Newsletter On Aging, Alzheimer's and Healthcare Issues Facing Americans

March, 2009
An Integrative Approach to Treating and Preventing Alzheimer’s Disease © Zoë A. Lewis, M.D., FACP

The truth is, care givers, doctors, and nurses get frustrated with the needs families often have because they are at a loss to know where to begin with help. Even when needs have been identified, and solutions offered, families are often lost in the maze of information they may be offered. Limited guidance often brings still more questions. Think of the directions we have all struggled with the first time in setting up a blackberry or other new tech devise. I reasoned at the time I dedicated my resources and life to write about my experiences with care giving and Alzheimer’s work, one simple holistic guide, that made it easy to find and access resources could make a big difference for families that had no clue what to do next. I knew they were going to need basic information. I also knew they were going to need to know about quality of life support and that meant introducing integrative techniques, especially music and art therapy. These are areas that are not so new any longer but were still unknown to me when I first started out in medicine 15 years ago. These strategies have worldwide recognition. (Both music and art therapy disciplines are organized in international associations). Important links for these Organizations and how they can and do help with dementia are here:
http://www.arttherapy.org/
http://www.musictherapy.org/

April, 9, 2009
Yoga and Pranayama – Possible Prevention against Alzheimer’s

"We're really going to have to do a better job of dealing with Alzheimer’s disease. We're going to have to find better treatments and preventions,” says Bill Thies, chief medical and scientific officer of the Alzheimer's Association. This comes after the report out in March, ‘The 2009 Alzheimer's Disease Facts and Figures’, indicating that an estimated 5.1 million Americans over 65 now have Alzheimer's with a new diagnosis made every 70 seconds.
Now for the scarier part, I suggest from what I see and hear, simply remaining active, both mentally and physically, the current best practice recommendations, does not seem to be enough to prevent Alzheimer’s disease or slow it down. Just consider the facts, and the famous among us associated with the disease. I Googled the search title, ‘Famous people with Alzheimer's’, and here is what I got:

