Medicare Stinginess Casts Pall Over Primary Care

Smart Clips: Medicare Stinginess Casts Pall Over Primary Care

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Smart Clips: Medicare May Help Snoring Seniors Rest Easier

clipped from blogs.wsj.com The Centers for Medicare and Medicaid Services has in mind to extend coverage of continuous positive airway pressure devices (that’s the mask plus a pump that pushes air into the lungs) to more people suffering from sleep apnea. The expansion would make coverage available to Medicare recipients who’ve tested positive for sleep apnea in home tests. The existing policy applies only to people whose disorder was diagnosed in sleep labs. Sleep apnea is a common problem characterized by frequent, brief interruptions of breathing during sleep. Some people think it’s just harmless snoring, but sleep apnea can raise blood pressure and the risk of cardiovascular disease. Some 12 million people in this country suffer from sleep apnea, according to the American Sleep Apnea Association. Because home testing will now be an option, scores of patients who may have otherwise gone undiagnosed will be able to seek the best treatment,

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Grace In The Time Of Alzheimer's

The first morning of my new job I sat in a kid's size wooden chair in the "activity room" of the Alzheimer's unit of the assisted living facility. The 20 or so residents seated in gliders and rockers were clearly waiting for the person in the kid's size wooden chair - me - to do something. Written on the white board beside the piano were promises of all sorts of interesting fun "activities" for the day ahead - exercise, cooking, word games, singalongs and so on.

Grace In The Time Of Alzheimer's

The Tampa Tribune


I'm always leery when a potential employer seems too eager to hire me, kind of like how Groucho Marx felt about not wanting to belong to a club where they'd accept him as a member. But when the woman who interviewed me told me this job would be "just having fun" and didn't raise her eyebrows at my colorful resume, I accepted her offer.

The first morning of my new job I sat in a kid's size wooden chair in the "activity room" of the Alzheimer's unit of the assisted living facility. The 20 or so residents seated in gliders and rockers were clearly waiting for the person in the kid's size wooden chair - me - to do something. Written on the white board beside the piano were promises of all sorts of interesting fun "activities" for the day ahead - exercise, cooking, word games, singalongs and so on.

It was my job to make those things happen.

I stood up and walked around the room and introduced myself. Some held my cold clammy hand a long time, concerned about my obvious lack of healthy blood circulation. I asked where they'd been born. A petite woman with cornflower blue eyes whispered that she couldn't remember her home state. So we decided she could be from Ohio, where the pretty lady next to her was from.

I'd spent a large part of my Alabama childhood in the near-constant presence of elderly grandparents, aunts and uncles, and so while I was comfortable on one level, these folks had no connection to me, no reason to think I was up to any good. Would they trust me?

But little by little, we grew to know and like each other.

Most days I couldn't believe I was getting paid to do something I enjoyed so much. Other days, it was painfully clear that I worked for a corporation, didn't play office politics very well and couldn't turn my head when I saw corners being cut in resident care.

When those facts had me down, I never failed to get a reminder of the bigger picture that I was privileged to be a part of.

On one of those particularly difficult days, during the conversation I had every afternoon with a tall, handsome gentleman with deeply intelligent eyes and a slight Southern accent, when he'd ask where his car was and I'd lie to him that I'd sent it to be washed, he told me, "You know, I remember you the most."

There simply was no higher compliment.

These folks were locked behind doors with numbered keypads, often unable to decide for themselves what they'd wear for the day or what they'd like for lunch, or the names of their children. And things would only get worse. Yet still they smiled, still laughed, still thanked me for every tiny deed I did for them. They didn't mind if I forgot ingredients when we baked cookies, if my jokes were lame, that my singing was painfully off key or that my dancing followed a rhythm you won't likely see on "Dancing with the Stars."

They ate, laughed, sang and danced with me anyway.

Their graciousness belied any infirmity.

This job was so much more than "just having fun."

Every day, I was reminded of the value of enjoying the present, that the past is best remembered however we like, and that worrying about the future is a waste of time. And for that, I would remember these people.

The most.

Sandra Webber is a freelance writer living in Clearwater.
Find this article at:
http://www2.tbo.com/content/2007/dec/16/bz-grace-in-the-time-of-alzheimers

The 36-Hour Day: A Family Guide to Caring for People with Alzheimer Disease and Memory Loss in Later Life

What If It's Not Alzheimer's: A Caregiver's Guide to Dementia

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How Much Are CT Scans Increasing Cancer Risk?

My mother received quite a few CT Scans and MRIs over the last few years.

clipped from blogs.wsj.com Americans get about 62 million CT scans every year — which could ultimately cause 1.5% to 2% of all cancers in this country, according to an estimate published in this week’s New England Journal of Medicine (online here). The article suggests that, while many scans are useful and even life-saving, others might be replaced with other procedures. For example, the authors say, ultrasound may often be as effective as CT when diagnosing appendicitis in children. It is tough to estimate the risk of developing cancer from radiation risk. As the authors (two Ph.D.s from Columbia’s Center for Radiological Research) point out, most such estimates are based on studies of survivors of the atomic bombs dropped on Japan in 1945. Arl Van Moore, chairman the American College of Radiology’s board, told the WSJ that “there are scans performed that may well be unnecessary,” he called the authors’ conclusions about the possible 2% rate of future cancer diagnoses “a reach.”

