Listening to music or sharing art can be soothing. Relatedly, creativity is a powerful capacity that all humans share. Unfortunately, for those suffering from cognitive impairments, the utilization of this capacity can be frustrated. However, with a healthy dose of – you guessed it! – creativity, caretakers can enable Alzheimer’s patients (even ones who are far advanced in their declines) to use the arts to express themselves and to realize some of the benefits previously noted. My dad’s case afforded me a glimpse into this fascinating and emotionally salubrious process.
For a bit more detail, you can read about my father, Jim, HERE. Suffice it to say that music and art were two of his many interests. He liked to listen to music and sketch people from the covers of TV Guides. Later, as his disease progressed, but while he was still residing at home, he became unable to plan and execute his own projects. Still, he used to sit with my mom as she made cards. Jim was able to help by brushing color on a background papers or performing rudimentary “stamping” operations with a sponge. As his disease worsened, he started a “music therapy” program in his nursing home. The overseers developed a play list of his favorite songs and fed it into an iPod. It was bittersweet to see him smiling and sometimes even humming along. But a key takeaway is that this therapy also helped to calm him.
In addition to the in-house efforts, the nursing home hired a musician to come about once a month to the main visiting area. Residents were encouraged to clap or sing along. Jim seemed to enjoy listening to the oldies. As he was fond of saying, during happier times in his life, they are “oldies, but goodies.”
Music and movement (like dancing) seems to make people with Alzheimer’s feel happier and more like socializing, thus creating a calmer environment. This could result in a decrease in anxiety and depression levels which, in turn, could possibly reduce the reliance on certain medications.
But being in a new area and seeing others respond to the music also helped to stimulate responses in him.
Art Has Effects That Go Beyond Mere Pacification
According to Generations Healthcare: “[I]n 2013 there were neurological studies done that revealed that artists with dementia could still draw familiar people, places and objects from memory.”[1] Art is also surmised to help build feelings of accomplishment and purpose.
Moreover, there is good reason to suppose that the arts might be able to reduce feelings of loneliness. In an article by the Chicago Bridge on Building Community Through the Arts, the author notes that older adults experience social isolation for a variety of reasons. Some experience it due to diminishing physical capabilities, such as loss of hearing. Similarly, others may find that their own voices become too weak for most people to hear without above-average concentration. Still others develop mental problems, like “aphasia” (i.e., comprehension or language impairment), a common difficulty arising with various forms of dementia.
Language abilities are a complex tapestry of mental powers. For instance, many discrete cognitive faculties contribute to, and constitute, the ability to keep up with a conversation’s flow and to initiate a response. Alzheimer’s sufferers become deficient in many of these relevant processes and can only follow a normal discussion with great effort (if at all).
However, the arts in general, and perhaps music in particular, has the unique ability to touch human beings in a direct and intuitive way that is almost, dare I say, magical.[2] Thus, the creative outlets just sketched give Alzheimer’s-afflicted persons a way to connect even when communication is difficult (or practically impossible).
Dr. Natalie Rogers, an art therapist, described this creative connection quasi-poetically as “a process in which one art form stimulates and fosters creativity in another art form, linking all of the arts to our essential nature. Using the arts in sequence evokes inner truths which are often revealed with new depth and meaning.”[3] This “art connection” arguably supports a total integration of a person’s mind and body, fosters deeper relationships with others, and may even facilitate greater awareness of oneself. Or, where the requisite understanding is lacking, as it is in Alzheimer’s Disease, if not self-awareness, at least a certain self-acceptance or personal peace.
How Do the Arts Help?
Art, dance, and music engage regions of the so-called “non-verbal” parts of the brain. People who have trouble with verbal communication can still connect with others through the kinds of creative activities that, in a way, bypass the neurological roadblocks that are erected by dementia.[4] (For an overview of the literal “plaques” and “tangles” plaguing the brains of Alzheimer’s sufferers, see HERE.)
Alzheimer’s makes it hard for people to handle too much sensory input. Music, somewhat counterintuitively, seems to be able to help patients process sensory stimuli better.[5] Specifically, art appears to have a “strengthening” effect on memory, supporting the brain’s ability to recall associations that have been made with certain sounds and sights.
Investigators theorize that art and music are able to activate areas of the brain that Alzheimer’s has “turned off.” Music is especially potent because it is supposed to be processed in many different areas of the brain.[6] Further, musical memories are believed, so to say, to be more “deeply entrenched” in the brain than even language. Musical recollection sets the limbic system in motion because of the tie between melodies and emotions.
Neurologist Oliver Sacks has gone so far as to opine that human beings listen to music “with our muscles.” Although this is a somewhat cryptic comment, he seems to have in mind the fact that sound processing starts in the primal brainstem and then registers in the root structures called the “basal ganglia” – which, along with the thalamus, control voluntary motor movements and routine behaviors.
Thus, we see that Sacks’s statement highlights the importance of movement. Muscle movement, locomotion, and the like stimulate circulation – specifically, blood flow to the brain.[7]
Tips for Your Own Caregiving Environment
All of this theory is well and good. But how can you implement general art, dance and music in your own caregiving environment – whether at home or in an assisted-living facility or nursing home?
Art
Begin with simple projects – maybe abstract watercolor painting. But note well that, although projects should be simple, they should not be childish.
Build conversation into whatever activity you select. Talk about what they are doing.
Don’t rush anything. Let the person take his or her time.
Recognize that you might have to help the person get started (for example, by moving the brush) to show them what to do.
Movement
Again, don’t place arbitrary or unnecessary time limitations on the activity. Let them take the time they need – or desire.
