Besides its not-inconsiderable practical burdens, Alzheimer’s also has numerous theoretical burdens as well. Chief among these are that we know neither precisely what causes Alzheimer’s, nor do we have any curative treatment available.
However, there is much speculation on both alleged causes and prospective cures. Readers can get a flavor for this by attending to the recent Awakening From Alzheimer’s “summit.” This presentation has given me hope, since doctors and researchers believe that they are making progress toward giving us explanations of, and possible solutions to, this dreadful disease.
The first of the many fascinating ideas that I encountered was the notion that our brains are akin to living organisms. On the face of it, this is trivially true, since our brains are part of our bodies and our bodies are, quite obviously, alive. The revelation really comes at the level of analysis, where a more organic view of brain is replacing a more computational/mechanical model.
Various research has convinced some investigators that healthy brains rejuvenate and change on almost a daily basis. But our brains need whole-body support to perpetuate these changes and to keep them going in a positive direction. Too often, poor diet and bad lifestyle choices lead to cognitive decline. (In a way, this is the theme of the entire weblog.)
The “Bredesen Protocol”
The prevailing opinion is that “amyloid plaque” causes Alzheimer’s Disease. An interesting alternative has been proposed by Dr. Dale Bredesen. He believes that the amyloid plaque is actually a reaction of the body to protect the brain from the underlying real cause. This real cause ties into Dr. Bredesen’s primary thesis: there are, in his estimation, different types of Alzheimer’s.
If Dr. Bredesen is correct, then we have some idea of why pharmaceutical companies have heretofore been unsuccessful at devising chemical interventions. They are on the wrong track. One pill cannot cure everyone (nor even slow down the progression of the disease); one size does not fit all, when it comes to dementia. Things are far more complicated than that. (For the received view, see HERE.)
He believes that there are multiple causes of multiple variations of Alzheimer’s. Therefore, we need multiple remedies.
The doctor’s entire schema, as well as his recipe for treatment, is termed the “Bredesen Protocol.” It rests on the posit that there are three different types of Alzheimer’s.
Type 1 – Inflammation Alzheimer’s. Type 1 is characterized by initial memory loss and is supposed to be caused variously by diets high in sugar and processed food or unspecified infection. This sort is generally of late onset.
Type 2 – Nutrient-Deficiency Alzheimer’s. Dr. Bredesen thinks that Type 2 is precipitated when the brain or nervous system lack essential nutrients – termed “trophic supports.” Like Type 1, Type 2 is late-onset and starts with memory loss.
Type 3 – Brain-Toxicity Alzheimer’s. This third sort is early onset and begins with the disruption of executive functioning, as opposed to mere memory loss. Dr. Bredesen believes that the relevant brain toxicity is caused by exposure to specific heavy metals like mercury, or to biotoxins like mold.
BRIGHT MINDS
Another worthy mention is Dr. Daniel Amen, who summarized his BRIGHT MINDS program. The name is an acronym in which the letters stand for factors pertinent to overall brain and cognitive health. Dr. Amen recommends that each factor be checked out and, if need be, issue in a dietary change or lifestyle modification.
In order, the elements are as follows.
Blood Flow – Ensure that your brain has adequate blood flow. Substances like caffeine can restrict blood flow. (On the other hand, some herbs like ginkgo and hawthorn are supposedly salubrious – see HERE.)
Retirement – Don’t just sit around; keep learning! (For some pointers, see HERE.)
Inflammation – Dr. Amen advises: Increase omega-3 levels, by using flaxseed oil, fish oil, and the like. (Additionally, turmeric is a potent, natural anti-inflammatory. For more, see HERE.)
Genetics – This underlines the obvious datum that you are believed to be at greater risk for Alzheimer’s if the disease runs in your family. (On available testing – including genetic testing – see HERE.) What can you do? Dr. Amen recommends that you drink green tea and supplement with vitamin D. (For more on vitamin D, see HERE.)
Head trauma – Dr. Amen colorfully likens our brains to “soft butter.” Protect your brain! Yes, it’s probably a bad idea to bicycle without a helmet or to ride in a car without a seatbelt.
Toxins – Like Dr. Bredesen, Dr. Amen points out that there appears to be a link between neurological degeneration and things such as alcohol, carbon monoxide, drugs of various kinds, mold, and so on.
Mental health – Get help dealing with anger, depression, stress, and the like.
Immunity and infection – Again, in common with Dr. Bredesen, Dr. Amen warns against the possible negative, systemic effects of unchecked infection. Boost your immunity naturally with vitamins C and D as well as probiotics. (Again, see HERE and HERE.)
Neurohormonal deficiency – Hormones should be at optimal – not just adequate – levels.
Diabetes – Cease and desist with the sugar, already! And, yes, we’re looking at you too, breads and pastas. Do you have to cut these yummy treats out entirely? Perhaps not. But, for your brain’s sake, cut down. Eat nutrient-dense foods such as asparagus, berries (like blueberries and strawberries), carrots, cruciferous veggies (e.g., arugula, broccoli, brussels sprouts, cauliflower, cabbage, collard greens, kale), fish (like salmon), lentils, sweet potatoes, and tomatoes.
Sleep – We generally need between 7 and 9 hours of sleep. And yes, you need those 7 hours (minimum) of shuteye each night. (For much more on sleep, see HERE and HERE.)
Get in Step With Your Circadian Rhythm
Dr. Michael Breus talked about our innate circadian rhythms, and how our brains are more receptive to certain types of activities at certain times of the day. For example, he alleges that, for many people, the brain is readier to learn new information in the morning after breakfast, and it’s more creative in the afternoon after lunch.
Dr. Breus speculates that this is because mental clarity and focus peak early in the circadian cycle, as opposed to creativity, which climaxes later. He also recommends that we venture outdoors to soak up some of the natural light – because, in his estimation, “light is medicine.” (See HERE.) So, on the advice of Dr. Breus: Take a walk!
Movement is also important. (We touched on this topic and the dangers of a sedentary lifestyle, HERE.) After lunch, when you feel your energy waning, go outside and get the blood flowing again. (There’s that Blood Flow, again – as mentioned by Dr. Amen.)
Dr. Brues gave a couple of tips on how to get to sleep. He stated that you want your cortisol levels to be low at night because cortisol is a hormone that indicates being stressed. On the other hand, you want high levels of melatonin because that hormone accompanies or marks states of relaxation. (Thus, it helps you get to sleep.) Other helpful tips include turning off computers (and other electronic gadgets) at least one hour before bed – as blue light inhibits (or “turns off”) melatonin production. (For much more on these and other matters, see my sleep articles, HERE and HERE.)
SHINE on, You Sane Diamond
Another method or system – the so-called “SHINE Protocol” – was explicated by Dr. Jacob Teitelbaum. Dr. Teitelbaum’s sketches five areas that are key to developing optimal energy and neurotransmitter functionality. Fine-tuning your nervous system enables your chemical messengers to carry their information from the nerve cells in the brain to other parts of the body in the most efficient manner feasible.
“SHINE” stands for:
Sleep – Not enough sleep can leave you tired and foggy. (Are you starting to get the picture? It’s like old computer-programming adage “garbage in, garbage out.” Many of our problems seem to stem from the fact that we don’t care for ourselves at the most basic levels.) Dr. Teitelbaum recommends 8-9 hours. (Again, see HERE and HERE.)
Hormones – Any kind of deficiency, here, can leave you achy, irritable, tired, and, if Dr. Bredesen is correct, possibly struggling with Type-2 Alzheimer’s. (For more on this, search “hormone” HERE.)
Immunity and infection – Gas and bloating can be a sign of a Candida infection. This, in turn, can be a sign of certain suboptimalities that can spell disaster for brain health.
Nutrition – Mainly watch the levels of your vitamins A, B12, C, and D, as well as of the mineral magnesium. These are easily depleted. (See HERE for more information.)
Exercise (as able) – Start slowly and with light weights. Increase speed and weight and your endurance and strength increase – under the guidance of a competent fitness or medical professional, of course.
Wait, You Want Me to Increase My Fat Intake?
Well, be careful with this one. But consider the words of one Dr. David Perlmutter. The doctor made the astounding statement that our brains are powered (that is, get their needed energy from) by fat – not sugar, as one might immediately think.
Dr. Perlmutter said that, in fact, the higher the blood sugar, the greater the risk for dementia. On the other hand, people who eat diets higher in (good) fat have a 44% risk reduction. Along this line, the best foods to eat for memory retention are avocados, beef (grass-fed), and coconut oil – of which he adds one tablespoon to his coffee every morning to help him feel full for hours.
Coffee also receives a high rank because it helps relieve oxidative stress and protect against neuro-degenerative diseases with a 65% risk reduction. However, presumably, this must be weighed against Dr. Amen’s warning that caffeine is a vasodilator and can restrict blood flow to the brain. (For the skinny on fats – as well as some other good info – see HERE.)
There are a number of reasons why automobiles pose particular risks for persons afflicted with Alzheimer’s disease and other forms of dementia. Most obviously, a motor vehicle is a 2,000-lb missile in the hands of an impaired driver. And, if it is anything, Alzheimer’s is a mental impairment.
But not all perils presuppose that the Alzheimer’s sufferer is in the driver’s seat. Dangers abound for passengers as well.
But there are several things that you can do with a car to minimize the risk to the patient and to others.
(Readers will observe that there are numerous points of contact between “Alzheimer’s proofing” and childproofing. For a few thoughts on that topic, see my overview, HERE.)
Let’s begin by distinguishing various categories of danger. On the one hand, there are dangers to persons inside of a car and, on the other hand, there are dangers to persons outside of a car.
Minimizing Dangers Inside of a Car
To add a further layer of complexity, this arguably has two versions to it. On one version, the Alzheimer’s sufferer is the driver (see the subsection “Supervise, Supervise, Supervise!” below) and on another (probably the more usual case for readers), he or she is a passenger.
1. Utilize Your Child Safety Locks
As discussed in a previous article (HERE), many childproofing suggestions pull double duty for Alzheimer’s proofing. In this case, we note that many (even most) sedans come with special safety latches built into the rear doors. On the majority of passenger cars built in the United States since the 1980s, turning on this safety feature is as easy as flipping as switch.
The function of the child lock is easily summarized. Most doors can be opened (and many can be unlocked) from within the cabin by simply pulling on the interior door handle. However, once the child-lock system has been engaged, the door cannot be opened from the inside. Even if the door is unlocked, the occupant has to be released from the cabin by someone operating the exterior door handle.
The only “loophole” is that the exterior door handle can be operated by reaching outside the vehicle – for example, through an open window. So, in addition to using the child-safety locks…
2. Utilize Your Window-Switch Locks
On most modern vehicles that are equipped with power-window switches, there is a master panel located on the driver’s door panel. On that door panel, usually, there is a “lock” or “window lock” button situated near the window switch assembly. The button gives the driver the ability to override auxiliary door switches so that the window positions on passenger doors cannot be changed without the driver’s authorization. Of course, it was designed primarily with children in mind. The idea was to prevent youngsters from playing around with the windows – perhaps raising and lowering them haphazardly, or at inappropriate times – and possibly getting one of their little digits crushed in the process.
But, as in other cases, what works to prevent children from getting hurt sometimes also translates into a workable solution for keeping Alzheimer’s patients out of trouble.
3. Clean up the Cabin Interior
This one may seem commonsensical, but it’s worth mentioning, nonetheless. Don’t leave a lot of trash lying around – anywhere. But inside the vehicle, it is impractical to expect that you can thwart your loved one’s every peculiar gesture while you’re driving the car. In other words, you may notice that mom or grandpa is straining to pick something up, but there will be little that you can do about it when you’re operating the vehicle. Before you put an Alzheimer’s sufferer in your car, double check that there is nothing dangerous (or just disgusting) within his or her visual field. If you encounter trash, discard it! If it’s something that you need to keep with you – like pepper spray or a first-aid kit, then at least put it inside of the glovebox. Most gloveboxes can be locked with your key.
4. Consider Using a Seatbelt-Button “Guard”
I have seen a few of these. Don’t be put off if the gizmo is stocked in the childproofing section – or even in pet supplies. The last thing you want is for grandma to release her seatbelt before it is safe to do so. Placing a “guard” over the seatbelt button can make it more difficult for grandma to inadvertently (or advertently!) trigger the retraction of her safety belt. Doubtless there are various models available, but the general idea is that releasing the guard takes a bit more dexterity than just depressing the seatbelt button. Alzheimer’s certainly diminishes fine motor skills, making it less likely that grandma (or whoever) will be able to defeat the extra layer of security. Remember: we’re trying to stack the odds in our favor.
Minimizing Dangers Outside of the Car
1. Restricting the Keys
One important consideration is going to be access to the vehicle’s keys. This is very basic. If a person has some form of dementia, such as Alzheimer’s, it may be necessary to restrict access to those keys for a number of reasons.
Why Might You Have to Restrict Key Access?
Depending upon the degree of impairment, it might be that the person in question can no longer safely or reliably operate a motor vehicle at all. So, one primary reason to restrict key access is simply to prevent your loved one from being able to drive the car on the road in the usual sense. Even starting a car and leaving it to idle in place can pose a danger (for example, with respect to things like carbon-monoxide buildup – click HERE for recommended CO detectors), especially if the vehicle is enclosed inside of a garage. (Of course, it’s a good practice to place carbon monoxide detectors inside of the garage and inside of the living space. I personally recommend getting a low-level detector, even though it costs a bit more, because of the fact that most detectors do you not report low-level conditions that can be dangerous over time.)
How Can You Restrict Access to the Keys?
A. Never leave the keys lying around; hide them. (As a special case, especially do not leave your keys inside of the ignition!)
Alzheimer’s is peculiar. People with the condition have periods of lucidity. Do not count on your aged mom, dad, grandma or grandpa being unable to recall that these keys go with that car. The best strategy is a comprehensive one, with layers of redundancy.
The first thing to do is to place the keys inside of a lock box or inside of a locked drawer or safe.
B. Alternatively, secure the keys some other way – for example, keep them on your person.
If it is inconvenient or otherwise infeasible to lock the car keys away someplace, another option is just to hang onto them yourself. Add your aging relative’s car key onto your own keychain, for instance. Or just keep their entire key ring in a pocket.
As I have mentioned in other places, I am a big believer in redundancy. So even after you have restricted access to the keys (e.g., by locking them safely out-of-reach or keeping hold of them), I would still recommend restricting access to the vehicle in other ways.
2. Controlling Entry to the Garage
If the car is inside of a garage, then you can do several things. Firstly, you can secure the door from the house to the garage – if such a door exists. Of course, the obvious first pass attempt would be to keep the door locked in the typical sense. If this is the route that you wish to go, a double-keyed deadbolt would be advisable.
In my dad’s case, I found a little gadget called a door “Guardian” and installed it on the relevant door. When engaged, the ingenious device holds the door closed, even if the usual locking mechanisms have been unlocked. The Guardian can be mounted up high, which is advantageous because I found that my dad seemed not to even notice that it was there. It’s also ideal for the present application because the disengagement of the Guardian, while easily accomplished by an adult possessed of all his or her mental faculties, is complex enough to frustrate a person with diminished cognition.
It may also be necessary to stow the garage-door openers, to prevent the Alzheimer’s-afflicted individual from gaining access to the vehicle from the driveway. However, I would also recommend securing the main entryway, to lessen or eliminate the possibility that mom or grandpa will be able to get outside unsupervised.
3. Defeating the Starting System
Another thing that you can do is install (or have installed) an inline switch between the vehicle’s battery and the starting circuit. The function of such a switch is basically to disable the car’s starter, even if dad or grandma get past your other measures. An alternative would be to have a full alarm system put on the car (which might not be such a bad idea, for other reasons). Many vehicle security systems include a “starter-interrupt relay” that prevents the car from being started – even with the key in the ignition.
A final suggestion – and a harder pill to swallow for some families – is to simply get rid of grandpa’s car. Of course, this doesn’t safeguard against the Alzheimer’s patient absconding with someone else’s car. But, truthfully, such a situation is probably out of the realm of the normal. Alzheimer’s decreases cognitive function. A sufferer is unlikely to be able to devise a plot to steal your car. What is more typical is that dad or grandma simply wants to do what he or she has always done: drive. So, they go to the usual place to find the key and try the usual things to get to the familiar car. The name of the game is Making It Difficult. But there is no substitute for supervision.
Supervise, Supervise, Supervise!
Even after you have secured the keys; even after you have interrupted the battery; even after you have secured the garage doors or emptied the garage altogether; there is no replacement for supervision. In many ways, a person with Alzheimer’s is like a child. Surrounded with environmental perils, such an individual lacks the discrimination to avoid (or get out of) danger. The bottom line? Your loved one needs your constant and watchful supervision.
An Overview of the Symbolism Behind the Color Purple
“I think it pisses God off if you walk by the color purple in a field somewhere and don’t notice it.” – Shug Avery, The Color Purple[1]
In a Nutshell
Purple has become the “official” color of Alzheimer’s awareness and other, allied movements. During the assigned month of November,[2] we encounter repeated entreaties to “Go Purple,” by donning some shade of the color that includes indigo, lavender, lilac, orchid, periwinkle, etc. Specifically, the Alzheimer’s Association variant appears to be a close cousin of iris or violet. Full disclosure: I am not a color theorist!
But why purple? A survey of the available information doesn’t reveal much on this specific question. As far as I can tell, therefore, the answer must remain somewhat speculative. It could simply be that Alzheimer’s Association founder Jerome Stone’s wife, Evelyn,[3] because of whom the organization was founded, happen to like purple. But, on the supposition that there is some deeper meaning lurking about, we might say something like the following.
A short answer: Recall from grade-school art class that purple is a product[4]of red and blue. In general, dark red symbolizes things that are mysterious and secret, and celestial blue variously represents dreams as well as the cold emptiness of vast bodies like the ocean and sky.[5] In a similar way, Alzheimer’s Disease is a mysterious entity or force that sucks hapless sufferers into a veritable vacuum that, to bystanders, appears to be close to a waking nightmare.
Curiously, purple or violet itself is reported by some writers to be “the color of …clarity of mind …and wisdom.”[6] So there would also seem to be a note of hopeful anticipation in the chosen hue. Perhaps it is no more complicated than the notion conveyed in the opening quotation: Purple reminds us to notice the “little things,” before we – or someone we love – is unable to do so.
But…if it is more complicated, then maybe some of the following will assist interested readers in digging beneath the surface.
At Greater Length
At first blush, purple may seem unsuitable for representing a brain-wasting condition. After all, historically, purple – sometimes itself classified as a variant of red – has nobler associations.
Monarchy and Royalty
For example, purple is a common color for aristocrats and rulers.[7] This has a long pedigree. “[I]n Rome[, purple] was the colour of generals, nobles and patricians. Consequently it became the imperial colour.”[8] According to symbologists Chevalier and Gheerbrant, “…purple (or deep or light violet) …[was] chosen by Constantine for the labarum,” or chi–rho symbol.[9] This consideration leads us onward to the following.
Christian Symbolism
Moving forward in history, this rich color is observed on the specialized clothing, or “vestments,” of Catholic clergymen during the liturgical seasons of Advent and Lent.[10] Both of these periods of time, in the Church’s reckoning, have to do with hardship and preparation. Traditionally, Advent precedes the celebration of the birth of Jesus Christ at Christmas, while Lent comes before, and prepares the Christian for, the memorial of his death and resurrection at Easter.