Discovery suggests new ways to treat Alzheimer's cause, not just symptoms

clipped from www.newsroom.ucla.edu For some time, scientists have blamed Alzheimer's disease on a small molecule called amyloid beta protein (A beta) that leaves large gummy deposits in the brain. Recent studies suggest that these A beta proteins stick together to form floating toxic clumps that kill brain cells. Now, UCLA scientists have identified a tiny loop in A beta as the likely culprit behind the adhesion process. The UCLA team discovered that gene mutations in A beta increase the loop's flexibility, enabling it to join easily with loops from other A beta proteins and form clumps. The loop also appears in the region of the protein that regulates how — and how much — A beta is made. Principal investigator David Teplow, professor of neurology at the David Geffen School of Medicine at UCLA, is available for interviews. The Proceedings of the National Academy of Sciences published the findings in its Oct. 10 online early edition. For a PDF of the study, see www.eurekalert.org/pio/tipsheetdoc.php/237/zpq7481.pdf.

Brain Activity Might Point to Early Alzheimer's

A team at Duke University Medical Center in Durham, N.C., used functional magnetic resonance imaging (fMRI) to study the brains of 13 patients with mild Alzheimer's disease, 34 patients with mild cognitive impairment, and 28 healthy people (averaging about 73 years of age) as they did a memory task.

Alzheimer's Reading Room: Brain Activity Might Point to Early Alzheimer's

Newly Discovered Antibody May Be Body's Natural Defense Against Alzheimer's (Gammagard)

In what could prove to be an important development in the search for a treatment of Alzheimer's disease, NewYork-Presbyterian Hospital/Weill Cornell Medical Center physician-scientists say the results of an initial (Phase I) clinical study provide encouraging evidence that antibodies derived from human plasma can capture the beta-amyloid protein in blood and exert positive effects on patients' thinking abilities.


Read more at the Alzheimer's Reading Room: Newly Discovered Antibody May Be Body's Natural Defense Against Alzheimer's (Gammagard)

Early signs of Alzheimer's (Dementia)

We are receiving many "hits" from people searching "early signs of dementia". I ran across this description of the "early signs of Alzheimer's" on the Milton S. Hershey Medical Center (Penn State) some time ago. I felt it might be helpful and decided to post it here.


Source Milton S. Hershey Medical Center

Alzheimer’s Disease

What is it?

Alzheimer's disease is the most common cause of a condition called dementia. Dementia is a general decline in mental ability, such as memory, language skills, judgment, and concentration. Alzheimer’s is a progressive disease, which means symptoms occur gradually and become worse over time. It is named for the German doctor who first described it, Alois Alzheimer.

Who gets it?

Alzheimer’s disease affects most commonly affects those over the age of 65, although it has been diagnosed in people in their 40s and 50s.

What causes it?

The degeneration of parts of the brain, which destroys brain cells, causes the symptoms of Alzheimer’s. However, at this time researchers are not sure what causes this degeneration. Those with a family history of Alzheimer’s are more likely to develop the disease as they age, so there is a gene abnormality that causes the disease in some people. Researchers are looking for links between Alzheimer’s disease and the environment, lifestyle, nutrition, and viruses.

What are the symptoms?

Alzheimer’s usually progresses in three stages, with each lasting anywhere from one to several years. The first symptom of Alzheimer’s disease is usually mild forgetfulness. Someone in the early stages may find him or herself unable to find the right word, recall where something was placed, or recall someone’s name. It may be difficult to concentrate. At this point, symptoms are so general that they do not signal a serious problem or have a great impact on day-to-day functioning. As the disease progresses to the second stage, the forgetfulness becomes worse, making it difficult to function at work, remember directions, or to even make it through the day without difficulty. The person may be restless and unable to sleep at night. His or her personality may change considerably, with increasing anxiety and decreasing emotions. By the late stages of Alzheimer’s, patients suffer from extreme confusion and memory loss. They are unable to recall the names of close friends and family or recent events, and cannot function socially or perform basic daily personal care. Late-stage Alzheimer’s patients may have hallucinations and delusions.

How is it diagnosed?

Alzheimer’s disease is diagnosed by taking a complete medical history and performing a thorough physical examination. Alzheimer’s is generally suspected when there is a gradual deterioration in mental ability. The doctor will perform tests, such as blood tests and brain scans, to rule out other possible causes of the symptoms. The doctor will also ask the patient a series of questions to test his or her mental status. One type of test of mental status is called neuropsychological testing, which is a standardized test of memory, concentration, and visual-spatial skills. Because a definite diagnosis can only be made by performing an autopsy after death, patients are diagnosed with “probable” Alzheimer’s. An autopsy of brain tissue, however, will show areas of abnormal tissue, called plaques, made up of abnormal proteins; a loss of nerve cells; and areas of tangles in the nerve cells that remain in patient’s with Alzheimer’s disease.

What is the treatment?

At this time, there is no cure for Alzheimer’s disease. Treatment focuses on maintaining the best possible quality of life for the patient by providing a supportive environment. Memory aids, such as calendars and other daily reminders of time and place, can help the patient feel more secure and reduce confusion. There are some medications that, when used in the early stages of this disease, can slow memory loss in some patients for a limited amount of time. However, these drugs are used with caution because of potential side effects. Other drugs may be prescribed to treat anxiety, sleeplessness, depression, and hallucinations, as necessary. In the early stages of Alzheimer’s, it is important to help the patient maintain as much independence as possible. As the disease progresses, it may be necessary to seek the help of a home healthcare aid, an adult daycare, or nursing home. While there is currently no treatment to prevent or stop the progression of Alzheimer’s, researchers are continuing to study this disease and test new drugs. There is a possibility that certain types of nonsteroidal anti-inflammatory drugs (NSAIDs) may slow the progression of Alzheimer’s.