Joe Adcock, baseball player
Mabel Albertson, actor
Dana Andrews, actor
Rudolph Bing, opera impresario
James Brooks, artist
Charles Bronson actor, film director
Abe Burrows, author
Carroll Campbell, Former Republican Senator
Joyce Chen, chef
Perry Como, Singer entertainer
Aaron Copland, composer
Willem DeKooning, artist
James Doohan, actor
Thomas Dorsey, singer
Tom Fears, professional football player and coach
Louis Feraud, fashion designer
Arlene Francis, actor
Mike Frankovich, film producer
John Douglas French, physician
Barry Goldwater, Senator of Arizona
Rita Hayworth, actress
Raul Silva Henriquez, Roman Catholic cardinal, and activist
Charlton Heston actor and political activist
Mervyn Leroy, director
Jack Lord, actor
Ross MacDonald, author
Burgess Meredith, actor
Iris Murdoch, author
Edmond O’Brien, actor
Arthur O’Connell, actor
Marv Owen, baseball player
Molly Picon, actor
Otto Preminger, director
Bill Quackenbush, professional hockey player
Ronald Reagan, 40th President of USA
Harry Ritz, performer
Sugar Ray Robinson, boxer
Norman Rockwell, artist
Simon Scott, actor
Irving Shulman, screenwriter
Betty Schwartz, Olympic gold medal winner in track events
Kay Swift,composer
Alfred Van Vogt, science fiction writer
E.B. White, author
Harold Wilson, British Prime Minister
These are only a few of the names, but notice in this list,( growing everyday with more illuminati) the inclusion of former Presidents, Prime Ministers, Olympians, scholars and athletes. You too might well be worried, 'what chances do I have?', as you read down the list , considering ongoing mental and physical activity are considered preventative - 'what happened to them?'
Of course we acknowledge there are numerous factors implicated in the development of this disease, but chronic anxiety and stress with deleterious hormonal changes that accompany cortisol elevation associated with chronic stress are under investigation and may be a major factor. Stress is the byproduct of the modern lifestyle. On a biochemical and molecular level, the strategy for dealing with stress today is no different than is was for our prehistoric ancestors. I would imagine running from a predator beast is as stressful as one can imagine. Yet, it is the chronic, daily and unremitting stress for many that has become part of the modern way of life. Traffic, multitasking and the like with deadlines and the 18 hour day many put in every day.
This modern lifestyle may be one of the factors leading to many diseases including Alzheimer’s and cardiovascular disease. Quite simply, chronic stress has a biochemical substrate for causing disease.
As an internist delivering primary care, I focus on natural solutions for the prevention of disease. Yoga and Pranayama, (a controlled breathing technique) may offer a benefit by reducing stress. Yogis tout health benefits and wellness from a steady yoga practice. Medical scientists and the skeptics among us want research and science as proof. I was surprised to be informed by the editors of numerous healthcare magazines, (even those targeting yoga and the natural life style) - “Can't prove it, we are not interested”. I believe there is an association between chronic stress and illnesses including cardiovascular and Alzheimer’s disease. Yoga and pranayama have been studied as stress reduction techniques and have been shown to improve blood pressure and reduce the symptoms associated with stress. There are no direct studies linking yoga, pranayama or other stress reduction methods – to the prevention of dementia, including Alzheimer’s disease,. Perhaps this is the direction we could be pointing for future investigations as some of the preliminary work in this field does suggest benefits. I am not a yoga salesperson or fanatic, but reason that if there is limited or emerging research to suggest any benefit, more attention should be given in academic circles. In the meanwhile, if yoga and pranayama appear to be beneficial for the modest reduction in stress associated symptoms, including hypertension, it may offer a preventative measure against diseases linked to chronic stress like Alzheimer's disease and other dementias.
Selected Research Investigating Yoga and Stress Reduction
Here is what we do know, and perhaps could be the basis for future investigations:
The Annals of Behavioral Science, October 2004, reported how yoga can reduce cortisol levels. In the June 2004 the Journal of Clinical Psychology cited that caregivers for people with dementia (including Alzheimer’s disease) improved physical and emotional functioning after practicing yoga. The February and August 2005 studies published in the Journal of Alternative and Complementary Medicine analyzed the breathing techniques of a specific yoga practice, (Hatha Yoga), and the authors maintain it reduced stress, including post-traumatic stress disorder. The Mindfulness-based Stress Reduction Program (MBSR), popularized by Jon Kabat-Zinn and the Center for Mindfulness in Medicine, Healthcare and Society at the University of Massachusetts Medical School, has been well studied around the world. Add to that the work of Dr. Herbert Benson of the Benson-Henry Institute for Mind Body Medicine (BHI), affiliated with Harvard Medical School. Yoga is one of the strategies they use to help people to manage the negative effects of stress.
The most substantial report to date, ‘Meditation Practices for Health: State of the Research in June 2007’ - funded by The National Center for Complementary and Alternative Medicine for The Agency for Healthcare Research and Quality, (part of the U.S. Department of Health and Human Services) concluded that many uncertainties surround the practice of meditation, but that TM®, Qi Gong and Zen Buddhist meditation significantly reduced blood pressure. It was also determined that yoga helped reduce stress. Studies also show if we reduce high levels of cortisol, we reduce the damaging effects of stress.
Pranayama - What does it mean?
In a Yogic point of view, Pranayama, is the science of breath control. It consists of series of exercises especially intended to meet the body's needs and keep it in health. Pranayama comes from the following words:
Prana - "life force" or "life energy"
Yama - "discipline" or "control"
Ayama - "expansion", "non-restraint", or "extension"

Thus, Pranayama means "breathing techniques" or "breathing control". It is intended for yoga practitioners to help and prepare them in their process, but it can be used by anyone to increase the amount of oxygen to the brain, thereby maintaining brain health and vitality. Simply by practicing deep and systematic breathing through Pranayama, we reenergize our body and restore balance.
Benefits of Pranayama
Pranayama develops our concentration and focus. It fights away stress and relaxes the body. Controlling one's breathing also results to serenity and peace of mind.
Pranayama offers a better self-control. Through concentration, one can better handle temper and reactions. Mind can function clearly, avoiding arguments. Self-control also involves control over one's physical body.
Look for my upcoming video that will be linked to this site, demonstrating pranayama – basic and advanced versions.

