A new study from researchers from Rowan University School of Osteopathic Medicine has found that delirium affects nearly 18 percent of nursing home residents and has a one-year mortality rate of 40 percent. The symptoms of delirium usually last one week, but can take weeks or months to resolve. The symptoms are similar to dementia, resulting in misdiagnosis in nursing home residents.

Delirium is a syndrome of altered mental status shown to produce disorganized thinking, deficits in attention and a fluctuating course, which plays a significant role in mortality of nursing home patients.  However, maintaining hydration and minimizing medication exposure is an effective means to prevent delirium. Pain can lead to delirium, and managing it well can improve outcomes.

The study was published in The Journal of the American Osteopathic Association.

WCCB Charlotte reported the tragic assault of a resident suffering from dementia by police with tasers.  When the incident happened in March, the sheriff made excuses defending the police by claiming the resident assaulted another resident and was resisting officers when they tried to get him to a doctor’s appointment.  The police body cam video shows the man waving his hands near the officers. When he attempted to walk away, the deputy tased him.  The family says the man died two months after the tasing, and believes his death is connected with what happened.  See more info at WWLP.

The Chronicle had an article on the benefits of lifelike baby dolls for dementia residents in nursing homes. Therapy dolls for dementia residents are one of the forms of treatment in the medical field. According to Central Ohio Alzheimer’s Association Sunday Adult Day Care program, centers started testing the dolls in April 2004 and saw immediate, positive results.

The Welcome Nursing Home was introduced to Bunny Bundles Reborns in the summer.  “We look for new ways to help them (get through) agitation, anxiety and negative behaviors,” said Heidi Freas, an occupational therapist and third generation owner of The Welcome Nursing Home. “And the babies are something that they can relate to because it takes them back to mostly a positive time in their life.”

Many residents do not need pharmaceutical intervention to help alleviate symptoms accompanied with dementia, Alzheimer’s or Parkinson’s disease. For some residents, just holding a therapy baby settles them when otherwise they may be upset.

The dolls are very realistic.

Fox News had an article about the declining rate of people suffering from dementia.  A new study released shows the rate of Alzheimer’s disease and other dementias in adults aged 65 and up dropped to about 9 percent in 2012 from nearly 12 percent in 2000, continuing a decline noted in earlier research. Led by University of Michigan researchers, the study was published in JAMA Internal Medicine. Dementia was most common in the oldest adults; in 2012 almost 30 percent of adults aged 85 and up were afflicted versus just 3 percent of those 65-74.

The dementia rate declined amid a rise in diabetes and heart disease. Both increase risks for Alzheimer’s and other dementias but the researchers say better treatment for both diseases may explain the results.

Obesity rates also increased, while dementia was most common among underweight adults. Previous research has shown weight loss may precede dementia by several years and that late-life obesity may be healthier than being underweight.

The Alzheimer’s Association estimates that about 5 million people aged 65 and older have Alzheimer’s, and that is expected to rise to almost 14 million by 2050.

 

 

Fox News had an interesting article on the increase of ventilator use among dementia residents in nursing homes. “The number of nursing home residents with advanced dementia who get hooked up to breathing machines has roughly doubled in recent years even though this doesn’t appear to help them live longer, a U.S. study suggests.”

Alzheimer’s disease is the most common form of dementia. As brain function declines over time, personality shifts and a loss of memory and judgment may occur that may make it difficult for them to live independently.

“My concern is the use of intensive care units and mechanical ventilation is like a runaway train where no one is able to hit the stop button and consider: `Is this what this patient wanted? Will this treatment result improved quality of life or only prolong their suffering to inevitable death?'” said lead study author Dr. Joan Teno, a geriatrics researcher at the University of Washington in Seattle.

The proportion of these hospitalized dementia patients admitted to intensive care units (ICUs) rose to 39 percent in 2013 from 17 percent in 2000, the researchers found.  Over time, as hospitals added ICU beds, their use of mechanical ventilation for these patients increased.

For every 10 ICU beds added by hospitals, the odds of mechanical ventilation among hospitalized nursing home patients with advanced dementia increased by 6 percent. When patients had pneumonia or bloodstream infections, the odds climbed by 11 percent.

As long as it’s easier to access an intensive care unit bed than comprehensive hospice and palliative care services in nursing homes, the trend of increasing use of mechanical ventilation for these individuals is likely to continue,” said Dr. Gary Winzelberg, a geriatrics researcher at the University of North Carolina at Chapel Hill, said by email to Fox.