Play music (for more on which, see below).
As before, you might need to jumpstart your loved one’s motions (in this case, by clapping with or for them, or tapping his or her feet, etc.)
Of course, movement can be rudimentary and still be benefit. This could range from dancing or just swaying, to pacing or walking, or even exercising. Hey, if it gets them moving, call it a win.
Music
Play music that is familiar to, or a favorite of, your loved one.
Tranquil music can calm, while a faster beat can boost the spirits. Mix it up.
Don’t play it too loud. Loud noise might cause agitation. On the other hand, remember that aging adults or dementia sufferers might have auditory difficulties on top of whatever other cognitive problems they have. So, be ready with the volume knob or remote in order to regulate the volume as needed.
Try to get commercial-free music in your play list. Commercials might confuse them. Additionally, commercials just break the mood and will tend to undercut the sustained effects that you are trying to achieve.
Encourage clapping, dancing, humming, or singing along.
Final Thoughts
Art therapy covers a lot of areas – dance/movement, drawing, improvisation, music appreciating, painting, sculpting, singing, and even (for those still higher functioning) writing. A common undercurrent is their engagement of the senses. For someone whose faculties are failing, these activities become rich avenues of information gathering. If a person’s vision and hearing are not as sharp as they once were, they may now rely on touch, taste and smell. So, don’t be afraid to add such pastimes as tasting or smelling different foods, looking at pictures, listening to rain, massage or aromatherapy.
Elaine Perry is a professor of Neurochemical Pathology at the Institute for Aging and Health – Newcastle University that is currently working on a study of aromatherapy for people suffering with Alzheimer’s and agitation. In one of her papers, she cites specific research that shows that certain essential oils are useful for elevating mood and calming agitation.[9] In several clinical tests using lavender and lemon balm as a natural treatment for residents having advanced dementia, it was found that there was a decrease in negative behavior. Geranium, rosemary and peppermint oils have also been tried with some success. Interestingly enough, the best delivery was in a lotion that was applied to the skin. The physiological effect is alleged to be present even if the person has lost their ability to smell (on which, see HERE).
For Further Research
Kate Gfeller and Natalie Hanson, Music therapy for Alzheimer’s and Dementia Individuals, Iowa City, Iowa: Univ. of Iowa, School of Music, 1995.
Notes:
[1] See the article titled “The Amazing Effect of Art and Music Therapy on Alzheimer’s,”
[3] Natalie Rogers, The Creative Connection: Expressive Arts as Healing, Palo Alto, Cal.: Science and Behavior Books, 1993.
[4] This has given way to the suggestion that cognitive skills may not be inextricably intertwined with the memory, as is presently the dominant view.
[5] It’s counterintuitive in the sense that music itself seems to be a kind of “sensory input.” Then why is it that music doesn’t seem to add to the feelings of overwhelm experienced by the Alzheimer’s sufferer? Perhaps the answer is something like this: the rhythm of the music may provide a kind of structure or “beat” to the afflicted person’s otherwise increasingly chaotic and unstructured thoughts. But this is just sheer speculation on my part.
[6] This is because the various elements involved in music – like pitch, rhythm and melody – are all processed by subtly different brain components.
[7] Oliver Sacks, Musicophilia, New York: Vintage Books, 2008. Sacks wrote: that there is “no single music center in the human brain, but the involvement of a dozen scattered networks throughout the brain.” He also credits the 19th-century German philosopher Friedrich Nietzsche with the thought that “Listening to music is not just auditory and emotional, it is motoric as well …[W]e listen to music with our muscles.”
Blood flow is one of the important factors in brain health according to Dr. Daniel Amen and his BRIGHT MINDS protocol. Exercise was also stressed by Dr. Jacob Teitelbaum’s program that highlights five areas for energy and brain health called SHINE. For more information on these matters, see HERE.
[9] Elaine Perry, “Aromatherapy for the Treatment of Alzheimer’s Disease,” Journal of Quality Research in Dementia, No. 3, n.d., (cached HERE).
The question of whether to drive or not is perhaps one of the most pressing to face dementia-afflicted patients. Basically, a person is licensed to drive when he or she is shown (usually by testing) to have mastered the mechanics and rules of driving as well as to be of legal age and of normal mental competence. Impairments of any sort might jeopardize mechanical mastery, obedience to and retention of the rules of the road, or general mental function. These factors, by themselves or together, may put the affected driver at risk (to him- or herself, or to others). However, a mere diagnose of Alzheimer’s Disease may not signal gross deficiencies in any relevant area. There are really two main facets to the query. One is: Is It Safe to Drive? I have covered this topic more fully elsewhere. (See HERE.)
It will have to suffice here to say (as was noted in my article on safe driving) that Alzheimer’s (and related dementias) affects coordination, cognition, concentration, decision-making, emotion, focus, memory, perception, reaction time, spatial awareness, understanding, and much else besides. Consequently, an Alzheimer’s sufferer might get “lost” more frequently than a non-sufferer; he or she may “misjudge” distances and turns; and such a person might “forget” (or neglect) good driving practices (otherwise known as the “rules of the road”). While these things tend to render a person with Alzheimer’s indisputably unsafe behind a wheel, the second question remains: what are the relevant legalities? I will tackle this, presently.
(For our State-specific guide to the relevant laws, see HERE.)
Does Alzheimer’s Mean Automatic License Revocation?
First and perhaps most obviously, does a diagnosis of some sort of dementia (including Alzheimer’s Disease) automatically entail license revocation? The short answer is: No – not necessarily.