Self-care tips

A diagnosis of probable Alzheimer’s is devastating for someone who has been accustomed to living an independent life. It is important to provide the patient with emotional and physical support as he or she adjusts to living with this disease. Keeping the daily routine consistent and as stress free as possible is helpful. Because depression is so common in the early stages of Alzheimer’s, you should be aware of the signs of depression and seek help for the patient as soon as possible. Caring for someone with Alzheimer’s can be demanding and discouraging, especially when the loved one does not remember who you are. Your doctor or local social services agency can direct you to support services to help make this time a little easier. Also seek legal advice so it is clear who has the power to make medical and financial decisions once your loved one is no longer able to do this for him or herself. If you have a family history of Alzheimer’s disease, see your doctor for regular checkups. An early diagnosis is important, especially as the medical community learns more about this disease and its treatment. While there is no way to prevent this disease, you can lower your risk and protect yourself from many illnesses by following a healthy diet that is high in fiber and antioxidants and low in saturated fat, and participating in regular physical exercise. Performing activities that stimulate your brain on a regular basis, such as crossword puzzles, word searches, or memory games, may also help maintain mental ability longer.


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This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

What If It's Not Alzheimer's: A Caregiver's Guide to Dementia

"early signs of Dementia", early signs of alzheimer's, early signs of alzheimers, early signs of Dementia, milton s hershey medical center, what causes it?, what is it?, who gets it?

I am an Alzheimer's Caregiver: Kids bring joy to Alzheimer's Sufferers

The following article shows that our children can really play an important community service role in our society. The kinds of interactions with Alzheimer’s patients that are described not only benefit the patients they give the children important lessons in life. I found this article uplifting.

On a personal note, I can tell you my mother is reacts very positively to children. A child always brings a smile to my mothers face. If you look closely you can see she is experiencing real feelings of joy and happiness. On those days where my mother has interactions with children or young adults she usually has a better, brighter day.

Source Sioux City Journal

The generations appear to mesh seamlessly when kids from Building Futures Child Care, a public program of the Boys & Girls Home, make their weekly visit to the Alzheimer's Association's Adult Day Services room.

Without being told, the youngsters eagerly fill in the couple of empty chairs at each table. The clients who came Thursday have been chatting, listening to music or just sitting. Soon, the children's teacher, Julie Bell, and aide Cindy Levering, are passing out clear plastic suncatchers and squeezing splats of bright-colored paints into trays for each person.

The children, ages 4 to 10, have come for an hour or two every Thursday this summer. They play board games, read a library book or do a craft and then share a snack with the clients. Both generations benefit from their time together, even if not everyone remembers it well.

'I love it'

"My middle name is Mess-up," client Marian Persinger laughed as she fixed a drip on her suncatcher. She said she enjoys the children's visits. "The camaraderie. Whatever (craft) they bring, we do. We frosted cookies with them last week," she remembered.

"I know. We made caterpillars," Dylan Thompson, 5, offered. It's not clear whether he meant last week or another time. It doesn't matter.

"Oh, I love it," client Kay Erskine said. "Seeing these kids and watching them, it's really neat."

The children provide a flashback to a happy time for Linda Young, as well. She has attended the center nearly every day for the past three years, since suffering a brain injury in a fall at work.

"It's my first time. I'll watch," said one man who actually comes to the center five days a week. Matt Elgert, 6, unperturbed by the disconnect, painted his suncatcher and talked about playing Candy Land on an earlier visit.

Client Mike Biderman, a retired Navy man who comes to the center often, said he thinks the interaction is good for the children, too. "They should have some exposure to adult life as early as possible," he said.



'Bring somebody joy'

Mary Jo Sikkema, director of the Alzheimer's Association, said the children's visits are important. They keep clients busy, stimulate their brains and give them an opportunity to socialize with other people. She said it's rare that a client doesn't want to participate, or gets agitated.

Stephanie Altamimi, director of Day Services, said she think the clients especially like doing crafts with the children because they feel they are helping the kids. And, she said, the adults feel a connection to all children who visit the center, whether it's the day care children or a family member's child.

Levering said she was surprised at first at how well the children handle their visits. "They're so patient with the clients," she said.

Bell added, "I explained to them they're volunteering their time to bring somebody joy. They really got the concept."

Altamimi said other young people also visit the Day Center. She said sometimes a church or high school group will come and stay most of the day. Some have played band instruments, or drummed up a game of chair volleyball with clients. "We don't ever turn anybody away," she said.

Bell said her group plans to keep its visits going, even after summer ends. They'll come to the center on all the "early out" Mondays of the school year. Days when classes end at 1 p.m., the kids in her program will assemble at the Alzheimer's Day Services Center for crafts, snacks -- and bringing joy.





The 36-Hour Day: A Family Guide to Caring for People with Alzheimer Disease and Memory Loss in Later Life

I am an Alzheimer's Caregiver: The early signs of Dementia (Alzheimer's)

Looking back, there is little doubt in my mind that if I had had the proper education or information I would have realized my mother was suffering from dementia sooner. Most people like me tend to ignore the symptoms at first believing they are simply signs of "old age". Anyone who ends up in my shoes knows and understands that a person in the early stages of dementia or Alzheimer’s can function with some normality--even drive a car. It is not until they deteriorate or until some "event" takes place that we wake up to reality.

The article on the next page is one of the best I have read. The basic underlying premise is that behavior changes slowly in the elderly and if they begin to suffer cognitive impairment it will be evidenced in behavioral changes. Sometimes these changes can be quite subtle but if detected could raise a “red flag”.

If my mother had been enrolled in any of these studies I feel certain she would have been diagnosed with dementia sooner. This would have allowed me to get her in an exercise program, get her proper nutrition, and insure that she was taking her medicines as prescribed. I leaned in the last three years how important these three factors are in the quality of her life.

My mother turned 91 years old in June and she suffers from Alzheimer’s disease. I am her CarGiver.


I am an Alzheimer's Caregiver: The early signs of Dementia (Alzheimer's)

Statins that stave off Alzheimer's (Zocor)

"The strength of this study is that it examines the issue with a huge amount of statistical power and uses existing data to look prospectively at Alzheimer’s and Parkinson’s," said lead author Benjamin Wolozin, MD, PhD, a professor of pharmacology at BUSM.