May 11, 2009
The Power of a Documentary Film to Educate Millions
© Zoë A Lewis, M.D., FACP

Maria Shriver is the latest celebrity spokesperson up to battling Alzheimer's disease. She went before the Senate last month and described the issues in caring for her famous father, Sergeant Shriver, stricken with AD in an effort to help bring about greater public awareness. She stated, "We have to put Alzheimer’s on the front burner, because if we don't, Alzheimer’s will not only devour our memories -- it will cripple our families, devastate our health care system, and decimate the legacy of our generation."
I watched the first of the four episodes last night. I can say the power of a documentary film with mass media distribution portraying accurate, unsentimental real life stories will do more for the American public’s education about this disease than my book, others books, speakers, TV shows, and organizations with panels of experts or news reports. The first night was a powerful collection of stories and was exemplary in details of behavior, emotions, with accurate inartistic and “reality based” portrayals of “how it is" from the time of early diagnosis to the very end and death. I was greatly moved and think millions will feel the same. At least viewers will get the big picture of what this disease does to our aging. Bravo and thank you HBO and the producers.
The Alzheimer’s Project is a presentation of HBO Documentary Films and the National Institute on Aging at the National Institutes of Health in association with the Alzheimer's Association, The Fidelity® Charitable Gift Fund and Geoffrey Beene Gives Back® Alzheimer's Initiative. All films will stream free of charge on www.hbo.com/alzheimers and will be offered for free on multiple platforms by participating television service providers.

June 26, 2009
What we need to know now on healthcare reforms for older adults: "Debunking the Financial Myths"© Zoë A. Lewis, M.D., FACP
How many times have you heard this?
"It's the old people that no longer contribute to society and rack up billions in health care costs - they are the real problem causing soaring healthcare costs today." It is a scary thought that healthcare may be “rationed" and if scapegoats exist, they would likely be those that cannot care for themselves, relying on advocacy groups to protect them. I will reprint an article that centers the arguments surrounding the myths of aging and healthcare costs. Sources are cited at the end.

NEW YORK (September 20, 2007) — Myth or fact: soaring medical costs in the United States can be blamed on the rapidly growing 65+ population? Myth, says a new report "Myths of the High Medical Cost of Old Age and Dying" from the International Longevity Center-USA (ILC-USA). According to the report, despite public perception, health care cost associated with aging is “quite limited”.
“When we imagine the end of life, most people picture a very frail older patient receiving expensive and unlimited medical care,” says Dr. Robert N. Butler, president and CEO of the ILC-USA. “The truth is only a fraction of older adults receive costly care at the end of life. In fact, they are less likely to receive aggressive care when dying then other age groups.”
The Seven Myths
The "Myths of the High Medical Cost of Old Age and Dying" identifies and dispels seven myths about caring for older people at the end of life.
Myth 1: The growing number of older people has been the primary factor driving the rise in America’s health care costs. Fact: Population aging is not the principal determinant of rising health care costs.
Myth 2: As the population ages, health care costs for older Americans will necessarily overwhelm and bankrupt the nation. Fact: Population aging need not impose a crushing economic burden, especially if we start now to conduct the necessary research and develop policies on health care at the end of life.
Myth 3: Putting limits on health care for the very old at the end of life would save Medicare significant amounts of money. Fact: Limiting acute care for the very old at the end of life would save only a small fraction of the nation’s total health care bill. The proportion of Medicare spending attributable to beneficiaries in the last year of life has remained stable over the past two decades.
Myth 4: Aggressive hospital care for the aged is futile; the money spent is wasted. Fact: Many older people who receive aggressive care survive and do well for an extended period.
Myth 5: It is common for older people to receive heroic, high-tech treatments at the end of life. Fact: Only a fraction of people over age 65 receive aggressive care at the end of life. The older people are, the less likely they are to receive aggressive care when dying.
Myth 6: Medicare covers everything that older adults need in terms of their health care. Fact: Medicare does not cover several essential components of health care for older Americans. For example, Medicare pays for custodial services only in the setting of acute illness; it does not pay for long-term care.
Myth 7: If all older patients had living wills or other kinds of advance directives, it would resolve dilemmas of how aggressively to provide care. Fact: Living wills and other forms of advance directives are not a panacea. They often have little impact on or relevance to end-of-life decision-making. Physicians and health care professionals need to be trained in communicating and advising patients and families about their options, potential outcomes, and time-limited trials, especially in the face of advancing medical technology.
To download the full report or purchase a hard copy visit www.ilcusa.org or email publications@ilcusa.org. The "Myths of the High Medical Cost of Old Age and Dying" is part of the ILC-USA’s project on Ageism In America with generous support from the Open Society Institute.
Journalists may contact the Communications Department for more information.
Email: media@ilcusa.org
Phone: 212-606-3380