Number one, remember that most forms of dementia – chiefly, for our purposes, Alzheimer’s – come in degrees or stages. (For a primer, see HERE.) Early-stage patients may still be able to drive even if, by middle stage, most sufferers are generally unsafe behind the wheel.[1]
While, again, this is not an article about safety, the present point is that unless a given driver is demonstrably unsafe, there are few grounds on which to base a case for revocation.[2]
Having said that, diagnoses of dementia may be grounds for license restriction.
What Is the Usual Process?
Different states tackle this differently. (For a State-specific guide to the relevant laws, see HERE.) But, speaking only in general terms, what typically happens is something like the following.
A person goes in for his or her license renewal. The renewal application has a question something like: “Do you suffer from a medical condition that could or does impair your ability to drive safely?” If a person answers “yes,” then that person would be medically evaluated straight away. (Possible results of this process are enumerated, below.) If, on the other hand, a person answers “no,” then he or she would have to undergo the usual renewal tests (driving, knowledge, vision, etc.), if any. If the applicant passes the tests, and has no impairments that are severe enough to be observed by the bureau/department of motor vehicle (BMV/DMV) employee, then the license will be renewed.
If the applicant’s license is renewed, then the entire process becomes reactive. To put it another way, the driver will be allowed to operate a motor vehicle with no restriction/oversight unless or until he or she is brought to the attention of the BMV/DMV. This might occur when the person’s doctor reports him or her for some medical reason. A handful of states have mandatory-reporting laws. (See the last paragraph of the next section for a list of said states.) Most states do not have such a requirement. However, physicians may report people for ethical reasons, to mitigate the attendant liability risks, or for other reasons.
A driver may also be reported by a court of law or by a law-enforcement officer. For example, these sorts of reports might occur after a traffic accident, traffic hearing, or traffic stop.
Finally, a person may be reported by a family member, caretaker, or even (in some jurisdictions) by concerned citizens or neighbors. Many times, these reports are treated as affidavits and must be dated, notarized, and properly signed. Typically, anonymous reports are rejected. However, a few states (including Florida, Ohio, South Dakota, and Washington, D.C.) treat reports as confidential. The concern with anonymous or strictly confidential reporting is twofold. Number one, for obvious reasons, states wish to avoid nuisance or revenge reporting (i.e., people reporting drivers for reasons of personal vengeance and the like). Number two, Western legal systems usually have provisions for enabling accused persons to confront their accusers.
(Again, to see the laws and regulations that are specific to your State, click HERE.)
Who Ultimately Decides Whether a Person May Drive?
Doctor’s evaluations usually settle the question either way. In a few states, physicians are actually required by law to report a diagnosis of Alzheimer’s (among other conditions) to various governmental bodies and, ultimately, to the department that oversees licensing or motor vehicles (such as the state BMV/DMV). (To get a sense of the myriad state-specific differences that arise at this point, see below.)
Even in states that do not mandate doctor reporting, there are usually mechanisms in place that allow other concerned or interested individuals (e.g., chiefly doctors, but also law-enforcement officials, relatives, or others) to file a report. In fact, most states are reactive in this way.[3] To put it slightly differently, the usual state of affairs is to leave licensed drivers alone unless or until one of more of the following occurs.
A person discloses that he or she suffers from some cognitive impairment, dementia, seizure disorder, etc. (that is, the afflicted person reports him- or herself);
The driver is brought to the attention of the licensing body via multiple accidents or other incidents; or
The Alzheimer’s sufferer is reported to the licensing agency by family members, law-enforcement personnel, or (mainly) physicians.
When any one of these “triggers” is tripped, the licensing or motor-vehicle department typically initiates a review process. This is the process by which the driver in question is put under scrutiny in an effort to ascertain his or her actual competency.
The individual’s driving and medical records may be examined. It is not uncommon for the licensing/motor-vehicle evaluators to send a letter to the targeted driver indicating that he or she is under review and giving said individual the opportunity to obtain the written opinion of his or her own doctor.[4] The review process may also involve requalifying the individual for a driver’s license by way of administering driving, vision, and written retesting.
In the end, for most states, the final word is given to competent medical personnel. Physicians evaluations are awarded immense weight. Additionally, “[s]ix States [California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania] currently require physicians to report certain types of impairments to the State licensing agency.”[5]
What Are the Main Outcomes of the Review Process?
Renewal – If a person obtains a favorable evaluation from his or her physician, then his or her license will likely be renewed. However, the licensing body may require more frequent reevaluations.
Restriction – Alternatively, a person could have his or her driver’s license renewed, but with certain provisos or restrictions. For example, someone might be limited to driving in a particular area, or to driving only during certain times of day (say, being required to avoid driving at night).
Revocation – If the person in question fails the retesting outright, or if the physician statement is unfavorable (from the point of view of renewal), then the license probably will not be renewed. Depending upon the state, there might be an appeals process or even the possibility of reexamination.[6]
What Are Possible Legal Repercussions From Driving While Cognitively Impaired?
Let’s face it, a main concern has got to be exposure to legal liability. If a licensed Alzheimer’s sufferer has an accident, is he or she open to a lawsuit? As I have stated elsewhere, I am incompetent to provide legal advice, but, intuitively, the short answer this time is surely yes. For one thing, almost anyone involved in an accident might be open to a legal action. Observe, also, that Alzheimer’s (and other dementias) are far from the only sorts of driving impairments. (Driving while under the influence of alcohol or drugs would also be impairments in the relevant sense.)