The Lenten season, in particular, is associated with sacrifice. Catholics commonly “give up something” for Lent. Catholic priests may also wear purple while administering the sacrament of the anointing of the sick, previously called “last rites” or “extreme unction.”[11]
Similarly, in the Eastern Church: “Light colors (white and green) are preferred [for clergy] for high festivals (esp. Easter), and dark colors (purple, blue, dark red, black) for services of penance and mourning.”[12]
It would seem that these uses of purple move us closer to the experience of an Alzheimer’s sufferer.
An Alchemical Angle? The Phoenix
Before you furrow your brow at the suggestion that there could be an alchemical aspect to our question, notice that the Alzheimer’s Association describes its symbol in terms of the language of the duality of “people and science.”[13] In a rough-and-ready way, alchemy has to do with transformation – specifically a sort of quasi-scientific transformation of human beings, allegorized as the turning of base metals (like lead) into gold.
Speaking of gold, Dennis Hauck informs us that gold is symbolized by “the sun, and gold was considered a king of concealed solar light. Sol [the sun] is the King of alchemy, and his royal purple color is the indicator of gold particles in solution. …Pure colloidal gold …has a royal purple hue… Historically, colloidal gold has been found useful in cases of …nervous unbalance [sic] because it seems to help …stimulate the nerves.”[14] (For more on colloidal gold, see HERE.)
The Alzheimer’s Association is certainly aiming to facilitate the transformation of an Alzheimer’s-afflicted brain into a higher-functioning one. Is this broadly “alchemical”? Perhaps. Is this definitive? Hardly. Still, it is worth observing that alchemy is rife with references to purple.
As offbeat writer Stuart Nettleton asserts: “Purple in Biblical and classical times” often denoted “…‘Red’…”.[15] With this in mind, note that the concluding stage of the alchemical “major work” (magnum opus), usually known as the “reddening,” is sometimes instead called iosis or purpureus, that is, the “purpling.”[16] Stuart Nettleton declares: “The purple color of lilac or lavender is the color of wisdom and the end of the [alchemical] work.”[17]
By some accounts, the end of the alchemical “work” is none other than the “Philosopher’s Stone.” Hence the color purple is arguably a key symbol for the powers of transformation.
Observe also that the mythical phoenix (also called the bennu or firebird) – depicted as red in the recent Harry Potter movies[18] – is associated with “purple.” “This fabulous bird was held to be reddish purple, the colour of the vital force… This is derived from ‘Phoenician,’ the people who discovered the properties of purple dye.”[19] Indeed, the phoenix and the Philosopher’s Stone are supposedly interconnected symbols.[20] Confused yet??
As an aside, it is believed by some that “in Ancient Egypt, the bird concerned was the purple heron…”.[21]
Whatever its origination, the fabled phoenix came to symbolize a cycle of death and rebirth – through a kind of self-inflicted fire. Relatedly, purple is “also a funereal colour …connected with death.”[22]
It’s also sometimes thought of as a “soul-bird.” “This purple-hued fire-bird – that is, a creature composed of the life-force – symbolized the soul to the Ancient Egyptians.”[23]
Speaking, again, of this “circle of life,” we turn once more to Chevalier and Gheerbrant who intriguingly comment that “violet lies directly opposite green. Thus it stands, not for the springtime passage from death into life, but for the autumnal passage from life into death… Violet may …be the other side of green and… linked to the symbolism of the mouth. Violet …is the mouth which swallows and puts out the light, while green is the mouth which regurgitates and rekindles it.”[24]
Hypnosis, Secrecy, and Other Odds and Ends
Researcher Rosemary Guiley claims that the proto-hypnotist Franz Anton Mesmer was known to wear purple robes.[25] Moreover, according to the same author, purple-colored candles are used in certain streams of “magic” (for instance, Wicca), for such things relevant purposes as “…reversing a curse; [and] speeding healing in illness…”.[26] Is the condition or “illness” of Alzheimer’s also a sort of curse? Many families would say so.
Investigator Dennis Hauck reports that “[b]lue or purple roses indicate spiritual longing, meditation, and the promise of a perfect world.”[27]
“[V]iolet is the colour of secrecy…”.[28] One way of thinking about it is as though it is partially composed of dark red, which is “…nocturnal, …secret, and …stands …for the mystery of life.”[29] Dark red is also said to symbolize knowledge, especially when hidden beneath some covering of blue.[30]
Typically, pairing colors in this way designates “gnosis,” or the sort of esoteric wisdom that only a few are able to acquire – usually after initiation into some secret society. But it is interesting to think of how this symbol complex applies to the Alzheimer’s patient – possessed, one presumes, of memories and information that are veiled beneath a layer of “amyloid plaques and tangles” (for more on which, see HERE.)
Notes:
[1] Alice Walker, The Color Purple, Boston: Houghton Mifflin Harcourt, 1982, p. 196.
[2] Relatedly, June is deemed “Alzheimer’s and Brain Awareness Month,” while the date of September 21 is designated “Alzheimer’s Action Day.”
[4] Speaking of a sort of color combination known as “subtractive.”
[5] See Jean Chevalier and Alain Gheerbrant, The Penguin Dictionary of Symbols, John Buchanan-Brown, transl., New York: Penguin, 1996, pp. 102f and 792f.
[6] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 1068-1069.
[7] See Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 159. On the other hand, maybe we’re not always right to place royalty on a pedestal. See this shockingly titled article from the British-based newspaper the Daily Mail: Fiona MacRae, “British Royalty Dined on Human Flesh (But Don’t Worry It Was 300 Years Ago),” Mar. 6, 2016, <http://www.dailymail.co.uk/news/article-1389142/British-royalty-dined-human-flesh-dont-worry-300-years-ago.html>.
[8] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 794. For the tie-in to Phoenicia, see further on in the text.
[9] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 159.
[11] Purple is also used within Roman Catholicism to signify the ecclesiological “rank” of bishop. “The pileus (also called a soli Deo), the small, round skullcap, is white for the pope, red for cardinals, purple for bishops, but otherwise black [for priests].” According to “Vestments,” David Barrett, Geoffrey Bromiley, et al., eds., Encyclopedia of Christianity, vol. 5, Grand Rapids, Mich.: William B. Eerdmans Publ.; Leiden: Brill, 2008, p. 675.
[12] “Vestments,” Barrett, Bromiley, et al., eds., Encyclopedia of Christianity, vol. 5, p. 675.
[14] Dennis William Hauck, The Complete Idiot’s Guide to Alchemy, New York: Penguin, 2008, pp. 210 & 257.
[15] Stuart Nettleton, The Alchemy Key: The Mystical Provenance of the Philosophers’ Stone, 11th ed., Sydney, Australia: privately publ., 2002, p. 451, n. 31.
[16] It is usually subsumed under the final phase: rubedo, or “reddening.” Writers disagree about whether ancient alchemy had three, four, or even five stages. In the threefold taxonomy, the process is given as (1) nigredo (blackening/melanosis); (2) albedo (whitening/leukosis); and (3) rubedo (reddening, purpling/iosis). Sometimes a single intermediate, namely citrinitas/flavum (yellowing/xanthosis) is listed between albedo and rubedo, yielding four stages. Other times, two intermediate stages are given: citrinitas and viriditas (greening/prasinosis). See: Matilde Battistini, Astrology, Magic, and Alchemy in Art, Los Angeles: Getty Publications, 2007, p. 320; Hauck, The Complete Idiot’s Guide to Alchemy, passim, but esp. p. 150; and P. T. Mistlberger, “Introduction to Psycho-Spiritual Alchemym” 2012, <http://www.ptmistlberger.com/psychospiritual-alchemy.php>.
[18] These movies also make mention of the Philosopher’s Stone, or the “Sorcerer’s Stone.”
[19] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 752. See also p. 110. On cloth, this was called “Phoenician” or “Tyrian purple.” Apparently, there was also a version of coloration, used on glassware and other vessels, that was called “purple of Cassius.”
[20] See, again, Nettleton, The Alchemy Key, pp. 296 & 326.
[21] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 752. See also p. 503.
[22] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 752. See also p. 793.
[23] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 752. See also p. 90.
[24] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 752. See also p. 1069.
[25] “Mesmer, Franz Anton (1734–1815),” Rosemary Ellen Guiley, The Encyclopedia of Magic and Alchemy, New York: Facts on File, 2006, p. 195.
[26] “Candles,” Guiley, The Encyclopedia of Magic and Alchemy, p. 54.
[27] Hauck, The Complete Idiot’s Guide to Alchemy, p. 65.
[28] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 752. See also p. 1069.
[29] Chevalier and Gheerbrant, The Penguin Dictionary of Symbols, p. 752. See also p. 792.
[30] As often occurs in the Tarot deck with trumps such as the “High Priestess” (or “Papess”) and the “Empress.”
Alzheimer’s Proofing Vs. Baby Proofing: An Overview
I have had the experience of having to make alterations around the house to better accommodate my Alzheimer’s-afflicted dad. As I reflect on these changes, and prepare to summarize them for web consumers, I am mindful that I have also been in the position of baby proofing a home for new arrivals.
I started thinking about some of the ways these two experiences were similar, and about other respects in which they were quite different. I offer a few thoughts as a sort of primer to my upcoming series on Alzheimer’s proofing your home.
When should you start baby proofing?
Most babies start crawling around eight months, however, many of them start crawling considerably earlier than this. A crawling infant will soon start pulling him- or herself up onto his or her feet, which means various surfaces will never again be out of reach. One recommendation for new parents would be to begin baby proofing as soon as the pregnancy test comes back positive! However, for those who found themselves in the position of having a newborn, but of not having a baby-proofed “pad,” all hope would by no means be lost at this point. Still, such parents would be highly encouraged to get started right away with their baby-proofing efforts.
Although it might strike first-time moms and dad as odd to baby proof a home when their little Bitsy Boo can’t really move much, veteran parents know all too well the surprising rapidity with which Munchkin will be “getting into” things. The moral of this story is obvious: it’s never too early to start taking precautions against Sweet’ums injuring him- or herself.
When should you start Alzheimer’s proofing?
Of course, the same logic can be applied to those at immanent risk of, or recently diagnosed with, Alzheimer’s or it’s precursor, mild cognitive impairment. In some respects, it might behoove people at various stages of life to begin making small changes around the house, just to lessen the extremity of any adjustments that are needed later in life. In other words, maybe we should all start Alzheimer’s proofing our digs for that unhappy day in the future when someone we care about becomes someone that we must care for in a house that is not up to the challenges dementia.
Let’s look at some of the similarities between baby proofing and Alzheimer’s proofing one’s living quarters.
Differences, Similarities, and Other Odds and Ends
Making the Environment Safer and More Controlled
Unfortunately, one thing that babies and (advanced) Alzheimer’s sufferers have in common is a low level of cognitive function.[1] For present purposes, this means that both classes of individual are unable to correctly and reliably avoid environmental perils. It is therefore necessary for caregivers to rearrange the environment to minimize particular risks.
Here are some tips to save both children and the elderly (or otherwise impaired) from damage and danger.
Manage cords
Power cords present a problem for both babies and Alzheimer’s victims. For both, there is a danger of electrical shock. But they are also a tripping hazard.[2] Use nylon (“zip”) ties to keep electrical and other cables well-maintained and out of eyesight (as much as feasible).
In a similar vein, running connecting cords through conduit can keep entertainment centers and personal-computer workstations better-managed and less likely to be messed with. (Split-loom tubing is also quite effective.)
Cover outlets
Speaking of electrical shock, put outlet caps into all accessible electrical sockets to shield little ones – and not-so-little ones – from possible electrocution.[3] More protection may be afforded by screw-in outlet cover plates or self-closing outlets. (For an additional layer (literally) of security, position furniture so that it obscures access to outlets.[4]) On the flip side, dementia sufferers periodically attempt to do things (like plugging in vacuums or rewiring outlets) that, when they were compos mentis, they were accustomed to doing.
I once discovered my dad, Jim (read his story HERE), “scouring the floor” (according to his explanation) with sugar granules – because he thought the floor ought to be cleaned, but I had hidden all the chemicals. Who’s to say that he wouldn’t have gotten the notion to try to perform the duties of an electrician using only a ballpoint pen clip or a spoon?
Consider further: sockets are presumably going to be at eye level for most youngsters, and Punkin’ might be tempted to put items like forks, etc., into them. Therefore, both parents and Alzheimer’s caregivers ought to endeavor to keep flatware secured in a (high?) cabinet where neither Lil’ Bit nor grandma can reach.
Lock knives away
While on the subject of eating utensils, tableware and the like, be sure to keep cutlery safely tucked away from curious youths as well as confused seniors. Magnetic locks can serve that purpose.
Cushion sharp or dangerous edges
There will undoubtedly be a couple of bumps and hits as little ones figure out how to walk. However, you can do a few of things to stop inevitable spills from becoming major disasters. Adding soft spreads to hard surfaces on floors and furniture shields your children from getting badly bruised or cut in the event that they take a tumble. Introducing child-safe gates at the top or bottom (or both) of stairs means they can’t get up or down without an adult. Keeping your staircase sufficiently well-lit (and free of toys) helps ensure that there will be fewer falls.
Some of these suggestions are equally advisable for older adults. Putting some “corner guards” (also known as “bumper” cushions) or foam edging on coffee tables and the like can pull double duty saving baby noggins and adult legs/shins from hard knocks. After a certain level of disability is reached, well-secured handrails become nearly essential features for staircases.
Guard entry ways
This has a dual aspect. On the one hand, parents and dementia-sufferer supervisors alike might wish to invest in “finger protectors,” so that their charges digits don’t get crushed in a door-closing mishap. On the other hand, “elopement” is an ever-present factor in some contexts. For containment purposes, it is therefore advisable to install some sort of childproof or “Alzheimer”-proof lock mechanisms on exits.
Our home has three entryways. We employed a Guardian door brace on the passage into the garage, installed too high up for my dad to reach without causing a commotion. On the front door, I actually resorted to reversing the storm-door lock, so that you needed a key to exit the house. The back door was similarly controlled. Except, there, I put on a double-keyed deadbolt.
Have working CO and smoke detectors
Of course, with everyone locked up safe and sound, it is imperative to keep watch over fire (and related) hazards. Minimally, smoke and CO detectors should be placed throughout the living space, with special attention on sleeping areas.[5] (As an aside, readily available battery-powered CO detectors – like THIS and THIS – typically detect levels of CO in concentrations of 60 parts per million or greater. THIS ONE mentions 400 ppm on the bottom – which is a lot! For maximum peace of mind, obtain a low-level CO detector. Kidde makes the KN-COU-B and Defender makes its LL6070. We purchased an NSI model 3000 from our local heating and cooling company.) I also obtained a plug-in natural-gas detector and placed it outside of the laundry area (where we have the furnace and the gas-fueled water heater). Smoke detectors are widely available.
Secure medicines and chemicals
Store all pharmaceuticals securely, such as in a high-bolted cabinet. Never remove anything from its unique childproof holder unless you have need of it, and then be sure to return it. Bear in mind that “childproof” caps can prevent dementia patients from accessing drugs due to the loss of dexterity that accompanies their condition.
For children as well as Alzheimer’s-afflicted adults, do whatever it takes not to open medication in front of your youngster. For toddlers, the fear is that or he or she might attempt to mimic your actions.[6] For older adults suffering from cognitive impairment, one danger is that seeing the medication will prompt a recurring anxiety over whether or not it’s time to “take a pill.” This can cause all sorts of trouble.[7]
Shield both inquisitive and curious children as well as disoriented and restless seniors from cleaners and miscellaneous chemicals by putting those things away in locked or otherwise secured cupboards or by installing magnetized security latches (or THIS) that “catch” automatically when you close cabinet doors. Other devices are available for drawers as well.
Take precautions in the car
Just as you would protect your child[8] in your automobile by activating the now ubiquitous “child safety locks” on passenger doors, the same technology can likewise prevent older adults from exiting the vehicle in an untimely (and possibly dangerous) manner.[9]
Ensure that objects are age-suitable
At present, it may be easier to follow this principle as it concerns youngsters than as it pertains to “oldsters.” For instance, toys labeled “Infant” or “Ages 0 to 6 months” are probably safe for your baby.[10]
Or, again, there are intuitive dangers to look out for. A good rule of thumb is to guarantee that your kids’ toys are significantly larger than their open mouths, to avoid choking. Additionally, verify that every one of the parts joined to a toy – like a doll’s button eyes or a teddy bear’s bows – are securely affixed and can’t become detached with reasonably minimal effort.
But what does one look for with aged adults? At the time of this writing, product labels like “Not Recommended for Those 75 Years Old or Older” or “Ages 18-75” are not commonplace. And one reason is apparent. With young children, it is plausible to think that age warnings will apply to (nearly) 100% of the relevant class. To put it differently, and for the most part, all two-month olds will be at risk of choking on small parts. But this does not seem to be the case with the elderly. Put another way, not all 80-year olds experience the sort of cognitive decline that might prompt a product warning aimed at them.
Still, there are a growing number of product lines that are geared specifically at the Alzheimer’s and dementia-suffer “market.” (See, for instance, THIS PUZZLE for an example of the phraseology I’m talking about.)
Minimize miscellaneous environmental risks
In the case of children, other choking and nonspecific perils are almost ever present.
Bedrooms
You should ensure, for example, that your infant’s playpen has fastened rails. Mobiles with little hanging parts should be removed when infants graduate to pulling themselves upright. As children age, they may require rails installed on conventional beds in order to reduce the risk of falling out of bed.
In a similar way, seniors can benefit from specialized mobility rails that both reduce the chance of tumbling out of bed, but also provide a means for older people to help pull themselves up when transferring in and out of bed.
Living rooms
Besides the tips like covering outlets and securing televisions, already mentioned above, you might consider corralling fledgling walkers inside of a “play yard” or equivalent. This worked for my family.
But what about for older adults? Unless the person is “non-ambulatory” or wheel-chair confined, it is probably useless to attempt to keep a dementia suffer cordoned off in a single room. The best that you can hope for is to enrich the environment with activities that absorb his or her attention.
However, when the allure of handicrafts wears off, as it inevitably will, it is best to have a contingency plan. The failsafe for my dad was to control the points of entry into the house so that he would be unable to wander off. (See, again, the section subtitled “Guard entry ways,” above.)
Bathrooms
For young ones, the risks of drowning and electrocution are preeminent. To stop your infant from burning him- or herself during shower time, set your water heater to a low temperature. In case you’re redesigning, install “anti-scald” valves on new pipes. Hold or secure the toilet seat in a downward position to prevent the infant from splashing around and falling in. Ensure all shower items, and cleaning supplies are in upper cupboards or cabinets that the child can’t reach. Never leave the baby in the bathroom alone particularly not in a filled bathtub. The point bears repeating: The bottom line for babies and toddlers is supervision. You simply cannot leave them unattended.
But seniors typically present somewhat different challenges. The constellation of hazards mainly centers around the risk of falling. Also relevant is the fact that many Alzheimer’s-afflicted persons retain their adult desire for privacy. You cannot easily supervise a dementia patient while toileting or bathing. Thus, bathrooms are of particular concern.
There are safety steps that can be taken, however. Think about converting a shower, especially if a person must step over a ledge to enter, into a walk-in bathtub. Lay non-slip mats on the ground. Ensure that the medicine cabinet is locked or relocated.[11] Restrict access to electrical appliances such as hair dryers. (Refer back up to the section on magnetic and other cabinet locks.)