"The strength of reduction of incidence of dementia with simvastatin is striking,".


Simvastatin
zocor
statins
alzheimer's
caregiving

Researchers from Boston University School of Medicine (BUSM) have found that the statin, simvastatin, reduces the incidence of Alzheimer’s disease and Parkinson’s disease by almost 50 percent. This is the first study to suggest that statins might reduce the incidence of Parkinson’s disease. These findings, will be published in the July online open access journal BioMed Central (BMC) Medicine.

Statins that stave off Alzheimer's

By Nicole Laskowski


Statins May Stave Off Alzheimer’s

What’s up:

If you’re taking a statin to reduce cholesterol, you may also be improving your chances of avoiding certain neurodegenerative diseases. New research from the School of Medicine indicates that simvastatin, a statin sold as Zocor, reduces the incidence of Alzheimer’s disease and Parkinson’s disease by almost 50 percent.

The researchers, led by Benjamin Wolozin, a MED professor of pharmacology, screened the Decision Support System database of the United States Veterans Affairs Medical System, looking for the effects of three statins — simvastatin, lovastatin, and atorvastatin — on the expected incidence of Alzheimer’s disease and Parkinson’s disease. His study of more than 700,000 subjects taking simvastatin showed that the drug reduced the incidence of both Alzheimer’s disease and Parkinson’s disease by almost 50 percent. A study of people taking atorvastatin showed that the drug reduced the incidence of Alzheimer’s disease by almost 10 percent. Lovastatin was not shown to reduce the incidence of either disease.

Wolozin is unsure why simvastatin reduces the incidence of these diseases, but he suspects that because the statin blocks a cholesterol-producing enzyme called HMG-CoA reductase, it may also affect the production of other chemicals. He notes that simvastatin reduces inflammation, and that it increases the production of some growth factors in the brain, which may make neurons more capable of resisting chronic degenerative disease.

What it means to you:

“If you are someone who is at risk for Alzheimer’s or Parkinson’s disease, you should use simvastatin because it could slow the process,” said Wolozin. “Most people currently use atorvastatin, because it is effective at reducing vascular injury related to cardiovascular disease. If your major health risk is cardiovascular disease, you might want to stay with atorvastatin, but if your major health risk is neurodegenerative disease, you might consider switching to simvastatin.”

Word to the wise:

At the moment, researchers recognize a relationship between simvastatin and the onset of Alzheimer’s and Parkinson’s disease. They do not know how this relationship works. Be advised that statins may cause side effects such as headaches, nausea, rash, weakness, and muscle pain.

What’s next: Wolozin hopes to learn to determine how strong the relationship is between statins and degenerative diseases, like Alzheimer’s and Parkinson’s disease. He plans on studying how the drug slows the progression of symptoms by gathering data on when Alzheimer’s and Parkinson’s disease patients, both on and off the drug, meet certain well-known markers of the diseases.

Simvastatin
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alzheimer's disease, BioMed Central (BMC) Medicine, Boston University School of Medicine, caregiving, dementia, HMG-CoA reductase, lovastatin, simvastatin, statin, zocor

Novartis' skin patch for Alzheimer's approved by FDA

Once-daily skin patch offers novel approach to treating mild to moderate Alzheimer's disease, providing smooth and continuous delivery of drug over 24 hours.

Exelon Patch preferred by caregivers in a study because it helps manage patient care and gives visual reassurance that medication has been administered.

Exelon Patch minimizes gastrointestinal side effects seen with oral form of drug.


Taken directly from the Novartis Press Release

Exelon®Patch, the first and only skin patch for the treatment of Alzheimer's disease, receives first worldwide approval in US



Once-daily skin patch offers novel approach to treating mild to moderate Alzheimer's disease, providing smooth and continuous delivery of drug over 24 hours
Similar efficacy to highest doses of Exelon capsules with significant improvement in memory and ability to perform everyday activities compared to placebo
Exelon Patch preferred by caregivers in a study because it helps manage patient care and gives visual reassurance that medication has been administered
Exelon Patch minimizes gastrointestinal side effects seen with oral form of drug

Basel, July 9, 2007 - Exelon®Patch (rivastigmine transdermal system) has received its first worldwide approval in the United States as an innovative way to deliver an effective medicine for mild to moderate Alzheimer's disease patients through a skin patch instead of an oral capsule.

This new therapy is the first and only transdermal treatment for this degenerative condition affecting millions of people in the US. Exelon Patch offers effective treatment based on placebo-controlled clinical trial results showing significant benefits to patients in terms of their memory and ability to perform everyday tasks as well as helping their overall functioning.

Exelon Patch maintains steady drug levels in the bloodstream, improving tolerability and allowing a higher proportion of patients to receive therapeutic doses of medication, with potential improvements in efficacy. It is applied to the back, chest or upper arm, and provides smooth and continuous delivery of medication through the skin over 24 hours.

Gastrointestinal side effects are commonly seen with this class of drugs called cholinesterase inhibitors. The target dose of Exelon Patch greatly reduces these side effects, with three times fewer reports of nausea and vomiting than with the capsule form of the drug.

"Exelon Patch represents a significant advance in the treatment of this debilitating disease," said George Grossberg, MD, at St. Louis University in St. Louis, Missouri. "The unique delivery system helps both the patient and the caregiver by providing a much easier way to manage their therapy. The patch provides a visual reassurance for the caregiver that the patient is receiving their medication and helps the patient stay engaged in the activities of daily living."

Exelon Patch is expected to be available in US pharmacies soon. The medication was submitted for review in the European Union in late 2006.