July 24, 2009
Movies and Alzheimer's Disease © Zoë A. Lewis, M.D., FACP

Are the topics of dementia and Alzheimer’s still taboo for Hollywood? Summer is a time for movies, so I had a look for what is available on the topic. Alzheimer’s disease is shut out of Hollywood with less than a handful of feature films dealing with the topic in the past decade. Films that have portrayed the issue have come away with American Academy Award nominations, Oscars and countless international film festival awards and honors. Yet, these films have examined the plight of only a small segment of our true society; we know Alzheimer’s strikes all races and backgrounds. With ten films on the topic of Alzheimer’s, I decided to rent them all.
Here is the list, and in my opinion, each has its own strength and weakness in coming to terms with the disease and its effects on the family and individual. By no means is this a complete list – but send me an email if you know of one.
1. Away From Her (2007)
In Away From Her, Julie Christie was Oscar-nominated for Best Actress for her portrayal of Fiona, a woman with Alzheimer's who voluntarily enters a long-term care facility to avoid being a burden on Grant, her husband of 50 years. After a 30-day separation (recommended by the facility), Grant visits Fiona and finds that her memory of him has deteriorated and that she's developed a close friendship with another man in the facility. Grant must draw upon the pure love and respect he has for Fiona to choose what will ensure his wife's happiness in the face of the disease. Christie won a Golden Globe Award for Best Actress in a Motion Picture (Drama) for her performance in this movie.
2. The Savages (2007)
Laura Linney and Philip Seymour Hoffman play siblings in this tragic comedy about adult children caring for a parent with dementia. Laura Linney was Oscar-nominated for Best Actress, and Tamara Jenkins was Oscar-nominated for best original screenplay. A rare combination of humility, dignity, and humor, Philip Seymour Hoffman was Golden Globe-nominated for Best Actor in a Motion Picture (Musical or Comedy) for his performance as the neurotic professor who begrudgingly unites with his sister for the sake of their father.
3. Aurora Borealis (2006)
Donald Sutherland and Louise Fletcher steal the show in this movie about relationships and difficult choices. Sutherland plays a grandfather with dementia who requires more care than his wife (Fletcher) can handle. They enlist the help of a home health aide (Juliette Lewis) and their grandson (Joshua Jackson), who forge a friendship as Sutherland's character -- who insists he can see the Northern Lights from his window -- becomes increasingly impaired. It was considered a well-crafted independent film that was released under the radar.

