons who previously received a dose of MMR vaccine in 1963–1967 and are unsure which type of vaccine it was, or if it was an inactivated measles vaccine, should be revaccinated with either 1 (if low-risk) or 2 (if high-risk) doses of MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered complete for their age or risk status.
Why does a birthdate prior to 1957 confer immunity to measles? People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very likely to have had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Persons born before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should be administered. Why is a second dose of MMR necessary? Between 2% and 5% of people do not develop measles immunity after the first dose of vaccine for a variety of reasons. The second dose is to provide another chance to develop measles immunity for people who did not respond to the first dose. Are there any situations in which more than 2 doses of MMR are recommended? There are two circumstances when a third dose of MMR is recommended, according to ACIP.
  1. Women of childbearing age who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive 1 additional dose of MMR vaccine (maximum of 3 doses). Further testing for serologic evidence of rubella immunity is not recommended. NOTE: MMR should not be administered to a pregnant woman.
  2. Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine (MMR or MMRV) to improve protection. More information is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf
Many people age 60 years and older do not have records indicating what type of measles vaccine they received as children in the early 1960s. What measles vaccine was most frequently given in that time period? That guidance would assist many older people who would prefer not to be revaccinated. Both killed and live attenuated measles vaccines became available in 1963. Live attenuated vaccine was used more often than killed vaccine. Without a written record, it is not possible to know what type of vaccine an individual may have received.
  • The killed vaccine was found to be not effective and people who received it should be revaccinated with live vaccine.
  • Persons born during or after 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles disease, should receive at least 1 dose of MMR.
  • Some people at increased risk of exposure to measles (such as healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least 4 weeks.
Do people who received MMR in the 1960s need to have their dose repeated? Not necessarily.
  • People who have documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated.
  • People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect people who may have received killed measles vaccine which was available in the United States in 1963 through 1967 and was not effective (see above).
  • Persons vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (such as persons who work in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.
Please explain the Advisory Committee on Immunization Practices (ACIP)’s revised definition of evidence of immunity to measles, rubella, and mumps. In the 2013 revision of its MMR vaccine recommendations, ACIP includes laboratory confirmation of disease as evidence of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of immunity for measles and mumps. Physician diagnosis was previously not accepted as evidence of immunity for rubella. The decrease in measles and mumps cases over the last 30 years has made the validity of physician-diagnosed disease questionable. In addition, documenting history from physician records is not a practical option for most adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf What can be done for unvaccinated people who have already been exposed to measles, mumps, or rubella? The measles vaccine, given as MMR, may be effective if given within the first 3 days (72 hours) after exposure to measles. Immune globulin may be effective for as long as 6 days after exposure. Post-exposure prophylaxis with MMR vaccine does not prevent or alter the clinical severity of mumps or rubella. However, if the exposed person does not have evidence of mumps or rubella immunity they should be vaccinated since not all exposures result in infection.

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Spring Training

Spring Training

Spring Training: Ramping Up after a Long, Sedentary Winter Whether you went into hibernation as the result of a record cold winter season, or took time off from your usual exercise routine because of a busy schedule or illness, spring is an ideal time to get back in action. When done with care, starting or...

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Aging Well, Aging Healthy…a continuing series

Aging Well, Aging Healthy…a continuing series

HealthWise Winter2016 Hasson

As almost 10,000 Baby Boomers officially become senior citizens each day, the focus on preventing and treating age-related ailments becomes distinctly more urgent. HealthWise presents an ongoing look at research that provides valuable insights to help today’s seniors – and the generations set to follow – create a vibrant next chapter. We began with strategies...

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