Kitchens
Children may view stovetop controls as great fun to pull and twist. Thankfully, they are usually out of reach, unless you have a “climber” on your hands. Get some knob covers. An appliance lock helps ensure that your little one can’t pull the entire oven door onto him- or herself.
Have something percolating or boiling on the stove? Burns are very common; tea can singe fifteen minutes after it’s been made. Keep hot beverages away from the edge of surfaces and put your cups down when playing with the babies. Turn pot handles away from the front of the stove, to minimize accessibility (little children tend to grab them). Additionally, various “stove guards” are available that offer extra layers of protection.
There’s really no way around it: the kitchen is a dangerous appliance. For those, like Alzheimer’s sufferers, whose cognitive faculties are comprised or undermined, it may be best to steer clear of this room entirely. My dad caused several (small) fires with paper towels carelessly placed onto the stovetop. The toaster is likewise troublesome. But heat and fires are not the only perils. Mental impairment can fail to prevent a person from drinking expired milk or eating improperly prepared meat. And in many kitchens, cleaning (and other) chemicals are sometimes found in close proximity to food. Mix ups can occur. Less dramatically, grandpa’s failure to thoroughly wash his hands can lead to the contamination of the cookie jar with something merely distasteful – such as granules of dog food – or, God forbid, with something potentially deadly – like drain-clearing crystals or rat poison. Lock the stuff up!
As stated previously, magnetic cabinet latches are a cheap and effective way to protect the aged as well as the young. My dad once attempted to make soup (we think) by placing a glass vessel on a stove burner. As it heated, the glass shattered and made quite a dangerous mess of things. Store glassware under lock and key.
Waste Disposal
Inquisitive children will attempt to get into anything you leave lying around. Relatedly, dementia-afflicted persons may become convinced that they have lost something – whether real or imagined – and begin rummaging through the garbage, putting themselves in danger. In case you’re discarding anything hazardous (e.g., batteries, broken glass, jagged metal, or plastic bags and packing material) it’s prudent to take it outside immediately. Alternatively, put the recycling and trash containers someplace your charges can’t reach.
Hallways
Ensure that hallways and walkways are clear, to minimize trips and falls.
Concluding Remarks
Alzheimer’s and baby proofing doesn’t totally dispose of the danger of damage, yet it does fundamentally diminish many of the most prevalent dangers. It’s about risk mitigation. Regardless of whether you’re in a new or old home, parts of your living space will always be in need of Alzheimer’s and baby proofing. Realistically, you can’t fully secure your place but you can reduce risk. Even if you are confident that you’ve performed a comprehensive “proofing,” chances are you’ve missed something. And it’ll be your charge that finds and exploits the weakness. No amount of child- or dementia-proofing should substitute for diligent watchfulness.
[1] Still, there are differences. Babies have this low functionality because their brains have not developed and grown as they are expected to in the coming years. Alzheimer’s patients, on the other hand, have brains that are at various levels of degeneration.
[2] A related danger is that electrical cords, when tripping over or pulled, can cause (sometimes heavy) appliances to fall on little noggins or on brittle feet. Children are periodically crushed to death by accidentally tipping onto themselves televisions and other massive pieces of furniture. See HERE and HERE and HERE and HERE and HERE.
[3] Parents: be mindful of the fact that some types of outlet cover could be potential choking hazards if, perchance, a child manages to pry them out of the socket (or to find one that was removed by an adult, but never replaced). An alternative is to search for covers that require two hands to remove or that feature cover plates that screw on.
[4] Just be sure that the furniture does not itself present a tipping risk. See, again, footnote #2.
[5] It is fairly intuitive that there is a greater danger while people are sleeping, since their senses and response times may be dulled. Caution is needed, however. For reasons that are probably too obvious to readers of this blog, babies and Alzheimer’s patients cannot be relied upon to react appropriately to detector alarms. Diligent supervision is always required.
[6] An added suggestion: If your child does see you taking medication, never refer to it as “candy.”
[7] Anyone who has spent time caring for Alzheimer’s sufferers probably realizes that routine tasks often become obsessions or, at the least, sources of great consternation. Even if you have just administered a dose of medication, an Alzheimer-afflicted senior can forget this and become distressed.
[8] Of course, there are numerous other safety tips that pertain to small children only. Most prominently, babies and little kids require special seating – e.g., rear-facing car seats are usually recommended up to a certain age or up to a particular weight. I will not get into such things here, as many internet sites are dedicated to these issues. Suffice it to say that parents should not use car seats with which they are unfamiliar. This should not be understood as a reason to avoid car seats, but as a motivator to familiarize oneself with your own model. Nowadays there are features that may have been added to newer seats that are not present on older models. Additionally, hand-me-down seats might have structural or other issues (like missing parts or lost directions) that render them unsafe or unwise to use. When in doubt, have a professional (e.g., a fire-department official) inspect your car seat and your installation. It might have been engaged in a crash or it might be past its termination date.
[9] One drawback is that such security measures are commonly installed on rear doors only.
[10] Still, a label is not a substitute for attentiveness. Also, keep an eye out for manufacturer recalls.
[11] For other reasons, like the high-humidity environment, it is probably unwise for anyone to keep pharmaceuticals in the bathroom.
Alzheimer’s, Too Much Television, and Too Much Sitting
It will come as no surprise to most readers that excessive TV-watching may be detrimental to one’s health. There are reports of links between television and: obesity (Psychology Today), depression (CBS), diabetes (Amer. Diabetes Assoc.), low sperm count (BBC, WebMD), violence (AACAP, Huffington Post, L.A. Times), poor nutrition (NCBI[1]), stunted language acquisition (NCBI[2]), sleep deprivation (NPR), and probably numerous other undesirable conditions or outcomes (see further on).
Now comes evidence that too much time in front of the “tube” (or flat screen, what have you) may be correlated with increased risk of Alzheimer’s Disease. In one particular study, conducted at San Francisco’s Northern-California based Institute for Research and Education, researchers associated 4+ hours of viewing time per day with lower cognition. The results manifest as early as middle age.[3]
But the problem of sitting in front of the television can be broken down into two things: sitting and being in front of the television. Each is bad news for cognitive function.
Two Problems: Sitting and Television
In fairness to TV, though, it seems that television per se is not the only culprit. Presumably, electronic screens of all sorts contribute to the potential problem. More to the point, however, it’s the time that we spend sitting in front of a video display of some kind that was emblematic (or indicative) of low levels of physical activity.
An underlying phrase seems to be “sedentary lifestyle.” As one author summarizes: “Excessive Sitting Cuts Life Expectancy by Two Years.”[4] Think about that for a second – preferably while you stand.
“Sedentary” generally refers to being inactive. The word comes down to us from the Latin verb sedere, meaning “to sit.” To be “sedentary,” then, is to be seated – especially in one place, without moving – for extended periods of time.
If you’re like a lot of people, you spend a great deal of time sitting. We sit in our cars on the way to work. We may sit at a desk once we arrive. And then, once we have sat through our lunches and our drives home, we go from sitting around the dinner table to sitting around the tv. Some days we may do little else besides sit. Then, after a few (hopefully, but often not, 8) hours of sleep, we wake up and do the same thing all over again.[5] It’s a vicious cycle of sitting.[6]
Here’s another disturbing factoid. As journalist Christopher Bergland put it: “In America, there are currently more televisions per home than human beings.”[7]
And it’s not just that we own these TV sets, we use them excessively, too. CNN relates that the ephemeral “average American” spends almost eleven hours every day in front of a video screen.[8] That’s a whopping 4,017 hours of sitting every year.
According to the University of California – San Francisco’s psychiatry professor Kristine Yaffe, habitual TV watchers underperform “on cognitive tests compared with those who watched less television.”[9]
Considering the panoply of common middle-aged recreational activities, watching TV is the only one “positively linked to developing Alzheimer’s disease.”[10] In the words of Dr. Robert Friedland, it turns out that Alzheimer’s patients were less active than non-Alzheimer’s sufferers in almost every category – “except for one, which is television.”[11]
What is not entirely clear is whether physical inactivity and TV watching cause Alzheimer’s, or whether Alzheimer’s-disposed brains simply tend towards inactivity and TV watching. In other words, the causal direction (if any[12]) is at present underdetermined by the evidence.
Still, if you’re like me, then you’re less interested in making true causal claims than you are in just avoiding (or minimizing your risk for) dementia. The takeaway, then, seems to be watch sit few hours in the day and watch less television. Easier said than done.
How Do You Sit Less?
There are not all that many postural categories. Intuitively, if you’re not sitting, then you’re either standing up or lying down. Since lying down isn’t exactly a deviation from an overall sedentary lifestyle, we’re basically left with the option of standing up more often. Here are ten ideas for how to do just that.
This is my stand-up desk, from VariDesk.
Ten tips for sitting a little bit less every day.
Take a daily walk. Walking can be good for your cardiovascular health. It can also rev up your metabolism and promote fat loss. To maximize this, walk in the morning, before you eat your first meal of the day. But if a morning walk is infeasible, then carve out some time later in the day.
Moreover, take every opportunity to walk. Whenever possible, walk for communication purposes. To put it differently, don’t text your coworker, stroll over to his or her cubicle (or wherever). Don’t telephone your neighbor, knock on his or her door. Of course, this is not always doable. In our modern world, we routinely find ourselves having to talk to people who are miles away from us. But this isn’t always the case. Take the stairs instead of the elevator.
While you’re at it, though, stand up while you’re on the telephone. Walk around. Go outside, weather permitting! You’ll feel better. Any little bit of movement – as little as five minutes – is better than nothing.[13]
Stand up at your desk or workstation. A typical work day lasts 7 or 8 hours. Purchasing a standing desk, or a sit-to-stand “adapter” is a great way to invest in your health. On a personal note, I have struggled the past four years with shoulder problems (rotator cuff). On the advice of my chiropractor, I acquired a stand-up computer assembly (HERE) from VariDesk. I credit this change, more than my physical therapy and chiropractic adjustments, with the vast improvement that I have experienced in the last ten months.
Set a timer when you’re seated. Force yourself to take short breaks. “[M]ini-breaks, just one minute long throughout the day, can actually make a difference.”[14] Another tip: move your printer away from your work station so that you are forced to get up to retrieve your documents.
Relatedly, don’t eat lunch in place. Get up. Move to a different location.
If you must drive somewhere, park a short distance away from the entrance. Give yourself an excuse to walk a little farther. As we have mentioned, every little bit counts.
Spend your break time on your feet. Run if you can. Take a short walk. But make sure that at least spend some time on your feet.
Relatedly, try standing up for your favorite movies or Netflix shows.
If you have to sit, make it count. Try swapping out the chair for an exercise ball or bar stool. Put a stationary bike in front of the television and peddle while you watch. But…, for goodness’ sake, limit your TV time!
How Can you Watch Less Television
I could – and do – say read a book once in while. But, frankly, I think we need to get down into the weeds a little bit more.
10 Tips for Watching Less TV
A head-on approach for counteracting excessive TV-watching (or gaming, etc.) is to invest in a “screen-time manager.” Whether to police your own video habits, or to reign in the display time of a loved one, you can make our electronic culture work for you, rather than against you. The company Hopscotch has an interesting device – called a “BOB” – that fits that bill. Basically, the thing is a timer that interrupts the power to the television. Users have personal identification numbers (or “PINs”) that they can use to access what amount to allotted pools of viewing time.[15] (Click HERE to check the price on Amazon.)
The BOB is marketed towards parents trying to limit their kids’ screen time. Video games and the like are obvious distractions that take valuable time away from homework and other, more worthwhile, endeavors. But it doesn’t take much imagination to see that the product could easily be applied to Alzheimer-sufferers’ situations. The guardian or adult-daycare supervisor would be in the role of the parent. But otherwise the principle is the same. Limit (or eliminate) the time that a person spends in front of brain-sapping video screens, by effectively locking the offending devices for certain periods of time or restricting the user to smaller intervals.
Keep your brain busy. Here’s where reading comes in. You can read books, magazines, newspapers, and so on. Specifically, we’re talking about print matter. Don’t read your articles online. Print a hard copy or go to the library – and get some walking in as well.
Pick up the telephone and have a voice conversation with a friend or relative. Or, better yet, walk to the neighbor’s house and have a face-to-face conversation.
Avail yourself of the various continuing-education classes offered by your local community college. Course don’t have to be taken for credit. And not all classes cost money.
Do some puzzles. These could be brain teasers, crosswords, jigsaws, or anything in between (heck, give Mad Libs a whirl, if you like). Mix it up. The idea is to get your neurons firing, making new connections, and revisiting old ones.
Speaking of revisiting old connections, get out your photo albums. Start a scrap-booking project. Besides getting your creative juices flowing, this is going to stir memories and, hopefully, bring a smile to your face. This fits into the larger category of “arts and crafts,” which also includes drawing, knitting, painting, sculpting, or whatever catches your interest.
Play some music. Put on a CD (or LP!) or play an .mp3[16] – but, avert your eyes from the screen! Sing along if there are lyrics – or hum along if there aren’t. Sit back down at that piano you haven’t touched in years. Pick up your old guitar or violin.
Clean up your living or working space. Pick a corner to begin with and then broaden the scope of your efforts as you make progress. Or just pick up a broom and tackle the back porch or patio. You can get as involved with the organization side of things as your concentration and energy will allow.
Keep a little garden, whether outside (thus getting your daily dose of natural vitamin D; see HERE) or inside (in the form of a planter or terrarium or whatever you have handy).
If safety and supervision aren’t pressing issues, then venture into the kitchen. Pick a recipe or two and do some baking or cooking.
Notes:
[1] Jennifer L. Harris and John A. Bargh, “The Relationship Between Television Viewing and Unhealthy Eating: Implications for Children and Media Interventions,” Health Communication, vol. 24, no. 7, Oct. 2009, pp. 660-673; online at the National Center for Biotechnology Information, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829711/>.
[2] Haewon Byeon and Saemi Hong, “Relationship between Television Viewing and Language Delay in Toddlers: Evidence from a Korea National Cross-Sectional Survey,” Haotian Lin, ed., PLOS One (Public Library of Science), vol. 10, no. 3, Mar. 2015, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365020/>.
[15] The device allows for the creation of up to six restricted PINs plus one “master” PIN. Each restricted PIN allows a user to access a “pool” of screen time. The master user can therefore manage TV-watching times and monitor activity on a daily basis.
[16] Here you might consider throwing in some classical, on the off-chance that there is something to the so-called “Mozart effect.” For an introduction to that thorny topic, see Claudia Hammond, “Does Listening to Mozart Really Boost Your Brainpower?” BBC, Jan. 8, 2013 <http://www.bbc.com/future/story/20130107-can-mozart-boost-brainpower>. Readers will recall my own point of view. I’m trying to stack the odds in my favor, rather than resolve a question scientifically. In light of this, I think I’ll let Mozart (or Bach or Beethoven or Handel) play in the background while the jury is still.
Alzheimer’s-Proofing Your Diet: Carbs, Fats and ‘Exotics’
This is Part Two in a series on Alzheimer’s-proofing your diet.
In Part One, I surveyed several vitamin (including B12, D, E, folic acid, and magnesium), herbal (e.g., gingko and turmeric), and other (COQ10 and fish oil) supplements reputed to give your brain a health boost. In this installment, I will review the postulated effects of curbing carbs, elevating (good) fats, and possibly experimenting with a few, less familiar, dietary “additives.”
Carbohydrates
Too much of a good thing can be bad.
Carbohydrates – “carbs, for short – have a bad reputation. And it’s getting worse all the time. According to some fitness writers,[1] fat isn’t the real culprit for making you fat – carbs are.
Carbs are also reported to be a major villain in several auto-immune diseases. Terry Wahls, professor of clinical and internal medicine at the University of Iowa, makes an even larger claim. She maintains that “[n]early every chronic disease today (high blood pressure, obesity, diabetes, heart disease, neurological problems, mental health problems, autoimmunity, and cancer) is an interaction with our genes and diet, toxin exposure, physical activity level, stress level, sleep quality and prior infections that account for the development of disease.”[2] Dr. Wahls is an advocate of a particular brand of high-fat, low-carb diet that she terms “ketogenic Paleo.”[3]
Now evidence from recent studies suggests that diets high in carbohydrates can have a damaging effect on the brain. “Holistic” physician and “alternative” medicine guru Andrew Weil states: “…[A] study from the Mayo Clinic show[s] that seniors whose diets are high in carbohydrates may have almost four times the normal risk of mild cognitive impairment, a mental change that may precede Alzheimer’s disease. The same study found that a diet high in sugar also increases the risk, while diets high in protein and fats relative to carbohydrates may be protective.”[4]
One popular theory has it that carbohydrates break down into glucose, also known as sugar. Sugar has been found to feed cancer[5] and, it seems, the beta-amyloid proteins which destroy the memory in the brain. Medical News Today reported: “…scientists suspect] is the accumulation of plaques of a faulty protein called. Now, a new study of mice shows how too much sugar in the blood can speed up the production of the [beta-amyloid] protein,” the accumulation of which is “one of the drivers” for Alzheimer’s Disease.[6]
(So-called amyloid “plaques” are clumps of sticky proteins. Amyloid plaque has been found in the brains of Alzheimer’s patients.[7] For my layman’s overview, see HERE.)
Of course, carbohydrates are essential for proper body functioning. Sugar gives us energy. What we’re really talking about, then, is eating too much sugar.
Over-consumption of sugar also has been found to damage neurons[8] and it’s linked to “poor memory formation, learning disorders, depression.”[9]
Neurons are nerve cells. Their job is threefold. Firstly, they receive information from the brain. Secondly, they integrate it. Thirdly, they send their electrochemical signals along to other cells in the body. It doesn’t take a neurologist to see from this how any damage to a nerve cell could have body-wide repercussions.
There’s no way around it: Our nervous system is vital to our health and safety. It serves us by helping us to make sense of our surroundings and to recognize where we are; it underwrites (so to speak) our our ability to perceive and react to danger. It even makes it possible for us to wonder about our world and about our own neural connections. How can we protect these priceless capacities? The verdict seems clear: Avoid over-indulging in the sweet stuff.
As one author puts it: “Avoid refined sugars – these ‘turn off’ the brain.”[10]
Although nothing beats sugar abstinence, if you find yourself constrained in your food choices (for instance, if you’re eating out), then you might maintain a supply of white kidney-bean extract. This stuff is marketed as under various permutations of the phrase “carb blocker.” While I am no expert, these carb blockers might lessen the amount of starch/sugar absorbed into your body – during those (periodic) occasions that you cannot reasonably make some other, lower-carb meal selection. It should probably go without saying that white kidney-bean extract is not intended to save you from poor, overall dietary choices!
Fats
In addition to cutting down on carbs and sugar, reports suggest replacing them with healthy fats. Healthy fats include those obtained from avocados, coconuts, olives, fish, flax, nuts (for instance, brazil nuts, hazelnuts, macadamia, pecans, pistachios, and walnuts), and seeds (for example, pumpkin, sesame, sunflower). Unhealthy fats are legion – and, unfortunately, common. By some reckonings, this category encompasses your plastic-bottled oils like canola and corn. But it also includes greasy meats like bacon, “hydrogenated fats,” and margarine.
Healthy fats have numerous benefits. One of which is that they help you feel “full” after any meal that includes them.
An Overview of Fat Types
There are ‘good’ and ‘bad’ fats.
It appears that there are two main categories of fat:[11] saturated and unsaturated. The quick-and-dirty indicator of a saturated fat is that said fat is solid at room temperature.
