I will be gone for 1 or 2 weeks

I will be out of pocket for a week or two. We just bought a cabin on a chain of lakes in north central Wisconsin and are setting it up. We have no internet service for a while.

MindStart

Sunday, May 6, 2012

By Monica Heltemes 

Today 5.4 million Americans are living with Alzheimer’s disease or other forms of dementia. Over 15 million family members or friends serve as caregivers (Alzheimer’s Association Facts and Figures 2012). These caregivers watch their loved one struggle with everyday tasks and lose memories of their life. Caregivers often do not know the steps to take to help keep the person “doing things” or staying active.

The new MindStart website at http://www.mind-start.com is the only one of its kind, providing both original Alzheimer’s activity products and education for family and professional caregivers on how to keep the person active and engaged.

The new MindStart website features expert-designed activity products that are made specifically for individuals with dementia and their caregivers. MindStart dementia products include large piece jigsaw puzzles, memory books, dementia games, word searches, and more. Products can be used with people at various stages of dementia and include user guides to help caregivers to choose the right level of challenge for the person. Multiple photo images and product videos are available through the website, to allow customers to see the products in use.

In addition to the products, the new MindStart website also includes educational content, including:

·             A section on how dementia affects the ability of the person to “do things”.

·             Easy tips and techniques to help caregivers incorporate activity into the day of the person with dementia. The latest Alzheimer’s and dementia care research on the use of activity engagement, or cognitive stimulation, in dementia care. A 2012 report by the Cochrane Review found that “activities that provide cognitive stimulation have a beneficial effect on the memory and thinking test scores of people with dementia… benefits that were over and above any medication effects".

·             A section that describes how staying active through cognitive stimulation serves as a form of therapy for the person with dementia and how the MindStart products might be used in this therapy.

·             A blog with informative posts about dementia care techniques and about noteworthy dementia-related news.

·             Access to the MindStart Facebook page, LinkedIn account, newsletter sign-up, and MindStart YouTube channel, which features videos about the MindStart products and videos about keeping people with dementia active.

The MindStart website is a valuable resource to both families and professional staff. It has already reached nearly 50 countries around the world. Monica Heltemes, OTR/L, founder of MindStart and occupational therapist, explains that people living with Alzheimer’s and other forms of dementia and their caregivers are starved for more information and resources.

 “Unlike medical conditions that are well known, Alzheimer’s is a hidden disease, for which most people do not understand, know how to handle, or are afraid to talk about. We need more resources, products, and overall awareness to help people living with dementia to have active and joyful lives. The MindStart website opens doors for educating caregivers and offers tools to use, so that the person with dementia can continue to live an active and joyful life.”

Learn more about keeping people with dementia active at http://www.mind-start.com. Also, a special thanks to Bob and readers for allowing me to share about this website.

Monica Heltemes is a practicing occupational therapist and owner of MindStart™. MindStart designs hobby-style items, such as games and puzzles, specifically for persons with memory loss. They keep persons with dementia active, while giving support to caregivers, and are quick and easy to use. Visit MindStart (Activities for Persons with Memory Loss) to learn more.

Low Rate of MCI Progression to Dementia in the Community

From Medscape Medical News > Neurology

Pam Harrison

March 31, 2011 (Toronto, Ontario) — Mild cognitive impairment (MCI) diagnosed in the community can progress to severe impairment or dementia, but it appears to do so at a much lower rate than that reported in clinical trials.

Mary Ganguli, MD, MPH, University of Pittsburgh, Pennsylvania, and colleagues found that MCI in the community is far more heterogeneous than MCI treated in a specialist setting and that caution should be used when extrapolating experience from memory clinics to the larger community. She also found that the prevalence of MCI in the population depends on the definition of MCI used to diagnose it.

"This is a population study which, like every other population study in the world, showed that when you apply current MCI criteria in a consistent and objective way to the population, you identify a lot of patients, some of whom are going to get worse and develop dementia, but many of whom are going to remain mildly impaired and a few of whom are going to get better," Dr. Ganguli told Medscape Medical News. "So clinicians should not assume that every case of MCI is early Alzheimer's disease because the latter 2 groups probably do not have progressive disease."

Their results were presented here at the Alzheimer's Disease International 26th International Conference.

Small Proportion Progress

For the study, researchers identified 1982 subjects 65 years and older from the voter registration list in Pennsylvania. Participants were classified as having MCI using definitions of several current criteria for MCI, including amnestic MCI by the Mayo criteria, expanded MCI by the International Working Group (IWG) criteria, Clinical Dementia Rating (CDR), and a purely cognitive classification into amnestic and nonamnestic MCI.

For each MCI definition, researchers examined 3 outcomes at 1-year follow-up. The first was worsening, defined as progression to dementia with a CDR score of 1 or more, or severe cognitive impairment at rates higher than cognitively normal peers. Researchers also evaluated the cohort for signs of improvement, characterized by reversion to a CDR score of 0 or normal cognition, and stability, reflected by an unchanged CDR score or cognitive status at follow-up.

"Regardless of the definition used, a small proportion of MCI patients in the community progress to dementia or severe cognitive impairment," Dr. Ganguli reported. Looking at CDR outcomes for different definitions of MCI, 2.8% of the group had worsened at 1 year when MCI was defined by Mayo criteria, whereas 72.2% remained unchanged and 17.4% improved.

When MCI was defined by IWG criteria, only 0.7% of the cohort had worsened at the end of 1 year, whereas 80% remained unchanged and 18.3% had improved. When using the CDR score of 0.5, 1.8% of the cohort worsened, whereas 72.3% remained unchanged and 25.9% improved.

