Alzheimer's or Dementia

Alzheimer’s or Dementia Therapy:

Deep Brain Stimulation

Researchers have seen considerable success in slowing down the progress of the disease.

Reality orientation is a technique in which people caring for others with this type of disorder take every opportunity to orientate the person.  This might be to remind the person where they are and what time and day it is.  It is important to validate accurate perceptions and disagree when the person says something incorrect.

Reality orientation does help people make changes and to respond realistically to their environment.  But, this should be sensitive to the person’s emotional state and to any care plan that is in place.

Reminiscence therapy involves stimulating the recollection of events and memories from the past.  This is achieved by using music, DVD, pictures, movies (that the person may have seen in their past) or food and clothing from past times.

People often enjoy this process and it does tend to make them feel empowered.  Older people love telling stories and younger people love hearing them.  Grandchildren will want to know stories about their parents as children.  Effective as this can be, it is still not going to prevent the memory getting worse in the long run.  Creative application of long term reminiscences can be comforting by being about situations that are familiar.

Validation therapy emphasizes the emotional world of the person and offers useful techniques for communication.  One may play a game of “tuning in” to a particular person or situation and guess strategies for handling or recognizing what is familiar. 

It is important to listen to the person but not get into protracted negotiation or arguments about dates, facts or realities.  Validate what is useful and concrete knowledge and perception but try to minimize the effects of failure. 

This may bring sense out of less clearly articulated communication.  The idea is not to impose our reality but to let them express a more real version of theirs. 

Memory training by using external aids, mnenemonies, photographs, and a written list of routine functions can be effective.

Going over self care tasks helps the person to feel empowered and less needy. Short daily training classes with a lot of stimulating interaction may prove useful.  Emphasis can be place on how the tasks feel rather than relying on verbal or written instruction.  This appeals to the person’s felt-sense experience.

Stimulate the individual by conversation, books, dance, art and movement.  Going shopping or for a drive while noticing the environment and sounds.  Use of exercise programs, and calming by stretching or relaxation all bring a sense of awareness which brings comfort and confidence.

Behavioral approaches promote a sense of achievement:

• Increase the person’s level of independence including relearning of lost skills and maintaining existing skills.  The use of caring verbal prompts helps as a reminder when short term memory is lacking.
• Reduce the level of behavioral disturbance and difficulty.  This would include independence in mobility and such basic issues as continence.  The person might be encouraged to void often and at regular intervals.

• COMMON DIETARY SUPPLEMENTS
• Ginkgo Biloba
• Vitamins B6, B9 & B12
• Vitamin E
• ω-3 Fatty Acids
• Vitamins A & C
• Vitamin D
• Phospholipids: Phosphatidylserine & Phosphatidylcholine
• Ginseng  

Cognitive-behavioral therapy with a trained professional has been found useful.  Weekly sessions may include caregivers as well as the person in need.  Thus, everyone learns to be more observant of change and more able to support.  This can assist with depression and burn out.  Therapy can include progressive relaxation techniques and strategies for anger and stress management.  Successive tensing and relaxation of muscle groups relies on procedural memory which is relatively spared in dementia.

Even after all of this it may be necessary to place the person in long term residential care. But the early adoption of interactive strategies can slow down the frustrations of impairments and support more active involvement in the community or family, and thus enhance quality of life.

Complementary Alternative Medicine should be explored as well as psychopharmacology of a more traditional ‘Western’ kind.  There have been many advances in geriatric care and prescription drugs.  As with everything, information brings power and safety.  Seek professional trained consultation at all times. 

Food, sugar, insulin, weight and glucose.

And our old friend CANDIDA! 

When we eat, our body converts digestible carbohydrates into blood sugar (glucose), our main source of energy. Our blood sugar level can affect how hungry and how energetic we feel, both important factors when we are watching how we eat and exercise. It also determines whether we burn fat or store it.

Our pancreas creates a hormone called insulin that transports blood sugar into our body's cells where it is used for energy. When we eat refined grains that have had most of their fiber stripped away, sugar, or other carbohydrate-rich foods that are quickly processed into blood sugar, the pancreas goes into overtime to produce the insulin necessary for all this blood sugar to be used for energy. This insulin surge tells our body that plenty of energy is readily available and that it should stop burning fat and start storing it.

However, the greater concern with the insulin surge is not that it tells our body to start storing fat. Whatever we eat and don't burn up eventually gets turned into fat anyway.