Many saturated fats come from animal products, such as eggs, dairy foods, and meats. However, plant-based oils also have saturated components. A few, like coconut and palm, are heavily saturated.
If I understand correctly, we generally want to minimize (or eliminate) saturated fats from our diets.
The alternative is, then, the unsaturated fat. And this comes in two (main) types as well: monounsaturated and polyunsaturated.
Polyunsaturated fats, for example, vegetable oils (canola, corn, cottonseed, flaxseed, hempseed, linseed, soybean) and omega-3 fatty acids (found in fish and flaxseed, and good for heart health) have some good properties, but should be consumed in moderation. (More on this, below.)
Monounsaturated fats – liquids at room temperature, and solids under refrigeration – include oil derived from avocado, ben, canola, olive, hazelnut, jojoba, palm-kernel, peanut, poppy seed, rice-bran, safflower, sunflower, and wheat-germ. They can also be found in various fruits (like cashews), nuts (such as almonds, brazil nuts, hazelnuts), and seeds (e.g., pumpkin and sesame). Monounsaturated fats (like olive oils) are a fixture of the so-called “Mediterranean Diet.”
What Is the “Mediterranean Diet”?
The ‘Mediterranean Diet’ is getting attention.
The Mediterranean diet (so named because it is the traditional fare in Mediterranean countries) is remarkable due to its low to moderate reliance upon protein. The diet consists mainly of fruits and vegetables, nuts, seafood, olive oil, and hearty grains. “Healthy grains” include things like barley, millet, pasta, oatmeal, popcorn, rice (brown),[12] and whole-wheat bread, all of which are credited with helping to prevent cancer, diabetes. heart disease, and – most importantly for our purposes – cognitive decline.
Here are some suggestions for adding Mediterranean flair to your meal:
More vegetables can be inserted in your meals by adding mushrooms and green peppers to thin crust pizza instead of meat. Also train yourself to think salads and soups.
Make one vegetarian meal per week using beans, whole grains, and veggies – little to no meat.
Cook with the “good” fats already mentioned. For instance, sauté in olive oil instead of butter.[14]
Lastly, have fruit for dessert – especially blueberries.
What About “Hydrogenation”?
According to my trusty Larousse Dictionary of Science and Technology, “hydrogenation” refers to any “[c]hemical [reaction] involving [the] addition of hydrogen …to a substance… Important processes are …the hydrogenation of fats and oils…” Clear it right up, doesn’t it?
Let’s leave it this way: Hydrogenation has a solidifying effect and it is generally considered bad.[15]
How Does Cholesterol Figure Into This?
According to health gurus, cholesterol also comes in two sorts: HDL, or “good” cholesterol, and LDL, or “bad” cholesterol. Confused yet?
There are indications that monounsaturated fats are able to lower the body’s levels of bad cholesterol, while being able to promote good cholesterol levels. Polyunsaturated fats, on the other hand, might lower both good and bad cholesterol levels, and should be ingested in moderation. Still, they are arguably healthier than saturated fats, and make good substitutes for things like margarine.
Sometimes I get onto a research trail that leads me off the beaten path, as it were. It turns out that various precious metals can be, and historically have been, used medicinally.[16]
In any event, arguably the best-known and most widely used of these metal, nowadays, is silver. Available in both “colloidal” and “ionic” formulas, silver is prescribed by naturopaths for a variety of ailments. Reportedly, this is because silver is reputed to have antibiotic properties.[17]
Although silver has its uses – and I keep my shelves stocked with the stuff – it’s not directly geared toward brain health.[18] Neither is the next entrant on my lists of exotics. Although, to my knowledge, gold is not believed to have any immediate bearing on cognition, it is esteemed by some for its alleged anti-inflammatory properties.
This might be neither here nor there as far Alzheimer’s and dementia are concerned were it not for the recent evidence suggesting that there is a link between Alzheimer’s and inflammation. Given this, a little colloidal gold might be just what the naturopath ordered.[19]
Rounding out this list of liquified precious metals, platinum is sometimes identified as boon to healthy intellectual function. One manufacturer suggests that platinum is useful for concentration, focus, and mental acuity – all obviously relevant for people aiming to maintain brain health.
Moreover, and more to the point as far as Alzheimer’s is concerned, platinum is supposed to promote DNA repair[20] and improve memory.[21]
Additional Herbals
In a previous post, I already mentioned the Ginkgo biloba (or “maidenhair”) tree. The upshot is that, for “[f]ailing memory and concentration,” take ginkgo.[22] Read more about this remarkable plant, HERE. But gingko is far from the only relevant herb. Here are a few others.
Also known as “Dragon’s Tooth,” antler has been used by traditional healers. According to author Jack Ritchason, “[t]he elixir” called “antler velvet …will provide …increasing memory.”[25]
Garlic has numerous uses – including, possible memory enhancement.
Widely used for its formidable antibiotic properties, garlic may also “be useful for treating physiological aging and age-related memory deficits.”[30] According to one nutritionist, “[g]arlic has been found to possess memory-enhancing properties” and is a “[p]otent brain cell protector.”[31]
Ginkgo (Ginkgo biloba)
Covered in part 1 (for which, click HERE), ginkgo is reportedly “useful as a treatment for dementia, including Alzheimer’s disease…”.
“Ginseng” is a confusing label. The Siberian variety in view here is not to be confused with American ginseng (Panax quinquefolius), “Blue” ginseng[32] (Caulophyllum thalictroides), Chinese[33] ginseng (Panax ginseng), Himalayan[34] ginseng (Panax pseudoginseng), or Tienchi[35] ginseng (Panax notoginseng). There are actually around nineteen (19) different plants (whether types or subtypes) that (at least sometimes) go by the name name “Ginseng.” For a more complete treatment of these (and related) complexities, see HERE.
What could be clearer, right? Thankfully, the “correct” herb is usually advertised under the full name “Siberian ginseng.” So, look for that, if you’re interested in trying it.
“Siberian Ginseng has been found to improve cerebral circulation, thereby increasing mental alertness.”[36]
According to one author, this herb “strengthens nervous system function and memory.”[37] Another writes that “Gotu Kola is a ‘brain food’ which promotes memory. …Gotu Kola is effective in the treatment of mental problems dealing with …loss of memory. It is sometimes known as the ‘memory herb’ because it …stimulate[s] circulation to the brain.”[38] “Traditionally used as an adaptogenic herb, gotu kola …promotes food memory and concentration…”.[39]
Magnolia (Magnolia officinalis)
Two studies from 2012 suggest that magnolia could serve as a powerful Alzheimer’s treatment. “The components of the herb Magnolia officinalis are known to have antiinflammatory, antioxidative and neuroprotective activities. …Alzheimer’s disease (AD) is the most common form of dementia and is characterized by deposition of amyloid beta (Aβ) in the brain. …[The study] showed that ethanol extract of M. officinalis effectively prevented memory impairment via down-regulating β-secretase activity.” “Magnolia officinalis were effective for prevention and treatment of AD through memorial improving and anti-amyloidogenic effects…”.
“Periwinkle is used internally for circulating disorders, cerebral circulatory impairment and support for the metabolism of the brain. It is also used internally for loss of memory…,” and can be made into a tea. “Since vincamine was discovered in the leaves, lesser periwinkle has been used to treat …dementia due to insufficient blood flow to the brain.”[40]
Pycnogenol, also called “Pine-Tree bark,” is also reputed to “protect brain cells and aid memory.”[41] I am personally wary of this one, since I seem to have reacted badly to it. But we’re all different and its wide availability suggests that many people are able to use it without ill effects.
Also called “Bear Garlic,” per its Latin moniker, this stuff helps improve circulation – a common theme with these brain-boosting herbals, as you may have noticed. “Better circulation assists memory.”[42]
Rosemary has a rich folk association with memory. In William Shakespeare’s Hamlet, the character Ophelia at one point gifts her brother, Laertes, with a bundle of flowers and poignantly declares: “There’s rosemary; that’s for remembrance… and there is pansies. That’s for thoughts.”[44]
Ritchason adds: “In ancient Greece, Rosemary was believed to strengthen the memory.”[45] This was passed down and became part of the European folk-medical tradition.[46]
It does have a strong (and perhaps acquired) taste. But given its literary celebration as a memory-promoter, rosemary is one of those herbs that should definitely get more mileage in your kitchen. Not to put too fine a point on it, but all signs indicate that rosemary “is beneficial for …brain health.”[47]
Saffron (Crocus sativus)
Another kitchen item with great potential as a dementia fighter is saffron, the orange spice derived from a crocus flower. Herbalist Andrew Chevallier writes: “Saffron appears to have marked neuroprotective activity… Iranian clinical research has examined saffron’s therapeutic potential in people with moderate Alzheimer’s disease. Though still at a very early stage, two small studies indicate that saffron, and particularly the crocins within it, acts on the brain to improve memory and cognitive function, including in those with dementia.”
Common, garden-variety sage is another so-called “memory strengthener.” Since it is easy to acquire – like rosemary, you might already have it on your kitchen spice rack[48] – incorporating it into your herbal repertoire should be a cinch.[49]
Turmeric (Curcuma longa)
Given additional space in part 1 of this series (available HERE), turmeric is a potent anti-inflammatory that “is largely taken as a supplement to prevent or treat cancer, dementia, and many auto-immune diseases.”
Also mentioned in my second article on Alzheimer’s and sleep, this plant has positive “effects on memory …[and] circulation” making it “an ideal herb for older people”.[50] A tincture of wood betony is made to order for conditions like “memory loss” and “poor concentration.”[51]
According to one study published in 2000, the brains of Alzheimer’s patients appear unable to “[convert] choline into acetylcholine.”[52] One major source of choline is a substance known as “lecithin.”
Lecithin for choline support.
So, the thinking goes, augmenting your diet with lecithin “may reduce the progression of dementia” – if not avoid the dread condition altogether.[53]However, lecithin isn’t the only menu option (so to speak).
A primary indicator of Alzheimer’s disease is that an afflicted brain has low levels of acetylcholine. Parallel reasoning to that just sketched in favor of lecithin supplementation may lead a person to simply experiment with taking acetylcholine directly. There may be no philosophical objection to this, but it might be biochemically infeasible. Most often one finds choline supplements, as opposed to acetylcholine. Not to worry, however, the former is the chemical precursor to the latter.
Perhaps, however, you could simply stop your body from breaking down acetylcholine, thus keeping your levels high. Intriguingly, there is an additional herbal tie-in. Specifically, considering “herbs that [prevent] the breakdown of acetyleholine…, Dr. [James] Duke [formerly of the U.S. Department of Agriculture] found …[that] rosemary (Rosmarinus officianalis) was the most effective.”[54] (Combination products are also available.)
A final possibility is supplementation with the related compound phosphatidylcholine. This was given impetus through a journal article suggesting that “[t]he administration of phosphatidylcholine to mice with dementia improved memory and generally increased brain choline and acetylcholine concentrations to or above the levels of the control normal mice.”[55]
This stuff is classified as a “metalloid,” and I almost situated it alongside silver, gold, and platinum – discussed above. Still, it’s a bit of an oddball – even for this list – as the word from the Wiki-verse is that meteorites are a principal source.
Boron is a component of meteorites.
According to “nutritional counselor” Phyllis Balch, boron “[i]proves brain and memory function,” but should be kept within the three to six milligram range, daily.[56]
In addition to its more famous sleep-inducing properties, this hormone is also “[a] powerful antioxidant that may prevent memory loss.”[57] It may be wise to cycle your intake, however. A widely repeated caution in the literature suggests that too-frequent melatonin supplementation might prompt your body to “shut down” its own, natural production of this vital chemical. For more information on melatonin, see, again, my sleep article.
[3]Ibid. One case study with considerable traction concerns a boy named Charlies Smith. “Little Charlie Smith had 300 seizures, some that made him lose consciousness. But a neurologist suggested his parents give him a ketogenic diet heavy in fatty foods and low in carbs, which, his mother said, has kept him seizure-free for two years.” This is according to Melanie Greenwood, in the article “Epileptic 6-year-old Cured of Seizures After Switching to High-Fat Diet, Parents Say,” New York Daily News, Jun. 12, 2014, <http://www.nydailynews.com:80/news/world/boy-cured-seizures-switching-high-fat-diet-article-1.1826792>.
[11] Caveat: Most oils are mixtures of the various types of fats. They are combinations of “bad” and “good” fats. For instance, avocado and canola oils contain both poly- and mono-unsaturated fat. Or again, avocado and peanut oil both have saturated and unsaturated components. Some oils, like cottonseed, palm, and soybean, may be fully or partially “hydrogenated,” which is another can of worms. This is apparently why some oils show up on various lists. It depends on which components an author is paying attention to.
[12] Brown rice has been found to contain high levels of arsenic as does white rice. To combat this, it is recommended that you soak the rice overnight, drain rinse and add fresh water. Cook the rice as you would pasta, in a 6-part-water to1-part-rice ratio. Then drain, rinse and add to your dish. This has been found to cut arsenic levels by at least 50-60%.
[13] Almost all seafood contains pollutants. Here’s some recommendation to mitigate the danger: Stay away from larger fish such as swordfish and shark, because they have higher levels of mercury in them. Try to eat fish and shellfish (like shrimp, canned light tuna, and salmon) that are lower in mercury content. Albacore generally has higher mercury levels as well. The herb cilantro is supposed to be one of the herbs that cleanses the body of toxins. I have started to sprinkle cilantro onto tuna-containing dishes.
[14] Grass-fed butter has high levels of omega-3 fatty acids, vitamins K2, A and E as well as CLA (conjugated linoleic acid) – which is reputed to be an immune booster and cancer/disease fighter.
[15] A sort of folk notion, which may or may not be up to snuff scientifically, is that fat solids “clog” arteries. From my untutored perspective, the research is in upheaval. The received view (developed over the last 50-odd years) – that butter is uniformly bad and “high cholesterol” is indisputably deadly – has begun to be challenged. We’ll have to see how things shake out.
[16] As an aside, there is an intriguing tie-in to the ancient discipline known as alchemy. Presently, I will not try to define that wooly notion (It seems to have occupied a space somewhere between art and (proto-)science.), except to say that it was concerned with transformation – sometimes physical, sometimes physical, sometimes both.
The alchemists associated particular metals with each of the “seven planets” – though, it is necessary to point out that their conception of a “planet” was different than ours. The traditional links were as follows.
Sun – Gold
Moon – Silver
Mercury – Quicksilver (Mercury)
Venus – Copper
Mars – Iron
Jupiter – Tin
Saturn – Lead
[17] According to some reports, other immune-boosting metals include copper, iridium, and zinc.
[18] Possibly, we could say that silver might promote overall health, and thus indirectly supports brain health. But see also the comments under the “Gold” section.
[19] Turmeric, reviewed in Part One, also has anti-inflammatory powers.
[20] Bee pollen is also sometimes linked with cellular and DNA health. See Jack Ritchason, The Little Herb Encyclopedia, 3rd ed., Pleasant Grove, Utah: Woodland Health Books, 1995, p. 311.
[21] Other, quirkier effects – such as heightened creativity and libido (as well as, allegedly, encouragement of the ability to dream lucidly) – are reported.
[22] Andrew Chevalier, Encyclopedia of Herbal Medicine, 2nd ed., New York: Dorling Kindersley, 2001, p. 319. But Chevalier advises (ibid.) that the herb should “be taken regularly for at least 3 months before there is a noticeable improvement.”
[28] Gruenwald, Brendler, and Jaenicke, op. cit., p. 243. It can cause urinary “irritation,” nausea, rashes, and “cardiac pain” – which, I grant you, doesn’t sound at all nice. Ibid., p. 244.
[32] On ginkgo: Andrew Chevallier, Encyclopedia of Herbal Medicine: 550 Herbs and Remedies for Common Ailments, New York: Dorling Kindersley, 2016, p. 100, <https://books.google.com/books?id=_BZJDAAAQBAJ&pg=PA100>. On “Blue” ginseng: It is occasionally seen as a substitute name for that plant more commonly called blue cohosh, but which is also sometimes designated papoose or squaw root.
[40] On magnolia: Y. Lee, Y. Choi, S. Han, Y. Kim, K. Kim, B. Hwang, J. Kang, B. Lee, K. Oh, and J. Hong, “Inhibitory Effect of Ethanol Extract of Magnolia officinalis on Memory Impairment and Amyloidogenesis in a Transgenic Mouse Model of Alzheimer’s Disease Via Regulating β-Secretase Activity,” Phytotherapy Research, vol. 26, no. 12, Mar. 19, 2012, pp. 1884-1892, <https://www.ncbi.nlm.nih.gov/pubmed/22431473> and Young-Jung Lee, Dong-Young Choi, Sang Bae Han, Young Hee Kim, Ki Ho Kim, Yeon Hee Seong, Ki-Wan Oh, and Jin Tae Hong, “A Comparison between Extract Products of Magnolia officinalis on Memory Impairment and Amyloidogenesis in a Transgenic Mouse Model of Alzheimer’s Disease,” Biomolecules & Therapeutics (Seoul, South Korea), May 2012, vol. 20, no. 3, pp. 332–339, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794532/>.
On periwinkle: Joerg Gruenwald, Thomas Brendler, and Christof Jaenicke, eds., PDR for Herbal Medicine, 4th ed., Montvale, N.J.: Thomson Healthcare, 2007, p. 645. Caution is needed, though, as periwinkle can cause “a severe drop in blood pressure.” Ibid. Andrew Chevallier, Encyclopedia of Herbal Medicine: 550 Herbs and Remedies for Common Ailments, New York: Dorling Kindersley, 2016, p. 282, <https://books.google.com/books?id=_BZJDAAAQBAJ&pg=PA282>.
On sage: Other easy-to-get herbals include thyme and violet, both of which are supposed to provide “nervous system support,” according to Hartung, op. cit., pp. 226 and 235.
[49] I almost said: “it should be a no brainer.” But that seems inappropriate given the context!
[54] “Prevent Alzheimer’s Disease by Changing Your Shampoo,” Women’s Health Letter, 2008, archived online at <https://www.thefreelibrary.com/Prevent+Alzheimer%27s+disease+by+changing+your+shampoo.-a0182976372>; citing James A. Duke, “Rosemary, the Herb of Remembrance for Alzheimer’s Disease,” Alternative & Complementary Therapies, Dec. 2007 and “Neurological Protection From Rosemary,” Stroke/Neuroprotection News, Oct. 31, 2007.
[55] S. Chung, R. Hirata, T. Kokubu, Y. Masuda, T. Moriyama, E. Uezu, K. Uezu, S. Yamamoto, N. Yohena, “Administration of Phosphatidylcholine Increases Brain Acetylcholine Concentration and Improves Memory in Mice With Dementia,” Journal of Nutrition, vol. 125, no. 6, Jun. 1995, pp. 1484-1489, <https://www.ncbi.nlm.nih.gov/pubmed/7782901>.
How to Detect Alzheimer’s: 10 Tests of Varying Accuracy
There are a number of things that can be meant by “detecting Alzheimer’s Disease.”
For one, Alzheimer’s progresses (or regresses) in stages. It may not take much to “detect” the condition once it is sufficiently advanced. A series of simple questions might ferret out the truth. (For more on the utility of such widely employed tests, read further on.) However, by the time the patient is far-gone enough to fail such a “mini-cognitive” test, the result could be of little use in terms of intervention and treatment – except perhaps as an official, doctor’s confirmation of an already obvious diagnosis.