However, there is much more nuance than a mere “yes.” The fact that an Alzheimer’s-afflicted driver might open him- or herself up to a lawsuit in the event of an accident does not, by itself, imply that the Alzheimer’s Disease is necessarily a factor – let alone the deciding factor – in such a case.
Several issues are important. Number one, the Alzheimer’s-affected driver would have to be the one at fault. Number two, the Alzheimer’s Disease (or other dementia) would have to have been determined to be a causal factor.[7] To put a finer point on it, the available evidence would have to show (to any pertinent legal standard) that the afflicted driver’s impairment contributed to the occurrence of the accident.
However, there are circumstances that can create serious liability issues for Alzheimer’s sufferers, their families, and their physicians.
For instance, there could be severe legal consequences if there is good reason to believe that an afflicted person, his or her family, or his or her physician ignored or failed to adequately address signs that the relevant driver was unsafe behind the wheel. A person who ought to voluntarily submit to medical evaluation or who ought to disclose a cognitive impairment, but who does neither, could be legally liable. Of course, sometimes Alzheimer’s impacts self-awareness. In cases where this awareness deficit exists, it may be that the sufferer’s culpability is mitigated. But, presumably, this would have to be determined by a court or judge of competent jurisdiction. The intuitive point is that if a person knowingly and willingly operates a motor vehicle while impaired, then he or she might have to face legal consequences.
Similarly, family members or physicians who allow persons under their care to drive while impaired could also face legal actions. Of course, there are complications and subtleties to these questions. A key phrase is such cases is “good faith.” The driver and his or her caretakers (if any) are expected to act in good faith and with reason and experience, jointly applied.
Once again, these considerations are supplied merely for illustrative purposes. They are neither meant to be exhaustive nor applicable to every situation. If you or a loved one is suffering from some form of dementia, then you should seek professional advice. Doctors and lawyers both have their own spheres of competence, and both sorts of professional may have something relevant to say on this issue.
State-Specific Complications
Legalities pertaining to drivers’ licensing are handled by the individual U.S. States. Each state has its own procedures. (For a list of State-specific laws, see HERE.) Indeed, each state has its own departmental structures.
In sixteen (16) states (such as Arizona, Delaware, Hawaii, Idaho, Iowa, Kentucky,[8] Maryland, Massachusetts, North Carolina, North Dakota, Oregon, Pennsylvania, Vermont,[9] West Virginia, Wisconsin, and Wyoming), drivers’ licensing is overseen by a Department of Transportation.
In other states, the Department of Transportation merely deals with the building and maintenance of public highways and roads and licensing is managed elsewhere.
It could be under the auspices of a Department of Revenue (as it is in Colorado, Kansas, Missouri, and Rhode Island).
Sometimes (as is the case in Alabama, Florida,[10] Minnesota, Mississippi, New Hampshire, Ohio, Oklahoma, South Dakota, Tennessee,[11] Texas, and Utah) licensing is directed by a Department of Public Safety.
The Secretary of State’s Office facilitates licensing in Illinois, Maine, and Michigan.
A handful of states have one-of-a-kind departments. In Montana, drivers are licensed by the Department of Justice; Arkansas seemingly has a hybrid Department of Finance and Administration; whereas, in Washington State, there is literally a Department of Licensing.
In Georgia, it’s called Driver Services. (The same phrase crops up in other states, too. But in Illinois, Pennsylvania, Tennessee, and Wyoming, “Driver Services” is a subset of some larger, overarching, agency.)
Then there is another layer of terminological difference. Most states (i.e., by my count, Alaska, Arizona, Colorado, Idaho, Kansas, Kentucky, Montana, New Hampshire, New Mexico, North Carolina, North Dakota, Oregon, Rhode Island, Utah, West Virginia, and Wisconsin) refer to their motor vehicles agencies as “Divisions.”
Similar units are called “Departments” in California, Connecticut, Washington D.C., Maryland, Nebraska, Nevada, New York, South Carolina, Vermont, and Virginia.
On the contrary, “Bureaus” carry out licensing functions in Indiana, Maine, and Ohio.
And usual, some states have sui generis labels (in Louisiana, there is an “Office” of Motor Vehicles; in Massachusetts, it’s called the “Registry” of Motor Vehicles; and it’s a Motor Vehicle “Commission” in New Jersey.) Still other states use combination terms. Iowa and Minnesota both have composite names such as the Division of Motor Vehicles and Driver Services.
[1] One wrinkle, here, is that persons with even advanced dementia may have “good” days during which they seem to lucid and able to reason. These good days will be sprinkled in the midst of “bad” days where the person’s cognitive abilities are subpar. Even though this variability is well known, it is likely that, as far as driving is concerning, the safest course is to make licensing decisions based upon a person’s worst days, rather than their best ones. The reason is that an Alzheimer’s sufferer has little to no power over whether a day will be “bad” or “good.” Therefore, any given driving outing is left to chance. If the Alzheimer’s-afflicted individual has declined to the point where he or she would be unsafe driving on “bad” days, then it’s probably time to hand the license over.
[2] It is not enough That a given driver with early-stage Alzheimer’s or Mild Cognitive Impairment will, given the natural course of the disease, eventually become unsafe is not enough.
[3] That is, the majority of states do not seem to proactively restrict Alzheimer’s patients. Instead, most states wait until a credible concern is filed, and then the driver in question is subjected to scrutiny.
[4] In some cases, of course, the family doctor may be the person who referred the individual to the licensing body for medical review in the first place. Whenever a physician is involved, the licensors will elicit the physician’s considered opinion of the patient’s ability to drive safely.