The greater concern is that the insulin surge causes too much blood sugar to be transported out of our blood and this results in our blood sugar and insulin levels dropping below normal. This leaves us feeling tired and hungry and wanting to eat more. The unfortunate result of this scenario is that it makes us want to eat something else with a high sugar content. When we do, we start the cycle all over again.

What to Watch For

• Simple Carbohydrates: Because of their small molecular size, simple carbohydrates can be metabolized quickly and are therefore most likely to cause an insulin surge.
Simple carbohydrates include the various forms of sugar, such as sucrose (table sugar), fructose (fruit sugar), lactose (dairy sugar), and glucose (blood sugar). Watch for the "-ose" ending.

• Hidden Sugar in Processed Foods: Watch for "hidden" sugar in processed foods like bread, ketchup, salad dressing, canned fruit, applesauce, peanut butter, and soups.
• Sugar in Beverages: Be aware of the amount of sugar in beverages, especially coffee and soda pop. It can add up quickly, and most such drinks aren't filling.
• Fat-Free Products: Sugar is often used to replace the flavor that is lost when the fat is removed. And as if that's not bad enough, without any fat to slow it down the sugar is absorbed into your blood faster.
• Cereal Box Claims of Less Sugar: Many newer cereals do contain less sugar, but the calories, carbohydrates, fat, fiber and other nutrients are almost identical to the full-sugar cereals. The manufacturers have simply replaced sugar with other refined, simple carbohydrates.
• No Sugar Added: It doesn't mean that the product doesn't naturally contain a lot of sugar. 100% fruit products often contain concentrated fruit juice, still another form of fructose or sugar.
Table sugar (sucrose) is often said to provide "empty calories" because it has no nutritional value other than providing fuel for energy. Honey and other more natural sugars, on the other hand, are often considered to be healthier because of the trace vitamins and minerals they provide. Still, for weight loss purposes, all of these sweeteners can simply be treated as sugar.

What You Can Do

It is also important to understand what happens when you skip a meal or go on a crash diet. When you skip a meal your metabolism slows to conserve your energy. And when you lose weight too quickly for a few days, your body thinks it is threatened with starvation and goes into survival mode. It fights to conserve your fat stores, and any weight loss comes mostly from water and muscle.

Regulating your blood sugar level is the most effective way to maintain your fat-burning capacity. Never skip a meal, especially breakfast, and eat healthy snacks between meals. Eating frequently prevents hunger pangs and the binges that follow, provides consistent energy, and may be the single most effective way to maintain metabolism efficiency.

When you will be away from home or work, plan your snacks and take them along so that you will be able to eat regularly and won't be tempted by junk food. This may be good advice for people who stay at home, too.

But remember that it was probably snacking between meals that caused you to become overweight in the first place. It will be very important that any snacks are healthy; that they are pre-portioned so you won't be tempted to overeat; and that meal sizes are reduced to compensate for the additional calories the snacks provide.

High fiber snacks and meals also help to regulate your blood sugar level. The fiber slows down glucose absorption and your rate of digestion, keeping your blood sugar level more consistent and warding off feelings of hunger. This makes eating apples and oranges a better choice than drinking (pulp free) apple and orange juice.

Small intestinal bacterial overgrowth or SIBO

More and more we read of people going through years of diagnostic tests trying to determine why they are not getting any better.  Sadder is that they often end up being sent to a psychiatrist because nothing concrete can be found.  However it is important to keep asking for attention because often it is actually something physical.  This is on of those pesky, protracted situations that is so demoralizing and depleting.

      

The actual test for SIBO is simple to administer and easy for the patient but it brings the sufferer a great deal of relief to know that there IS something!

EMDR

Recently somebody asked about EMDR. This blog has always responded with information and this was a reply from a PhD in the Seattle area. I pass it along for recreational and informational purposes. This is VERY serious technique and is not for everyone. Take care to find a true and accredited professional who is prepared to work with your healthcare professional to avoid any negative repercussions

Are you familiar with EMDR, eye movement desensitization and reprocessing?  What is it and will it make me acknowledge and move on or away from the thoughts and situations that bother me?

EMDR is a recognized but largely un-researched form of therapy dealing with PTSD.  The science behind it is that when we are asleep Rapid Eye Movements occur in deep sleep when the brain is still active processing.  I trained under Dr Francine Shapiro in 1989, but I am not certified in the formal program,  and occasionally do a form of desensitization to work with individuals that need to deal with pervasive and persistent thoughts or memories.