4. The Notebook (2004)
Based on Nicholas Sparks' best-selling novel of the same name, The Notebook features James Garner as Noah, the loving husband of Allie (Gena Rowlands), who is in a nursing home due to Alzheimer's disease. He attempts to rekindle her memories of their long history by reading to her from his notebook. Ryan Gosling and Rachel McAdams play the couple in their younger years. Described as a true romance, the movie was directed by Nick Cassavetes, son of Gena Rowlands.
5. A Song For Martin (2001)
Sven Wollter and Viveka Seldahl -- married in real life -- play married couple Martin and Barbara in this Swedish movie with English subtitles. Martin is a conductor and composer; Barbara, a violinist. They meet and marry in middle-age, but soon after, they find out that Martin has Alzheimer's disease. This moving story is considered one of the most realistic depictions of care giving on film.

6. Iris: A Memoir of Iris Murdoch (2001)
Based on the book Elegy for Iris by John Bayley, this movie tells the true story of English novelist Iris Murdoch's descent into Alzheimer's disease and the unconditional love of Bayley, her partner of 40 years. Jim Broadbent won an Academy Award and a Golden Globe for Best Supporting Actor for his portrayal of Bayley in his later years; Judi Dench and Kate Winslet received both Academy Award and Golden Globe nominations for Best Actress and Best Supporting Actress, respectively, for their portrayal of Murdoch in her older and younger years.
7. Firefly Dreams (2001)
This Japanese film with English subtitles won several international film festival awards. It tells the story of Naomi (Maho), a troubled teenager sent to the country for the summer to work for her aunt and uncle. She's asked to care for an aging neighbor with Alzheimer's disease; Naomi is initially unhappy about the arrangement, but soon connects with the woman in a transformative way.
8. Age Old Friends (1989)
Hume Cronyn achieves another great performance as John Cooper, who chose to live in a retirement home instead of live with his daughter (played by real-life daughter Tandy Cronyn) as a symbol of maintaining his independence. He befriends Michael (Vincent Gardenia), who starts showing signs of dementia. When John's daughter extends her offer to live with her again, he must decide between leaving the rigid structure of the retirement home and staying to help his friend cope with his disease.
9. Son of the Bride(2001) El Hijo de la Novia
Norma (Norma Aleandro) suffers from Alzheimer's disease and the main character Rafael has not seen her in a year. Rafael sees his father Nino (Héctor Alterio) frequently but his friends rarely. He's fielding offers to sell the restaurant he runs in Buenos Aires, but changes his mind because it was started by his mother and father and has been in the family for years. One day, Rafael suddenly suffers a heart attack and, as he recovers in the intensive care unit, he is forced to reevaluate his life and decide his priorities. He now wants to sell the restaurant and move to southern Mexico and raise horses. At the same time his father wants to remarry his wife( Norma) because they were never married in the Catholic Church. Rafael is opposed to the renewal of vows because his ailing mother will not be much of a participant.

10. Memories of Tomorrow (2007)
Masayuki Saeki, who is at the peak of his advertising career, living with a loving family, and his only daughter is getting married soon, is diagnosed with Early Onset Alzheimer’s disease. Played by Academy Award nominee Ken Watanabe ("Last Samurai", "Batman Begins", "Memoirs of a Geisha"), he expressed his passion for putting this work onto the big screen when he was in Hollywood. He is not only the leading actor, for the first time he is also the executive producer of this movie. Moreover, the role Emiko, who fully supports her husband even after the diagnosis, is played by famous actress Kanako Higuchi.
Enjoy.

August 16, 2009

Focus on diet, exercise and lifestyle as the greatest disease preventative factors for dementia. Comments on the JAMA article on Alzheimer's Disease and  Prevention,© Zoë A. Lewis, M.D., FACP

 JAMA recently published an online story which appeared Aug.12, 2009:

JAMA. 2009;302(6):627-637.

Physical Activity, Diet, and Risk of Alzheimer Disease Nikolaos Scarmeas, MD; Jose A. Luchsinger, MD; Nicole Schupf, PhD; Adam M. Brickman, PhD; Stephanie Cosentino, PhD; Ming X. Tang,PhD; Yaakov Stern, PhD.