[5] Here is an illustration of the authority given to healthcare professionals. One reference, for the state of Nebraska, states: “If the guidelines …indicate that [a] driv[ing] test need not be administered, but if [a] physician indicates on the …Physician [Statement] that one should be administered, follow the physician’s recommendations.” On the mandatory-reporting laws, see Medical Oversight of Noncommercial Drivers, Highway Special Investigation Report, Washington, D.C.: National Transportation Safety Board, 2004, Appendix E, p. 69. “California Lapses of consciousness and Alzheimer’s Disease severe enough to be likely to impair a person’s ability to operate a motor vehicle [;] Delaware Loss of consciousness due to diseases of the central nervous system[;] Nevada Epilepsy[;] New Jersey Recurrent convulsive seizures, recurrent periods of unconsciousness, or recurrent impairment or loss of motor coordination due to conditions such as epilepsy[;] Oregon Loss of consciousness or control. Cognitive and functional impairments that are severe and/or uncontrollable to a degree that may preclude safe operation of a motor vehicle and are not correctable by medication, therapy, surgery, driving device, or technique[; and] Pennsylvania Lapses of consciousness or other mental or physical disabilities affecting the ability of a person to drive safely[.]” Ibid.
[6] Again, however, if a driver is evaluated as unsafe because he or she is having one is his or her “bad” days, then this probably should be taken as an indication that the condition has advanced to the point where the driver is not reliably safe. A person should probably not be licensed just because he or she might be safe, but because he or she is predictably safe. While they may enjoy periods of lucidity, at a certain point in their decline, Alzheimer’s patients are no longer predictably safe. Therefore, unfortunately, they are not reliably safe, and probably should not be licensed. Another issue is the cost. Although some states may not charge for the initial review, if the outcome is contested, then the affected driver may end up having to pay for any requested reevaluations.
[7] Even if were not the only factor. It is arguable that many (if not most) accidents have complex causes.
Can an Alzheimer’s Patient Have Sexual Intercourse?[1]
This was the question fired at me from my two teenaged boys. My background is in philosophy, so I was able to talk a bit about issues of autonomy and consent (on which, see further on). But the total answer is, perhaps predictably, complex. Dr. Bruce Miller describes a study done “[a]round 1995” when nurses affiliated with the University of California – San Francisco “did a survey on [Dr. Miller’s] Alzheimer and frontotemporal dementia patients regarding sexual activity. The majority [of surveyed patients] had decreased sexual activity[;] some maintained activities similar to before [contracting] the disease[;] and …around 8% [actually] had increased activity.”[2] So, can we say anything, in general?
“[A] quick, general answer” comes to us by way of Dr. Victor Henderson, director of Stanford University’s Alzheimer’s Disease Research Center. He writes that “[i]n mild and moderate stages of their illnesses, many – and perhaps most – men with Alzheimer’s disease, and virtually all women with Alzheimer’s disease [AD], would be able to engage in sexual intercourse.”[3]
Dr. Gregory Jicha, “Dr. J,” of the University of Kentucky Alzheimer’s Disease Center, adds: “Sexuality and intimacy remain an important part of one’s life as they age. It is no different in AD.”
However, a lot turns on just how one understands the word “able” – in Dr. Henderson’s statement that Alzheimer’s sufferers are “able to engage in” sex. Let’s dig a bit deeper.
Physical Issues
Dr. Allan Levey puts it succinctly when he says, “There are no physiological reasons …why a person with Alzheimer’s disease would be unable to have sexual activity, except until late stages of the disease.”[4] Dr. J concurs, stating: “There are no physical impediments to engage in sexual activity that develop in Alzheimer’s disease until the very end stage when even walking is affected.”
“Alzheimer’s,” Dr. Caleb Finch remarks, “differs widely between individuals and …the parts of the brain usually damaged do not involve physical function in early stages.”[5]
However, Dr. Swerdlow reminds “…that people with Alzheimer’s are often older, may be frail, and frequently have other comorbid medical issues.” The Mayo Clinic’s Lunde expands on this by saying: “most individuals living with the disease are older adults and so age-related issues such as menopause, decreased sperm count, arthritis, hormonal changes, Erectile Dysfunction, illness, medications and depression are often factors related to sexual arousal and/or function.”
To put it slightly differently, even if Alzheimer’s itself does not destroy sexual functionality, said functionality may be diminished by other physical ailments or conditions that attend the aging process.[6] Dr. Mary Sano adds that the “stage of disease may relate to ability to be aroused or want to be aroused as well as to be sexually functional.” (More on this angle, below.)
On the other hand, Dr. James “Jim” Brewer relates that he is “aware of several AD patients whose physical state is outstanding[,] and there would be no physical impediments to [their engaging in] sexual activity.”[7]
A final consideration comes by way of Dr. Eric Reiman who notes that “effects of medications” might also affect sexuality – whether physically, emotionally or otherwise.
As Dr. Hank Paulson helpfully summarizes: “Sexual function is a complicated matter, of course, and many things beyond physiology contribute.”
Emotional Issues
Angela Lunde helpfully frames this part of the discussion, writing that “…the issues have more to do with changes in sexual feelings, desire, and behavior…” than with anything physical, per se. We might say that this constellation of concerns is broadly “emotional.”
Most relevantly, Dr. Marek-Marsel Mesulam notes that, “[g]enerally, Alzheimer’s decreases libido.”[8] Lunde hastens to say, though, that some Alzheimer’s-afflicted individuals actually suffer from an opposite problem, specifically “hyper-sexuality.” We may say, therefore, even if everything is physically operational (so to speak), without sexual desire the arousal mechanisms may be impaired.