On the other hand, a diagnosis in an early stage of Alzheimer’s could be quite important, therapeutically speaking (albeit emotionally devastating and unwelcomed). Such a diagnosis could serve as a warning and encourage the implementation of lifestyle (for example, to diet [see HERE] and sleep [see HERE and HERE]) and medical changes that could potentially slow down the degenerative process.[1]
At present, though, there simply is no one test that can definitively establish that a person is in early stages of Alzheimer’s.[2] Unfortunately, only an autopsy can confirm, 100%, that a person has Alzheimer’s telltale “amyloid plaques.” Once again, however, by the time an autopsy is relevant, the patient has presumably already succumbed to the disease.[3]
Nevertheless, there are a several tests available. Although they may or may not detect Alzheimer’s in any given instance, they are (collectively and individually) they best that we have for the time being.
Here is my list of ten such tests, in no particular order.[4]
Olfactory: “Peanut-Butter Smell” Test
This particular item came across my desk in late 2015. Numerous news sources ran with phrases like “peanut-butter smell test.” Designed by one Jennifer Stamps,[5] a graduate student in neurology at the University of Florida, the test requires only a dollop of peanut butter and a ruler. It is motivated by the thought that Alzheimer’s patients typically have lost or severely compromised senses of smell.
This point was made vividly for me during one family get-together years ago. At the time, I dabbled in making home-made, flavored liqueurs. I passed around a few samples for some relatives to smell (and, yes, taste!). I recall that my dad, Jim, literally ended up with one of his nostrils pressed firmly around the rim of a bottle. We knew his condition. But I just thought that the culprit was lost motor skills or messed-up spatial awareness. Heck, I even entertained the notion that he might have just lacked the requisite tact for the occasion. In hindsight, I feel confident saying that he simply couldn’t smell the concoction, and so he kept trying to get his nose closer and closer.
The test is administered one nostril at a time. The subject is instructed to close his or her eyes, mouth, and one nostril. The tester then opens and raises a jar (or other container) of peanut butter, positions a ruler vertically under the open nostril, and tracks the peanut butter upwards along the ruler. The test ends when the subject declares that he or she can smell the peanut butter.
It is not entirely clear to me whether how researchers interpret their results. Presumably, they hope eventually to hash out a range of measurements to wield for diagnostic purposes.
Some articles applaud the test and suggest that fine points, like alleged differences in a single patient’s nostril sensitivity, may be explained in virtue of which side of the brain is Alzheimer’s-affected. Other articles are thoroughly skeptical. Still others advise that while the “smell test” might serve a purpose in confirming a diagnosis of Alzheimer’s, it is not well-evidenced enough to be relied upon by itself.
So…can Alzheimer’s be detected by such a crude test? Let’s say that the jury is still out.
It certainly seems possible to approximate this test yourself. Peanut and measuring sticks are easily obtained. The downside, however, is that you will likely have trouble interpreting your results. It’s probably best to stick (no pun intended) with the experts.
Proprioceptive: “One-Leg” Balance Test
In 2009, Science Daily published an article titled “Simple Balance Test May Predict Cognitive Decline in Alzheimer’s Disease.”[6] In it, the author unpacked a somewhat quirky test in which the subject was instructed to try to maintain his or her balance for as long as possible, while standing on one leg.
From grade-school anatomy classes, I recall that the cerebellum is the brain structure credited with the primary role in regulating balance. Indeed, there is evidence that “frontotemporal” dementia affects the cerebellum. (What areas of the brain are affected? See HERE.)
Five seconds seems to be the important threshold. If a person is unable to hold themselves up on one leg for at least five seconds, then their balance is labeled “abnormal.” Although this test is even easier than the previous one to replicate at home, it is possible that balance can be negatively affected by causes other than Alzheimer’s Disease.
Intuitively, certain earaches and headaches might throw your balance off kilter. Additionally, the low blood-sugar conditions experienced periodically by diabetics may render a person unable to maintain his or her balance. Finally, leg or join pains of various sorts might make you physically (or mechanically) incapable of standing on one leg, even if you would be capable from a “mental” (or “proprioceptive”) perspective.
Spatial Acuity: The “Four Mountains” Test
Simply put, the Four Mountains or 4MT test is a test of spatial memory. During the examination, testers present a subject with a digital topographical map that looks like it is a snapshot from an environment in a video game. As the name implies, this landscape sports four “mountain” formations. The subject is then shown four additional images. One of these subsequent images represents the same four-mountain terrain – albeit from a slightly different point of view. The other three images are simply representations of different computer-generated mountain clusters.
According to test creators, 4MT is dependent upon this core idea. “Allocentric spatial memory is a key function of the hippocampus, one of the earliest brain regions to be affected in Alzheimer’s disease (AD) and impairment of hippocampal function predates the onset of dementia.”[7]
Designers maintain, therefore, that the 4MT test is capable of distinguishing “mild cognitive impairment” (MCI) due to Alzheimer’s, from MCI that is caused by other forms of dementia.
Mental Status: Six-Item Cognitive-Impairment Test, “Mini-cog” (Mini Mental-State Examination), and Other Short-Term Memory Tests
These tests are commonly administered by doctors’ offices, insurance companies, and the like. For the former, the objective may be to evaluate a patient’s memory and reasoning abilities without having to be physically invasive.[8] Similarly, insurers are looking to estimate an individual’s risk for needing long-term care due to cognitive issues.
In employing tests of this sort, administrators are looking to gauge a person’s cognitive abilities by asking a series of simple questions.
In one version of the test, a person is given a short list of words (3 to 10) and is then asked to perform a simple task, such as positioning clocks to a certain position. Once the task is complete, the interviewer asks the subject to repeat the list of words. There are numerous variations of this test.
In another permutation, published by the British newspaper Daily Mail, an individual is asked a handful of questions. Example questions include: What is the year? What’s the month? What time is it? (With or without looking at a clock face.) Can you count down from [n]? (N is some number, say 25.) Can you name the months of the year – in reverse?
Such tests also include some component designed to test short-term memory. For instance, a name or address might be given to the target at the beginning of the test. At the end, the administrator would ask the person if he or she recalls the given information.
Commonly, incorrect answers are awarded points. The number of points is then tallied and, if it exceeds some (presumably experimentally established) threshold, then it is deemed to be clinically significant.
Visual: Eye Tests
There are a couple of options when it comes to eye tests. One basic test has to do with changes in visual acuity. Specifically, some researchers believe that early stages of Alzheimer’s might be detectable by tracking certain perceptual “color changes” using a device called a hyperspectral endoscope. The idea is that amyloid deposits will change the way the eye receives and processes light, resulting in measurable wavelength shifts that may be an early indicator of Alzheimer’s.
A second sort of test relies upon techniques for assessing the thickness of a cluster of neurons termed “macula.” It turns out that thinning macula are correlated with diminishing cognition. State-of-the-art optometric imaging machines may therefore be able to warn of impending Alzheimer’s by peering into a subject’s eyes.
Hematologic: A Blood Test for MCI
Mild cognitive impairment, or MCI, is a condition that attends early-stage Alzheimer’s Disease. However, it is also associated with other sorts of dementia and with pathologies, including multiple sclerosis and Parkinson’s Disease. In 2016, news broke concerning the possibility that a blood test could both detect MCI and distinguish Alzheimer’s-related MCI from other types.
According to one of the test’s designers, “it is possible to use a small number of blood-borne autoantibodies to accurately diagnose early-stage Alzheimer’s.”[9] Researchers devised a panel of 50 “autoantibody biomarkers” that, they believed, were highly correlated with Alzheimer’s.
It appears that this test is still in an experimental phase. But it holds the promise of being able to detect Alzheimer’s Disease years before it manifests its giveaway symptoms.
For the latest on blood tests, see my video:
Genetic: DNA Test
The company 23AndMe offers a saliva-based genetics test for Alzheimer’s.
Whereas blood testing purports to reveal when a person has early-stage Alzheimer’s, genetic testing supposedly can disclose your risk before any clinical signposts are present. The California-based firm 23AndMe, already widely known for its ancestry analyses, has released a DNA test that predicts one’s risk level for Alzheimer’s dementia. At least, that is the claim.
Like its ethnicity test, the disease test begins with the collection of a person’s saliva. The company then tests the saliva for the “E4 variant” of the “Apolipoprotein E” (or APOE) gene.
Apparently, processing once took around two months. Now you frequently receive your results in about two to three weeks.
23AndMe acknowledges that environmental and lifestyle factors may affect a person’s overall Alzheimer’s risk. Furthermore, the test only looks at one specific genetic factor. There might even be other genetic factors that are relevant to overall risk, but that are ignored by the test.
It is important to note that the test does not “diagnose” a person with Alzheimer’s – it merely indicates one factor that is presently believed to increase a person’s genetic risk.
In fact, designers maintain that the test can disclose predispositions toward nine other diseases, in addition to Alzheimer’s, including coeliac disease, and Parkinson’s.
The price includes laboratory-testing fees. So, after you purchase your package, and receive a saliva-collection kit, all you have to do is send your sample back to the company. You will then get a stack of genetic reports – the company numbers them at “75+.”
Of all the tests covered in this post, this one is probably the best value, in terms of both accessibility and scientific credibility. It’s not invasive, and it gives genuinely important and pertinent information about your risk level. But it is certainly not the final word.
Although it is far from clear that health providers will be recommending this sort of test, I can tell you that I am interested enough to take it myself. I will be reporting on my own experience in a later post. (UPDATE: See the video, below, for a start.)
Cerebrospinal: Lumbar Puncture
The collection of cerebral-spinal fluid (CSF) begins another test with encouraging results when it comes to the early detection of Alzheimer’s dementia. Specifically, the relevant test evaluates two amyloid proteins, labeled beta and tau, that are prevalent in the brain deposits and plaques that are characteristic of an Alzheimer’s-riddled brain. Alzheimer’s patients customarily have elevated levels of these proteins in their CSF.[10]
Various CSF tests are commercially available. However, they are definitely “invasive.” The participant must submit to a collecting procedure that is variously termed “lumbar puncture” or the evocative (and, dare I say, heavy-metal-ly) “spinal tap.” A small needle is inserted into the spinal area and some fluid is removed for analysis.
There is a constellation of side effects that can accompany spinal-tap procedures. The most common of these is a bad headache. This is so widely experienced that numerous resources refer to this as a “post-lumbar puncture headache.” There can also be unspecified pains as well as dizziness, nausea, and vomiting.
Brain Imaging: Amyloid PET Scan
Just the facts: Positron Emission Tomography uses radioactive sugar (e.g., fluorodeoxyglucose, or FDG) to give doctors a peek at a person’s brain tissue.[11] PET scans, as they are called, “…[measure] important body functions, such as blood flow, oxygen use, and sugar (glucose) metabolism, to help doctors evaluate how well organs and tissues are functioning.”[12] Their benefit is that they reveal the amyloid plaques that announce the presence of Alzheimer’s Disease.
So, an upside is that this test is reliable.
A downside is that it radioactive.
My opinion: I am a bit leery. Healthcare workers typically insist that “low doses” of radiation have “no known” lasting negative (or adverse) effects.[13] But, as an article on MedLine Plus discloses: “…The risk of cancer depends on the dose and begins to build up even with very low doses. There is no ‘minimum threshold.’…”[14]
This makes sense when we consider the canonical description of how cancer originates. In the words of the editorial board at Cancer.net: “All cancers begin when one or more genes in a cell are mutated, or changed.”[15] One or more.
Of course, when we are considering a person who is suspected of having Alzheimer’s, it may well be worth the risk of cancer (however high or low it might be) to “risk” the radioactivity of the PET scan.[16]
On a personal note, my dad (read “Jim’s Story”), had two surgeries prior to reaching “advanced” stages of Alzheimer’s. He had a triple bypass for his heart and a colectomy to remove a cancerous portion of his bowel. In hindsight it is tempting to think that he may have had less miserable experience dying of cancer than of Alzheimer’s. But, as one instructor put it once (concerning counterfactual statements): There is no way to get an answer, and nothing to do with the answer even if you could get it.
Autopsy
A final “test” is not really a test in the same sense as the previous nine entrants on this list. An autopsy,[17] of course, is a port-mortem medical examination – that is, one performed on a deceased person’s body. According to the Alzheimer’s Association: “While the diagnosis of A[lzheimer’s] D[isease] can now be up to 90% accurate, it can only be positively confirmed through autopsy.”[18]
Apparently, some autopsies still collect brain material for purposes of scientific study. Others are performed to confirm the diagnosis of Alzheimer’s, which, since it enhances the detail of the medical record, can benefit other family members down the road.
The Alzheimer’s Association stresses the need to plan and to coordinate such an undertaking with the funeral home, hospital, primary-care doctor, and nursing home. (It’s morbid, but a brain autopsy must be performed prior to the embalming process.)
The next of kin (usually a surviving spouse or adult child) must sign a permit. Autopsies cost anywhere from $0 to a few thousand dollars, depending on the circumstances and facilities involved.
Notes:
[1] As one New York Times writer put it: “Alzheimer’s …starts a decade or more before people have symptoms. …[B]y the time there are symptoms, it may be too late to save the brain. …[T]he hope is to find good ways to identify people who are getting the disease, and use those people as subjects …in studies of drugs that may slow or stop the disease.” (Gina Kolata, “In Spinal-Fluid Test, an Early Warning on Alzheimer’s,” Aug. 9, 2010, <http://www.nytimes.com/2010/08/10/health/research/10spinal.html>.)
[2] Developing tests is tricky business. The tests have to meet various criteria, reliability perhaps foremost. But tests also have to be available – both to doctors and patients – and affordable (or at least “covered” by health insurance). The ten tests (or categories of test) surveyed herein are each at different developmental stages. Not all of them are equally accessible, affordable, or reliable.
[3] Of course, a person could die at any time from a variety of causes – both natural and non-natural. It is possible for a person’s Alzheimer’s to be detected during an autopsy that was performed after a death unrelated to dementia. But I am ignoring that possibility, here.
[4] Full disclosure: I had intended to try to “rank” the tests in terms of accuracy. But since I am neither a clinical researcher nor physician, I lack the requisite qualifications to carry out such a task. Moreover, a quick glance at the popular-level literature suggests that there may be no fact-of-the matter about this sort of hypothetical ranking. Alternatively, even if there is an answer, objectively speaking, it could be unknowable – at least given the current state of the relevant science. So, even though my list might look like a “ranking,” I’m sticking to my story: It isn’t!
[5] Stamps apparently worked at least partially under the direction of Professor Kenneth Heilman, in the University of Florida’s College of Medicine.
[7] Neil Burgess, Dennis Chan, Laura Marie Gallaher, Kuven Moodley, Ludovico Minati, and Tom Hartley, “The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer’s Disease,” Journal of Visual Experiments, no. 116, 2016, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5092189/>.
[8] Several authors refer to these sort of cognitive tests as “invasive.” Surely, this is not true in a physical sense. Still, it is obvious sense that being unable to answer basic questions (like “what year is it?”) is embarrassing. There may be some sense, then, in which these tests are “emotionally invasive.”
[10] The New York Times cited a study in which 75% of people with MCI displayed increased amyloid levels in their CSF; while 33% of “normal” people did as well. The Times author added that researchers suspected the 33% were in a “pre-symptomatic” stage and would ultimately develop Alzheimer’s. Another study apparently found that the signature CSF elements were identified in 100% of Alzheimer’s patients tested. See Kolata, loc. cit.
[11] Other types of imaging are available. Writers at Alz.org remind that an important part of a doctor’s procedure in diagnosing Alzheimer’s (or any condition) is a general review of the patient’s case. This will include family and personal medical history as well as other facets of a “routine” examination. To this end, CT (computed tomography) and MRI (magnetic resonance imaging) may be employed “to rule out other conditions that may cause symptoms similar to Alzheimer’s…,” “Tests for Alzheimer’s Disease and Dementia,” <https://www.alz.org/alzheimers_disease_steps_to_diagnosis.asp>.
[16] There are hypothetical questions about the use of PET scans in routine-screening procedures. Maybe there is a fruitful comparison to be made with mammography. Again, I quote the New York Times: “A 17-year study has concluded that screening mammography — in which all women in certain age groups are routinely screened for breast cancer — does not reduce the incidence of advanced tumors, but does increase the diagnosis of lesions that would never have led to health problems.” Nicholas Bakalarian, “The Downside of Breast Cancer Screening,” Jan. 11, 2017, <https://www.nytimes.com/2017/01/11/well/live/the-downside-of-breast-cancer-screening.html>.
[17] The word “autopsy” is interesting. It has Greco-Roman roots and is basically has two components: autos, meaning “self,” and opteuō, meaning “I see.” The sense of autoptēs was “seeing with one’s own eyes” and sometimes conveys the idea of being an “eyewitness.” See William Arndt, Walter Bauer, Frederick Danker, and Felix Gingrich, A Greek-English Lexicon of the New Testament and Other Early Christian Literature, 3rd ed., Frederick Danker, ed., Chicago: Univ. of Chicago Press, 2000, p. 152. There is an intriguing quasi-religious angle. A similar etymology, tracing the word to autopsia, is given by Albert Mackey in “Autopsy,” Encyclopedia of Freemasonry, Robert Clegg, ed., vol. 1, Chicago: Masonic History Co., 1956, p. 113. The Online Etymology Dictionary concurs and adds: “Sense of ‘dissection of a body to determine cause of death’ is first recorded 1670s, probably from the same sense in French autopsie (1570s).” Douglas Harper, “Autopsy,” <https://www.etymonline.com/word/autopsy>.
Alzheimer’s and Sleep: Herbs, Spices, and Other Supplements
This Is Part 2 of a Two-Part Series on Alzheimer’s and Sleep
How Can We Improve our Caliber of Sleep?
There are a lot of questions that remain unanswered. Given all of what we know about the importance of sleep (see HERE), we can draw certain theoretical conclusions from the data. However, I am more interested in the practical side of things. What can I do – concretely – to try to Alzheimer’s-proof myself?
For me, I am betting on the need for good quality, nightly sleep. A secondary practical question then presents itself. How can I be better rested? Here are some things that I have tried, or plan on trying soon.
Reduce Your Light Exposure
Avoid blue-lighted gizmos at bedtime.
Light of any kind can interfere with the production of the “sleep chemical” melatonin.[1] But especially harmful is the blue light emitted from electronic devices.
An obvious culprit, depending on the time of day that you hit the hay, is sunlight. While it is important to keep your vitamin-D levels up, and while the most natural (and inexpensive!) way to keep your vitamin-D levels up is to ensure that you have adequate exposure to sunlight, you want to taper off this exposure once you near your bedtime. If you are stuck in a position of having to get some shuteye while the sun is still a factor, then your best bet is to try to make your sleep area as dark as possible.
Light-blocking curtains can be of great assistance. In my own case, I have doubled up on the window treatments, creating a layered effect that can be more effective than a single curtain alone. However, depending on such things as color and density, some curtains may not be adequate even if you “stack” them on top of each other.
If you are serious about keeping light out of your room, then you should buy “blackout” curtains. As expected, they come in various colors, to match, as they say, almost any decor.
If you usually go to sleep after dark, then sunlight won’t be your biggest problem. However, light from street[2] and other outside lighting[3] can also inhibit your body’s melatonin production and frustrate your ability to fall asleep. Again, selecting the right window treatments can mean the difference between getting a good night’s sleep and being awakened by the neighbor’s motion-sensing porch lamp.
It’s been suggested that people stop using electronic devices (including cell phones, computers, tablets, televisions, etc.) at least one hour before bedtime. The light emitted by video screens can make just as much mischief for your melatonin levels as the other sorts of lighting just discussed.