“Completion of a living will and/or designating a health care proxy can help ensure that patients’ values are known and respected when dementia deprives them of decision-making abilities,” Winzelberg said.

The Star Tribune reported that the Minnesota Department of Health said the Gardens at Cannon Falls “did not have an adequate system to ensure cognitively impaired residents on [liquid] diets were adequately supervised.” Nursing home staff knew the resident was dissatisfied with her limited liquid diet, and that she would routinely try to take the solid foods of others and throw her own meals onto the floor, the investigation noted.

State death records identify her as 77-year-old Margarita M. Schuler.  A nephew who lives a few miles from the nursing home expressed exasperation with his aunt’s care. “Wow, we had been working with the staff for quite a while about her needing extra care,” Mike Kulhanek said. “I was personally frustrated with that.”

 According to the investigation:

On a Sunday night in mid-November, Schuler was in her wheelchair in the dining room and roughly 3 feet from where sandwiches, cookies and liquefied snacks were put out for residents.

When none of the three staff members in the room was looking, and after sitting near the snacks for more than an hour, Schuler rolled over to the food and “was trying to quickly eat the sandwich.”

When she began choking, staff members attempted to dislodge the food with chest compressions and the Heimlich maneuver, and called 911. Schuler died in an ambulance on the way to a hospital. Her choking caused her to go into cardiac and respiratory arrest, according to the death certificate.

new study just published in Nature offers some encouraging — but by no means conclusive — evidence that we could be looking at significant progress in slowing or defeating Alzheimer’s dementia.  See article from NY Magazine about the drug called aducanumab and it may help reduce the so-called amyloid-β plaques that build up in their brains of Alzheimer’s patients. Many researcher assert that these plaques are partially responsible for the disease’s toll on memory, personality, and sense of self.

The authors wrote that “one year of monthly intravenous infusions of aducanumab reduces brain Aβ in a dose- and time-dependent manner. This is accompanied by a slowing of clinical decline measured by Clinical Dementia Rating — Sum of Boxes and Mini Mental State Examination scores.”

The fact that the researchers reported a slowing in the development of symptoms, rather than any reversal, should be put in context: For one thing, given the timetable of how Alzheimer’s symptoms develop, a significant slowing of cognitive decline could have a major quality-of-life impact on sufferers and their families. For another, this was a Phase 1b clinical trial, meaning that the point of the study was more to establish a proof of concept for the drug’s effectiveness, and to solidify the case that it is safe to administer to patients, than to prove it “works” (overall, under FDA clinical-trial rules, Phase 1 is more broadly about proving a drug is safe than proving it is effective).

In an interview with NPR’s Jon Hamilton, Biogen’s chief medical officer, Dr. Alfred Sandrock, reiterated the paper’s optimistic language. “We think we have something important here,” he said. “We hope we’re right because if it’s true it would benefit millions of patients. But we don’t know we’re right yet.” They — and we — will know more soon: NPR reports that “Biogen has already begun two much larger studies of aducanumab. They will include a total of 2,700 patients, and results are still several years off.”

In a study appearing in the August 16 issue of JAMA, Susan L. Mitchell, M.D., M.P.H., of Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Boston, and colleagues examined feeding tube insertion rates from 2000-2014 among U.S. nursing home residents with advanced dementia.

Fewer U.S. nursing home patients with dementia are getting feeding tubes as mounting evidence suggests it may not help them live longer or make them more comfortable, new research suggests. Researchers limited their focused on the sickest dementia patients who are at risk for chewing and swallowing problems, and may also struggle to speak, recognize loved ones, get out of bed or go to the bathroom independently.  One limitation of the study is that it focused on a subset of nursing home residents with advanced dementia that had been identified as needing help to eat, which may underestimate the number of feeding tubes inserted. Another shortcoming is that the proportion of U.S. nursing home residents with advanced dementia and eating problems declined during the study period. This, too, might mean the findings don’t reflect every advanced dementia patient that received a feeding tube.

The proportion of these advanced dementia patients who got feeding tubes when they couldn’t eat on their own dropped from 12 percent in 2000 to 6 percent in 2014, according to an analysis of data on 71,000 nursing home residents published in JAMA.