“[M]any patients do lose interest in sex – but [it’s not] that the disease [by itself] imposes peripheral physiological challenges to sexual intercourse.” So reports the aforementioned Dr. Miller.
Dr. J, professor of neurology and part of the University of Kentuck-based Sanders-Brown Center on Aging, and his colleagues “studied changes in sexuality and intimacy in normal aging as well as in those with AD and their spouses. …What we …[found] was a general feeling of emotional estrangement in spousal caregivers, with their needs for intimacy and sexuality not being met. The person with AD was almost universally oblivious to this and felt that their needs were met and that the relationship was intact.” Dr. Reiman makes the point that “much of …[this] will depend on the couple.”
Again, Dr. J: “While our study did not further explain the ‘WHY?’ for this [phenomenon], we can postulate that it may be socially or culturally mediated, i.e. a feeling that it is not ‘right’ to engage in intimacy or sexual conduct with an impaired person[.] It could also be due to a reduction in emotional depth that could occur as part of the loss of cognitive processes in AD[.]”[9]
Along similar lines, Dr. Finch (quoted earlier) again remarks that “[s]ocial sensitivity …may be impaired in early stages.” It may therefore be that the Alzheimer’s afflicted individual no longer recognizes sexual “cues” from his or her partner.
Again, I turn to Dr. Sano. “When we talk about capacity, we falsely think it is the same as cognition and it is not. …[W]hile a person may not be able to ‘rationally report what they want’ they may still want a sexual life.” Unfortunately, we cannot peer into the afflicted person’s thoughts. “Additionally, as a person becomes more impaired, they may not be able to understand what another person wants.”
Ethical Issues
Of course, Alzheimer’s Disease undermines cognitive function. But, along with diminishing cognition comes diminishing capacity to consent. As Dr. Mary Sano relates: “Many things depend on the stage of dementia (with our assumption that milder patients have greater cognition and greater capacity to make decisions for themselves).”
In terms of ethics, specifically, there are several considerations that loom large when it comes to any discussion about sexual intercourse. One relevant notion (of many that could be mentioned) is that of autonomy, and another is informed, mutual consent. The two issues converge – and come apart – in interesting ways.
Autonomy is a Greek-derived word meaning, roughly, “self-law.” The idea is that an “autonomous person” is one who chooses (e.g., courses of action, values, etc.) for oneself. A mental competent[10] person (who has attained the age of majority and not forfeited his or her freedom, through imprisonment, military service, or whatever) has the right to determine his or her own courses of action – within the limits of the law. Other free agents have duties or obligations[11] to honor the choices of competent persons.
Similarly, “consent” has to do with agreement or compliance. In order for agreement to be fully “consensual,” the relevant agreement has to be “informed.” So, roughly, “informed consent” happens when a competent person has adequate information to make a responsible decision.
Requiring informed, mutual consent before engaging in sexual activities with another person is one way that person’s autonomy is properly respected. So, for example, a prospective, sexual partner much be made aware of my intentions as well as crucially relevant background information that might affect his or her decision (for instance, my sexual-health status). The other person needs then to be given the space to decide, free from bullying, coercion, or threats of any kind.
The obvious difficulty comes by virtue of the fact that, at certain stages of the disease at any rate, an Alzheimer’s sufferer is not mentally competent.[12]
Alzheimer’s and related dementias are by no means the conditions or situations that present challenges to informed consent. To get a flavor for this, think about a case in which a set of people with normal cognitive functioning volunteer for medical or scientific studies. Suppose that we’re talking about studying the effects of a migraine pharmaceutical. The researchers might disclose certain statistics relating to possible benefits (eliminating the migraine in 15 minutes, for instance). But they will also have to apprise potential participants of the pertinent risks (maybe stroke).
However, persons with “normal” brain functions will not necessarily be able to interpret benefit and risk statistics. It is well known that scientific-study participants sometimes do not (seem to) understand some of the relevant background information. For example, a person may believe that he or she will be receiving an actual dose of some drug, without giving appropriate weight to the possibility that it will be a placebo instead. Or a person might hear various probabilities for some adverse medical event (like the aforementioned possibility of stroke), without appreciating the actual risk that he or she faces.
Of course, Alzheimer’s sufferers are in an even worse position.
Think back to Dr. J’s comments regarding marital sexuality. A husband and wife share sexual experiences and strive for intimacy. Alzheimer’s patients may desire continued intimacy but be unable to express their desires. Alternatively, certain patients may lack the desire. But, from the point of view of the spouse/potential sexual partner, without the expression, it’s dicey business to just dive right in, so to say.
For we already rehearsed the idea that informed consent is the bedrock of respect for personal autonomy. The trick, therefore, is to understand what the Alzheimer’s-afflicted person’s wishes are, and to try to honor them. But this is obviously more easily said than done, since Alzheimer’s is – eventually – partially characterized by the inability to express one’s wishes (and, possibly, by the absence of concrete wishes of certain sorts).
In closing, though, it is well to bear in mind the words of Dr. Nathaniel Chin: “People with dementia can still appreciate human contact, emotional love, and have feelings of love, even if they cannot express it.” This seems plausibly true. And, even if it isn’t true, it is probably more responsible (and charitable) to behave as if it were true, than to behave as though it were not.
Final Remarks
I cannot hope to resolve every issue in this brief treatment. Hopefully, however, what has been said suffices to give you an apprehension of the some of the range of relevant issues.[13]
[1] In an email exchange, Dr. Gregory Jicha, Robert T. & Nyles Y. McCowan Endowed Chair in Alzheimer’s Disease in the University of Kentucky’s neurology department, called the question “fascinating” lamenting that it “has not been fully explored” but opining that it “certainly deserves more attention.”