The patch was designed with compliance in mind, and was preferred to capsules by more than 70% of caregivers as a method of drug delivery according to clinical study data, because it helped them follow the treatment schedule, interfered less with their daily life and was easier to use overall than the oral medication.

The approval of Exelon Patch is based on results from the international IDEAL (Investigation of Transdermal Exelon in ALzheimer's disease) clinical trial, involving nearly 1,200 patients with mild to moderate Alzheimer's disease. Exelon Patch showed similar efficacy to the highest doses of Exelon capsules1 and the target dose (9.5 mg/24 hours) was well tolerated by patients.

"Innovation isn't just about developing new compounds, but also about meeting therapeutic needs by taking existing knowledge and applying it in new ways," said James Shannon, MD, Global Head of Development at Novartis Pharma AG. "Exelon Patch addresses an important medical need by delivering a proven drug in an entirely new form that meets the needs of patients and their caregivers."

Alzheimer's disease is a progressive, degenerative disease that alters the brain, causing impaired memory, thinking and behavior. Approximately 18 million people worldwide have Alzheimer's disease. In the US, more than five million people suffer from Alzheimer's disease and almost 10 million people provide care for someone living with dementia, most of which is related to Alzheimer's disease. By 2030, the number of people in the US who are age 65 and over with Alzheimer's disease is estimated to reach 7.7 million, more than 50% more than current levels.

The FDA also approved the use of Exelon Patch in treating patients with mild to moderate Parkinson's disease dementia. Parkinson's disease is a chronic and progressive neurological condition that affects approximately 1.5 million people in the US. Parkinson's disease dementia is a distinct and common disorder, one characterized by impairments in executive function, memory retrieval, and attention, in patients with an established diagnosis of Parkinson's disease. Two of five people with Parkinson's disease are estimated to have Parkinson's disease dementia.


Disclaimer
The foregoing press release contains forward-looking statements that can be identified by forward-looking terminology, such as "expected to be", or implied statements regarding potential future revenues from the Exelon Patch. Such statements involve known and unknown risks, uncertainties and other factors that may cause the actual results to be materially different from any future results, performance, or achievements expressed or implied by such statements. There can be no guarantee that Exelon Patch will reach any particular sales levels. In particular, management's expectation regarding the commercial success of Exelon Patch could be affected by among other things, uncertainties relating to product development, regulatory actions or delays or government regulation generally, the ability to obtain or maintain patent or other proprietary intellectual property protection and competition in general, as well as factors discussed in the Form 20F filed with the Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those described herein anticipated, believed, estimated or expected. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.


About Novartis
Novartis AG (NYSE: NVS) is a world leader in offering medicines to protect health, cure disease and improve well-being. Our goal is to discover, develop and successfully market innovative products to treat patients, ease suffering and enhance the quality of life. We are strengthening our medicine-based portfolio, which is focused on strategic growth platforms in innovation-driven pharmaceuticals, high-quality and low-cost generics, human vaccines and leading self-medication OTC brands. Novartis is the only company with leadership positions in these areas. In 2006, the Group's businesses achieved net sales of USD 37.0 billion and net income of USD 7.2 billion. Approximately USD 5.4 billion was invested in R&D. Headquartered in Basel, Switzerland, Novartis Group companies employ approximately 100,000 associates and operate in over 140 countries around the world. For more information, please visit http://www.novartis.com.

# # #


Novartis Media Relations



Corinne Hoff
Novartis Global Media Relations
+41 61 324 9577 (direct)
+41 79 248 5717 (mobile)
corinne.hoff@novartis.com Christine Cascio
Novartis Pharma Communications
+1 862 778 8026 (direct)
+1 917 449 9982 (mobile)
christine.cascio@novartis.com

The Emotional Survival Guide for Caregivers: Looking After Yourself and Your Family While Helping an Aging Parent

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Alzheimer's, Validation Therapy and the CareGiver

I ran across this article while "fishing" on the Internet. This tried-and-true technique can be used when you are at "wits" end when dealing with difficult behavior. The article contains examples that should help you develop your own frame of reference, techniques when dealing with difficutl situations on a daily basis. It should be particularly useful in helping you understand that the often bizarre behaviors evidenced by your Alzheimer's loved one are not uncommon and can be dealt with effectively. This article is worthwhile reading and is worth "salting away" for future reference.

Nursing Homes, June, 2000 by Mark Warner

DESIGNS for Validation Therapy

Mark Warner

This tried-and-true technique can be supported in the Alzheimer's environment

As each member of the group sat in the circle hoping the balloon would gently drift their way, Roxanne burst from her chair in a fit of rage, shouting "There'll be no ball-playing in my house!" Furious at the insolence of the players who ignored her commands, Roxanne forcefully attacked a staff member, who tried to comfort her by explaining that she was not in her house, but merely with her friends playing a game. Roxanne didn't buy that and swung wildly, hitting the staff member squarely in the chest.

Fearing that I, too, might fall victim to the same fate, I cautiously approached Roxanne.

I put my arm around her shoulder and supported her in her cause that there should be no ball-playing in her house. "This is terrible," I said. "You're right, they should not be throwing that ball in your house, should they?"

"No, they shouldn't," bellowed Roxanne, showing only the slightest relief that someone saw her point of view.

"But you know, Roxanne, the only way they will stop throwing that ball is if we write down the rules for them. I think it's the only way they'll listen." Roxanne was buying this approach, so I suggested, "Let's go into that room over there and write down all the rules for them, okay?" Much to my relief, Roxanne agreed, and hand-in-hand we went into the room to write down the "rules."

"Okay," I began, "Rule Number One is 'No ball-playing in the house,' right?"

"That's right," agreed Roxanne.

"So what will Rule Number Two be," I asked, and then offered, "How about, 'No running in the house'?"