"When definitions focused on memory impairment and multiple cognitive domains, higher proportions progressed and lower proportions reverted to CDR," investigators add.

Table. One-Year CDR Outcomes

MCI definition	Worsened, %	Unchanged, %	Improved, %
Mayo	2.8	72.2	17.4
IWG	0.7	80.0	18.3
CDR score of 0.5	1.8	72.3	25.9

CDR = Clinical Dementia Rating; IWG = International Working Group; MCI = mild cognitive impairment

Two-Year Follow-up

At 2-year follow-up, Dr. Ganguli also reported that no patient diagnosed as having MCI at baseline but who had improved during the first year worsened in the second year. Among the group who remained stable during the first year, 0% to 10% worsened during the second year based on CDR outcomes, whereas using purely cognitive measures, 0% to 27% worsened during the second year. "Patients most likely to worsen were the multidomain amnestic group," Dr. Ganguli noted.

As Dr. Ganguli also pointed out, a previous meta-analysis of population studies showed that the annual conversion rate from Mayo defined MCI to various forms of dementia were higher in specialist clinical settings than in community studies and that most people with MCI in the community will not progress to dementia ever after 10 years of follow-up (Acta Psychiatr Scand. 2009;119:252-265).

"We are talking about different people," Dr. Ganguli said, explaining the discrepancy between studies and the population. In clinical series, she noted, people are seeking care for dementia or cognitive impairment.

In contrast, those in the community might tell a physician they are having memory problems if asked and, on testing, do have memory deficits, but they are not actively seeking help.

"As a clinician, I have lots of patients who have been mildly impaired for years, but they are not getting any worse and sometimes they get better," Dr. Ganuli told Medscape Medical News, "so there are many patients who have mild impairment but without calling it MCI."

Community Population

Session chair Mariella Guerra, MD, with the Alzheimer's Association of Peru, told Medscape Medical News that it's important to keep in mind that this study was performed in a community and not in a clinical trial setting; these are not patients asking for evaluation and they are not experiencing memory loss, whereas those who present to a memory clinic who are experiencing memory deficits probably already have MCI, she noted.

"Physicians therefore should not assume that if they diagnose MCI, patients will go on to dementia," Dr. Guerra reiterated. "There are patients with MCI who can revert, as these results show."

The study is currently in press and is scheduled to be published in the Archives of Neurology.

The study was funded by the National Institute on Aging. Neither Dr. Ganuli nor Dr. Guerra have disclosed any relevant financial relationships.

Alzheimer's Disease International (ADI) 26th Annual Conference: Abstract OC124. Presented March 29, 2011.

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Expert Doctor Q&A

Half of Alzheimer's cases misdiagnosed Roughly half of the people who are told they have Alzheimer's disease may in fact have other forms of dementia that produce similar symptoms, according to a new study. Doctors have known for some time that the confusion and memory loss caused by the brain lesions associated with Alzheimer's can also be caused by other types of brain changes, such as tissue damage stemming from strokes. The study suggests that it may be even harder than previously thought to identify the source of dementia while a patient is still alive, says lead researcher Lon White, M.D. Health.com: 25 signs and symptoms of Alzheimer's Disease "There are at least five different kinds of important lesions which can produce a picture that looks like Alzheimer's," says White, a professor of geriatric medicine at the University of Hawaii in Honolulu. "Each of those five kinds of lesions is apparently driven by its own pathologic process, and having one doesn't protect you from having others. All are independent and all are increasing with age." White and his colleagues performed brain autopsies—the only surefire way of diagnosing Alzheimer's—on more than 400 elderly Japanese-American men. Only about half of those who had a diagnosis of Alzheimer's before death had the brain plaques that signal the disease. The dementia in the other half appeared to have been caused by abnormal protein deposits (known as Lewy bodies), stroke-related tissue death (microinfarcts), cell damage, or some combination thereof. The researchers have since completed another 400 or so autopsies with similar results, and will present their findings in April at the annual meeting of the American Academy of Neurology. Unlike studies published in medical journals, these findings are still preliminary and have yet to be thoroughly vetted by other experts in the field. Health.com: 9 foods that may help save your memory An Alzheimer's misdiagnosis doesn't have immediate consequences for the patient because no treatments exist that can stop the steady progression of the disease. And the drugs that, in some people, help slow Alzheimer's or make it more tolerable appear to work for other types of dementia, White says. Patients and their families can nevertheless benefit from an early and accurate diagnosis. Ruling out other forms of dementia may help relatives plan for future care and determine their own risk for Alzheimer's, for instance. Accurately diagnosing Alzheimer's is even more critical for research on potential treatments. Without knowing precisely who has Alzheimer's, pharmaceutical companies that have been developing new drugs "are not going to be able to see a true assessment of how effective their drug is," White says. Health.com: Should I take medicine for Alzheimer's disease? Some promising advances in diagnosis have been made recently. A study published last year found that spinal fluid tests can predict Alzheimer's with a high degree of accuracy, and the Food and Drug Administration is currently weighing the approval of a brain scan that uses dye to highlight the plaques characteristic of Alzheimer's. The reliability of these methods needs to be confirmed, however. "Everybody knows we need to do a better job of diagnosing," says Maria Carrillo, Ph.D., the senior director of medical and scientific relations at the Alzheimer's Association, a research and advocacy organization based in Chicago. "We are all trying to make that diagnosis better, earlier, faster. All of those things are currently under way in terms of research study." Copyright Health Magazine 2011