[2] Angela Lunde, education program manager for the prestigious Mayo Clinic, comments that “overall, there is no single pattern of sexual change in person living with AD.” Miller’s research seems to bear this out.
[3] He notes further: “Some of the other forms of dementia do affect the ability of men to engage in intercourse.”
[4] This was echoed by numerous other experts, including Dr. Russell Swerdlow, who added: “The AD would not be expected to profoundly directly impact a person’s sex organs. So physically there would not be [any predictable negative] …effect [sexually]. …Alzheimer’s in and of itself would not have a profound impact on the function of the sex organs.” Angela Lunde puts it this way: “Alzheimer’s disease alone does not generally impede one’s physical capacity and/or sexual function and reproduction.” Dr. May Sano demurs, however. She expresses doubts “that anyone has answers” to these questions.
[5] Understanding stages is crucially important to understanding Alzheimer’s. As Dr. Nathaniel Chin reports: “A person with dementia due to AD can still have sexual intercourse but it will depend on the stage. As the dementia worsens a person’s sexual drive as well as their physical ability to have sex can become impaired. Additionally, mood becomes affected and medications used to treat mood can interfere with a person’s emotional and physiological drive to have sex. Early in the disease there may not be any physical impairment to sexual function. Dynamics in relationships may change but a person with dementia physiologically can still have desires for sex.” More on these emotional angles, below.
[6] Dr. Hank Paulson adds: “Alzheimer’s does not typically lead to major changes in the physiology of sexual function, although some other neurodegenerative diseases can, such as multiple system atrophy.”
[7] He adds these thoughts: “The disease has a lot of sad components, and I often find myself thinking what a shame it is when a patient’s brain fails so much earlier than the body. It seems to me that these individuals would have lived a long, healthy life, if it weren’t for their brain condition.”
[8] It may increase “inhibition,” in Lunde’s words.
[9] He adds: “My guess is that this is a common problem that is simply not discussed often for a variety of social and cultural reasons. … Our ultimate goal would be to develop an intervention to help maintain emotional and physical intimacy given its importance to us as humans throughout our lifespan.”
[12] I.e., he or she is generally regarded as non compos mentis.
[13] Dr. Reiman notes that interested readers can find more information online, for example from the British Alzheimer’s Alzheimer’s Society, e.g., <https://www.alzheimers.org.uk/sites/default/files/migrate/downloads/factsheet_sex_and_intimate_relationships.pdf>. Sarah Brisebois, Research Study Coordinator at the Alzheimer’s Disease Center on the campus of the University of Texas’s Southwestern Medical Center – Dallas, points us to several articles on the Alzheimer’s Association’s website: <https://www.alz.org/national/documents/topicsheet_sexuality.pdf>, <https://www.alz.org/oregon/images/microsoft_word_-_intimacy_and_sex-feb_08.pdf>, <https://www.alz.org/library/downloads/sexandintimacy_rl2015.pdf>.
When Is a Person With Alzheimer’s Too ‘Far Gone’ to Drive Safely? Can Someone Drive With Mild Cognitive Impairment?
These are very sensitive issues and should be discussed with the afflicted person (if possible) along with the attending physician, family members, legal advisers, and so on. Although this website cannot and does not provide specific advice (whether legal or otherwise), we will lay out – for conversational and informational purposes only – some general, practical guidelines.
The first and most obvious point is that Alzheimer’s varies according to stages. (For a brief introduction, see HERE.) In early stages, Alzheimer’s may not significantly impair a person’s driving ability.[1] As the sufferer declines, regrettably, cognitive and reasoning functions, memory, and physical reflexes will inevitably diminish to the point that safe driving will no longer be possible. The main question is when, precisely, this tipping point occurs.[2]
In order to prepare for the virtually unavoidable conclusion, but before the relevant problems surface, it is wise to consider – and plan for – means of transportation that can serve as driving substitutes. In most cases, and for short trips, these alternatives (depending on the area) will be things such as buses, personal drivers, shuttles, taxis, trains, and the like.
(Although cycling, walking, and other similar activities may be options early on [and for more on their benefits, see HERE], numerous factors – such as physical enfeeblement and inclement weather – might remove them as recourses – whether permanently or temporality.[3])
If possible, you may want to test these (and other) options out, as well as consult with family members and friends who already utilize them, to help determine the one that best meets your loved one’s needs.
How do I keep driving safely? Pre- and Early-Stage Alzheimer’s
While your or your loved one’s ability to drive represents independence, it also may jeopardize his or her safety and that of other drivers on public roads. Therefore, again, these tips should be taken as general rules of thumb, but not as universally applicable – or even universally advisable. Consult pertinent healthcare providers for more insight and for case-specific recommendations. Keep in mind that some areas may have laws that govern some of these issues. It may therefore also be necessary or prudent to seek legal advice from a competent attorney.
That said, it is still true that simple measures may help to extend your or your loved one’s time behind the wheel. There are a few relevant categories. Here are a few things to consider.
Vision Considerations
Schedule regular eye and vision examinations. This is one of the staples of general, preventative medicine in any case. But it is of vital importance when it comes to keeping a person safely operating a motor vehicle. (Did you know, some eye tests can actually detect Alzheimer’s? See HERE.)
Update eyeglass or contact-lens prescriptions. This is really an extension of the previous point. Corrective lenses only function correctly if they are suitable.