“Families should understand that by foregoing tube-feeding, care is not stopped,” said lead study author Dr. Susan Mitchell of the Hebrew SeniorLife Institute for Aging Research at Harvard University in Boston.  “Rather, care is focused on treatments that maximize comfort and quality of life,” Mitchell added.

There was, however, a stark racial divide in feeding tube use.  The proportion of white dementia patients who got feeding tubes dropped from 8.6 percent to 3.1 percent during the study period, while the decrease for their black peers was from 38 percent to 18 percent.

Dr. Laura Hanson, a geriatric medicine researcher at the University of North Carolina in Chapel Hill said “Several studies compare persons with advanced dementia who do or do not receive a feeding tube, and show this procedure does not add to survival time, function or offer other health benefits.”

 

A story about a long term care facility created to look like a 1940’s neighborhood went viral on social media.  The assisted living facility  is Lantern of Chagrin Valley in Chagrin Falls, Ohio, one of a trio of properties designed specifically for patients with dementia and Alzheimer’s disease. The building’s interior courtyards and corridors were planned to look like tiny houses with front porches looking out over a golf course.  Very peaceful.

“Every little thing you see, the wall color, the paint, actually has a therapeutic benefit, a therapeutic value,” CEO and occupational therapist Jean Makesh told the News-Herald. There are even calming scents piped into the air, like peppermint and frankincense.

The look is deliberately reminiscent of an American small town in the 1940s, according to the News-Herald. The “sky ceiling” features fiber optics that mimic daylight and starry skies, depending on what time it is. The floor is painted green like grass, bird-chirping sound effects play in the background, and artificial plants dot the common spaces. At night, “porch” lights turn on outside residents’ rooms.

New York Magazine had an incredible article on a rare medical condition called “pure alexia” which is defined as “a selective impairment of reading in the absence of other language deficits [that] occurs as a consequence of brain injury in previously literate individuals.”

The condition is discussed in Scientific American by Yale University psychiatry resident Daniel Barron in the case of “Mike Brennan” (a pseudonym), a 63-year-old man who discovered he no longer had the ability to read. He hadn’t suffered any trauma, wasn’t battling any neurological disease — it was like his reading ability had been lifted cleanly out of his head, leaving him otherwise healthy and intact.

Brennan, fearing that he suffered a stroke went to the ER for testing, which revealed no other symptoms — his vision and hearing were normal, he still knew the names of objects and colors, and he had no trouble thinking clearly. The only issue was reading: He could recognize letters, but he couldn’t string them together; he could write, but he couldn’t make sense of what he’d put on the page.

Brennan was diagnosed with “pure alexia”.  In his case, as he had suspected, the injury turned out to be a stroke – a tiny one, in a part of the brain called the left inferior occipitotemporal cortex, which helps process visual information.

Barron wrote two things were particularly unusual about Brennan’s diagnosis: One, it was the first time that such a small stroke had caused the disorder, which usually results from much more significant injuries. And two, it pointed to the existence of a part of the brain that scientists had been hotly debating for years.

The “visual word form area” — a brain structure specifically devoted to processing letters — was first proposed in the 1990s by researchers who noticed that reading caused an uptick in activity in the left inferior occipitotemporal cortex, where Brennan’s stroke occurred. The theory immediately led to controversy:

For one thing, the very search for a “visual word form area” was misguided because it personified the brain’s real work, which is to process and decode visual information. Brain regions act as an assembly line of neural groups that each contribute some cognitive rivet or weld to a larger percept. A visual word form area confused an assembly line for a one-man-band.

Finally there was the problem of evolution. Because reading was a relatively new cultural invention, humans couldn’t have evolved to read text in the same way that mammals evolved to recognize faces—there simply hadn’t been enough time. This made it hard to believe in a brain structure expressly devoted to reading.

Over the next several years, though, a series of studies incrementally pushed scientists closer to accepting the possibility. One experiment found that as adults learned to read, gray matter builds up in specific parts of the brain. Another, comparing literate and illiterate adults, zeroed in on changes in the left inferior occipitotemporal cortex: “When one learns to read,” Barron explained, the area “is recycled from a general visual recognition center to a specialized word recognition center, at the expense of other tasks.”

And then came Brennan’s case which proved the existence of the visual word form area by showing what happened when it was damaged. It’s also a powerful example of the brain’s flexibility: “The way in which the area is repurposed from general visual recognition to word specialist,” he wrote, “is a reminder of how powerfully the brain can retool and adapt—essential processes both in learning and healing.”