I prefer to do a form where the client is under their own control and can also use the technique themselves at home - instead of once a week in the office.  Done the way that Shapiro recommends the therapy only exists in the controlled circumstance of the clinical setting, with up to twelve sessions to start with!  We have also discovered that there are other repetitive techniques that work just as well and are not nearly as intrusive. 

The issue is to define what are called "Significant Units of Distress" (SUD )  and then to get the brain to automatically deal with them whenever they occur by desensitizing using hand movements, noise ( such as rhythmic tapping ), or breathing instead of cognition or thought.  So it is a form of conditioned response to a stimuli ---- a similar phenomena exists when a behavior is extinguished by snapping an elastic band on the wrist until the sensation outweighs the craving or impulse.

Obviously I have no problem teaching you -  but you may want to think very carefully if you want to learn to turn your brain off around those thoughts.  The motivation has to be very secure ---- you can't do it halfway.  That is you can't say that you want the thoughts to go away when you are living your day-to-day life but want to examine the thoughts when you are feeling angry because you still have unanswered questions.   This means that you have learned a brain process which eventually will kick in automatically whenever you go near, or think about, a stimulus.  True cognitive behavioral programming. 
 
What is an EMDR® session like?
First, client and therapist work together to collect basic information about the traumatic experience. The most disturbing part of the incident is identified and becomes the processing target. Example: Image of the rapist’s face. The negative belief connected to the trauma is identified. Example: I’ll never get over this. And a preferred, positive belief is named. Example: It’s over, I can move on with my life now. Next, client is asked to rate (on a 1-7 scale) how true the positive belief feels when paired with the target. Usually it does not feel very true at this point. Client is asked to name the emotions the target elicits, to rate the associated distress level (on a 0-10 scale), and to locate the disturbance in the body. Example: Fear and shame, with disturbance level 10, in belly and chest. Then, client is asked to hold in awareness the target, the negative belief, and the disturbing body sensations. At the same time, the therapist guides the client’s eyes to move rapidly back and forth. This is done in sets, which may last from a few seconds to a few minutes. During each set the client is instructed to just notice whatever changes occur in mind and body, without controlling the experience in any way. Very often, in the first few sets there is an increase in the disturbance level. After awhile, with each new set, the target becomes less and less disturbing and the positive belief feels more and more true. The target is completely processed when recall of the image no longer brings up disturbing emotions, and the preferred positive belief feels totally true. Example: Client recalls that the rapist’s face was threatening then but does not feel threatened by the image anymore. (Bilateral audio tones are an alternative to eye movements)

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Subjective Units of Disturbance (SUD)

It hurts.
That's right, and on a scale of 1-10 how bad?
EMDR has patients rate their Subjective Units of Discomfort (SUD) at beginning of treatment, and during its course. Not only does this operationalize the presenting problem, but gives the practitioner a means of tracking progress. The rating of the presenting problem in an objective manner, also prevents the subject from denying the significance of positive change when it occurs .
An initial treatment goal--which I point out for those yet unfamiliar with the optimistic expectations of what I'll call "edge therapies"--is bringing even an SUD rating of 9 or 10 down to a 1.

Desired Positive Cognition (VOC scale)

EMDR has patients rate the power of their belief(s) on a Validity of Cognition (VOC) scale (1-7). For example, let us say that an individual has experienced a traumatic event involving a family member from which nightmares are still occurring years later. The individual rates discomfort (SUD) as a "nine"; and there's an accompanying negative belief: "I'm worthless." The latter sufferer may know rationally, and desire emphatically to believe: "I am a powerful and resourceful human being." But what EMDR wants to happen, is that the individual BELIEVES that with the conviction indicated by a strong self-rating, for example, "six," on the VOC scale. Again, the EMDR clinician wants a SUD of "one" or "two" before initiating work with the positive cognition.

Technique

In its simplest form, the technique itself, involves an individual 1) holding in mind a representative image (pictures, sounds, feelings) of "the problem," while 2) watching a clinician's left-right hand or finger movements in short sets.
After each set, the patient/client describes what happened. The original image (sound, feeling, etc.) may change. And the clinician tracks movement in a positive direction. There are several ways in which this "positive" movement may be determined.
A client may report that the original image significantly changed in a way that makes it less troublesome, for example, the image moved farther away, or changed from color to black-and-white. The client may report a decrease in SUD rating. The clinician might note a shift in nonverbal behavior, perhaps fuller, relaxed breathing, or decrease in muscle tension.
Again, the goal is a SUD of 1. As the targeted cognition changes and decreases in negative effect, other targets may surface. Each successive target is then exposed to the EMDR technique.
 
 

Mental health