I also suggest that you turn off completely any LED displays (particularly blue lights), because even those little lights can deprive your brain of the requisite time for accumulation of the melatonin needed to sleep. For those appliances that cannot (or should not) be switched off, a bit of electrical tape over the LED could do the trick. Additionally, you can turn the alarm clock away from you or otherwise place it out of sight. (More on melatonin, below.)
If you absolutely must keep working, then you might consider acquiring special, blue-light-blocking glasses. Some manufacturers claim that their products help avoid eyestrain, perhaps by given us an assist in the refocusing department.
I have tried the Gunnar brand gaming and screen eyeglasses with some success. These are yellow-tinted glasses that are designed to block blue-shifted light. Although they do not state this, it appears that my Gunnars have a slight magnification. (I am not an eye specialist. Although it seems likely that this is far less than 1x, it is still noticeable.)
Eliminate Background Chatter or Add White Noise
For those who are either easily awoken by background sounds, or who have trouble falling asleep when it’s “too quiet,” there are devices that can help. For years, I slept with the aid of an old “SleepMate” machine, manufactured by the company Marpac.
I notice that they have updated their product line. In general, I can vouch for the fact these little appliances really seem to help. Other options include HoMedics’s “Sound Spa” and iHome’s “Zenergy” sound maker. (More on iHome’s offerings in the aromatherapy section, below.)
For one thing, these machines mask background sounds quite effectively. (Typical offerings include volume controls and can be adjusted to your sound-floor preferences.) Moreover, I have discovered that focusing on the noise can have a relaxing effect. To some extent the noise can “drown out” the mental chatter that keeps my mind going some nights and prevents me from drifting off to sleep.
Work out
Exercise is great,[4] and it is positively correlated with improved sleep, but should be done no later than a few hours before you retire. Unfortunately, my schedule is such that I am routinely in a position of having to decide between working out right before bed, or not working out at all. To be sure, this is a difficult call to make. In my case, I decide on a case-by-case basis. If I am feeling unwell or if I am sleep-deprived, I may skip the weights for the day. If I am feeling well-rested and energetic, then I will probably go for it. Just know that if you go for it, also, it might result in a less restful night than you would have had otherwise.
On the subject, however, some “fitness trackers” can pull double duty as sleep monitors. As of this writing, one big “name” in the industry is FitBit. As for me, I have been eyeballing the Charge 2, because it’s less bulky (and less expensive) than items such as FitBit’s Ionic SmartWatch.
When it comes to Alzheimer’s patients, of course, it is probably somewhere between difficult and useless to attempt to fit them with a sleep monitor. However, for those who are still in the position of trying to avoid Alzheimer’s, such a monitor might be worth the investment. For one thing, just getting in the habit of wearing one might make it more likely that I would continue to wear it in the unfortunate event that I am display signs of dementia. But also it might enable me to tweak my sleeping routine now so as to help me avoid Alzheimer’s in the future.
Avoid These Things
Caffeine is obviously counterproductive to the goal of getting to sleep. So, lay off the stuff well (some say as many as six hours, but at least four) before hitting the hay. (If your dietary goals call for you ramping up your metabolism, you might try a non-caffeinated supplement. I have tried MET-4 by Dietetic Advantage and am happy with it.[5])
There are other reasons that you might want to incorporate some alcohol, for example in the form of a glass or two of red wine, into your diet.[6] But from the perspective of maximizing your sleep potential, steer clear of the stuff toward bedtime.
Other substances, like alcohol, might give the impression of being relaxation aids. But, under the surface, they actually interrupt healthy body rhythms and can impede sleep. At least, they can prevent the brain from entering, or enjoying the benefits of, the sort of deep, restorative sleep that (I earlier suggested) benefits cognition. To put it bluntly, passing out from alcohol is not the same thing as getting a good night’s sleep.
It may be surprising, but similar warnings attend the use of nicotine. While it may seem to provide a tranquilizing effect, nicotine also has stimulant properties.
Instead, Try Some of These
There are many natural sleep aids available. In fact, there are vitamins and minerals that support the body’s ability to sleep and could therefore be thought of as “sleep aids” in a broad sense. For some people, getting a better night of rest may be as simple as elevating your levels of these compounds by supplementing with a multivitamin. For those who desire a bit more specificity, let’s look at a handful (or a few handfuls, hands full) of options.
Herbal Tea
Relax with a book, a cup of herbal tea, a warm bath, or some combination. (Don’t get your book wet.)
Nowadays, herbal teas come in a variety of packages. There are a plethora of distributors offering everything from single-herb teas to blends. For example, chamomile (as well as catnip), which is a solid reputation among herbalists as a calming herbal tea, can be obtained by itself or in various sleep-aid concoctions.
Celestial Seasonings’ “Sleepytime” mixture is a personal favorite of mine. The classic version is a composite of chamomile, spearmint, west Indian lemongrass, tilia flowers, blackberry leaves, orange blossoms, hawthorn and rosebuds.
Recently, Celestial Seasonings introduced a “Sleepytime Extra” offering that adds valerian into roughly the same mix of chamomile, tilia flowers, spearmint, lemongrass, and hawthorn.
Incidentally, valerian (root) is also available singly. Alvita, for instance, sells Valerian Root tea. In my opinion, based on my own (admittedly uncontrolled) experiments, it can be quite effective,[7] but it is also an acquired (and slightly “pine-needly”) taste.
For a more flavorful treat, you might consider Bigelow’s “Sweet Dreams” that, similarly to Celestial Seasonings’ products, combines chamomile, hibiscus, peppermint leaves, rose blossoms, spearmint leaves, (unspecified) spice, and orange blossoms.
Actually, almost any (non-caffeinated) tea can be sipped for relaxation and general enjoyment. Two of my all-time favorites are Celestial Seasonings Bengal and Gingerbread Spice blends. Find something that you like and make it part of your nightly, wind-down routine.
Herbal Capsules
If you’re not much of a tea drinker, then you might prefer just popping some herbal “pills” instead. Here is my own master list, broken down into four categories.
Category 1: Herbs Recommended for Insomnia by “Commission E”
“Commission E” refers to the German-based Bundesinstitut für Arzneimittel und Medizinprodukte.[8] The group is essentially the German equivalent of the American Food and Drug Administration (FDA). Formed in 1978, Commission E weighed scientific evidence for the approval (or disapproval) of various substances and products previously used in traditional, folk and herbal medicine. Here are four herbs listed by Commission E as recommended sleep aids.
Hops (Humulus lupulus)[9] Hops was one of the herbs expressly “approved” by Commission E for the treatment of insomnia.
Lemon Balm (Melissa officinalis) Also packaged as “Melissa,” it’s approved by Commission E for both nervousness and sleeplessness, my PDR for Herbal Medicines lists no known adverse reactions or contraindications. It might be a good choice (but see the footnote) for those wanting to begin with a mild herbal sedative.[10]
Passion Flower (Passiflora incarnata) Likewise Commission-E approved for anxiety and insomnia, it appears to be generally safe if taken as indicated on the label.
Valerian (Valerian officinalis)[11] Valerian was approved for nervousness and insomnia. It is potentially powerful, but readers should be aware of two things. Firstly, sometimes, albeit rarely, people display signs of valerian allergy.[12] Secondly, valerian can have a stimulating effect on some people. (See, again, footnote #7.)
If you don’t have ambition enough to select (and take) herbals individually, you could also try one or more of the various sleep-formulated blends on the market. (Just don’t try multiple formulas all in the same night!) I have tried, and include in my regimen, Solaray Sleep SP-17 and Nature’s Way Silent Night. However, there are a million alternatives (e.g., this, and this, and that, etc.), so find one that works for you.
Category 2: Generally Safe Herbs With “Unproven”[13] Folk Reputations as Sedatives
Besides the specific plants receiving Commission E’s herbal-medical seal of approval, there are a number of other offerings that I have considered, sampled, or worked into my nightly, supplement repertoire. Here are nine.
Birch (Betula lenta)[14] Although I have yet to try birch myself, it has a good reputation and is purportedly safe and potentially effective for some people.
Catnip (Nepeta cataria)[15] I use catnip frequently. I usually “cycle” my nighttime herbs. To put it differently, I change up what I take so that my body doesn’t get too accustomed to any particular one.
Chamomile (German: Matricaria chamomilla or recutita)[16] I also use German chamomile – both in capsule and tea form.
Fennel (Foeniculum vulgare)[17] Often suggested for digestion or menstruation pains, fennel may also have mild sedative properties. You might already have some on your kitchen spice rack. (Another kitchen spice is saffron, which may have dementia-fighting properties.)
Lady’s Slipper (Cypripedium calceolus) Also called “nerve root,” Lady’s Slipper has a folk reputation for relieving nervousness and tension. It also crops up on lists – like this one! – for herbal insomnia treatments.
Poppy (California: Eschscholtzia californica) It’s simply listed in some resources as an “unproven” herbal insomnia treatment.[18]
Poppy (Red: Papaver rhoeas) Also known as “corn poppy,” it appears to be generally considered safe. In fact, at least one source[19] recommends it for children.[20]
Skullcap[21] (Scutellaria lateriflora) Another fairly widely listed herbal sedative, it seems (in the literature that I consulted) to be largely without adverse-reaction warnings. I use skullcap regularly.
Wood Betony (Betonica or Stachysofficinalis) It has a reputation among herbalists as a treatment for anxiety and insomnia, “unproven” though it may be. Like Lady’s Slipper, it is supposedly mostly safe, without any remarkable contraindications or warnings.
Category 3: More Potentially Dangerous Herbs With Reputed Sedative Properties
Some herbals appear on various sleep-aid lists, but strike me as a bit riskier than the plants just surveyed. Out of the following four, I have taken ginseng, but I am a bit gun-shy about the others.
Ginseng (Panax ginseng) Ginseng is something of a puzzle. It can have stimulating effects and has been reported to cause sleeplessness in people who “overuse” it. Nevertheless, sometimes it finds its way onto lists of herbal sedatives. I disfavor trying ginseng for purposes of supporting sleep since, similarly to black cohosh, it apparently has estrogen-like actions.[22]
Kava Kava (Piper methysticum) Although it was “approved” by Commission E for anxiety and nervousness, the U.S. Food and Drug Administration (FDA) advises that kava kava may increase your risk of severe liver damage or toxicity, particularly if used in conjunction with alcohol. So much for my kava-kava shooter recipe! Not a few web sources suggest – often in heated terms – that you stay well away from it. If I could be persuaded to give it a whirl, it would only be in consultation with, and under the supervision of, a qualified naturopath or equivalent.[23]
Lobelia (Lobelia inflata) Part of lobelia’s folk-medical reputation has it that the stuff possesses sedative properties. However, because it is supposed to be potentially fatal in high-enough dosages (and therefore has a lot of “street cred”), I have never had the gumption to try it. It is usually found in homeopathic preparations and in small amounts.[24]
Wild Lettuce (Lactuca virosa) It’s also a folk remedy for cough, bronchitis, and whooping cough (so it’s included in the next section). However, it is supposedly possible to “overdose” on wild lettuce. Another name for it is “poison lettuce”! Still, I don’t find that it is as potentially harmful as lobelia; it’s sometimes eaten in salads.
Category 4: Cold-Remedy Herbs With Secondary Sedative Effects
You might consider these herbals if you’re sleepless because of some upper-respiratory junk.
Black Cohosh (Actaea or Cimicifuga racemosa)[25] I have tried black cohosh. I usually reserve it for times when I am under-the-weather – usually with a respiratory virus – and need to sleep. I do not prefer black cohosh since I am male, and it is often associated with menstruation-related conditions and is possibly estrogen-enhancing.
Elder Flower (European: Sambucus nigra)[26] I love elder – elderberries and elder flowers. However, I do not turn to it first as a sleep aid. Similarly to black cohosh, I find myself going to elder when I am sick with a cold or flu.
Linden (Tilia tomentosa, inter alia) Linden is actually Commission-E approved for bronchitis and cough. Sources[27] suggest that Linden is mostly safe when used as directed, but its purported sedative effects may be qualified as “unproven.” I have it, but like black cohosh and elder, I typically reserve it for times when I am sick.
Vervain (Verbena officinalis) A few lists designate vervain, also known as “Enchanter’s Plant,” as mildly sedating. However, it is more commonly thought of as a folk cold remedy (or palliative). Thus, I would lump it together with black cohosh, elder, linden, and wild lettuce.
Wild Lettuce (Lactuca virosa) Wild lettuce is not without some rather striking warnings, so see the comments in the previous section. However, since it is regarded as an effective folk treatment for chest congestion (among other things), it is in somewhat the same class as the other herbs in this subcategory.
Oils can be released into the air using a diffuser. If you want to try to soothe several of your senses with one machine, iHome’s Zenergy-Aroma combines the functions of an essential-oil diffuser and a sound machine (for more on which, see above). added to a carrier oil like almond, coconut, or jojoba (to create a concoction that can be massaged onto your feet and body), or just included in the water of your warm bath (a few drops should do it). Another option for bath time is the employment of what is evocatively termed a “bath bomb.”
With essential oils, the selection is likewise variegated. Here are a few widely used scents.
A subcategory under “aromatherapy” should make mention of so-called “sleep pillows.” These can be as simple as bits of fabric that are stuffed with dried herbs and tied shut. Some herbs of choice include:
With a bit of fabric, some string, and a pinch of dried herbs, you can make your own.
More Exotic Supplements
There are a few other things that you might be able to throw into the mix as you try to develop, maintain, or support your body’s healthy sleep patterns. One category of substance is the amino acid. Constituents of proteins, amino acids are used by our bodies for an enormous range of purposes. Of importance to us here, obviously, is the role that some aminos play in aiding sleep.
Amino Acids
By far the best-known sleep-aiding amino acid is l-tryptophan.
L-Tryptophan – Found in poultry, especially turkey (but chicken, also); other meats (from the commonplace beef, lamb, and pork to the less common goat and rabbit); fish (e.g., cod, halibut, mackerel, salmon, trout, and tuna); shellfish (for instance clams, crabs, crayfish, lobsters, oysters and scallops); some fruits (apricots, bananas, cashews, dates, figs, grapefruits, etc.); nuts and seeds (including almond, chia, flax, hazel, pistachio, pumpkin, cashew, sesame, and sunflower); dairy (including milk, yogurt, and cheeses like cheddar, mozzarella, parmesan, and swiss); and certain wholegrains (buckwheat, oat bran, oats, wheat bran, and even whole-grain crackers).
Of course, aminos like l-tryptophan can be taken in capsule form. It’s best to supplement with them on an empty stomach, because this is supposed to aid with absorption. So make the capsule the last thing that you take at night, a good 30-60 minutes after your nighttime snack.
However, tryptophan is not the only game in town. Other amino acids that promote restfulness or sleep, include:
5-HTP – 5-Hydroxytryptophan, generally referred to as “5-HTP” (but also sometimes called oxitriptan), is an amino acid and l-tryptophan by-product that acts, in part, as a precursor for the neurotransmitter[28] serotonin. 5-HTP is routinely employed as a sleep-aid due to its supposed ability to increase serotonin production. It is believed to have a calming effect and is therefore also used to treat “mood disorders” like over-anxiety and depression.
GABA – Many of these amino supplements are mouthfuls to say, and gamma-aminobutyric acid is no exception in that regard. Like serotonin, GABA is a neurotransmitter. Apparently, while some neurotransmitters amplify or enhance nerve-signals, GABA has an opposite effect. It is perceived to perform an attenuating or dampening action on nerve impulses. Thus, like 5-HTP and many other compounds surveyed in this post, GABA is reputed to have a sedative effect.[29]
Glycine – I recently ran across an article,[30] available on the National Institutes of Health website, discussing the positive effects of glycine on regular sleep patterns. So, you might consider supplementing with it to keep your body at optimum levels.
Hormones
Melatonin– By now, this nighttime sleep aid has become fairly widely used. It is made by the body under low-light conditions, which is one reason why blocking light (as discussed above) is crucial to sleep success. Still, I confess that I keep 1mg, 3mg, and 5mg versions on my shelf.
However, I sometimes cut the 1mg capsule into quarters, and take 0.25mg instead of a full dose. (Use something like this.) At any rate, I have read that “overuse” (whatever that comes to) of melatonin can cause your body to shut down it’s own natural production of the stuff – a less-than-desirable state of affairs, to be sure.
Less Exotic Supplements
We have run through a wide assortment of herbals and other things. But, amazingly (to me, anyway), it turns out that you can support your body’s sleeping abilities just by keeping your vitamins at recommended daily levels. So, I’ll end this post with some more common supplements.
Vitamins and Minerals
Calcium – According to nutritionist Phyllis Balch, calcium “[h]as a calming effect.”[31] She recommends it in its chelated form. Vitamin D assists the body in the absorption of calcium. Several products, like this one, therefore combine calcium with vitamin D. Remember, also, that vitamin D is important in its own right as a possible Alzheimer’s-prevention supplement. (See HERE.)
Magnesium – Calcium is apparently “counterbalanced” by magnesium, presumably in a similar way that potassium and sodium interact in the body. Magnesium is also supposed to possess muscle-relaxant properties. There are many forms of magnesium, as discussed in another post. Presently, I use magnesium citrate and malate. But you might also consider magnesium glycinate, orotate, or threonate.
Vitamin C – Insofar as sleeplessness can be precipitated by stress, it is crucial to include antioxidants in your diet. As it happens, emotional stress is believed to increase the number of “free radicals” wandering around the body. Antioxidants like vitamin C can counteract these free radicals and, in theory, help mend your body from the effects of stress.
Zinc – A final mention should be given to zinc. Again, Ms. Balch informs us that it “[a]ids in the recovery of body tissues while sleeping.”[32]
In general, you might benefit from taking a multivitamin supplement that is tailored to your particular activity level, age, sex, etc. (Your actual daily vitamin needs are dependent on factors such as age, sex, and activity level.)
[1] On the other hand, you absolutely want to ensure that you are getting at least some sunlight exposure during the day.
[2] These lights typically utilize mercury, neon, or sodium.
[3] Commonly available lighting types are compact fluorescent, traditional fluorescent, halogen, and incandescent.
[4] You should always consult with your healthcare provider or physician before beginning any exercise program. Moreover, you would want to start off small, with light weights or simple movements.
[5] Over the years, I have become sensitive to caffeine. Even a little bit gives me awful “jitters.” At first, I was a bit skeptical that it was “caffeine-free” given its inclusion of green tea extract. But I have had no ill effects from MET-4, which leads me to believe that it really is non-caffeinated after all. Still, I am no dietician. Consult with an expert if you have any concerns about your own tolerance levels.
[6] One commonly mentioned reason is to benefit from resveratrol.
[8] “Federal Institute for Pharmaceuticals and Medical Products.”
[9] Hops is contraindicated for pregnant women and those suffering from clinical depression. It should also be avoided, or used only under medical supervision, by persons with breast cancer. It should not be mixed with other central nervous system (CNS) depressants and it may react adversely with various barbiturate drugs and estrogen.
[10] It is best to fact-check my claims for yourself. Once again, I am incompetent to recommend herbal medicines to anyone. I offer this information solely from my own personal experiences and untutored research, as-is, for illustrative and informative purposes only. You must consult a health professional for personalized advice.