"That's right," said Roxanne, "my grandchildren are not allowed to run in my house."

"Roxanne, you've got grandchildren," I said, raising the tone of my voice with delight.

"Oh, yes, my little gran'boy is six years old, and he is as smart as they come." Roxanne was on a roll now, and the upset caused earlier by the balloon toss in the next room might as well have been miles away. Fifteen minutes later, when the game was over, Roxanne and I emerged from the room, both of us just as happy as we could be, the "rules" left on the table and the incident long forgotten.

The technique used here is called Validation Therapy. It assumes that no matter what illusion the person with Alzheimer's disease (AD) is living, she is right, and nothing you can say or do will convince her otherwise. Naomi Feil is the acknowledged expert on validation therapy and wrote the book The Validation Breakthrough. The basic concept is that you have to buy into the resident's illusion and convincingly play along with it, there by validating it. Eventually you'll see opportunities to mold the tale--and the resident's behavior--into something that is acceptable and no longer upsetting.

"What has this got to do with design," you ask? Everything, in fact. Understanding Alzheimer's disease and the many creative ways to deal with it are as much a challenge of designing an environment as of caregiving within it.

Angie is always complaining about the stranger in the bathroom. She won't use the toilet while "the other lady" is in there. She says that the bathroom is occupied, not realizing it is her own reflection that she sees. Do you explain that she is seeing herself in a mirror?

No. You go along with her. How about, "I'm sorry, Angie, let me see what's taking that lady so long." You go into the bathroom and somehow cover the mirror. One family confronted by this situation told their mother that the mirror was dirty and needed to be cleaned. They sprayed it with a powdered deodorant, creating a haze that obscured any reflection. "Mom, she's out of there now," her daughter said. "I wonder what took her so long. Let me know if you need anything. I'll be right here waiting for you."

Caregiver 1: "Deborah won't eat anything. She just sits at the table and stares at the food. She loves gardening, though; we spend hours every day weeding and pruning the vegetables in our garden."

A golden opportunity awaits us here. Figure it out. Deborah loves gardening, but won't eat.

"So we tried something a little different. Though the tomatoes were days from ripening, I went to the grocery store and picked out some beautiful red ones. Instead of putting them on the table in front of her, I pretended to come in from the garden, tomatoes in hand. As Deborah Looked at the tomatoes, I told her, 'They came from our garden and don't they Look delicious?"'

Granted, such ploys are not always so successful, but many are. Sharing the bounty of the garden, enjoying the fruits of your labor that you grew together, can somehow trigger pleasant, guiding thoughts and behaviors when all else fails. Perhaps it stirs up memories from long ago, or maybe it's just the thrill of eating your own garden vegetables. Regardless, it adds a new dimension to life that might very well conquer the ravages of the disease and perhaps bring new purpose to those waist-high gardens many facilities are installing these days.

Taking validation to the next step often involves anticipating the problem and creating the illusion. Validation, also referred to as deceptive therapy, white lies and fiblets, means creating a story--in the best interest of the person who is "confused."

"Dad, who's president? Do you remember his name?"

"Of course l do, it's Roosevelt!"

If your family member believes it is the 1930s, so be it. As he regresses in time, so do his memories of values, experiences and people. What was important then becomes important now!

Given residents' belief that they are living when Roosevelt was president, what would the world have been like back then? What would the good experiences and environmental features have been? How can we recreate the familiar feelings of that period in a convincing and subtle way?

For example, those were the days when they hung the clothes on a line in the back yard. Isn't that the kind of good and secure feeling we would want to recreate--possibly by merely providing a clothesline? Others might be enjoying the time when they were raising their families. What better way to indulge them than by allowing them to once again care for their spouse or children by hanging "their" clothes out to dry?

Or, perhaps they have less comforting memories.

Caregiver 2: "Mom collects everything--rubber bands, paper clips paper...everything! And she stores them everywhere. You can hardly walk in her room, there is so much stuff in there!"

Perhaps Mom is reliving times when the country was at war, when every little scrap was valuable in the war effort, or the Great Depression, when times were so tough that you had to keep everything, when nothing that might be useful was thrown out. Environmental validation then might mean providing easy-to-see drawers, trunks or cabinets to store these important items.

How were evenings spent in the good ol' days (before TV, let's say)? Many families spent hours sitting on the porch, watching people go by, talking to neighbors, etc. Why not create a porch, complete with rockers and swing gliders? Locate it carefully and safely, but within view of interesting activities (maybe a playground where children play). Make sure it is secure for those who might try to leave or climb over the railing; it should also be far enough from strangers outside who might be perceived as intruding into their space. Perhaps a screened porch would do the trick.

One should also beware of environmental miscues.

"Bruce, why aren't you eating?"

"I didn't bring my wallet and can't pay for the meal."

Although Bruce is living in an assisted living facility and doesn't have to pay for his meal, he doesn't realize that. As far as he is concerned, this large, beautiful dining room is a restaurant, and the more he eats, the bigger the bill. Perhaps if we had divided the room into smaller, more homelike dining rooms and spared the expense of the huge chandelier, Bruce would feel more comfortable with his home-cooked meal.

Don't forget that little environmental touches can mean a lot.

Caregiver 3: "My mother refused to take a bath. For years, soaking in a warm tub of water had been the highlight of her day. But now, for some reason, she feared the tub and everything it represented. Eventually she confided in me, relating a childhood story about a little girl who got sucked down the bathtub drain. She recalled that tale and, like that little girl, she was afraid that she too might fall victim to that terrible fate. The solution: We put a mat over the drain. Her fear suddenly disappeared."