Periodically replace windshield wipers and, in general, keep the car’s mirrors, windows and windshield clean. Maintain headlamps in proper working condition and adjust the brightness on the vehicle’s instrument panel for optimal visibility.
Broader Health Considerations
Schedule periodic wellness checkups. If cognitive-impairment is suspected, ensure that you or your loved one disclose all relevant concerns to a qualified healthcare provider. Tests such as the Mini Mental-State Exam might be usefully employed. (For more on this test and others, see HERE.)
Your or your loved one’s life – as well as the lives of others – is more valuable than having a few more outings behind a steering wheel. Be sure to honestly bring driving-related questions to your physician.
In certain cases, and for particular conditions, occupational or physical therapy may assist a driver in maintaining or rehabilitating skills that are essential for safe motor-vehicle operation.
Other Vehicle Considerations
It may be worth replacing a car or truck with a vehicle that is more suitable for your or your loved one’s condition or life station. Although some of the following are, by now, nearly universal, here are some general things that might get you thinking in the relevant direction.
Automatic transmissions are usually easier to operate than manual transmissions.
Power brakes and power steering should be available and properly functioning.
Instrument panels should be easy-to-read and without extraneous or confusing information.
Doors and seats should facilitate ease of vehicle entry and exit.
Commensensical Driving Dos and Don’t
Avoid distracting your loved one or competing for his or her attention. Don’t let your own mind wander. Minimize noise and reduce disturbances! Here are a few (fairly obvious) tips that might apply to some situations. If there is a common undercurrent, it would be: Exercise an abundance of caution and focus.
Avoid driving in inclement weather, during high-traffic (“rush-hour”) times, or in the dark.
Observe all rules of the road, including: checking traffic and signaling properly when changing lanes, looking twice before reversing, maintaining sufficient vehicle distance, and so on.
Limit or postpone having conversations until out of the vehicle.
Turn down music, podcasts, radio programs, and so on. In other words, concentrate on the road!
Set air-conditioner or heater controls before the vehicle is in operation.
Map routes and plan trips ahead of time and select roads for their drivability and not necessarily for their drive times.
If you or your loved one drives infrequently, skills may slip. Keep in practice. Depending upon your area, it may also be possible to enroll in continuing-education courses in order maintain (or enhance) skills, in addition to acquiring strategies for coping with dementia or disabilities.
Finally, as hard as it may be to read, it is a good practice to have competency assessed periodically – both through physicals administered by a healthcare provider as well as via relevant tests (driving, vision, and written).
When to Give up the License/Signs of an Unsafe Driver
You or your loved one may need to have significant restrictions imposed (up to and including license revocation) if certain warning signs surface. Here are things to look for. Your loved one:
Has difficulty discerning the gas pedal from the brake pedal.
Sometimes confuses turning right with turning left – or vice versa.
Declines, forgets, or refuses to use turn signals (or displays other poor decision-making faculties).
Changes lanes in a dangerous manner, does not yield correctly, or weaves in his or her lane.
Has obvious trouble recognizing road signs.
Routinely disregards or otherwise fails to obey traffic signals (e.g., not stopping at red; stopping on green; etc.).
Cannot hear sirens from emergency vehicles.
Cannot see or focus on the road.
Does not seem to notice other cars on the road.
Believes that most other drivers are going “too fast.”
Believes that other drivers go “too slow.”
Has had accidents, actual moving violations, “close calls” or “warnings” more and more frequently.
Misjudges distances, as evidenced in virtue of erratic turning (turning too widely and veering out of a lane, or too narrowly and running onto the shoulder or a curb) or following other vehicles improperly (giving too much distance, or not enough).
Has physical difficulties with the mechanics of driving. [4]
Gets (inappropriately) angry, confused, or frustrated driving.
Forgets how to navigate to or from familiar places.
Feels fatigued or overwhelmed after brief periods of driving.
If children, other family members or friends become worried about someone’s driving ability, then this should be taken as an immediate and obvious red flag. Bear in mind that some Alzheimer’s-afflicted persons may be self-aware enough to accurately assess their own driving abilities and to honestly catalog their limitations. Other dementia patients do not display this sort of insight (or honesty) and, therefore, require much closer attention from doctors, family, friends, or other professionals.
Check Yourself!
AAA once published a self-assessment test under the title “Drivers 55 Plus: Self-Rating.”[5] The assessment included questions about whether you or your loved one:
Habitually signals when changing lanes.
Properly and regularly wears seat belts.
Has difficulty navigating through four-way stops or otherwise busy intersections.
Has trouble merging into congested highway traffic.
Perceives himself or herself to be “slower” in terms of cognition, perception, reflexes, and the like of that.
Has difficulty separating him- or herself from emotional states or becomes easily angered by high-traffic situations.
Cannot stop his or her mind from wandering.
Sees general practitioners and specialists (like eye doctors) regularly to ensure that overall health, prescriptions, and vision are optimal.[6]
[1] Of course, other conditions – for instance, those that result in blackouts, dizziness, or seizures – might undercut driving abilities. But these, except insofar as they are byproducts of dementia, lie beyond the scope of the present article.
[2] Bear in mind that there may be a transitional period during which the patient alternates between lucidity and confusion.
[3] At a certain point, it is likely that the patient will need full-time care. For a discussion of long-term care – with an emphasis on the attendant costs – see HERE.
[4] For example, maybe grandma has a problem shifting pressure between pedals. Perhaps grandpa’s arthritis prevents him from controlling the steering wheel or changing gears. It might be that dad cannot turn his head to check his blind spots. Maybe mom’s prescriptions are causing her to become sleepy and inopportune times.
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>.