[11] It should be avoided while breastfeeding or pregnant. Some sources also caution that overuse, often in conjunction with other “hepatoxic agents,” could result in liver damage. When taking valerian, steer clear of alcohol, barbiturates, benzodiazepines, iron, loperamide, and opioid analgesics.
[13] I put “unproven” in scare quotes because I have reservations about the phrase. One sometimes reads that herbal remedies are “unproven” when what is usually meant is that they have not been positively established as effective by some (for example) FDA-approved trial. This might make them “unproven” in a narrow, or strict, scientific sense. But, really, hundreds of years of folk traditional testimony arguably counts as evidence in a broad, or looser, sense. Thus, I take umbrage at the idea that herbal remedies “have no evidence” in their support. As a matter of fact, they have quite a bit of evidence; it’s simply that we are talking about “evidence” in a sense that is less rigorous than how the word is used in scientific contexts.
[14] Birch is contraindicated for heart or kidney problems.
[16] Do not take German chamomile is you have hay fever or ragweed allergies. Also, persons with known sensitivities to arnica (Arnica montana), feverfew (Tanacetum parthenium), mugwort (Artemisia vulgaris), tansy (Tanacetum vulgaris), or yarrow (Achillea millefolium).
[17] Avoid this herb if you are allergic to celery or pregnant. Do not administer to children.
[19] Julie Bruton-Seal and Matthew Seal, Backyard Medicine, New York: Castle Books, 2012, pp. 144-145.
[20] Still the herbal PDR, cautions that it is not without some risk. (Joerg Gruenwald, et al., eds., PDR For Herbal Medicines, 4th Ed., Montvale, N.J.: Thomson Healthcare, 2007, p. 230.)
[22] Caution is needed for those with diabetes or cardiovascular disease. It might also interact poorly with anticoagulants, insulin, diuretics, estrogen, monoamine oxidase inhibitors, nifedipine, and albendazole.
[23] It is contraindicated for breastfeeding mothers, people with mood/neurological disorders (especially depression), and pregnant women.
[24] Not to be used while pregnant. Probably best to use only under the supervision of a qualified herbalist, naturopath, or physician.
[25] Black cohosh is often used to treat premenstrual syndrome and may have abortifacient properties. Hence, it should not be used by pregnant women. Additionally, there are adverse-reaction warnings associated with black cohosh in conjunction with the following drugs: azathioprine, cyclosporine, antihypertensive medications, iron-containing pills, and tamoxifen.
[26] Unripe berries can be mildly toxic. Do not use, except under medical supervision, if you are diabetic. Should not be taken alongside any iron-containing supplement.
[28] A “neurotransmitter” is a chemical that is produced, secreted, or otherwise released by a nerve cell. This chemical release is precipitated by (electrical) nerve impulses and it assists in the passing of signals between nerve fibers, or between nerve and muscle cells, and so on. Suffice it to say that neurotransmitters are important for nervous-system function.
[29] According to writers at the University of California – Berkeley, some pharmaceutical “[s]leeping pills such as zolpidem [marketed under names like Ambien, Edluar, and Intermezzo] and eszopiclone [Lunesta] work by improving the ability of GABA to bind to receptors in the brain…” (“Can Supplements Help You Sleep?” Berkeley Wellness, Oct. 1, 2013, <http://www.berkeleywellness.com/supplements/other-supplements/article/can-supplements-help-you-sleep>.)
[30] Makoto Bannai, Nobuhiro Kawai, Kaori Ono, Keiko Nakahara, and Noboru Murakami, “The Effects of Glycine on Subjective Daytime Performance in Partially Sleep-Restricted Healthy Volunteers,” Frontiers in Neurology, vol. 3, no. 61, Apr. 18, 2012; <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328957/>.
Alzheimer’s and Sleep: Too Little, Too Much and Just Right
Part 1 of a Two-Part Series on Alzheimer’s and Sleep
Dementia can run the gamut in terms of sleep disturbances. From excessive sleep, in often late-stage patients (see further on), to insomnia, Alzheimer’s patients may experience some sort of disordering of their slumber.
What’s Wrong With Not Getting Enough Sleep?
Lack of adequate sleep is correlated with mood disorders such as anxiety and depression. It’s linked with obesity. It’s associated with premature aging – no wonder some call it “beauty rest.” In relation to the present topic, though, I note that not getting enough sack time can also have a pronounced and negative effect on cognitive function.
If it is anything, Alzheimer’s Disease is a condition characterized by suboptimal brain function. It is tempting, therefore, to think that something that, when missing, drives down your cognition will also ramp up your risk of dementia. Contrariwise, if getting plenty of rest helps you to maintain optimal mental functionality, then it is reasonable to think (or hope!) that it might lower your risk of Alzheimer’s.
As I have stated elsewhere, I do not suggest that this is, without exception, a true causal statement. I think of this rather as a bet. Let me put it this way. Personally, I am betting on my health and trying to avoid Alzheimer’s. If I think that there is even the slightest chance that I can stack the deck in my favor by making a little lifestyle tweak, then I will do it! So, if something is correlated with optimal brain function, and the lack of that same thing is correlated with substandard function, then that’s good enough to prompt me to bet on that thing – whatever it is.
And there’s just such a correlation with sleep.[1]
Why Might Sleep Be Important for Dealing With or Avoiding Alzheimer’s?
But the inability to get some restful shuteye can afflict almost anyone. And one concern is that this inability could be a possible dementia risk factor. Still thinking in terms of placing wagers, then, I am interested in treating seriously – and addressing – my own, periodic sleep interruptions.
To put it directly and simply, sleep is important for healthy brain function. It seems to relate especially to how nerve cells communicate.
Despite outward appearances, our brains and bodies are active even when we are sleeping. Recent studies lend credence to the idea that the body repairs, and cleans out toxins from, the brain while we are asleep.[2] Some scientists believe that this “drainage” or elimination system fixes the wear and tear on the brain that due to the stresses of daily living. It supposedly restores our neural command center to peak performance.[3]
The brains of Alzheimer’s sufferers tend to display accretions of amyloid plaques, proteins and other junk. It is intriguing to consider the possibility that these telltale indications of a dementia-plagued brain accumulate, in part, due to something as basic as a breakdown in the sufferer’s power to sleep.
What Is Sleep?
It sounds like a silly question. But, as one recent news headline put it: sleep is a bona fide mystery.[4] Obviously, sleep is more than just lying down and closing your eyes. Some of you can perhaps to relate to the frustrating experience of doing both of those things – maybe for hours on end – without ever actually falling asleep. Delving into the information available on these topics, I read that there are two main “types” of sleep: Non-rapid-eye-movement sleep and rapid-eye-movement sleep. The former is termed non-REM and the latter REM.
Apparently, we go from “deep” sleep into “lighter,” or REM, sleep, in approximately 90-minute cycles. Presumably, each of us may have cycles of varying lengths. Moreover, it may be that an individual’s cycles vary depending on health and other factors. In light of this, the 90-minute interval is probably best thought of as an average. On average, people sleep in cycles of an hour and a half.
The deep-sleep period is, at least according to one prominent sleep theory,[5] supposedly the restorative time. This deeper sleep, however, is claimed to occur more at the beginning of the night[6] than at the end. As the sleeper proceeds from cycle to cycle, REM becomes more frequent and longer-lasting, climaxing in the predawn hours.
Sidebar: Sleep Affects Learning
Since sleep is vital for proper brain function, it is unsurprising (indeed, virtually tautological) that every brain activity is affected by the quantity and quality of sleep that we get.
Consider, for instance, our ability to learn. It seems obvious that dementia sufferers eventually lose this fundamental human power. Yet our capacity for learning is intimately connected to the caliber of our sleep.
On one simple model, the learning process (at least in behavioral terms) may be imagined as consisting of three distinct functions.[7]
Acquisition – Or the period during, and process by, which the brain “takes in” some emotion or piece of information. In more computational terms, “acquisition” is a data-input operation.
Consolidation – “Consolidation” is a word for the interim stage when the brain converts certain bits of data (emotional, informational, what have you) into long-term, recoverable memories. Thinking along the lines of a computer analogy, perhaps we can say that this second learning function is akin to the act of “saving” data on a hard drive or other storage device.
Recall – This is the time at, or means by, which the brain retrieves a piece of stored information or acts upon an associated emotional (or other) state. Crudely carrying forward our PC comparison, we might envision “recall” as an “output” mechanism.
Acquisition and recall are accomplished while we are awake. However, consolidation, which is the somewhat mysterious time when our brain forms ideational and neural connections[8] (some of which we term “long-term memories”), happens while we sleep. (Or so it seems to some researchers.)
Why Does My Alzheimer’s-Affected Relative Sleep So Much?
The thrust of a lot of research on sleep, and certainly a main point of what has been written herein, is that – on average – we need more sleep than we get. It’s easy to think that we should grab as many “winks” as we can.
But a fair number of people who have spent time around Alzheimer’s patients might wonder: Why do many dementia-afflicted persons sleep so much? Why would this be, if sleep is restorative and helpful for maintaining brain function? Would an Alzheimer’s sufferer be chronically sleep-deprived?
Answering these questions presents us with many difficulties. There are several complexities that arise.
Firstly, it is far from obvious that all Alzheimer’s patients do sleep a lot. True, many frequently seem to be asleep. But others – e.g., the so-called “Sundowners” – appear to be awake at all hours of the night.
Secondly, getting restful, restorative sleep involves more than merely reclining with your eyes closed – even if you don’t respond to your name being called. And this exposes another problem: many Alzheimer’s patients are elderly people whose auditory (and other) sensory abilities have dulled. Do grandma or grandpa not react because they are in deep sleep, or because of a lack of awareness that you are trying to communicate? Or is it somewhere in between?
Thirdly, and relatedly, sleep studies[9] (like studies of many other sorts) depend crucially on self-reporting. For example, a person’s nighttime sleep might be monitored and then, upon waking, the person many be asked how rested he or she feels. Thus, the researchers associate being rested or tired with particular patterns of observed sleep behavior (at least partially) on the basis of what the test subject reports.[10]
Once Alzheimer’s is far enough advanced, however, it is apparent that it would be futile to ask the sufferer much of anything, meaningfully. Either the patient’s language capabilities have eroded to a point that makes any verbal communication difficult to impossible, or else the patient’s cognition and memory have decline below the threshold of reliability.
In other words, either the dementia patient can say nothing, or nothing that they say can be accepted at face value. But this bodes ill for the success of any sleep study based on the collection of self-reports.[11]
Despite these difficulties, we may be on at least semi-solid ground if we speculate along the following lines. It certainly seems that some Alzheimer’s sufferers sleep a lot. Several possible explanations are available.
One is that this initial appearance is (at least sometimes) deceptive. Although the dementia-afflicted person might appear to be asleep a lot, this is (again, at least sometimes) not the case. I grant that this suggestion might seem far-fetched at first blush. However, given that we are dealing with often aged individuals whose sensory faculties have diminished and who often revert to childlike (or childish) states of mind, I submit that it cannot be ruled out. If the Alzheimer’s-afflicted person is (at least sometimes) not actually sleeping at all, this would explain why he or she is not getting the restorative benefits of sleep.
But if you don’t care for that possibility, here is another. We have seen that “sleep” is a generic term. There are (at least) two subtypes of “sleep.” Let’s call them deep sleep and shallow sleep. Therefore, even if an Alzheimer’s patient is observed to be “asleep,” it doesn’t follow that the person is cycling from deep to shallow sleep as he or she should. It remains possible that dementia sufferer is “stuck,” as it were, in shallow sleep. This would explain why the person could be observed to be “sleeping” but also why the person is not enjoying the restorative benefits. Restorative benefits only attend to deep sleep, and, for some reason, the Alzheimer’s sufferer only manages to sleep shallowly.
Finally, it must be kept in mind that the brain of an Alzheimer’s patient is basically damaged at a neural-physical level. This damage affects cognition, memory, reasoning, and so on. It is possible, then, that while the restorative process that we sketched above is associated with, or occurs during, deep sleep, it is handled by an isolated or separate “mechanism” within the brain. It may be something like this. The Alzheimer’s sufferer can manage “deep” sleep but, unfortunately, some other neural mechanism is essential for restoration and that mechanism has already been destroyed.
Any of these three suggestion may help explain why some Alzheimer’s patients are, or seem to be, asleep without showing signs of sleep’s purported restorative benefits.[12]
What’s the Right Amount of Sleep?
So, proceeding on the assumption that sleep is both good and restorative, the next obvious question has to do with the amount. This is quite an important question, both for Alzheimer’s sufferers and for anyone who desires to keep his or her body in healthy condition.
We have all heard the proverbial eight-hours-per-day recommendation. And, indeed, this is a good rough-and-ready figure to gauge whether your “hibernation” time is in the ballpark of adequacy.
But…what’s the precise “right” amount of sleep? The answer is: itdepends.
It depends on your age. Children require much more sleep than do adults.[13] As we will see in a moment, elderly adults typically get less sleep than younger adults. Whether this is an indicator of a lesser “need” is, however, another question.
The amount of sleep that you need also depends on your health.[14] If you are ailing, you may well need a lot more sleep than you would need if you were healthy. Sleep seems to help our bodies fight infections and recover from illnesses. Moreover, people under stress might require more sleep than they would otherwise. If you’re changing jobs, moving, or going through a divorce, you might catch a few more “Zs” than usual. Likewise, women may sleep more often while pregnant than they do when not pregnant since pregnancy puts inordinate pressures on women’s bodies.
How Much Sleep Does an Alzheimer’s Patient Need?
In general, older adults tend to need between 6 to 8 hours of sleep each night. In general. But these numbers typically assume that we’re talking about older adults with more or less “normal” (for their age) health. When we focus on Alzheimer’s sufferers in specific, we hit another bumpy patch. (Why can’t anything ever be simple?!)
One immediate problem is somewhat indelicate. If John has a cold, we might say: “John, you need more rest.” But that phrase is some what elliptical. To put it another way, “you need more rest” is kind of a shorthand way to tell John that he “needs more rest so that he can get better.” Or again, when Jane is pregnant, we might tell her to go ahead and sleep more. What we mean is usually something like this: “Go ahead and sleep more so that your body can get through this pregnancy and deliver a healthy baby.”
As things currently stand, the first problem, then, is that a person with Alzheimer’s is not going to recover. If Bob suffers from Alzheimer’s and we notice that he’s only sleeping six hours a night, we can’t really say “You need more sleep” in the same way that we did to John and Jane. The clause following the word “so” isn’t curative. After all, the prevailing view is that Alzheimer’s is not like a cold virus that will pass it you just get more rest, eat right, and stay hydrated. Similarly, having Alzheimer’s is not like being pregnant. It’s not a temporary state-of-affairs that puts additional stress on your body, but will be over at a predictable time in the future.
Still, we might think that getting sufficient rest could help Bob (or his caretakers) to better manage his care. Maybe getting more sleep might even improve Bob’s mental clarity to some degree. True, he may never fully recover, but perhaps his decline can be slowed. Thus, there is something that we can put after the “so.” We can say something like, “Bob, you need to get more rest so that you can better cope with your condition.”
Here, we run into the second problem. It’s a practical matter of getting Bob to alter his behavior. If I tell John that he needs more rest, he may or may not agree. He may or may not try to get more rest. But whatever he does, presumably, will be a conscious decision on his part to either ignore or heed my advice. The case is similar with Jane. However she modifies her schedule (or not!) is presumably going to have been her own willful choice. Again, Bob is relevantly different.
Alzheimer’s patients may not be able to comprehend the idea of getting more sleep. It is debatable whether Bob will grasp what we are suggesting to him. Dementia clearly affects the brain’s linguistic abilities. Depending upon the Alzheimer’s stage that he is in, he may not understand part or any of the statement. Even if he does grasp the words, he may be unable to resolve to change his behaviors. For Alzheimer’s also effects a person’s volitional faculties.
Going further, in the case of a person who apprehends and resolves to do what is said, he or she may not remember to follow through with the necessary changes. The most obvious fact about Alzheimer’s is that it severely undercuts memory.
In light of these considerations, we may just have to shrug our shoulders and let Bob sleep as little or as much as he happens to do. The administration of relaxation and sleeping drugs to Alzheimer’s patients arguably has as much (if not more) to do with making the caretaker role more manageable than it does with making the patient more comfortable. It’s a bit of an ethical pickle. If Bob is awake at all hours of the night, is it really “bad” for Bob? Or is it just an inconvenience on his custodian?
It’s not my intention to definitely answer these questions as much as it is just to bring them to the surface. Speaking in broad terms, the human body seems to require between 6-10 hours of sleep, with 8 being the average. Insofar as a person’s nighttime sleep amount is less than 6 hours, it is probably a good bet that encouraging, recommending, suggesting, or otherwise supporting them to get more sleep would benefit their overall health. But for dementia patients, the process of “encouraging,” “recommending,” “suggesting,” and “supporting” might be fraught with practical difficulties or result in outcomes that offset or undermine the hypothetical advantages. The upshot? It might be better to let sleeping patients lie, and let awake patients just roam – focusing, of course, on ensuring that they have a safe environment in which to do so.
But…for those of us who take at least some of these sleep recommendations to heart, or for those early-stage patients who have an interest in enhancing up their own sleep experience, what can be done?
[1] Numerous online sources highlight diet and sleep as two of the most important health categories to start with for to try to maintain – or improve – your neurological health, both now and in the future. Diet requires its own separate treatment, which you can find here: “Alzheimer’s-Proof Your Diet, Part 1” and “Alzheimer’s-Proof Your Diet, Part 2.”
[3] Interestingly enough, I encountered one article that stated sleeping on your side facilitated this drainage and cleansing better than sleeping on your back. On August 4, 2015, Stony Brook University’s online Newsroomposted this suggestion under the heading “Could Body Posture During Sleep Affect How Your Brain Clears Waste?” The article, itself a summary of findings published in the Journal of Neuroscience by researchers Helene Benveniste, Hedok Lee, et al., describes the role of something termed the “glymphatic pathway” – named after the body’s “glial” cells – in “the clearance of amyloid from the brains” under scrutiny. The study, which was performed on mice and is admittedly speculative, nevertheless suggested to investigators that sleeping on your side is superior, for waste-removal purposes, to sleeping on your back or front. For the full report, see: Helene Benveniste, Hedok Lee, Rashid Deane, Tian Feng, Hongyi Kang, Jean Logan, Maiken Nedergaard, Mei Yu, and Lulu Xie, “The Effect of Body Posture on Brain Glymphatic Transport,” Journal of Neuroscience, vol. 35, no. 31, Aug. 5, 2015, pp. 11034-11044; online at <https://doi.org/10.1523/JNEUROSCI.1625-15.2015>.
[6] I am assuming that we are talking about sleeping at night and being awake during the day. I understand that for some people, due to scheduling demands, this is not the order of events. There is some evidence to suggest that human beings are “made,” so to speak, to be awake during the day and asleep at night. Pursuing this line of thought, you might read that if you go to bed once the nighttime is far advanced, or if you sleep during the day, then you may not be getting much of the sort of sleep that restores your brain and body. Some writers label specific times the “best hours for deep sleep.” One source suggested that this most-advantageous period may be 10 pm to 2 am.
[7] This is all simplistic. It may also be that this particular model is specific to certain branches of psychology. Again, my aim is not to teach a psychological course, but to simply avoid Alzheimer’s. Perhaps the point, then, is this: The brain is important in the learning process, and sleep is important to the brain. Conversely, we might say: Sleep is important in the learning process, and the learning process is important to the brain. I’m just going for intuitive plausibility. I think the statements have that much going for them.