In a daycare center, angry and impatient residents wait for their rides to take them home. Each time the door opens, one, two or even three of them race to it and powerfully attempt to get into the van, which has actually arrived to transport someone else. Staff members intervene, often unsuccessfully, overcome by the strength and determination of people with a very important cause (the van is there for them). If we, as facility planners and designers, can anticipate this kind of behavior, we can plan door placement to eliminate visibility of the van outside, thus avoiding this upsetting and potentially volatile situation. There are design solutions for problems like these, if problems are simply acknowledged and thought about ahead of time.

Although the stories I've recounted are all too familiar to healthcare professionals, they are often "Greek" to design professionals. Nevertheless, it is a design credo: To design for any client, you have to understand the client. Why should those who have Alzheimer's disease be treated any differently?

We are only in the earliest days of learning how to design for dementia. Hopefully, there will soon be a cure for these devastating diseases, making an article such as this a moot exercise. But until then, we must continue to delve into our creative minds, take chances and discover what works and what doesn't for this population. Nursing home/assisted living managers should help designers understand how people with dementia perceive and interpret their worlds. Only when equipped with this knowledge can we designers begin to address these problems with the tools that we have available to us.

Mark Warner, AIA, is the author of The Complete Guide to Alzheimer's Proofing Your Home, the first book in the Homes That Care series on age related conditions and creating homes for those suffering from them. His firm, Ageless Design, Inc., offers consultation and assistance in the design of environments for seniors. For more information, call (561) 745-0210, visit the Web site at www.agelessdesign.com or e-mail ewarner@agelessdesign.com.




The Emotional Survival Guide for Caregivers: Looking After Yourself and Your Family While Helping an Aging Parent


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Mental Activity Helps to Lower Risk of Alzheimer’s Disease

Taken directly from the Rush Memory and Aging Project news release.

How often older adults read a newspaper, play chess, or engage in other mentally stimulating activities is related to the risk of developing Alzheimer’s disease, according to a study by researchers at Rush University Medical Center.

Taken directly from the Rush Memory and Aging Project news release.


Frequent Brain Stimulation in Old Age Reduces Risk of Alzheimer’s Disease


(CHICAGO) – How often older adults read a newspaper, play chess, or engage in other mentally stimulating activities is related to the risk of developing Alzheimer’s disease, according to a study by researchers at Rush University Medical Center published June 27 in the online edition of Neurology®, the medical journal of the American Academy of Neurology.

For the study, more than 700 people in Chicago with an average age of 80 underwent yearly cognitive testing for up to five years. Participants were part of the Rush Memory and Aging Project, a longitudinal study of more than 1,200 older people. Of the participants, 90 developed Alzheimer’s disease. Researchers also performed a brain autopsy on the 102 participants who died.

The study found that a cognitively active person in old age was 2.6 times less likely to develop dementia and Alzheimer’s disease than a cognitively inactive person in old age. This association remained after controlling for past cognitive activity, lifetime socioeconomic status, and current social and physical activity.

Researchers say the findings may be used to help prevent Alzheimer’s disease.

“Alzheimer’s disease is among the most feared consequences of old age,” said study author Robert S. Wilson, PhD, a neuropsychologist at the Rush Alzheimer’s Disease Center. “The enormous public health problems posed by the disease are expected to increase during the coming decades as the proportion of old people in the United States increases. This underscores the urgent need for strategies to prevent the disease or delay its onset.”

Wilson says the study also found frequent cognitive activity during old age such as visiting a library or attending a play, was associated with reduced risk of mild cognitive impairment, a transitional stage between normal aging and dementia, and less rapid decline in cognitive function.

The study was supported by grants from the National Institute on Aging and the Illinois Department of Public Health.

The Rush Alzheimer's Disease Center is one of 29 NIA-supported Alzheimer's Disease Centers across the U.S. which conduct basic science, clinical, and social and behavioral research on dementia and AD. General information on aging and aging research can be viewed at the NIA's home website, www.nia.nih.gov. For more information on the Rush Alzheimer’s Disease Center, visit www.rush.edu.



The Emotional Survival Guide for Caregivers: Looking After Yourself and Your Family While Helping an Aging Parent


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Clinical Trial: Omega 3 Fatty Acid, Slowing the Progression of Alzheimer's Disease

Preliminary studies have shown a reduced risk of Alzheimer's disease (AD) in people consuming increased amounts of fish in their diets. Many of the health benefits of fish are attributed to the abundance of omega 3 fatty acids. Docosahexaenoic Acid (DHA) is the most abundant omega 3 fatty acid in the brain. Data from several animal models supports the hypothesis that DHA may be an effective treatment for AD by means of anti-amyloid, antioxidant, and neuroprotectant mechanisms.

This study is currently recruiting patients.

Personal Note: I have been feeding my mother fish and giving her Omega 3 Oil daily for a couple of years. I believe it is beneficial.

For a complete description of the trial including eligibility requirements go to the Clinical Trials Page

Official Title: A Randomized Double-Blind Placebo-Controlled Trial Of The Effects Of Docosahexaenoic Acid (DHA) In Slowing The Progression Of Alzheimer’s Disease

Study Type: Interventional

Study Design: Treatment, Randomized, Double-Blind, Placebo Control, Parallel Assignment, Efficacy Study

Further study details as provided by National Institute on Aging (NIA)

Primary Outcome Measures:
Changes in rate of cognitive and functional decline measured by ADAS-Cog and CDR-SOB

Preliminary studies have shown a reduced risk of Alzheimer's disease (AD) in people consuming increased amounts of fish in their diets. Many of the health benefits of fish are attributed to the abundance of omega 3 fatty acids. Docosahexaenoic Acid (DHA) is the most abundant omega 3 fatty acid in the brain. Data from several animal models supports the hypothesis that DHA may be an effective treatment for AD by means of anti-amyloid, antioxidant, and neuroprotectant mechanisms.