I am going to refer readers to the link below on a new observational study from Columbia University that suggests that exercise combined with a Mediterranean-style
diet is linked with a lower risk for Alzheimer's disease. The researchers said the findings were strong enough to justify setting up controlled trials to investigate the link more robustly and see if there are any other factors that might have an effect on Alzheimer's risk.

I believe prevention is more than diet - it is behavior as well. Food that is fresh and nutritious, where ever it is found, when served fresh to the table, is rich in antioxidants and vitamins, the very things that protect our immune system. But stress and the deleterious effects it has on the biochemical substrate of our bodies, can undo the healthy diet.

 It is the anti-western society lifestyle that is perhaps worth studying. The slow versus the fast. The rural agrarian societies versus the modern mechanized and computerized. Perhaps the consistent addition of things like the curry in the diet may also be studied against controls ( less than 1% Alzheimer's in certain rural villages of India) along with specialized exercise with breathing techniques,  and calming, centering meditative practices and the slow lifestyle.

I will be looking for these studies and post them. For now here is the link:

http://jama.ama-assn.org/cgi/content/full/302/6/627.

August 30, 2009

World Alzheimer's Day™ 2009 - 'Diagnosing Dementia: See It Sooner'.

Join me for this one hour program with special guests as we focus on the importance of getting a diagnosis and encouraging medical professionals to screen for dementia. Families also need  to recognize the early warning signs of the disease in order for those affected to receive treatment and begin the care planning they need. Every year on 21 September Alzheimer associations across the globe unite to recognize World Alzheimer's Day. Memory walks, open days, lectures, training courses, entertainment and conferences taking place internationally. Read about planned events for World Alzheimer's Day 2009 around the world, and in your community. I posted a link for easy access under resources. For my part, as the author of two books on Alzheimer ’s disease, I will be gifting my free Alzheimer’s book in English to the first 20 emails I receive during the show. (media mail shipping costs not included).

September 19, 2009

Natural Therapies for the Prevention of Alzheimer's Disease

suntimes.empowereddoctor.com/natural-therapies-for-the-prevention-of-alzheimers-disease

October 9, 2009
Barriers to timely diagnosis for Latinos, © Zoë A Lewis, M.D., FACP

Barriers  to an early diagnosis of any disease create the potential consequences of poorer outcome if treatments are started later. It appears from numerous investigations that Latino groups are diagnosed later and have more difficulties with accessing programs for Alzheimer’s and dementia care. Patients diagnosed in later stages may be less able to contribute to decision making plans regarding disease management. The capacity for future financial and care-giving plans is inevitably underestimated and will present burdens when sudden expectations for caregiver needs go unmet.
What are these barriers? Why is the Hispanic community hardest hit? The Alzheimer's Foundation of America report, “Investigating Caregivers’ Attitudes and Needs (I CAN 2) Survey, reports on several types of barriers. Sociocultural, professional and technical issues all play a role. In many Hispanic communities senility is considered a natural part of aging. The ‘craziness of elders’ is also reported as the old timer’s disease and accepted without knowledge of available treatment. Many have folkloric attitudes about the aged as well, and accept the debility of their family member with indifference and neglect.

 Recent reports show failures of healthcare system hurt Hispanics with Alzheimer’s most. Older Latinos with dementia overwhelmingly remain living in the community longer, albeit with higher levels of physical and cognitive impairment compared with their non-Latino counterparts in the area. Latino caregivers care for family members with more complex health, social, and long-term-care needs than are found in mainstream families. Hispanic caregivers of people with Alzheimer’s disease are significantly more likely than caregivers of other races to consider the disease a normal part of the aging process and dismiss its symptoms as part of getting older. This gap in understanding sheds light on the reasons for delay in diagnosis and treatment, which is an unnecessary setback for caregivers and individuals with the disease alike.

 Most families miss out on critical community resources and the most innovative and internationally accepted care practices today, unless they have help in finding them. This is a call to action!