[8] Those in the teaching profession attest to the importance, in improving the retention of newly learned information, of forming “connections.” However, these connections are arguably subsumed under the heading of “acquisition” in our threefold schema. To put it another way, acquisition of information can be enhanced when conscious emphasis is placed upon associations existing among the relevant pieces of information. The operative idea seems to be that these associations, or connections, encourage consolidation.
[9] At least sleep studies involving human beings.
[10] This is overly simplistic. Many studies could be designed to run subjects through various tasks. A subject’s time and accuracy in completing the tasks could then be used to draw conclusions about how rested or alert they are. Still, in Alzheimer’s patients, the nature of the affliction practically guarantees that assigned tasks may be done incorrectly – whether the subject is fully awake and alert, or not.
[11] It is arguable that even studies that utilize brain-scanning technology still bottom out, as it were, with self-reporting. This is more controversially, philosophically. But one attractive picture is that brain states and mental states “come apart.” A neurologist plausibly has direct access to your brain states – via imagining and scanning equipment. So, suppose that Dr. Alpha scans Miss Omega and observes that Region 1 of Miss Omega’s brain displays marked neural activity. Still, Dr. Alpha has only one way to know what is going on in Miss Omega’s private, mental state. He must ask her.
[12] Of course, there is a also the possibility that sleep doesn’t have restorative benefits. But this flies in the face of the empirical evidence surveyed above.
[13] Newborns may sleep upwards of 15 hours a day. This declines a bit to around 12 hours per day when children become toddlers. Even older children and teenagers might require between 9 and 11 hours of slumber every night.
[14] It is worth noting, at least for people who get into or believe in “biorhythms,” is worth noting that a person’s placement on the various (allegedly) cycles (e.g., physical, emotional, intellectual)
Alzheimer’s-Proof Your Retirement Savings With Long-Term Care Insurance
My dad, Jim, passed in 2016 at age 85 from Alzheimer’s-related complications. At the time, he had been in a nursing home for almost four years. (For more details, see “Jim’s Story.”)
Nursing-home costs vary by region. There are also price differences that depend upon offered amenities and services. However, on average, it is not uncommon for nursing-home care to run in the ballpark of $75,000 to $150,000 annually.
At a middling $100,000/year level, a four-year stay (as my dad had) would come to $400,000. This could easily devastate your – or your surviving spouse’s – retirement plans. Additionally, once an estate is spent down, it can be difficult or impossible to leave a legacy to your children or grandchildren.
Sadly, my family discovered this all too well.
Jim’s Case
My dad retired from Sears (he always called it “Sears Roebuck”) after nearly forty-five years of service. At first, he worked in display. This was back when department-store displays were impressive and custom-assembled setups. Jim was trained in glass cutting and other skills that are now largely lost, in a time when what brick-and-mortar stores are left typically have pre-fabricated displays crated in from corporate headquarters.
Ultimately, he ended up in “maintenance.” A lot of the creativity was gone from the job that he had originally entered. Especially towards the end of his working life, he didn’t make much, salary-wise.
It’s probably safe to assume that he brought in around $20,000/year. At age 65, when he retired, Jim had around $300,000 from his Sears profit-sharing plan.
For illustration purposes, let’s think of this $300,000 as a well of money that can be drawn out a little at a time. There are ways of using the money (for example, to purchase an annuity) that do not consist in treating it as a pool. But we will put that to the side, presently.
Now, abstracting away from niceties like cost-of-living increases and supplemental incomes (like from Social Security), let’s consider three sample scenarios.
Three Hypothetical Situations
Firstly, imagine No-Change Jim. No-Change Jim wants his retirement years to be the same as his working years – no change in lifestyle. A conservative assumption would be that Jim needed most (if not all) of his $20,000/year income to pay expenses. So, drawing $20,000 from our well of money every year, No-Change Jim would deplete his $300,000 in fifteen years.
As stated, and in fact, the real Jim retired at 65 and died at 85. But, for the moment, put aside the fact that the real Jim got Alzheimer’s Disease around the age of 75.
Drawing off $20,000 every year, No-Change Jim would have had fifteen years of money. That would have allowed him to live, with “no changes,” to age 80. If No-Change Jim had lived to age 85, as the real Jim had done, he would have run out of money five years too early. This is even on a “best-case” scenario where No-Change Jim never needed any extra money for emergencies (like needing a new roof or needing nursing-home care). No-Change Jim cannot really have “no change” after all. He has major problems by age 80. Additionally, No-Change Jim was “locked” into the spending habits he had when he was working. $20,000/year would have kept him where he was at, financially, but would not have provided any funds for any retirement-specific activities (like, say, traveling to Europe). So, No-Change Jim can keep going for a while in the lifestyle to which he had been accustomed. But he can’t keep going until the end of his life. What will No-Change Jim do at age 80?
Let’s modify some of our assumptions. Think of a man that we’ll call “You-Only-Live-Once Jim.” YOLO Jim values enjoyment above being conservative. YOLO Jim wants to do some traveling with his new-found free time. To be sure, there are extreme versions of YOLO Jim where he takes the $300,000 in a lump sum, pays the taxes, and then blows the remainder on a few purchases. But let’s remain tethered to financial conservatism in some respects. Suppose that YOLO Jim simply wants to keep his overall lifestyle the same as it was while he was working, plus add on a $10,000 vacation each year (or build a “man cave” with a nice entertainment system, or whatever). To keep his pre-retirement lifestyle, we have seen that he requires $20,000/year. But to add on his desired vacation (or whatever), he needs an extra $10,000/year. That brings us to $30,000 each year. With $30,000 being drawn off every year, YOLO Jim’s $300,000 would have lasted him ten years. Again, holding fixed real Jim’s ages of retirement and death, YOLO Jim would have run out of money at age 75. YOLO Jim could have been “living large” for a while. But it catches up with him. How is YOLO Jim supposed to survive the last ten years of his life?
Maybe there’s a version of Jim that thinks through possibilities 1 and 2 and wishes to avoid them. This hypothetical Jim does not want to outlive his money. Let’s call this man “Frugal Jim.” Frugal Jim faces head-on the fact that he cannot spend money on retirement trips (or man caves). Moreover, Frugal Jim realizes that – spending-wise – he cannot even keep leading the life that he was leading prior to retirement. $20,000/year is too much to spend. Therefore, Frugal Jim gives himself a pay cut.
Now there are two subtypes of Frugal Jim that I want to look at. One can see the future with his crystal ball, and the other cannot.
Crystal-Ball Jim can be frugal, but can also minimize his pay cut. Still leaving the Alzheimer’s aside, Crystal-Ball Jim knows that he will die at age 85. Since he retires at 65, Crystal-Ball Jim knows that he needs income for the next 20 years. By simple division, Crystal-Ball Jim takes his $300,000 and divides it by the 20 years he knows that he will live, and arrives at the figure of $15,000/year. So, he gives himself a $5,000/year pay cut. Presumably, this will mean that Crystal-Ball Jim needs to cut expenses somehow. But, suppose it’s possible. With $300,000, Crystal-Ball Jim could live out his life on $15,000/year.
But, clearly, few people would claim to have the requisite knowledge of the future. So, let’s envision a version of Frugal Jim without a crystal ball. Unaware Jim doesn’t know that he will die at 85 (we’ll continue to assume). Unaware Jim only worries that he will outlive his money and that believes that he needs to scale down his expenses in order to protect himself against that outcome. As with YOLO Jim, there are extreme versions of Unaware Jim who scale back so radically that they practically (or actually) end up living on the streets. But, once again, we will commit ourselves to minimalism, change-wise. Since he doesn’t know that he will die at 85, our version of Unaware Jim decides to plan to live until 90. So, our version of Unware Jim wants to ensure that he has income to live on for the next 25 years. $300,000 divided by 25 gives us the amount that Unaware Jim has to be able to live on: $12,000/year. Supposing that Unaware Jim manages to eke out an existence on $12,000/year, he spends $240,000 over the next 20 years, dies at 85, and leaves $60,000 as a legacy (of which, a portion will be paid in taxes).
How Much Money Do You Need to Retire?
What’s the “moral” of these various hypothetical case studies?
The first thing that jumps out at me is this: My dad didn’t have enough money to retire! Financially, retirement had been inadvisable for him.
Of course, there are seldom one-size-fits-all answers. Things like your assets, lifestyle preferences, location, and so on, all figure in any satisfying response. Your retirement goals (including your idea of what retirement consists in) plan a role as well. If your idea of retirement is to travel around the world, then you’ll probably need more money than someone whose idea of retirement has them living in a log cabin in an isolated part of the country. For an individualized answer, you should really address retirement-related questions in consultation with one or more trusted financial advisors – people to whom you feel comfortable disclosing your personal financial information.
However, general statements can be made. Current estimates suggest that the average worker needs upwards of $2 million to retire. The financial website TheStreet published an article in 2016 outline reasons for thinking that $2 million is the “new amount needed for retirement.” Previously, the baseline number was thought to be $1 million.
Citing the considered opinions of various investment and wealth managers, TheStreet author Ellen Chang contended that the $2 million figure is a “good goal” to aim at.
One Jon Ulin stated that each million saved could issue in an estimated income stream of between $30,000 to $40,000 per year.
It’s easy to see the difference that $2 million, or even $1 million, would have made to my dad’s case studies. Still thinking of the $1 million as a pool of money to be drawn upon (and not as the single premium on an annuity or as the base amount in an investment portfolio), we see that my dad could have drawn $25,000 each year and not outlived his money even if he would have lived to 100. Indeed, Jim could have lived on over $30,000/year and had enough to survive until the age of 90 – assuming that he never got Alzheimer’s Disease.
What About the Cost of Alzheimer’s?
By this point, you should be saying (and hopefully not screaming): “But he did get Alzheimer’s!”
And this is part of the point of going through the case studies. It’s hard enough to plan for a “normal” retirement. But even a person who had budgeted enough for him- or herself to carry a current lifestyle forward into retirement may find that Alzheimer’s blows that budget to smithereens. All the figures just covered assume everyday expenses only. We have not factored in the cost of Alzheimer’s care.
Given that male residents may spend between one to three years in a nursing home, and that females may spend between three and five years, estimated costs can be calculated for husband-wife pairs.
We said earlier that yearly nursing-home expensive range from $75,000 to $150,000. On the low end, if the husband spends one year in a $75,000/year home, and the wife spends 3 years at the same facility (whether concurrently or successively), that comes to $300,000. On the other hand, if a husband and wife spend three and five years, respectively, in a $150,000/year home, the total expense would be $1,200,000 (that’s 1.2 million dollars).
Of course, there are scenarios in which the husbands and wives spend more or less time and the facilities cost more or less than the costs sketched above. But this carves out a general estimated range for projecting Alzheimer’s-care expenses.
On average, we could say that total, estimated nursing-home expenses for Alzheimer’s-related care for a married couple run between $300,000 and $1.2 million.
Alzheimer’s is not the only danger to retirement funds. Any condition that results in the loss of two out of six “activities of daily living” (ADLs) or results in severe cognitive impairment can trigger the need for what is termed “long-term care.”
It is arguable, if not obvious, that my dad didn’t have the financial resources for normal, retirement-related expenses, let alone resources enough to afford long-term care.
In fact, Jim’s long-term care did cost around $75,000/year. This means that his care actually cost $300,000 over the four years that he ended up spending in a nursing home. He would have blown through his entire profit-sharing fund even if he had saved it, at its full value, until he needed full-time care in a facility.
A husband-wife pair with $1 million in retirement assets could reasonably plan to spend between $300,000 to $600,000 on long-term care, if they resolved only to utilize facilities that are on the low end of expenses, around $75,000/year. (As we have seen, 8 years of combined care in a facility costing $150,000/year costs $1.2 million.) This is between 30% and 60% of their available assets.
It may be a bit clearer why many writers are advising people to have $2 million put away for retirement.
A husband and wife with $2 million for retirement between the both of them might have to spend 15%-60% (if facilities cost upwards of $150,000) of those assets on Alzheimer’s, or other long-term, care.
Just working with $100,000/year, a married couple should probably budget $400,000 to $800,000 for their combined long-term care costs.
If you have around $2 million in retirement assets, could you afford to pay $400,000 to $800,000 for long-term care? Perhaps, if you could afford to pay for your other, pre-long-term care expenses with the remaining $1.2 or $1.6 million that remains.
However, there is another alternative.
Retirement Insurance
One alternative is to (try to) acquire long-term care (or “retirement”) insurance. There are different varieties of long-term care (LTC) insurance available. Presently, I will simply sketch a few of the basic concepts.
Two Main Types of Long-Term Care Insurance
In the main, there are two sorts of LTC policies. Number one, there are policies that only cover expenses occurred by an individual in a nursing home. Predictably, these sorts of policies are often designated nursing home only.
Number two, there are policies that cover a broader range of expenses. To understand this second sort of policy, usually referred to as a comprehensive plan, you should be aware of the range of possible care options (and attendant expenses).
Adult Daycare – This is basically like a child day care. It is probably best described as a place offering custodial, recreational/social, and supervisory services to older adults who primary live at home, but are dropped off at the daycare center for limited periods of time. Not usually an option for people who require around-the-clock attention or are confined in some way, it may nevertheless be suitable for many families. For instance, if adult children take care of their aged moms or dads, but need a place to take them while going to work, then adult daycare may fit the bill.
Assisted Living – Assisted-living facilities are a combination of senior housing and limited care services. You might take grandpa or grandma to an assisted-living home if he or she need some help with daily activities, but do not (yet) require skilled-nursing or 24-hour care.
Home Health Care – As the name expresses, this option is for seniors who do not need institutional care because they are receiving help at their own (or someone else’s) home. The health plan may still include periodic visits from a skilled nurse who may perform various therapies and generally will be overseen by a physician.
Hospice Care – During that unhappy time when the end draws near for a terminally ill individual, hospice-care personnel focus upon the comfort of the patient and the emotional wellbeing of the family. Nurses do not administer curative or remedial care, but try to minimize the patient’s pain. Hospice teams typically offer bereavement and counseling services as well.
Nursing-Home Care – This is what may immediately come to mind when the subject of long-term care is broached. Nursing homes offer a mixture of custodial and skilled-nursing care. They are equipped to provide care 24 hours a day.
What Types of Care Do Long-Term Care Policies Cover?
The only type of care covered by long-term care insurance is custodial care. “Custodial care” refers to care administered in order to help people perform the activities of daily living or help people who suffer from debilitating cognitive problems (like severe memory and reasoning deficits). Custodial-care workers do not require medical training.
Skilled-nursing care, on the other hand, is only performed by a licensed nurse. The nurse will be depending upon an attending physician for the patient’s care plan. Usually, the phrase “skilled nursing” designates nursing care that is available around the clock, 24 hours a day, 7 days a week, 365 days a year. Long-term care policies do not cover skilled nursing care. It would be covered under health insurance, hospitalization policies, and Medicare.
On the other hand, neither healthcare plans nor Medicare cover custodial care! The only game in town for non-individual long-term care coverage is Medicaid. And Medicaid only covers people who are financially impoverished.
You might also run across the phrase “intermediate care.” This is also performed by a licensed nurse, under a doctor’s orders. However, this is less-than-24 care. It’s medical care, but it is not performed around the clock. Again, long-term care policies do not cover intermediate care. Health insurance, hospitalization policies, and Medicare cover intermediate care (which is often temporary, transitional, and ordered to support patient recovery).
Benefit Amount
Perhaps the most conspicuous consideration is the benefit amount. Generally, LTC benefits are paid on a dollar-per-day basis. So, your benefit amount might be $100/day, for example. Available benefit amounts typically range from $50 to $500 per day. Different companies will have different per-day maximums. Intuitively, the higher the per-day benefit, the higher the premium cost. All things being equal, the lower the per-day benefit, the lower the premium cost.
The average per-day cost for long-term care presently hovers around $200/day. At this rate, a $200/day benefit would cover 100% of expected costs, in today’s dollars, while a $100/day amount would could about half the anticipated costs. And so on. (Your own care experience may be very different. Again, this is for illustrative purposes only.)
Benefit Period
Another consideration is the benefit period. This is the period of time over which your benefit amount will be paid. Often, you can specify a benefit period something like 1, 3, 3, 5, or 10 years, etc. Similarly to what was said before, longer benefit periods translate into higher premium costs; shorter benefit periods generally mean lower premium costs.
Elimination Period
It was earlier briefly mentioned that long-term, or custodial, care has two “triggers”: one physical, one mental. Physically, LTC is triggered when an individual lacks the ability to perform two out of six activities of daily living. Mentally, LTC is trigged when an individual suffers cognitive impairment severe enough to require around-the-clock custodial supervision.
However, once one (or both) of these triggers is activated, the LTC benefit period does not begin until after the “elimination period” has been satisfied. An elimination period is sometimes characterized as a “time deductible.” It is the amount of time you must wait, after you are eligible for benefits, but before your benefit period begins.
Theoretically, the elimination period could be any arbitrary number of days.[1] It generally ranges from 30 days to 180 days. The shorter the elimination period, the higher the premium.
If your elimination period were 0 (zero) days, your premium payments would be extremely high. With a zero-day elimination period, your benefits would begin as soon as your need for long-term care is triggered.
If, to swing to the other extreme, your elimination period were 365 days (i.e., an entire year), your premium would be lower than it would be if you had selected a briefer elimination interval. However, your out-of-pocket costs would high. Essentially, a one-year elimination period means that you will be paying for your first year of nursing-home care out of your own assets or income. Since we already estimated one year of nursing-home care at between $75,000 and $150,000, these would be your expected out-of-pocket expenses before your long-term care benefit period begins.
Usually, people opt for something in the middle. 90 days is a commonly selected option. In this case, once you have triggered your need for long-term care, you would have to cover nursing-facility expenses out of your own pocket for three months and then your LTC insurance would begin paying your benefit amount.[2]
Three months of care at a $75,000/year facility would run $18,750. At a facility that costs double every year (or $150,000), your three-month cost would also double. In this case, that would be $37,500.
What Insurance Companies Offer Long-Term Care Insurance?
Here is a sample of companies that do, or did, offer long-term care insurance.[3]
Genworth (Rated B by A.M. Best; B+ by Standard & Poor’s; and B2 by Moody’s)
John Hancock (Rated A by A.M. Best; AA- by S&P; A1 by Moody’s; AA- by Fitch)
Transamerica (Rated A+ by A.M. Best; AA- by S&P; A1 by Moody’s; A+ by Fitch)
Notes:
[1] There is also a finer-grained distinction between “calendar” and “service” days. When an elimination period is based on calendar days, the first day of a claim starts the clock and it runs continuously until the elimination period is complete. On the other hand, when an elimination period is based on service days, the clock begins when the claim is made and the individual actually receives care. If a given person only receives in-home care three days out of the week, then only three days per week will be counted toward the fulfillment of the elimination period.
[2] Note that you may still have out-of-pocket expenses even after the benefit period begins. In any case where your contractual per-day benefit amount is less than your actual per-day cost of care, you will have to pay the difference out of your own assets/income.
[3] I have done my best to report accurate financial-strength ratings (as of this writing). However, I offer this list for informational purposes only and make no guarantees or warranties. I encourage anyone who is considering the purchase of a long-term care policy to do his or her own research into a company’s financial strength and philosophy before making a purchase. Moreover, a would-be purchaser may find that Company A offers a better policy than Company B for your individual needs. In this case, it may make sense to favor A over B, even if B has a higher financial rating. You should seek professional advice.