In this study, 400 individuals with mild to moderate AD will participate at approximately 53 study sites throughout the US for 18 months. Participants will be randomized so that 60% will receive approximately 2 grams of DHA, divided into 4 capsules, 2 capsules taken twice a day, while 40% receive an identical placebo.

Potential participants will go to their study site for a screening visit, where eligibility is determined, and if accepted, for a baseline visit where cognitive status, behavioral status, functional status, and global severity of dementia will be assessed. Vital signs and biomarker labs will also be obtained. Subsequent visits will occur every three months for medication checks and, every 6 months, further assessments, physical exams, and labs.

Some participants will also take part in MRI (magnetic resonance imaging) and/or CSF (cerebrospinal fluid) sub-studies. For the MRI sub-study, scans will be done prior to beginning the study medication, and again after 18 months. Likewise, for the CSF sub-study, a lumbar puncture will be done prior to beginning the study medication, and again after 18 months.

Enrollment is restricted to individuals who consume no more than 200 mg of DHA per day, which is almost 300% of the average daily intake in an American diet. Individuals who take fish oil or omega 3 fatty acid supplements are also not eligible. Each visit will include completion of a very brief food frequency questionnaire to monitor dietary DHA levels.

Risk Evaluation and Education for Alzheimer's Disease

REVEAL, the Risk Evaluation and Education for Alzheimer's Disease— Study is a multi-center funded research project.

The goal of REVEAL is to provide healthy adults with genetic susceptibility testing and information about their chances to develop Alzheimer's disease.

Genetics and Alzheimer's Risk

More at the Alzheimer's Reading Room,

The National Public Health Road Map to Maintaining Cognitive Health (Road Map)

Download the The Healthy Brain Initiative

A National Public Health Road Map to Maintaining Cognitive Health.

The Healthy Brain Initiative

The Healthy Brain Initiative

Myriad Genetics (MYGN) Presents Mathematical Comparison of Disease Modification Trial Designs at Alzheimer's Conference

Current Flurizan™ Phase 3 Study Design May Demonstrate Disease Modification

Read the entire release at The Alzheimer's Reading Room

myriad genetics
"staggered start"
Alzheimer's Association Prevention Conference
disease modification
Flurizan Phase 3

The 36-Hour Day: A Family Guide to Caring for People with Alzheimer Disease, Other Dementias, and Memory Loss in Later Life

This best-selling book is the "bible" for families caring for people with Alzheimer disease...



Read the full text review at The Alzheimer's Reading Room

Americans Fear Alzheimer’s More Than Heart Disease, Diabetes or Stroke

A recent study by the MetLife Foundation found that Americans fear getting Alzheimer's disease more than heart disease, stroke, or diabetes. Alzheimer's ranks second in the minds of American's only to cancer.

Read this at the Alzheimer's Reading Room, The: Americans Fear Alzheimer’s More Than Heart Disease, Diabetes or Stroke

Fruit Smoothie Could Improve Thinking, Memory In Alzheimer's Patients

This article on the smoothie really caught my attention. Why? I drink one of those almost every day. Oddly, when I try to get my mother, the Alzheimer's patient, to drink one along with me she refuses.

A simple fruit smoothie could soon help improve thinking and memory in Alzheimer's patients.



Fruit Smoothie Could Improve Thinking, Memory In Alzheimer's Patients

St. Louis University is the only U.S test center to study whether the drink actually works. The beverage isn't a new drug, but a nutritional drink with a combination of vitamins, antioxidants and lipids that are consumed once a day. The smoothie comes in peach or cappuccino flavors.

Dr. Theodore Malmstrom is one of three researchers looking into what could soon be a very important weapon in the fight against Alzheimer's.

"There is increasing evidence that concentrated components of natural foods can improve memory so those components have been put in a drink and we are hopeful it will help," said Malmstrom.

The goal now is to get actual patients to test it out.

SLU researchers need at least 10 Alzheimer's patients to take part in the study. They are looking for people recently diagnosed with Alzheimer's, but not currently taking medications.

Patients will be divided in two groups. One group will get a daily supply of drinks with nutritional supplements. The other group will get a similar drink but without the nutritional additions.

Results of the 24-week study will hopefully end with good news.

"There is always great hope whenever you can have new research emerging. One of the Alzheimer's Associations mission (is) to fund research programs so we are very excited," said Stephanie Rohlfs-Young, the outreach director for the St. Louis Chapter of the Alzheimer's Association.

The risk of side effects from the drink are very minor compared to side effects from the five FDA-approved medications that treat Alzheimer's.

For more information, contact Malmstrom at 314-577-8745.

2007 Alzheimer’s Disease Facts and Figures

The links provided below will take you to the factsheets and full report published by the Alzheimer's Association.

Quote Sheet (2 pages)

FactSheet (2 pages)

2007 Alzheimer’s Disease Facts and Figures (28 pages)

The CareGiver Blog

Robert T DeMarco

AllAmerican Senior Care

AllAmerican Senior Care Weblog

Senior CareElder CareCareGiver Alzheimer’sDementia> CareGiver

Alzheimer's Disease Rate Rises to More Than Five Million in the United States

Someone Develops Alzheimer's Every 72 Seconds, According To New Alzheimer's Association Report.

The Alzheimer’s Association today reports that in 2007 there are now more than 5 million people in the United States living with Alzheimer’s disease. This number includes 4.9 million people over the age of 65 and between 200,000 and 500,000 people under age 65 with early onset Alzheimer’s disease and other dementias.


Read more about this topic at The Alzheimer's Reading Room

Many Alzheimer's caregivers seek help in God

About a third of those who take care of loved ones with the disease feel 'more religious' because of their experiences, a new national study says.


You can read this article at The CareGiver Weblog